Local formularies and good patient care.
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Drug Prescriptions↗
Biomedical subjects
S V Brown
Publications and source records attributed to S V Brown.
Eleven cases of sarcoidosis of the optic nerve.
Of 11 patients (eight women and three men, ranging in age from 16 to 48 years) who had sarcoidosis of the optic nerve that caused decreased visual acuity and visual field abnormalities, only two were known to have sarcoidosis at the time the visual impairment developed. Four patients had granulomas involving the optic nerve head, four had granulomatous inflammation of the orbital or intracranial optic nerve or chiasm, and three had retrobulbar neuritis. All 11 patients had histologically confirmed idiopathic noncaseating granulomatous inflammation and eight of the 11 had abnormalities compatible with sarcoidosis in chest roentgenograms. In the three patients in whom the serum level of angiotensin-converting enzyme was determined, it was increased in one and normal in the other two. Computed tomography of the anterior visual pathways was the single most useful neurodiagnostic study. Treatment with corticosteroids was beneficial in six of the 11 cases. These cases demonstrated that sarcoidosis should be included in the differential diagnosis of any inflammatory or compressive lesion involving the anterior visual pathways.
Adolescent↗
Postmarketing drug surveillance by record linkage in Tayside.
The feasibility of conducting postmarketing drug surveillance by record linkage in Tayside was assessed. The key feature of the method is that all hospital discharge data are already computerised by the area health board and may be accessed through the unique community health number (CHNo) which has been allocated to all Tayside residents. The 12 861 prescriptions for cimetidine dispensed in Tayside over a nine month period were collected and the CHNo identified for 76%. These corresponded to 3802 individuals and their discharge data, together with those for an equal number of controls matched by age, sex, and general practitioner were retrieved from the computer. The expected excess of those diseases for which cimetidine is prescribed (peptic ulcer and oesophagitis) was observed. Other drug-disease associations were observed but may have been due to confounding and emphasise the inadequacy of community based controls. The major advantages of record linkage are, firstly, the low cost of the method, the present study costing just over pounds 12 000, and, secondly, the duration of patient follow up which may may be extended for as many years as required simply by rerunning the computer programs. To assemble large patient cohorts the study would have to be extended to other area health boards that are currently developing similar computer systems. Record linkage may provide a cost effective method for the follow up of patients to identify serious adverse drug reactions, particularly those that take several years to develop.
Cimetidine↗
Intraocular pressure after intracapsular cataract extraction.
We studied the incidence of postoperative intraocular pressure elevations in 42 patients following intracapsular cataract extraction with alpha-chymotrypsin (1:5,000) and noted 17% to develop pressures greater than 30 mm Hg and 38% greater than 24 mm Hg within a 48-hour time interval. Additionally, we studied the effect of a single immediate postoperative instillation of timolol maleate 0.5%; this was associated with a slight reduction of intraocular pressure at the three- and six-hour time intervals, but did not eliminate the pressure spikes.
Aged↗
Early childbearing and poverty: implications for social services.
Economic problems are among the most adverse consequences associated with early childbearing. This paper looks at various social services to determine whether current services are assisting teenage mothers who liver at or below the poverty line to move toward greater productivity and self-sufficiency in adulthood. The results of a national survey of public social services to teenage mothers show that not only are current services inadequate, but are lacking in areas which are directly related to the future economic well-being of early child-bearing females. Public social services appear to be ineffectual in alleviating the conditions that lead to poverty, namely deficits connected with education, employment, home management and family planning. Black and Hispanic teenage mothers were found to be at highest risk of poverty conditions due to their greater dependence on public agencies. The implications of these service deficiencies are discussed in relation to the future economic welfare of these teenage mothers and the need for a restructuring of social services in the traditional child welfare sector.
Adolescent↗
Duplicate prescriptions: an aid to research and review.
We describe a method of studying patterns of prescribing and related morbidity in general practice. Prescribing data were automatically duplicated onto a ;no-carbon-required' prescription-pad. Additional information about diagnosis and indications for each drug, an indication of whether the drug was newly prescribed or a repeat, and a patient identification code were entered onto the bottom copy. A computer was used to process the data, which were gathered over a period of seven months.The method offers an efficient means of collecting data which can be applied by individuals or groups of doctors to improve patient care and help achieve rational prescribing.
Data Collection↗
Prescribing in general practice and the provision of drug information.
Duplicate prescriptions were used to monitor patient prescribing and morbidity data for 20 Tayside general practitioners during a two-year study. Each participant took part in two periods of active monitoring separated by a three-month gap. Prescribing statistics collected during the first period of monitoring formed the basis of drug information which was circulated to participants shortly after the start of the second period. Some of this information was purely statistical; other information included comments as well as statistics. Subsequent monitoring assessed any changes in prescribing. The results indicate that drug information of this kind can influence general practitioner prescribing but that there were no differences in response to information which was purely statistical and information which included comments.
Drug Information Services↗
Management of a partial-thickness scleral-flap buttonhole during trabeculectomy.
I report the use of partial-thickness Tenon's-conjunctival tissue in the repair of an intraoperative scleral-flap buttonhole that developed during trabeculectomy using adjunctive mitomycin C.
Aged↗