Biomedical subjects

T L Davis

Publications and source records attributed to T L Davis.

112 records · Page 7Linked to original sources

PubMedDate not supplied

Clinical, pharmacokinetic, and pharmacodynamic effects of tolcapone withdrawal in levodopa-treated patients with parkinsonism.

The effect and clinical significance of tolcapone withdrawal on erythrocyte catechol-O-methyltransferase (COMT) activity, levodopa pharmacokinetics, and levodopa requirements were investigated in 59 patients with fluctuating parkinsonism who were randomized to receive placebo or tolcapone 100 or 200 mg three times daily for 6 weeks. Tolcapone withdrawal caused a transient elevation in COMT activity by 64% in patients receiving 100 mg three times daily and by 128% in those receiving 200 mg three times daily at approximately 1-2 weeks after discontinuation of drug. Thereafter, COMT activity was declining but did not reach baseline values by the 12-week study endpoint. However, this had no effect on plasma levodopa and 3-O-methyldopa (3-OMD) concentrations or on levodopa requirements. During treatment, tolcapone increased "on" time and decreased "off" time; after discontinuation of study medication and levodopa dose adjustment, on and off times were similar to baseline. Withdrawal was generally well tolerated; no patients withdrew from the trial during the posttreatment period, and no serious adverse events were observed. In conclusion, the transient increase in erythrocyte COMT activity observed after discontinuation oftolcapone is not associated with changes in peripheral levodopa metabolism and therefore has no significant clinical consequences in terms of levodopa requirements, clinical symptoms, or adverse events.

Aged↗

PubMedDate not supplied

Service line concept gaining strength.

A survey was conducted in August 1988 to determine the extent to which service lines are being developed in hospital settings. The survey also attempted to determine the involvement of physicians in the planning, implementation, and implementation, and successful operation of service lines. Responses were obtained from 324 (27 percent) of the 1,198 hospital-based physician executives who received the survey questionnaire.

Data Collection↗

PubMedDate not supplied

Hospitals monitor resource consumption.

Early in 1988, a survey questionnaire was mailed to all hospital-based members of the American Academy of Medical Directors (now the American College of Physician Executives) to determine the extent to which the institutions were monitoring and controlling physician-directed resource consumption under the DRG-based prospective pricing system. This article is a summary of the survey findings.

Hospital Bed Capacity↗

PubMedDate not supplied

Peripheral blood progenitor cell transplantation: impact on the pharmacy workload and budget.

Due to reduced engraftment times and significantly shortened hospitalizations, peripheral blood progenitor cell (PBPC) transplantation has reduced the costs associated with autologous transplantation. Several institutions reported a reduction of 20-50% in transplantation cost using PBPCs and an aggressive outpatient program. These savings could be offset by hospital readmissions, but improvements in supportive care such as administration of colony-stimulating factors and broad-spectrum oral antibiotics, and assigning a 24-hour caregiver as a prerequisite for transplantation enable safe performance of outpatient transplantation and limit readmission rates to about 20-40%. At this institution, the effect of this program on the pharmacy has been a shift in staff and drug costs to outpatient cost centers. The transition from inpatient to outpatient care did not necessitate a greater investment in pharmacy staffing, but did require cross-training for inpatient and outpatient pharmacists. Future management of outpatient transplantation will apply a cooperative care philosophy that will rely to a large extent on patient care by family members and on a multidisciplinary model of seamless care.

Ambulatory Care↗