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Biomedical subjects

T R Einarson

Publications and source records attributed to T R Einarson.

At least 73 records · Page 4Linked to original sources
PubMed1991

Relationship between gestational cocaine use and pregnancy outcome: a meta-analysis.

Despite a growing number of studies that have investigated the reproductive effects of maternal cocaine use, a homogeneous pattern of fetal effects has not been established and there is little consensus on the adverse effects of the drug. We used meta-analysis to evaluate the reproductive risks of cocaine. We reviewed the 45 scientific papers published in the English language dealing with effects of cocaine used during pregnancy on pregnancy outcome in humans, and identified 20 papers eligible for meta-analysis (cocaine use in pregnancy, pregnancy/fetal outcome studies, human studies, original work, cohort or case control studies, control group present, English language). Our analysis revealed that very few adverse reproductive effects could be shown to be significantly associated with cocaine use by polydrug users when compared to control groups of polydrug users not using cocaine [genitourinary malformations; odds ratio of 6.08 (95% CI 1.18-31.3); gestation age: Cohen's d 0.37 (CI 0.2-0.55)]. When the control groups consisted of no drug users, the polydrug users abusing cocaine had a higher risk for spontaneous abortions [odds ration 10.50 (CI 11.74-64.1)]. Similarly, comparison of users of cocaine alone or no drug users revealed a higher risk for in utero death, in addition to genitourinary tract malformations. Analysis of continuous variables (head circumference, gestational age, birth weight and length) revealed that the effect size was dependent upon the nature of the comparison. Comparison of cocaine users to no drug users consistently yielded a medium effect size (Cohen's d) between 0.50 and 0.58, while comparison of polydrug/cocaine users to polydrug/no cocaine users provided effect sizes small to non existent (0.06-0.37). These discrepancies suggest that a variety of adverse reproductive effects commonly quoted to be associated with maternal use of cocaine may be caused by confounding factors clustering in cocaine users.

Abortion, Spontaneous↗
PubMed1991

A pilot study of process and outcome assessment in antibiotic therapy.

A quality assurance survey of cefazolin therapy was conducted by pharmacists using process-related and outcome-related assessments. The purpose of this survey was to study the possibility of having pharmacists review and categorize the appropriateness and success of antibiotic therapy. During a three week period, 168 orders for cefazolin were identified and 67 prophylactic and medical therapies were selected and submitted for possible pharmacist review. Thirty-seven therapies were reviewed by staff pharmacists who scored each therapy for the acceptability of risk of adverse drug effect, the cost-effectiveness, and the overall appropriateness. An evaluation form was used, but explicit utilization criteria were not provided. The average scores (+/- SD) on a 10 centimeter visual analog scale were 9.1 (+/- 0.71), 8.7 (+/- 1.21), and 8.8. +/- 0.79) respectively. Twenty-six (70%) of these therapies were monitored to resolution, and 24 (65%) were successful in achieving the therapeutic goal. No adverse effects were noted. The average estimated times to complete the initial review and follow-up review were 10.1 (+/- 5.60) and 3.5 (+/- 2.29) minutes respectively, less than the 19.5 minutes estimated using the Canadian Hospital Pharmacy Workload Measurement System. This survey demonstrated that pharmacists can provide both process-related and outcome-related QA data.

Anti-Bacterial Agents↗
PubMed1991

Pharmacokinetic consultation service workload measurement study.

A study was conducted to collect work measurement data for pharmacokinetic drug consultation services. A stopwatch was used to measure the time required to perform pharmacokinetic consultations in the Ottawa General Hospital, a 530-bed tertiary care teaching hospital. Ten pharmacists provided 166 drug consults primarily for phenytoin, aminoglycosides, digoxin, and theophylline. The time required to obtain drug level measurements averaged 1.10 minutes. Consults required an average of 8.28 (SD = 4.72) minutes. Initial consults took 10.35 (SD = 5.07) minutes, while repeat consults took 6.62 (SD = 3.67) minutes. The difference was significant (t = 5.48, df = 164, P less than 0.001). No significant differences were found among consults for different drugs nor between primary and secondary patient coverage areas. There was a significant difference in the time required to perform a consult among pharmacists. Consult times were considerably less than those reported by the Canadian Hospital Pharmacy Workload Measurement Study.

Analysis of Variance↗
PubMed1990

Maternal spermicide use and adverse reproductive outcome: a meta-analysis.

A meta-analysis was performed to determine whether the literature provides evidence that periconceptual or postconceptual maternal use of spermicides is detrimental to the developing fetus. Nine studies that investigated teratogenicity met the inclusion criteria. The Mantel-Haenszel summary odds ratio was 1.02 (95% confidence interval = 0.78 to 1.32). The chi 2 analyses was 0.10 for significance from unity (p = 0.748) and 8.73 for homogeneity of effects (p = 0.365). Studies comparing specific abnormalities with other abnormalities also indicated no association (odds ratio = 0.96; 95% confidence interval = 0.72 to 1.28). Studies investigating other adverse events (spontaneous abortion, stillbirth, reduced fetal weight, prematurity, or increased incidence of female births) showed similar negative results. Cohen's d, the overall effect size as determined by Tukey's jackknife method, was -0.001 (95% confidence interval = -0.018 to 0.017). These results indicate that maternal use of spermicides is not associated with adverse fetal outcomes. Meta-analysis adds quantitative support for conclusions from traditional reviews of the subject.

Female↗
PubMed1990

Lumbar epidural fentanyl infusions for post-thoracotomy patients: analgesic, respiratory, and pharmacokinetic effects.

Ten patients undergoing a thoracotomy were studied for 24 hours postoperatively to determine the effects of a continuous lumbar epidural fentanyl infusion on postoperative pain, arterial blood gases (ABG), respiratory pattern (respiratory inductive plethysmography, RIP), and fentanyl plasma concentration (CONC). Patients served as their own controls because RIP and ABG data were obtained the night prior to surgery during sleep. Epidural fentanyl was administered as a bolus of 1.5 micrograms/kg followed by an infusion of 1.0 micrograms/kg/h started 1 hour after induction. Insufficient analgesia was treated with a bolus of 0.5 micrograms/kg and an infusion increase of 0.25 micrograms/kg/h. Postoperative assessment included RIP, ABG, CONC, and visual analog pain score (PS). The average infusion rate postoperatively was 1.47 +/- 0.08 micrograms/kg/h (114.3 +/- 8.3 micrograms/h). A mean PS of 2.1 +/- 0.3 was achieved; however, there was a delay in attaining this. There was no significant incidence postoperatively of apnea or slow respiratory rate. A significant but clinically insubstantial increase in PaCO2 and decrease in pH occurred. A steady state CONC of approximately 2.0 ng/mL was reached after 9 hours. The PS correlated with CONC in half the patients (0.60 less than r less than 0.86), indicating a systemic component may have contributed to the analgesic effect.

Adult↗
PubMed1990

Physician assessment of pharmacists' interventions--a method of estimating cost avoidance and determining quality assurance.

The impact and quality of select pharmacists' interventions were assessed by four physicians with pharmacology experience. Each physician was sent 30 interventions and asked to indicate if the intervention by the pharmacist was of a positive nature and would prevent morbidity and/or mortality. They were also questioned regarding effect of the intervention on hospital stay. Each physician received 15 interventions which were, and 15 interventions which were not assessed by three other physicians. Of the 15 interventions assessed by all four physicians there was favourable agreement among the physicians with respect to the impact of the intervention with 86.7 percent (52 of 60) of the judgements indicating that the pharmacists' intervention had a positive effect on therapy. There was less agreement with regard to whether hospital stay would, and the extent to which it would, have been prolonged. Using consensus it was estimated that eight of 15 interventions would have prolonged stays approximately 3.7 days each. The use of physicians was helpful in assessing the impact of pharmacists' interventions.

Adolescent↗
PubMed1990

Cost containment measures in hospital pharmacy: a bibliography.

The pharmacy literature was searched for cost containment articles. The articles were classified according to content and the Canadian studies were identified. In total, 170 publications were identified, of which 51 (30%) were Canadian. Overall, 28.2% dealt with hospital administrative measures, 20.0% with pharmacy operations management, 14.7% with pharmacy materiels management, and 37.1% with clinical pharmacy services. The area of most frequent focus for Canadian articles was clinical pharmacy (43.1%), followed by hospital administrative measures (35.3%). References were provided for all articles.

Bibliographies as Topic↗
PubMed1990

Acceptance of pharmacists' suggestions by prescribers: a literature review.

Acceptance of pharmacists' suggestions by prescribers is a necessary component of the evaluation of clinical pharmacy services that is often overlooked. A literature search was performed to review the information on this topic. Acceptance was defined as a measure of a prescriber's compliance with a pharmacist's recommendation regarding drug therapy. In order for the pharmacist to impact upon the quality of patient care or drug costs, the prescriber must accept the suggestions. A total of 23 studies was found that addressed the topic. The average rate of acceptance was 85.5%. Factors affecting acceptance included time, communication, solicited versus unsolicited recommendations, type of prescriber, and type of pharmacist. Factors leading to non-acceptance included lack of physician awareness of pharmacokinetic parameters, quality of suggestions, prescribers' exercise of caution with respect to patient safety and well-being, and negative attitude toward clinical pharmacy. More research needs to be done in order to evaluate the importance of these factors.

Attitude of Health Personnel↗
PubMed1989

Effect of auxiliary prescription labels on the elderly ambulatory patient's drug knowledge.

The elderly take more drugs per capita than younger age groups. As a result, they may require more drug information. Auxiliary prescription labels are a common, yet little studied method of providing drug information. We studied 4 groups of 20 patients aged 65 or older, who obtain prescriptions at community pharmacies. They received either auxiliary label(s), counseling, both counseling and auxiliary labels, or no supplementary information at all. Counseling provided the same information verbally as was provided on the labels. Patients were interviewed 3-15 days later. Sixty-six percent were able to read auxiliary labels without difficulty. Significantly more patients who received auxiliary labels, with counseling (65 percent) or without counseling (63 percent), were able to recall supplementary information correctly and completely compared with patients who did not receive supplementary information (25 percent). However, a significant improvement in understanding or ability to apply this information was not found. Counseling alone did not significantly improve either outcome. It was concluded that the use of auxiliary labels is a useful, although not ideal, method of providing drug information for elderly patients in a busy community pharmacy setting.

Aged↗
PubMed1989

Survey of pharmacotherapy monitoring in Canadian acute care hospitals.

A survey questionnaire was sent to all hospitals in Canada that had 100 or more acute care beds. Objectives were to determine the current level and extent of pharmacist monitoring and prescriber acceptance of recommendations with respect to patient drug therapy. Three levels of patient drug therapy monitoring were identified, as were two extended forms of service. The response rate was 52.0 percent (130/250). A majority (92.3 percent) of respondents monitor drug therapy from the pharmacy, and only 6.2 percent provide monitoring service on patient wards. Among the respondents, 75.4 percent reviewed all (more than 90 percent) medication orders before the drug was dispensed for the patients. Of the respondents, 32.3 percent provided pharmacokinetic monitoring and 29.9 percent provided proactive pharmacist interventions via rounding with physicians. Higher levels of monitoring were associated with higher levels of pharmacy staffing. The acceptance rate of pharmacist recommendations by prescribers was more than 80 percent.

Canada↗
PubMed1989

Serum drug level utilization: a literature analysis.

A literature analysis was performed to quantify and evaluate the amount of inappropriate utilization of serum drug level assays. Studies that determined appropriate use based on institution-specific criteria were extracted from the literature. Inappropriate use was categorized as to indication, sampling, or use of results. Canadian studies were isolated and compared to American studies. A total of 35 studies was identified as meeting the study criteria. The rates of inappropriate utilization of drug level assays were 34.7% for indication, 47.2% for sampling, and 40.2% for use of results. Twelve studies reported an overall average inappropriate use of 58.8%. Estimations of annual waste due to inappropriate blood level use ranged from $1,221 to $100,917 per hospital. Canadian studies reported rates of 37.2%, 52.5%, and 44.5% for the three categories, respectively, and an overall inappropriate rate of 53.3%. None of these values differed significantly from those of American studies (p greater than .1). It was concluded that there is a great deal of inappropriate drug level utilization that wastes much in terms of patient care, personnel time, and costs. A great potential exists for pharmacists to intervene and improve this area of drug utilization.

Canada↗
PubMed1989

Review of Canadian pharmacist involvement in adverse drug reaction reporting.

Adverse drug reaction (ADR) recognition, evaluation and reporting are important aspects of modern pharmacy practice. Pharmacists have the knowledge and responsibility to contribute to ADR reporting programs. A total of eight studies have reported the incidence of ADRs in Canadian hospitals. On average one in every six patients (17 percent) develop an adverse drug reaction. This may prolong hospital stay, increasing the cost of hospitalization by millions of dollars annually. Although ADR programs can be time consuming, the potential of reducing the financial burden of ADRs would be a positive outcome. A great opportunity exists for pharmacists to contribute in this area of patient care.

Canada↗
PubMed1988

Establishment and evaluation of a serum cholesterol monitoring service in a community pharmacy.

A clinical pharmacy service providing blood cholesterol testing and consultation was implemented in a community pharmacy. In this pilot study, 27 patients each paid $10 to have a serum cholesterol determination. All subjects completed a questionnaire to determine attitude toward such a service, intention to use it in the future, and willingness to pay for its use. A posttest patient satisfaction questionnaire was completed after blood-level results were reported and discussed with the patient. All subjects stated that they were strongly in favor of such a service, that they would use it, and that they would pay an average of $11.60 for the test. On the posttest questionnaire, patients expressed strong satisfaction with various aspects of the service, and the amount that they were willing to pay increased significantly to $14.35. It is recommended that community pharmacies implement such patient-oriented services.

Adult↗
PubMed1988

A method for meta-analysis of epidemiological studies.

This article presents a stepwise approach for conducting a meta-analysis of epidemiological studies based on proposed guidelines. This systematic method is recommended for practitioners evaluating epidemiological studies in the literature to arrive at an overall quantitative estimate of the impact of a treatment. Bendectin is used as an illustrative example. Meta-analysts should establish a priori the purpose of the analysis and a complete protocol. This protocol should be adhered to, and all steps performed should be recorded in detail. To aid in developing such a protocol, we present methods the researcher can use to perform each of 22 steps in six major areas. The illustrative meta-analysis confirmed previous traditional narrative literature reviews that Bendectin is not related to teratogenic outcomes in humans. The overall summary odds ratio was 1.01 (chi 2 = 0.05, p = 0.815) with a 95 percent confidence interval of 0.66-1.55. When the studies were separated according to study type, the summary odds ratio for cohort studies was 0.95 with a 95 percent confidence interval of 0.62-1.45. For case-control studies, the summary odds ratio was 1.27 with a 95 percent confidence interval of 0.83-1.94. The corresponding chi-square values were not statistically significant at the p = 0.05 level.

Antiemetics↗
PubMed1988

Clinical pharmacy administration.

Clinical pharmacy administration has emerged as a separate discipline, but this new field has not been functionally defined. This article defines clinical pharmacy administration from an academic point of view and provides a framework within which it may be understood. It is an applied field of study that deals with the research, evaluation, and management of the patient, the drug, and the health care practitioner as they all relate to patient care. These entities and relationships are studied at the micro, macro, and global levels from financial, economic, managerial, legal, ethical, social, behavioral, educational, and historical perspectives. It is intended that this paper generate debate and discussion in order to refine and develop the field.

Pharmacy Administration↗
PubMed1988

The dilemma of clinical pharmacy research.

Clinical pharmacy research is defined as investigation of patient oriented drug related services. The dilemma is that Canadian practitioners have failed to do sufficient research in the area of clinical pharmacy programs, and this is desperately needed. A simple two-factor model is proposed to help explain the problem. Factors facilitating research are termed personal and enabling. Personal factors are: knowledge and skills in research design and statistical analysis, as well as personal qualities which include a positive attitude toward research, desire for involvement, and drive to carry it out. Enabling factors are leadership and support (resources, encouragement from management, time, and finance). It is suggested that lack of research skills in practitioners, lack of leadership, and lack of management support are prime reasons for the dilemma. The author proposes that: 1. undergraduates and graduates receive more formal instruction in research methodology and statistical analysis; 2. skilled researchers assume a leadership role, and; 3. research be encouraged by giving it a higher priority, by allowing adequate time for research, and by providing financial and political support.

Canada↗