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Biomedical subjects

W E Wade

Publications and source records attributed to W E Wade.

At least 37 records · Page 2Linked to original sources
PubMed1996

The expanding role of pharmacy and therapeutics committees. The 1990s and beyond.

Traditionally, pharmacy and therapeutics (P&T) committees have been responsible for overseeing the drug use process, using formulary systems to control drug costs. Primarily, these committees act in an advisory capacity as policy-recommending bodies within healthcare systems, for the specific purpose of promoting rational drug therapy. Methodologies utilised by these committees include drug use evaluation, medical staff education, continuous quality improvement, formulary restriction and therapeutic interchange. Future roles of P&T committees will include the evaluation of clinical outcomes information, including quality-of-life issues, to establish policies governing the use of drugs at all levels and in all types of healthcare.

Pharmacy and Therapeutics Committee↗
PubMed1995

How a CQI program improved aminoglycoside use in a community hospital.

The P & T Committee of our institution, a 285-bed, non-tertiary care regional medical center, undertook a study to evaluate the use of the aminoglycoside amikacin sulfate (Amikin). Results of an initial DUE, a follow-up to an educational effort, and the estimated annual cost savings that could be achieved with appropriate prescribing of aminoglycosides are presented.

Aminoglycosides↗
PubMed1994

Educational effort and CQI program improves ordering of serum digoxin levels.

In a 289-bed, acute-care, non-tertiary-care regional referral center, a continuous quality improvement educational effort successfully improved ordering of serum digoxin levels. Following a determination that physicians were not requesting serum digoxin levels correctly, the P & T Committee issued a letter describing appropriate wording of orders for serum digoxin levels. The number of incorrectly ordered serum digoxin levels requested dropped significantly over a 49-month period as a result of the intervention described below, which also resulted in cost savings.

Cost Savings↗
PubMed1991

Lack of effect of a high-fat meal on the volume of distribution of theophylline in humans.

The pharmacokinetics of intravenously administered theophylline were studied in five healthy nonsmokers. Each subject received 5 mg/kg of theophylline as aminophylline after an overnight fast and again after a standard high-fat meal. Although there was wide between-day variation in the elimination rate constant in three of the five subjects, no statistically significant differences were observed in area under the time-versus-concentration curve, maximum serum theophylline concentration, elimination rate constant, or apparent volume of distribution between the two treatments. A statistical power analysis indicated that if differences in volume of distribution and maximum serum theophylline concentration occur in the general population, the mean differences are less less than 15% and 20%, respectively. This suggests that alterations in intravascular drug distribution resulting from eating a high-fat meal do not contribute importantly to previously reported effects of food on serum theophylline concentrations after oral dosing.

Adult↗
PubMed1991

Depression associated with antihypertensive drugs.

BACKGROUND: Depression is a potential side effect of antihypertensive drug therapy. Consideration of this side effect is a reason often cited by physicians for not choosing certain drugs. METHODS: In this prospective study the relative rates of depression were measured by the Zung Self-Rating Depression Scale (SDS) in patients from four hypertension treatment groups. Treatment groups consisted of 466 patients receiving: (1) no drug therapy, (2) diuretics only, (3) diuretics plus reserpine, and (4) diuretics plus beta-blockers. Demographic data including age, sex, and race were collected. Analysis of variance was used to compare the rate of depression among the treatment groups, as well as among age, sex, and racial groups. RESULTS: Using a Zung SDS index of greater than or equal to 50, 35.4% of the hypertensive population was depressed. Age and sex were not significant factors in the frequency of depression. Blacks scored higher than whites in all drug treatment groups except those treated with high lipophilic beta-blockers, but the rate of depression was not higher. Whites on the lowest dose of reserpine had the lowest rate of depression. The rate of depression among those taking reserpine or beta-blockers was no different than that among those receiving either no treatment or diuretics. CONCLUSIONS: Reserpine or beta-blocker therapy did not cause any more depression than any other antihypertensive treatment.

Adolescent↗
PubMed1990

Therapeutic drug monitoring in a community hospital.

This study describes an aminoglycoside dosing service in a community hospital. Between 95 and 98% of all aminoglycoside doses are calculated by staff pharmacists using traditional pharmacokinetic equations. All patients dosed by the pharmacy are then monitored by clinical pharmacists who make necessary dosage modifications following serum peak and trough levels. After the first year of this service, it was determined that a slight change in the volume of distribution equation would allow the pharmacy to calculate maintenance doses that would more accurately result in estimated serum peak and trough levels. Physicians are pleased with this service and professional job satisfaction is experienced by the pharmacists. Therapeutic drug monitoring is an important component of patient care and can be implemented in community hospitals. Other pharmacy departments are encouraged to establish similar services.

Aminoglycosides↗
PubMed1990

Drug usage evaluation of aminoglycoside-induced nephrotoxicity in a community hospital.

A DUE was conducted at this institution to determine the incidence of aminoglycoside-induced nephrotoxicity. The charts of all patients (113) who received an aminoglycoside during the first quarter of 1989 were reviewed. Information gathered included patient age, aminoglycoside used, loading and maintenance doses, serum peak and trough concentrations, changes in serum creatinine during aminoglycoside administration, and culture and sensitivity results. Physicians were inconsistent in prescribing loading doses, while all patients dosed by the pharmacy received an initial dose of 1.5 to 1.75 mg/kg of ideal body weight for gentamicin and tobramycin. Ninety percent of maintenance doses were calculated by the pharmacy. All patients had serum peak concentrations between 3 and 10 micrograms/ml, and only three patients had serum trough concentrations greater than 2 micrograms/ml. No patient demonstrated changes in serum creatinine suggestive of clinically apparent nephrotoxicity. This study suggests that with routine pharmacist intervention (via a pharmacist-managed dosing service), aminoglycosides can be prescribed with a low incidence of nephrotoxicity.

Aminoglycosides↗
PubMed1989

The use of aerosolized tobramycin in the treatment of a resistant pseudomonal pneumonitis.

Aerosolized tobramycin was given to a 68-year-old man with resistant Pseudomonas aeruginosa pneumonitis at a dose of 100 mg every 8 h via a tracheostomy, after the patient failed to respond adequately to parenteral aminoglycoside and ticarcillin therapy. Minimum inhibitory concentration and minimum bactericidal concentration for tobramycin and gentamicin were 16 micrograms/ml and greater than 16 micrograms/ml, which necessitated aerosol administration. Tracheal concentrations 15 min and 4 h after a dose were 1,560 and 930 micrograms/ml. The patient responded and eventually was discharged from the hospital. Thus, monotherapy with an aerosolized aminoglycoside may be effective in some patients with resistant Pseudomonas aeruginosa pneumonitis.

Aerosols↗
PubMedDate not supplied

Pharmacoeconomic impact of a drug use evaluation of ceftriaxone in an acute-care medical center.

Inappropriate prescribing of antimicrobial agents may result in considerable expense to the health care system. It was noted in a 295-bed, acute-care medical center that ceftriaxone was being prescribed every 12 hours in what appeared to be a disproportionately large percentage of patients. A drug evaluation was conducted to determine the appropriateness of the prescribing of this agent. Based on indication, it was determined that a significant number of patients receiving a twice-daily dosing should receive once-daily dosing. An educational effort directed to the medical staff was implemented via the pharmacy and therapeutics committee on the proper prescribing of ceftriaxone. A follow-up drug use evaluation demonstrated appropriate prescribing in most situations, resulting in cost savings in excess of $25,000.

Adult↗
PubMedDate not supplied

Cost analysis of ardeparin versus enoxaparin for the prophylaxis of deep vein thrombosis after knee arthroplasty.

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are major complications associated with total knee arthroplasty. The American College of Chest Physicians recommends twice-daily, fixed-dose low-molecular-weight heparin (LMWH) as routine prophylaxis in this patient population. This study represents a cost analysis of ardeparin and enoxaparin, the two LMWHs currently available for this indication in the United States. Costs for treating DVT, PE, and major bleeding episodes were derived from values reported in the literature. Both ardeparin and enoxaparin were found to produce significant cost savings when used routinely as DVT prophylaxis after knee replacement surgery compared with no prophylaxis. Based on the currently available data, enoxaparin 40 mg once daily appears to be the least costly LMWH for routine pharmacoprophylaxis of DVT in patients undergoing knee replacement surgery.

Arthroplasty, Replacement, Knee↗
PubMedDate not supplied

Venous thrombosis after acute spinal cord injury: cost analysis of prophylaxis guidelines.

OBJECTIVE: Venous thrombosis and pulmonary embolisms are major complications associated with acute spinal cord injury. The purpose of this study was to perform a cost analysis on the two pharmacoprophylaxis regimens suggested for deep vein thrombosis prophylaxis in this population. METHODS: Efficacy and safety data were obtained from the literature. RESULTS: Results of the cost analysis demonstrates that adjusted dose unfractionated heparin produces a cost savings over enoxaparin at 30 mg every 12 hr. CONCLUSION: Further studies are needed to determine the most cost-effective therapy for preventing deep vein thrombi in this population.

Anticoagulants↗
PubMedDate not supplied

Pharmacist-managed aminoglycoside therapy in combination with a beta-lactam agent in the treatment of nosocomial pneumonia in critically ill patients.

We attempted to determine the outcome of treatment with aminoglycosides, dosed pharmacokinetically using traditional strategies, in combination with synergistic antibiotics in the management of nosocomial pneumonia in critically ill patients over a 1-year period. Twenty-three adults cared for in an intensive care unit received an aminoglycoside dosed by a pharmacist plus a beta-lactam antibiotic. Of these, 21 experienced clinical cure of the disease and 2 died of unrelated complications. No treatment failures were encountered. Therapy with aminoglycosides, dosed by traditional pharmacokinetic methods, in combination with synergistic antimicrobials, was effective in managing nosocomial pneumonia in this nontertiary care regional referral center.

Adolescent↗