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PubMed2001

Practical approach to the use and monitoring of dofetilide therapy.

FDA's requirements for the use of dofetilide are described, and one hospital's strategy for meeting the requirements is discussed. Dofetilide is a specific class III antiarrhythmic agent approved for use in the conversion of atrial fibrillation and atrial flutter and the maintenance of normal sinus rhythm. It is available as an option for highly symptomatic patients who fail to respond to or do not tolerate other antiarrhythmic agents and patients with structural heart disease. Because of the risk of torsade de pointes associated with dofetilide, FDA has mandated in-hospital initiation of dofetilide therapy and has restricted its availability to hospitals and prescribers who have received appropriate education on dofetilide treatment initiation and dosing. Control of the drug's distribution is limited to a single wholesaler and a single mail-order pharmacy. These restrictions, along with the FDA labeling and the inherent risks associated with dofetilide use, have made this drug a complicated agent to use within an institution. When dofetilide was added to the formulary at Harper University Hospital, policies and procedures were developed to ensure appropriate use and monitoring. The use of dofetilide within health systems requires detailed procedures for prescribing, dispensing, and monitoring and thorough education of caregivers about those procedures. Pharmacists have a pivotal role in ensuring the appropriate use of dofetilide.

Anti-Arrhythmia Agents↗
PubMed1994

Preliminary report on an automated screening test for detection of antibody to human immunodeficiency virus type 1 in whole blood.

We developed and evaluated an automated screening test for antibody to human immunodeficiency virus type 1 (HIV-1) using EDTA-2Na-treated whole blood and an extract of paper disk-absorbed dried whole blood from 60 hemophiliacs infected with HIV-1 and 210 diseased and healthy controls. The specificity and the sensitivity of this system were judged to be 100% with both the whole blood and the extract. This test allows measurement of HIV-1 antibody in whole blood and dried whole blood on a small paper disk and gives a result within 13 minutes; the system can process 150 samples per hour. Therefore, it may be useful at many testing sites, such as emergency departments, intensive care units, blood banks, and commercial laboratories, as well as for mail-order testing from remote areas and developing countries.

AIDS Serodiagnosis↗
PubMed1999

Applying a contingency model of strategic decision making to the implementation of smoking bans: a case study.

A model of strategic decision making was applied to study the implementation of worksite smoking policy. This model assumes there is no best way of implementing smoking policies, but that 'the best way' depends on how decision making fits specific content and context factors. A case study at Wehkamp, a mail-order company, is presented to illustrate the usefulness of this model to understand how organizations implement smoking policies. Interview data were collected from representatives of Wehkamp, and pre- and post-ban survey data were collected from employees. After having failed to solve the smoking problem in a more democratic way, Wehkamp's top management choose a highly confrontational and decentralized decision-making approach to implement a complete smoking ban. This resulted in an effective smoking ban, but was to some extent at the cost of employees' satisfaction with the policy and with how the policy was implemented. The choice of implementation approach was contingent upon specific content and context factors, such as managers' perception of the problem, leadership style and legislation. More case studies from different types of companies are needed to better understand how organizational factors affect decision making about smoking bans and other health promotion innovations.

Adult↗
PubMed2001

'Natural' progesterone creams for postmenopausal women.

Creams containing 'natural' progesterone for application to the skin have been available over the counter in mainland Europe and the USA for around 20 years. They are not licensed in the UK and their availability here (in the form of Pro-Gest or Pro-Juven creams, all distributed by Higher Nature) is limited to provision by prescription on a named-patient basis (related formulations are also being purchased from abroad by mail-order and via the Internet). Their UK distributor claims the creams can help treat menopausal symptoms and may prove useful in the prevention and treatment of osteoporosis in postmenopausal women. Here, we assess the efficacy and safety of 'natural' progesterone creams in the treatment of postmenopausal symptoms. In particular, we look at whether the products can protect against osteoporosis, or adequately oppose stimulation of the endometrium by exogenous oestrogen and so replace the progestogen component of conventional HRT.

Drug Costs↗
PubMed1991

Perceived purpose of prescription drugs: the Iowa 65+ Rural Health Study.

In order to assess elderly patients' knowledge of their medications, the Iowa 65+ Rural Health Study asked a rural, elderly population the purpose of their prescription drugs. Ten percent of all drug purposes reported were considered inappropriate by our criteria. There was some variability between therapeutic categories and their frequency of purpose misperception. For 40 percent of drugs whose purpose was inappropriate, the respondent reported another drug for which that purpose would have been appropriate. Respondents were as likely to state a medication's appropriate purpose whether it had been dispensed by a pharmacy or a physician. The highest percentage of drugs whose purpose was appropriately perceived was dispensed by mail-order pharmacies.

Aged↗
PubMed1995

The future of pharmacy: Armageddon or Pollyanna?

OBJECTIVE: To review important events and predictions about pharmacy that have occurred in the practice since my career began and describe changes in opportunities that have developed over the past 35 years. DATA SOURCES: I used personal recollections and information from the State of Florida Pharmacy Association journal over a 35-year period. Other supporting data were used to describe current practice opportunities. DATA SYNTHESIS: Over the past 35 years many people have predicted the demise of the pharmacy profession. The reasons stated for this demise have varied over the years and include government interference, the expansion of chain and mail-order pharmacies, managed care, loss of the compounding function, Medicaid reimbursement, national health insurance, and pharmacy technicians. Despite these gloomy predictions, community and hospital pharmacies have flourished over the past 35 years and new roles for pharmacists have emerged in managed care, consultant pharmacy, academic pharmacy, and the pharmaceutical industry. With the enactment of the Omnibus Budget Reconciliation Act of 1990 requirements, it appears that the public has even greater expectations from community pharmacists as medication advisors. The pharmacy profession is changing more rapidly than ever and pharmacists must prepare for these rapid changes. Colleges of pharmacy should inculcate in their students the importance of lifelong learning to keep abreast with change. CONCLUSIONS: Society will always need experts on drugs. Pharmacists must rise to the challenge and accept new and changing roles in drug therapy management. If that occurs the future of pharmacy will be ensured.

Forecasting↗
PubMed1995

A comparison of six intra-oral X-ray films.

OBJECTIVES: To compare objectively and subjectively national-brand dental X-ray films with widely available and less costly brands. METHODS: A range of dental films, including the recently released Kodak Ektaspeed Plus, was purchased from mail-order suppliers at the lowest published price. Objective measurements (film speed, contrast, fog levels, costs, physical characteristics) and subjective evaluations (ease of use, film graininess, overall appearance) were made. RESULTS: Private-label films were obtained at less cost than those of major vendors. Not all film speeds, sizes and wrapping materials were available from individual manufacturers. Objective measures and subjective appraisals showed that Ektaspeed Plus was the fastest film and had good contrast with the clinically useful density ranges. Agfa Dentus was the next fastest film, but it had rather low contrast and was grainier than the other films. The non-proprietary brands were difficult to open with primary glove barriers, making effective infection control practices arduous. All films were relatively stable over a 16-week period regardless of storage location. CONCLUSIONS: The major manufacturers offered more choices of film sizes and speeds than did private label suppliers. The films from the major manufacturers, although more expensive, were more conducive to effective infection control practices. Ektaspeed Plus had a performance comparable with or better than the other available films. Based on this preliminary study, it is recommended that this new film is considered as an alternative to D-speed films.

Absorptiometry, Photon↗
PubMed1998

Safety recommendations for laser pointers.

The use of laser diode pointers that operate in the visible radiation region (400-760 nm) is becoming widespread. These pointers are intended for use by educators while presenting talks in the classroom or at conventions and meetings. They are also useful in any situation where one needs to point out special items during any instructive situation. The pointers can be purchased in novelty stores, mail-order magazines, office supply stores, common electronic stores, and over the internet. The power omitted by these laser pointers ranges from 1 to 5 mW. The potential for hazard with laser pointers is generally considered to be limited to the unprotected eyes of individuals who might be exposed by a direct beam (intrabeam viewing). No skin hazard usually exists. There are, however, even more powerful laser pointers now appearing. The units are imported into the U.S. often without proper manufacturer certification or labeling. The potential for hazards with these devices is not well understood by the general public and workers, and numerous exposure incidents have been recorded by the authors. Users of these products need to be alerted to the potential hazards and be encouraged to follow appropriate safety recommendations. These factors are discussed and safety recommendations for laser pointers are presented.

Certification↗
PubMed1994

[The dedicated amateur].

This is the text of an inauguration lecture at Umeå Universitiy (a chair of the history of science and ideas). The lecture is based on a study of magazines like Populär Teknik (Popular Technology), popular science literature, handbooks for mechanical and electrical experimentation, mail-order catalogs etc. from 1920-50, and its theme is that amateurs and hobbyists interested in popular science, technology and "do-it-yourself" have played an important role in modern society. Here we find a world exclusively occupied by boys and men, where it is made a virtue of playing with technological toys, and where mechanical and electrical tinkering becomes a significant part of the construction of masculinity. But the activities of amateurs and hoppyists can also be seen as an important way of self-education where the boy may get in touch with the scientific and technological frontier of the time, and there are many examples (e.g. in early history of radio or personal computers) where amateurs invented and developed new technology. The spirit of amateurs and hobbyists can even contain elements of a modern civic ideal: don't become dependent upon professional experts, don't trust authorities or big business that want to control technology, trust yourself and your knowledge. In short: do it yourself.

Biotechnology↗
PubMed1989

Experience with staffing alternatives in a pediatric teaching institution.

Staffing alternatives and recruitment and retention strategies used by the pharmacy department of a pediatric teaching hospital are described. In addition to overtime compensation, the following alternative strategies have been implemented: (1) use of contingent or "on-call" personnel, (2) coverage by management staff, (3) use of temporary agencies, (4) review of ongoing activities, and (5) use of supportive personnel. All these strategies have been effective in compensating for shortages by supplying qualified individuals on an as-needed basis, eliminating nonessential departmental activities, or delegating nonprofessional duties to technicians and other supportive personnel. Effective recruitment and retention strategies include scholarship and training programs, communication with pharmacy staff about management efforts to improve salary and practice opportunities, and insight into the nature of the local competition from chain and mail-order pharmacies. Use of alternate approaches to staffing has helped the pharmacy department at this institution maintain adequate staffing during periods of pharmacist shortages.

Communication↗
PubMed1988

Dangerous information: product tampering and poisoning advice in revenge and murder manuals.

This paper reviews 18 publications that advocate the use of product tampering and other poisoning methods as techniques for exacting revenge against individuals and corporations, as methods of committing murder, and for other criminal purposes. Several of the particular techniques recommended in these publications subsequently have been used in criminal tampering incidents. The published sources of technical guidance for the would-be tamperer and poisoner are examined in detail to alert forensic scientists, law enforcement authorities, and the food and drug industry to the particular techniques that are being advocated. Possible criminal and civil liability of the publishers and authors is discussed. The author suggests that food and drug retailers consider the wisdom of selling magazines that advertise the availability of revenge and murder manuals advocating product tampering and poisoning, that food and drug manufacturers test the effects on their products of the contaminants that are being recommended, and that investigators be alert to the existence of such manuals and mail-order suppliers of poisons.

Crime↗
PubMed1987

[The Veterinary Drug Act and the practitioner].

The consequences of the Veterinary Medicinal Products Act to veterinary practitioners are described and assessed. Registration is favourably regarded, although there is a variety of views on directing veterinary drugs into specific channels, partly positive, partly negative. The position of the Group of Large Animal Practitioners of the Royal Netherlands Veterinary Association with regard to vaccination policy and 'mail-order veterinarians' is reported. In conclusion, a discrepancy in government policy is pointed out.

Animals↗
PubMed1994

Horseback riding injuries among children and young adults.

BACKGROUND: Horseback riding injuries are responsible for an estimated 2300 hospital admissions annually among persons younger than 25 years of age in the United States, but injury rates, patterns of injury, and risk factors for this population have not been well studied. METHODS: Study participants were selected from a list provided by a national mail-order company that sells riding equipment. A total of 557 persons younger than 25 years of age who rode horses at least six times a year completed survey questionnaires. RESULTS: Among the study participants, 34 (6.1%) had been hospitalized at least once because of a riding injury and 153 (27.5%) had been treated by a physician within the previous 2 years for such an injury. The overall injury rate was 0.6 per 1000 riding hours. Among those injured, sprains or strains (41.8%), lacerations or bruises (40.0%), and fractures or dislocations (33.3%) were the most common types of injury. A total of 27.5% of those injured sustained concussions or other head injuries. Riding 15 to 24 hours per month (odds ratio [OR] = 2.04), being female (OR = 1.81), and riding English style (OR = 1.77) were the characteristics most strongly correlated with injury. CONCLUSIONS: Horseback riding injuries among participants in this study tended to be serious. Family physicians should inform their patients who ride horses about the risks associated with equestrian activities and should emphasize helmet use.

Adolescent↗
PubMed1994

Desiccated thyroid in a nutritional supplement.

Nutritional or vitamin supplements, which are largely unregulated by the Food and Drug Administration (FDA) and are sold in health food stores and through mail-order catalogs, may contain various combinations and doses of vitamins, minerals, herbs, chemicals, and animal tissues. Some of the products marketed as nutritional supplements contain desiccated porcine or bovine thyroid. A patient came to our family practice center with resting tachycardia, amenorrhea, and weight loss. She had been taking a nutritional supplement containing desiccated thyroid for 3 months. Laboratory studies confirmed the presence of hyperthyroidism. The daily recommended and consumed dose of the product she had been taking exceeded the normal replacement dose by two to three times. There is potential for harm in the unregulated availability and distribution of desiccated thyroid to the public.

Adult↗
PubMedDate not supplied

Helmets and horseback riders.

To determine patterns of helmet use and attitudes toward helmets among horseback riders, we analyzed a subset of data (n = 1,834) from a cross-sectional mail survey of horseback riders conducted from July to December 1991. Riders were randomly selected from the mailing list of a national mail-order company that sells horseback-riding equipment. Of 900 English-style riders, 517 (57.5%) wore helmets on their last ride, compared with only 81 of 684 (11.8%) Western-style riders. Among 546 riders who did not own helmets, their most commonly cited reasons included believing that helmets were unnecessary (43.8%) or uncomfortable (29.9%). Of the 1,263 helmet owners, nearly 62% had one or more complaints about helmets, but 41.1% of owners reported that their helmet had prevented at least one head injury. Increasing helmet use will require major educational efforts with horseback riders and design changes by manufacturers.

Adolescent↗
PubMed1998

Patient education programs and continuance with estrogen replacement therapy: evaluation of the women's health exchange.

OBJECTIVE: This study examined the impact of the Women's Health Exchange (WHE), a program aimed at educating women about menopause and estrogen replacement therapy, on patient continuance with Estraderm, a transdermal estrogen replacement medication. DESIGN: The prescription database of Express Scripts, Inc., a pharmacy benefits management company serving a large, nationwide insured population, was used for the study. All study subjects had one or more claims for Estraderm between 2/1/95 and 8/31/95. The intervention group consisted of 299 WHE enrollees, and the control group comprised a random sample of 1,513 patients who had not enrolled in WHE. RESULTS: A multivariate Cox regression model found that older age, longer prior length of Estraderm use, progestin use, and patronage of a mail-order pharmacy were associated with increased continuance. Controlling for these factors and for HMO enrollment and copay amount, the likelihood of discontinuing Estraderm was significantly lower for WHE enrollees compared to non-WHE enrollees. Sensitivity analyses tested the effects of preexisting differences between the WHE and control group subjects on study findings. Even when WHE enrollees were compared with control subjects having similar medication costs, disease severity, or continuance with chronic medications, WHE enrollment was associated with an increased length of Estraderm therapy. CONCLUSIONS: These findings suggest that patient education programs may improve continuance with transdermal hormone replacement therapy for patients with a prescription benefit.

Administration, Cutaneous↗