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At least 991 records · Page 55Linked to original sources
PubMed2000

Alcohol abuse and dependence in a national sample of psychiatric patients.

OBJECTIVE: To examine clinical characteristics and services being provided to Alcohol Abuse/Dependent (AAD) patients in current psychiatric practice. METHOD: In a national sample of psychiatrists (N = 417), each provided data on three preselected patients (N = 1,245; 51.8% women) that included demographics, DSM-IV diagnoses, treatment setting and health-plan measures. Logistic regression was used to compare patients with and without an AAD diagnosis. RESULTS: Only 12% of patients (n = 151) had an AAD diagnosis. AAD patient care was more frequently subject to utilization review and restriction or specification of medications to be prescribed (formulary). Psychiatrists also perceived greater restrictions on AAD patient care (e.g., requirements to use specific practice guidelines or treatment algorithms). CONCLUSIONS: Findings suggest that health care systems are subjecting treatment patients with AAD to greater scrutiny and may be limiting the extent and nature of care provided to these patients. The low prevalence of AAD among patients being seen by psychiatrists also warrants further attention. Study findings highlight the utility of practice-based research in addiction psychiatry.

Adult↗
PubMed1989

Surgical management of the peripheral nerve gap.

The classic management of the nerve gap is reviewed. Utilization of a conduit to bridge a short nerve gap and the distal neuratization procedure to recover critical nerve function are discussed. The experimental concepts of the use of nerve allograft and nerve expansion for extensive nerve injury are introduced.

Arm↗
PubMed1995

A review of the utility of soluble peptide combinatorial libraries.

This paper reviews the preparation and use of soluble synthetic combinatorial libraries (SCLs) made up of millions of peptide and nonpeptide sequences for the identification of highly active individual compounds. First presented in 1991, SCLs have been prepared in a number of different lengths and formats, and are composed entirely of L-, D-, and unnatural amino acids. Also, existing peptide libraries have been chemically transformed to yield large diversities of nonpeptidic compounds. This review encompasses the published work from this laboratory using SCLs for the identification of antigenic sequences recognized by monoclonal antibodies, novel peptide agonists and antagonists to opioid receptors, new trypsin inhibitors, novel antibacterials, and compounds that inhibit melittin's hemolytic activity. SCLs offer a fundamental, practical advance in the study of interactions between peptide and nonpeptide sequences and their biochemical or pharmacological targets.

Amino Acid Sequence↗
PubMed2005

The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines.

Radiotherapy utilization rates for cancer vary widely internationally. It has previously been suggested that approximately 50% of all cancer patients should receive radiation. However, this estimate was not evidence-based. The aim of this study was to estimate the ideal proportion of new cases of cancer that should receive radiotherapy at least once during the course of their illness based on the best available evidence. An optimal radiotherapy utilization tree was constructed for each cancer based upon indications for radiotherapy taken from evidence-based treatment guidelines. The proportion of patients with clinical attributes that indicated a possible benefit from radiotherapy was obtained by adding epidemiologic data to the radiotherapy utilization tree. The optimal proportion of patients with cancer that should receive radiotherapy was then calculated using TreeAge (TreeAge Software, Williamstown, MA) software. Sensitivity analyses using univariate analysis and Monte Carlo simulations were performed. The proportion of patients with cancer in whom external beam radiotherapy is indicated according to the best available evidence was calculated to be 52%. Monte Carlo analysis indicated that the 95% confidence limits were from 51.7% to 53.1%. The tightness of the confidence interval suggests that the overall estimate is robust. Comparison with actual radiotherapy utilization data suggests a shortfall in actual radiotherapy delivery. This methodology allows comparison of optimal rates with actual rates to identify areas where improvements in the evidence-based use of radiotherapy can be made. It provides valuable data for radiotherapy service planning. Actual rates need to be addressed to ensure better radiotherapy utilization.

Evidence-Based Medicine↗
PubMed2006

The futility of universal pre-employment chest radiographs.

In a developmental center, a preemployment chest x-ray was required for all job applicants. We scrutinized the pros and cons of this practice through a review of the medical literature and our experience, and discussion with our colleagues. We concluded that such chest x-ray caused unwarranted radiation exposure, did not produce compliance with the tuberculosis laws, gave a false sense of security regarding workers' compensation risk management, was contrary to established occupational medicine practice guidelines, and was unnecessary and wasteful. We discontinued such chest x-rays. The purpose of the pre-employment examination should remain narrowly job related. Even long-established procedures require periodic utilization review.

Cost-Benefit Analysis↗
PubMed1991

Drug usage evaluation: H2-receptor antagonist use in 30 hospitals.

In this 30-hospital survey, data on usage, adverse drug reaction (ADR) rates, and drug interactions (DI) of the H2-receptor antagonists (H2RA) cimetidine, ranitidine, and famotidine were analyzed. Approximately 8% (1,768 patients) admitted to participating hospitals received an H2RA (range: 0.5 to 30%). Patients admitted to a critical care area were significantly (p less than 0.025) more likely to receive ranitidine, were more likely (p less than 0.005) to receive more than one H2RA, and were more likely (p less than 0.0005) to receive an H2RA for "stress ulcer" or a "history of peptic ulcer disease". Doses of the H2RAs were appropriate in less than 50% of cases. Sixty ADRs and 29 DIs were reported. There was no significant difference (p greater than 0.70) between cimetidine and ranitidine with regard to the number of ADRs reported; however, cimetidine was associated with a significantly greater (p less than 0.0005) number of reported DIs. The results of this utilization review indicate that H2RAs are frequently prescribed drugs in hospitalized patients. All ADRs and DIs were reported in patients in critical care areas, suggesting that these patients are "at risk" of developing side effects to H2RAs.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

A model for improving medication use in home health care patients.

OBJECTIVES: (1) To develop a model for the identification and resolution of problems associated with suboptimal medication use in elderly patients receiving home health care; (2) To select the most important identifiable problems and develop structured procedures for their resolution. DESIGN: Expert panel review, problem selection, and development of a problem resolution model and guidelines. SETTING: Home health care. PARTICIPANTS: A panel with expertise in home health nursing, pharmacy, clinical pharmacology, gerontology, pharmacoepidemiology, and health services research. INTERVENTIONS: A list of potential problems associated with the most frequently used classes of drugs was compiled for review by the panel. Problems that were controversial or that could not be identified in the home care setting were excluded. Panel members individually ranked the remainder. Detailed procedures for identification and resolution of the 15 top-ranking problems were developed. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Potential medication problems were defined by both drug use and symptoms or clinical signs associated with specific adverse effects, to ensure that clinically relevant problems would be identified. The model developed for problem assessment and resolution was centered on the drug utilization review (DUR) coordinator and the attending home health nurse. Following guidelines developed by the panel, the DUR coordinator advises the home health nurse about identified problems and how to resolve them. One of these practitioners, usually the nurse, then contacts the attending physician to explain their concerns, offer potential solutions, and request instructions. CONCLUSION: A potentially useful model for the identification and resolution of medication problems in the home health care setting was developed. This model is currently being evaluated in a randomized controlled trial.

Aged↗
PubMed2006

Maintaining patient throughput on an evolving trauma/emergency surgery service.

BACKGROUND: The case-management team (CMT) has been an effective tool to decrease denied days and improve hospital throughput on a trauma service. With the addition of emergency general surgery (EGS) to our practice, we reviewed the ability of the case management team to absorb EGS patients on the inpatient trauma service while maintaining the improvements initially realized. METHODS: An interdisciplinary CMT was implemented in January 1999. CRNPs were added in August 2003 to address the Accreditation Council for Graduate Medical Education resident work-hour restrictions. "Key communications" for each CMT member are reported three times per week as defined by a hospital-approved policy. Beginning in August 2001, the trauma service was expanded to include EGS patients. Data from the trauma registry, hospital utilization review, and finance office were analyzed before (1998 and 1999) and after (2003 and 2004) the addition of EGS. Tests of proportion were used to evaluate questions of interest. RESULTS: The number of injured patients admitted to the trauma service remained relatively constant during the study periods, ranging from a high of 1,365 in 1999 to a low of 1,116 in 2003. Beginning in 2003, the influx of emergency surgery patients to the service was marked. By 2004, there were 561 emergency surgery admissions, representing more than 30% of the total service admissions. As a result, the total number of service admissions has dramatically increased, reaching 1,833 in CY 2004, a 56% increase from CY 1998 levels. Hospital length of stay data varied from a low of 5.5 days in CY 1999 to a high of 6.9 days in CY 2003. Length of stay appeared to be associated with injury severity (mean Injury Severity Score 11.8 in 1999 and 13.1 in 2003) and case mix, but not associated with denied days. The percent of denied days decreased over the study periods, from 4.6% in 1998 (before the implementation of the CMT) to 0.5% in 2004 (p<0.01). The percent of readmissions also fell significantly over the study periods (4.0% in 1998 to 1.8% in 2004; p<0.01). CONCLUSIONS: The initial improvements in patient throughput noted after the introduction of a CMT in January 1999 have been maintained in recent years despite the addition of an EGS component to the trauma service. Percent denied days and readmissions have continued to decrease. The length of stay for these patients remains, in part, dependent on other factors. The CMT plays an integral role in maintaining the efficiency of a trauma/emergency surgery service.

Adolescent↗
PubMed2004

Pharmacoepidemiology and the "impact factor".

The field of "Pharmacoepidemiology/Drug Utilization" research has been analysed by studying published research articles under the medical subject headings (MeSH terms) "Pharmacoepidemiology", "Drug Utilization" and "Drug Utilization Review". There were 1822 articles published, and stored in Medline, during the 32-month period between 1 January 2001 and 31 August 2003; these papers might represent a field of research, due to the similarity of MeSH terms used for coding and the set of journals in which the articles were published. A total of 457 articles, representing 25% of all articles in the field, were published in 14 different journals, and 50% of all articles (948) were collected in only 64 different journals. The two main journals publishing research in "Pharmacoepidemiology/Drug Utilization" are Pharmacoepidemiol Drug Saf and the Eur J Clin Pharmacol. These two publications are the official journals of the three main societies in the field and are at least partially focused on this subject, with 45.7% of all articles in Pharmacoepidemiol Drug Saf and 11.1% of all articles in Eur J Clin Pharmacol included under the studied MeSH terms; other journals only occasionally publish papers in this line of research. These two journals are the leaders in pharmacoepidemiology and drug utilization research, having impact factors (IFs) in 2002/2003 above (1.955/1.972 for EJCP) and a bit below (1.092/1.257 for PDS) the middle of the ranking of publications, according to the IF, in the "Pharmacology and Pharmacy" list of the Science Citation Index (SCI).

Bibliometrics↗
PubMed2001

Service system finance: implications for children with depression and manic depression.

An estimated 6.2% of children in the United States satisfy the criteria for a depression diagnosis, but approximately half of this group do not receive necessary treatment. Thus it is important to consider potential barriers to use through service system finance. This article reviews three major types of changes affecting access: parity legislation, managed care, and public contracting. How these developments will affect children with depression and manic depression (DMD) is unclear. To better understand the potential effects on children with DMD, this review uses new data from the Medical Expenditure Panel Survey to describe the service use patterns of this population. These children have higher levels of expenditures, higher rates of inpatient use, and higher rates of Medicaid payment than do other children with mental health diagnoses; they also are overrepresented among the costliest cases of mental illness in children. Children with DMD pay a relatively low out-of-pocket share, suggesting that parity efforts focusing only on copayments and deductibles will have little effect on the absolute out-of-pocket burden for these children. Because children with DMD are overrepresented among high utilizers of health services, health care rationing arrangements or techniques, such as utilization review and capitation, may place this population at particular risk.

Bipolar Disorder↗
PubMed2006

Management of esophageal coins.

PURPOSE OF REVIEW: Coins are the most commonly ingested foreign body encountered in the pediatric population. Coins that are in the esophagus and are causing symptoms (cough, stridor, respiratory distress, drooling or pain) are managed with immediate removal via various methods. Asymptomatic coins have been a perplexing problem to the clinician for decades, with some advocating for immediate removal while others are proponents of "watchful waiting". RECENT FINDINGS: This article will provide a review of the current literature on management options for symptomatic and asymptomatic esophageal coins. The article will discuss clinical decision-making strategies for the diagnosis of the unwitnessed ingestion, as well as diagnostic studies, such as plain radiographs, as well as novel modalities, such as metal detectors. Discussion of the anatomic issues related to esophageal foreign bodies will be addressed. Treatment options for asymptomatic patients will be reviewed utilizing data from retrospective studies as well as a prospective randomized trial. SUMMARY: In the symptomatic patient with an esophageal coin, immediate removal via endoscopy is recommended. For the asymptomatic patient with an esophageal coin, current data support expectant management for a period of 12-24 h with the hope of spontaneous passage and avoidance of general anesthesia and surgical procedure.

Child↗
PubMedDate not supplied

Improving medication compliance: a review of selected issues.

The impact of various factors on patient compliance with prescribed therapy was determined from a review of the relevant literature. Complexity of treatment regimen was found to be directly related to noncompliance as well as to increased use of health-care services. Accordingly, physicians, pharmacists, and health-care administrators are urged to develop formulary recommendations in light of potential effects on patient well-being and aggregate health-care expenditures. The development of institutional initiatives (clinical protocols) for pharmaceuticals are also urged, to give physicians greater access to therapeutic options with which to reduce patients' regimen complexity. Finally, the adoption of a team-management approach in the treatment of chronic disease and the implementation of interactive health-education programs, such as pharmacy-based medication utilization review, are advocated, as measures that have been shown to increase both the continuity and quality of patient care.

Aged↗
PubMed1984

Drug utilization study of antiepileptics in Hungary.

This paper describes drug utilization review activities on anticonvulsant drugs in Hungary. Data on the use of phenytoin, carbamazepine, primidone, and sulthiam in the 20 administrative regions of the country are presented. From 1971 to 1980, consumption of these anticonvulsants doubled, and most of them were used in combination therapy. Estimates of the numbers of epileptics in the country were calculated from data on the international incidence of epilepsy and from total drug consumption data in Hungary.

Anticonvulsants↗
PubMed1991

Physiological roles of the DnaK and GroE stress proteins: catalysts of protein folding or macromolecular sponges?

When organisms ranging from microbes to man are subjected to certain environmental stresses a characteristic 'heat shock' response is observed. In Escherichia coli this response is characterized by the induction of several proteins, three of which are the 70 kilodalton product of the dnaK gene, the 60 kilodalton product of the groEL (mopA) gene and the 15 kilodalton product of the groES (mopB) gene. In this review, utilizing enteric bacteria as model organisms, we focus on the role of these proteins within the context provided by well-established functions of other heat shock products. These facts serve as a starting point from which to speculate upon the in vivo role of these proteins during steady-state growth.

Bacterial Proteins↗
PubMed1989

Albumin utilization in a university hospital.

The inappropriate use of high-priced agents such as human serum albumin significantly contributes to the rising cost of medical care. A utilization review was conducted at the University of Michigan Hospital in order to identify the appropriateness of use of this agent. Criteria were developed and prescribing was retrospectively evaluated for 81 patients. Of the 935 units administered to these patients, 692 (74 percent) were judged to be inappropriate. This inappropriate use accounted for a projected annual expenditure of nearly $281,000. Interventions have previously demonstrated success in improving prescribing.

Drug Utilization↗
PubMed1986

Impact of an aminoglycoside kinetic service on aminoglycoside use in a community hospital.

The effectiveness of an aminoglycoside monitoring service in improving the prescribing patterns of physicians in the hospital was evaluated. A drug utilization review (DUR) done as part of routine monitoring demonstrated a deficiency in eight of 19 elements based on national DUR standards. An aminoglycoside monitoring program developed by the Pharmacy Department was then implemented. A comparative DUR demonstrated significant improvement in five previously deficient elements, a trend towards improvement in two elements, and no change in one element. We conclude that a concurrent drug monitoring program with aggressive pharmacy participation improves prescribing patterns by physicians.

Aminoglycosides↗
PubMed1987

Changing prescribing patterns: a program of physician education.

A drug utilization review identified significant inappropriate use of second-generation cephalosporins at a 700-bed community teaching hospital. As a result, an educational program designed to modify physician prescribing patterns was developed as a cost-containment measure. Educational guidelines listing indications and contraindications for cefamandole and cefoxitin and comparing their costs with those of first-generation cephalosporins were placed in patient records, and physician use of these agents was reviewed before, during, and after the intervention. The rate of combined appropriate use of cefamandole and cefoxitin increased from 30 to 58% during the study. A change from the second-generation cephalosporins to therapeutically equivalent, less-expensive drugs was noted in 28% of patients' medical records within 48 hours after placement of the guidelines. This educational program proved to be a low-cost method of successfully altering the prescribing patterns of physicians.

Cephalosporins↗