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PubMed1997

Prediction of membrane protein topology utilizing multiple sequence alignments.

A technique for prediction of protein membrane topology (intra- and extracellular sidedness) has been developed. Membrane-spanning segments are first predicted using an algorithm based upon multiply aligned amino acid sequences. The compositional differences in the protein segments exposed at each side of the membrane are then investigated. The ratios are calculated for Asn, Asp, Gly, Phe, Pro, Trp, Tyr, and Val, mostly found on the extracellular side, and for Ala, Arg, Cys, and Lys, mostly occurring on the intracellular side. The consensus over these 12 residue distributions is used for sidedness prediction. The method was developed with a set of 42 protein families for which all but one were correctly predicted with the new algorithm. This represents an improvement over previous techniques. The new method, applied to a set of 12 membrane protein families different from the test set and with recently determined topologies, performed well, with 11 of 12 sidedness assignments agreeing with experimental results. The method has also been applied to several membrane protein families for which the topology has yet to be determined. An electronic prediction service is available at the E-mail address tmap@embl-heidelberg.de and on WWW via http://www.embl-heidelberg.de.

Amino Acid Sequence↗
PubMed2004

Patient experiences and attitudes about access to a patient electronic health care record and linked web messaging.

OBJECTIVE: Patient access to their electronic health care record (EHR) and Web-based communication between patients and providers can potentially improve the quality of health care, but little is known about patients' attitudes toward this combined electronic access. The objective of our study was to evaluate patients' values and perceptions regarding Web-based communication with their primary care providers in the context of access to their electronic health care record. METHODS: We conducted an online survey of 4,282 members of the Geisinger Health System who are registered users of an application (MyChart) that allows patients to communicate electronically with their providers and view selected portions of their EHR. To supplement the survey, we also conducted focus groups with 25 patients who were using the system and conducted one-on-one interviews with ten primary care clinicians. We collected and analyzed data on user satisfaction, ease of use, communication preferences, and the completeness and accuracy of the patient EHR. RESULTS: A total of 4,282 registered patient EHR users were invited to participate in the survey; 1,421 users (33%) completed the survey, 60% of them female. The age distribution of users was as follows: 18 to 30 (5%), 31 to 45 (24%), 46 to 64 (54%), 65 and older (16%). Using a continuous scale from 1 to 100, the majority of users indicated that the system was easy to use (mean scores ranged from 78 to 85) and that their medical record information was complete, accurate, and understandable (mean scores ranged from 65 to 85). Only a minority of users was concerned about the confidentiality of their information or about seeing abnormal test results after receiving only an explanatory electronic message from their provider. Patients preferred e-mail communication for some interactions (e.g., requesting prescription renewals, obtaining general medical information), whereas they preferred in-person communication for others (e.g., getting treatment instructions). Telephone or written communication was never their preferred communication channel. In contrast, physicians were more likely to prefer telephone communication and less likely to prefer e-mail communication. CONCLUSION: Patients' attitudes about the use of Web messaging and online access to their EHR were mostly positive. Patients were satisfied that their medical information was complete and accurate. A minority of patients was mildly concerned about the confidentiality and privacy of their information and about learning of abnormal test results electronically. Clinicians were less positive about using electronic communication than their patients. Patients and clinicians differed substantially regarding their preferred means of communication for different types of interactions.

Attitude to Computers↗
PubMed1996

The effects of a health newsletter for foster parents on their perceptions of the behavior and development of foster children.

Foster children have a high prevalence of medical, emotional, development, and behavioral problems originating both with events leading up to placement and as a consequence of the placement itself. Foster parents are often inadequately trained to understand and help with these difficulties. This may result in the persistence or aggravation of problems, and thereby increase the risk of placement failure. Because of the high demands on foster parents, any such training that is offered may be poorly attended. Methods to better inform these parents delivered in their own home may be more practical and better accepted. Parents at Heart is a quarterly health newsletter mailed to foster parents that deals with topics relevant to foster children. A questionnaire administered before the first issue determined some characteristics of these parents and ascertained their attitudes about a series of child development situations and behavior problems. A questionnaire after the fourth issue of Parents at Hear showed that many of these attitudes were influenced by the material in the newsletter.

Adult↗
PubMed1989

Outlook of British dentists towards their profession.

Dental practice in Britain has undergone significant changes in recent years. These changes have undoubtedly affected the outlook of dentists towards dentistry. This study was undertaken to examine the current outlook of general dental practitioners working in the General Dental Service. A representative sample of 1000 dentists was surveyed by mail. The response rate was 73.7 per cent. Most characteristic of the respondents' outlook on various aspects of their profession is the wide diversity of opinion. Neither respondent gender or practice location were associated with outlook. More preventively oriented dentists and those whose practices were most busy, however, were found to have a more positive outlook.

Attitude of Health Personnel↗
PubMed1998

Endodontic patient recall procedures: a national survey of endodontic practices.

A survey was conducted to measure the extent of patient recall procedures and perceived success and failure in treatment from a sample of endodontists. A comparison to the accepted Quality Assurance Guidelines set forth by the American Association of Endodontists was conducted. Three hundred surveys were mailed to as many active members of the American Association of Endodontics. Two hundred thirty-three responses were returned for a response rate of 77.6%. The only statistically significant finding was that military practitioners in general do not have an active recall system. This was significant at the p < 0.008 level.

Appointments and Schedules↗
PubMed2006

Germ line mutations of mismatch repair genes in hereditary nonpolyposis colorectal cancer patients with small bowel cancer: International Society for Gastrointestinal Hereditary Tumours Collaborative Study.

PURPOSE: The aim of study was to determine the clinical characteristics and mutational profiles of the mismatch repair genes in hereditary nonpolyposis colorectal cancer (HNPCC) patients with small bowel cancer (SBC). EXPERIMENTAL DESIGN: A questionnaire was mailed to 55 members of the International Society for Gastrointestinal Hereditary Tumours, requesting information regarding patients with HNPCC-associated SBC and germ line mismatch repair gene mutations. RESULTS: The study population consisted of 85 HNPCC patients with identified mismatch repair gene mutations and SBCs. SBC was the first HNPCC-associated malignancy in 14 of 41 (34.1%) patients for whom a personal history of HNPCC-associated cancers was available. The study population harbored 69 different germ line mismatch repair gene mutations, including 31 mutations in MLH1, 34 in MSH2, 3 in MSH6, and 1 in PMS2. We compared the distribution of the mismatch repair mutations in our study population with that in a control group, including all pathogenic mismatch repair mutations of the International Society for Gastrointestinal Hereditary Tumours database (excluding those in our study population). In patients with MSH2 mutations, patients with HNPCC-associated SBCs had fewer mutations in the MutL homologue interaction domain (2.9% versus 19.9%, P = 0.019) but an increased frequency of mutations in codons 626 to 733, a domain that has not previously been associated with a known function, versus the control group (26.5% versus 2.8%, P < 0.001). CONCLUSIONS: In HNPCC patients, SBC can be the first and only cancer and may develop as soon as the early teens. The distribution of MSH2 mutations found in patients with HNPCC-associated SBCs significantly differed from that found in the control group (P < 0.001).

Adaptor Proteins, Signal Transducing↗
PubMed2004

Variation in the distribution of patient-reported outcomes based on different definitions of defining asthma severity.

OBJECTIVES: The purpose of this study was to observe the variation in the distribution of health-related quality of life and work performance scale scores based on using different methods of determining asthma severity. METHODOLOGY: Five methods of determining asthma severity were used, including three patient-derived measures (patient perceived severity or PPS; overall symptom-derived severity or OSS; and nocturnal symptom-severity or NSS); and 2 methods using retrospective pharmacy claims (reliever/oral steroid use or ROSU and multi-drug use or MDU). Three levels of severity were examined: mild, moderate, and severe, requiring condensing some severity categories of several methods. Data were obtained from a cross-sectional mail survey of 603 adults with asthma in a US managed care organization linked to pharmaceutical/medical claims data. Patient-reported outcomes included the Physical Component Summary Score (PCS) and the Mental Component Summary Score (MCS) of the SF-36, the summary score (AQLQ) of the Asthma Quality of Life Questionnaire, and the Work Performance Scale score (WPS) of the perceived work performance scale of the Functional Status Questionnaire. Analysis of variance (ANOVA) was used to examine each method's ability to distinguish between severity levels. Descriptive statistics were used to observe differences in scale scores between methods. RESULTS: Within each method, significant severity effects (except MDU) were found for PCS, AQLQ, and WPS. In post-hoc analyses, mild-moderate and mild-severe comparisons were consistently significant (p < 0.05). In the cross-method analyses, method effects were found at all levels of severity for most scale scores with ranges increasing with increases in severity level. Within-method results were consistent with previous studies demonstrating a significant relationship between severity, health-related quality of life (HRQL) and work performance (WP). However, HRQL and WP scale scores varied by the method used to define severity. CONCLUSION: This variation should be considered when performing cross-study comparisons of burden of illness and treatment effects.

Adult↗
PubMedDate not supplied

Effectiveness of a large-scale distribution programme of free nicotine patches: a prospective evaluation.

BACKGROUND: After an increase in cigarette taxes and implementation of smoke-free workplace legislation, the New York City Department of Health and Mental Hygiene, the New York State Department of Health, and the Roswell Park Cancer Institute undertook large-scale distribution of free nicotine replacement therapy (NRT). We did a 6 month follow-up survey to assess the success of this programme in improving smoking cessation on a population basis. METHODS: 34,090 eligible smokers who phoned a toll-free quitline were sent a 6-week course of nicotine patches (2 weeks each of 21 mg, 14 mg, and 7 mg per day). Brief follow-up counselling calls were attempted. At 6 months after treatment, we assessed smoking status of 1305 randomly sampled NRT recipients and a non-randomly selected comparison group of eligible smokers who, because of mailing errors, did not receive the treatment. NRT recipients were compared with local survey-derived data for heavy smokers in New York City. FINDINGS: An estimated 5% of all adults in New York City who smoked ten cigarettes or more daily received NRT; most (64%) recipients were non-white, foreign-born, or resided in a low-income neighbourhood. Of individuals contacted at 6 months, more NRT recipients than comparison group members successfully quit smoking (33%vs 6%, p<0.0001), and this difference remained significant after adjustment for demographic factors and amount smoked (odds ratio 8.8, 95% CI 4.4-17.8). Highest quit rates were associated with those who were foreign born (87 [39%]), older than 65 years (40 [47%]), and smoked less than 20 cigarettes per day (116 [35%]). Those who received a counselling call were more likely to stop smoking than those who did not (246 [38%] vs 189 [27%], p=0.001). With the conservative assumption that every 6-month follow-up survey non-respondent continued to smoke, the stop rate among NRT recipients was 20%. At least 6038 successful quits were attributable to NRT receipt, and cost was 464 US dollars per quit. INTERPRETATION: Easy access to cessation medication for diverse populations could help many more smokers to stop.

Administration, Cutaneous↗
PubMed2001

The contribution of MD-PhD training to academic orthopaedic faculties.

UNLABELLED: Little is known about the distribution of research-trained physicians across the various specialties. To document the extent to which MD-PhD programs are a source of research-trained faculty for orthopaedic departments, this study examined the specialty choices of graduates of the Medical Scientist Training Program (MSTP) from 1964 to 1994. The MSTP, a combined MD-PhD program supported by the National Institute of General Medical Sciences, (NIGMS), produces roughly 25% of all MD-PhDs in the US. METHODS: Copies of the appendices from training grant applications containing information on MSTP graduates were obtained from the NIGMS. Also, a questionnaire was mailed to 116 university-affiliated orthopaedic surgery departments asking how many faculty were MD's, PhDs or MD-PhDs. RESULTS: Records were obtained for all MST programs. Information on postdoctoral training and/or a current position was reported for 1615 graduates who earned both MD and PhD. Of these graduates, 277 chose non-clinical paths. The other 1338 entered a residency or internship. Of these, 593 were still in residency training, 566 were academic faculty members and 130 were in private practice. In the records, 12 (0.9%) were listed as orthopaedic surgical residents (6) or faculty (6). At this time, all 12 have completed training, and 11 are in academic practice. Eighty-three departments replied to the questionnaire. In that sample of 1761 faculty positions, 1478 were MDs, 217 were PhDs and 36 (2.0%) were MD-PhDs. CONCLUSION: Despite robust support of MD-PhD programs, the number of dual degree recipients on orthopaedic faculties is small when compared to the relative size of the specialty. Other sources of research-trained staff should perhaps be developed.

Career Choice↗
PubMed1996

Reproducibility and validity of a self-administered physical activity questionnaire for male health professionals.

We assessed the reproducibility and validity of a self-administered physical activity questionnaire used in a prospective study of 51,529 men. The questionnaire was administered by mail twice to 238 participants 2 years apart. During this interval, the participants completed a past-week recall and a 1-week activity diary at four times corresponding to different seasons throughout a year. Also, a step test was taken by a subset of the study participants. The intraclass correlation coefficients used to measure reproducibility were 0.39 for inactivity, 0.42 for nonvigorous activity, and 0.52 for vigorous activity. The correlations between diary-based and questionnaire-based activity scores, adjusted for variation in the diary measurements, were 0.41 for inactivity, 0.28 for nonvigorous activity, and 0.58 for vigorous activity. The distribution of activity scores was similar between the questionnaires and the average of past-week recalls, indicating the participants' ability to incorporate seasonal variation into their recall on a questionnaire. The correlation between vigorous activity and resting pulse was -0.45, whereas, for the pulse rate after stepping, the correlation was -0.41. These data indicate that this physical activity questionnaire is reproducible and provides a useful measure of average weekly activity, particularly vigorous activity, over a 1-year period.

Adult↗
PubMed2004

Removing a barrier to computer-based outbreak and disease surveillance--the RODS Open Source Project.

INTRODUCTION: Computer-based outbreak and disease surveillance requires high-quality software that is well-supported and affordable. Developing software in an open-source framework, which entails free distribution and use of software and continuous, community-based software development, can produce software with such characteristics, and can do so rapidly. OBJECTIVES: The objective of the Real-Time Outbreak and Disease Surveillance (RODS) Open Source Project is to accelerate the deployment of computer-based outbreak and disease surveillance systems by writing software and catalyzing the formation of a community of users, developers, consultants, and scientists who support its use. METHODS: The University of Pittsburgh seeded the Open Source Project by releasing the RODS software under the GNU General Public License. An infrastructure was created, consisting of a website, mailing lists for developers and users, designated software developers, and shared code-development tools. These resources are intended to encourage growth of the Open Source Project community. Progress is measured by assessing website usage, number of software downloads, number of inquiries, number of system deployments, and number of new features or modules added to the code base. RESULTS: During September--November 2003, users generated 5,370 page views of the project website, 59 software downloads, 20 inquiries, one new deployment, and addition of four features. CONCLUSIONS: Thus far, health departments and companies have been more interested in using the software as is than in customizing or developing new features. The RODS laboratory anticipates that after initial installation has been completed, health departments and companies will begin to customize the software and contribute their enhancements to the public code base.

Disease Outbreaks↗
PubMed2005

Health-related quality of life of coronary artery bypass grafting and percutaneous transluminal coronary artery angioplasty patients: 1-year follow-up.

OBJECTIVES: The aim of the study was to compare the health-related quality of life (HRQoL) of patients undergoing coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA) before the interventions and 6 and 12 months afterward, and to compare their HRQoL also with that of the general population. METHODS: The sample (n = 615) consisted of consecutive coronary artery disease patients treated with elective CABG (n=432) or PTCA (n=183). The baseline data before the treatments were collected by structured interview, the follow-up data mainly by mailed self-administered questionnaires. HRQoL was measured by the 15D. For comparisons, the groups were standardized for differences in socioeconomic and clinical characteristics with a regression analysis. RESULTS: At baseline, the average 15D scores of the patient groups were 0.752 (95 percent confidence interval [CI], 0.743-0.761) in CABG and 0.730 (95 percent CI, 0.716-0.744) in PTCA. After standardization, the difference between the groups was statistically significant but not clinically important. These scores were significantly worse (statistically and clinically) than the score of 0.883 (95 percent CI, 0.871-0.879) in the general population sample matched with the gender and age distribution of the patients. By 6 months, the CABG and PTCA patients had experienced a statistically significant and clinically important improvement to 0.858 (95 percent CI, 0.844-0.872) and 0.824 (95 percent CI, 0.806-0.842), respectively. No significant change took place in either group from 6 to 12 months. CONCLUSIONS: Both CABG and PTCA produces an approximately similar, clinically important improvement in HRQoL in 1-year follow-up.

Adult↗
PubMed1996

A randomised trial of two information packages distributed to new cancer patients before their initial appointment at a regional cancer centre.

The purpose of this study was to evaluate the extent to which a new patient information package (NPIP) or a mini version of the same package (mini-NPIP) reduces emotional distress and meets the informational needs of patients arriving at a tertiary cancer centre for the first time. A comprehensive package, NPIP, consisting of procedural information regarding cancer centre location, description of the health care team, treatment services, research, educational activities, accommodation and community services provided at the centre; and a condensed version of the same package, mini-NPIP, were developed. Consecutive patients with newly diagnosed breast, gynaecological, lung and prostate cancer, referred to the centre for the first time were prerandomised to receive NPIP, mini-NPIP or no information package. Patients randomised to NPIP or mini-NPIP were mailed the information package at least one week before their first appointment. On arrival at the centre, patients were administered the Brief Symptom Inventory (BSI) which measures psychological distress, and interviewed regarding preferences for information and acceptability of the information packages. Of 465 randomised patients, 161 were excluded post-randomisation and 304 completed the entire interview: 100 were randomised to the NPIP, 102 to the mini-NPIP and 102 to the control group. Emotional distress as measured by the BSI was similar for all groups (P = 0.98). Most patients preferred to receive the information (98%), receive it before the first appointment (84%) and by mail (79%). These preferences were more evident for those given the information packages. The majority of patients found the information packages easy to understand (88%) and useful (89%), and no differences were detected between packages. The cost of production and dissemination of NPIP was more than double the cost for mini-NPIP: $ 8.93 vs $ 3.98 (Canadian dollars) per patient. For patients presenting to a cancer centre for the first time, packages of procedural information do not appear to reduce psychological distress, but are preferred by patients. Given the cost of producing NPIP, mini-NPIP is the preferred approach.

Feasibility Studies↗
PubMedDate not supplied

Comparison of double-hole and single-hole pencil-point needles for spinal anesthesia with hyperbaric bupivacaine.

BACKGROUND AND OBJECTIVES: The use of thin single-hole pencil-point (SHPP) spinal needles may be a reason for subarachnoid maldistribution of local anesthetic. A new double-hole pencil-point (DHPP) needle may be preferable because of a theoretic more uniform initial distribution of local anesthetic. METHODS: This was a prospective, double-blinded study of 50 patients randomly selected to have spinal anesthesia using either single-hole 27-gauge (B. Braun, Melsungen, Germany) or double-hole 26-gauge (A.L.B. Medical Inc., U.S.A.) pencil-point needles. The former were inserted with the side port directed caudally and the latter with openings in both caudal and cranial direction. Two milliliters of hyperbaric 0.5% bupivacaine were injected in 1 minute, and sensory and motor block were studied at regular intervals during spinal anesthesia. All patients were interviewed on the first (personal) and the seventh (mailed questionnaire) postoperative day. Furthermore, microscopic inspection of the spinal needles was performed. RESULTS: There were no statistically significant differences in sensory or motor block levels between the two needle types at any time during spinal anesthesia. Likewise, there was no difference in the duration of spinal block. The postanesthetic side effects (headache, backache, pricking, numbness, weakness) were similar in both groups. Light and electron microscopic examination showed resistance of the SHPP needles to tip damage. On the other hand, the DHPP needle tips seemed to be distorted quite frequently, and, even in unused needles, the tip was blunt and asymmetric. CONCLUSION: There was no difference between the spread of analgesia using either SHPP or DHPP spinal needles. The DHPP needles appear to be vulnerable to tip damage from mechanical contact.

Adult↗
PubMed1996

Preclinical course-evaluation methods at U.S. and Canadian medical schools.

BACKGROUND: Despite the apparent prevalence of the use of course evaluations by medical schools, course and curriculum evaluation have gone relatively unnoticed in the medical education literature. METHOD: In the fall of 1993, a 17-item questionnaire was mailed to all 141 U.S. and Canadian medical schools to elicit information concerning any course-evaluation systems in place in the schools' preclinical curricula. RESULTS: A total of 101 schools (72%) returned usable questionnaires. Of these, 79 reported having a centralized course-evaluation system and 56 used oversight committees consisting of administrators, faculty, and students. Beyond the use of written questionnaires (reported by 100 schools), course-evaluation practices varied widely. Eighteen schools reported that questionnaire content was the same across courses, while 56 used a common core of items with modifications for specific courses. The frequency and timing of questionnaire distribution varied from once at the final examination to weekly during the course. Summarized course-evaluation results were made available to departments (91 schools), the oversight committee (50 schools), the administration (47 schools), and students (13 schools). The feature most frequently cited as being a positive aspect of the course-evaluation process was student involvement (23 schools). Most frequently cited as areas of concern were low response rates to questionnaires (20 schools) and the need for simpler, more reliable methods of data collection (13 schools). Seventy schools reported specific types of changes that had resulted from course evaluation. CONCLUSION: The results confirm that course evaluation via student questionnaires is ubiquitous in North American medical schools. Most schools used centralized systems, but individual schools had developed their own combinations of technique and organization. This lack of uniformity may be due to the sensitivity of evaluation processes to local contexts, but it may also be due to the lack of literature on the subject.

Canada↗
PubMed1988

A pilot outreach program for small quantity generators of hazardous waste.

The Massachusetts Department of Environmental Management initiated a pilot project to improve compliance with hazardous waste regulations and management of hazardous wastes with auto body shops around the state. The program consisted of mass mailings, a series of workshops throughout the state, a coordinated inspection program by the state regulatory agency, and technology transfer. At the start of the program in January 1986, approximately 650 of the estimated 2,350 auto body shops in the state had notified EPA of their waste generating activities; by January 1987, approximately 1,200 shops had done so. Suggestions for improving program efforts include tailoring the outreach effort to the industry, government-sponsored research and development directed at the needs of small firms, mandatory participation in hazardous waste transportation programs, and better coordination by EPA of its information collection and distribution program.

Automobiles↗
PubMedDate not supplied

International survey of peritoneal dialysis training programs.

OBJECTIVE: To survey nurses around the world about current practices for peritoneal dialysis (PD) home training programs. DESIGN: Random sampling of nurses to complete a written survey from the International Society for Peritoneal Dialysis Nursing Liaison Committee. SETTINGS: United States, Canada, South America (Brazil, Columbia), The Netherlands, Hong Kong. METHODS: Surveys and responses were sent by fax whenever possible, or by regular mail, or hand carried, or conducted by telephone. Results were stratified by geographic areas as well as by cumulative responses and were expressed as medians with ranges. Kruskal-Wallis was used to evaluate differences in responses. Associations between variables were tested with Pearson correlation. Univariate regression analysis was used to evaluate the impact of variables on peritonitis rates. Variables with p < 0.10 were included in a multivariate analysis. RESULTS: A total of 317 nurses responded: 88 in the United States, 46 in Canada, 58 in South America, 58 in Hong Kong, and 67 in The Netherlands. This represented 37% of all surveys distributed. Respondents had a median of 12 years' experience in nephrology (range 1-35 years), but only 31% had a formal background in adult education. Nearly half received their guidance to patient training from a nurse colleague, 11% were guided by a corporate colleague, and 8% were simply self-taught. Clinics responding had a median of 30 PD patients (range 1-400) and reported they trained a median of 8 patients per year (range 0-86). Reported peritonitis rates were a median 0.46 per year or 1 episode every 26 months. Peritonitis rates, however, were not known by 53% of respondents. Total training time per patient had a very wide range of hours, from 6 to 96. There was no correlation between training time and peritonitis rates among the study respondents (p = 0.38), nor with any other variables. CONCLUSIONS: There is wide variation in practices for PD patient training programs within countries and around the world. Training time did not appear to be related to peritonitis rates. Randomized trials of training practices are needed to determine which approaches produce the best outcomes for patients.

Hemodialysis, Home↗
PubMed1989

National survey of critical-care pharmaceutical services.

The results of a national survey of critical-care pharmaceutical services are reported. A questionnaire was mailed on March 8, 1988, to 1500 of the 6800 U.S. hospitals with more than 100 beds. The questionnaire was divided into four sections: (1) critical-care pharmaceutical services; (2) critical-care clinical pharmacy activity; (3) critical-care pharmacy standards; and (4) general information on the hospital, including pharmaceutical services provided to patients who are not critically ill. A total of 613 usable questionnaires were returned, for a response rate of 41%. Respondents from 124 hospitals reported having a critical-care satellite pharmacy. Critical-care beds served by satellite pharmacies were more likely to have unit dose drug distribution services than were critical-care beds not served by satellite pharmacies. The level of clinical and educational services provided to critical-care patients was significantly lower for intensive-care unit (ICU) pharmacists practicing in satellite pharmacies than it was for ICU pharmacists not associated with satellite pharmacies. There were no differences between satellite and nonsatellite ICU pharmacists in either the percentage of a typical day spent providing clinical services to critical-care patients or the percentage of critical-care patients receiving those services. Respondents expected their hospitals to add 301 full-time-equivalent critical-care pharmacists to their staffs during the next two years, for a 39% increase. Respondents strongly favored establishing 24-hour unit dose drug distribution and i.v. admixture services, providing inservice education to nurses and physicians, and providing written pharmacokinetic consultations.(ABSTRACT TRUNCATED AT 250 WORDS)

Critical Care↗