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PubMedDate not supplied

Tachyarrhythmia therapy utilizing electrical stimulation: a review.

The review is structured in such a way as to fall naturally into four main sections. These are as follows: clinical overview of the common mechanisms leading to the generation of tachyarrhythmias; commonly used sensing techniques and algorithms for the detection of tachyarrhythmias; electrical stimulation algorithms used to terminate many of the rhythms; existing implantable devices and a brief look at the future. The clinical overview introduces the reader unfamiliar with tachyarrhythmias to such mechanisms as sinus tachycardia, supraventricular tachycardias (SVTs), ventricular tachycardia, 'torsade de pointes', and ventricular fibrillation. SVT includes paroxysmal SVT, atrial flutter, atrial tachycardia and junctional tachycardia (enhanced automaticity). Also there is a brief introduction to alternative therapies (drugs, surgery etc.) The sensing techniques section covers input signal processing to enable the R wave to be adequately detected; while the tachycardia detection algorithms section discusses such areas as simple rate detect, rate of change of rate detect, stability of rate, the so-called probability density function technique and some other more complex detection algorithms. The section on electrical stimulation algorithms used for tachycardia therapy discusses burst pacing techniques, special cases such as automatically decrementing bursts and automatically incrementing bursts, defibrillation shock therapy (since fibrillation is a form of tachyarrhythmia) and several other more complex algorithms. The review finishes up with a discussion of current implantable antitachy pacemakers and defibrillators. There is also a speculative look at the future to enable the reader to obtain a full picture.

Algorithms↗
PubMed1976

Effect of medical care review on the use of injections: a study of the New Mexico Experimental Medical Care Review Organization.

Evaluation of peer review activities in the New Mexico Medicaid program (1971 to 1973) showed that it can affect aspects of quality, that is, the appropriateness of the use of injections as judged by medical criteria. Use of injections, nearly 50% of which were antibiotics, declined by more than 60%, from 41 to 16 per 100 ambulatory visits. Still, at the end of the study, 40% of the injections given were considered medically unnecessary. Analyses showed that [1] groups used injections more appropriately; [2] for solo physicians, being board-certified, being a doctor of medicine, and being a pediatrician were all associated with more proper use of injections; [3] 6% of the physicians gave 40% of the medically unnecessary injections, but even their behavior changed dramatically for the better as a result of the peer review system.

Age Factors↗
PubMed1992

The Fourth PRO Scope of Work: automating the medical review process through the Uniform Clinical Data Set.

With the advent of the Fourth Scope of Work, peer review organizations are beginning to implement the Uniform Clinical Data Set, an automated medical review system designed to collect standardized data from Medicare medical records and provide a data base to determine the most effective treatment for a given illness or disease. In this article, the author discusses the Health Care Financing Administration's development of the Uniform Clinical Data Set and its proposed application within the context of the Health Care Quality Improvement Initiative and the Fourth Scope of Work.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1993

A concurrent cefuroxime use evaluation in pediatric patients.

A concurrent evaluation of cefuroxime use in pediatric patients is described. From March 5, 1991 to May 15, 1991, the use of cefuroxime in pediatric patients was evaluated. The pediatric liaison pharmacist collected clinical information about each patient prescribed cefuroxime and assessed the therapy according to pre-established criteria for use. When therapy did not meet criteria, the pharmacist could intervene by speaking with the prescribing physician. The Coordinator, Drug Use Evaluation (D.U.E.) Program and a pediatrician, reviewed the data collection forms to assess whether therapy met criteria and the outcome of pharmacist-physician interactions. Thirty-five pediatric patients were prescribed cefuroxime during the concurrent evaluation. All courses were empiric. Community-acquired pneumonia accounted for 21 treatment courses in which cefuroxime was prescribed with 18 of these deemed to meet the criteria. It was also prescribed empirically in otitis media (eight cases), meningitis (two cases). Overall, seventy-seven percent of therapeutic courses of cefuroxime were found to meet established criteria for use. The pediatric clinical pharmacist intervened in six therapeutic courses which did not meet criteria. Three of these interventions resulted in a change of therapy for the patient.

Cefuroxime↗
PubMed1994

Target drug monitoring: a cost-effective service provided by staff pharmacists.

A concurrent drug use evaluation program that improves patient care while meeting JCAHO requirements was designed and implemented. Integration of staff pharmacists into the program has been an important component. The net annual savings of the program for H2 antagonists and cephalosporins was $16,756. The net annual cost of the program if all drugs were studied throughout each quarter would be $1,336. The program essentially pays for itself, meets medication use standards for JCAHO, and may save significant healthcare costs if potential drug misadventures are avoided.

Concurrent Review↗
PubMed1994

Concurrent ceftazidime DUE with clinical pharmacy intervention.

Ceftazidime use at our institution, a 580-bed county teaching hospital, has steadily increased since its addition to the formulary in 1986. In response to this increased use and because the institutional antibiogram showed increased resistance by Pseudomonas aeruginosa (from 10 to 28% resistant), the P & T Committee requested that a drug use evaluation (DUE) of ceftazidime be conducted. Analysis of this retrospective pilot study showed that 87% of ceftazidime use was inappropriate. To further evaluate ceftazidime use, to identify problems not assessed during retrospective review, and to correct problems while patients were receiving the drug, a concurrent ceftazidime use evaluation was conducted. The methods and results of the concurrent review are presented below.

Ceftazidime↗
PubMed1993

A clinically based service limitation option for alternative model rural hospitals.

Alternative model rural hospitals are designed to address problems faced by small, isolated rural hospitals. Typically, hospital regulations are reduced in exchange for a limit on the services that alternative models may offer. The most common service limitation is a limit on length of stay (LOS), a method with little empirical or conceptual support. The purpose of this article is to present a clinically based service limitation for alternative model rural hospitals, such as the rural primary care hospital. The proposal is based on an analysis of Medicare discharges from rural hospitals most likely to convert and the judgments of a technical advisory panel of rural clinicians.

Aged↗