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Evaluation of pharmacy and therapeutics committee drug evaluation reports.

Pharmacy and therapeutics (P & T) committee drug evaluation reports prepared by pharmacies and drug information centers (DICs) and product package inserts were compared with standard guidelines to evaluate their quality. Letters were sent to 143 hospital pharmacies asking them to submit a previously prepared drug evaluation report on temazepam, moxalactam disodium, or atenolol. The reports and package inserts for these three drugs were evaluated by the presence of 40 elements derived from the published ASHP guidelines for drug evaluation report preparation. Responses were obtained from 124 (87%) pharmacies; however, only 80 reports (60 DIC-prepared and 20 pharmacy-prepared) were received. The reports contained a mean of 28 of the 40 (70%) possible elements. The most frequently omitted elements were AHFS number, potential unlabeled uses, drug-drug interactions, drug-disease-laboratory test interactions, risk and benefit data, prevention and treatment of side effects, comparisons with established treatment, and disadvantages of the drug under consideration. Although the reports prepared by the DICs and pharmacies contained the same amount of information, the DIC-prepared reports included data more frequently on supply sources, therapeutic indications, approved labeling, comparison with established treatment, bioavailability and pharmacokinetics, and recommendations. Most of the reports contained more elements than the corresponding package inserts. The product package inserts did not contain the comparative elements required for P & T committee decisions. Both the pharmacy- and DIC-prepared reports failed to contain all 40 elements recommended in the standard guidelines, suggesting the need for more thorough reports.

Atenolol

Evaluation report: surgical diathermy units.

A recent issue of 'Health Equipment Information' (No. 122, April 1984) contains evaluation reports on three surgical diathermy units: the Downs Diadon 170, the Martin Elektrotom 500B, and the Olympus PSD-2. In addition to the detailed evaluation reports, 'HEI' 122 also contained a glossary of terms associated with these devices, and a summary of a discussion on the safety of surgical diathermy units presented in a fuller form in 'HEI' 99. A review of the principles and practice of surgical diathermy has recently been published in 'Journal of Medical Engineering & Technology'. Technical aspects of the equipment have been assessed against BS 5724 Part 1, which is the British version of IEC Publication 601-1, in conjunction with a particular standard for surgical diathermy units, IEC 601-2-2, which modifies the general standard. The protocol for the user trials was devised jointly by DHSS, together with local physics staff and surgeons. Orders for 'HEI' 122 (f3.00) to DHSS Leaflets Unit, PO Box 21, Stanmore, Middlesex HA7 1AY, UK. NHS staff can obtain it, free, through their Administrator. For full details of the evaluation findings, readers should consult 'HEI' 122: the following are extracts from the report.

Electrocoagulation

Evaluation report: defibrillators.

As part of the continuing evaluation programme of medical equipment sponsored by the UK Health Departments, the evaluation of defibrillators is being carried out within the Sheffield and Rotherham District Health Authorities. The following is a version of 'Health Equipment Information' ('HEI') Number 186, published in September 1988, which contains evaluation details on a further five defibrillators. These are the Cardiac Recorders CR26, the Hewlett-Packard HP43120A, the Physico-Control Lifepak 8, the PPG Hellige SCP 852 and the Simonsen & Weel Defi 2. A further model, the Seward Medical 9922 is covered very briefly as it has, as a result of the evaluation, been withdrawn from the market. Earlier summaries of evaluation reports have appeared in 'Journal of Medical Engineering and Technology', together with a review of debrillator design and development.

Electric Countershock

Evaluation report: infusion pumps and controllers.

A recent edition of 'Health Equipment Information' ('HEI'), Number 175, published in October 1987, contains evaluation reports on a further six infusion devices. These are the Fresenius Injectomat S, the Imed 800, the Sky Electronics PSA 55, the Vi-Tal Vi-Flow, the Braun Dropmat Secura and the Ivac 281 Site Saver. The evaluation was carried out for the Department of Health within the Bath District Health Authority. Technical assessment was carried out by the Bath Institute of Medical Engineering and testing, to BS 5724, at the British Standards Institution.

Equipment Design

Evaluation report: infusion pumps.

'Health Equipment Information', No. 147, published in October 1985, is the fifth in the series dealing with infusion pumps and contains evaluation reports on five volumetric devices. These are the Braun Infusomat Secura, the Ivac 560, the Ivac Neo-mate 565, the Travenol 6100 and the Travenol 8000. Technical performance assessment was carried out at the Bath Institute of Medical Engineering, and user assessment undertaken at various hospitals within the Bath District Health Authority. For full details of the evaluation findings readers should consult 'HEI' 147 - the following are only extracts from the report. ('HEI' is free to appropriate NHS staff, who should request copies from their Regional or District Administrator. Others can order the journal [pounds 5/copy, cash with order] from DHSS [Leaflets], PO Box 21, Stanmore, Middlesex HA7 1AY, UK.)

Evaluation Studies as Topic

[Health policy goals in child and adolescent health reporting--evaluation with reference to an intermediate-term evaluation].

As a result of the first report on the health of children in Hamburg (1990) 14 primary health policy objectives were identified and related to specific intervention fields. The health information system group at Hamburg has prepared an interim evaluative statement for 1994 on whether and how far each objective has been achieved compared to the targets formulated for the years 1995 and 2000 respectively. 8 out of 14 objectives are considered remaining unchanged as before (i.e. unintentional conception), either proceeding towards the target (i.e. low birth weight, dental health) or having reached the target for 1995 (i.e. infant mortality, age-appropriate vaccination). With 4 objectives the trend deteriorated (i.e. body weight of teenagers, accidents). One objective was monitored on the basis of a new data source (violence against children) and for one objective information could not be proved or updated (breast feeding). In traditional areas of local health policy (i.e. dental health, infant mortality) the health information system and the health targets may be sufficient to help improve the health of the city. In non-lobbied fields (i.e. breast feeding) or those without a consensus on responsibilities (i.e. violence, health and social discrimination) health reports on their own do not invoke achievements, but need to be supported by additional measures.

Adolescent

The chief scientist reports ... Evaluation of the Scottish shadow fund-holding project: first results.

This paper reports preliminary findings from the action research evaluation of the Scottish shadow fund-holding project. Fifty doctors looking after 84,000 patients in six groups negotiated and managed a paper fund for six months, and then a real fund for six months. First analyses of quantitative data suggest that the numbers of prescriptions written, investigations done and referrals made remained stable over the period of study. The length of time spent at consultations varied apparently independently of holding a fund. Patient satisfaction with actions taken by doctors and their feelings of benefit from consultations were high throughout the study, but a consistent and significant shift from very satisfied to satisfied categories was noted in all practices for most variables surveyed during the course of 1990-91. Analyses to explain this are continuing. Qualitative study identified benefits in terms of a greater understanding of the costs of activities, and new working patterns between hospital, general practice and administrative staff have led to progressive work in contracting for quality of patient care. At the same time, the lack of sophistication of fund setting needs to be addressed; equity issues will become relevant as fund-holding reaches a larger proportion of practices. The pressures on those taking leading roles in administration are high, and this is confirmed by parallel quantitative work. Further information is becoming available on both prescribing and the care of selected 'marker' conditions, and these will be the subject of further reports.

Contract Services

Incident reporting: evaluation of New York's pilot incident logging system.

A revised incident reporting system that combined an abbreviated logging procedure for documenting minor incidents and a more comprehensive and detailed procedure for documenting major incidents was pilot tested in three New York State adult psychiatric centers. The pilot test had two major goals: to reduce the volume of work associated with current reporting procedures, and to facilitate even more thorough investigation of incidents warranting prompt and comprehensive review. Evaluation of pilot study data showed that a logging procedure is viable for the management of minor incidents.

Aggression

Evaluation report: dialysis and ancillary equipment.

As part of the continuing programme of evaluation of medical equipment sponsored by the UK Health Departments, the evaluation of dialysis and ancillary equipment is being carried out within the University of Sheffield, under the direction of Professor M. M. Black. 'Health Equipment Information' Number 148, published in December 1985, carries full reports on the Cobe Centry 2Rx haemodialysis system with double blood pump module (DBPM), the Lucas Medical 2100 haemodialysis system, and the Permutit Series 8 water softener. It also contains summaries of full reports on the Organon-Teknika Sorbsystem and Cordis-Dow Seratron haemodialysis systems, and the Gordonsal RD500 and Elga Mediro D water softeners, which were published in 'HEI' 136. Readers should note that the Cordis Seratron and Lucas 2100 models are no longer available in the UK. Extracts of the evaluations of the Cobe Centry 2Rx + DBPM and the Permutit Series B models, together with summaries and overall comparisons, are given below. 'HEI' (ISSN 0261-0736) is free to NHS staff and 5.00 pounds/copy to others. Editorial enquiries to DHSS Scientific and Technical Branch, 14 Russell Square, London WC1B 5EP.

Dialysis