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OBJECTIVES: To assess the impact of the British Columbia Reference Drug (RD) Program on the management of hospital formularies in the province. MATERIALS AND METHODS: A survey of pharmacy managers in British Columbia hospitals with more than 100 beds was conducted in November, 1997. The survey instrument contained questions regarding hospital characteristics, drugs listed on the formulary before and after implementation of RD policies for four drug classes, the hospitals' responses to RD policies and the respondents' opinions of the RD Program. RESULTS: Thirty-two (86%) hospitals returned the survey by the stated deadline. Before the RD Program was implemented, significantly more hospitals listed cimetidine (P=0.03), felodipine (P<0.001), quinapril (P<0.001) and ramipril (P<0.001) on the hospital drug formulary. The main reasons given for changes to hospital drug formularies were community prescribing patterns (25% to 38%) and the RD Program (23% to 44%) depending on the drug category. Twenty-seven (84%) hospitals did not automatically adopt RD policies; 22 (69%) hospitals reviewed the policies at Pharmacy and Therapeutics Committee meetings. Sixteen (50%) respondents thought that hospitals should change their drug formularies to match the policies. Median satisfaction with the RD Program on a 10-point rating scale (1 = unsatisfied, 10 = satisfied) was 7 (range 2 to 10). CONCLUSIONS: Respondents appeared to be neutral when asked their opinion of the RD initiative. The RD policies resulted in drug category-dependent changes in the hospital formulary listings. H2 receptor antagonists and antihypertensives were the most significantly influenced drug categories. RD status does not automatically confer formulary status of a drug; however, it does appear to be a criterion in most hospitals when considering a drug for inclusion in the formulary.

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The purpose of this study was to assess the impact of an educational program, Learning About AIDS, on Grade 6 students' knowledge of HIV/AIDS and attitudes towards persons living with AIDS(PLWAs). A pretest/post-test/follow-up comparison group design was utilized to evaluate this intervention. Findings indicated that Grade 6 students who received Learning About AIDS were significantly more knowledgeable about HIV/AIDS at post-test and follow-up than were comparison group students. As well, the treatment group students' attitudes toward PLWAs were significantly more positive than those of the comparison group at both post-test and follow-up. It was concluded that Learning About AIDS was a beneficial and worthwhile program for these Grade 6 students.

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Histopathological changes in intestinal and hepatic amoebiasis were studied in Swiss albine mice with and without silica pretreatment. The intestinal infection rate was higher in silica treated mice (83%) as compared to non-silica treated mice (33%). Histologically all the silica treated mice had caecal ulceration which tended to spread across the muscularis propria into the serosal layer. The hepatic lesions were observed grossly in 100 and 60 per cent mice with and without silica treatment, respectively. However, the liver lesions in the silica treated mice were more severe, leading to satellite abscesses and in some cases the capsule ruptured leading to adhesions to the diaphragm and peritoneum. Histologically, the blockade of histiocytes with silica resulted in mainly a neutrophilic damage which was extensive and widespread. It also destroyed the amoeba and led to abundant fibrosis. In the non-silica group the damage was slow and devoid of neutrophils with quicker healing and lack of fibrosis resembling human hepatic lesions.

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The comparative histopathological details of amoebic liver abscess were studied following intracaecal and intramesenteric inoculation of Entamoeba histolytica into guinea-pigs. The histological changes of amoebic liver abscess formed via the former route were similar to those seen in man. These consisted of a central necrotic area with few lymphomononuclear cells and E. histolytica trophozoites at the periphery of the lesion. The amoebic liver abscess formed via the intramesenteric route, however, differed from that formed by intracaecal inoculation in three ways: (i) in having an intense inflammatory reaction, (ii) healing of the abscess by fibrosis and (iii) exhibiting a giant cell reaction.

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The lymphocyte subpopulations in peripheral blood and blast transformation were studied on days 0, 3, 7, 11, 15, 20 and 35 after infection in progesterone-treated guinea-pigs which had been experimentally infected with Entamoeba histolytica by intracaecal inoculation. In animals with intestinal infection, lowered T cell numbers and blast transformation were seen during the acute phase with a subsequent tendency to recover. In guinea-pigs with hepatic amoebiasis, both these parameters were significantly depressed throughout the period of study with no tendency to recovery. In progesterone-treated and sham-operated animals, a less marked depression of T cells, was observed. The B cell population did not vary greatly in either group. This study has thus shown that in hepatic amoebiasis there is highly significant depression in both number and function of T cells in comparison to intestinal amoebiasis.

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Histopathological studies in guinea-pigs infected intracaecally with Entamoeba histolytica were carried out longitudinally on days 3, 7, 11, 15, 20 and 35 after infection. Three characteristic modes of development of caecal lesions were observed. These in order of their prevalence were the classical inflammatory cellular infiltration, lymphoid hypertrophy and necrotizing colitis. Occasional amoeboma formation was observed in progesterone-treated animals. This is the first time that histological lesions which mimic the human intestinal amoebiasis have been described in the experimental animal.

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An experimental model of hepatic amoebiasis in guinea-pigs, simulating the natural infection in man, induced by progesterone following intracaecal inoculation of Entamoeba histolytica has been developed. On Day 3 after infection, 60% of the animals developed amoebic liver abscess, but on Days 7, 11, 15, 20 and 35 after infection liver involvement was recorded in all the animals. No animal in the control group developed hepatic amoebiasis. Severity and frequency of caecal lesions was greater in the control groups than in the experimental group receiving progesterone injections. The antiamoebic antibody levels were slightly higher in the experimental group as compared to the control group.

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This study shows the relationship between lymphocyte subpopulations and their response to non-specific stimulant phytohaemagglutinin (PHA) and specific stimulant (amoebic antigen) in cases of amoebic liver abscess in relation to the duration of disease, based on the first appearance of symptoms and/or signs, 26 patients with amoebic liver abscess and 20 normal, healthy controls were studied. Five of the patients gave a history of alcohol intake for the last 10 to 15 years. Eight had a solitary abscess and five had multiple abscesses, as seen on liver scan. No change in the B cell count was noticed in any of the patients. Depression of the T cell number and function was noticed from two weeks onwards. A history of alcohol intake made no difference. Cases with multiple liver abscesses were more immunologically depressed than were those with a solitary abscess.

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