RESUMEN
We report the case of a 65-year-old black man who presented to our facility with pseudo-obstruction of the bowel within two weeks of the initiation of oral sustained-release procainamide hydrochloride therapy. The syndrome continued despite conversion to intravenous procainamide and only resolved after discontinuation of the medication. We believe that the anticholinergic properties of procainamide, coupled with the patient's diabetes, contributed to severe hypomotility of the gastrointestinal tract and, subsequently, a pseudo-obstructive state. The syndrome of drug-induced pseudo-obstruction is also reviewed.
Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Seudoobstrucción Intestinal/inducido químicamente , Procainamida/efectos adversos , Anciano , Preparaciones de Acción Retardada , Humanos , Masculino , Procainamida/administración & dosificaciónRESUMEN
The impact of a decision analysis model on pharmacists' preferences for a drug therapy was studied. Three hundred forty members of the American College of Clinical Pharmacy were randomly assigned to receive either a copy of a drug therapy review alone (control group) or the review plus a decision analysis of the same clinical problem (experimental group). The disease selected was pseudomembranous colitis, and the drugs to be considered were vancomycin, metronidazole, and bacitracin. The review and the decision analysis recommended metronidazole as the best agent. Each subject completed a short questionnaire, read the review or the review plus the analysis, and completed a follow-up questionnaire. Both questionnaires asked the subjects to rank the agents in order of preference. There were 164 usable responses, 86 from the control group and 78 from the experimental group; the total response rate was 48.2%. The difference in the proportion of respondents in each group who chose metronidazole as the most preferred agent, both before and after the intervention, was not significant. Of the 40 experimental-group subjects who ranked metronidazole as their second or third choice in the pretest, 16 (40%) ranked it as the most preferred agent in the posttest. Ten of these 16 stated that the model influenced their decision. Decision analysis plus a drug therapy review had no greater impact on pharmacists' opinions on the selection of drug therapy for pseudomembranous colitis than did the review alone. The model did influence some of those who changed their opinion.
Asunto(s)
Técnicas de Apoyo para la Decisión , Quimioterapia/estadística & datos numéricos , Farmacéuticos , Servicio de Farmacia en Hospital/estadística & datos numéricos , Actitud del Personal de Salud , Recolección de Datos , Quimioterapia/normas , Enterocolitis Seudomembranosa/tratamiento farmacológico , Humanos , Proyectos de Investigación , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Overall, the systems approach employed in this study has significantly decreased the frequency of missing medication requests on one pharmacy satellite by 38 percent. The most dramatic impact came from the systems-change phase of the study. While the pharmacy personnel-change phase did not contribute to the overall reduction in missing medications, there was a large decrease in missing medications due to discrepancies between the nursing MAR and the pharmacy profile. This study has prompted further investigation into the p.r.n. drug-distribution subsystem.
Asunto(s)
Sistemas de Medicación en Hospital/normas , Servicio de Farmacia en Hospital/normas , Análisis de Sistemas , Estudios de Evaluación como Asunto , Hospitales con más de 500 Camas , Registros de Enfermería/normas , Servicio de Enfermería en Hospital/normas , Philadelphia , Comité de ProfesionalesRESUMEN
Fax technology is the transmission of text and graphic data between two locations via telephone lines. The advantages of this technology include the speed with which a document can be sent anywhere in the world and the decreased cost versus traditional courier and Telex services. Several different types of machines exist, but standard operating parameters are set by the Consultative Committee for International Telephone and Telegraph (CCITT). There are four categories of machines, called Groups, which aid in classifying the various fax units. Group 3 machines are the most common comprising about 75% of the market. Standard features vary between and within groups, depending on the manufacturer and model. Features such as polling, document broadcasting, security levels, and computer linkage are discussed. The healthcare industry has been slow to adopt fax technology. Applications in hospital pharmacy are the main focus of attention of some hospital administrators and directors of pharmacy. A few studies have shown decreased medication order turnaround time after implementation of a fax-based pharmacy order system. However, problems such as order clarity and legibility, elevated nursing expectations and increased use of paper can decrease its usefulness. Overall, facsimile technology will find a place in the healthcare arena and may become an integral part of the modern pharmacy department.