Transport of groundwater, heat, and radiogenic He in topography-driven basins.

The goal of the study is to assess the feasibility of characterizing the caprock integrity by utilizing sampled helium (He) concentration in fluids and temperature measurement prior to CO2 injection. A series of simulations representing pre-CO2 injection phase was conducted to reveal the spatial distribution of groundwater, temperature, and He concentration under various geologic conditions of topographically driven basin. Then, their profiles in preinjection conditions were compared with dynamic signatures of both injection-induced pressure and leaked brine concentration at post-CO2 injection conditions. In the topographic basin, He and heat transports generally show analogous transport except the low-permeability basin where the conductive heat and diffusive solute transports are the primary transport mechanisms. The transition occurred at permeabilities between 10(-15) and 10(-14) m2. Inclusion of low-k layer (low-k layer: 10(-16) m2 and surrounding basin: 10(-13) m2) segregates shallow and deep groundwater system and creates a 3-km single large free convection of groundwater driven by unevenly distributed thermal profile of basin. Finally, He and temperature profiles with high-k pathways at pre-CO2 injection scenarios and NaCl mass fractions at post-CO2 injection showed systematic trends and relationships, suggesting that proper understanding of these trends will aid to identify the seal integrity.

M-Mode and 2-dimensional echocardiographic characteristics of the Ionescu-Shiley valve in the mitral and aortic positions.

Using M-mode and 2-dimensional (2-D) echocardiography, ultrasonic features of the Ionescu-Shiley valve were characterized. A number 23 prosthesis was placed in a saline-filled chamber and subjected to pulsatile flow. Production of a linear tear at the base of a cusp resulted in coarse fluttering in the open position, and there was a reduction in the anterior cusp slope. Partial detachment of a cusp from its stent produced high-amplitude low-frequency fluttering during ejection. Alteration of transducer position eliminated the abnormal echoes. Fourteen patients with aortic and 11 with mitral prostheses were studied. There was a close approximation of echographically determined values for the bare stent internal diameter, cusp excursion, and valve orifice diameter compared with the manufacturer's specifications. Random punctiform echoes were noted when the cusps opened. Cusp echoes were superimposed on stent echoes in 21% of patients, and a third cusp was detected in 29%. Two-dimensional echocardiograms of good quality were recorded in the vast majority of subjects. Cusp echoes were smooth and had a consistent motion in both the short and longitudinal axis. Multiple transducer positions were required to delineate prosthetic components with optimal clarity. It is concluded that (1) M-mode and 2-D echocardiography is useful in assessing Ionescu-Shiley valve function, (2) in vitro valve tears or detachment produces characteristic cusp fluttering, (3) careful attention to transducer positions is necessary to record high-quality valve images, and (4) these findings represent a data base for the longitudinal follow-up study of patients with the Ionescu-Shiley valve.

Cryptococcal meningitis in patients with the acquired immunodeficiency syndrome.

The optimum therapy for cryptococcal meningitis in patients with the acquired immunodeficiency syndrome (AIDS) remains unresolved. Traditional therapy consists of amphotericin B with or without flucytosine. Obstacles exist in administering these agents to patients with AIDS. Mortality rates during initial therapy are relatively high. Given the lack of proved benefit, we do not recommend adding flucytosine to amphotericin B routinely. The search for more efficacious and less toxic agents continues. The oral triazoles, especially fluconazole, have increased the options for treatment of this disease. New strategies and novel approaches in managing cryptococcal meningitis in patients with AIDS continue to be developed.

Technology assessment and the drug use process.

UNLABELLED: This activity is designed for pharmacists, physicians, physician assistants, nurses, and other healthcare team members, payers for health services, and healthcare executives. OBJECTIVES: Upon completion of this activity, the participant should be able to: 1. Describe the rationale behind, the development of, and the advantages arising from the formulary process, and discuss the health professionals involved in the creation of formularies. 2. Describe the impact of new drug development and technology on the drug use process. 3. Discuss the functions of the pharmacy and therapeutics committee. 4. Describe the impact of consumers on the drug use process.

Development and validation of the pharmaceutical care satisfaction questionnaire.

The development and validation of a survey instrument to assess consumer satisfaction with pharmacy services is discussed. The Pharmaceutical Care Satisfaction Questionnaire (PCSQ) is a 30-item instrument administered by someone other than the pharmacist that uses a Likert scale to score respondents' answers. The PCSQ is written approximately at a seventh grade reading level. Following initial development, the PCSQ was administered to 360 consumers in ambulatory pharmacies and to 311 patients in a multicenter hyperlipidemia outcomes study. The Cronbach coefficient alpha was .94 for the consumer data, with a 64.8% variance accounted for by the 4-factor solution. A coefficient alpha of .84 was found on all 30 items in the hyperlipidemia study, with a variance of 63.78% in control patients and 60.16% in treatment patients. The PCSQ is easy to administer and score, with minimal cost. Unlike other satisfaction surveys, the PCSQ contains patient evaluations regarding outcomes of care. A primary limitation of the PCSQ is that it is a newly developed instrument that needs to be used in more studies to strengthen its validity.

Using the business plan to propose revenue-generating pharmacy services.

The business plan is a document that may be used to initiate administrative action on revenue generating business ventures. It has proven to be a powerful tool in the financial business community for a number of years. The article discusses the components of a business plan in detail. It also provides some general examples of how a business plan may be used in pharmacy.

Types of selected security devices for hospital pharmacies.

Every pharmacist, whether in the hospital or in a community environment, faces the daily possibility of a holdup, burglary, or forged prescription. Statistics on drug-related crime are on the upswing as an increasing number of perpetrators recognize that wholesalers and hospitals are large depots of injectable narcotics and controlled substances. In response to this, many Federal drug crime laws and increased security have been proposed. This report identifies many types of security devices available to provide early warning or deter robberies. They include perimeter security systems, motion detectors, surveillance cameras, bullet-resistant windows, and key-lock systems. This report also suggests several considerations to be used in developing a security system in a hospital pharmacy. A basic understanding of security devices will enhance the manager's ability to choose the appropriate devices(s) for a particular service.

The evaluation of pharmacist-technician teams applied to a satellite pharmacy.

The team work group design has been suggested as a mechanism to integrate clinical and distributive pharmacy services, expand clinical roles, enhance staff satisfaction, and promote resource efficiency. A pharmacist-technician team was created at Henry Ford Hospital, Detroit, and the effects of the team were assessed via pre and post data collection of attitudinal, behavioral and pharmacy service aspects. Each of three satellite teams were responsible for all pharmacy services to a target group of patients. The results of the team design include a significant decrease in pharmacist and technician perceptions of role stress, especially in the categories of role overload, role isolation, and role ambiguity, and less total hours of work lost by pharmacists (54% improved) and technicians (29% improved). The nurses perceived slightly better pharmacy services upon survey, although not statistically significant, and IV solution wastage decreased 5.6%. Clinical pharmacist compliance to standards of practice was unchanged in spite of increased supervisional responsibilities. We were able to show that the pharmacist-technician team design decreased stress and created more efficient pharmacy services.

An analysis of 1986 drug procurement practices in hospitals within the United States.

The purpose of this study was to statistically answer a set of predefined objectives concerning pharmaceutical procurement. The key indicators were assumed to be cost per patient day and turnover rate. Of the 5,911 surveys mailed, 709 surveys were returned for a 12% response rate. The following statements were based on attempts to answer the six predetermined objectives. Pharmaceutical purchasing is controlled by pharmacy departments to the extent that comparisons to pharmaceutical purchasing by materials management departments was not possible. Prime vendor purchasing is the procurement method of choice. Competitive bidding through a group process is so popular that a valid comparison to nongroup bidding could not be accomplished with the results of this survey. Certain variables of group purchasing such as group age, contract adherence, and volume commitment, do not appear to be correlated to purchasing outcomes in this study. When comparing government to private hospitals, the private sector seems to have an advantage in managing turnover rates. Cost per patient day results were less conclusive. As single and multiple hospital systems were compared for purchasing outcomes, the results were not totally conclusive. Although, multiple hospital systems had a significantly higher turnover rate. Finally, a comparison based on the use, or lack of use, of prime vendor arrangements demonstrated interesting results. The duration of contract did not significantly affect the purchasing outcomes. Other hospital variables such as size, type, ownership, and organization, demonstrated notable trends. The importance of examining hospitals based on case mix and mission seems to be most important. Also, the ability to relate purchasing outcomes with formulary management strategies needs further study before conclusive statements can be adopted.

A survey of current operations and future plans for ambulatory pharmacy services.

Survey results indicate that the number of hospital-based ambulatory pharmacies in the survey area is increasing substantially. By the end of 1989, there would have been a 71 percent increase in the number of hospitals providing ambulatory pharmacy services in this region. This assumes that those hospitals in the planning stages of developing ambulatory pharmacy services completed their plans. While the number of hospital-based ambulatory pharmacies is on the rise, there has been a concurrent increase in the number of services provided by the pharmacies already in operation. There has been a 38 percent increase in the number of services provided by these pharmacies since the inception of DRGs. The services that have been added are primarily specialized services including home TPN compounding, intravenous antibiotic compounding, intravenous chemotherapy compounding, medical supplies, and durable medical equipment. It is likely that these services will continue to increase in the coming years as home therapies continue to become more advanced. The study also indicates that most hospital-based ambulatory pharmacies in this region are operated as nonprofit entities. A trend toward for-profit pharmacy operations was anticipated, and this is still anticipated as more ambulatory pharmacy operations become separate entities from inpatient services. Future studies of this type should monitor this possible trend. Most hospital-based ambulatory pharmacies are owned by the hospital or a hospital affiliate. More than half of respondents reported their ambulatory pharmacies are located within the inpatient pharmacy of the hospital. As the trend toward separate ambulatory pharmacy operations increases, it would not be unusual for the pharmacies to be operated by for-profit affiliates of the hospital or outside contractors. Barker predicts that hospital-based ambulatory pharmacies could become units of major drug store chains in the future. This is another area that is worthy of future studies of hospital-based ambulatory pharmacy operations. Overall, the results of this study indicate that hospitals in this region have not remained static since the inception of DRGs. There seems to be a dynamic period of change evolving in the delivery of health care services in this region. The demographic section of this study reveals that the majority (more than 70 percent) of the hospitals surveyed are operating fewer numbers of beds for inpatient services since ther inception of DRGs. The length of time that patients remain in the hospital for inpatient services is decreasing, resulting in decreased demand for inpatient beds.(ABSTRACT TRUNCATED AT 400 WORDS)

Work group design in pharmacy: the pharmacist-technician team.

The contemporary pharmacy practice manager faces the challenge of designing pharmacy service programs that not only satisfy the needs of the patient, but at the same time satisfy and motivate the pharmacists and technicians who sustain the programs. This research examined the team design, which has been recommended but not fully described in the literature. This application did not explore the full potential of the team design in the hospital pharmacy setting. More study is needed in this area to assess the impact of work group design on the expansion of clinical programs, employee turnover rates, quality and quantity of work produced, and, most important, the impact on job satisfaction enjoyed by pharmacists and technicians.

Evaluation of a quality assurance technique for a pharmacokinetic dosing service.

A quality assurance (QA) technique that measured process and outcome was tested on a clinical pharmacokinetic dosing service (CPDS). The process measurement criteria evaluated the CPDS pharmacists' ability to maintain serum aminoglycoside levels within the desired range (peak 6-10 micrograms/ml, trough less than 2.0 micrograms/ml). The outcome measurement criteria evaluated the patients' clinical response to the aminoglycoside therapy based on changes in the patients' temperature, white blood cell count, bacterial cultures, and other variables. The process evaluation found that in a majority of the patients (80 percent), the CPDS pharmacist was performing at a level exceeding the process criteria. The outcome evaluation found that in a majority of the patients (76 percent), the therapeutic outcome criteria were not met. Statistical analysis using Spearman's Rho was not able to relate process and outcome measures significantly (p greater than 0.05). The patient outcome criteria may not have accurately measured patient outcome because of inflexibility, not measuring other patient variables, and the lack of a subjective component. Validation of the QA technique was not possible in this study.

Integrating postgraduate pharmacy training programs into colleges of pharmacy.

An important issue facing colleges of pharmacy is the integration of postgraduate clinical training programs into the mainstream of pharmacy education. Colleges of pharmacy have a major role to play in postgraduate clinical training programs to the benefit of the college, resident, and institution. Students must be provided with information about residencies during their first year, and this information must be continually reinforced throughout their academic career. Residency and fellowship programs contribute significantly to the education of pharmacy students. Colleges must take an active role, working in partnership with institutions to enhance postgraduate pharmacy training programs.

Twenty-four hour emergency pharmaceutical services.

Operation of an emergency department satellite pharmacy in which the pharmacist provided clinical, educational, and drug distribution services during patient visits is described. In a Detroit trauma and ambulatory-care center, drugs were dispensed to outpatients 24 hours a day from a satellite pharmacy located in the 75-bed emergency department. Emergency department pharmaceutical services were expanded to include distributive, clinical, and educational activities by the pharmacist on a 24-hour basis. The pharmacist contributed to improved inventory control and billing for drug products. When reductions in the work force were necessary, the institution chose to retain 24-hour pharmacist coverage during emergency department patient visits and to eliminate 24-hour dispensing to outpatients. In this urban trauma center, the emergency department pharmacist's clinical, distributive, and educational services contributed substantially to delivery of patient care.

Facsimile machines for medication order transmission.

The use of facsimile machines for medication order transmission has improved turnaround time and provided benefits for the Department of Pharmacy Services and the hospital. As a result of this program pharmacists have more time and more opportunities to improve drug therapy because they no longer have to travel to patient care units or handle patient charts for the purpose of order entry. Pharmacists will have even more time when technicians have been fully trained to carry out medication order entry. Important also is the ability for nurses to FAX rather than hand carry urgently needed orders to the pharmacy satellites. The use of FAX machines in this manner lowers the cost of patient care and makes this technology available for other purposes as well. It is becoming increasingly clear that pharmacists, as well as others, can utilize modern technology such as this to maintain and improve services in the presence of a cost-containment environment.

Impact of pulmonary rehabilitation team effort for ambulatory patients with chronic lung disease.

The pulmonary rehabilitation program at the Veterans Affairs Medical Center in Memphis, Tennessee, is a program consisting of an interdisciplinary team effort that is coordinated by a clinical pharmacist and focuses intensively on educating patients with chronic lung disease about their disease, the basics of care, and life style changes that may prevent acute illnesses and help the patient remain as functional as possible. Implementation of this program, including information and data on proposal and development of this preventive care program are included. The success has been measured in the accomplishment of its goals of decreasing inpatient acute care needs through patient and family education, increasing functional status of patients handicapped with lung disease, and increasing patients' satisfaction with their care.

Evaluation of a cardiopulmonary-resuscitation training manual for pharmacists.

The development and evaluation of a training manual for pharmacists participating in cardiopulmonary resuscitation (CPR) efforts at an institution encompassing ambulatory-care, acute-care, and emergency-trauma facilities are described. The manual was developed to familiarize pharmacists who had little or no experience in CPR procedures with the equipment and medications used and the pharmacist's role on the CPR team. To evaluate the effectiveness of the manual, a 29-question multiple-choice test was administered to 35 staff pharmacists who were randomly assigned to study and control groups. Training manuals were issued to members of the study group, who were asked to document time spent studying them. Three weeks after the pretest, the same test was administered to all subjects. There was no control on the number of CPR events attended during the three-week period. The study group spent less than two hours (mean +/- S.D. = 97.5 +/- 34.22 min) using the manual. For the study group, posttest scores were significantly higher than pretest scores. The difference in pretest scores for the study and control groups was not significant, but for the posttest the study group scores were significantly higher. Because use of the manual appeared to improve knowledge of drug therapy and procedures used in CPR, the pharmacy department incorporated it into its orientation procedure.