Post-operative blood salvage with autologous retransfusion in primary total hip replacement.

Clinical, haematological or economic benefits of post-operative blood salvage with autologous blood re-transfusion have yet to be clearly demonstrated for primary total hip replacement. We performed a prospective randomised study to analyse differences in postoperative haemoglobin levels and homologous blood requirements in two groups of patients undergoing primary total hip replacement. A series of 158 patients was studied. In one group two vacuum drains were used and in the other the ABTrans autologous retransfusion system. A total of 58 patients (76%) in the re-transfusion group received autologous blood. There was no significant difference in the mean post-operative haemoglobin levels in the two groups. There were, however, significantly fewer patients with post-operative haemoglobin values less than 9.0 g/dl and significantly fewer patients who required transfusion of homologous blood in the re-transfusion group. There was also a small overall cost saving in this group.

A Bayesian population PK-PD model of ispinesib-induced myelosuppression.

The goal of the present analysis is to fit a Bayesian population pharmacokinetic pharmacodynomic (PK-PD) model to characterize the relationship between the concentration of ispinesib and changes in absolute neutrophil counts (ANC). Ispinesib, a kinesin spindle protein (KSP) inhibitor, blocks assembly of a functional mitotic spindle, leading to G2/M arrest. A first time in human, phase I open-label, non-randomized, dose-escalating study evaluated ispinesib at doses ranging from 1 to 21 mg/m(2). PK-PD data were collected from 45 patients with solid tumors. The pharmacokinetics of ispinesib were well characterized by a two-compartment model. A semimechanistic model was fit to the ANC. The PK and PD data were successfully modelled simultaneously. This is the first presentation of simultaneously fitting a PK-PD model to ANC using Bayesian methods. Bayesian methods allow for the use of prior information for some system-related parameters. The model may be used to examine different schedules, doses, and infusion times.

Satisfaction with prescriptive authority protocols.

OBJECTIVES: The use of prescriptive authority protocols by pharmacists and physicians in Washington was described as to: (1) types of decisions made, frequency of use, and nature of working arrangements among participants; (2) their perceived impact on professional practice and care rendered to patients; and (3) their satisfaction with the protocol arrangements. DESIGN: A mail survey of participants currently engaged in prescriptive authority was conducted. RESULTS: Responses were received from participants in 44 of 57 protocols. A total of 135 prescribers and 84 pharmacists responded. On average, 7 pharmacists and 27 prescribers were involved in each protocol, and had been involved for 6 years or more. It was estimated that approximately 10% of all active practitioners participated in protocols. Most protocols involved continuation of drug therapy or authorizing renewals. Modification of therapy (usually involving dosage or dose from changes) was practiced in two-thirds of the protocols, and initiation of therapy in about half of them. Most existed within managed care and group practice settings. Most prescribers (98%) and pharmacists (95%) were satisfied with protocol arrangements. Additionally, they generally agreed that the protocols increase patient convenience and increase the quality of patient care, and they encouraged their colleagues to use prescribing protocols. CONCLUSIONS: Protocol arrangements appear to be working well from the perspective of participants. Based on this experience, the authors encourage the development of similar protocol arrangements in other states.

Triplicate prescriptions in Washington State.

In summary, I believe that this program, although limited in scope, has been of value to our State in controlling the inappropriate prescribing of controlled substances. We have identified several problems that have been or are being addressed in order to make the program even more effective. The program targets only those prescribers who have been identified as having drug use or prescribing problems rather than subjecting all practitioners to a program for the purpose of finding a relatively small number of violators. Thus, the intimidation factor alleged to be present in full triplicate programs is absent in the limited program. It is flexible since the drugs included in the monitoring can range from a single controlled substance schedule, all schedules, or even to all prescriptions. The program includes both prescribed drugs and those administered in the office or dispensed by the practitioner. The responsibility for compliance is placed on the prescribers, not on the pharmacists. The way the law is written, the program could be expanded to include a sample of all prescribers, providing information that could be used to determine prescribing norms. Overprescribing appears to be in the eyes of the beholder. A pharmacist may view certain prescribing habits differently than a disciplinary board. The availability of norms would assist boards in making more scientific determinations regarding alleged overprescribing practices.

Assessment of social adjustment in chronic ambulatory schizophrenics.

Fifty-six chronic schizophrenic outpatients and their significant others were interviewed separately and given the Social Adjustment Scale II. Intraclass correlations revealed a statistically significant level of agreement between the patients' and the significant others' reports of social adjustment. The mean scores for different areas of social adjustment showed considerable variation, and there were interesting differences between the raters' and significant others' judgments of the social adjustment of the patient.