Pharmacy and herbal medicine in the US.

Herbal medicine is increasing in popularity in the United States. The market continues to grow, with a presence being established for commercially-prepared herbal products in community pharmacies throughout the nation. This survey was conducted to describe that presence in pharmacies and to describe pharmacists' perceptions of this product class. A response rate of 26.3% (n = 512) was achieved for a five-page mail survey sent to a geographically stratified random sample of community pharmacies in the United States. Approximately 73% of pharmacists responding indicated that their pharmacy carried commercially-prepared herbal products. Attitudinal items were included to measure pharmacists' perceptions toward these products, as those perceptions have the potential to influence attitudes and subsequently behavior (such as clinical involvement with patients wishing to integrate herbal products into an existing regimen). Pharmacists, on average, did not believe that herbal products are well standardized, or that the products are well accepted by the Food and Drug Administration or the National Association of Boards of Pharmacy. Much potential exists for pharmacists to fill a role as information provider to patients who self-medicate with herbal medicines; must their perceptions of the product class be changed first?

Sale of tobacco products in pharmacies: results and implications of an empirical study.

OBJECTIVE: To provide national-level data concerning the percentage of pharmacies selling tobacco products, examine relationships between selling practices and pharmacy characteristic variables, and explore perceptions of conflicts between tobacco-selling activity and professional and personal values and the potential effects of such conflicts. DESIGN, SETTING, PARTICIPANTS: Data were collected from a geographically stratified systematic random sample of 899 pharmacies. Multiple mailings were sent to the attention of the pharmacy manager. A random sample of nonrespondents was also contacted by telephone, urging participation. MAIN OUTCOME MEASURES: Whether the pharmacy currently sold cigarettes and/or smokeless tobacco products, and if so, whether these practices differed from what respondents' personal or professional values tell them to do. Scales designed to measure job satisfaction, job-induced tension, and propensity to leave were also included. RESULTS: Slightly more than half (50.5%) of the pharmacies sold cigarettes and 35.4% sold smokeless tobacco products. Independents were less likely than chain pharmacies to sell tobacco products. For those respondents working in pharmacies where tobacco products were sold, 47.6% responded that this practice differs from what their personal values tell them to do and 63.9% replied that this practice differs from what their professional values tell them to do. Even when controlling for pharmacy type, respondents working in pharmacies that sold tobacco products had significantly lower levels of global job satisfaction, higher levels of job-induced tension, and a higher propensity to leave than did respondents working in pharmacies that did not. CONCLUSION: Decision makers in pharmacies where tobacco products are still sold should take a serious look at the justification for the continued availability of tobacco products in an environment that has a goal of promoting health.

The effects of acquisition cost and budget-based compensation on the attitudes of pharmacy directors toward the adoption of a cost-effective new drug.

To test the effect of differences in acquisition cost and budget-based monetary compensation systems on the intent to support the adoption of a cost-effective new drug, over 350 hospital pharmacy directors were asked to indicate their intentions as to the adoption of a cost-effective new thrombolytic agent, presented at 3 different prices. Although the economic savings for the hypothetical product were constant across all price points tested, respondents exposed to the highest price were more likely to resist the adoption of the new agent than those exposed to lower prices (p < 0.001). Respondents whose compensation was contingent on their control of the drug budget indicated a higher likelihood to resist the adoption of the new agent than did those whose salary was not so determined. These findings indicate that significant hurdles, psychological and organisational, still exist for the acceptance and use of pharmacoeconomic information in the hospital setting.

A systems-based disease management model: achieving optimal health care outcomes.

In this article, the "disease management system model" is presented, which is applicable to health care providers practicing in community, hospital, and long-term care settings. The core service of patient information for diabetic care is used to demonstrate how the model integrates individual system components involved in health care delivery.

An evaluation of interventions designed to stimulate physician reporting of adverse drug events.

A frequent complaint among health care professionals about ADE reporting programs is that they never know what happens to the information they took the time and effort to report. In the Mississippi ADE program, physicians appreciated the feedback they were provided--in letter form--indicating the ultimate disposition of the reported information. Also, a regular newsletter summarizing the number and types of reports and the drugs involved was well received. This vehicle was also used to educate physicians about new drugs on the market that warranted closer scrutiny. Reminder posters placed at strategic points around the hospital and periodic inservices on the program are effective in maintaining a level of awareness about the importance of ADE monitoring and its impact on the quality of care.

Isolation of deoxyribonucleic acid (DNA) from saliva and forensic science samples containing saliva.

Saliva and saliva-stained materials were examined as potential sources of deoxyribonucleic acid (DNA) for DNA analysis and identity testing. In this paper, the authors demonstrate that DNA was isolated and DNA banding patterns suitable for DNA typing were obtained from fresh saliva and various saliva-stained materials, such as envelopes, buccal swabs, gags, and cigarettes. Furthermore, DNA and DNA banding patterns were obtained from actual forensic evidentiary samples containing mixed saliva/semen stains. The DNA banding patterns obtained from saliva or saliva-stained material were indistinguishable from the patterns obtained from blood or hair from the same individual. Intact DNA was readily isolated and DNA banding patterns were obtained from saliva stored at -20 degrees C and dried saliva stains stored under varying conditions. We conclude that saliva and saliva-stained material can be good sources of DNA for analysis and for DNA typing in certain forensic settings.

Genetic markers in human bone: I. Deoxyribonucleic acid (DNA) analysis.

Deoxyribonucleic acid (DNA) was isolated from a number of spongy and compact human bone tissue specimens, and the yield was estimated on a "per milligram of starting tissue" basis. DNA was, in addition, isolated from a number of corresponding blood and bone tissue specimens. Spectrophotofluorometry and ethidium bromide visualization on minigels were used to estimate the quantity and degree of degradation of DNA. The DNA from several blood-bone pairs is shown to give concordant restriction fragment length polymorphism (RFLP) typing results by two different typing protocols with five different single-locus probes. DNA from several additional blood-bone pairs is shown to give concordant results for human leucocyte antigen (HLA)-DQ alpha phenotypes following polymerase chain reaction (PCR) amplification and hybridization to specific allele-specific oligonucleotide (ASO) probes, and for the variable numbers of tandem repeats (VNTR) length polymorphisms 3' to the human apolipoprotein B (APOB) gene following PCR amplification with specific primers and analysis of the products by electrophoresis and ethidium bromide visualization.

Adverse drug reaction monitoring in Mississippi home health care agencies.

A statewide survey of home health care agency directors in Mississippi was conducted to determine the extent of Adverse Drug Reaction (ADR) monitoring and reporting by health care professionals. A 24-item questionnaire was sent to agency directors eliciting responses on agency characteristics, rate of occurrence of ADRs, and attitudes toward responsibility for monitoring ADRs. A total of 77 questionnaires were returned yielding a response rate of 48%. The average program enrolled 104 patients with 3.5 ADRs reported by health care professionals per year (range 0-65). Agency directors reported that physicians, nurses, pharmacists, and members of the pharmacy and therapeutics committee should monitor ADRs. Results indicated a need for all health-care professional involved in home health care to increase their ADR monitoring and reporting activities.

Use of deoxyribonucleic acid (DNA) fingerprints for identity determination: comparison with traditional paternity testing methods--Part I.

A study involving comparison of the deoxyribonucleic acid (DNA) finger-printing test with traditional methods used for paternity testing is presented. Samples from 191 cases were tested for a series of blood group and polymorphic protein markers. DNA "fingerprints" were then obtained for all samples using the multilocus probes 33.6 and 33.15. The results of DNA fingerprinting correlated well with those of traditional methods and proved to be informative in cases where traditional methods yielded inconclusive or insufficient results.

Use of deoxyribonucleic acid (DNA) fingerprints for identity determination: comparison with traditional paternity testing methods--Part II.

Six red blood cell (RBC) antigen systems, coupled with human lymphocyte antigen (HLA) phenotyping, were used to establish paternity on 28 mother/child/alleged-father trios. Samples were subsequently examined using the deoxyribonucleic acid (DNA) fingerprinting test with the multilocus Jeffreys DNA probes 33.6 and 33.15. In 27 of 28 paternity cases, the DNA fingerprinting test results supported and enhanced the results of RBC and HLA typing by resolving disputed paternity cases conclusively. One discrepancy between conventional serological methods and DNA analysis is discussed.

Beneficial effects of vitamin C on risk factors of cardiovascular diseases.

The aim of this investigation is to study the hypothesis that vitamin C has beneficial effects on some risk factors of cardiovascular diseases. Sixty-seven volunteers participated in this study. Thirty and thirty-seven subjects were assigned randomly to two groups. The first was given a placebo and the second was given a vitamin C, respectively. Both regimens were followed for six months. The dose of vitamin C was 500 mg/day. Double blind technique was used throughout the study. These data supported part of the beneficial effects of vitamin C on atherosclerosis process, i.e. reduce significantly body fat, systolic blood pressure, and pulse, and increase significantly high density lipoprotein. On the other hand, these data did not show favourable effects on other lipid parameters, i.e. cholesterol, triglyceride, low density lipoprotein, and very low density lipoprotein.

Reporting of adverse drug and biologic reactions in Mississippi hospitals.

There can be no doubt of the therapeutic need for adverse drug reaction (ADR) monitoring in hospitals. In addition, JCAHO requirements mandate the maintenance of concurrent ADR monitoring programs. In order to obtain data pertaining to ADR reporting in hospitals in Mississippi, a survey of statewide hospital-pharmacy directors was conducted. Respondents indicated the average number of ADRs reported to the pharmacy departments was 19.2 ADRs per year. An average of 2.2 ADRs were forwarded to the FDA yearly. Respondents who had recently (since 1984) undergone JCAHO inspection agreed to a greater extent than others that it was the P & T Committee's responsibility to monitor ADRs. The results indicate a need for other health professionals in hospitals to monitor and report ADRs. In addition, submission of ADRs to the FDA must occur to a greater extent than presently is occurring.

Attitudes of Nigerian physicians toward a National Health Service.

Despite efforts to improve health services in Nigeria, considerable problems in distribution and access persist. At present, the health care system in Nigeria is organized and financed at the states' level rather than at the national level. A severe maldistribution of resources exists, as does a lack of coordination among states. An alternative system, albeit expensive, is a National Health Service (NHS). The purpose of this research is to quantify physicians' attitudes towards the concept of NHS. Although physicians in Nigeria are mandated to provide government-funded support, a substantial private practice thrives. Accordingly, physicians' attitudes that may be transferred into behavior are a major determinate of a potential NHS' long term success. In summary, Hausa physicians from the north tended to be more favorable to NHS than did others. Also, younger physicians and those who believed Nigeria's present system to be inadequate favored NHS. There was no association between a physician's gender, locus of medical education, and source of support for medication education and attitude. Finally, physicians in private practice and those in urban areas held more negative attitudes. In spite of Nigeria's present difficulties, a NHS may become a viable alternative. At this point, the overall concept is not opposed by physicians.

Designing new substance abuse treatment services for a competitive environment.

A multivariate analysis of the relationships between service attributes and physician perceptions was conducted as an approach to marketing substance abuse treatment services. The results of this attribute-perceptive-preference study indicate: the physician(s) on staff attribute makes the greatest contribution to perceived quality and efficiency; easy referral admission makes the largest contribution to accessibility perceptions; and providing feedback produces the greatest contribution to perceived continuity. The JCAH attributes neither adds to nor subtracts from the perceptions of any of the four perceptual attributes. Other findings indicate that perceived efficiency produces the greatest contribution to overall consumer preference. Quality perceptions make the second largest contribution to overall preference, followed by continuity and accessibility perceptions.

Factors affecting physician participation in a state Medicaid program.

Critical to policy planning for a program of national health insurance or a National Health Service is an understanding of the strengths and weaknesses of current federally-supported health programs. One program which has been subjected to criticism is Medicaid. A major problem facing Medicaid is the high proportion of physicians who refuse to participate in the program, thus preventing the target population from obtaining access to medical care. A telephone survey was conducted to assess the attitudes and behavior of a stratified random sample of physicians regarding their participation in a Medicaid program. Physicians were asked to identify major advantages and disadvantages of the program to individual patients, to society and to their medical practice. Non-participants were asked to identify the major reasons why they did not participate in the program. Medical specialty was the only significant demographic determinant of participation. Inadequate reimbursement, excessive paperwork, patient abuses of the program and bureaucratic complexity were among the most prominent factors contributing to nonparticipation. Implications of these findings are discussed with respect to the role of primary care providers' perceptions in the planning of future national health programs.