The effect of cimetidine on serum concentrations of piroxicam.

To evaluate the effect of cimetidine on serum concentrations of piroxicam, we administered a single 20-mg oral dose of piroxicam to 10 healthy male volunteers on 2 occasions. The first was given on day 1 of the study and the second on day 15, 7 days after starting cimetidine 300 mg orally 4 times a day. Nineteen blood samples were drawn for 7 days after each piroxicam dose to characterize its pharmacokinetics. Piroxicam was analyzed by high-performance liquid chromatography. The mean piroxicam elimination rate constants (Kel), elimination half-lives, and area under the serum concentration-time curves (AUC) were as follows (mean +/- standard deviation): (formula; see text) Data were analyzed with a Wilcoxon matched-pairs, signed-ranks, two-tailed statistical test. Although the increase in AUC was statistically significant, it was of low amplitude (mean 15%) and is probably not clinically significant. The results of this study suggest that cimetidine does not significantly alter the elimination kinetics of a single dose of piroxicam in young healthy males. Additional investigation is needed to confirm these findings in other patient populations.

Economics of microsurgical cases and routine cases in a medical center.

This report describes the economic impact of microsurgical cases and routine plastic surgery cases in our medical center. The study is based on a financial analysis of the practices of two surgeons. Financial data of patient encounters (admission to the hospital or a surgical unit) identified with each surgeon were categorized into microsurgical and related cases and routine cases (including cosmetic procedures and general hand cases). Revenues, costs, and profits were tabulated. Data were analyzed for 2 fiscal years (1994-95 and 1995-96). Analysis of the first fiscal year showed that microsurgery encounters (n = 188) generated $4.4 million in revenue with a profit margin after direct costs of $2.5 million (57 percent) and a net profit, after indirect costs, of $1 million (23 percent). Routine encounters (n = 262) generated $1.7 million with a net loss of -$145,000 after direct and indirect costs. In the second fiscal year, microsurgery encounters (n = 230) had income of $4.7 million, a profit over direct costs of $2.5 million (53 percent), and a net profit after indirect costs of $0.9 million (19 percent). Routine cases (n = 202) in the same period earned $1.3 million with a net loss of -$107,000. This analysis formulates a comprehensive definition of microsurgical practice and shows that cases within this definition generated dramatically higher hospital incomes and profits compared with routine plastic surgical practice. In the circumstances of our medical center, development of this subspecialty is fiscally justifiable.

Cover gowns. Researching their effectiveness.

1. Bacterial colony counts on the right shoulder of the subject's scrub suits were lower after lunch when a. cover gowns were worn over scrub suits outside the OR during lunch, and b. when fresh scrub suits were put on after lunch. 2. Bacterial colony counts were higher after lunch when a. scrub suits were worn without cover gowns outside the OR during lunch, and b. when they were removed before lunch, stored in a locker, and put on again after lunch. 3. The thigh region can be assumed to be dirtier than the shoulder area on scrub suits. From this study, the researchers concluded that wearing cover gowns outside the OR exerts a protective effect against bacterial contamination as determined by samples taken from the right shoulder. Furthermore, this protective effect is comparable to that seen when subjects changed into fresh scrub suits after lunch.

Perioperative introductory column.

Our future in the operating room (OR) depends on our ability to remain productive and valuable to surgeons, patients and administration. Together, we can ensure that quality and efficiency in the OR are not casualties of the health care revolution. Let us all share our knowledge and experience to help ourselves through to the next century.

Mini-coronary artery bypass grafting.

Perioperative nursing has been impacted by a multitude of changes as medical technology continues its rapid advance. What may prove to be a major innovation in coronary artery bypass surgery is currently being performed in the United States, Europe and South America. Mini-coronary artery bypass grafting (CABG) is a minimally invasive procedure in which the surgery is performed through small incisions made in the chest wall, eliminating the need to "crack" the chest. This method reduces the pain and trauma to the patient and shortens the time required for hospitalization and recovery.

The operating room of the future.

As more and more care moves to the home setting, the ability to undergo a surgical procedure from the comfort of your own home may not be that far away. As for the operating room itself, patient care will be radically different than it has been in the past. Radiologists, assisted by computers and robots, may be performing procedures on patients "anesthetized" by acupuncture, therapeutic touch and aromatherapy in a totally bloodless environment.

What is the future of the OR director?

So, if there are still some nurses out there who want to get into administration, here's some good advice: "Pick your mentors, get a master's degree early in your career, get involved in your professional association and the sooner you commit, the better." There are still a lot of opportunities for OR managers, and the better ones will flourish in tomorrow's OR. The efficient and forward-looking OR managers will always do well and the well-managed ORs will survive!

Culture and consent.

Consent for surgical procedures is a surgeon's nontransferable legal duty. However, nurses often are involved in the communication of relevant, culturally sensitive information.

The merger of two great forces in health care.

Two university medical centers, Stanford and the University of California at San Francisco, join to preserve excellence in patient care, research and education while enhancing their already impressive market share.

Telepresence: what is it?

The great technological advances of the past 25 years are having a profound impact on the practice of medicine. Combined with the ever-present demand to decrease costs and improve quality driven by the managed care market, telemedicine has emerged as a possible method to at least reach more people and to improve the quality of care.

The future of minimally invasive surgery.

When it was first introduced, minimally invasive surgery longer to perform than open surgeries, limited the number of instruments that could be used simultaneously; restricted the manipulation of instruments, reduced the surgeon's depth perception, decreased eye/hand coordination and eliminated the ability to palpate tissue directly. However, recent advances have corrected some of these deficits and minimally invasive surgery eventually will be used for all gynecological procedures and most general surgery, chest and coronary artery bypass procedures.

Reengineering: avoiding the pitfalls and overcoming the barriers.

Many health care facilities are in the process of reengineering in order to reduce costs and remain competitive in the marketplace. If your facility is in the planning stages or early on in the process of reengineering, here are tips from some experts to help with this process.