Drug Intelligence & Clinical Pharmacy

The pharmacist is an active member of the cardiopulmonary resuscitation (CPR) team in many hospitals, dispensing medications, maintaining records, providing drug information, calculating doses, and mixing intravenous fluids. We surveyed 135 emergency department nursing directors across the country to assess the methods of and persons responsible for documentation during CPR. Ninety-five (70 percent) completed surveys were returned, showing that documentations was usually done by a nurse (81 percent), by a nurse and pharmacist (9 percent), by a pharmacist (7 percent), or by others (ward clerks, paramedics, or physicians) (3 percent). CPR flowsheets (83 percent), nurses' notes (7 percent), or other methods (10 percent) including notes on paper towels and blackboards are used to record such information in the emergency department. Most respondents were fairly confident (49 percent) or very confident (48 percent) that they could recreate the resuscitative sequence from the information recorded; 2 percent did not have confidence in the reproducibility of the data. Respondents felt that cardiac rhythms (83 percent), drugs and dosages administered (34 percent), and temporal sequence of events (33 percent) could be more accurately recorded during CPR. A majority of respondents (57 percent) felt that an automated recording system would be useful. We conclude that there appears to be considerable variability in the method of documentation of events during CPR in emergency departments throughout the country. Future efforts in emergency care should include the involvement of pharmacists in the development and implementation of a uniform database for use by field and hospital personnel during CPR.

Metronidazole in high cumulative doses has been associated with convulsions. A case is presented in which this relationship is clear. In all reported cases of metronidazole-associated seizures, the cumulative dose of metronidazole has been high (greater than 40 g). The cumulative dose rather than the serum level is important in the pathogenesis of this complication.

This article describes the number and types of psychotropic drugs on the market in Denmark, Finland, Norway, and Sweden from 1950-1977. The total number of drugs on the market in each country depended greatly on how psychotropic drugs were defined, but trends with time and differences between the countries were less affected by this definition. The number of drugs was highest in Finland and lowest in Norway. In all countries, the number of drugs increased from 1950 to the mid-1960s, most abruptly in Finland. They then quickly decreased in Finland and Sweden, but remained fairly constant in Denmark and Norway. The number of different active substances was much smaller than the number of drugs, and the differences between the countries were also smaller. The proportions of combination and hidden psychotropic drugs in relation to all psychotropics were considerable in Finland and Sweden, and the varying numbers of combination drugs contributed greatly to the wide differences in the number of drugs. From the medical point of view, far too many drugs were on the market in that period.

In an attempt to determine the interrelationships of articles published regarding drug information services activity, a citation analysis was performed. The period chosen for study was 1961-1979. During this period, some 258 publications were identified as meeting the operational definition of drug information services activity. A subset of publications was selected for further study and showed that (1) less than 1/3 of the articles in the subset cited one another, (2) the "classic" article(s) are seldom cited, and (3) authors tend to cite themselves more frequently than others. A historiograph is presented which shows all of the citation interrelationships of the subset of publications.

The author discusses the results of surveys conducted in Warsaw, concerning the extent of use of unprescribed medicine from 1970-1980. Drug use did not increase over the decade studied, and most respondents took the medication to treat particular complaints. No correlation was found between self-medication and social or occupational status. Respondents often began using unprescribed drugs on the recommendation of a doctor; self-medication, while widespread, does not imply a negative attitude toward health professionals or the existing system of medical care.

In this paper the author recommends that American pharmaceutical education should move rapidly in the direction of a single terminal professional doctor of pharmacy degree for all of its graduates. An attempt is made to review for the reader: (1) some of the historical events of the twentieth century that influenced the direction of education in pharmaceutical, medical and related health professions,1,2,3,4 (2) the Pharmaceutical Survey of 1948 5,6 which was the last major introspective study prior to the present work underway by the Millis Commission, (3) the report of the Citizens Commission On Graduate Medical Education7 which appeared in 1966, (4) several tracts of the past few decades2,3,8,9,10 which have focused on the changing scene in American pharmaceutical education, (5) the development7,10 in medical education which have provided important precedents for pharmacy and (6) several recent papers11,12 which have espoused the professional doctor of pharmacy degree. The author particularly calls upon direct quotes and recommendations from the Findings And Recommendations of the Pharmaceutical Survey of 1948. Also, he draws upon and paraphrases remarks of The Report of the Citizens Commission and Graduate Medical Education, chaired by John S. Millis, and which appeared in 1966.

The impact of a specially designed patient education program upon the diabetes-related knowledge and compliance of insulin dependent diabetic patients was investigated. The program consisted of an audiovisual presentation, illustrated handout material, and pharmacist-patient counseling. Based on statistical considerations, 65 eligible patients were assigned systematically to a control group (Group I) and a study group (Group II) and were evaluated for compliance following a standardized protocol. Immediately following the interview, Group II patients were instructed utilizing the patient education program. Scores for initial and final evaluations of knowledge and compliance were compared using appropriate statistical procedures. The program was successful in producing improvements in both knowledge and compliance but a need for individualization of patient education efforts was indicated. Significant improvements in compliance were not observed among patients older than the mean age for study patients and those with diabetes complicated by cardiovascular and hypertensive disease.

During June and July 1982, the Pharmacy Services Department of the Brigham and Women's Hospital conducted its second annual national survey by mail questionnaire regarding postgraduate pharmacy fellowships. There was a total response of 80 percent to the questionnaire. Sixty-three fellowships are offered at 25 fellowship sites. Information regarding type of specialty fellowship, fellowship characteristics, fellowship location and contact person, and qualifications of applicants is reported.

The author discusses the role of the pharmacist as a patient counselor, using as a background the history of the USP as a mirror to the changing roles of pharmacy practitioners. The controversy over patient package inserts is presented as a conflict between pharmacy's traditional functions and the Food and Drug Administration's perception of a need for higher standards in patient information and as an example of how pharmacists, through their own neglect, stand in danger of abrogating their function as patient counselors. The author advocates that pharmacy expand its activities through increased attention to and more judicious use of the USP Dispensing Information and the other services that the USPC offers.

During June and July 1983, the Pharmacy Services Department of the Brigham and Women's Hospital conducted its third annual national survey by mail questionnaire regarding postgraduate pharmacy fellowships. There was a total response of 76 percent to the questionnaire. Eighty-three fellowships are offered at 31 fellowship sites. Information regarding type of specialty fellowship, fellowship characteristics, fellowship location and contact person, and qualifications of applicants is reported.

During July and August 1984, the Pharmacy Services Department of the Brigham and Women's Hospital conducted its fourth annual national mail questionnaire survey of postgraduate pharmacy fellowships. It was found that 91 fellowships are offered at 36 fellowship sites. Information regarding type of specialty fellowship, fellowship characteristics, fellowship location and contact person, and qualifications of applicants is presented.

During August and September 1985, the Brigham & Women's Hospital Pharmacy Services Department conducted its fifth annual nationwide survey of postgraduate pharmacy fellowships. There are 115 fellowships offered with 89 fellows at 33 sites.

Cyclosporine is an important immunosuppressive agent in organ and bone marrow transplantation. The pharmacokinetics of cyclosporine are quite complex and are complicated by the availability of two assay systems that yield differing results. This article summarizes the views from two major solid organ transplant centers and one bone marrow transplant center on important cyclosporine monitoring questions. A general consensus exists in the four areas discussed that: cyclosporine concentrations must be monitored due in part to the extreme variability in kinetics, either blood or plasma can be used in monitoring programs, the radioimmunoassay or high pressure liquid chromatography can be used in routine monitoring, and the interpretation of cyclosporine concentrations must be performed in relation to patient variables that affect drug response and toxicity.

During September and October 1986, the Brigham and Women's Hospital Pharmacy Services Department conducted its sixth annual nationwide survey of postgraduate pharmacy fellowships. There are 170 fellowships offered with 146 fellows at 44 sites.

During August and September 1987, the Brigham and Women's Hospital Pharmacy Services Department conducted its seventh annual nationwide survey of postgraduate pharmacy fellowships. There are 185 fellowships offered with 150 fellows at 53 sites.

This comprehensive bibliography is intended to enhance the education of the practitioner, student, and academician in the area of parenteral nutrition. This bibliography is not all-inclusive but serves as an update from the original published in 1983. Of particular note in this work is the addition of topics that reflect a growing interest in medical specialties with regard to patient nutritional status and support.