A team approach to reduce antibiotic costs

After partial success in reducing antibiotic drug costs by traditional methods (i.e., closed formulary, use of generic drugs, retrospective drug usage review, continuing education), a study of a new "team approach" was implemented. The study involved a clinical pharmacist and physicians working together to select the most appropriate antibiotic therapy. The clinical pharmacist reviewed the culture and sensitivity data and the pattern of infectious disease over the six-month period prior to the initiation of the study and prepared a list of the most appropriate antibiotics based on clinical efficacy and cost effectiveness. He then joined the physicians on morning rounds to monitor therapy and help in the selection of the most appropriate drug regimen. At the end of the study period, antibiotic cost savings of 58.6 percent were achieved.

Effect of assay methodology on the prediction of lithium maintenance dosage

Test dose methods have been used to predict the maintenance dosage of lithium carbonate tablets in bipolar patients. These methods require a lithium analytical method that is accurate to the second decimal place. Successful use of these test methods has employed the atomic absorption spectrophotometric method, yet many hospitals use a flame spectrophotometric method. We evaluated a two-point method to predict lithium maintenance dosages of slow-release lithium carbonate tablets in 20 bipolar patients using both assay methodologies. No clinically significant differences were found between the two sets of predictions, suggesting that either assay methodology has requisite sensitivity and accuracy for use in test dose predictions of lithium maintenance dosages.

Effect of gamma irradiation on the B vitamins of pork chops and chicken breasts

A study was made of the effect of low-dose gamma irradiation on the content of thiamine (B1), riboflavin (B2), niacin, pyridoxine (B6) and cobalamin (B12) in pork chops, and thiamine, riboflavin and niacin in chicken breasts. Gamma irradiation from a caesium-137 source was used to irradiate the samples in a range of 0.49 to 6.65 kGy from -20 to +20 degrees C. Over the range of dose and temperature studied it was possible to derive a mathematical expression for predicting the losses. A calculation was made of the effect of the loss of thiamine, riboflavin and niacin due to irradiation on the overall loss of these vitamins in the American diet. The losses of riboflavin and niacin were of the order of a fraction of a per cent. Pork is an important source of thiamine, but the calculated loss at 1.0 kGy of this vitamin in cooked pork was only 1.5 per cent. There were initial increases with radiation doses up to 2-4 kGy in the measured concentrations of riboflavin and niacin in both pork and chicken. The increases were highly significant, and are of concern both to the study of radiation effects and the chemical method of the determination of these two vitamins.

Specifications for a mass producible static lounge chair for the elderly

An adjustable seating rig was used to create the three-dimensional shape of a static lounge chair. Elderly subjects from long-term care and rehabilitation hospital wards tested the chair. Questionnaires and video tapes were used to evaluate their comfort, posture, safety and ease of ingress/egress. The test shape was modified on the basis of results and retested to a total of four shapes. Contours and specifications of the final chair are presented.

Counselling in a general practice setting: controlled study of health visitor intervention in treatment of postnatal depression

OBJECTIVE

To determine whether counselling by health visitors is helpful in managing postnatal depression.

DESIGN

Controlled, random order trial.

SETTING

Health centres in Edinburgh and Livingston.

PATIENTS

Sixty women identified as depressed by screening at six weeks post partum and by psychiatric interview at about 13 weeks post partum. Five women did not wish to participate, and a further five did not complete the trial. Age, social and obstetric factors, and diagnosis were similar in women who completed the trial and those who withdrew.

INTERVENTION

Eight weekly counselling visits by health visitors who had been given a short training in counselling for postnatal depression.

END POINT

Reduction of depression. MEASUREMENTS and main results--Standardised psychiatric interviews and a 10 point self report scale were used to identify depression before and after intervention. The psychiatrist was not told to which group women were allocated. After three months 18 (69%) of the 26 women in the treatment group had fully recovered compared with nine (38%) of the 24 in the control group. The difference between the groups was thus 32% (95% confidence interval 5 to 58).

CONCLUSIONS

Counselling by health visitors is valuable in managing non-psychotic postnatal depression.

Chairs for the elderly--design considerations

Ageing brings a number of normal physical changes and sometimes is accompanied by diseases that affect physical functions and abilities. Therefore, the elderly require special consideration in the design of chairs. Requirements for three types of chairs for the elderly are presented. A description of a typical user of each chair provides a reference for the level of ability that must be accommodated. Features of the chairs that promote comfort, safety, ease of ingress and egress and ease of propulsion (where applicable) are discussed in relation to some of the special problems experienced by some of the older members of the population.

FDA's Factored Food Vocabulary for food product description

The Food and Drug Administration's Factored Food Vocabulary (FFV) uses standardized language to describe characteristics of food products that are important for food safety and nutritional quality. Each food product is described by a set of descriptors from the following factors: product type; food source; part of plant or animal; physical state, shape, or form; degree of preparation; cooking method; treatment applied; preservation method; packing medium; container or wrapping; food contact surface; and user group. The purpose of the vocabulary is to facilitate retrieval of food composition, food consumption, food contamination, and other food-related data relative to these factors. The major advantages of this system are flexibility with specificity, enhanced searchability with economy, and ease of change and updating.

Appropriateness of the use of serum lithium assays

The performance of 222 lithium assays was studied in a psychiatric hospital to determine if their use was appropriate and therapeutically beneficial. Charts of all patients whose serum lithium levels were measured in a month were reviewed to determine whether the assays were indicated, whether they were performed correctly, and whether the dosage was adjusted appropriately. Of the assays reviewed, 16 percent were performed for inappropriate indications and 98 percent were drawn at correct times. Of 157 assays that should not have resulted in a dosage change, 8 changes were made; of 63 assays that should have resulted in a dosage change, only 23 changes were made. Inappropriate orders for assays cost the hospital +5016 per year. If routine serum lithium assay monitoring is changed to a three-month frequency, the total cost savings would be +16,632 per year. Clinical pharmacists with specialized knowledge of clinical pharmacokinetics should work with physicians and treatment teams in monitoring serum drug assays to ensure appropriateness of assay request, more complete interpretation of results, and proper follow up.

Evaluation of a two-point method for prediction of lithium maintenance dosage

A lithium test dose method, based on the two-point method of Perry et al. (1982), was evaluated in 20 patients for the prediction of maintenance dosage of slow-release lithium carbonate tablets. These predictions were compared with the predictions obtained from the dosing chart of Cooper et al. (1973). The two-point method accurately predicted the maintenance dosage within clinically acceptable limits, but dosages predicted from the dosing chart would have yielded much higher serum lithium concentrations.

A nationwide sampling of fast-food fried chicken: starch and moisture content

A nationwide sampling plan was executed to estimate the nutrient composition of fast-food fried chicken in the United States. Ninety-four composite samples were selected from major chains in 10 cities. Starch contents were determined using a modified American Association of Cereal Chemists method. The amount of glucose formed during enzymatic hydrolysis was quantified either by a gas-liquid-chromatographic or a high-performance liquid chromatographic technique. The starch content ranged from 6% to 13% (wet weight basis). Moisture was determined by both microwave and vacuum oven methods; levels ranged from 38% to 49%. Analysis of variance for both starch and moisture indicated that starch was significantly (p less than .01) higher for light cuts than for dark cuts across all brands. Extra crispy recipes were significantly higher in starch than other recipes. Light cuts were significantly (p less than .01) lower in moisture than dark cuts. In addition, significant differences existed among brands. However, no significant difference was found between samples within a brand obtained from the five regions.

Vitamin and proximate composition of fast-food fried chicken

As part of the USDA's effort to obtain accurate data for nutrient composition handbooks, we determined proximate composition and vitamin (thiamin, riboflavin, niacin, folacin, pantothenic acid, and vitamins B-6 and B-12) content of fast-food fried chicken. Ninety-four samples were purchased from six chains in 10 cities throughout the United States. Vitamin content of breast and thigh meat portions differed, and slight differences in composition among brands were noted. Thiamin values for breast and thigh muscle, respectively, ranged from 0.062 to 0.136 and from 0.078 to 0.122 mg/100 gm; riboflavin, from 0.176 to 0.205 and 0.249 to 0.328 mg/100 gm; niacin, from 6.32 to 8.46 and 3.86 to 5.57 mg/100 gm; vitamin B-6, from 0.315 to 0.390 and 0.189 to 0.271 mg/100 gm; folacin, from 4.2 to 6.9 and 5.00 to 8.00 micrograms/100 gm; vitamin B-12, from 0.331 to 0.459 and 0.382 to 0.596 micrograms/100 gm; and pantothenic acid, from 1.48 to 1.68 and 1.58 to 1.77 mg/100 gm. Pressure-fried samples tended to have higher percentage moisture and lower percentage fat than crispy, open-vat fried samples. Fat ranged from about 15% to 20%.

Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale

The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.

Selenium content of a core group of foods based on a critical evaluation of published analytical data

References published since 1960 that report analyses of selenium in foods were collected and evaluated according to criteria in five categories: number of samples, analytical method, sample handling, sampling plan, and analytical quality control. Data were grouped by food item and rated according to the criteria that had been developed specifically for evaluating the quality of selenium data. Ratings assigned to the data from each study yielded a Quality Index, indicating which data would be included in the calculation of the mean selenium value for each food item. The Quality Indexes for acceptable studies were summed to determine a Confidence Code, intended to indicate the relative degree of confidence the user can have in each mean selenium value. The selection of selenium core foods was based on their selenium concentration and frequency of consumption. Foods were ranked by multiplying selenium concentration by the amount consumed by the 36,255 individuals who provided 3-day dietary intake data in the U.S. Department of Agriculture's 1977-78 Nationwide Food Consumption Survey. Mean, minimum, and maximum selenium values, Confidence Codes, ranks, and references have been compiled for 114 food items. The five most highly ranked food aggregates (beef, white bread, pork, chicken, and eggs) provided half of the selenium accounted for in the diets of the survey respondents.

Extent of artificial limb use following rehabilitation

The extent of prosthesis use is reported for 104 lower limb amputees from the onset of gait training up to 2 years later. Subjects were divided into groups according to age (greater than or equal to 65 years or less than 65 years) and amputation level. An analysis of variance including the factors of age and level of amputation was done. Unilateral trans-tibial (UTT) amputees progressed more quickly during the inpatient gait training program that did unilateral trans-femoral (UTF) subjects (p less than 0.05). UTT subjects also walked more than UTF subjects just prior to discharge (p less than 0.05), during the first year after discharge (p less than 0.01), and during the second year after discharge (p less than 0.01). Similarly, younger patients progressed more quickly in gait training (p less than 0.05) and walked more than older subjects throughout the study period (p less than 0.05). There were no significant interactions between age and amputation. The extent of walking of these amputees is compared with the minimal levels required for them to function in different living environments. At the time of discharge from the inpatient gait training program, older unilateral amputees and trans-femoral amputees were not able to walk the 600 steps a day necessary to manage with a moderate level of support in a one-level apartment or home. The declining number of steps taken in the follow-up period indicated that the UTF subjects might benefit from some special attention paid to their community support needs. These findings are also viewed in the context of limited data available on the extent of walking of non-amputees.

Results of the pilot phase of a clinical evaluation of computer aided design of trans-tibial prosthesis sockets

This study served as a pilot to develop the methodology for a larger number of clinical trials. Ten trans-tibial amputees compared sockets made by conventional methods with sockets made using computer aided socket design (CASD). Prosthetists, paired for experience, fitted each subject with one prosthesis using each method. A preferred socket was selected by the subject on the basis of comfort without knowledge of the method by which the socket was designed. Prosthetists also evaluated the sockets. Three subjects preferred sockets built using CASD and one subject preferred the conventional socket only slightly more than the CASD socket. Six subjects clearly preferred the conventional fitting.

Selenium in self-selected diets of Maryland residents

The mean selenium level in six self-selected, daily diets chosen by each of 22 free-living Maryland residents was 81 +/- 41 microgram. per day. Diets that were higher in selenium also were significantly higher in copper, iron, magnesium, and manganese and slightly higher in zinc. However, in general, the levels of these minerals were low, probably because of low consumption of grains, legumes, and nuts. Diets higher in selenium contained more fish and less processed meat than other diets.

Norm qualities and alcoholism

This study examined the relationship between three types of norms and chronic alcoholism. Three types of norms-proscriptive, prescriptive, and nonscriptive-were used as categories to investigate the norms of American chronic alcoholics. Five sources of norms were used to investigate the norms of American chronic alcoholics. Five sources of norms were used to identify the reference groups who were perceived as influencing the alcoholics' drinking patterns. The reference groups included co-workers, church, family, friends, and parents. Among 85 American subjects, chronic alcoholism tended to be highest in a proscriptive environment, lower in a prescriptive environment, and lowest in a nonscriptive environment. Proscriptive norms were those which were perceived as stating directly that a person should not drink excessively at all. The sources of the proscriptive norms were analyzed. Church and parents were found to be the perceived sources of proscriptive norms for the chronic alcoholics studied. The data suggest that both parents and church members need to be taken into consideration when planning rehabilitation programmes for chronic alcoholics.

Zinc and copper in self-selected diets

Levels of zinc and copper in the self-selected diets of twenty-two men and women were determined by atomic absorption spectrophotometry. Sixty-eight per cent of the subjects consumed less than two-thirds of the recommended allowance for zinc (15 mg). Eighty-one per cent consumed less than two-thirds of the suggested level of copper (2.0 mg). Average daily intake of protein exceeded the recommended allowance. However, the mean zinc:calorie ratio for those subjects was only 4.19 mg. per 1,000 kcal. Using the recommended allowances for zinc and for energy, the zinc:calorie ratio would be 6.5 mg. per 1,000 kcal. For copper, the suggested nutrient density is 0.85 mg. per 1,000 kcal vs. the 0.50 mg. per 1,000 kcal observed in this study. These metallo:calorie ratios indicate that the nutrient density of these two trace elements in the diet is low and that diets supplying adequate amounts of energy and protein do not guarantee adequate levels of zinc and copper.

Amoxapine in depressive illness

A double-blind trial was carried out in 29 patients recently admitted to hospital with depressive illness to compare the effectiveness and side-effect liability of treatment with amoxapine and imipramine. Both drugs were given in a dosage of 25 mg 3-times daily over a period of 4 weeks, and patients' progress was assessed using psychiatric and psychological rating scales for depression. Although amoxapine and imipramine proved equally effective, response to amoxapine was quicker and appeared to have the same effect after 1 week as did imipramine after 2 weeks. In addition, dryness of the mouth was complained of most frequently by patients taking imipramine.

A short interview as an assessment of student health and potential

A prospective study of the effectiveness of a short interview in assessing health needs and potential performance of students. The results indicate that such an interview is of limited value in the recognition of the vulnerable student, can predict performance of the best students with reasonable accuracy, can recognise potential drop-outs, but failed to distinguish in a borderline group between those likely to succeed and those not.