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Hartley KA, Guthrie KD, Stoner SC, May JR, Hartwig DM, Liu Y. Community Pharmacist Telephonic Medication Reviews with Uncontrolled Asthma Patients: A Pilot Study. Pharmacy (Basel) 2021; 9:pharmacy9010025. [PMID: 33499009 PMCID: PMC7838915 DOI: 10.3390/pharmacy9010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 11/16/2022] Open
Abstract
This study reports the process of telephonic medication reviews conducted by community pharmacists for patients with asthma. The study occurred at an independent community chain in association with a Missouri Medicaid consulting group. Participants were identified utilizing claims data and met the National Quality Forum criteria for uncontrolled moderate-to-severe persistent asthma. A pharmacist performed the initial encounter via telephone which included a knowledge questionnaire, symptom control assessment, and medication review. Pharmacists identified drug-related problems (DRPs) and faxed recommendations to patients’ primary care providers (PCPs). Thirty days later, pharmacists called to follow up with the patients and faxed PCPs to resolve any outstanding DRPs, new DRPs, or recommendations. Questionnaire scores and symptom control assessments were compared and analyzed utilizing a paired t-test, Chi-squared test, or Fisher’s exact test. The number and categories of DRPs, recommendations made by pharmacists, and intervention time were reported. Fourteen participants completed initial encounters with twelve completing follow-up. The majority answered ‘yes’ to at least one symptom control assessment question indicating partially controlled to uncontrolled asthma. The average knowledge assessment score was 5.17 out of 7 initially and 5.42 for the follow-up. Pharmacists identified 43 DRPs and made 41 recommendations with a mean intervention time of 65 min.
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Affiliation(s)
- Kathryn A. Hartley
- Pharmacy, University of Kansas Health System, Kansas City, KS 66160, USA;
| | - Kendall D. Guthrie
- School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.C.S.); (Y.L.)
- Correspondence:
| | - Steven C. Stoner
- School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.C.S.); (Y.L.)
| | - Justin R. May
- Bothwell Regional Health Center, Sedalia, MO 65301, USA;
| | | | - Yifei Liu
- School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.C.S.); (Y.L.)
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Liu Y, Guthrie KD, May JR, DiDonato KL. Community Pharmacist-Provided Wellness and Monitoring Services in an Employee Wellness Program: A Four-Year Summary. Pharmacy (Basel) 2019; 7:E80. [PMID: 31269732 PMCID: PMC6789580 DOI: 10.3390/pharmacy7030080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 06/22/2019] [Accepted: 06/28/2019] [Indexed: 12/26/2022] Open
Abstract
Objective: To assess the clinical outcomes of participants of an employee wellness program during four years of service implementation. Methods: A prospective cohort study was conducted at 15 independent community pharmacy chain locations in northwest and central Missouri. A total of 200 participants were enrolled in an employee wellness program, and the program included five monitoring groups-cholesterol, blood pressure, blood glucose, weight, and healthy participant groups. Participants selected a pharmacist wellness coordinator and wellness appointments were conducted, consisting of education, goal-setting, and monitoring through physical assessment and point of care testing. The primary outcome measures were total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), body mass index (BMI), and waist circumference (WC). The secondary outcome measures were the proportion of patients who achieved the clinical value goals at baseline versus 48 months. The primary outcome measures among data collection time points were compared using one-way analysis of variance (ANOVA) tests, and the secondary outcomes were compared between baseline and 48 months by Chi-square or Fisher's exact tests. One-way ANOVA post hoc tests were also performed using least significant difference, to further identify which time points differed from each other. Results: At baseline, there were 134 patients in the cholesterol monitoring group, 129 in the weight monitoring group, 117 in the blood pressure monitoring group, 46 in the blood glucose monitoring group, and 26 in the healthy participant monitoring group. For patients in the blood pressure monitoring group, compared with baseline, there was a significant decrease in DBP at months 12, 24, 36, and 48, and a significant increase in the proportion of patients achieving blood pressure goals at 48 months. For patients in the blood glucose monitoring group, compared with baseline, there was a significant decrease in FBG at months 12, 24, 36, and 48, and a significant increase in the proportion of patients achieving blood glucose goals at 48 months. Conclusions: Pharmacist-led wellness visits provided to employee wellness patients in a community pharmacy may lead to improvements in BP and FBG values.
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Affiliation(s)
- Yifei Liu
- Division of Pharmacy Practice and Administration, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Kendall D Guthrie
- Division of Pharmacy Practice and Administration, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO 64108, USA.
| | - Justin R May
- Bothwell Regional Health Center, Sedalia, MO 65301, USA
| | - Kristen L DiDonato
- The Kroger Co. Columbus Division, Kroger Pharmacy, Toledo, OH 43615, USA
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Tetuan CE, Guthrie KD, Stoner SC, May JR, Hartwig DM, Liu Y. Impact of community pharmacist–performed post-discharge medication reviews in transitions of care. J Am Pharm Assoc (2003) 2018; 58:659-666. [DOI: 10.1016/j.japh.2018.06.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 06/01/2018] [Accepted: 06/24/2018] [Indexed: 11/26/2022]
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Séraphin MN, Didelot X, Nolan DJ, May JR, Khan MSR, Murray ER, Salemi M, Morris JG, Lauzardo M. Genomic Investigation of a Mycobacterium tuberculosis Outbreak Involving Prison and Community Cases in Florida, United States. Am J Trop Med Hyg 2018; 99:867-874. [PMID: 29987998 PMCID: PMC6159577 DOI: 10.4269/ajtmh.17-0700] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 05/18/2018] [Indexed: 01/10/2023] Open
Abstract
We used whole-genome sequencing to investigate a tuberculosis outbreak involving U.S.-born persons in the prison system and both U.S.- and foreign-born persons in the community in Florida over a 7-year period (2009-2015). Genotyping by spacer oligonucleotide typing and 24-locus mycobacterial interspersed repetitive unit-variable number tandem repeat suggested that the outbreak might be clonal in origin. However, contact tracing could not link the two populations. Through a multidisciplinary approach, we showed that the cluster involved distinct bacterial transmission networks segregated by country of birth. The source strain is of foreign origin and circulated in the local Florida community for more than 20 years before introduction into the prison system. We also identified novel transmission links involving foreign and U.S.-born cases not discovered during contact investigation. Our data highlight the potential for spread of strains originating from outside the United States into U.S. "high-risk" populations, such as prisoners, with subsequent movement back to the general community.
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Affiliation(s)
- Marie Nancy Séraphin
- Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
| | - Xavier Didelot
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - David J. Nolan
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida
- Bioinfoexperts, LLC, Thibodaux, Louisiana
| | - Justin R. May
- Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
| | - Md Siddiqur Rahman Khan
- Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
| | - Ellen R. Murray
- Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
| | - Marco Salemi
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - J. Glenn Morris
- Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
| | - Michael Lauzardo
- Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
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Guthrie KD, Stoner SC, Hartwig DM, May JR, Nicolaus SE, Schramm AM, DiDonato KL. Physicians' Preferences for Communication of Pharmacist-Provided Medication Therapy Management in Community Pharmacy. J Pharm Pract 2016; 30:17-24. [PMID: 26033794 DOI: 10.1177/0897190015585764] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES (1) To identify physicians' preferences in regard to pharmacist-provided medication therapy management (MTM) communication in the community pharmacy setting; (2) to identify physicians' perceived barriers to communicating with a pharmacist regarding MTM; and (3) to determine whether Missouri physicians feel MTM is beneficial for their patients. METHODS A cross-sectional prospective survey study of 2021 family and general practice physicians registered with MO HealthNet, Missouri's Medicaid program. RESULTS The majority (52.8%) of physicians preferred MTM data to be communicated via fax. Most physicians who provided care to patients in long-term care (LTC) facilities (81.0%) preferred to be contacted at their practice location as opposed to the LTC facility. The greatest barriers to communication were lack of time and inefficient communication practices. Improved/enhanced communication was the most common suggestion for improvement in the MTM process. Approximately 67% of respondents reported MTM as beneficial or somewhat beneficial for their patients. CONCLUSIONS Survey respondents saw value in the MTM services offered by pharmacists. However, pharmacists should use the identified preferences and barriers to improve their currently utilized communication practices in hopes of increasing acceptance of recommendations. Ultimately, this may assist MTM providers in working collaboratively with patients' physicians.
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Affiliation(s)
- Kendall D Guthrie
- 1 Red Cross Pharmacy, Inc, Warrensburg, MO, USA.,2 Was PGY1 Community Practice Resident, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA at the time this study was conducted
| | - Steven C Stoner
- 3 School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | | | | | | | - Kristen L DiDonato
- 3 School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA.,4 Red Cross Pharmacy, Inc, Excelsior Springs, MO, USA
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Hart JD, Lutz CT, Jennings CD, May JR, Nelson K, Jacobs S, Hoopes CW. Falsely incompatible B-cell flow cytometry crossmatch after pronase treatment: a case report. Transplant Proc 2015; 47:831-3. [PMID: 25891741 DOI: 10.1016/j.transproceed.2014.12.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 12/04/2014] [Accepted: 12/31/2014] [Indexed: 11/26/2022]
Abstract
This report presents a falsely incompatible B cell crossmatch by flow cytometry in a lung transplant recipient. The patient was a 35-year-old Caucasian male with end-stage lung disease secondary to cystic fibrosis whose pretransplantation serologic workup did not disclose the presence of anti-HLA class II antibodies by single antigen bead testing. Unexpectedly, crossmatch of recipient sera with pronase-treated donor lymphocytes resulted in antibody binding to B cells only. The positive reactivity was reproducible in pronase-treated autologous B cells. Recipient sera did not react with nontreated donor or autologous lymphocytes. Herein, we describe our approach to this unexpected crossmatch result and consider the implications of false-positive crossmatch results on transplantation.
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Affiliation(s)
- J D Hart
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky
| | - C T Lutz
- Department of Microbiology, Immunology, and Molecular Genetics, University of Kentucky, Lexington, Kentucky.
| | - C D Jennings
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky
| | - J R May
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky
| | - K Nelson
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky
| | - S Jacobs
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky
| | - C W Hoopes
- Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky
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DiDonato KL, Vetter KR, Liu Y, May JR, Hartwig DM. Examining the Effect of a Medication Synchronization or an Education Program on Health Outcomes of Hypertensive Patients in a Community Pharmacy Setting. Innov Pharm 2014. [DOI: 10.24926/iip.v5i3.357] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To examine the effect of a medication synchronization or education program on hypertensive health outcomes.
Methods: This study used a design of randomized controlled trial lasting four months taking place within a family-owned community pharmacy chain in a U.S. Midwestern state. A total of 302 hypertensive patients were randomized into 3 study groups - control, medication synchronization, and education. Interventions included management of medication refills through a medication synchronization program for the medication synchronization group, and monthly hypertension (HTN) education for the education group. Outcome measures included systolic blood pressure (SBP), diastolic blood pressure (DBP), percentage of patients at blood pressure (BP) goal, self-rated change in medication adherence, and patients' HTN knowledge.
Results: All groups had significant decline of SBP from baseline; however the final analysis showed no significant SBP differences among study groups. The proportion of patients achieving BP goals in both the control (p=0.005) and education (p=0.019) groups increased at Month 4. Changes in self-reported adherence were not significant for any groups. All groups showed positive changes on HTN knowledge questions with the education group showing the greatest change.
Conclusion: Compared to the control group, there was no difference in the primary outcomes. However, this study demonstrated that educational materials written at an appropriate level and presented by community pharmacists to patients may have been associated with an increase in HTN knowledge and a significant increase in the proportion of patients achieving their BP goal. These educational interventions had a greater impact on helping patients achieve their blood pressure goals than medication synchronization. This may indicate that further intervention is needed to impact adherence aside from ensuring that patients have their medication on hand. Taking the time to educate patients about hypertension led to self-reported positive change with being more careful about taking medications and with not forgetting to take medications when they felt better.
Type: Original Research
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Schramm AM, DiDonato KL, May JR, Hartwig DM. Implementation of a financially incentivized weight loss competition into an already established employee wellness program. Innov Pharm 2014. [DOI: 10.24926/iip.v5i3.352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To assess improvement in clinical outcomes and patient satisfaction of a financially incentivized weight loss competition adjunct to a currently established pharmacist-directed employee wellness program.
Design: Retrospective, cohort, pilot study
Setting: 6 independent community pharmacy chain locations, two long-term care pharmacies, and a pharmacy corporate office in northwest and central Missouri, from January 2013 to April 2013.
Participants: 24 benefit-eligible patients employed by the self- insured pharmacy chain.
Intervention: A financially incentivized weight loss competition focusing on healthy lifestyle practices was implemented at nine pharmacy locations over an eight week period.
Main outcome measure(s): Change from baseline in mean total cholesterol, serum triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), diastolic blood pressure (DBP), weight, and body mass index (BMI). Patient satisfaction was also assessed after completion.
Results:24 patients completed the competition. The average weight loss among all participants was 10 ± 7.3 pounds. A mean decrease in serum triglycerides was significant at 36.9 mg/dL per participant (p
Conclusion: The implementation of a financially incentivized weight loss competition provided significant short-term weight loss to a patient population that was already enrolled in an established pharmacist-directed employee wellness program and had not shown clinical improvement prior to the intervention. Overall the patients were satisfied, felt healthier, and agreed to continue following the recommendations of the program.
Type: Original Research
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DiDonato KL, May JR, Lindsey CC. Impact of wellness coaching and monitoring services provided in a community pharmacy. J Am Pharm Assoc (2003) 2013; 53:14-21. [DOI: 10.1331/japha.2013.11227] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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May JR. Allergic rhinitis: nothing to sniffle at. J Am Pharm Assoc (Wash) 2001; 41:891-2. [PMID: 11765115 DOI: 10.1016/s1086-5802(16)31339-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Affiliation(s)
- J R May
- Medical College of Georgia Hospitals & Clinics, Augusta, USA.
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Platts WE, May JR. Defending against violence in hospitals. J Healthc Prot Manage 1999; 14:1-7. [PMID: 10182051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The authors examine the rise of violence in the healthcare setting and present some practical methods for identifying high-risk individuals and reducing the incidence of violence. Some commonsense strategies are presented to help healthcare security professionals combat workplace violence.
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Affiliation(s)
- W E Platts
- Providence Hospital and Medical Centers, Southfield, MI, USA
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Abstract
OBJECTIVE To analyze the current practice of drug information and develop a strategic plan for a "valued" specialty of medication information practice. DATA SOURCES The Consortium for the Advancement of Medication Information, Policy, and Research (CAMIPR) met in June 1994 to initiate a strategic plan for a future of medication information practice. A multidimensional situation analysis and strategic planning process was conducted and the results are discussed. RECOMMENDATIONS Trends in health care (e.g., healthcare reform, managed care) will impact the future of medication information practice, and the medication information specialist must evolve with society's values. Medication information practice must transform and attention will likely focus on medication policy research/ development and information systems. However, new skills, resources, and relationships must be developed to facilitate this evolution. In addition, interest in the practice of drug information has declined. Strategies are presented to enhance the "value" and "image" of future medication information practice.
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Affiliation(s)
- G J Vanscoy
- Drug Information and Pharmacoepidemiology Center, University of Pittsburgh Medical Center, USA
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13
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May JR. Hospital violence. J Healthc Prot Manage 1996; 11:25-44. [PMID: 10144024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The author discusses the problem of healthcare violence, including factors that contribute to it, how to identify high-risk individuals, the socioeconomic impact of assault injuries, violence associated with prisoners as patients, and psychiatric ward violence. He also provides an outline of emergency department security survey procedures, as well as guidelines for improving hospital security.
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Affiliation(s)
- J R May
- Henry Ford Community College, Dearborn, MI, USA
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Phillips MS, Williams DB, May JR. Using pharmacist clinical intervention data for quality improvement of medication use and physician assessment. Jt Comm J Qual Improv 1994; 20:569-76. [PMID: 7842063 DOI: 10.1016/s1070-3241(16)30103-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Patient-specific intervention data are often used for drug usage evaluation (DUE), but their use in physician assessment is less often discussed. In response to the quality assurance department's request, the pharmacy department at the Medical College of Georgia (Augusta) developed a database and a reporting system that supports quality assessment of the medical staff, identifies housestaff education needs, and directs efforts for improvement in medication use. THE REPORTING SYSTEM: In 1991 the comprehensive, concurrent screening of drug therapy by pharmacists formed the foundation of the hospital's DUE program. Each month information from the pharmacy database is sorted with use of a spreadsheet software program to generate medical department-level reports and for use in physician reappointment. Identified performance deficiencies can be used to educate individual prescribers and to develop educational programs for the department or specialty areas. Feedback from the medical staff assessment is useful for pharmacist education, such as identifying newly reported indications and dosage regimens. RESULTS During the first six months after all pharmacists began participating in the reporting program, a mean of 224 interventions were recorded monthly. For the period January through June 1994, 400-550 interventions were recorded monthly. System improvements in medication during the first year of implementation included hospitalwide guidelines for parenteral potassium and phosphate dosing and administration and a renewed focus on patient allergies. CONCLUSION Emphasis for use of intervention data has shifted from identifying "problem" persons to improving performance by identifying topics for corrective education and redesigning systems to promote positive patient outcomes.
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Affiliation(s)
- M S Phillips
- Pharmacy Department, Medical College of Georgia Hospitals & Clinics, Augusta 30912-5600
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May JR, Rutkowski AF. The role of nondepolarizing neuromuscular blocking agents in mechanically ventilated patients. J Med Assoc Ga 1994; 83:473-6, 484. [PMID: 7822974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Prolonged use of the nondepolarizing neuromuscular blocking agents in the critical care setting has greatly increased in the recent past. Accompanying the increased use of these agents are numerous accounts of long-lasting adverse outcomes such as muscular atrophy and neuropathy that can be attributed to pharmacologic paralysis. There has been a financial impact on hospitals as well. Responding to these facts, the medical staff at the Medical College of Georgia Hospital and Clinics recently approved guidelines for the use of nondepolarizing neuromuscular blocking agents in the intensive care setting. These guidelines recommend clinical indications for these agents and dosing ranges reflecting current medical opinion.
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Affiliation(s)
- J R May
- University of Georgia College of Pharmacy
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Rogers DA, Dingus D, Stanfield J, Dipiro JT, May JR, Bowden TA. A prospective study of patient-controlled analgesia. Impact on overall hospital course. Am Surg 1990; 56:86-9. [PMID: 2407164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Previous studies have shown that patient-controlled analgesia (PCA) provides effective pain control in the postoperative patient. To determine the impact of PCA technology on the overall hospital course, we designed a randomized controlled study comparing patients receiving analgesia using PCA infusion (Abbott Lifecare, Abbott Laboratories; Chicago, IL) with patients receiving analgesia by traditional intramuscular or intravenous methods. All patients had undergone elective cholecystectomy. Sixty-nine patients completed the study, 35 received traditional postoperative analgesia, and 34 received analgesia using the PCA infuser. Comparison of both groups demonstrated no significant difference in postoperative bowel activity with both groups receiving liquids on the first postoperative day. There was no significant difference between the two groups with respect to postoperative length of stay (3.4 days for PCA vs 3.6 days for traditional). Patients demonstrated a wide range of analgesic requirement in the first 24 hours but the average of the total analgesic required was higher in the PCA group (average, 29.5 mg) than the traditional group (22.8 mg). Urinary complications occurred more commonly in the group of patients receiving traditional analgesia than in the group of patients receiving analgesia with the PCA device. When compared with patients receiving analgesia by traditional methods, patients receiving the PCA infusion required more analgesia with fewer urinary complications and similar postoperative length of stay.
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Affiliation(s)
- D A Rogers
- Department of Surgery, Medical College of Georgia, Augusta
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Mansberger AR, Doran JE, Treat R, Hawkins M, May JR, Callaway BD, Horowitz M, Horowitz B, Shulman R. The influence of fibronectin administration on the incidence of sepsis and septic mortality in severely injured patients. The Medical College of Georgia Fibronectin Research Group. Ann Surg 1989; 210:297-306; discussion 306-7. [PMID: 2505698 PMCID: PMC1357990 DOI: 10.1097/00000658-198909000-00005] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Eighty-five trauma patients between the ages of 18 and 55, with American College of Surgeon's (ACOS) trauma scores greater than or equal to 7 were entered into a double-blind, randomized, placebo-controlled study to assess the efficacy of prophylactic fibronectin (Fn) administration on clinical course, sepsis development, and septic mortality. Patients were randomized on admission to receive purified human virus-inactivated Fn or placebo control (human serum albumin, HSA). Fn or HSA was administered on a daily basis if and when the patient was Fn deficient (less than 75% normal). When a Fn deficiency was not evident, the patient received saline. Seventy one patients developed Fn deficiencies during their initial clinical course: 36 received Fn, 35 received HSA. Fourteen patients did not develop a Fn deficiency after trauma and thus received only saline. Analysis of admission data demonstrated no significant differences between the three groups with respect to extent of injury (injury severity score, ACOS trauma score) or physiologic assessments of organ function (serum creatinine, bilirubin, lactic acid). On day 1 after trauma, Fn levels were shown to correlate with other plasma proteins and cellular components (range of r values, 0.24 to 0.75; all p less than 0.05), but not with organ function parameters. Eighteen of 85 patients became septic as judged by clinical criteria. Ten of these patients had received Fn (10 of 36), five had received HSA (5 of 35), and three had received only saline (3 of 14) before the development of sepsis (differences not significant). When septic, nine of 17 patients developed Fn deficiencies. Six patients received Fn while septic, three received albumin, and eight received saline. Seven patients died: 5 of 6 Fn patients, 1 saline, and 1 HSA recipient. Our data suggest that exogenous Fn repletion in states of deficiency does not alter clinical course, the development of sepsis, or septic mortality.
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Affiliation(s)
- A R Mansberger
- Department of Surgery, Medical College of Georgia, Augusta 30912
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Abstract
The concepts of having fun and being aware of feeling states are presented as two critical factors in ski racing. First, the positive motivational characteristics of 'fun' are outlined. It is suggested that fun is not only a concept for young athletes but elite ones as well. Preliminary data based on a questionnaire, completed by the United States Alpine Ski Team and approximately 150 ski coaches, are represented. Second, the discussion on feelings refers to the mental programming of tactile sensations and determining one's emotional arousal (feeling state) prior to, and during, competition. Practical suggestions are made with regard to the psychological states and their effects on ski racing.
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Affiliation(s)
- J R May
- Department of Psychiatry and Behavioural Sciences, University of Nevada School of Medicine, Reno 89557
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May JR. How we review patient profiles regarding Rx and OTC drugs. Pharm Times 1987; 53:35-8. [PMID: 10283622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Spooner LE, May JR. How you can help to avoid medication errors in your hospital pharmacy. Pharm Times 1987; 53:101-5. [PMID: 10282423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Abstract
Drug interactions, defined as when the administration of a single substance (drug, nutrient, or tobacco) modifies the response to a drug, occur relatively frequently in surgical patients and may result in increased morbidity and lengthened hospital stay. Drug interactions also account for some instances of drug ineffectiveness or exaggerated pharmacologic response. There are many types of drug interactions. However, most of them are related to altered drug pharmacokinetic properties, where there are alterations in drug absorption, distribution, metabolism, or elimination; or altered drug pharmacodynamic actions, where two agents may have synergistic, additive, or antagonistic pharmacologic effects. The term, drug interaction, usually refers to pairs of drug substances administered concurrently, but more than two agents may be involved. When patients are taking a large number of different medications, there may be multiple drug interactions with additive or antagonistic effects, the overall effects of which are difficult to predict. There are hundreds of reported drug interactions, and some may be of important clinical consequence. In surgical patients, the majority of drug interactions involve histamine-2 blockers (particularly cimetidine), digoxin, warfarin, or a variety of agents that may be administered during anesthesia. Recognition of the potential for adverse drug interactions is of primary importance in minimizing their effects. Usually, potentially interacting drugs may be administered concurrently as long as appropriate patient or laboratory assessments are performed. For some agents, such as digoxin or theophylline, serum drug concentrations may aid in the avoidance of adverse drug interactions.
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Abstract
In brief: We assessed life events, depression, and general well-being (health concerns, energy, life satisfaction, cheerfulness, tension, and emotional control) in 73 members of the US Alpine Ski Team. We compared these psychological factors with subsequent surveys of general health, illness, and athletic performance and found that psychological status (especially general well-being) was associated with subsequent health problems, injuries, and performance levels. These findings indicate that coaches and sports medicine specialists must be sensitive to psychological disorders in elite athletes and provide appropriate clinical assessment and treatment.
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Durrence CW, DiPiro JT, May JR, Nesbit RR, Sisley JF, Cooper JW. Potential drug interactions in surgical patients. Am J Hosp Pharm 1985; 42:1553-6. [PMID: 4025352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The incidence and frequency of potentially serious drug interactions were evaluated in hospitalized surgical patients. Drug profiles of patients on the general surgical service of a tertiary-care teaching hospital were retrospectively reviewed for two six-month periods to determine how often drugs that are known for major interactions were prescribed concurrently. Interactions were studied that were relatively well documented and potentially harmful to the patients. A total of 1825 patient profiles were reviewed (21,888 patient days). At least one potential drug interaction was found in 17% of the patients. Interactions were found to occur at the rate of 1 for every 59 patient days. Digoxin and cimetidine were the potential interacting drugs in almost 90% of the cases. Hospitalized surgical patients require close monitoring because they frequently receive potentially interacting drugs.
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Majercik PL, May JR, Longe RL, Johnson MH. Evaluation of pharmacy and therapeutics committee drug evaluation reports. Am J Hosp Pharm 1985; 42:1073-6. [PMID: 4003418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Pharmacy and therapeutics (P & T) committee drug evaluation reports prepared by pharmacies and drug information centers (DICs) and product package inserts were compared with standard guidelines to evaluate their quality. Letters were sent to 143 hospital pharmacies asking them to submit a previously prepared drug evaluation report on temazepam, moxalactam disodium, or atenolol. The reports and package inserts for these three drugs were evaluated by the presence of 40 elements derived from the published ASHP guidelines for drug evaluation report preparation. Responses were obtained from 124 (87%) pharmacies; however, only 80 reports (60 DIC-prepared and 20 pharmacy-prepared) were received. The reports contained a mean of 28 of the 40 (70%) possible elements. The most frequently omitted elements were AHFS number, potential unlabeled uses, drug-drug interactions, drug-disease-laboratory test interactions, risk and benefit data, prevention and treatment of side effects, comparisons with established treatment, and disadvantages of the drug under consideration. Although the reports prepared by the DICs and pharmacies contained the same amount of information, the DIC-prepared reports included data more frequently on supply sources, therapeutic indications, approved labeling, comparison with established treatment, bioavailability and pharmacokinetics, and recommendations. Most of the reports contained more elements than the corresponding package inserts. The product package inserts did not contain the comparative elements required for P & T committee decisions. Both the pharmacy- and DIC-prepared reports failed to contain all 40 elements recommended in the standard guidelines, suggesting the need for more thorough reports.
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Jamieson DM, Guill MF, Wray BB, May JR. Metabisulfite sensitivity: case report and literature review. Ann Allergy 1985; 54:115-21. [PMID: 2578754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Sulfiting agents have recently been identified as food and drug additives responsible for adverse reactions. These reactions are not rare and may result in life-threatening asthma and anaphylaxis. We report a 34-year-old female with intractable asthma and urticaria. Sensitivity to sulfites was suspected based on exacerbation after restaurant meals and metaproterenol 5% inhalant solution. Bronchial provocation challenge resulted in a 28% decrease in FEV1 and a 34% decrease in FEF25-75 at the 0.01 mg/ml dose. Thirty-two cases of sulfite sensitivity reported in the literature are reviewed. Foods and drugs containing sulfites are listed. The pathogenic mechanism is unknown. The FDA allows the addition of sulfites to foods and drugs without disclosure. Only recently has this potential hazard been recognized. The FDA is considering a labeling requirement on drugs that do contain sulfites.
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Griffin JW, May JR, DiPiro JT. Drug interactions: theory versus practice. Am J Med 1984; 77:85-9. [PMID: 6507453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Cimetidine inhibition of P-450 oxidative metabolism results in interactions with many drugs, leading to clinically significant drug toxicity. A one-year survey of inpatient prescribing practices revealed a 32.6 percent incidence of concomitant cimetidine and interacting drug use. Retrospective chart review showed statistically significant increased toxic drug plasma levels in patients receiving theophylline and cimetidine, and a strong trend to increased rates of drug toxicity in phenytoin-cimetidine treated patients. Ranitidine appears to be a superior choice in patients receiving drugs metabolized by P-450 oxidation. When cimetidine and known interacting drugs are prescribed together, more frequent assessment of blood levels of the affected drug will be required, increasing substantially the cost to patients. Drug interactions of clinical significance occurring due to altered absorption because of effects of H2-receptor antagonists on gastric secretion are reviewed.
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May JR, Andrusko KT, DiPiro JT. Impact and cost justification of a surgery drug newsletter. Am J Hosp Pharm 1984; 41:1837-9. [PMID: 6496519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Abstract
Training in progressive muscle relaxation can improve psychophysiological response to stress but is often time-consuming and may prove ineffective for some individuals. Nitrous Oxide (N2O)may offer an effective adjunct or alternative to training. This study evaluated the relative efficacy of these procedures. Subjects were randomly assigned to one of four treatment conditions: relaxation-only, N2O only, relaxation with N2O, and room air-control. The relaxation procedure was modeled on color videotape. Nitrous oxide was administered from a balloon. In addition to various psychological measures, treatment effects were measured for skin temperature, heart rate, systolic blood pressure, and two measures of diastolic blood pressure. Subjective reports of tension were also recorded. There was a significant multivariate difference between treatment groups. The relaxation-only procedure was generally superior to the others on most dependent measures. Subjects receiving N2O appear to have experienced an improvement in mood. Paradoxically, the initially more relaxed subjects seemed to derive the greater benefit from the inhalation of N2O. The use of videotape-modeled relaxation procedures is discussed.
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Waitley DE, May JR, Martens R. Sports psychology and the elite athlete. Clin Sports Med 1983; 2:87-99. [PMID: 6627423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Stillman PL, May JR, Meyer DM, Rutala PJ, Veach TL, Montgomery AB. A collaborative effort to study methods of teaching physical examination skills. J Med Educ 1981; 56:301-306. [PMID: 7218294 DOI: 10.1097/00001888-198104000-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
A collaborative study was conducted between two medical schools to evaluate critically the teaching of physical examination skills to first-year medical students, assess the effect of different instructional methods on student performance, and improve teaching programs at both schools. Students at the two schools were videotaped performing a physical examination on a paid model at the completion of their physical diagnosis courses. The videotapes were sent to a third school for independent evaluation based on criteria agreed upon by all three schools. Students participating in a highly structured course and utilizing a very specific behavioral checklist as both a teaching and evaluating instrument tended to perform more complete physical examinations than students from a less structured course and employing a more generalized checklist. Both medical schools benefited from participation in the study.
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May JR. The hospital and neighborhood health centers. Case Stud Health Adm 1977; 1:194-200. [PMID: 10287544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Abstract
The induction of L-forms of Haemophilus influenzae by penicillin, amoxycillin and glycine has been studies in vitro on a nutrient-agar medium. The minimal inducing concentrations of the antibiotics were generally the same as their minimal inhibitory concentrations, but the addition of a sub-inducing concentration of glycine lowered the minimal inducing concentration of penicillin. Preliminary observations have shown that L-forms are induced by penicillin or amoxycillin on a medium in which mucoid sputum forms the sole source of nutrients, and that they remain viable for at least 48 h in the absence of added osmotic stabiliser. The minimal inducing concentration on "sputum agar" is within the range of concentrations measured in sputum from patients receiving amoxycillin therapy. The implications of these observations in relation to bactericidal therapy of haemophilus infections of the respiratory tract are discussed.
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May JR, Roberts DE, Ingold A, Want SV. Osmotically stable L forms of Haemophilus influenzae and their significance in testing sensitivity to penicillins. J Clin Pathol 1974; 27:560-4. [PMID: 4547629 PMCID: PMC475396 DOI: 10.1136/jcp.27.7.560] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The sensitivity of Haemophilus influenzae to penicillins in vitro, determined either by serial antibiotic dilution in broth or by the disc method on agar, is apparently profoundly influenced by inoculum size if the results are read by macroscopic inspection. Microscopic inspection of the growth, however, reveals that the turbidity in heavily inoculated broth containing concentrations higher than the minimal inhibitory concentration is the product of L forms which have failed to succumb to osmotic lysis. Similarly, minute colonies appearing in the ;inhibition zone' of disc tests are composed of L forms. In both broth and agar tests reduction of the osmolality of the medium from 340 to 144 mOsm per kg failed to bring about lysis of organisms exposed either to ampicillin or amoxycillin. The significance of this remarkable osmotic stability of haemophilus L forms is discussed in relation both to testing of sensitivity of this organism to penicillins and to persistence of chronic haemophilus infections of the lower respiratory tract.
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Davies JL, Laughton CR, May JR. An improved test for Haemophilus influenzae precipitins in the serum of patients with chronic respiratory disease. J Clin Pathol 1974; 27:265-8. [PMID: 4211799 PMCID: PMC478099 DOI: 10.1136/jcp.27.4.265] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The detection of antibacterial precipitins in the serum of patients with chronic lower respiratory infections has been shown to be of great value in the assessment of pathogenicity of the corresponding bacterial species in the sputum. The test used hitherto, however, is time-consuming and cumbersome owing to the need to distinguish, by immunoelectrophoresis, between antibodies specific to the organism in question and those which react with antigens common to various Gram-negative species. A method has now been devised for the preparation of an extract of Haemophilus influenzae containing species-specific antigens only. Use of this extract obviates the need for immuno-electrophoresis and improves the sensitivity of the test.
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May JR, Peto R, Tinker CM, Fletcher CM. A study of Hemophilus influenzae precipitins in the serum of working men in relation to smoking habits, bronchial infection, and airway obstruction. Am Rev Respir Dis 1973; 108:460-8. [PMID: 4542824 DOI: 10.1164/arrd.1973.108.3.460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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May JR, Davies J. Haemophilus influenzae apparently resistant to trimethoprim. Br Med J 1973; 3:407-8. [PMID: 4542344 PMCID: PMC1586637 DOI: 10.1136/bmj.3.5876.407-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Abstract
Tests for precipitins against Staph. aureus, H. influenzae, Ps. aeruginosa, Strep. pneumoniae, and Kleb. pneumoniae were carried out on the serum of 195 patients with cystic fibrosis, whose ages ranged from 3 weeks to 31 years. Sputum was obtained for culture from 96 patients over 5 years old. Precipitins against Ps. aeruginosa were more common than those against any other organism, including Staph. aureus, in the 0- to 5- and 6- to 10- year-old groups, while mucoid Ps. aeruginosa was the commonest pathogen isolated from the sputum of the 6- to 10-year-old children. These findings suggest that Ps. aeruginosa is the commonest bronchial pathogen in the younger patients and seem to conflict with the belief that Staph. aureus is always the initial pathogen in cystic fibrosis. Indeed, in 2 patients Ps. aeruginosa was proved to be the initial pathogen, and it is probable that patients with cystic fibrosis are susceptible from birth to bronchial infection by any pathogen with which they come in contact. The prevalence of pseudomonas infection, in contrast to that for staphylococcal or haemophilus infections, fell strikingly in the oldest patients, and this may reflect the failure of many patients with pseudomonas infections to survive into adult life.
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Abstract
Out of 210 isolates of Haemophilus influenzae obtained from the sputum of 63 patients with chronic respiratory infections 109 (52%) were resistant to trimethoprim-sulphamethoxazole by the disc test. The minimal inhibitory concentrations of trimethoprim for 17 out of 18 strains recorded as resistant were 10 mug/ml or higher. Resistant strains were isolated from time to time from 32 (82%) out of 39 patients known to have been treated with trimethoprim-sulphamethoxazole, compared with only 1 (12.5%) out of 8 patients known not to have been treated with this drug combination. Resistant strains were isolated most frequently from patients who had received long-term treatment. Since sulphamethoxazole penetrates from the blood into the bronchial secretions less readily than does trimethoprim it seems likely that the ratio of the two drugs in the bronchial tree is far from ideal. This may be an important factor in the use of these drugs for chest infections.
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May JR, Ingold A. Epiglottitis in adults. Br Med J 1971; 4:46. [PMID: 4999568 PMCID: PMC1799175 DOI: 10.1136/bmj.4.5778.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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May JR. Haemophilus influenzae in cystic fibrosis. Lancet 1969; 2:905. [PMID: 4186472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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