Patterns of antimicrobial resistance during an outbreak of nosocomial infections caused by Acinetobacter baumannii were studied. The medical records of all patients admitted to the hospital between February 1993 and Febr...Patterns of antimicrobial resistance during an outbreak of nosocomial infections caused by Acinetobacter baumannii were studied. The medical records of all patients admitted to the hospital between February 1993 and February 1994 from whom A. baumannii was cultured were reviewed for demographic data, confirmation of the isolation report, admission date, date of first isolation of the organism, and antimicrobial use before and after the culture and susceptibility test results were obtained. The culture and susceptibility test data were reviewed for all specimens submitted to the laboratory during the review period. A total of 87 patients (mean +/- S.D. age, 37.9 +/- 8.7 years) with nosocomial infection or colonization with A. baumannii were identified. All the patients were surgical intensive care unit residents and had predisposing factors for acinetobacter infection. A total of 107 isolates of the organism were cultured from various sites; sputum was the most common source. The number of isolates per month increased steadily beginning in September 1993 and then declined over the winter. The median time between admission and first isolation of resistant A. baumannii was 11 days. Infections were manifested clinically as pneumonia (36 patients), bacteremia (8), wound infection (6), and urinary-tract infection (2). Of the 107 isolates, all were resistant to formulary cephalosporins, extended-spectrum penicillins, quinolones, and aztreonam. Only nine isolates were susceptible to one or more aminoglycosides. All the isolates were susceptible to imipenem-cilastatin. During an outbreak of nosocomial infections with A. baumannii, all or nearly all of the 107 isolates were resistant to a broad range of antimicrobials with the exception of imipenem-cilastatin, to which all the isolates were susceptible.
The greatest health care challenge of the next decade is making the best use of limited available resources to attain the highest quality for the lowest cost. This will require the use of economic information in all heal...The greatest health care challenge of the next decade is making the best use of limited available resources to attain the highest quality for the lowest cost. This will require the use of economic information in all health care decisions, but particularly those concerning drug formularies. Pharmacoeconomic data have become increasingly available and will be playing a major role in formulary decisions in many countries around the world. In preparation, P&T committees must consider how such information will be dealt with in the formulary decision-making process at the institutional and organizational levels.
A model for forecasting a hospital pharmacy drug budget is described, and its results in 10 hospital pharmacy departments are evaluated. A model for forecasting inpatient drug expenditures was developed based on the meth...A model for forecasting a hospital pharmacy drug budget is described, and its results in 10 hospital pharmacy departments are evaluated. A model for forecasting inpatient drug expenditures was developed based on the method of exponential smoothing. Exponential smoothing predicts a value based on the forecast for the prior period, with adjustment for the error of that forecast. Recent data are weighted more heavily than older data; as data become older, weights decline exponentially. The model incorporates changes in workload in addition to drug expenditure data. The variable used for workload can vary from one hospital to another, depending on the statistics that are available. The model was designed to be more accurate than current methods, easy and quick to use, and usable with a minimal knowledge of statistics and forecasting theory. The model was tested on fiscal 1988-1992 drug budget data from 10 British Columbia hospital pharmacy departments. Four departments had insufficient data; of the remaining six, the forecasting model performed better than the hospitals' current methods in four departments. The mean absolute deviation between budgeted (by current methods) and actual drug expenditures was 8.70% (range, 6.19-15.16%). The forecasting model yielded a mean absolute deviation of 5.93% (range, 3.13-7.66%). Better forecasts resulted when pharmacy medication-order volume was used as a workload variable, as compared with hospital inpatient days. An exponential smoothing model improved the accuracy of drug-budget forecasts in four of six pharmacy departments.
Recent findings about the effects of biorhythms on cardiovascular disorders are reviewed, and their implications for drug therapy are discussed. The chronobiological approach to physiology evaluates time-dependent change...Recent findings about the effects of biorhythms on cardiovascular disorders are reviewed, and their implications for drug therapy are discussed. The chronobiological approach to physiology evaluates time-dependent changes in biological functions and considers those changes to be multifactorial. Characterization of disease states with this approach allows more accurate determination of the times when patients are at highest risk and therefore in greatest need of preventive measures; it also provides a mechanism for designing optimal drug regimens. There is evidence of circadian variations in the occurrence of myocardial ischemia, acute myocardial infarction, ventricular tachycardia, and sudden cardiac death. Many cardiovascular disorders occur with greatest frequency between 0600 and 1200 in the general population. Blood pressure, too, follows a distinct circadian pattern. Factors affecting circadian variations in cardiovascular disorders include physiological determinants, such as heart rate, catecholamine release, and platelet aggregation--which themselves vary cyclically--and exogenous factors, such as mental stress, anxiety, and physical activity. In chronotherapy, circadian variations in disease states and in the pharmacodynamic properties of drugs are exploited to improve prevention and treatment. Conditions in which research suggests a chronotherapeutic approach may be advantageous include thromboembolism, hypertension, stable exertional angina, variant angina, sustained ventricular tachycardia, and acute myocardial infarction. Information on circadian patterns in the occurrence of many cardiovascular disorders is enabling clinicians to tailor treatment in ways that may lead to improved patient outcomes.