In the 6 months after sumatriptan therapy was initiated, health care resource use and time lost from workplace productivity and nonworkplace activity were reduced, while health-related quality of life and patient satisfaction scores improved for the managed care migraineurs enrolled in this study.
This study examined the determinants of compliance with clinical guidelines for glucocyte colony-stimulating factor (GCSF), a biotechnology product designed to reduce postchemotherapy infections. The pattern of compliance did change over time. After the guidelines were disseminated, appropriate use of GCSF increased. However, inappropriate use also increased. Patients who were younger and had an attending physician who was an oncologist or hematologist were more likely to receive GCSF whether they met the guideline criteria or not. Our findings suggest that older patients may be treated less aggressively than others and that physicians who are the most knowledgeable about guidelines may feel the most qualified to override the guidelines when they believe they do not apply. Our findings also demonstrate that it is easier to encourage physicians to do more for patients rather than less.
Objective To determine the pharmacokinetic parameters of aminoglycosides in patients with AIDS and to compare these parameters with those of a control group of patients not infected with HIV. Design Retrospective, chart-review study. Patients Nineteen AIDS patients and 19 non-HIV-infected patients (control) were identified through a review of pharmacokinetic monitoring cards. Methods Patients’ charts were reviewed for demographic data, aminoglycoside (gentamicin, tobramycin, and amikacin) dosing schedule, and steady-state peak and trough concentrations. Pharmacokinetic parameters were calculated using a one-compartment open model. Results Significant differences were found in the elimination rate constant (Ke) between the two groups (mean ± SD, 0.20 ± 0.084/h in the AIDS group and 0.26 ± 0.095/h in the control group). Half-life was significantly longer in the AIDS group versus controls (4.3 ± 2.5 and 2.99 ± 1.15/h, respectively). The volume of distribution (Vd), expressed in terms of liters and liters per kilogram total body weight (TBW), was significantly larger in the AIDS group than in the control group (28.3 ± 14 L [0.43 ± 0.21 L/kg TBW] and 19.2 ± 4.95 L [0.28 ± 0.07 L/kg TBW], respectively). Clearance in terms of liters per hour and Vd in terms of L/kg ideal body weight were not significantly different between the two groups. Albumin was similar in both groups (34 ± 7 g/L, control group; 28 ± 7 g/L, AIDS group). Conclusions Aminoglycoside pharmacokinetics were found to be altered in the patients with AIDS. When calculating an initial dose of an aminoglycoside in AIDS patients, use of estimated normal population parameters may result in lower peaks in these individuals. Pharmacokinetic parameters may need to be adjusted in AIDS patients because of their large Vd and slower Ke.
A retrospective pharmacoeconomic analysis was conducted to compare lengths of hospital stay for, and usage of hospital resources by, patients (850 admissions) who received either ondansetron or standard antiemetic therapy during hospital admissions for cancer chemotherapy. Average hospital costs for patients admitted to a 720 bed academic medical centre for maintenance chemotherapy between October 1990 and September 1991 were analysed using the hospital's online computerised clinical financial management system. A separate prospective time-and-motion study was used to evaluate specific costs of nursing care associated with episodes of severe nausea and vomiting. In addition, patient perception of quality of life and satisfaction with therapy were evaluated for 27 chemotherapy patients using quality-of-life measurements on the Functional Living Index-Cancer (FLIC) scale. The results of these studies showed that the average length of hospital stay was shorter for patients who received ondansetron rather than standard antiemetic therapy, but that average hospital costs were not significantly different. The reduced hospitalisation costs offset the higher acquisition cost of ondansetron. Mean quality-of-life scores decreased significantly after chemotherapy for patients receiving either ondansetron or standard therapy, but the changes in scores were not strongly associated with the antiemetic agents used or with any of the clinical or demographic variables measured in this study.
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