Involvement of a pharmacy department in a hospital's transition to patient-centered care.

This article will describe our hospital's transition to a patient-centered care environment as a response to rising costs within the hospitals and a desire to improve the quality of patient care through systems improvement. The involvement of pharmacy managers in the new organizational structure will be detailed, as well as their new roles and responsibilities as care center leaders. The traditional pharmacy management structure has been replaced by a team approach to decision making and problem solving. Challenges exist to the pharmacy managers as they reorganize to accommodate new responsibilities within the care centers. Opportunities exist within this setting to support pharmaceutical care.

Effect of peritonitis on plasma and dialysate alpha 1-acid glycoprotein concentrations in peritoneal dialysis patients.

The effect of peritonitis on plasma and dialysate alpha 1-acid glycoprotein (AAG) concentrations was determined. Plasma and dialysate samples were obtained at the onset of infection and one month after treatment from 10 peritoneal dialysis patients with peritonitis. Plasma and dialysate samples were also obtained from 10 noninfected matched controls. Sampling was repeated after a minimum of one month. Samples were assayed for AAG by radial immunodiffusion. The mean +/- S.D. plasma AAG concentrations for patients with peritonitis and for control patients were 152.4 +/- 30.9 mg/dL and 146.6 +/- 45.0 mg/dL, respectively (p > 0.05). The dialysate AAG concentrations for nine control patients were below the limit of detection. The mean +/- S.D. dialysate concentration for the nine infected patients with detectable AAG concentrations was 15.4 +/- 9.5 mg/dL. After successful antimicrobial therapy, dialysate AAG concentrations declined. There was no obvious correlation between dialysate white blood cell count and dialysate AAG concentration during peritonitis. Peritonitis increased dialysate AAG concentrations but had no effect on plasma AAG concentrations.

Pharmacokinetics of intraperitoneal, intravenous, and subcutaneous recombinant human erythropoietin in patients on continuous ambulatory peritoneal dialysis.

The pharmacokinetics of recombinant human erythropoietin (Epo) were compared after mean single 99.1 U/kg intraperitoneal (IP), intravenous (i.v.), and subcutaneous (SC) doses in eight noninfected patients on peritoneal dialysis in a randomized, three-way, cross-over fashion. Continuous ambulatory peritoneal dialysis was performed in all patients on the days of the study. The IP dose was instilled into an empty peritoneum; total dwell time was 10 hours (4 hours dry, 6 hours with 2 L of peritoneal dialysis fluid). Blood samples were collected for 96 hours following IP and SC Epo, and for 72 hours following i.v. Epo. For the IP dose, a 10-hour effluent dialysate sample was collected to determine Epo recovery. Enzyme immunoassay was used for Epo analysis. The mean apparent volume of distribution was 0.05 L/kg, equivalent to 4.5% of total body weight; the mean total body clearance was 0.08 mL/min/kg. All eight patients exhibited multiexponential decay in serum Epo concentrations following i.v. Epo. Absorption of IP Epo was significantly greater than previous reports, presumably due to its administration into a dry peritoneum. The maximum concentrations following the IP and SC doses were nearly identical, but amounted to only 5% of the maximum concentrations for the i.v. dose. Subcutaneous Epo took nearly twice as long as IP Epo to achieve peak serum concentrations (17.1 +/- 5.0 hours v 9.4 +/- 1.9 hours). Compared with the IP route, the SC dose achieved a higher area under the serum concentration time curve from time 0 to 96 hours (AUC0-96; P = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)