Experiences sharing of implementing Template-based Electronic Medical Record System (TEMRS) in a Hong Kong medical organization.

This paper aims to investigate the efficacy and feasibility of Template-based Electronic Medical Record System (TEMRS) and factors for its successful implementation. A TEMRS was designed and implemented in one core clinic of a Hong Kong professional multi-disciplinary medical services provider with four core clinics located in different parts of Hong Kong. Eight doctors participated in the study. Surveys and interviews were conducted to acquire the users' feedback and satisfaction level. The design, development, and the factors related to the success of the implementation of TEMRS were analyzed. In the study period, 3,032 cases were collected. The most encountered diagnosis were upper respiratory tract infection (50.59%), gastroenteritis (10.19%), dermatitis (5.87%), dyspepsia (5.28%) and rhinitis (4.82%). The system gained an overall satisfaction by the users and the most satisfied areas were rapid retrieving the necessary information of patient (75%) and fasten the diagnostic selection (75%). TEMRS is an enabling system which can reduce the user resistance in new technology with its flexibility. The consideration of cost, security, human, technical, data migration and standardization issues are essential in the implementation of the TEMRS and further research should be conducted to expand the TEMRS's implementation in health care system.

Decontamination issues and perceived reliability of the laryngoscope--a clinician's perspective.

The laryngoscope is identified as a potential vector for cross-infection. Case reports are presented, as are reports of bacterial and occult blood contamination of laryngoscope blades and handles. Infection control policies covering laryngoscope blade and handle processing are outlined relative to procedures of a teaching hospital department. Repeated decontamination of laryngoscope blades has resulted in a perceived decrease in reliability. This is reflected in a departmental survey where 86% of respondents consider the standard laryngoscope is only intermittently reliable and that there is room for improvement.

Comparison of the pharmacokinetics of fosinoprilat with enalaprilat and lisinopril in patients with congestive heart failure and chronic renal insufficiency.

AIMS: To compare the serum pharmacokinetics of fosinoprilat with enalaprilat and lisinopril after 1 and 10 days of dosing with fosinopril, enalapril and lisinopril. METHODS: Patients with congestive heart failure (CHF, NYHA Class II-IV) and chronic renal insufficiency (creatinine clearance

Fosinopril/hydrochlorothiazide: single dose and steady-state pharmacokinetics and pharmacodynamics.

AIMS: Fosinoprilat, the active product of fosinopril, is eliminated by an hepatic pathway in addition to the renal pathway shared by other angiotensin converting enzyme inhibitors (ACEIs). This study aimed to determine whether impaired renal function affects the pharmacokinetics and pharmacodynamics of a combination of fosinopril and hydrochlorothiazide (HCTZ). METHODS: The study had a parallel-group design comparing patients with renal impairment and body-mass-index-matched normal controls. The study was done in a University clinic in 13 patients with renal impairment (mean creatinine clearance 55.7+/-15.6 ml min-1 1.73 m-2 ) and 13 age-, sex-, and body-mass-index-matched normal controls (mean creatinine clearance 102.4+/-8.9 ml min-1 1.73 m-2 ). All patients and normal controls received fosinopril sodium 20 mg and HCTZ 12.5 mg as a daily oral administration on days 1-5. Non-compartmental pharmacokinetic parameters of fosinoprilat and HCTZ were determined from blood and urine samples obtained over 48 h starting on Day 1 (single dose) and Day 5 (steady state): maximum serum concentration (Cmax ), time to maximum serum concentration (tmax ), area under the serum concentration-time curve during the dosing interval (AUC), cumulative urinary excretion (CUE) and the accumulation index (AI; ratio of AUC-day 5/AUC-day 1). Pharmacodynamic parameters were also measured over 24 h on day 1 and over 48 h on day 5: serum ACE activity and arterial blood pressure. RESULTS: Fosinoprilat pharmacokinetic parameters on day 1 in renally impaired vs normal patients: Cmax=387+/-0.19 vs 324+/-0.25 ng ml-1 (P=0.07); tmax=3.5 vs 3.0 h (P=0.58); AUC=3510+/-0.29 vs 2701+/-0.35 ng ml-1 h (P=0. 072); CUE=5.08+/-2.70 vs 7.40+/-2.56% (P=0.009). Fosinoprilat parameters on day 5: Cmax=517+/-0.40 vs 357+/-0.19 ng ml-1 (P=0. 007); tmax=3.0 vs 3.0 h (P >0.99); AUC=4098+/-0.43 vs 2872+/-0.30 ng ml-1 h (P=0.027); CUE=6.81+/-3.53 vs 8.10+/-2.80% (P=0.068). AI=1. 17+/-0.33 vs 1.06+/-0.23 (P=0.29). In both groups ACE inhibition and blood pressure response were similar over 24 h and slightly greater 48 h after last dosing. CONCLUSIONS: In renally impaired subjects fosinopril and HCTZ can be coadministered without undue increases in fosinoprilat concentrations or any clinically significant pharmacodynamic effects. This is probably due to the dual excretory pathways for fosinoprilat.

Antiallergic effects of the new histamine H1-receptor antagonist tazifylline in healthy atopic and non-atopic subjects.

Single oral doses (5, 10 and 15 mg) of the new H1-receptor antagonist 3,7-dihydro-7-[2-hydroxy-3-[4-[3-phenylthio) propyl]-1-piperazinyl]propyl-1,3-dimethyl-1H-purine-2,6-dione dihydrochloride (tazifylline, RS-49014) were administered at 7-day intervals to 12 atopic and 12 non-atopic volunteers in a double-blind randomised cross-over study. Antiallergic activity was evaluated from pre to 60 min post dose inhibitions of wheal and flare areas provoked by various cutaneous challenges. Atopic subjects showed greater skin reactivity than non-atopics to some challenges. Tazifylline was associated (in atopics and non-atopics) with statistically significant dose related inhibitions, of flare over 5-15 mg and of wheal (10-15 mg) induced by the more potent and reproducible challenges of codeine, 1% histamine and anti-IgE. Antiallergic activity of tazifylline in the 10-15 mg dose range was superior to 5 mg without the intervention of clinically significant sedative effects at any of the 3 dose levels tested.

Confidence interval approach for evaluating bias in laboratory methods.

A statistically significant difference in mean values between two laboratory quantitation methods is interpreted as a bias. Sometimes such a difference is so minute that it does not constitute any practical concern. An alternative approach is to test statistically whether the two methods are close enough, not for equality. This is to look at the confidence interval of the mean method difference and does not entail any additional statistical tests.

The calculation of probabilities in rejecting bioequivalence.

Methods are given for deriving the lower and upper bounds of the probabilities for rejecting bioequivalence. Except when two formulations are nearly equal, the lower and upper bounds become very close and thus give an exact probability. The methods can be used in two- or higher-way crossover or parallel groups designs. One can also determine the sample size from the equations. The results are compared with the probabilities obtained by simulation.

The effect of chronic treatment with a non-selective beta-adrenoceptor antagonist on the enteroinsular axis and intermediary metabolites.

In a single-blind randomized placebo-controlled cross-over study in hypertensive patients we have examined the effects of treatment with the non-selective beta-adrenoceptor antagonist nadolol on the responses of glucose, intermediary metabolites and the hormones of the enteroinsular axis to the ingestion of a mixed meal. During treatment with nadolol the plasma insulin concentration 30 min after ingesting the meal was significantly lower than on placebo and the plasma glucose rose more slowly. Plasma concentrations of GIP tended to be higher during nadolol than placebo treatment. No significant effects of treatment with nadolol were noted on pancreatic glucagon or intermediary metabolites.

One year's experience in a new dental day-stay unit.

The records of six hundred and fifty-five patients treated in the Dental Day-Stay Unit over a twelve-month period were reviewed. 2.1% of 95 patients assessed as suitable for day-stay surgery, and 2.2% of 542 patients not assessed prior to anaesthesia were admitted postoperatively. As an index of outcome, 2.56% of 547 day cases were admitted postoperatively, 0.73% being attributable to anaesthesia. Forty-seven day patients were treated in the dental chair, and 108 were treated as inpatients. Over 37% had at least one concurrent medical problem, while 10.4% were mentally handicapped. Guidelines for day-care selection require that the procedure be straightforward, the patient medically fit, be discharged escorted, and live within a reasonable distance of the hospital. From our study, four specific patient groups are identified. These are: the young and healthy, the mentally handicapped, the medically compromised, and those with airway problems.

Warning on phaeochromocytoma.

A case of a 35-year-old female patient, who had previously undergone extensive investigations for hypertension, is reported. At an elective operation for cholecystectomy she was found to have a phaeochromocytoma. This serves as a warning to those who may be required to anaesthetize, or operate on, patients with hypertension of undiagnosed origin.

Fibrinogen determination in a series of proficiency studies.

Fibrinogen estimations were performed in four quality control proficiency studies conducted by the National (UK) Reference Laboratory for Anticoagulant Reagents and Control for over five hundred hospitals in the UK and overseas during 1976--1978, to evaluate the various techniques in current practice. More than 30 different estimation techniques were employed by participants and these could be classified into eight groups. The success in detecting a fibrinogen level below the normal range ('sensitivity') and reliability in providing a normal result for a value within the normal range ('specificity') have been determined. No method failed in both aspects. The tyrosine, clot weight, immunological and Clauss technique appeared reasonably satisfactory. The best results were obtained with the Clauss technique although the difference between this and the other quantitative techniques did not achieve statistical significance. Some were less dependable, notably the turbidity techniques and the thrombin time. Although no technique appeared to be superior to others from the standpoint of precision, turbidity techniques appeared to be the least precise showing the largest co-efficient of variation.

Heparin and partial thromboplastin time: an international survey.

The reliability of routine partial thromboplastin time (PTT) methods in the measurement of the anticoagulant effect of heparin has been assessed in a study involving over 300 hospitals in the U.S. and overseas. Commercial PTT methods were relatively insensitive to heparin, added in vitro, compared with the standardized PTT method tested by the same laboratories. Non-commercial, locally-prepared reagents compared well with the standardized method particularly in the detection of a low concentration of heparin. The value of a sensitive reference preparation for the calibration of routine PTT reagents used in heparin control is demonstrated.

Effects of manufacturing oral contraceptives on blood clotting.

In monitoring the effects of industrial exposure resulting from the pharmaceutical manufacture of oestrogen-progestogen combinations by coagulation studies acceleration of some clotting tests was found. The most pronounced changes were in workers most closely associated with the industrial process. Less pronounced changes were found in women employees not closely concerned with the processing and may have been secondary to the postmenopausal bleeding to which they were prone. A safer work procedure elaborated by the Employment Medical Advisory Service was monitored by clotting studies for over a year but the three most highly exposed subjects showed no substantial improvement.