Prolactin receptors in the brain during pregnancy and lactation: implications for behavior.

Numerous studies have documented prolactin regulation of a variety of brain functions, including maternal behavior, regulation of oxytocin neurons, regulation of feeding and appetite, suppression of ACTH secretion in response to stress, and suppression of fertility. We have observed marked changes in expression of prolactin receptors in specific hypothalamic nuclei during pregnancy and lactation. This has important implications for neuronal functions regulated by prolactin. In light of the high circulating levels of prolactin during pregnancy and lactation and the increased expression of prolactin receptors in the hypothalamus, many of these functions may be enhanced or exaggerated in the maternal brain. The adaptations of the maternal brain allow the female to exhibit the appropriate behavior to feed and nurture her offspring, to adjust to the nutritional and metabolic demands of milk production, and to maintain appropriate hormone secretion to allow milk synthesis, secretion, and ejection. This review aims to summarize the evidence that prolactin plays a key role in regulating hypothalamic function during lactation and to discuss the hypothesis that the overall role of prolactin is to organize and coordinate this wide range of behavioral and neuroendocrine adaptations during pregnancy and lactation.

Implementation and analysis of a non-floor stock controlled substance unit dose system in a pediatric hospital.

The purpose of this study was to evaluate the implementation of a modified unit dose dispensing system for schedule II controlled substances. Each dose is signed out of stock for the intended patient. Changes in the system required revision of dispensing records and procedures in pharmacy and nursing. After implementation the error rate for controlled substances was reduced to a level equivalent to non-controlled substances. A workload study was conducted in the pharmacy and on two general medical-surgical units. Small increases in workload occurred. Although this system is a modified unit dose system it does provide some of the safety features found in unit dose systems. Patient care benefits may decrease hospital liability in high-risk patients to offset cost factors.

Establishing a pharmacy department for a large pediatric hospital: managerial problems, opportunities, and lessons.

The process of planning and establishing a pharmacy department in a pediatric hospital is described, and lessons learned from the experience are summarized. Since its founding in 1954, Texas Children's Hospital (TCH) had shared pharmacy services with St. Luke's Episcopal Hospital. The decision to terminate the shared-services agreement in the mid-1980s made it necessary for TCH to establish an independent pharmacy department. A director of pharmacy was hired in March 1988, and November 30 of that year was set as the target for implementation of the TCH pharmacy. It was decided that six services--a decentralized unit dose distribution system, an i.v. admixture service, delivery services, ambulatory-care services, a formulatory system, and a drug information service--would be offered initially. Decisions concerning department organizational structure and staffing, space allocations, and a computer system were made. A multidisciplinary advisory committee was appointed; one of its responsibilities was to oversee inservice staff training. The pharmacy areas were to be opened on a staggered basis, beginning with the hematology-oncology clinic pharmacy. A number of problems arose immediately following the opening of the central pharmacy, including inaccurate computer profiles, lower-than-estimated productivity resulting from staff members' unfamiliarity with the new system, higher-than-estimated patient census, and orders for nonformulary drugs. Delays in drug delivery times were unacceptably high. A crisis-management plan was implemented to cover both short- and long-term problems, and within a few months operations had stabilized. The opening of the intensive-care and sixth-floor satellite pharmacies enhanced decentralized operations and had an important role in improving response times.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of a microcomputer in a pediatric hospital.

The implementation and uses of a microcomputer in a 186-bed pediatric hospital are described. A Kaypro-10 portable microcomputer and an Epson Fx-80 printer were purchased in anticipation of increased workload generated by addition of beds to the hospital's neonatal intensive-care unit. Programs in C-BASIC language were developed for performing mathematical calculations, labeling of unit dose injections and oral liquids, and generating automatic-stop-order renewal notices. A master menu was designed to allow access to all programs. Work sheets to aid in the calculation of solution volumes required to deliver desired dosages of emergency drugs and for preparation of parenteral nutrient solutions are generated by the microcomputer, along with labels for these solutions. Other computer programs allow charging of floor stock items for i.v. admixtures, tracking of emergency-drug boxes, and generation of controlled-substances and anaphylaxis-dosing labels. A total of 510 hours was required to develop the microcomputer programs at a salary cost of $2600. Hospital pharmacies experiencing an expansion of patient services may be able to reduce the impact of the increased workload on manpower requirements by computerizing existing systems. Pharmacies with specialized needs can consider microcomputer implementation and inhouse software development as one alternative.

Formulary management to reduce cost: P & T committee strategies.

The hospital pharmacy can achieve cost reductions through a variety of means. These include controlling personnel costs, conducting systems and facilities design analyses, operating shared services, controlling inventory, and assisting the P & T Committee in implementing and operating a hospital formulary system. The type of formulary system within an institution and the effectiveness of the P & T Committee both influence cost saving programs in acquiring and dispensing therapeutic agents. Strategies effective in developing a workable formulary and ways in which the P & T Committee can encourage cost-effective drug acquisition and use are outlined.

Survey of expiration dating policies for repackaged pharmaceuticals.

A national survey was conducted to determine the policies of hospital pharmacies regarding expiration dates for repackaged pharmaceuticals. A cover letter, questionnaire, and self-addressed stamped envelope were mailed to the directors of pharmacy of 360 randomly selected hospitals. Definitions of bulk and extemporaneous repackaging were provided. The response rate was 57%. Less than one third of the responding institutions followed the current FDA recommendations for dating oral solids repackaged in bulk. Almost one quarter used the manufacturer's date. Only 5.6% of the hospitals used more conservative dating. Similar percentages were found for the dating of oral liquids. One third of the hospitals used 30-90 days to date repackaged injectables ; however, a large range of expiration dates was reported. Almost one third of the hospitals applied the current FDA bulk repackaging dating recommendations to extemporaneous repackaging . A large percentage (29% for oral solids and 31% for oral liquids) used the manufacturer's date. A wide variety of arbitrarily assigned expiration dates are being used by hospital pharmacists in the bulk and extemporaneous repackaging of oral solids, liquids, and injections.

The cost of medical care.

Health care costs continue to spiral at a rate faster than the general economic sector, due to factors which uniquely affect the health care industry. Several of these factors are discussed. The effect of the spiraling costs are felt throughout all departments of the hospital. Recognition of the need for cost containment measures, by health professionals in addition to governmental laws and regulations and consumer pressures, have stimulated the search for more efficient methods of operation. If cost containment measures are not to affect the quality of care adversely, increases in productivity must be achieved and wasteful operations eliminated. The need for further research in these areas is cited.