Consultative total parenteral nutrition teams: the effect on the incidence of total parenteral nutrition-related complications.

A two part, prospective study was undertaken to establish the existing frequency of total parenteral nutrition-(TPN) related mechanical, metabolic, and septic complications in an institution with a consultative TPN team (group A) and to determine if increasing the involvement of the TPN team in patient monitoring and verifying adherence to TPN infection control guidelines would reduce the incidence of these complications (group B). The initial 28 consecutive patients were managed entirely by their primary physicians with the role of the TPN team limited to consultative activities while the next 29 patients receiving TPN were managed jointly by their primary physicians and the TPN team. Analysis of the results show group B to have a significant reduction in metabolic complications, decreased incidence of mechanical abnormalities, and approximately equal incidences of documented sepsis. However, when compared to the results of an institution in which the TPN team has complete control of TPN therapy, even the group B patients had a relatively excessive number of TPN-related complications especially in the categories of mechanical and metabolic abnormalities. Thus, consultative TPN teams do not necessarily ensure optimum TPN therapy and institutions using this approach to provide nutrition parenterally must be prepared to establish the incidence of TPN-related complications and to expand the involvement of the TPN team as required to control the frequency of these anomalies.

An education program that improves the psychomotor skills needed for metaproterenol inhaler use.

This is the first report assessing an education program's impact on teaching patients the psychomotor skills needed for proper use of the metaproterenol inhaler. Most patients do not use pressurized inhalers correctly. This inability could lead to suboptimal or ineffective therapy. Pharmacists provided a standardized education program to asthma patients and to those with chronic obstructive pulmonary disease for three clinic visits. Proper use of the inhaler was assessed by evaluating the patient's psychomotor performance for each visit before and after instruction. Of 19 patients, 18 demonstrated a mean improvement of 33.5 percent from preinstruction to postinstruction evaluation at the first visit (Student's t-test, p less than 0.0005). Both preinstruction and postinstruction scores demonstrated an upward trend for all three visits, the postinstruction scores always being higher than the preinstruction scores. These results indicate that our standardized education program helped improve psychomotor performance. Certain instructional aspects that need emphasis in future education programs have been identified.

Evaluation of computer-assisted self-instructional module for pharmacy continuing education.

A computer-assisted self-instructional module was developed as a method of providing continuing education to pharmacists. A prospective, nonrandomized study was conducted to investigate the effectiveness of computer-assisted instruction (CAI). Using an Apple II microcomputer and anticoagulant therapy as the content base, a series of ten case studies was written and programmed. Twenty-two staff pharmacists from a university hospital and a community hospital participated. Participants were first given a pretest, proceeded through the CAI, took the same test as a posttest, then two weeks later, took a different posttest to measure knowledge retention. The mean test scores before and immediately after the CAI were 55.8% and 80.4%. The mean test score for the two-week posttest was 74%. The mean difference was found to be highly significant for both the pretest and immediate posttest (P less than 0.0001) and the pretest and two-week posttest (P less than 0.001). The study suggested that the use of a CAI module was effective in improving, as well as maintaining, pharmacists' knowledge and that a significant portion of knowledge gained was retained after a period of two weeks. Pharmacists' evaluations of this method of continuing education were generally favorable.

Program for aminoglycoside dosage calculations using an inexpensive calculator.

A program for gentamicin and tobramycin dosage calculations using a pocket-size programmable calculator was developed and evaluated. A program based on the first-order one-compartment pharmacokinetics model for aminoglycoside dosage calculations was developed for the Sharp EL-5813 pocket-size calculator, which can store 30 programming steps and has six constant memories. (The program also can be used in other calculators with similar capabilities.) The programming steps and operational procedures for calculating loading and maintenance doses, steady-state peak and trough concentrations, the patient's elimination constant, creatinine clearance, and volume of distribution are presented. The program was evaluated by comparing predicted and observed steady-state peak and trough concentration for 24 patients receiving gentamicin therapy. There was a significant relationship between predicted and observed peak and trough plasma concentrations. The mean time required to program the calculator was less than 30 seconds, and the mean time required for each dosage and plasma-concentration calculation was approximately 2.5 minutes. The program provides a simple method to make aminoglycoside dosage recommendations and predictions of peak and trough plasma concentrations with acceptable accuracy.

Temperature dependence of the stability of tobramycin mixed with penicillins in human serum.

The stability of tobramycin in pooled human serum when combined with ampicillin, carbenicillin disodium, or penicillin G potassium after storage at 0, 23, or 37 degrees C was evaluated. Samples of pooled human serum containing tobramycin sulfate 8 micrograms/ml alone or combined with ampicillin, carbenicillin disodium, or penicillin G potassium 200 micrograms/ml were prepared and stored at 0, 23, and 37 degrees C. Single samples were removed periodically for 48 hours and frozen until assayed. Tobramycin concentration was measured by a radioenzymatic assay. A tobramycin degradation rate constant was calculated for the tobramycin control and each tobramycin-penicillin combination at each temperature; from this, the time for the tobramycin concentration to decline to 90% of the initial concentration (t90) was estimated. Stability of the penicillins was not assessed. Tobramycin degradation approximated a log-linear process in all samples for the 48-hour period. The tobramycin control sample was more stable than any of the tobramycin-penicillin solutions at each temperature. At 0 degrees C, tobramycin mixed with ampicillin was the least stable of all mixtures; at 23 and 37 degrees C, tobramycin mixed with carbenicillin was the least stable. Storing tobramycin and carbenicillin samples on ice (0 degrees C) prolonged t90 from 10 hours (23 degrees C) and 12 hours (37 degrees C) to 36 hours. The t90 values for tobramycin when mixed with ampicillin were 19, 16.5, and 20 hours at 0, 23, and 37 degrees C, respectively. Mixed with penicillin G, tobramycin t90 values at 0, 23, and 37 degrees C were 48, 44, and 16 hours, respectively. More than a 10% loss of tobramycin potency occurred in some tobramycin-penicillin solutions under the conditions of this study. Because this loss would affect the accuracy of tobramycin pharmacokinetic calculations, the authors suggested guidelines for handling tobramycin serum samples.