Clinical relevance of the substitution of different brands of sustained-release theophylline.

In order to assess whether clinically important changes in serum theophylline concentrations occur when patients switch their brand of slow-release (SR) theophylline, 10 subjects with asthma were administered the same dose of four different SR theophylline formulations for 2-week periods in a random, double-blinded, crossover manner. Analysis of the data revealed significant differences in mean peak-to-trough fluctuations of serum theophylline concentrations between the formulations of SR theophylline, which varied from 60% to 106% of trough concentration (p less than 0.0001, analysis of variance). On at least one occasion in every subject, switching between brands of SR theophylline was responsible for raising the serum theophylline concentrations outside the accepted therapeutic range, and this was associated with symptoms of toxicity in five of the subjects. Worsening pulmonary functions were observed in two of the subjects whose switching resulted in lowered theophylline concentrations. Many of the formulation-related changes in theophylline concentrations appeared to be idiosyncratic and could not be predicted by the overall bioavailability differences between the drugs. These results argue against the open substitution of these formulations and suggest that if patients are switched between different brands of SR theophylline, their serum theophylline concentrations need to be closely monitored.

Evaluation of system providing feedback to students on videotaped patient encounters.

A technique in which feedback is provided on videotaped performances to teach interview and examination skills in a pediatric clerkship was evaluated with a single-blind, controlled study. At the beginning of the pediatric ambulatory rotation, each of 105 third-year medical students received verbal and written instruction in conducting pediatric patient interviews and examinations. Then an encounter between each student and a patient was videotaped using a stationary camera mounted in an examination room. The students were randomly assigned to one of three groups: to receive critiques of their performances on the videotaped encounters by their preceptors; to critique their own recorded performances themselves using a written checklist; and to have no critiques. At the end of the clerkship, a second patient encounter was videotaped and was rated and scored by three faculty pediatricians who were unaware of the students' group assignments. Students who received critiques from their preceptors performed significantly better on the second recorded interview and examination (p less than 0.001) than did those who had self-guided critiques or those in the control group that received no critiques.

Evaluation of family physician prescribing: influence of the clinical pharmacist.

This study was designed to determine whether prescribing patterns in family practice residency training offices were more favorable in offices with clinical pharmacists. Two family practice residency training offices with clinical pharmacists and two offices without clinical pharmacists served as study sites. At each office, 100 prescription copies were selected by stratified random sampling, and a case abstract was constructed from the medical record. An additional 38 prescriptions that resulted from clinical pharmacist consultation were studied. A blinded review panel evaluated the cases for appropriateness of drug choice and dose and anticipated benefit of the prescription. Prescriptions from offices with clinical pharmacists and consult prescriptions were rated significantly more favorably both for drug choice and drug dose (p less than 0.02). These data suggest that clinical pharmacists involved in family practice residency programs may refine and improve otherwise acceptable prescribing.

Accidents as a symptom of alcohol abuse.

This review of the literature on the association between accidents and alcohol abuse presents data from a variety of studies performed in many of the industrial nations of the world. These studies demonstrate a consistent relationship between alcohol abuse and accidents. The family physician should be aware of this association and utilize it in the identification and treatment of his alcoholic patients.