RESUMO
Allocation of medical resources, especially resources with absolute scarcity such as organs for transplant, is a difficult task. Medical, surgical, and ethical considerations should be evaluated. In solid organ transplantation, ethics committees are the gate keepers that deal with moral philosophy when moral values are in conflict. Often, no good solution to a dilemma in these medical ethics exists. Our case presents split living liver donation for retransplantation in a mentally disabled girl, with few medical ethics principles at stake.
Assuntos
Transtornos Cognitivos/complicações , Falência Hepática/complicações , Falência Hepática/terapia , Transplante de Fígado/ética , Doadores Vivos/ética , Adulto , Criança , Transtornos Cognitivos/etiologia , Pessoas com Deficiência , Ética Médica , Família , Evolução Fatal , Feminino , Rejeição de Enxerto , Humanos , Masculino , ReoperaçãoAssuntos
Sulfanilamidas/metabolismo , Sulfapiridina/metabolismo , Acetilação , Animais , Disponibilidade Biológica , Feminino , Meia-Vida , Cinética , Fenótipo , CoelhosRESUMO
A three-step method for administering lidocaine intravenously was developed and tested in 19 patients. Of all plasma concentrations measured, 70% were within the desired range of 2 to 4 micrograms/ml after the new method of lidocaine administration. Compared with other methods it is superior with respect to percent of time in the therapeutic range. No ventricular arrhythmias were evident, and no toxicities were associated with the new method. Infusions of lidocaine for more than 6 hr were associated with progressive increases in plasma concentrations that were higher (p less than 0.01) at 24 hr than at 6 hr.
Assuntos
Lidocaína/administração & dosagem , Idoso , Arritmias Cardíacas/tratamento farmacológico , Computadores , Feminino , Humanos , Infusões Parenterais , Injeções Intravenosas , Cinética , Lidocaína/sangue , Masculino , Pessoa de Meia-Idade , Modelos BiológicosRESUMO
The approach used by a hospital pharmacy in planning, implementing, and evaluating a major formulary revision and the strategies used in deleting popular analgesics from the formulary are described. All phenacetin-containing products were deleted from the formulary of The Ohio State University Hospitals. The following steps of the process are described; identification of the problem, literature evaluation, soliciting medical staff support, presentation to the pharmacy and therapeutics committee, designing an implementation timetable, education, monitoring analgesic use, coordination of departmental activities, implementation and follow-up. The strategy used in this case resulted in the policy being implemented successfully.
Assuntos
Formulários de Hospitais como Assunto , Serviço de Farmácia Hospitalar , Fenacetina , Analgésicos , Uso de Medicamentos , Hospitais com mais de 500 Leitos , Humanos , Ohio , Comitê de Farmácia e TerapêuticaRESUMO
The development of a structured method of providing administrative experience for hospital pharmacy residents, using internal audit techniques, is described. Residents were assigned topics to investigate in the administrative area of hospital pharmacy early during their two-year, academically affiliated residency. They were expected to review and evaluate the topic critically using internal audit techniques; written and oral reports were presented to the administrative staff. Residents were able to complete the audits while attending classes as part of their academic experience. As a result of performing the audits, residents have learned administrative skills in problem identification, assessed their personal competency by reviewing major components of contemporary practice, learned accepted standards of pharmacy practice, and developed skills in making improvements in conformity with quality assurance standards. This program has been incorporated as an integral part of the residency program.
