Personnel requirements for an outpatient chemotherapy admixture service.

Chemotherapy preparation times and personnel requirements for an outpatient chemotherapy admixture service (CAS) were determined in this study. CAS activities and time measurement endpoints were identified by process analysis. Direct time studies were performed over a 2-month period on approximately 400 variable (chemotherapy admixture) activities and on their related fixed (auxiliary) activities. Variable activities were divided into four distinct categories based upon the original formulation of the antineoplastic agent and its complexity of admixture. All CAS activities were performed by a pharmacy technician under the supervision of a pharmacist. Mean preparation times for the different categories of variable and fixed activities were determined. Variable, fixed, and estimated nonproductive time were combined with 8 months retrospective output data to determine total weakly CAS service hours and personnel requirements. Variable activity time varied widely among the four categories of admixtures and had an aggregate mean time of 9.7 minutes per admixture. Variable and fixed activity time comprised 13.5 and 4.5 mean weekly service hours, respectively. Total weekly service time was 18 hours or 0.48 full-time equivalents. These results on elemental times and personnel requirements are similar to those obtained in previous studies.

Computer program for comparing total costs of intravenous antibiotic regimens.

A computer program for estimating and comparing the costs of intravenous antibiotic therapy is described, and a cost comparison of two antibiotic regimens using the program is demonstrated. Data unique to each antibiotic (e.g., dosage regimen, duration of therapy, need for pharmacokinetic monitoring, and acquisition cost per dose) are entered into the first part of the program (ABDATA) and combined with preprogrammed hospital-specific data, such as personnel and material costs, to produce an itemized list of the total cost of therapy. With the second part of the computer program (ABCOMP), antibiotic regimen costs that have been entered into ABDATA can be compared. Cost comparisons are made with the assumption that the antibiotic regimens have similar efficacy and toxicity. A sample cost comparison was performed using data from a recent study comparing the use of ceftazidime or tobramycin-ticarcillin therapy in the treatment of nosocomial pneumonia and bacteremia. The computer-generated cost comparison showed that although the unit cost of ceftazidime was more than the combined unit cost of tobramycin and ticarcillin, the total cost of a 10-day course of therapy with ceftazidime (which included personnel and material costs) was less than the cost of therapy with a combination of tobramycin and ticarcillin. A computer program that incorporates hospital-specific personnel and material costs with unit drug costs can be used to facilitate comparisons of the overall cost of intravenous antibiotic regimens.

Cost comparison of seven antibiotic combinations as empiric therapy in a simulated febrile neutropenic patient.

Total costs, drug and supply costs, and personnel costs for 14 days of therapy with seven therapeutically equivalent i.v. antibiotic combinations were calculated for a simulated febrile neutropenic patient. The cost for each antibiotic regimen was calculated using a previously developed computerized model that included the cost elements involved in preparation, administration, and pharmacokinetic monitoring of i.v. antibiotic therapy. Comparative costs for the seven antibiotic regimens were determined by inserting the costs of the individual elements into the model. Total costs for the 14 days of therapy varied greatly among the seven regimens, ranging from $908 to $2543. Antibiotics constituted the greatest percentage of total expenditures for each regimen (64-92%). Costs were increased substantially when a third-generation cephalosporin was included in the regimen. Antibiotic costs correlated strongly with total costs, while personnel costs correlated poorly with total costs and accounted for only 6-30% of the total expenditures. Computerized analysis of all costs involved in antimicrobial therapy for this simulated neutropenic patient showed that total costs varied widely in direct proportion to antibiotic costs. In selecting antimicrobial agents for high-risk patients, costs should be considered along with efficacy.

Pathological Interaction of a Combination of Heterodera schachtii and Meloidogyne hapla on Tomato.

Increased culturing of a tomato population of Heterodera schachtii (UT1C) on tomato for 480 days (eight inoculation periods of 60 days each) significantly increased virulence to 'Stone Improved' tomato. A synergistic relationship existed between Meloidogyne hapla and H. schaehtii on tomato. A combination of H. schachtii (UTIC) and M. hapla significantly reduced tomato root weights by 65, 64, and 61% below root weights of untreated controls, and single inoculations of M. hapla and H. schachtii, respectively. This corresponded to root reductions of 42, 44, and 46% from a combination of H. schachtii (UT1B) and M. hapla. Antagonism existed between H. schachtii and M. hapla with regard to infection courts and feeding sites. The root-knot galling index dropped from 6.0 with a single inoculation of M. hapla to 4.3 and 3.3 with combined inoculations of M. hapla plus UT1B and M. hapla plus UTIC cyst nematode populations. The pathological virulence of H. schachtii to sugarbeet was not lost by extended culturing on tomato; there were no differences in penetration, maturation, and reproduction between sugarbeet populations continually cultured on sugarbeet and the population continually cultured on tomato.

Sustained behavioral contrast in children.

Children were exposed to a multiple schedule involving equal variable-interval schedules in each of two components and a multiple schedule involving a variable-interval schedule in one component and an extinction schedule in the other. Response rates were equal in both components when each involved a variable-interval schedule. Response rates differed in the two components of the multiple variable-interval extinction schedule. Response rates were higher in the variable-interval schedule when the accompanying schedule was extinction than when it was variable interval. The increase in response rate in the variable-interval component, simultaneous with the decrease in response rate in the extinction component, illustrated sustained behavioral contrast, and was the first evidence of this phenomenon in children.

Attraction of Ditylenchus dipsaci and Meloidogyne hapla by Resistant and Susceptible Alfalfa Seedlings.

Ditylenchus dipsaci Kühn were equally attracted to and equally invaded resistant ('Lahontan') and susceptible ('Ranger') germinating alfalfa (Medicago sativa L.) seedlings exposed singly in moist sand except at a distance of 12.5 mm at 20 C when the susceptibles proved more attractive than the resistants. Larvae hatching from egg-masses of Meloidogyne hapla Chitwood were also attracted equally to germinating seedlings of resistant ('M-9') and susceptible ('Lahontan') alfalfa offered singly. When hatched midway between resistant and susceptible, however, more larvae were attracted to the susceptibles. M. hapla larvae were attracted equally to the root and stem apices, region of elongation, and upper hypocotyl of resistant and susceptible plants.