Vascular complications of intraaortic balloon counterpulsation.

Between February 1973 and December 1986, 4,787 patients underwent open heart surgery at Samuel Merritt Hospital. Retrospective analysis revealed 395 (8 percent) consecutive patients who required hemodynamic support with the intraaortic balloon pump. Thirty percent of the patients had preoperative placement, 56 percent needed the balloon in order to wean from cardiopulmonary bypass, and 14 percent required placement in the postoperative period. The intraaortic balloon pump was instituted with multiple techniques and insertion sites. Three hundred eighty-three balloon catheters (96 percent) were inserted through the groin by surgical cutdown or a percutaneous approach. The remaining devices were inserted through the aortic arch. A 12 F. catheter was utilized in 239 patients (61 percent) and a smaller 10.5 F. catheter was placed in 156 patients (39 percent). The hospital mortality rate was 47 percent. Seventy-two of the 395 patients (24 percent) sustained vascular complications related to balloon use. Major complications occurred in 43 patients. Twenty-nine patients sustained minor complications that resolved spontaneously with balloon removal. Risk factors evaluated included patient gender, New York Heart Association class, catheter size, method of introduction, duration of counterpulsation, and presence of symptomatic peripheral vascular disease. Since percutaneous placement was associated with a significant decrease in complications, we concluded that use of the smaller 10.5 F. catheter placed percutaneously is the safest means of employing the intraaortic balloon pump. A monitoring line is placed percutaneously through the femoral artery in high-risk patients before operation. This allows easier access for intraaortic balloon pump placement in hypotensive patients. The presence of a clinical history of peripheral vascular disease was also a highly significant risk factor for vascular complications. Other risk factors increasing the likelihood of vascular compromise included catheter size and duration of counterpulsation.

Pharmacy practice in the United States Army.

The current status of pharmaceutical services in the United States Army Medical Department is described. The mission of the Army Medical Department is to ensure the health of the soldier during times of peace and war. Of the 225 commissioned pharmacy officers currently on active duty, 156 are assigned to U.S. Army medical centers and community hospitals in the United States, and 29 are stationed at hospitals in Europe, Korea, Panama, and Japan. Army pharmacy officers are supported by 879 Army-trained pharmacy technicians and 319 civilian pharmacists employed by the Army. Army Medical Department hospital pharmacies provide inpatient and ambulatory-care services as well as specialized nuclear pharmacy, oncology, investigational drug, and materials development services. Pharmacy officers assigned to the Pharmacy Branch of the U.S. Army Academy of Health Sciences conduct 17-week technician training programs six times a year and provide other pharmacy courses and continuing education programs. The U.S. Army Allergen Extract Laboratory dispenses diagnostic and immunotherapy agents by mail in response to prescriptions submitted by military allergy clinics. Pharmacy officers may be deployed with field hospitals during times of combat or for extended training exercises in places such as Egypt, Grenada, and Honduras. Pharmacy officers may also be assigned to three- or four-year tours of duty in Army hospitals located in Europe. In the future, the emphasis of Army pharmacy practice will be on the expansion of clinical pharmaceutical services and the development of advanced interactive communication systems, quality assurance programs, and peer-review programs.

Pharmacy technician training in the United States Army.

Pharmacy technician training in the U.S. Army is described. The training program, officially titled the pharmacy specialist course, is conducted at the U.S. Army Academy of Health Sciences on Fort Sam Houston in San Antonio, Texas. The 17-week program is conducted six times a year, accommodating up to 75 students per class. Before entering the course, the soldiers must complete basic combat infantry training and a general medical orientation course. Standardized examinations are given to ensure the students have the basic prerequisite knowledge. The curriculum emphasizes psychomotor skills with laboratory requirements supported by didactic instruction. During the first seven weeks of the course, the students receive instruction in pharmacy administration, pharmaceutical chemistry, pharmaceutical calculations, and pharmaceutical preparations. The last nine weeks of instruction focus on pharmacology, physiology and pathology, and hospital pharmacy practice. The laboratory simulates a hospital pharmacy and is used exclusively for the training program. The students are continually evaluated and provided with individualized supportive counseling by the faculty. Overall attrition has remained at approximately 22% for fiscal years 1981, 1982, and 1983. Following graduation and assignment to a medical-treatment facility, the technicians have several opportunities for advanced training and continuing education. The proficiency and competency of the graduates are continually monitored by an annual skill qualification test. The pharmacy specialist course conducted by the U.S. Army, accredited by ASHP, can serve as a standard for the comprehensive vocational and technical training of pharmacy technicians.