Journal of Pharmacy Technology

Communicating to nurses new information on therapeutics or pharmacy procedures is a frequent challenge faced by most hospital pharmacists. Pharmacists should use the most efficient and effective methods to inservice nursing staff. The purpose of this study was to compare five methods of inservicing in a neonatal intensive care unit (NICU) to determine which method resulted in the greatest knowledge retention as assessed by a ten-question quiz.

Various combinations of written guideline alone, verbal discussion by a pharmacist with and without a written guideline, and verbal discussion by a nurse with and without a written guideline were used to introduce nurses to the use of caffeine for apnea/bradycardia of the newborn. Each nurse completed a quiz to assess knowledge retention. The written guideline and quiz were prepared by a pharmacist.

Forty-eight nurses participated in the study: (1) group 1 (n=11) received the written guideline only (no verbal discussion); (2) group 2 (n=14) received verbal discussion by a pharmacist plus a written guideline; (3) group 3 (n=9) received verbal discussion by a nurse-educator plus a written guideline; (4) group 4 (n=9) received verbal discussion by a pharmacist (no written guideline); and (5) group 5 (n=5) received verbal discussion by a nurse-educator (no written guideline).

Mean quiz scores for all groups were compared and assessed using the Irwin-Fisher test for equality of binomial probabilities on all possible pairs of groups.

Mean quiz scores for groups 1 and 3 were 10; for group 2, 8.6; for group 4, 9; and for group 5, 9.2. Using the Irwin-Fisher tests for equality of binomial probabilities on all possible pairs of groups, the probability of obtaining a perfect score on the quiz was the highest for groups 1 and 3 (p≤0.05).

Within the limitations and the setting of this study, the two most effective methods of nursing inservice were a pharmacist-prepared written guideline followed by a quiz, and the written guideline plus a verbal discussion by a nurse-educator followed by a quiz. Use of these methods can reduce pharmacist inservice time and improve medication knowledge of the nurses and possibly reduce errors in the NICU.

To assess the use of intravaginal bromocriptine mesylate in women intolerant of orally administered bromocriptine.

Two consecutive women of reproductive age with prolactin-secreting pituitary microadenomas who were intolerant of oral bromocriptine.

Normoprolactinemia with eumenorrhea was obtained using intravaginal bromocriptine.

Intravaginal bromocriptine is recommended as an alternative route of administration in women intolerant of oral therapy.

To provide an overview of the selection criteria for and proper use of sunscreen products. The effects of ultraviolet (UV) radiation on the skin are also discussed.

References were selected from published bibliographies of books and articles dealing with UV radiation and sunscreen agents, manufacturers’ product information, and topical searches in MEDLINE computerized database (English language, through 1991).

Studies that investigated the short- and long-term effects of UV radiation (UVA and UVB) on human skin were reviewed. Equal weight was given to information published in authoritative textbooks by prominent photobiologists and dermatologists. Data relating to human skin were selected in preference to animal data, and data involving ingredients approved for use in the US were used in preference to those of products approved in foreign countries.

The literature describing the effects of both UVA and UVB on human skin is substantial. However, there is considerably less information on UVA in terms of how its effects impact the formulation and use of commercially produced sunscreen products. Information regarding the proper use of currently available sunscreen products and the appropriate patient counseling information for pharmacists is both considerable and consistent.

In recent years, the concerns about UV radiation have shifted from the short-term hazards of sunburn to the long-term hazards of skin cancer and premature aging of the skin. Available data suggest that a life-long approach to minimizing exposure to UV radiation including the use of sunscreens with a minimum sun protection factor of 15 will reduce overall morbidity and mortality. Authorities in the field are calling for the continuing development of commercial sunscreen products that provide a broad spectrum of protection against both UVA and UVB and their proper use by the public.

In a randomized, controlled trial evaluating the impact of clinical pharmacists’ consultations on physicians’ prescribing decisions, a seven-member physician/pharmacist panel developed an instrument to characterize and quantify the full range of drug-prescribing problems. The instrument was tested for validity and reliability.

The instrument was applied in reviewing prescribing for 236 geriatric outpatients.

To ensure internal validity of the instrument, five panel meetings were devoted to reaching a consensus on procedures, categories, criteria, and scoring. Each case was evaluated independently by two reviewers and each drug in the regimen was evaluated for drug-drug interactions, dosage, schedule, allergic reactions, therapeutic duplication, use of drugs without established diagnoses, and inappropriate drugs for the patient's clinical conditions; discrepancies were adjudicated by the panel chairperson. Self-reported adverse effects of 60 study patients who were interviewed, and hospital readmissions of all study patients were used to test the external validity of the instrument.

Inter-rater reliability improved over time, reaching a high of 97.1 percent after six months. A positive association was determined between the prescribing scores and the number of reported adverse effects (rho=0.28, p=0.02). Although the number of patients with drug-related hospital readmissions was too few to establish a significant association between the prescribing scores and readmissions, the findings were expected.

Given current requirements for drug utilization reviews in hospitals, health maintenance organizations, and Medicaid programs, this instrument may prove to be very useful.

To describe the use of sodium valproate in patients with advanced cancer for the relief of neuropathic pain.

Case series. A retrospective, descriptive review using medical records.

Ambulatory and hospitalized patients referred to the Central Sydney Palliative Care Service, based at the Royal Prince Alfred Hospital, an 800-bed teaching hospital, in Sydney, Australia.

Of all the 364 patients who were referred to the Service in 1987, 64 received sodium valproate for neuropathic pain and were eligible for inclusion in the study.

Documentation by physicians of pain control and the dose of sodium valproate.

Forty-three of the 64 patients (67 percent) had an indication of efficacy noted on their record. In 26 of these 43 patients (60 percent), sodium valproate was the only therapy introduced or the dosage was increased immediately prior to the documentation of pain relief. Only 3 patients totally discontinued sodium valproate. The 1 patient who experienced an adverse effect of sedation temporally related to institution of sodium valproate had therapy successfully reintroduced at a lower dosage. The dosages used for analgesia were much lower than those used for epilepsy. The mode and median doses were 400 mg/d (interquartile range 200–600 mg).

This medical record review raises the hypothesis that sodium valproate may be useful therapy in the management of cancer-related neuropathic pain.