Pharmacotherapy
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Comparative Study Clinical Trial
Pharmacokinetics and pharmacodynamics of high-dose zidovudine administered as a continuous infusion in patients with cancer.
To investigate the pharmacokinetics and pharmacodynamics of high-dose intravenous zidovudine (ZDV). ⋯ The pharmacokinetics of high-dose ZDV administered by continuous infusion to patients with cancer are similar to those reported with lower doses in patients with infection due to the human immunodeficiency virus. Further study of potential nonlinear pharmacokinetic behavior at doses above 20 g/m2/day is necessary. The high between-patient variability in ZDV clearance results in variable levels of exposure in vivo, and indicates the need for concentration- or effect-controlled study designs in the further evaluation of the agent's antineoplastic effects.
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Propofol was administered intravenously using a first-order, three-compartment, computer-controlled infusion pump (CCIP) based on the Ohmeda 9000 syringe pump. The CCIP system produced a target-controlled infusion (TCI) based on the estimated blood concentration (EBC). ⋯ The emergence EBC was 1.55 +/- 0.21 micrograms/ml, and the discharge EBC was 1.06 +/- 0.22 micrograms/ml. The EBC, together with clinical signs, allowed for predictable inductance and emergence from anesthesia using propofol.
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Problems occurred with train-of-four (TOF) monitoring during prolonged therapy with nondepolarizing neuromuscular blocking agents (NNMBAs). A previously healthy 25-year-old male with metastatic testicular teratocarcinoma was paralyzed with an atracurium infusion to facilitate mechanical ventilation. Dosage titration was initially based on clinical assessment; however, on day 4 of atracurium, TOF monitoring was initiated. ⋯ Although these problems were rectified, TOF response continued to be erroneous. Thus we had to rely primarily on clinical assessment to monitor the duration of NNMBA therapy. This case demonstrates that TOF data and clinical assessment of neuromuscular blockade may not always correlate.
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Comparative Study
Publication rates in U.S. schools and colleges of pharmacy, 1976-1992.
To establish publication rates of U. S. schools and colleges of pharmacy (SCOP) for 1976-1992, we obtained data from the Science Citation Index (SCI) Corporate Index. The SCI data base covers the top 4500 journals in the technical and scientific fields. ⋯ Only 13 (18%) SCOP averaged 1.0 or more publication/faculty/year, and 38 (52%) averaged fewer than 0.5. Publication rates were greater for medical center-based than for nonmedical center-based SCOP (p < 0.05), and for public than for private SCOP (p < 0.05). These data suggest that over half of the existing SCOP are minimally productive, generating less than 20 publications/year or 0.5 publication/faculty/year.
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A pattern of nerve stimulation called train-of-four (TOF) is frequently used to monitor therapy with nondepolarizing neuromuscular blocking agents in patients treated in intensive care units. Based on our experience with TOF monitoring in several critically ill patients, we believe its application as an indicator of neuromuscular blockade may be problematic in this setting.