Cost of gentamicin assays carried out by microbiology laboratories.

Aims: To assess the current range of prices charged for gentamicin assays in United Kingdom laboratories; and to examine the laboratories' likely response to increases or decreases in the demand for the service.

Methods: A postal survey of the 420 members of the Association of Medical Microbiologists was used to establish the range of prices charged for aminoglycoside assays. Additionally, eight private institutions were contacted to determine what the private sector was charging for aminoglycoside assays.

Cloning of the X-linked glycerol kinase deficiency gene and its identification by sequence comparison to the Bacillus subtilis homologue.

cDNA clones from a human adult testis cDNA library were isolated and sequenced as part of a programme to produce expressed sequence tags (ESTs). ESTs were used routinely to search DNA and protein sequence databases. One clone (142) showed 60% identity to the Bacillus subtilis glycerol kinase gene at both the DNA and amino acid sequence levels.

Pharmacoeconomics of antimicrobial prophylaxis.

Pharmacoeconomic analysis of the prevention of infection is based on quantification of the benefits which result from prevention, rather than simple counting of the number of cases prevented. In general, benefits are best quantified as continuous variables which measure severity as well as occurrence, for example, cost of antibiotics prescribed is a useful continuous measure of severity to add to a discontinuous measure, such as number of patients who received antibiotics. Considerable progress has been made in the USA with the application of decision analysis to clarify the options available for dealing with a problem, the probability of good and bad outcomes for each choice and the utility which is associated with each outcome.

Phase I study of hyperfractionated whole brain irradiation (HWBI) in the treatment of primary cerebral lymphoma.

The poor prognosis for primary cerebral lymphoma following conventional radiation therapy has generally been attributed to high local relapse rates despite initial local control. Hyperfractionated radiation therapy may improve the therapeutic ratio by allowing higher total radiation doses to be prescribed without exceeding the radiation tolerance of the central nervous system (CNS). Eight patients entered a study of hyperfractionated whole brain irradiation (HWBI) between October 1988 and May 1991.

Postmarketing surveillance of quinolones, 1990 to 1992.

During the last 2 years, the major event in the postmarketing surveillance of quinolones has been the worldwide withdrawal of temafloxacin after only 15 weeks on the USA market. The Adverse Drug Reaction (ADR) reports that led to the withdrawal have been reviewed and show that the frequency and type of ADR and serious ADR were highly unusual in comparison with other quinolones marketed in the USA (ciprofloxacin, norfloxacin and ofloxacin). The difficulty in establishing causality between drugs and ADRs is discussed.

Cost-effectiveness of single dose cefotaxime plus metronidazole compared with three doses each of cefuroxime plus metronidazole for the prevention of wound infection after colorectal surgery.

The cost-effectiveness of prophylaxis for colonic surgery with single dose cefotaxime plus metronidazole has been compared with that of three doses each of cefuroxime plus metronidazole, by analysing data from a previously published study supplemented with additional data on the hospital and community costs of wound infection after colonic surgery. The original trial included 942 patients having elective colonic surgery in 14 hospitals. The data on costs of wound infection were collected from a further 124 patients undergoing elective colonic surgery at Ninewells Hospital.

Ventilation in chronic heart failure: effects of physical training.

Objective: To assess the effects of exercise training on ventilatory function in chronic heart failure.

Design: Observer blinded random allocation crossover training and detraining trial.

Setting: Assessment in hospital based clinical laboratory; training home based.

Measuring the cost-effectiveness of antibiotic prophylaxis in surgery.

Cost-effectiveness analysis is primarily a decision-making aid for budget holders. The first questions that must be answered are: Costs to whom? Effects on whom? Ideally cost-effectiveness analysis should address these questions separately from the perspective of the hospital, the community health services, the patient, and society in general. However, it may not always be practical to perform such a wide-ranging study.

Cost effectiveness of once-daily oral antimicrobial therapy.

Once daily dosing of oral antimicrobials achieves significantly better patient compliance than three or four times daily dosing, and limited data suggest that this is associated with greater efficacy. Comparison of once daily and twice daily dosing is less consistent, and most studies show only marginally better compliance with once daily dosing versus twice daily dosing. Detection of urinary antimicrobial activity provides a simple method for checking compliance with oral antimicrobials and deserves wider study.

Costing wound infection in a Scottish hospital.

Data from a trial of preoperative whole body disinfection in postoperative wound infection prophylaxis involving 3733 patients were used to analyse the cost of a postoperative wound infection. The overall wound infection rate was 14.73% (513/3482), 61% of which were diagnosed after hospital discharge (312 outpatient infections versus 201 inpatient infections).

Cost-effectiveness analysis of the use of chlorhexidine detergent in preoperative whole-body disinfection in wound infection prophylaxis.

A total of 3482 general surgical patients entered a trial in which they had a chlorhexidine or placebo detergent shower three times before elective clean wound or potentially contaminated surgery. Patients who showered with a chlorhexidine detergent (N = 1744) had a significant reduction in skin flora compared with those who showered with a placebo detergent (N = 1738). The majority of wound infections occurred outside hospital (312 outpatient infections vs.

A cost-effectiveness study of the management of intractable urinary incontinence by urinary catheterisation or incontinence pads.

Study Objective: The aim was to compare the costs and effects of management of intractable urinary incontinence by urinary catheterisation or incontinence pads.

Design: This was a prospective, randomised study comparing catheterisation with pads, supplemented by additional data collected from patients with chronic indwelling catheters. Main outcome measures were costs of equipment, nursing time, patient preference, nursing preference, and clinical and bacteriological assessment of urinary infection.

Controlled trial of physical training in chronic heart failure. Exercise performance, hemodynamics, ventilation, and autonomic function.

Background: Many secondary abnormalities in chronic heart failure (CHF) may reflect physical deconditioning. There has been no prospective, controlled study of the effects of physical training on hemodynamics and autonomic function in CHF.

Methods And Results: In a controlled crossover trial of 8 weeks of exercise training, 17 men with stable moderate to severe CHF (age, 61.

Pharmacoeconomics of antibacterial treatment.

Antibacterial drugs account for between 3 and 25% of all prescriptions, between 6 and 21% of the total market value of drugs in a single country, and up to 50% of the drug budget in hospitals. Bacterial infection is widely perceived as disease caused by harmful outside agents which can be isolated and tested to select the best drug for treatment. In fact, the need for any treatment and the pros and cons of different drugs are just as debatable as in any other therapeutic area.

A comparison of the costs of ceftazidime therapy and gentamicin combinations in three UK hospitals.

This study compares the utilization costs of ceftazidime therapy with those of gentamicin in combination with other antibacterial drugs. The results show that the relatively high purchase cost of ceftazidime compared to combinations is more than counterbalanced by the additional materials used for drug administration and serum antibiotic assays, even when other drugs were combined with ceftazidime. The average drug and equipment costs were 230.

Pharmacoeconomics of intravenous drug administration.

Direct administration of a drug into a vein guarantees bioavailability, i.e. the total amount of drug is fully available to the bloodstream for transport to all areas of the body.