Adjustments of distributive and clinical pharmacy services to financial constraints.

The effects of hospital budget constraints on a pharmacy department's ability to provide distributive and clinical services are described, and the development and use of workload-monitoring systems to match resources with demand is discussed. In 1980, the pharmacy department at Grace Hospital, a 402-bed community hospital in Detroit, Michigan, began quantifying workload by using five drug distribution indicators. After the pharmacy began providing clinical services in 1981, workload elements were measured in a pilot program for ASHP's Hospital Pharmacy Management Information System.

A unified approach to dose-effect relationships in radiotherapy. II: Inhomogeneous dose distributions.

Conventional dose-effect relationships, such as those based upon the NSD or linear-quadratic concepts, do not account for dose inhomogeneities. Only a single "dose" value can be used in these equations and this can give rise to significant errors in the estimation of the "tolerance" dose in situations where dose distributions are inhomogeneous. This paper presents a method of "integrating" the biologically effective dose over the entire volume of each organ or tissue irradiated.

A unified approach to dose-effect relationships in radiotherapy. I: Modified TDF and linear quadratic equations.

A linear quadratic factor analogue (LQF) to the variable-exponent TDF model is introduced. In both of these models, account is taken of the volume of tissue irradiated. Scaling factors are used such that an LQF or a TDF of 100 represents tolerance for each volume or partial volume of each tissue or organ irradiated.

Temporalis muscle-galea flap in craniofacial reconstruction.

With the advent of increasing technological and surgical sophistication in craniofacial surgery, reconstructive efforts are challenged to provide a reliable means of compartmentalization. When dural integrity is compromised in the face of nasopharyngeal or paranasal communication, the risk of ascending infection and potential life-threatening meningitis mandate cranial and facial compartments, separated by sufficient and healthy soft tissues. This paper describes a method of providing pedicled soft tissue coverage and support for the contents of the anterior cranial fossa using a temporalis muscle-galea rotation flap.

Injury to the orbital plate of the frontal bone.

Twelve cases of fracture of the orbital plate of the frontal bone are reviewed to clarify this important clinical problem and to suggest satisfactory methods of management. Common signs and symptoms include forehead laceration and deformity, and fracture of the frontal sinus. Loss of vision can occur, and in the seeing eye, diplopia can develop in several fields of gaze.

Detection and quantification of laryngotracheopulmonary aspiration with scintigraphy.

Aspiration is analyzed by a new scintigraphic technique and standard videofluoroscopy in 78 patients with head and neck pathology and neurologic disorders. When both methods are compared to clinical aspiration and a positive x-ray film of pneumonia, they appear to complement each other and provide a very accurate evaluation. Scintigraphy is a more sensitive method for detecting aspiration below the vocal cords and also provides for flow dynamics and a method of quantifying the amount of aspirated material.

Post-traumatic epilepsy following head injury.

The occurrence of post-traumatic epilepsy (PTE) was studied in 164 consecutive closed head injury patients, each of whom had been unconscious and amnestic for at least one hour. The overall incidence of PTE was found to be 25%, significantly higher than previously reported. Analysis of data revealed PTE was not related to the presence or absence of a hematoma, but rather to the duration of the coma.

Chemotherapeutic management of head and neck cancer.

The use of chemotherapy in patients with head and neck cancer is increasing. In patients with recurrent head and neck cancer, a large number of chemotherapeutic drugs have shown antitumor activity. These drugs are discussed, and factors which influence response rate and survival are examined.