Robert Quercia

Improved glucose control associated with i.v. chromium administration in two patients receiving enteral nutrition.

PURPOSE The effect of i.v. chromium administration on glucose control in two patients receiving enteral nutrition is described. SUMMARY Chromium supplementation has been hypothesized to potentiate the actions of insulin in facilitating cellular uptake of glucose. We report two cases-one involving a diabetic patient and the other a nondiabetic patient-in which chromium administration appeared to decrease insulin requirements. In case 1, a diabetic patient given a single course of chromic chloride appeared to have a probable response to the drug. Within the first day of chromic chloride administration, insulin requirements declined. When chromic chloride was discontinued, insulin requirements did not rise, suggesting efficacy and sustained effect. The patients glucose intake and blood glucose levels remained relatively stable, while there was a significant decline in insulin requirements. Serum chromium levels were not assessed, so it is uncertain if the patient experienced chromium deficiency or if it was adequately treated with chromium supplementation, and a dose-response relationship could not be ascertained because the patient received a continuous infusion of chromium. In case 2, the insulin requirements of a nondiabetic patient appeared to decrease in response to multiple courses of chromic chloride. Upon initial discontinuation of chromic chloride, the patients lower insulin requirements were sustained for a few days, but changes in clinical status and other medications precipitated elevated insulin requirements and the need for subsequent chromic chloride administration. Further research in more controlled settings is necessary to elucidate chromiums effect on insulin requirements. CONCLUSION Infusion of chromic chloride appeared to reduce insulin requirements in one diabetic patient and one nondiabetic patient.

Cost Avoidance and Clinical Benefits Derived from a Pharmacy-Managed Anemia Program

A pharmacy-managed anemia program included distribution and clinical components, with the goal of making epoetin alpha therapy for hemodialysis patients more cost-effective. The Pharmacy Department prepared epoetin alpha doses for patients in unit-dose syringes, utilizing and documenting vial overfill. Pharmacists dosed epoetin alpha and iron (oral and intravenous) per protocol for new and established patients. Baseline data were obtained in 1994, one year prior to implementation of the program, and were re-evaluated in 1995 and 1998. Cost avoidance from utilization of epoetin alpha vial overfill in 1995 and 1998 was

A CQI Program for Prescribing and Dispensing Total Parenteral Nutrition

83,560 and

Systematic Review: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II–Receptor Blockers for Ischemic Heart Disease

91,148 respectively. In 1995 and 1998, cost avoidance from pharmacy management of anemia was

Delivery of esomeprazole magnesium enteric-coated pellets through small caliber and standard nasogastric tubes and gastrostomy tubes in vitro.

191,159 and

Effectiveness and Safety of Antiepileptic Medications in Patients With Epilepsy

203,985 respectively. The total cost avoidance from 1995 through 1998 was estimated at

Cost-benefit analysis of a pharmacy-managed medication assistance program for hospitalized indigent patients

1,018,638. The number of patients with hematocrits under 31% decreased from 32% in 1994 to 21% and 14% in 1995 and 1998 respectively. We conclude that a pharmacy-managed anemia program for hemodialysis patients results in significant cost savings and better achievement of target hematocrits.

Comparative Effectiveness of Angiotensin Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Stable Ischemic Heart Disease

An increase in total parenteral nutrition (TPN) prescribing errors at Hartford Hospital provided the impetus for implementing a continuous quality improvement (CQI) program for prescribing and dispensing TPN. The CQI process identified a number of problems in the prescribing and dispensing system. A severalpronged approach that incorporated education, revision of the TPN order form, and institution of dispensing safeguards was undertaken to resolve these problems. The cornerstone of this program was the unique coupling of a drug utilization evaluation (DUE) process for TPN with an automated TPN intervention program. The computerized intervention program enabled pharmacists to prospectively document, intervene, and track TPN prescribing errors. Through the DUE feedback mechanism, individual physicians received educationally oriented feedback specific to their prescribing errors by the director of the nutrition support team (NST). Six months after implementing the CQI program, the average daily error rate d...