Todd Franke

PREVALENCE OF GLAUCOMA: THE BEAVER DAM EYE STUDY

PURPOSE The purpose of this study is to determine the prevalence of glaucoma in the population participating in the Beaver Dam Eye Study (n = 4926). METHODS All subjects were examined according to standard protocols, which included applanation tonometry, examination of the anterior chamber, perimetry, grading of fundus photographs of the optic disc, and a medical history interview. Visual field, cup-to-disc ratio, and intraocular pressure (IOP) criteria were used to define the presence of open-angle glaucoma. Definite open-angle glaucoma was defined by the presence of any two or all three of the following: abnormal visual field, large or asymmetric cup-to-disc ratio, high IOP. RESULTS The overall prevalence of definite open-angle glaucoma was 2.1%. The prevalence increased with age from 0.9% in people 43 to 54 years of age to 4.7% in people 75 years of age or older. There was no significant effect of sex after adjusting for age. Of the 104 cases of definite open-angle glaucoma, 33 had IOPs less than 22 mmHg in the involved eye. Hemorrhage on the optic disc was found in 46 people; 2 of these had glaucoma. Narrow-angle glaucoma was rare, with two definite cases in the population. CONCLUSION The prevalence of open-angle glaucoma in Beaver Dam is similar to that in other white populations. Findings from this study re-emphasize the notion that estimates of glaucoma prevalence should be based on assessing multiple risk indicators.

Hospital Admission Risk Profile (HARP): Identifying Older Patients at Risk for Functional Decline Following Acute Medical Illness and Hospitalization

OBJECTIVES: To develop and validate an instrument for stratifying older patients at the time of hospital admission according to their risk of developing new disabilities in activities of daily living (ADL) following acute medical illness and hospitalization.

The Relationship of Cardiovascular Disease and Its Risk Factors to Age-related Maculopathy: The Beaver Dam Eye Study

PURPOSE To examine the association between cardiovascular disease and its risk factors to age-related maculopathy in a population-based study of people between the ages of 43 and 86 years (n = 4926) between 1988 and 1990. METHODS Population-based prevalence study using standardized protocols for physical examination, blood collection, administration of a questionnaire, and stereoscopic color fundus photography to determine age-related maculopathy. Standard univariate and multivariate analyses were performed. RESULTS After controlling for age, early age-related maculopathy was related to low total serum cholesterol levels in women and a high high-density lipoprotein (HDL) cholesterol level and a low total cholesterol/HDL-cholesterol ratio in men. After controlling for age and sex, age-related exudative macular degeneration was associated with higher hematocrit values (odds ratio, 1.09; 95% confidence interval, 1.00, 1.19) and higher leukocyte count (odds ratio, 1.10; 95% confidence interval, 1.00, 1.19). There was no statistically significant relationship between blood pressure, hypertension, or history of cardiovascular disease and exudative macular degeneration or geographic atrophy. CONCLUSION With the exception of relationships between serum lipids and early age-related maculopathy, and hematocrit values, leukocyte counts, and exudative macular degeneration, these data suggest that most cardiovascular disease risk factors are not related to age-related maculopathy. Further longitudinal study is needed.

Clinical Pharmacy Services, Hospital Pharmacy Staffing, and Medication Errors in United States Hospitals

The direct relationships and associations among clinical pharmacy services, pharmacist staffing, and medication errors in United States hospitals were evaluated. A database was constructed from the 1992 National Clinical Pharmacy Services database. Both simple and multiple regression analyses were employed to determine relationships and associations. A total of 429,827 medication errors were evaluated from 1081 hospitals (study population). Medication errors occurred in 5.22% of patients admitted to these hospitals each year. Hospitals experienced a medication error every 22.04 hours (every 19.13 admissions). These findings suggest that at minimum, 90,895 patients annually were harmed by medication errors in our nations general medical‐surgical hospitals. Factors associated with increased medication errors/occupied bed/year were drug‐use evaluation (slope = 0.0023476, p=0.006), increased staffing of hospital pharmacy administrators/occupied bed (slope = 29.1972932, p<0.001), and increased staffing of dispensing pharmacists/occupied bed (slope = 19.3784148, p<0.001). Factors associated with decreased medication errors/occupied bed/year were presence of a drug information service (slope = −0.1279301, p<0.001), pharmacist‐provided adverse drug reaction management (slope = −0.3409332, p<0.001), pharmacist‐provided drug protocol management (slope = −0.3981472, p=0.013), pharmacist participation on medical rounds (slope = −0.6974303, p<0.001), pharmacist‐provided admission histories (slope = −1.6021493, p<0.001), and increased staffing of clinical pharmacists/occupied bed (slope = −9.5483813, p<0.001). As staffing increased for clinical pharmacists/occupied bed from the 10th percentile to the 90th percentile, medication errors decreased from 700.98 ± 601.42 to 245.09 ± 197.38/hospital/year, a decrease of 286%. Specific increases or decreases in yearly medication errors associated with these clinical pharmacy services in the 1081 study hospitals were drug‐use evaluation (21,372 more medication errors), drug information services (26,738 fewer medication errors), adverse drug reaction management (44,803 fewer medication errors), drug protocol management (90,019 fewer medication errors), medical round participation (42,859 fewer medication errors), and medication admission histories (17,638 fewer medication errors). Overall, clinical pharmacy services and hospital pharmacy staffing variables were associated with medication error rates. The results of this study should help hospitals reduce the number of medication errors that occur each year.

Clinical pharmacy services and hospital mortality rates.

We evaluated the associations between clinical pharmacy services and mortality rates in 1029 United States hospitals. A data base was constructed from Medicare mortality rates from the Health Care Financing Administration and the National Clinical Pharmacy Services data base. A multivariate regression analysis, controlling for severity of illness, was employed to determine the associations. Four clinical pharmacy services were associated with lower mortality rates: clinical research (p<0.0001), drug information (p=0.043), drug admission histories (p=0.005), and participation on a cardiopulmonary resuscitation (CPR) team (p=0.039). The actual number of deaths (lower) associated with the presence of these four services were clinical research 21,125 deaths in 108 hospitals, drug information 10,463 deaths in 237 hospitals, drug admission histories 3843 deaths in 30 hospitals, and CPR team participation 5047 deaths in 282 hospitals. This is the first study to indicate that both centrally based and patient‐specific clinical pharmacy services are associated with reduced hospital mortality rates. This suggests that these services save a significant number of lives in our nations hospitals.

Health care professional staffing, hospital characteristics, and hospital mortality rates.

To evaluate associations among hospital characteristics, staffing levels of health care professionals, and mortality rates in 3763 United States hospitals, a data base was constructed from the American Hospital Associations Abridged Guide to the Health Care Field and hospital Medicare mortality rates from the Health Care Financing Administration. A multivariate regression analysis controlling for severity of illness was employed to determine the associations. Hospital characteristics associated with lower mortality were occupancy rate and private nonprofit and private for‐profit ownership. Mortality rates decreased as staffing level per occupied bed increased for medical residents, registered nurses, registered pharmacists, medical technologists, and total hospital personnel. Mortality rates increased as staffing level per occupied bed increased for hospital administrators and licensed practical‐vocational nurses. To our knowledge, this is the first study to show that pharmacists were associated with lower mortality rates.

Clinical Pharmacy Services, Pharmacy Staffing, and the Total Cost of Care in United States Hospitals

This study evaluated direct relationships and associations among clinical pharmacy services, pharmacist staffing, and total cost of care in United States hospitals. A database was constructed from the 1992 American Hospital Associations Abridged Guide to the Health Care Field and the 1992 National Clinical Pharmacy Services Database. A multiple regression analysis, controlling for severity of illness, was employed to determine the relationships and associations. The study population consisted of 1016 hospitals. Six clinical pharmacy services were associated with lower total cost of care: drug use evaluation (p=0.001), drug information (p=0.003), adverse drug reaction monitoring (p=0.008), drug protocol management (p=0.001), medical rounds participation (p=0.0001), and admission drug histories (p=0.017). Two services were associated with higher total cost of care: total parenteral nutrition (TPN) team participation (p=0.001) and clinical research (p=0.0001). Total costs of care/hospital/year were lower when any of six clinical pharmacy services were present: drug use evaluation

Interrelationships among Mortality Rates, Drug Costs, Total Cost of Care, and Length of Stay in United States Hospitals: Summary and Recommendations for Clinical Pharmacy Services and Staffing

1,119,810.18 (total

Clinical pharmacy services, pharmacist staffing, and drug costs in United States hospitals.

1,005,589,541.64 for the 898 hospitals offering the service), drug information

Diagnostic x-ray exposure and lens opacities: the Beaver Dam Eye Study.

5,226,128.22 (total