HearthBeat

Infusion Services: Needed in the Nineties

Advances in infusion technology are driving change and presenting challenges in the U.S. health system, according to Jack Saladow of Pacific Marketing Resources in Laguna Niguel, California. In a session on infusion therapy in alternate-site environments at ASHP's Midyear Clinical Meeting in December, he and other speakers outlined the trends driving care into ambulatory infusion centers, homes, and long-term care facilities.

Tom Schleis of Infections Limited in Tacoma, Washington, said that the ambulatory infusion center reduces costs for home care agencies by centralizing care and making it more easy to coordinate. Certain treatments-such as amphotericin B or blood transfusions-can be given at centers with physicians, nurses, and pharmacists. The Joint Commission's new accreditation process for ambulatory care centers was reviewed by Ramona Moenter of OptionCare in Sacramento, California, the first ambulatory infusion center affiliated with a home infusion company to be surveyed.

Drugs and Elderly Subject of Special Issue

The International Journal of the Addictions has published a special issue on "Drugs and the Elderly: Use and Misuse of Drugs, Medicines, Alcohol, and Tobacco." It contains 14 articles on subjects such as epidemiology of problem drinking, medical manifestations of alcoholism, alcoholism and dementia, alcohol and drug misuse in the nursing home, and use of illicit drugs.

R.E. Finlayson, in an article on prescription drug misuse, discusses problems with confusion, falls, and aggravation of untoward emotional states secondary to adverse drug effects. He says, "Diagnosis of drug dependency states is difficult because of overlap of general medical disorders and mental disorders and a lack of suitable diagnostic criteria for the aged." Reprints: R.E. Finlayson, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905.

Prices for individual copies of the full journal were not listed in the journal, but requests for copies of this issue may be requested from Marcel Dekker Journals, P.O. Box 5017, Monticello, NY 12701-5176. Full-year subscriptions cost $625 for individuals and $1,250 for institutions.

Clozapine-Benzodiazepines Cause Cases of Delirium

Three case reports of delirium associated with administration and onset of benzodiazepines in patients receiving clozapine are reported by Jackson et al in the Annals of Clinical Psychiatry. No rechallenges were conducted, and the cases were confounded since patients had previously received the drugs without delirium.

Reprints: C. W. Jackson, PH 343, MUSC, 171 Ashley Ave., Charleston, SC 29425.

Oral Health Important

An aspect of home care easily overlooked is oral health, but substantial morbidity or even mortality can result from poor care of the gums and teeth. This was a central message in a review of oral health in the older patient by Shay and Ship in the Journal of the American Geriatrics Society.

The dentists report: "Common disease processes affecting oral health include tooth loss, dental caries, periodontal diseases, and oral mucosal diseases (including candidiasis and squamous cell carcinoma). Systemic diseases and their treatments frequently affect salivary, oral motor, and oral sensory functions.… Clinicians caring for older people need to recognize the importance of stomatological health, including an oral component in the multidisciplinary geriatric assessment, support the education of patients on aspects of oral health, and advocate the expansion of personal and public oral health benefits for older adults."

Reprints: K. Shay, Dental Svc. (160), VA Med. Ctr., Ann Arbor, MI 48105.


L. Michael Posey, Academics Editor
The Consultant Pharmacist

HearthBeat is published bimonthly. Articles about clinical practice and regulatory news, as well as practice innovations, are provided within the realm of home care pharmacy. Contributions, always welcome, should be sent to Academics Editor L. Michael Posey, P. O. Box 6565, Athens, GA 30604; 706-613-0100, 706-613-0200 (fax), mposey@aol.com (e-mail).

TCP is seeking ideas for future installments of HearthBeat and a new column, Hospital Forum. What problems have you encountered today-be they clinical, management, or reimbursement in nature? Send an e-mail to the Academics Editor at mposey@aol.com, or fax a note to 706/613-0200. Include your name and address if you have other information that could be shared with TCP readers.