Automated pharmaceutical assistance systems

The function of the clinical pharmacokinetic service (CPS) in University Hospital is described. A methodological procedure was developed for routine interpretation of specified drug serum levels. Work lists that identify analytical procedures to be included for clinical pharmacokinetic evaluation are prepared daily. The results of all analyses of serum drug levels are evaluated by a pharmacist who is trained in clinical pharmacokinetics. Patient variables that influence serum levels of drugs are mathematically manipulated by program logic. Projections of expected drug levels as a result of dosing regimens are made and compared to measured laboratory results. Iterative programming that modifies projections on the basis of actual measurements is employed to determine individual drug dosing regimens the provide therapeutic/nontoxic serum levels of drugs. The drug/test interference system, which accesses the CPS data base, provides information concerning the potential physiologic, therapeutic, or toxic effect of drugs on biochemical substances. The system allows display of data concerning each drug before it is administered. Information concerning the date and time of initiation and termination of drug therapy allows for a warning comment to be attached automatically to the appropriate laboratory test result if interference is indicated.     

16 detector multislice CT versus skeletal scintigraphy in the diagnosis of wrist fractures: value of quantification of 99Tcm-MDP uptake

To compare the measured uptake of 99Tcm-methylene diphosphonate (99Tcm-MDP) in those scaphoid fractures seen on both 16 detector multislice CT and scintigraphy, with those seen only on scintigraphy. Over a 12 month period a total of 51 patients with suspected fracture underwent both conventional 99Tcm-MDP scintigraphy and 16 detector multislice CT on the same day. The 99Tcm-MDP uptake was then quantified in patients with identified fracture. This was measured by placing a region of interest (ROI) over the fracture site and the mean and maximum number of counts were compared with those in a similar size ROI placed over background bone activity. A total of 23 fractures were identified on scintigraphy of which 16 were also detected on CT (concordant). In seven cases the fracture was not seen on CT, even in retrospect (discordant). In the discordant cases, follow-up radiographs and MRI (where available) also failed to demonstrate a fracture. The mean fracture count to background bone activity ratio averaged 7.7 (range 3.2-18.5) for concordant fractures and 3.8 (range 1.7-5.3) for discordant fractures (t-test p=0.04). The maximum fracture count to background bone activity ratio averaged 12.7 (range 4.3-27.7) for concordant fractures and 6.3 (range 2.6-9.5) for discordant fractures (t-test p=0.03). It is speculated whether these discordant fractures with less 99Tcm-MDP uptake may represent a less severe injury such as bone bruise.