LEHI~VAILEY H<>sl•n:\L Medical Staff

Volume 4, Number 9 Progress Notes September, 1992

with the capabilities this organization, - .. From the the Raleigh Group, a national health .... - care consulting firm with regional President - offices (Philadelphia). The American College of This group is going to begin work Executives sponsors a National Awards promptly here, including initial Program for innovations in health care evaluation of the existing status of which is open to as well as managed care activity in the Lehigh other health care professionals. The Valley. In addition, individual Medical annual awards are given for Staff members may receive requests for improvements in the quality of health interviews in an attempt by the care or for contributions to controlling consultant to obtain more information health care costs. For more about our Medical Staff and its current information about this program, contact practice patterns. Medical Staff Services at 402-8968. The Mini-Internship Program, being The Partnership for Community Health run in conjunction with Lehigh County in the Lehigh Valley continues to meet Medical Society, is scheduled for regularly. Sponsored by the Pool October 19 and 20. Those invited as Trust, this is an effort to address broad interns include various community concerns in the Lehigh leaders such as CEOs and health care Valley, including care for the un- and officials from local corporations, under-insured. Efforts have been made representatives from the media, labor, to include both senior management and health care coalitions, etc. Those of medical staff leadership of the various you who volunteered for service as regional hospitals in a collaborative In This Issue ... physician "faculty members" have had relationship to solve these problems. their names submitted to Lehigh Initial meetings have been very County Medical Society for further Parking News encouraging. consideration. We are optimistic that -Page 2 this program will provide a "hands on" Photo J.D. Badge A "winner" in the consultant evaluation look at the typical day in the life of a News process was recently selected for the practicing physician for key members -Page 2 Medical Staff PPO/IPA feasibility of the community. Physician Well­ study, from an impressive group of Being News interested organizations which had -Page 5 responded with proposals. A P & T Highlights presentation was made to the Strategic - Pages 14 & 15 Development Committee of the Medical Staff which was impressed Parking News - are requested to park in the third Cedar Crest & 1-78 section (most distant from the building) of the Physicians' Parking Lot. The Due to the parking changes currently in first and second sections of the parking effect at Cedar Crest & 1-78, all lot should be used by those physicians physicians who spend a major portion who come and go throughout the day. of the day at the hospital, namely, anesthesiologists, emergency Your cooperation and patience are physicians, pathologists, radiologists, appreciated during this most hectic and second and third year residents, time.

Photo J.D. Badge News

Pick-up Schedule Revised

New hospital identification badges for members of the Medical Staff who have had their photos taken will be available for pick-up from 8:30a.m. to 4:30p.m. as follows:

Week of September 21 -Medical Staff Services, Second Floor, Cedar Crest & 1-78

Week of September 28- POPS Office, First Floor, 17th & Chew Make-up Photo Sessions Scheduled Week of October 5 -Medical Staff Services, Cedar Crest & 1-78 Beginning September 22, make-up sessions for photo !.D.'s will be Week of October 12- POPS Office, available on Tuesdays and Thursdays 17th & Chew from 6 to 9 a.m. and from 2 to 5 p.m., in Room 4901 on the Fourth Please Note: Your old identification Floor of the School of Nursing, 17th & badge is required in exchange for Chew. No appointment is necessary. your new one.

Page 2 New Test: Beta-2- Effective September 1, this test will be offered Monday through Friday. Microglobulin Please contact the laboratory at Health Network Laboratories now 402-9751 for more information. offers Beta-2-microglobulin as an in- house test through the Hepatitis C Testing Department. Testing for Hepatitis C Virus (HCV) In normal individuals, B2-micro- antibody using a second generation globulin is found in both serum and enzyme immunoassay (EIA) is now urine. performed by the staff of the Immunology Division, either as an Proximal tubular disfunction results in individual test order or as part of the elevated urinary concentrations (either hepatitis profile. The laboratory will random or 24-hour specimen is automatically reference repeatably acceptable). Serum levels are a reactive EIA specimens for function of its rate of synthesis and are supplemental RIBA testing. elevated in inflammatory disorders, lymphoproliferative diseases, and as a To date approximately 22% of predictive test measuring the specimens submitted to our laboratory progression to AIDS in HIV infections. for EIA testing have been positive; 98% of these specimens have also been If you have any questions, please reactive in the supplemental RIBA test. contact Gerald E. Clement, Ph.D., Director, Toxicology/Immunology/ Heptavax Follow-up Chemistry, at 402-2534, or Gale Many physicians have ordered tests for Fritch, Supervisor, at 402-2845. the presence of Hepatitis B antibody on specimens collected from their office Leukemia/Lymphoma staff as a follow-up to the OSHA guidelines that state Heptavax must be Immunophenotyping by offered to all health care workers. The Flow Cytometry_ appropriate way to order post-Heptavax The Flow Cytometry Division has testing is to request "Hepatitis B recently added a Leukemia-Lymphoma Surface Antibody" or "HBsAb." Phenotyping Panel to its test services. This panel assesses the presence or ~equests using other terminology have absence of various lineage specific cell lead to confusion and misinterpretation surface antigens and is designed to be of the order and should, therefore, be utilized in conjunction with the avoided. Your cooperation in using standard morphological and the recommended terminology as cytochemical test data to characterize outlined above will ensure the correct and classify the disease. test is performed and ultimate! y an efficient service is provided. In-house testing will provide improved turn-around time of results to If you have any questions, please physicians which will expedite contact Gale Fritch at 402-2845 or treat~ent decisions. Diane C. Halstead, Ph.D. at 402-2834 or beeper 1193. Page 3 ...... 1.-.-...,.-,.....--...... , At the August Medical Record However, the Medical Record .·.·.·-:-:-:-:-:-:.:-:-:-:-:-:-:-:-:-: ...... Committee meeting, the following Committee would like to remind the :NE'NJ~TH!:•::::: results of concurrent monitoring of Medical Staff, in accordance with operative reports were revealed. Medical Staff Bylaws and JCAHO :::•:oEP.~·:·•·:•:: ...... regulations, operative reports are to be In June, 74% were dictated within 24 dictated immediately following hours post-op, and 87% were dictated . If dictating stations are within 48 hours post-op. In July, 87% unavailable, telephones can be used. were dictated within 24 hours post-op, with 92% dictated within 48 hours post-op.

These percentages have improved since the inception of concurrent monitoring of operative reports by the Medical Record Department.

Nuclear Medicine News

Effective Monday, August 24, the As a reminder, reports for Nuclear Medical Record Department will now Medicine, Cedar Crest & I-78, are also type all reports from Nuclear typed by Medical Records. These Medicine, 17th & Chew. The reports reports may be reviewed by dialing the may be reviewed by any physician by access number (Ext. 8365). dialing the access number for 17th & Chew (Ext. 2515) and then following the instructions.

Research Advisory Committee - Request for Proposals

The Research Advisory Committee All proposals submitted by October 9 (RAC) meets quarterly to review will be reviewed at the October 28 clinical/epidemiological research RAC meeting. Further information proposals (requests for funding) and proposal guidelines may be submitted by the Medical and obtained by contacting James F. Reed Professional staff of Lehigh Valley III, Ph.D., Director of Research, or by Hospital. The next meeting of the calling the Research Department at RAC is October 28. 402-8889.

Page 4 Next Cycle for Physician Well-Being Group to Begin in October

Due to the enthusiasm and positive response from its current members, the Conference Room (located in the trailer Physician Well-Being group will behind the Shock/Trauma Unit at continue to meet regularly on an Cedar Crest & I-78). alternate week basis with the assistance of a professional facilitator, John C. Any physicians who are interested in Turoczi, Ed. D. participating in this worthwhile program should contact Janet M. The first meeting of the next cycle will Laudenslager, Coordinator, Physician be held on Monday, October 5, from 6 Office Practice Services (POPS), at to 7:30p.m., in the Shock/Trauma 402-2780.

News from Enterostomal : Perineal Care Peri-Wash and Critic-Aid Paste (also available together in a hospital pack) Triple Care Perineal Wash and are indicated for skin that is inflamed Unisalve Ointment have been replaced . and denuded as a result of urinary or with products that will improve patient fecal incontinence or enzymatic care and be cost effective. drainage that cannot be protected by a skin barrier or collection device. In Peri-Wash and Baza Cream (available hospital trials, Critic-Aid was found to together in a hospital pack) are be more effective than Lasser's Paste. indicated for prevention for any bedbound patient and any patient who Both product packages are stocked in is incontinent. It is effective when SPD and do not require a physician's erythema is present with intact skin. order.

Revised Vascular Lab Hours

Effective September 14, the hours of the Vascular Lab at 17th & Chew will be from 8:30a.m. to 5 p.m. If you have any questions, please call the Vascular Lab at 402-4837.

Page 5 Broselow Pediatric Emergency Tape dosages should be calculated. In Effective September 14, all Pediatric addition, the colored portion of the Code Carts will have a Broselow tape includes equipment sizes. The Pediatric Emergency Tape in the bottom portion of the tape includes medication drawer of the Pediatric information on the compression rate Code Cart. This will help to determine and depth. approximate weights of children in order to assist with medication The Code Blue Committee feels this dosages, equipment sizes, and oxygen tape will be instrumental in assisting all supplies. staff with pediatric dosages, equipment sizes, as well as vital signs and CPR The tape is simple to use. Simply lay instructions. After the code is the child on the tape (head should be completed, please clean the tape and on the top red arrow) and measure to return it to the Code Cart to be used the heal of the child. The tape is for subsequent pediatric codes. designed to include children from 3KG to 34KG. Each block on the tape is If you have any questions regarding the for a separate KG weight and includes use of the tape, please contact Mary dosages and equipment for that weight. Alexander, R.N., M.S.N., Head Wherever the heel of the child's foot Nurse, Emergency Department, at ends is the location where medication 402-2246.

Student Internship Opportunities for Physicians' Offices

The Allentown Business School plans part of each course and is a learning to offer three programs which may be experience for the student, no of interest to physicians' offices. remuneration is expected. These programs include a nine-month Medical Office Management program, Any physicians interested in providing an 18-month Medical Assisting/ an internship opportunity to a student Secretarial program, and a 12-month enrolled in one of these programs Medical Business and Clinical should contact Mary Wagner, Specialist program. Prior to Supervisor, Medical Internship/Externship Program, completion of each program 1 students are required to complete an internship Allentown Business School, at in a health facility. As an internship is 791-5100.

Page 6 Sources for Free Medications

The Pharmaceutical Manufacturers As part of a pilot program to assist Association (PMA) has published a physicians in obtaining free directory of prescription drug medications for their patients, PMA companies that provide free also has established a toll-free number to physicians whose patients might not for physicians. In Pennsylvania, the otherwise have access to necessary number is 1-800-762-4636 or 1-800- medications. PMA-INFO.

Physicians may obtain a copy by writing to: 1992 Director of Prescription Drug Indigent Programs, Pharmaceutical Manufacturers Association, 1100 15th Street, N.W., Washington, DC 20005.

Congratulations! Michael L. Stevens, D.P.M., podiatrist, was notified that he Nancy A. Mao, M.D., general successfully passed both parts of the internist, and her-husband, Jeffrey L. 1992 Foot Surgery certification Gevirtz, M.D., urologist, welcomed examination and is now a Diplomate of their first child, Samuel Joseph, on the American Board of Podiatric August 3.- Surgery with Certification in Foot Surgery. Zirka M. Halibey, M.D., obstetrician/gynecologist, and her husband, Gary Madine, welcomed their second child, Peter, on August 17. Peter has a brother, Daniel.

Jamie D. Paranicas, M.D., cardiologist, was recently notified that she was elected to Fellowship in the American College of .

Catharine L. Shaner, M.D., pediatrician, was recently selected as the recipient of a Governor's Highway Safety Award in the Safety Education category.

Page 7 Publications, Papers and Glen L. Oliver, M.D., ophthalmologist, presented a paper, Presentations The Oliver-McFarlene Syndrome, at the recent Annual Wills Fluorescein George F. Carr, D.M.D., vice Conference which was held in chairman, Department of , Philadelphia. This syndrome presents presented Creating a Third Dentition as a congenital trichomegaly with for the Annual Pennsylvania associated , pigmentary Prosthodontic Association Meeting retinal degeneration, dwarfism and which was held recently in State mental retardation. A 27-year update College. on the original case was presented along with a review of the literature. In addition, Dr. Carr presented a table clinic at the Annual Meeting of the Peggy E. Showalter, M.D., American College of Implantology on psychiatrist, co-authored an article, Two Phase Oral Impression Learning Priorities of Staff, Technique for Implant Dentistry. Residents, and Students for a Third The meeting was held in Chicago, Ill., Year Psychiatric Clerkship, which last month. has been accepted for publication in Academic .

Health Promotion

Program News Wednesday, October 7, 7 to 8:30 p.m.; Tuesday, October 13, 9:30 to 11 . The Health Promotion Program of a.m.; Wednesday, October 14, 7 to Lehigh Valley Hospital will present a 8:30p.m.; and Tuesday, October 20, program for healthier food shopping 9:30 to 11 a.m. Group size is limited. practices. For more information, please call the Health Promotion Program at It's in the Bag: Heart Healthy 821-2150. Shopping will feature a dietitian who will lead group tours highlighting In addition to the above program, "heart healthy" food choices. This will numerous other classes and programs include the "new" food groups, for weight control, stress management, convenience food items, label reading, and smoking cessation are available and special occasion food selections. which may benefit your patients.

Shopping location for October will be For more information regarding these the Giant Food Store at Cedar Crest and other programs, please call Boulevard and Tilghman Street, 821-2150. Allentown. Dates and times include

Page 8 Upcoming Seminars, subarachnoid hemorrhage, and spinal Conferences, and cord trauma. Meetings Physicians, nurses, and other health care workers concerned with Regional Symposium management of patients requiring Series IV neuroscience intensive care will benefit from the program. Fifth Annual Coagulation Symposium will be held on Friday, For more information about these October 2, from 9 a.m. to 3:45p.m., programs, please contact Human in the Auditorium of Lehigh Valley Resource Development at 402-8322. Hospital, Cedar Crest & I-78. Medical Grand Rounds At the completion of this program, the participant should be able to identify Neurological Problems Seen in ways to evaluate abnormal prothrombin Cardiology & will times and actuated partial be presented by Robert Brennan, thromboplastin times; understand the M.D., Associate Professor of theory behind INR reporting; , Hershey Medical Center, differentiate between unfractionated on Tuesday, September 15. and low molecular weight heparin; and describe theory behind and techniques Radiocontrast Induced Acute Renal used in identifying heparin associated Failure will be presented by Michael thrombocytopenia and thrombosis. . Rudnick, M.D., FACP, member, Division of and Physicians, medical technologists, and Hypertension, Graduate Hospital, on laboratory administrators will benefit Tuesday, September 22. from the program. Anxiety Disorders will be presented Fourth Annual Neuroscience by Peggy Showalter, M.D., Symposium: Neuroscience Intensive consultation-liaison psychiatrist, Lehigh Care will be held on Friday, October Valley Hospital, on Tuesday, 16, from 8 a.m. to 3:30p.m., in the September -29. Auditorium of Lehigh Valley Hospital, Cedar Crest & I-78. Medical Grand Rounds are held each Tuesday beginning at noon in the At the completion of this program, Auditorium of Lehigh Valley Hospital, participants should be able to present Cedar Crest & I -78. current research findings with clinical application for Guillian-Barre' For more information, contact the Syndrome and coma; discuss the use Department of Medicine at 402-8200. and efficacy of thrombolytic therapy in acute stroke; and discuss neurosurgical Continued on Page 1 0 approaches to the injured brain,

Page 9 Continued from Page 9 Recent Advances and Future Department of Directions for Cystic Fibrosis will be presented by Jullian Allen, M.D., Expanded Newborn Screening will be Director, Cystic Fibrosis Center, St. presented by Edwin Naylor, M.D., Christopher's Hospital for Children, on Department of Reproductive Genetics, Friday, October 9, at noon. Magee-Woman's Hospital, on Tuesday, September 15, at 8 a.m. The above Pediatric conferences will all be held in the Auditorium of Lehigh Update on Managed Care Activities Valley Hospital, 17th & Chew. will be presented by Greg Kile, Corporate Health Management, Lehigh For more information, contact Beverly Valley Hospital, on Friday, September Humphrey in the Department of 25, at noon. Pediatrics at 402-2410.

* Physician Needed - Family practitioner * For Sale -- Professional Office Building or general internist needed for hospital on West Broad Street, near the coverage. Duties to include rounds of Allentown/Bethlehem border. 4,500 sq. two to three hours per day plus very low ft. with plenty of parking on corner lot. demand call. Compensation very good. Excellent opportunity for someone who * For Lease -- Slots are currently wants to supplement income. Weekdays available for the Brown Bag suite at and weekends. If interested, please write Kutztown Professional Center. to P.O. Box 398, Whitehall, PA 18052- 9998. * For Lease -- Share large medical office near Cedar Crest & 1-78. Fully furnished * For Sale or Lease -- Medical­ and staffed. Multiple line phone system. Professional Office Building on Cedar Computerized billing available. Crest Boulevard, just minutes from Cedar Crest & 1-78 and 17th & Chew. Plenty of * For Lease -- Specialty practice time­ parking. Ideal for physician. share space available in a comprehensive health care facility. Riverside Professional * For Sale or Lease -- Springhouse Center, 4019 Wynnewood Drive, Laurys Professional Center, 1575 Pond Road. Station. Half- or full-day slots Ideal for physician's office. immediately available. Approximately 2,500 sq. ft. Will finish space to specifications. * For Lease -- Share medical office space at Riverside Professional Center in Laurys * For Sale or Lease -- Medical­ Station. Ideal for solo or small group professional office building on South practice. Cedar Crest Boulevard, just minutes from Cedar Crest & 1-78 and 17th & Chew. For more information or for assistance in 3,560 total sq. ft. Ample parking, finding appropriate office space to meet security/fire alarms installed. Ideal for your needs, contact Joe Pilla, POPS physician group. Representative, at 402-9647.

Page 10 WHO'S NEW

The Who's New section of Medical Mark E. Moran, DO Staff Progress Notes contains an 1251 S. Cedar Crest Blvd. Suite 301C update of new appointments, address changes, newly approved privileges, Allentown, PA 18103 (215) 435-8088 etc. Department of Surgery Division of Please remember that each department Provisional Courtesy or unit is responsible for updating its directory, rolodexes, and approved Michele A. Pisano, Dl\ID privilege rosters. 17th & Chew P.O. Box 7017 Medical Staff Allentown, PA 18105-7017 (215) 402-9636 Appointments Department of Dentistry Division of General Dentistry James Balducci, MD Provisional Active Director, Maternal-Fetal Allentown Medical Center Edward A. Tomkin, DO 401 N. 17th Street 2895 Hamilton Blvd. Suite 208 Suite 102 Allentown, PA. 18104 Allentown, PA 18104 (215) 402-9595 (215) 432-8551 Department of and Department of Surgery Gynecology Division of Otolaryngology Division of Obstetrics Provisional Courtesy Section of Maternal-Fetal Provisional Active Marijo A. Zelinka, :MD Lehigh Valley Hospital - Alan B. Leahey, MD 17th & Chew (Robert Kiesel, MD, PC) Allentown, PA 18105-7017 Fairgrounds Medical Center (215) 402-2410 400 N. 17th Street, #102 Department of Pediatrics Allentown, PA 18104 Division of Neonatology (215) 439-8910 Provisional Active Department of Surgery Division of Ophthalmology Leave of Absence Provisional Courtesy Nancy Urankar, :MD JenniLevy,:MD Department of Medicine Lehigh Valley Hospital Division of General 17th & Chew Allentown, P A 18105-7017 (215) 402-9524 Continued on Page 12 Department of Medicine Division of General Internal Medicine Provisional Active Page 11 Continued from Page 11 Allen J. Weinstein, DO Department of /Diagnostic Change of Status Medical Imaging Division of Diagnostic Radiology Victor Ehrens, DMD Active Department of Surgery Diagnostic Ultrasound Privileges Division of Oral Surgery From Active to Courtesy Christopher J. W ohlberg, MD Department of Medicine Gregory Dimmich, DMD Division of Neurology Department of Surgery Active Division of Oral Surgery Transcranial Doppler Evaluation From Active to Courtesy (TCD) Privileges Ocular Pneumoplethysmography-G Paul S. Raphael, MD (OPG) Privileges . Department of Medicine Carotid Ultrasound InterpretatiOn Division of Physical Privileges Medicine/Rehabilitation From Courtesy to Consulting New Division/Section Chiefs Stuart Schwartz, DDS Chief, Division of Obstetrics Department of Surgery James Balducci, MD Division of Oral Surgery From Active to Courtesy Chief, Section of Maternal-Fetal Medicine Additional Privileges James Balducci, MD

John E. Castaldo, MD Chief, Division of Gynecology Department of Medicine Ernest Y. Normington II, MD Division of Neurology Active Chief, Section of Gynecologic Ocular Pneumoplethysmography-G (OPG) Privileges Gazi Abdulhay, MD

Robert V. Cummings, MD Chief, Section of Reproductive Department of Obstetrics and Gynecology Bruce I. Rose, MD Provisional Active Obstetrical Privileges Chief, Section of Benign Gynecology •.. M. Bruce Viechnicki, MD William Gee, MD Department of Surgery Division of Active Continued on Page 13 Transcranial Doppler Evaluation (TCD) Privileges

Page 12 Continued from Page 12

Change. of Address Arthur A. Zellner, PA-C Physician Extender Laura S. Kramer, DO Physician Assistant VA Outpatient C1inic (Lehigh Valley Orthopedics - Anson) 2937 Hamilton Blvd. Allentown, PA 18103 Additional Privileges (215) 776-4367 Leslye Kappauf, RN Paul L. Orr, MD Physician Extender 2844 Pennsylvania Street Professional - RN Allentown, PA 18104 (Tamar D. Earnest, MD) - Use of Needles Joseph T. Sembrot, MD - Manipulation of Vital Organs VA Outpatient Clinic 2937 Hamilton Blvd. Change of Supervising Allentown, PA 18103 Physician, Alternating & (215) 776-4344 Substitute Farhad Sholevar, MD Allentown Medical Center Jean E. Hudson-Fischer, PA-C 401 N. 17th Street Physici~ Extender Suite 214 Physician Assistant . . (From Khindri Cardiovascular Specialists to F. Allentown, PA 18104-5014 Geoffrey Toonder, MD; Effective 1011192 Alternating Physician- Mark N. Martz, MD; Substitute Physician - Chetan Khindri, MD) Charles W. Umlauf, MD Allentown Medical Center Ruben P. Romero, PA-C 401 N. 17th Street Physician Extender Suite 214 Physician Assistant Allentown, PA 18104-5014 (Alternating Physician- Mark N. Martz, MD; Effective 1011/92 Substitute Physician - Chetan Khindri, MD) Allied Health Professionals

Appointments

Jean Rohal, CRNP Physician Extender Professional - CRNP (Trauma - M. Rhodes)

Page 13 LEHUWVAI.LEY HOSPITAL

P&T Highlights September. 199.. The following actions were taken WHAT GOES UP, CAN COME DOWN - at the August 10,1992 P& T Committee Parenteral Antibiotic Order Program Update meeting. The committee was informed that compliance (This lowered the cost per dose for the majority James Giardina, RPh, Director, has been 76%. Complaints of missed orders of intermittently infused N products). The were studied by a prospective review of 443 Committee also approved the Clinical Phar­ charts - no missed orders were found. The macy/Infectious Disease Service proposal to Committee also reviewed antibiotic expense closely monitor usage of Aztreonam, Ampicillin/ since the program was implemented in March, Sulbactam (Unasyn), Ceftazidime, 1992. (See Table 1 -Antibiotic Cost Report). Ciprotloxacin and Ceftriaxone. Usage guide­ June showed a significant drop due primarily to lines on the back of the order sheet will be used the implementation of a syringe based N for comparison. Ceftriaxone will be reviewed Admixture Program at Cedar Crest & I-78 against dosing criteria. Formulary Addition Antibiotic Cost Report (1992, Thousands of Dollars) Requests The following drugs were added to the fonnu- 175 . lary. l111 & Chew lice & I-78 Fludarabine (Fludara, ·B~lex) - an antimetabo­ lite, similar to Cytarabine, is currently indicated 150 for the treatment of chronic Lymphocytic Leukemia (CLL) in patients who have not responded to or have progressed during treat­ ment with at least one standard alkylating agent 125 containing regimen. Fludarabine may also be useful in non-Hodgkin's lymphoma and is being studied in other leukemias. Fludarabine acts primarily by inhibiting DNA synthesis in the S­ 100 Phase. The recommended adult dosing sched­ ule in CLL is 25mg/m2 over 30 minutes for 5 days - repeated every 28 days. The major adverse reactions include myelosuppression, 75 primarily leukopenia. Nausea and vomiting occur only rarely. Dose related neurotoxicity has been seen in high dose studies. 50 Serum Albumin level monitoring may be warranted as it appears to be strongly predictive of outcome. Patients should also be monitored for signs and symptoms of infection and neuro­ 25 toxicity. Fludarabine is supplied in 50mg/2ml vials at a cost of$138.00 each. Fosinopril (Mcmopril, Squibb)- is an angioten­ 0 sin converting enzyme (ACE) inhibitor indi- Jan Feb Mar Apr May Jun Jul Page 14 cated for the treatment of mild to moderate patients requiring up to 80mg per day. hypertension. It is the pro-drug which is Zakitadine (HIVID, Roche)- an anti-retroviral hydrolyzed to the active agent, fosinoprilat, agent used in combination with Zidovudine during or following absorption. Fosinopril's (AZI) in advanced lllV infection (CD 4 cell clinical effects do not differ significantly from 3 count .s. 300 cells/mm ) who have demonstrated the other available ACE inhibitors and offers no significant clinical or immunologic deteriora­ clear advantages in patients with normal renal tion. Zalcitadine received FDA approval based function. However, fosinopril may be of some on two ongoing clinical trials which showed an advantage in patients with impaired renal improved CD count response over function. In the presence of renal insufficiency, 4 monotherapy. Peripheral neuropathy is the fosinopril undergoes a compensatory shift to major adverse effect with a 17% to 31% non-renal (ie. hepato-biliary) clearance, obviat­ incidence. Other adverse effects include a 1% ing the need for dosage adjustment in these How Much incidence of pancreatitis. The usual adult dose patients. The usual maintenance dose of is 0.750mg Zalcitadine and 200mg Zidovudine Fluid for fosinopril is 10-4Qmg once daily with some Dopamme . ???... .(AZI)Q8H. The Committee One Alone for the Quinolones - Quinolone Study reviewed information provided bythe The Infectious Disease Service together with cost/day of therapy to Ciprofloxacin. Nursing Peer Review the Pharmacy and Clinical Laboratory (Micro­ Ofloxacin's in vitro MIC 90 data is not as Process which biology) Departments recommended a three impressive as Ciprofloxacin's; the clinical showed that Dopamine orders for month susceptibility study of Pseudomonas relevance of which requires further investiga­ renal perfusion aerogniosa isolates against both Ciprofloxacin tion - hence the study. Study results will be patients being (Cipro, Miles) and Ofloxacin (Floxin, Ortho). presented to the P & T Committee and one of transferred to Med/ Ofloxacin was recently marketed in both oral/ these two agents will be recommended for jurg units are not intravenous formulations with a similar pharma­ inclusion in the formulary. always being changed to the cokinetic and microbiologic profile at a lower 200mg/250ml concentration Drug Use Evaluation (DUE) Comer specified by the current policy. The A two month review of Flumazenil (Mazicon, patients were treated with Flumazenil alone and Committee asked Roche) usage was conducted and presented to 6 were treated with Flumazenil and Naloxone Pharmacy, Nursing concomitantly. The Committee recommended and Nephrology to the committee. Eleven patient courses were review the reviewed. Two patients received benzodiazepine forwarding the results to the Chief of Gastroen­ concentration and sedation alone, while 9 received a benzodiaz­ terology and Chairman of Medicine for review, recommend action to epine together with a narcotic analgesic. Five and follow-up as necessary. the committee.

Table 2- Available MAO Inhibitors MAO Inhibitor Drug Pargyline (Entonyl, Abbott) - antihypertensive Interaction Information 'Whenever an MAO inhibitor is prescribed for Isocarboxazid (Marplan, Roche) - antidepressant an inpatient, information on the more signifi­ Phenelzine (Nardil, Parke-Davis) -antidepressant cant drug interactions involving this class of Tranylcypromine (Parnate, SKB) - antidepressant agents will be sent to the Patient Care Unit (See Table 2 for listing ofMAOI's). This sheet, 1 Selegiline (Eldepryl, Somerset) - antiparkinson which is not intended to be a permanent chart 1 form, should be placed on top of the chrono­ • Sekgiline in high doses (30-40mglday) may act as a nonsekctive MAO inhibitor. logical sheet so all Physicians can review it prior to prescribing additional medications.

Page 15 Non-Profit Org. · U.S. Postage lEHigH VAlLEY PAID Allentown, PA HOSPIT:\L Permit No. 1922 17th & Chew Post Office Box 7017 Allentown, PA 18105-7017

Medical Staff Progress Notes

John Jaffe, M.D. President, Medical Staff Joseph A. Candio, M.D. President-elect, Medical Staff Charles J. Scagliotti, M.D. Past President, Medical Staff John W. Hart Vice President Medical Staff Progress Notes is published monthly to inform Rita M. Mest Medical Staff Coordinator the Lehigh Valley Hospital Medical Staff and employees of important issues concerning the Medical Staff. Articles Janet M. Laudenslager should be submitted to Janet M. Laudenslager, Coordinator, Physician Office Coordinator, Physician Office Practice Services, 17th & Practice Services Managing Editor Chew, by the first of each month. If you have any questions regarding the newsletter, please call Ms. Laudenslager at 402-2780.