We report a case of a patient affected by epidermoid anal cancer who had hepatic progression after standard therapy with the Nigro regimen (fluorouracil and mitomycin C plus radiotherapy). This is an uncommon neoplasm against which only few chemotherapeutic agents have been tested. In our patient salvage treatment with low dose irinotecan resulted in a partial response.

The activities of three staff clinical pharmacists practicing in a university medical center hospital were studied using work sampling direct observation techniques. The results of the activity analysis were compared with the functional criteria of the Task Force on the Pharmacist's Clinical Role. It was found that the clinical pharmcists devoted a large portion (72.36 percent) of their total practice time to accomplishing professional activities. A very low percentage (2.27) of time was observed to be spent in nonproductive idle time. The cost to provide clinical pharmacy services to the 165.23 average census of inpatients supported by the clinical pharmacists was calculated to be $1.18 per patient per day. It was concluded that the observed pharmacists were highly motivated and provided a wide variety and extensive amount of professional clinical pharmacy services. Recommendations were made calling for research of other clinical pharmacy practice models, standardization of pharmacy activity terminology, determination of clinical pharmacy outcomes and identification of motivational factors present in the study model environment.

The ability to precisely predict serum digoxin concentrations using 12 published methods in a group of 85 patients was undertaken. Two methods of estimating creatinine clearance and two estimates of ideal body weight were employed as input variables using the 12 dosing methods. This resulted in 40 relationships from which correlation coefficients and linear regression constants were derived for predicted versus measured serum digoxin concentrations. The correlation coefficients between predicted and measured serum digoxin ranged from -0.393 to 0.389. Possible explanations for the low correlation coefficients are interpatient variability in the kinetics of digoxin, the small number of subjects used to generate some of the digoxin dosing methods, undetected patient noncompliance in the present study, the use of empirically derived dosing methods, and/or the use of rather homogeneous patient populations to develop a given method while this study is comprised of a heterogeneous group of patients. The methods studied tend to overpredict serum digoxin concentrations and therefore generally allow safe, first approximations for digoxin dosing.

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