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To intercompare various techniques used in reconstructing tomographic images, and to benchmark those results with direct observations obtained by the incoherent scatter technique. an experimental campaign and subsequent analysis program-the Russian-American Tomography Experiment (RATE) were implemented in late 1993. Russian experiment teams from the Polar Geophysical Institute in Murmansk and Moscow State University joined with American investigators from the Phillips Laboratory and the Massachusetts Institute of Technology, and an array of four receiving stations was set up in the northeastern United States and in eastern Canada to obtain data for the tomographic reconstructions. Phase-difference and total-phase tomographic reconstruction techniques have been employed and are intercompared. The spatial/altitude distribution of ionospheric electron content was observed by the MIT Millstone Hill incoherent scatter radar that scanned the ionosphere in a plane parallel to the satellite over flights. We present preliminary reconstructions of the Ionospheric structure observed during a severe mid- latitude ionospheric storm that took place during the campaign. The drastic large-scale changes in the ionospheric structure that accompanied the November 1993 storm were well observed by the two diagnostic techniques. [ABSTRACT FROM AUTHOR]

Objectives: To: (1) develop a pharmaceutical care multicenter outcomes research project using clinical pharmacy residents and preceptors; (2) develop two research protocols to document pharmacists' impact on clinical, economic, and humanistic outcomes of therapy; (3) develop and implement a data collection process and methodology for outcomes research; (4) evaluate the effectiveness of the multicenter outcomes research process; and (5) prepare clinical pharmacy preceptors and residents to conduct outcomes research., Design and Setting: Two research protocols were developed, each a randomized, parallel, open-label evaluation of patients at 10 Department of Veterans Affairs and 1 university medical center. One protocol focused on patients with chronic obstructive pulmonary disease (COPD) and the other on patients with hypertension. The study evaluated pharmacists' management of these two patient groups., Patients and Other Participants: 133 patients with hypertension and 98 patients with COPD; 33 pharmacy directors and preceptors; 45 pharmacy residents., Main Outcome Measures: Clinical, economic, and humanistic outcomes of pharmacists' interventions. The processes of developing a multicenter outcomes study were evaluated, including the data collection process., Results: The two study protocols and an educational program for study participants were developed. A data collection process was developed and implemented, with the paper process being successful and the computer data collection process not implemented due to time constraints. Overall, the multicenter outcomes research process was successful., Conclusion: The study provides a framework of processes and sites for the future development of other outcomes research studies. Clinical, economic, and humanistic outcomes are reported in Parts 2 and 3.

Objective: To evaluate the impact of pharmaceutical care on selected clinical and economic outcomes in patients with hypertension or chronic obstructive pulmonary disease (COPD) in ambulatory care settings., Design: Clinic patients with hypertension or COPD were randomly assigned to a treatment group (pharmaceutical care) or a control group (traditional pharmacy care) over a six-month period. Clinical pharmacists and pharmacy residents conducted the protocols. There were 133 evaluable patients (63 treatment and 70 control) in the hypertension study arm and 98 evaluable patients (43 treatment and 55 control) in the COPD study arm., Setting: 10 Departments of Veterans Affairs medical centers and 1 academic medical center., Interventions: Patient-centered pharmaceutical care model (employing standardized care) implemented by clinical pharmacy residents., Main Outcome Measures: Patient knowledge, medication compliance, and health resource use., Results: The hypertension treatment group had a significantly greater reduction in systolic blood pressure from visit 1 to visit 5 than did the control group. In the COPD study arm, trends were positive in the treatment group for patients ratings of symptom interference with activities and dyspnea measures. There was a significant difference between the hypertension treatment and control group for compliance. There were no significant changes in compliance scores in the COPD study arm. Mean number of hospitalizations and other health care provider visits was higher for the hypertension control group. For patients with COPD, hospitalizations increased in the control group, and the number of other health care provider visits was higher in the control group., Conclusion: Pharmacists' participation in a pharmaceutical care program resulted in disease state improvement in ambulatory patients with hypertension and COPD.

Objective: To evaluate the effects of pharmaceutical care on selected humanistic outcomes in patients with hypertension or chronic obstructive pulmonary disease (COPD)., Design: Clinic patients with hypertension or COPD were randomly assigned to a treatment group (pharmaceutical care) or a control group (traditional pharmacy care) over a six-month period. Clinical pharmacists and pharmacy residents conducted the protocols. There were 133 evaluable patients (63 treatment, 70 control) in the hypertension study arm and 98 evaluable patients (43 treatment, 55 control) in the COPD study arm. The Pharmaceutical Care Questionnaire evaluated patient satisfaction with care. Tests specific to the disease states assessed disease and disease management knowledge. Quality of life (QOL) was evaluated using the Health Status Questionnaire 2.0 (HSQ 2.0) in the COPD arm; in the hypertension arm, the Hypertension/Lipid TyPE Specification Form 5.1 was used., Setting: Ambulatory care centers of 10 Department of Veterans Affairs (DVA) medical centers and 1 university medical center., Interventions: Patient-centered pharmaceutical care model (employing standardized care) implemented by clinical pharmacy residents., Main Outcome Measures: Satisfaction with pharmaceutical care, disease and disease management knowledge, and QOL., Results: Statistically significant differences in most satisfaction items were found, with treatment patients expressing greater satisfaction. Treatment groups in both arms strongly agreed that pharmacists helped them with confidence in use of their medication and understanding of their illness, gave complete explanations about their medications, made them feel that their care was a priority, and followed up on their questions and concerns. In the hypertension arm, treatment patients demonstrated significant increases in knowledge scores. Trends in QOL were positive for both hypertension groups, with a significant decrease found in number of treatment patients reporting problems with sexual function. In the COPD arm, improvement trends were significantly stronger for treatment patients., Conclusion: Although patients were not dissatisfied with traditional pharmacy care, they were more satisfied overall with the pharmaceutical care model.

The policies, standards, guidelines, and criteria that each member of the healthcare team uses to assist in the delivery of comprehensive healthcare are constantly being defined and redefined. This article has discussed many of those changes as they relate to diabetes management. The entire healthcare team must have a working knowledge of these changes so that they can continue to deliver the best possible care to patients with diabetes. Improvements in quality of life, decreases in mortality and morbidity, and subsequent declines in healthcare costs will benefit both individual patients and society. The profession of pharmacy has realized the need for additional education and training in managing the patient with diabetes. Many colleges of pharmacy, as well as companies in the pharmaceutical industry, are offering diabetes certification and diabetes disease management programs to pharmacists to enhance their ability to manage these patients (Lyons T, Gourley DR, unpublished data, 1997. Similar efforts in diabetes management have been made in other health professions as well, such as nursing.

Cardiovascular disease related to hyperlipidemia is a significant cause of morbidity and mortality in the United States. The benefit of lowering lipid levels in patients with and without cardiovascular disease has been demonstrated in numerous clinical trials. The results of these trials prompted the National Heart, Blood, and Lung Institute to form the Nation Cholesterol Education Panel (NCEP). This panel developed guidelines for identifying and treating lipid disorders. Before starting antilipemic therapy, patients should be evaluated for secondary causes of hyperlipidemia, including disease states and medications. Risk factors for cardiovascular disease should be identified and used to determine the patient's goal low-density lipoprotein level. Regardless of the drug therapy used, the cornerstone treatment for hyperlipidemia is dietary changes. The NCEP recommendation for dietary modification follows a two-step plan to reduce intake of cholesterol and dietary fats. Other nonpharmacologic treatments for hyperlipidemia include exercise, weight reduction for obese patients, reduction of excessive alcohol use, and smoking cessation . Drug therapy should be considered in patients who do not respond to an adequate trial of dietary modifications and lifestyle changes. The principal lipid-lowering agents currently used are the bile acid sequestrants, nicotinic acid, 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors, and fibric acid derivatives. Estrogen, fish oil, and alcohol also can decrease the risk of developing heart disease. In pharmacoeconomic studies, lipid-lowering drug therapy has been shown to decrease the number of procedures, hospitalizations, and other medical interventions required by patients with cardiovascular disease.