Current Issue : July - September Volume : 2016 Issue Number : 3 Articles : 5 Articles
Purpose. Drug dose recommendations are not well defined in patients undergoing continuous renal replacement therapy (CRRT)\ndue to limited published data. Several guidelines and pharmacokinetic equations have been proposed as tools forCRRT drug dosing.\nDose recommendations derived from these methods have yet to be compared or prospectively evaluated. Methods. A literature\nsearch of PubMed, Micromedex, and Embase was conducted for 40 drugs commonly used in the ICU to gather pharmacokinetic\ndata acquired from patients with acute and chronic kidney disease as well as healthy volunteers. These data and that obtained\nfrom drug package inserts were gathered for use in three published CRRT drug dosing equations. Doses calculated for a model\npatient using each method were compared to doses suggested in a commonly used dosing text. Results. Full pharmacokinetic data\nwas available for 18, 31, and 40 agents using acute kidney injury, end stage renal disease, and normal patient data, respectively.\nOn average, calculated doses differed by 30% or more from the doses recommended by the renal dosing text for >50% of the\nmedications. Conclusion.Wide variability in dose recommendations for patients undergoing CRRT exists when these equations are\nused. Alternate, validated dosing methods need to be developed for this at-risk patient population....
Gram-negative pneumonia in patients who are intubated and mechanically ventilated is associated with increased\nmorbidity and mortality as well as higher healthcare costs compared with those who do not have the disease. Intravenous\nantibiotics are currently the standard of care for pneumonia; however, increasing rates of multidrug resistance\nand limited penetration of some classes of antimicrobials into the lungs reduce the effectiveness of this treatment\noption, and current clinical cure rates are variable, while recurrence rates remain high. Inhaled antibiotics may have\nthe potential to improve outcomes in this patient population, but their use is currently restricted by a lack of specifically\nformulated solutions for inhalation and a limited number of devices designed for the nebulization of antibiotics.\nIn this article, we review the challenges clinicians face in the treatment of pneumonia and discuss the characteristics\nthat would constitute an ideal inhaled drug/device combination. We also review inhaled antibiotic options currently\nin development for the treatment of pneumonia in patients who are intubated and mechanically ventilated....
Background: Serious inhaler technique errors can impair drug delivery to the lungs. This randomised, crossover,\nopen-label study evaluated the proportion of patients making predefined serious errors with Pulmojet compared\nwith Diskus and Turbohaler dry powder inhalers.\nMethods: Patients ââ?°Â¥18 years old with asthma and/or COPD who were current users of an inhaler but naÃ?¯ve to the\nstudy devices were assigned to inhaler technique assessment on Pulmojet and either Diskus or Turbohaler in a\nrandomised order. Patients inhaled through empty devices after reading the patient information leaflet. If serious\nerrors potentially affecting dose delivery were recorded, they repeated the inhalations after watching a training\nvideo. Inhaler technique was assessed by a trained nurse observer and an electronic inhalation profile recorder.\nResults: Baseline patient characteristics were similar between randomisation arms for the Pulmojet-Diskus (n = 277)\nand Pulmojet-Turbohaler (n = 144) comparisons. Non-inferiority in the proportions of patients recording no\nnurse-observed serious errors was demonstrated for both Pulmojet versus Diskus, and Pulmojet versus Turbohaler;\ntherefore, superiority was tested. Patients were significantly less likely to make ââ?°Â¥1 nurse-observed serious errors using\nPulmojet compared with Diskus (odds ratio, 0.31; 95 % CI, 0.19ââ?¬â??0.51) or Pulmojet compared with Turbohaler\n(0.23; 0.12ââ?¬â??0.44) after reading the patient information leaflet with additional video instruction, if required.\nConclusions: These results suggest Pulmojet is easier to learn to use correctly than the Turbohaler or Diskus for\ncurrent inhaler users switching to a new dry powder inhaler....
Background: Most randomised clinical trials typically exclude a significant proportion of asthma patients, including\nthose at higher risk of adverse events, with comorbidities, obesity, poor inhaler technique and adherence, or\nsmokers. However, these patients might differentially benefit from extrafine-particle inhaled corticosteroids (ICS).\nThis matched cohort, database study, compared the effectiveness of extrafine-particle with fine-particle ICS in a reallife\npopulation initiating ICS therapy in the Netherlands.\nMethods: Data were from the Pharmo Database Network, comprising pharmacy and hospital discharge records,\nrepresentative of 20 % of the Dutch population. The study population included patients aged 12 âË?â?? 60, with a\nGeneral Practice-recorded diagnosis for asthma (International Classification of Primary Care code R96), when\navailable, ââ?°Â¥2 prescriptions for asthma therapy at any time in their recorded history, and receiving first prescription\nof ICS therapy as either extrafine-particle (ciclesonide or hydrofluoroalkane beclomethasone dipropionate [BDP]) or\nfine-particle ICS (fluticasone propionate or non-extrafine-particle-BDP). Patients were matched (1:1) on relevant\ndemographic and clinical characteristics over 1-year baseline. Primary outcomes were severe exacerbation rates, risk\ndomain asthma control and overall asthma control during the year following first ICS prescription. Secondary\noutcomes, treatment stability and being prescribed higher versus lower category of short-acting Ã?²2 agonists (SABA)\ndose, were compared over a 1-year outcome period using conditional logistic regression models.\nResults: Following matching, 1399 patients were selected in each treatment cohort (median age: 43 years; males:\n34 %). Median (interquartile range) initial ICS doses (fluticasone-equivalents in Ã?¼g) were 160 (160 âË?â?? 320) for\nextrafine-particle versus 500 (250 âË?â?? 500) for fine-particle ICS (p < 0.001). Following adjustment for residual\nconfounders, matched patients prescribed extrafine-particle ICS had significantly lower rates of exacerbations\n(adjusted rate ratio [95 % CI], 0.59 [0.47ââ?¬â??0.73]), and significantly higher odds of achieving asthma control and\ntreatment stability in the year following initiation than those prescribed fine-particle ICS, and this occurred at lower\nprescribed doses. Patients prescribed extrafine-particle ICS had lower odds of being prescribed higher doses of\nSABA (0.50 [0.44ââ?¬â??0.57]).\nConclusion: In this historical, matched study, extrafine-particle ICS was associated with better odds of asthma\ncontrol than fine-particle ICS in patients prescribed their first ICS therapy in the Netherlands. Of importance, this\nwas reached at significantly lower prescribed dose....
Molecular imaging based personalized therapy has been a fascinating concept for individualized therapeutic strategy, which is\nable to attain the highest efficacy and reduce adverse effects in certain patients. Theranostics, which integrates diagnostic testing\nto detect molecular targets for particular therapeutic modalities, is one of the key technologies that contribute to the success of\npersonalized medicine. Although the term ââ?¬Å?theranosticsââ?¬Â was used after the second millennium, its basic principle was applied\nmore than 70 years ago in the field of thyroidology with radioiodine molecular imaging. Differentiated thyroid cancer, which arises\nfrom follicular cells in the thyroid, is the most common endocrine malignancy, and theranostic radioiodine has been successfully\napplied to diagnose and treat differentiated thyroid cancer, the applications of which were included in the guidelines published by\nvarious thyroid or nuclear medicine societies. Through better pathophysiologic understanding of thyroid cancer and advancements\nin nuclear technologies, theranostic radioiodine contributesmore to modern tailored personalized management by providing high\ntherapeutic effect and by avoiding significant adverse effects in differentiated thyroid cancer. This review details the inception\nof theranostic radioiodine and recent radioiodine applications for differentiated thyroid cancer management as a prototype of\npersonalized medicine based on molecular imaging....
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