Current Issue : January - March Volume : 2011 Issue Number : 1 Articles : 8 Articles
Background: Preventable adverse drug events (pADEs) are widely known to be a health care issue for hospitalized\npatients. Surgical patients are especially at risk, but prevention of pADEs in this population is not demonstrated\nbefore. Ward-based pharmacy interventions seem effective in reducing pADEs in medical patients. The costeffectiveness\nof these preventive efforts still needs to be assessed in a comparative study of high methodological\nstandard and also in the surgical population. For these aims the SUREPILL (Surgery & Pharmacy in Liaison) study is\ninitiated.\nMethods/Design: A multi-centre controlled trial, with randomisation at ward-level and preceding baseline\nassessments is designed. Patients admitted to the surgical study wards for elective surgery with an expected\nlength of stay of more than 48 hours will be included. Patients admitted to the intervention ward, will receive\nward-based pharmacy care from the clinical pharmacy team, i.e. pharmacy practitioners and hospital pharmacists.\nThis ward-based pharmacy intervention includes medication reconciliation in consultation with the patient at\nadmission, daily medication review with face-to-face contact with the ward doctor, and patient counselling at\ndischarge. Patients admitted in the control ward, will receive standard pharmaceutical care.\nThe primary clinical outcome measure is the number of pADEs per 100 elective admissions. These pADEs will be\nmeasured by systematic patient record evaluation using a trigger tool. Patient records positive for a trigger will be\nevaluated on causality, severity and preventability by an independent expert panel. In addition, an economic\nevaluation will be performed from a societal perspective with the costs per preventable ADE as the primary\neconomic outcome. Other outcomes of this study are: severity of pADEs, number of patients with pADEs per total\nnumber of admissions, direct (non-)medical costs and indirect non-medical costs, extra costs per prevented ADE,\nnumber and type of pharmacy interventions, length of hospital stay, complications registered in a national\ncomplication registration system for surgery, number of readmissions within three months after initial admission\n(follow-up), quality of life and number of non-institutionalized days during follow-up.\nDiscussion: This study will assess the cost-effectiveness of ward-based pharmacy care on preventable adverse drug\nevents in surgical patients from a societal perspective, using a comparative study design.\nTrial registration: Netherlands Trial Register (NTR): NTR2258...
The reusable gum elastic bougie serves as a reliable aid to intubate and exchange a tracheal tube as tube exchanger. Serious complications related to bougie use, such as airway trauma, false passage are rare; in fact, there are only a few case reports.A 50 yr male patient with cervical spine C5-C6 fracture posted for anterior cervical laminectomy had been intubated in the emergency casualty with 7.5 mm I.D endotracheal tube. In view of high airway pressure, it was decided to change ETT over bougie.On withdrawing ETT, bougie also came out along as bougie had engaged murphys eye which is very rare incidence....
Background: Vomiting in children with acute gastroenteritis (AG) is not only a direct cause of fluid loss but it is\nalso a major factor of failure of oral rehydration therapy (ORT). Physicians who provide care to paediatric patients in\nthe emergency department (ED) usually prescribe intravenous fluid therapy (IVT) for mild or moderate dehydration\nwhen vomiting is the major symptom. Thus, effective symptomatic treatment of vomiting would lead to an\nimportant reduction in the use of IVT and, consequently, of the duration of hospital stay and of frequency of\nhospital admission. Available evidence on symptomatic treatment of vomiting shows the efficacy of the most\nrecently registered molecule (ondansetron) but a proper evaluation of antiemetics drugs largely used in clinical\npractice, such as domperidone, is lacking.\nObjectives: To compare the efficacy of ondansetron and domperidone for the symptomatic treatment of vomiting\nin children with AG who have failed ORT.\nMethods/Design: Multicentre, double-blind randomized controlled trial conducted in paediatric EDs. Children\naged from 1 to 6 years who vomiting, with a presumptive clinical diagnosis of AG, and without severe dehydration\nwill be included. After the failure of a initial ORS administration in ED, eligible children will be randomized to\nreceive: 1) ondansetron syrup (0,15 mg/Kg of body weight); 2) domperidone syrup (0,5 mg/Kg of body weight);\n3) placebo. The main study outcome will be the percentage of patients needing nasogastric or IVT after symptomatic\noral treatment failure, defined as vomiting or fluid refusal after a second attempt of ORT. Data relative to study\noutcomes will be collected at 30 minute intervals for a minimum of 6 hours. A telephone follow up call will be made\n48 hours after discharge. A total number of 540 children (i.e. 180 patients in each arm) will be enrolled.\nDiscussion: The trial results would provide evidence on the efficacy of domperidone, which is largely used in\nclinical practice despite the lack of proper evaluation and a controversial safety profile, as compared to\nondansetron, which is not yet authorized in Italy despite evidence supporting its efficacy in treating vomiting. The\ntrial results would contribute to a reduction in the use of IVT and, consequently, in hospital admissions in children\nwith AG. The design of this RCT, which closely reflect current clinical practice in EDs, will allow immediate\ntransferability of results.\nTrial Registration: ClinicalTrials.gov: NCT01257672...
Background: The use of newer azoles as prophylaxis in hematological patients undergoing stem cell transplantation or immunosuppressive chemotherapy has been shown to decrease the risk of developing invasive fungal disease (IFD). However, the cost-effectiveness of such a strategy is dependent on the local epidemiology of IFD. We conducted an audit of hematological patients with IFD in our institution in order to derive the prevalence and types of IFD that occur locally. \r\nFindings: We conducted a retrospective chart review of all hematological patients who developed possible, probable or definite IFD according to EORTC/MSG criteria in the period from Oct 2007 to Apr 2010. The prevalence of IFD was determined via correlation with institutional database records of all hematological patients treated at our institution over the same time period. There were 39 cases of IFD diagnosed during the study period, with 8 (20.5%) possible, 19 (48.7%) probable and 12 (30.8%) definite cases of IFD. Aspergillus spp. accounted for 83.9% of all probable and definite infections. There was 1 case each of Rhinocladelia spp., Coprinopsis cinerea, Exserohilum spp. sinusitis and Rhizopus spp. sinusitis. IFD occurred in 12 of 124 (9.7%) AML and 4 of 103 (3.9%) ALL patients treated at our institution respectively. There were 10 (16.1%) infections among 62 allogeneic HSCT recipients, six of whom were having concurrent graft-versushost disease (GVHD). Five other cases occurred after allogeneic HSCT failure, following salvage chemotherapy for disease relapse. The prevalence of IFD during induction chemotherapy was 8.9% (11 of 124 cases) for AML and 1.0% (1 of 103 cases) for ALL. Fluconazole prophylaxis had been provided for 28 out of the 39 (71.8%) cases, while 4 (10.3%) were on itraconazole prophylaxis. The in-hospital mortality was 28.2% (11 of 39 cases), of which 5 (12.8%) deaths were attributed to IFD.\r\nConclusions: The burden of IFD is high in our institution, especially in allogeneic HSCT recipients and patients on induction chemotherapy for AML. A prophylactic strategy directed against invasive mould infections for local highrisk patients may be considered as the comparative costs of treatment, prolonged hospitalisation and subsequent delayed chemotherapy favours such an approach....
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Because of substantial interpatient differences in sensitivity to warfarin, numerous variables that can alter the response to therapy with time, and the potential risk for major hemorrhage, a systematic approach to therapeutic drug monitoring must be carried out for every patient with anticoagulant therapy. The purpose was to identify most frequent existent possible warfarin interactions in the hospital drug prescribing, analyze the effects of interactions on the warfarin dose for cardiological elderly patients. In this study patients (age >65) with indications for warfarin therapy from cardiological department of the hospital were included at the time from May 2009 to September 2009. A total of 100 patients (60 male, 40 female) met the study inclusion criteria. The mean age was 69 ± 3 years. Concomitant other drugs were analyzed which are known either to prolong the prothrombin time or international normalized ratio (INR) or interact with warfarin such as amiodarone (25%), statins (13%), anti-inflammatory drugs (aspirin (4%)), proton pump inhibitor (omeprazole (4%)) In this study we found inverse correlation between starting dose of warfarin and maintenance dose of amiodarone (r2 = 0.94, p < 0.005). When we calculated the dose of anticoagulant for these patients, it seemed to be decreased for 32% mean maximum in the warfarin dose being required by the elderly population with concomitant warfarin and amiodarone therapy (200mg/d). The clinical caveats in the elderly include reduced starting doses, elimination of unnecessary medications and anticipating and monitoring for drug interactions, especially when prescribing warfarin and amiodarone....
Purpose was to systematically review clinical trial data on the effects of statins on high-density lipoproteins (HDL) and to examine the leading efficacy of Rosuvastatin among all statins to provide cardiovascular benefits in addition to those derived from reductions in low-density lipoproteins (LDL). The leading indexed database was searched for publications describing clinical trials of atorvastatin, pravastatin, rosuvastatin, and simvastatin and other lipid lowering drugs and on the basis of predefined criteria, 75 were selected for review. Compared with placebo, statins raise HDL, measured as HDL-cholesterol (HDL-C) and apolipoproteinA-I (apo A-I); Rosuvastatin raise HDL the most, these elevations are maintained in the long-term. In hypercholesterolemia, HDL-C is raised by approximately 4% for atorvastatin to 10% for rosuvastatin. The percentage changes are greater in patients with low baseline levels, including those with the common combination of high triglycerides (TG) and low HDL-C. These effects do not appear to be dose-related although there is evidence that, with the exception of atorvastatin, the changes in HDL-C are proportional to reductions in apo B-containing lipoproteins. The most likely explanation is a reduced rate of cholesteryl ester transfer protein (CETP)-mediated flow of cholesterol from HDL. Statins cause modest increases in HDL-C and apo A-I probably mediated by reductions in CETP activity and Rosuvastatin seems to be greatly improving the HDL levels in comparison to other statins. It is plausible that such changes independently contribute to the cardiovascular benefits of the statin class but more studies are needed to further explore this possibility....
The most common side effect associated with nevirapine is rash and it may also cause asymptomatic or severe clinical hepatitis. The objective of the study is to find out the correlation between the skin rash and the liver enzymes. A total of 100 mothers were included in this study in PMTCT center at Namakkal government Hospital Liver enzymes were performed for all the mothers and qualitative HIV-1 DNA PCR was performed for the infants. Skin rashes were seen in 7%, one (14.3%) had elevated AST and another one (14.3%) had elevated ALT. Of 93 no skin rash mothers, elevation of AST in 19, ALT in 30, ALP in 2 and GGT was seen in 1. 7 infants of these mothers were found to be HIV-1 infected. There was no significant correlation between skin rashes and liver enzyme abnormalities in this study....
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