scholarly journals Evaluation of Potential Drug-Drug Interactions among Patients of the Nephrology and Kidney Transplant Wards of a Major Teaching Hospital in Iran

2021 ◽  
pp. 66-78
Author(s):  
Shahriyar Shahbazi Khamas ◽  
Mohammadkazem Lebadi ◽  
Asieh Ashouri ◽  
Gholamreza Mokhtari ◽  
Atefeh Jafari
Keyword(s):  
Kidney Transplant ◽  
Adverse Outcomes ◽  
Education History ◽  
Potential Ddis ◽  
Online Application ◽  
Major Teaching Hospital ◽  
Major Teaching ◽  
History Of ◽  
Comorbidity Index

Aims: This study was aimed to find the prevalence of potential DDIs in patients and identify factors associated with these interactions. Study design:  All patients' medication regimens were screened for potential DDIs through Lexi-Interact® Online application. Place and Duration of Study: This study was conducted for five months in 2017-2018 at the nephrology and kidney transplant ward of Razi hospital, Rasht, Iran. Methodology: Each potential DDI was characterized based on severity, onset, mechanism, risk rating and reliability rating.  The patient's comorbidity was assessed with the Charlson comorbidity index. The quality of patients' life was assessed with the Kidney Disease Quality of Life Instrument-SF36TM questionnaire. Results: The study included 191 patients (109 [57.07%] males and 82 [42.93%] females) with a mean age of 58.09 ± 17.76 years. The analysis revealed that 29.4 % of potential DDIs had good and 13.5% had excellent evidence. There was a statistically significant association among the number of prescribed medications (polypharmacy), hospital ward, age, Body Mass Index, education, history of drug addiction, length of hospitalization, dyslipidemia, and hypothyroidism. Conclusion Potential DDIs are common in patients of the nephrology and kidney transplant wards, so proper patient monitoring is essential for minimizing and preventing potential adverse outcomes of DDIs.

scholarly journals Atrial fibrillation and clinical outcomes 1 to 3 years after myocardial infarction

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001726
Author(s):  
Anthony P Carnicelli ◽  
Ruth Owen ◽  
Stuart J Pocock ◽  
David B Brieger ◽  
Satoshi Yasuda ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Oral Anticoagulants ◽  
Adverse Outcomes ◽  
Increased Risk ◽  
History Of ◽  
The Impact

ObjectiveAtrial fibrillation (AF) and myocardial infarction (MI) are commonly comorbid and associated with adverse outcomes. Little is known about the impact of AF on quality of life and outcomes post-MI. We compared characteristics, quality of life and clinical outcomes in stable patients post-MI with/without AF.Methods/resultsThe prospective, international, observational TIGRIS (long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease) registry included 8406 patients aged ≥50 years with ≥1 atherothrombotic risk factor who were 1–3 years post-MI. Patient characteristics were summarised by history of AF. Quality of life was assessed at baseline using EQ-5D. Clinical outcomes over 2 years of follow-up were compared. History of AF was present in 702/8277 (8.5%) registry patients and incident AF was diagnosed in 244/7575 (3.2%) over 2 years. Those with AF were older and had more comorbidities than those without AF. After multivariable adjustment, patients with AF had lower self-reported quality-of-life scores (EQ-5D UK-weighted index, visual analogue scale, usual activities and pain/discomfort) than those without AF. CHA2DS2-VASc score ≥2 was present in 686/702 (97.7%) patients with AF, although only 348/702 (49.6%) were on oral anticoagulants at enrolment. Patients with AF had higher rates of all-cause hospitalisation (adjusted rate ratio 1.25 [1.06–1.46], p=0.008) over 2 years than those without AF, but similar rates of mortality.ConclusionsIn stable patients post-MI, those with AF were commonly undertreated with oral anticoagulants, had poorer quality of life and had increased risk of clinical outcomes than those without AF.Trial registration numberClinicalTrials: NCT01866904.

Changing practice for neuraxial applications using NRFit™ small-bore connectors to improve patient safety

2021 ◽  
Vol 30 (4) ◽  
pp. S22-S27
Author(s):  
Karin Cannons ◽  
Ian Shaw
Keyword(s):  
Patient Safety ◽  
Teaching Hospital ◽  
Improve Patient Safety ◽  
Clinical Staff ◽  
Major Step ◽  
Changing Practice ◽  
Major Teaching Hospital ◽  
Major Teaching ◽  
History Of ◽  
Improve Patient

Clinical staff always aim to offer the best care for their patients while striving to minimise the risk of errors. The worldwide adoption of the NRFit™ system for neuraxial and regional block procedures is a major step forward. This article discusses the history of neuraxial needles and the experience of a major teaching hospital in adopting non-luer equipment for neuraxial procedures. References are made to resources that are available for other hospitals in the process of implementing the change to the NRFit system, which should result in the reduction of harm to patients.

scholarly journals Historical Neurology and Neurosurgery A History of Neurology in Toronto 1892–1960: Part II

1996 ◽  
Vol 23 (1) ◽  
pp. 63-75 ◽  
Author(s):  
John R. Wherrett
Keyword(s):  
Teaching Hospital ◽  
History Of Neurology ◽  
Medical Resources ◽  
Special Unit ◽  
Major Teaching Hospital ◽  
Major Teaching ◽  
History Of

In Part 1 of this history of neurology in Toronto, the advent of neurology as a specialty in 1892 and its progress over the next 20 years was described (Can J Neurol Sci 1995; 22: 322–332). Donald Campbell Meyers, the first neurologist received his training from “founders” in Paris, Vienna and London and returned to Toronto to establish his own private neurological hospital and a special unit – “the Nervous Wards” – in the Toronto General, the major teaching hospital. These pioneering initiatives clashed with an alienist establishment, itself internally in conflict, and the “Nervous Wards” were lost in the ensuing competition for medical resources.

scholarly journals The Lived Experiences of Retired Collegiate Athletes With a History of 1 or More Concussions

2018 ◽  
Vol 53 (7) ◽  
pp. 646-656 ◽  
Author(s):  
Rebecca Cover ◽  
Trevor Roiger ◽  
Mary Beth Zwart
Keyword(s):  
Quality Of Life ◽  
Lived Experiences ◽  
Injury Severity ◽  
Collegiate Athletes ◽  
Adverse Outcomes ◽  
Return To Play ◽  
Telephone Interviews ◽  
Persistent Symptoms ◽  
History Of

Context: Concussions remain misunderstood, underreported, and undiagnosed. Although most concussion symptoms resolve within 2 weeks, some patients experience persistent symptoms that adversely affect physical, emotional, social, or cognitive functioning or a combination of these. Minimal evidence delineating the effect of concussions on recently retired collegiate athletes currently exists.Objective: To examine the lived experiences of retired collegiate athletes with a history of 1 or more concussions to discern individual concussion histories, knowledge and perceptions of concussions, and postconcussion quality of life.Design: Qualitative study.Setting: Telephone interviews.Patients or Other Participants: Former National Collegiate Athletic Association Division I athletes (n = 14) with a history of 1 or more concussions and retired from 1 to 5 years.Data Collection and Analysis: Fourteen semistructured telephone interviews (8 men and 6 women) were audiotaped. Interviews were transcribed and inductively analyzed by 3 athletic trainers with 34 combined years of professional experience. Themes were negotiated through consensual review. Participant checks were completed to ensure trustworthiness of the findings.Results: Participants sustained their first concussion during adolescence and often experienced difficulties transitioning back into the postconcussion academic environment. Judgments of injury severity were clearly evident in participants' knowledge and perceptions of concussions. Participants experienced an array of emotional, physical, cognitive, and social challenges during the immediate postconcussion period but did not feel their concussion history decreased their current quality of life.Conclusions: Adolescent exposure to concussions is of concern due to the risk imposed on the developing brain and the potential for adverse outcomes later in life. Although a graduated return to play is heavily emphasized in concussion management, researchers need to investigate barriers inhibiting the implementation of return-to-learn protocols. Concussion education should aim to modify indifferent attitudes toward concussive injuries. Additionally, investigators should continue to assess how a history of concussion affects quality of life in recently retired collegiate athletes.

scholarly journals Mortality and Morbidity in Kidney Transplant Recipients With a Failing Graft: A Matched Cohort Study

2020 ◽  
Vol 7 ◽  
pp. 205435812090867
Author(s):  
Ngan N. Lam ◽  
Devon J. Boyne ◽  
Robert R. Quinn ◽  
Peter C. Austin ◽  
Brenda R. Hemmelgarn ◽  
...  
Keyword(s):  
Cohort Study ◽  
Kidney Transplant ◽  
Adverse Outcomes ◽  
Similar Degree ◽  
Matched Cohort ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Mortality And Morbidity ◽  
History Of ◽  
Residual Confounding

Background: Due to their history of renal disease and exposure to immunosuppression, kidney transplant recipients with a failing graft may be at higher risk of adverse outcomes compared to nontransplant controls. Understanding the burden of disease in transplant recipients may inform treatment decisions of people whose native kidneys are failing and may be eligible for a transplant. Objective: To compare mortality and morbidity in kidney transplant recipients with a failing graft to matched nontransplant controls. Design: Retrospective cohort study. Setting: Alberta, Canada. Patients: Kidney transplant recipients with a failing graft were identified as having at least 2 estimated glomerular filtration rate (eGFR) measurements between 15-30 mL/min/1.73 m2 (90-365 days apart). We also identified nontransplant controls with a similar degree of kidney dysfunction. Measurements: Mortality and hospitalization. Methods: We propensity-score matched 520 kidney transplant recipients with a failing graft to 520 nontransplant controls. Results: The median age of the matched cohort was 57 years and 40% were women. Compared to matched nontransplant controls, recipients with a failing graft had a higher hazard of death (hazard ratio, 1.54; 95% confidence interval [CI], 1.28-1.85; p < .001) and a higher rate of all-cause hospitalization (rate ratio, 1.67; 95% CI, 1.42-1.97; p < .001). Kidney transplant recipients also had a higher rate of several cause-specific hospitalizations including genitourinary, cardiovascular, and infectious causes. Limitations: Observational design with the risk of residual confounding. Conclusions: A failing kidney transplant is associated with an increased burden of mortality and morbidity beyond chronic kidney disease. This information may assist the discussion of prognosis in kidney transplant recipients with a failing graft and the design of strategies to minimize risks.

scholarly journals Protein Intake, Fatigue and Quality of Life in Stable Outpatient Kidney Transplant Recipients

Nutrients ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2451
Author(s):  
Antonio W. Gomes Neto ◽  
Karin Boslooper-Meulenbelt ◽  
Marit Geelink ◽  
Iris M. Y. van Vliet ◽  
Adrian Post ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Kidney Transplant ◽  
Protein Intake ◽  
Lower Risk ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Severe Fatigue ◽  
Modifiable Factors ◽  
History Of

Fatigue is a frequent complaint in kidney transplant recipients (KTR), often accompanied by poor quality of life (QoL). The role of nutrition as determinant of fatigue in KTR is largely unexplored. The aims of this study are to examine the association of protein intake with fatigue and QoL in KTR and to identify other determinants of fatigue. This cross-sectional study is part of the TransplantLines Cohort and Biobank Study (NCT03272841). Protein intake was calculated from urinary urea nitrogen (UUN) in 24-h urine samples. Fatigue was assessed by the Checklist Individual Strength (CIS) questionnaire; moderate and severe fatigue were defined as a CIS score of 20–34 and ≥ 35, respectively. QoL was assessed with the RAND-36-Item Health Survey (RAND-36). Associations of protein intake with fatigue and QoL were analyzed using multinomial logistic and linear regression analyses. We included 730 stable outpatient KTR (median age 58 year [IQR 48–65], 57% male) with a mean protein intake of 82.2 ± 21.3 g/d. Moderate and severe fatigue were present in 254 (35%) and 245 (34%) of KTR. Higher protein intake was significantly associated with lower risk of moderate fatigue (OR 0.89 per 10 g/d; 95%CI 0.83–0.98, p = 0.01), severe fatigue (OR 0.85; 95%CI 0.78–0.92, p < 0.001) and was associated with higher physical component summary score of QoL (β 0.74 per 10 g/d; 95%CI 0.39–1.09, p < 0.001). Higher BMI, a history of dialysis, glomerulonephritis as primary kidney disease and a history of combined organ transplantation were also associated with severe fatigue. In conclusion, amongst the potential modifiable factors of fatigue, higher protein intake is independently associated with lower risk of moderate and severe fatigue and with better QoL in KTR. These findings underline the need to incorporate nutritional assessment in the diagnostic work-up of fatigue. Intervention studies are needed to assess the benefits and safety of higher protein intake in KTR.

Clinical Programme Management: A Model of Promise?

1993 ◽  
Vol 60 (4) ◽  
pp. 200-205 ◽  
Author(s):  
Sue Baptiste
Keyword(s):  
Health Care ◽  
Work Place ◽  
Health Care Environment ◽  
Care Environment ◽  
Quality Of Working Life ◽  
Use Of Resources ◽  
Major Teaching Hospital ◽  
Major Teaching ◽  
Initial Idea

As professionals working within a rapidly changing health care environment, it becomes critical to recognize alternatives for the management of clinical services to maximize the use of resources. However, it is also critical to remain constantly aware of the needs of valued and valuable employees, ensuring that the quality of working life is considered whenever any decisions are being made which will affect the work place. This paper reviews some of the literature related to decentralized structural models for health care institutions, and details the selection and implementation of one model in a major teaching hospital. The process of development from the initial idea through to the actual operationalization of a clinical programme management model is outlined, providing a critique of strengths and weaknesses of the model in the context of this particular organization.

USE OF UTILIZATION REVIEW TO ASSESS THE QUALITY OF PEDIATRIC INPATIENT CARE

PEDIATRICS ◽  
1972 ◽  
Vol 49 (2) ◽  
pp. 169-176
Author(s):  
Raymond S. Duff ◽  
Charles D. Cook ◽  
Gary R. Wanerka ◽  
Daniel S. Rowe ◽  
Thomas F. Dolan
Keyword(s):  
Teaching Hospital ◽  
Utilization Review ◽  
Community Hospitals ◽  
Optimal Care ◽  
Major Teaching Hospital ◽  
Major Teaching ◽  
Pediatric Inpatient ◽  
The Cost ◽  
Hospital Days

Between 100 and 123 medical records of children hospitalized in each of three community hospitals and one major teaching hospital were examined to determine the need for and the quality of the care administered. Twenty-five percent of all patient days were considered unnecessary; this varied from 7% in the teaching hospital to a mean of 38% in the community hospitals. The cost of unnecessary hospital days and laboratory and x-ray studies for the 428 patients was $37,460, or $88 per patient discharged; the means per patient discharged from the three community hospitals and the teaching hospital were $101 and $54 respectively. About one-third of all the patients received less than optimal care; this varied from 13% in the teaching hospital to 43% in the community hospitals. Misuse of antibiotics and questionable use of other drugs accounted for 79% of instances of questionable care.

Probiotics in gastroenterology – from a different angle

2013 ◽  
Vol 154 (8) ◽  
pp. 294-304 ◽  
Author(s):  
György Miklós Buzás
Keyword(s):  
Side Effects ◽  
Beneficial Effect ◽  
Analytical Data ◽  
Well Being ◽  
Gastrointestinal Diseases ◽  
Convincing Evidence ◽  
Probiotic Treatment ◽  
History Of ◽  
Irritable Bowel

After a short overview of the history of probiotics, the author presents the development of human intestinal microflora based on the newest genetic data and the microbiological features of main probiotics. The indications of probiotic administration have been defined and extended in recent years. The author reviews significant results of probiotic treatment in some gastrointestinal diseases based on meta-analytical data. Probiotics are useful in preventing and treating diarrhoea caused by antibiotics and Clostridium difficile caused diarrhoea. In the treatment of Helicobacter pylori infection, preparations containing certain Lactobacillus,Bifidobacterium strains or Saccaromyces boulardii could enhance by 5–10% the rate of successful eradication and reduce the incidence and severity of the side effects. Some symptoms of irritable bowel syndrome and thus the quality of life can be improved by probiotics. Their beneficial effect in ulcerative colitis was proven, while in Crohn’s disease has not yet been defined. The use of probiotics is not included in guidelines, with the exception of the Maastricht IV/Florence consensus. For each disease it is advisable to use probiotics containing strains only with proven beneficial effect. The efficiency of preparations containing mixed strains has not yet been properly investigated. The author reviews the rare but potentially serious side effects of probiotics. In Hungary, there are many probiotic preparations available which can be purchased in pharmacies without prescription: their use is more empirical than evidence-based. The European Food Safety Authority has recently rejected claims for probiotics to be classed as medicines given the lack of convincing evidence on the effects of probiotics on human health and well-being. Clearly, further research is needed to collect evidence which could be incorporated into the international guidelines. Orv. Hetil., 2013, 154, 294–304.

EXPLORING HEALTHCARE ARCHITECTURE THROUGH THE MEDIUM OF FILM: Motives and Techniques

2014 ◽  
Vol 8 (1) ◽  
pp. 29
Author(s):  
Stephen Verderber
Keyword(s):  
Real World ◽  
The Real ◽  
Healthcare Settings ◽  
Interdisciplinary Field ◽  
Body Of Knowledge ◽  
Behavior Setting ◽  
Physical Environments ◽  
Scant Attention ◽  
History Of

The interdisciplinary field of person-environment relations has, from its origins, addressed the transactional relationship between human behavior and the built environment. This body of knowledge has been based upon qualitative and quantitative assessment of phenomena in the “real world.” This knowledge base has been instrumental in advancing the quality of real, physical environments globally at various scales of inquiry and with myriad user/client constituencies. By contrast, scant attention has been devoted to using simulation as a means to examine and represent person-environment transactions and how what is learned can be applied. The present discussion posits that press-competency theory, with related aspects drawn from functionalist-evolutionary theory, can together function to help us learn of how the medium of film can yield further insights to person-environment (P-E) transactions in the real world. Sampling, combined with extemporary behavior setting analysis, provide the basis for this analysis of healthcare settings as expressed throughout the history of cinema. This method can be of significant aid in examining P-E transactions across diverse historical periods, building types and places, healthcare and otherwise, otherwise logistically, geographically, or temporally unattainable in real time and space.

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