P.32 Intrathecal anaesthetic drug dosing strategies for repair of perineal tears: An evaluation of current practice

2021 ◽  
Vol 46 ◽  
pp. 103030
Author(s):  
M. Ince ◽  
R. Clark
Keyword(s):  
Current Practice ◽  
Anaesthetic Drug ◽  
Drug Dosing ◽  
Perineal Tears ◽  
Dosing Strategies

scholarly journals Antimicrobial Doses in Continuous Renal Replacement Therapy: A Comparison of Dosing Strategies

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Anna P. Kempke ◽  
Abbie S. Leino ◽  
Farzad Daneshvar ◽  
John Andrew Lee ◽  
Bruce A. Mueller
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Drug Dose ◽  
Published Data ◽  
Pharmacokinetic Data ◽  
Drug Dosing ◽  
Dosing Strategies ◽  
Dose Recommendations

Purpose. Drug dose recommendations are not well defined in patients undergoing continuous renal replacement therapy (CRRT) due to limited published data. Several guidelines and pharmacokinetic equations have been proposed as tools for CRRT drug dosing. Dose recommendations derived from these methods have yet to be compared or prospectively evaluated.Methods. A literature search of PubMed, Micromedex, and Embase was conducted for 40 drugs commonly used in the ICU to gather pharmacokinetic data acquired from patients with acute and chronic kidney disease as well as healthy volunteers. These data and that obtained from drug package inserts were gathered for use in three published CRRT drug dosing equations. Doses calculated for a model patient using each method were compared to doses suggested in a commonly used dosing text.Results. Full pharmacokinetic data was available for 18, 31, and 40 agents using acute kidney injury, end stage renal disease, and normal patient data, respectively. On average, calculated doses differed by 30% or more from the doses recommended by the renal dosing text for >50% of the medications.Conclusion. Wide variability in dose recommendations for patients undergoing CRRT exists when these equations are used. Alternate, validated dosing methods need to be developed for this at-risk patient population.

scholarly journals Therapeutic Drug Monitoring of Piperacillin-Tazobactam Using Spent Dialysate Effluent in Patients Receiving Continuous Venovenous Hemodialysis

2010 ◽  
Vol 55 (2) ◽  
pp. 557-560 ◽  
Author(s):  
Michael J. Connor ◽  
Charbel Salem ◽  
Seth R. Bauer ◽  
Christina L. Hofmann ◽  
Joseph Groszek ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Kidney Injury ◽  
Therapeutic Drug ◽  
Plasma Drug ◽  
Drug Dosing ◽  
Drug Levels ◽  
Drug Concentrations ◽  
Continuous Venovenous Hemodialysis ◽  
Dosing Strategies

ABSTRACTSepsis and multisystem organ failure are common diagnoses affecting nearly three-quarters of a million Americans annually. Infection is the leading cause of death in acute kidney injury, and the majority of critically ill patients who receive continuous dialysis also receive antibiotics. Dialysis equipment and prescriptions have gradually changed over time, raising concern that current drug dosing recommendations in the literature may result in underdosing of antibiotics. Our research group directed its attention toward antibiotic dosing strategies in patients with acute renal failure (ARF), and we sought data confirming that patients receiving continuous dialysis and antibiotics actually were achieving therapeutic plasma drug levels during treatment. In the course of those investigations, we explored “fast-track” strategies to estimate plasma drug concentrations. As most antimicrobial antibiotics are small molecules and should pass freely through modern high-flux hemodialyzer filters, we hypothesized that continuous renal replacement therapy (CRRT) effluent could be used as the medium for drug concentration measurement by reverse-phase high-pressure liquid chromatography (HPLC). Here we present the first data demonstrating this approach for piperacillin-tazobactam. Paired blood and dialysate trough-peak-trough samples were drawn from 19 patients receiving piperacillin-tazobactam and continuous venovenous hemodialysis (CVVHD). Total, free, and dialysate drug concentrations were measured by HPLC. Dialysate drug levels predicted plasma free drug levels well (r2= 0.91 and 0.92 for piperacillin and tazobactam, respectively) in all patients. These data suggest a strategy for therapeutic drug monitoring that minimizes blood loss from phlebotomy and simplifies analytic procedures.

scholarly journals Tuning Spatial Profiles of Selection Pressure to Modulate the Evolution of Resistance

2017 ◽  
Author(s):  
Maxwell G. De Jong ◽  
Kevin B. Wood
Keyword(s):  
Drug Resistance ◽  
Spatial Heterogeneity ◽  
Selection Pressure ◽  
First Passage Time ◽  
Passage Time ◽  
Spatial Profile ◽  
Drug Dosing ◽  
Spatial Gradients ◽  
Resistance Evolution ◽  
Dosing Strategies

Spatial heterogeneity plays an important role in the evolution of drug resistance. While recent studies have indicated that spatial gradients of selection pressure can accelerate resistance evolution, much less is known about evolution in more complex spatial profiles. Here we use a stochastic toy model of drug resistance to investigate how different spatial profiles of selection pressure impact the time to fixation of a resistant allele. Using mean first passage time calculations, we show that spatial heterogeneity accelerates resistance evolution when the rate of spatial migration is sufficiently large relative to mutation but slows fixation for small migration rates. Interestingly, there exists an intermediate regime—characterized by comparable rates of migration and mutation—in which the rate of fixation can be either accelerated or decelerated depending on the spatial profile, even when spatially averaged selection pressure remains constant. Finally, we demonstrate that optimal tuning of the spatial profile can dramatically slow the spread and fixation of resistant subpopulations, even in the absence of a fitness cost for resistance. Our results may lay the groundwork for optimized, spatially-resolved drug dosing strategies for mitigating the effects of drug resistance.

scholarly journals Cancer Chemoprevention: Preclinical In Vivo Alternate Dosing Strategies to Reduce Drug Toxicities

2019 ◽  
Vol 170 (2) ◽  
pp. 251-259 ◽  
Author(s):  
Altaf Mohammed ◽  
Jennifer T Fox ◽  
Mark Steven Miller
Keyword(s):  
Drug Efficacy ◽  
Cancer Chemoprevention ◽  
Short Review ◽  
Primary Concern ◽  
Chemopreventive Agents ◽  
In Vivo Models ◽  
Drug Dosing ◽  
Dosing Strategies ◽  
Asymptomatic Individuals

AbstractCancer chemopreventive agents inhibit the formation of precursor lesions and/or the progression of these lesions to late stage disease. This approach to disease control has the potential to reduce the physical and financial costs of cancer in society. Several drugs that have been approved by the FDA for other diseases and have been extensively evaluated for their safety and pharmacokinetic/pharmacodynamic characteristics have the potential to be repurposed for use as cancer chemopreventive agents. These agents often mechanistically inhibit signaling molecules that play key roles in the carcinogenic process. The safety profile of agents is a primary concern when considering the administration of drugs for chemoprevention, as the drugs will be given chronically to high-risk, asymptomatic individuals. To decrease drug toxicity while retaining efficacy, several approaches are currently being explored. In this short review, we describe studies that use preclinical in vivo models to assess efficacy of alternative drug dosing strategies and routes of drug administration on chemopreventive drug efficacy. In vivo drug dosing strategies that reduce toxicity while retaining efficacy will pave the way for future cancer prevention clinical trials.

Management of Bacterial Urinary Tract Infections in Adults

1994 ◽  
Vol 28 (11) ◽  
pp. 1264-1272 ◽  
Author(s):  
Jimmi Hatton ◽  
Melody Hughes ◽  
Claire H. Raymond
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
English Language ◽  
Data Extraction ◽  
Background Information ◽  
Duration Of Treatment ◽  
Drug Dosing ◽  
Medline Search ◽  
Dosing Strategies ◽  
Tract Infections

OBJECTIVE: To provide a comprehensive review of the diagnosis and therapeutic management considerations in patients with urinary tract infections (UTIs). DATA SOURCES: A MEDLINE search was used to identify pertinent English language literature, including reviews. Infectious disease textbooks were used for background information. STUDY SELECTION: Clinical trials evaluating drug therapy in a variety of patient populations with UTIs were reviewed. DATA EXTRACTION: Background information was obtained from comprehensive reviews. Drug dosing strategies and efficacy comparisons were extracted from the investigations in this area. DATA SYNTHESIS: Information was processed to provide general guidelines and resources for practitioners to use in managing UTIs. CONCLUSIONS: There are a number of useful antibiotics for the management of UTIs. The distinctions between infection severity and underlying risk factors within a given population influence the appropriateness of drug selection and duration of treatment.

scholarly journals Prediction of Kidney Drug Clearance: A Comparison of Tubular Secretory Clearance and Glomerular Filtration Rate

2020 ◽  
pp. ASN.2020060833
Author(s):  
Yan Chen ◽  
Leila R. Zelnick ◽  
Andrew N. Hoofnagle ◽  
Catherine K. Yeung ◽  
Laura M. Shireman ◽  
...  
Keyword(s):  
Predictive Accuracy ◽  
Drug Clearance ◽  
Tubular Secretion ◽  
Drug Elimination ◽  
Drug Dosing ◽  
Liquid Chromatography Tandem Mass ◽  
Dosing Strategies ◽  
Proximal Tubular ◽  
The Mean ◽  
Solute Clearance

BackgroundAlthough proximal tubular secretion is the primary mechanism of kidney drug elimination, current kidney drug dosing strategies are on the basis of eGFR.MethodsIn a dedicated pharmacokinetic study to compare GFR with tubular secretory clearance for predicting kidney drug elimination, we evaluated stable outpatients with eGFRs ranging from 21 to 140 ml/min per 1.73 m2. After administering single doses of furosemide and famciclovir (metabolized to penciclovir), we calculated their kidney clearances on the basis of sequential plasma and timed urine measurements. Concomitantly, we quantified eight endogenous secretory solutes in plasma and urine using liquid chromatography-tandem mass spectrometry and measured GFR by iohexol clearance (iGFR). We computed a summary secretion score as the scaled average of the secretory solute clearances.ResultsMedian iGFR of the 54 participants was 73 ml/min per 1.73 m2. The kidney furosemide clearance correlated with iGFR (r=0.84) and the summary secretion score (r=0.86). The mean proportionate error (MPE) between iGFR-predicted and measured furosemide clearance was 30.0%. The lowest MPE was observed for the summary secretion score (24.1%); MPEs for individual secretory solutes ranged from 27.3% to 48.0%. These predictive errors were statistically indistinguishable. Penciclovir kidney clearance was correlated with iGFR (r=0.83) and with the summary secretion score (r=0.91), with similar predictive accuracy of iGFR and secretory clearances. Combining iGFR with the summary secretion score yielded only modest improvements in the prediction of the kidney clearance of furosemide and penciclovir.ConclusionsSecretory solute clearance measurements can predict kidney drug clearances. However, tight linkage between GFR and proximal tubular secretory clearance in stable outpatients provides some reassurance that GFR, even when estimated, is a useful surrogate for predicting secretory drug clearances in such patients.

Translating Principles of Speech Science to Clinical Practice: Current and Future Trends in Craniofacial Disorders

2008 ◽  
Vol 18 (1) ◽  
pp. 31-40 ◽  
Author(s):  
David J. Zajac
Keyword(s):  
Clinical Practice ◽  
Speech Intelligibility ◽  
Current Practice ◽  
Computer Assisted ◽  
Behavioral Management ◽  
Single Word ◽  
Future Directions ◽  
Speech Science ◽  
The Impact ◽  
Opinion Article

Abstract The purpose of this opinion article is to review the impact of the principles and technology of speech science on clinical practice in the area of craniofacial disorders. Current practice relative to (a) speech aerodynamic assessment, (b) computer-assisted single-word speech intelligibility testing, and (c) behavioral management of hypernasal resonance are reviewed. Future directions and/or refinement of each area are also identified. It is suggested that both challenging and rewarding times are in store for clinical researchers in craniofacial disorders.

Principles of Solution Focused Therapy and Their Application to Audiology

2014 ◽  
Vol 15 (1) ◽  
pp. 27-33
Author(s):  
James C. Blair
Keyword(s):  
Basic Assumption ◽  
Current Practice ◽  
Helping Professions ◽  
Patient Centered ◽  
Therapy Approach ◽  
Agents Of Change ◽  
Centered Care ◽  
Client Centered Therapy ◽  
Solution Focused ◽  
Solution Focused Therapy

The concept of client-centered therapy (Rogers, 1951) has influenced many professions to refocus their treatment of clients from assessment outcomes to the person who uses the information from this assessment. The term adopted for use in the professions of Communication Sciences and Disorders and encouraged by The American Speech-Language-Hearing Association (ASHA) is patient-centered care, with the goal of helping professions, like audiology, focus more centrally on the patient. The purpose of this paper is to examine some of the principles used in a patient-centered therapy approach first described by de Shazer (1985) named Solution-Focused Therapy and how these principles might apply to the practice of audiology. The basic assumption behind this model is that people are the agents of change and the professional is there to help guide and enable clients to make the change the client wants to make. This model then is focused on solutions, not on the problems. It is postulated that by using the assumptions in this model audiologists will be more effective in a shorter time than current practice may allow.

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