scholarly journals The relationship between vitamin C or thiamine levels and outcomes for severe sepsis patients admitted to the ICU

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nandan Prasad ◽  
Anne V. Grossestreuer ◽  
Nuala J. Meyer ◽  
Sarah M. Perman ◽  
Mark E. Mikkelsen ◽  
...  
Keyword(s):  
Ascorbic Acid ◽  
Severe Sepsis ◽  
Vitamin C ◽  
Reference Range ◽  
Medical Center ◽  
Academic Medical Center ◽  
Plasma Ascorbic Acid ◽  
Academic Medical ◽  
The Relationship ◽  
Thiamine Level

AbstractPreliminary data have produced conflicting results regarding whether initial vitamin C levels in patients with severe sepsis correlate with mortality outcomes. We hypothesized that low plasma ascorbic acid or thiamine levels in severe sepsis patients admitted from the Emergency Department (ED) to the Intensive Care Unit (ICU) would be associated with increased mortality and an increased incidence of shock. Retrospective analysis of a prospective database of severe sepsis patients admitted to the ICU at an urban, academic medical center. Ascorbic acid and thiamine levels were analyzed in relation to survivors vs. non-survivors and shock vs. non-shock patients. 235 patients were included; mean age, 59.4 years ± 16.8 years; male, 128 (54.5%); in-hospital mortality, 16.6% (39/235); mean APACHE3 score, 61.8 ± 22.8; mean ascorbic acid level (reference range 0.40–2.10 mg/dL), 0.23 mg/dL (95% CI 0.07–4.02); and the mean thiamine level (reference range 14.6–29.5 nmol/L), 6.0 nmol/L (95% CI 4.0–9.5). When survivors were compared to non-survivors, survivors were more likely to be male (57.7% [113/196] vs. 38.5% [15/39]) and have lower APACHE3 scores (58.2 ± 22.6 vs. 79.9 ± 16.0). For the total cohort of 235 patients, there was no statistically significant relationship between a patient’s initial ascorbic acid or thiamine level and either survival or development of shock. In this analysis of early plasma samples from patients with severe sepsis admitted from the ED to the ICU, we found that mean ascorbic acid and thiamine levels were lower than normal range but that there was no relationship between these levels and outcomes, including 28 day mortality and development of shock.

scholarly journals 1575. Vancomycin Loading Doses and Nephrotoxicity on Medicine Teaching Services

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S575-S575
Author(s):  
Phillip Wagner ◽  
Jon Arnold ◽  
Kathleen R Sheridan
Keyword(s):  
Drug Exposure ◽  
Standard Dose ◽  
Medical Center ◽  
Academic Medical Center ◽  
Kidney Injury ◽  
Loading Dose ◽  
Academic Medical ◽  
Trough Concentrations ◽  
Seriously Ill Patients ◽  
The Relationship

Abstract Background IDSA guidelines recommend the usage of a loading dose when using vancomycin for seriously ill patients to rapidly achieve adequate trough concentrations. While the relationship between vancomycin and nephrotoxicity is the focus of many studies, and with the strength of that relationship still debated, few studies have examined the relationship between vancomycin loading doses and nephrotoxicity. Methods We performed a retrospective cohort study examining vancomycin dosing for internal medicine teaching services’ patients over the 2014–15 academic year at one academic medical center. We generated a list of all hospitalized patients aged 18–85 who received vancomycin and were admitted to a teaching service. Patient data were extracted from the inpatient EMR via manual chart review. Patients were excluded if their pretreatment calculated glomerular filtration rate (GFR) was less than 50 mL/minute, if they received less than three doses of vancomycin, or if their initial dose was subtherapeutic (<10 mg/kg). Nephrotoxicity was determined by 7-day acute kidney injury (AKI) rate. Patients in the loading dose (>20 mg/kg) cohort were compared with those in the standard dose cohort (10–20 mg/kg). Our primary modeling used multi-variable logistic regression with AKI as our outcome of interest. Results 438 of the initial 804 patients were enrolled. The loading dose (n = 365, 83%) and standard dosing (n = 73, 17%) cohorts were not significantly different regarding demographics, GFR, nephrotoxic drug exposure, total vancomycin received, trough levels, or comorbidities, and were only significantly different regarding body mass index (BMI). The 7-day AKI rate was not significantly different between the two arms (6.3% in the standard dosing arm and 8.2% in the loading dose arm P = 0.6). AKI rate significantly increased in both arms in the setting of concurrent piperacillin–tazobactam and vancomycin administration (OR 2.5, P = .04). There was no association between BMI and AKI. Conclusion Few studies have examined the relationship between nephrotoxicity and vancomycin loading doses. The results of this study provide evidence that the use of loading doses is not significantly associated with increased 7-day AKI rate. Disclosures All authors: No reported disclosures.

Impact of an innovative partnership in patient care between an academic medical center department of pharmacy and a school of pharmacy

2019 ◽  
Vol 76 (24) ◽  
pp. 2070-2076
Author(s):  
Mary-Haston Vest ◽  
Mary G Petrovskis ◽  
Scott W Savage ◽  
Nicole R Pinelli ◽  
Ashley L Pappas ◽  
...  
Keyword(s):  
Patient Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Lessons Learned ◽  
Residency Programs ◽  
Pharmacy Department ◽  
Academic Medical ◽  
American Society ◽  
The Impact ◽  
The Relationship

Abstract Purpose Pharmacy departments and schools of pharmacy have long held professional affiliations. However, the success of each entity is often not interdependent and aligned. In 2010, our institutions found ourselves in a position where the complementary motivations of each aligned to support a more meaningful and committed engagement, leading to the development of the Partnership in Patient Care. The impact of the partnership was evaluated 7 years postimplementation, and both the successes realized and the lessons learned are described. Summary The partnership provided many advantages to our pharmacy department and the school of pharmacy. This initial iteration of the partnership was a strong proof of concept that an intentional approach to the relationship between a school of pharmacy and a pharmacy department can lead to substantive improvements in a wide array of meaningful outcomes. We experienced an increase in the number of student rotation months completed, growth in the American Society of Health-System Pharmacists–accredited residency programs, and enhanced clinical services. However, the partnership was not without challenges. For instance, lack of a formalized tracking method made certain outcomes difficult to track. Conclusion The purposeful establishment of the Partnership in Patient Care, built on the needs of a school of pharmacy and an academic medical center pharmacy department, allowed our institutions to develop an intertwined mission and vision. Over the initial years of the partnership, many successes were realized and lessons were learned. Both the successes and the challenges are serving as the foundation for future iterations of the partnership.

CHARACTERIZING COMPLIANCE VARIABILITY AMONG THREE DIFFERENT SEVERE SEPSIS BUNDLES AT AN ACADEMIC MEDICAL CENTER.

2006 ◽  
Vol 34 ◽  
pp. A99
Author(s):  
Jeffrey Fong ◽  
John W Devlin ◽  
Karen Cecere ◽  
John Unterborn ◽  
Erik Garpestad ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Medical Center ◽  
Academic Medical Center ◽  
Sepsis Bundles ◽  
Academic Medical

scholarly journals Elevated FGF23 Levels Are Associated with Impaired Calcium-Mediated Suppression of PTH in ESRD

2010 ◽  
Vol 24 (12) ◽  
pp. 2406-2407
Author(s):  
James B. Wetmore ◽  
Peter Santos ◽  
Jonathan D. Mahnken ◽  
Ron Krebill ◽  
Rochelle Menard ◽  
...  
Keyword(s):  
Parathyroid Gland ◽  
Medical Center ◽  
Fibroblast Growth Factor 23 ◽  
Academic Medical Center ◽  
Positive Association ◽  
Calcium Sensing ◽  
Academic Medical ◽  
High Calcium ◽  
Gland Function ◽  
The Relationship

Abstract Context: The positive association of elevated fibroblast growth factor-23 (FGF23) with PTH levels in the setting of secondary hyperparathyroidism is paradoxical to the purported effects of FGF23 to suppress PTH secretion. Objective: We used dynamic calcium-mediated suppression of PTH levels in hemodialysis (HD) patients to determine the relationship between FGF23 levels and parathyroid gland function. Design: HD patients with elevated PTH were washed out of vitamin D analogs and/or calcimimetics and then exposed them to a high-calcium dialysate bath designed to suppress PTH. Setting: The study was conducted at an outpatient HD unit of an academic medical center. Participants: Eighteen maintenance HD patients with elevated PTH levels participated in the study. Main Outcome Measures: Ionized calcium (iCa), PTH, and FGF23 levels were measured during HD. The slope of the relationship between iCa and PTH (a marker of parathyroid gland mass) and the iCa level required for a 50% reduction in PTH were determined, and the association of these with FGF23 levels was determined. Results: Increased baseline log FGF23 levels were associated with putative alterations in gland mass as estimated by significantly shallower slopes of the iCa/PTH suppression curves (P = 0.0004), but there was no association between FGF23 and calcium sensing as measured by ionized Ca associated with a 50% suppression of PTH (P = 0.38). FGF23 levels decreased significantly during HD, but this change was not correlated with decrements in either renal phosphate or PTH. Conclusions: High FGF23 levels may be a marker for parathyroid gland hyperplasia in HD patients. Acute reductions in neither PTH nor renal phosphate during dialysis correlated with PTH suppression.

scholarly journals QOLP-19. INSOMNIA IN BRAIN TUMOR PATIENTS: ASSESSING NEEDS IN NEURO-ONCOLOGY

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii178-ii179
Author(s):  
Kelcie Willis ◽  
Scott Ravyts ◽  
Autumn Lanoye ◽  
Ashlee Loughan
Keyword(s):  
Brain Tumor ◽  
Sleep Disturbance ◽  
Pharmacological Treatment ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Brain Tumor ◽  
Academic Medical ◽  
Fatigue Severity ◽  
Negative Side Effects ◽  
The Relationship

Abstract BACKGROUND Insomnia is a prevalent consequence of cancer diagnosis and treatment. In primary brain tumor (PBT) patients specifically, insomnia has been rated as one of the most severe symptoms and linked with other negative side effects, such as increased fatigue and emotional distress. Despite these findings, research has consistently omitted PBT patients in understanding the detailed effects and treatment for insomnia. METHODS Adult PBT patients (N=74) completed anonymous surveys at routine neuro-oncology appointments at an NCI-designated academic medical center. The surveys included validated measures of insomnia (ISI & PSQI), fatigue (BFI), and other original items (e.g., How would you describe your feelings towards medication treatment for insomnia?). The current investigation aimed to assess: 1) the prevalence of clinically elevated symptoms of insomnia, 2) the relationship between sleep disturbance and daytime fatigue and distress, and 3) patients’ preferences for pharmacological and non-pharmacological treatment for insomnia in PBT patients. RESULTS Of the sampled PBT patients, 38% reported significant sleep disturbance as measured by the PSQI. Moreover, 23% endorsed clinically elevated, moderate-severe symptoms of insomnia as measured by the ISI. Excessive worrying (r =.31) and bad dreams (r =.29, p&lt; .05) were both associated, though not predictive of insomnia severity (p &gt;.05). Insomnia symptoms predicted increased fatigue severity, F(1,72) =52.60, β=.65, p&lt; .001, R2 =.42. Of the patients with clinical insomnia, 59% felt that their symptoms were not well-managed by their medical team; 53% expressed interest in pharmacological treatment and 47% in non-pharmacological treatment. CONCLUSIONS The prevalence and consequences of insomnia identified in PBT patients are similar to that of other cancers, yet the majority of PBT patients with insomnia reported their symptoms were poorly managed. Though there was slight preference for pharmacological treatment, the sizeable proportion of those interested in non-pharmacological treatments warrants investigations into such therapies (e.g., CBT-I) in medical settings

scholarly journals Duodenal Aspirates for Small Intestine Bacterial Overgrowth: Yield, PPIs, and Outcomes after Treatment at a Tertiary Academic Medical Center

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Diana L. Franco ◽  
Molly B. Disbrow ◽  
Allon Kahn ◽  
Laura M. Koepke ◽  
Lucinda A. Harris ◽  
...  
Keyword(s):  
Medical Records ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bacterial Overgrowth ◽  
Small Intestinal Bacterial Overgrowth ◽  
Intestinal Bacterial Overgrowth ◽  
Academic Medical ◽  
Small Intestine Bacterial Overgrowth ◽  
Small Intestinal ◽  
The Relationship

Duodenal aspirates are not commonly collected, but they can be easily used in detection of small intestinal bacterial overgrowth (SIBO). Proton pump inhibitor (PPI) use has been proposed to contribute to the development of SIBO. We aimed to determine the yield of SIBO-positive cultures detected in duodenal aspirates, the relationship between SIBO and PPI use, and the clinical outcomes of patients identified by this method. In a retrospective study, we analyzed electronic medical records from 1263 consecutive patients undergoing upper endoscopy at a tertiary medical center. Aspirates were collected thought out the third and fourth portions of the duodenum, and cultures were considered to be positive for SIBO if they produced more than 100,000 cfu/mL. Culture analysis of duodenal aspirates identified SIBO in one-third of patients. A significantly higher percentage of patients with SIBO use PPIs than patients without SIBO, indicating a possible association. Similar proportions of patients with SIBO improved whether or not they received antibiotic treatment, calling into question the use of this expensive therapy for this disorder.

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