scholarly journals 13 Amending Admission Protocol to Reduce Proton Pump Inhibitor-Induced Hyponatraemia on A Specialist Hip Fracture Unit

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
R Darnell ◽  
B Clements ◽  
E Reeve ◽  
N Singh
Keyword(s):  
Hip Fracture ◽  
Proton Pump Inhibitor ◽  
Elderly Patients ◽  
Proton Pump ◽  
Side Effect ◽  
Sodium Concentration ◽  
Improvement Project ◽  
Number Of Patients ◽  
Group A ◽  
Group B

Abstract Introduction Hyponatraemia is a common electrolyte disturbance amongst elderly patients. Defined as a sodium concentration below 135 mmol/L, the BNF cites hyponatraemia as a ‘rare’ side effect of Omeprazole, a common proton pump inhibitor (PPI). In elderly patients, hyponatraemia can have significant morbidity. On our Hip Fracture Unit (HFU) at St Helier Hospital, all patients are commenced on Omeprazole on admission. We conducted a quality improvement project to reduce the incidence of PPI-induced hyponatraemia by altering standard protocol from Omeprazole to Ranitidine. Methods Phase 1: Retrospective analysis identifying incidence of PPI-induced hyponatraemia, defined as sodium concentration below 133mmol/L on two consecutive readings and resolving on switching to Ranitidine (Group A: n=86). Phase 2: Identifying incidence of hyponatraemia following administration of Ranitidine from admission (Group B: n=62). Exclusion criteria: Patients already on gastric protection or hyponatraemic on presentation. Chi squared analysis to establish statistical significance for risk of hyponatraemia associated with omeprazole. Results Total number of patients was 148. Age range 60-101 years (median 82 years). Incidence of PPI-induced hyponatraemia in Group A was 10.5% (9 cases). All resolved on switching to ranitidine. Following change in admission protocol to Ranitidine (Group B), incidence of hyponatraemia was 1.6% (1 case). The chance of developing hyponatraemia with Omeprazole was significantly higher than with ranitidine (P=0.0454). Conclusions 10.5% of admissions to the HFU experienced PPI-induced hyponatraemia. The European Medicines Agency defines side effects occurring at greater than 10% as very common. Whilst 45% of patients were on medication associated with hyponatraemia on admission, the absence of hyponatraemia at presentation and biochemical response when switching to ranitidine, demonstrates this is a significant side effect of PPIs. Given the increased morbidity associated with hyponatraemia, particularly in frail, elderly patients, amending protocol to ranitidine for gastric protection has the potential to reduce harm and improve patient outcomes.

scholarly journals The Rate of Prescribing Gastrointestinal Prophylaxis with Either a Proton Pump Inhibitor Or an H2-Receptor Antagonist in Nova Scotia Seniors Starting Nonsteroidal Anti-Inflammatory Drug Therapy

2010 ◽  
Vol 24 (8) ◽  
pp. 481-488 ◽  
Author(s):  
Bogdan Superceanu ◽  
Sander Veldhuyzen van Zanten ◽  
Chris Skedgel ◽  
Michael Shepherd ◽  
Ingrid Sketris
Keyword(s):  
Nova Scotia ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Nonselective Nsaid ◽  
H2 Receptor Antagonist ◽  
Number Of Patients ◽  
Increased Risk ◽  
Gastroprotective Agent ◽  
Anti Inflammatory ◽  
One Year

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used agents that can cause serious gastrointestinal (GI) side effects. For patients at increased risk of NSAID-related GI complications, prophylaxis with either a nonselective NSAID plus gastroprotective agent (GPA) or, alternatively, therapy with a cyclooxygenase-2 selective inhibitor with or without a GPA such as a proton pump inhibitor (PPI), is recommended.AIM: To describe the rate, timing and duration of GI prophylaxis in Nova Scotia seniors receiving nonselective NSAIDs.METHODS: The Nova Scotia Seniors’ Pharmacare Program beneficiaries for the years 1998 to 2002 were studied. A cohort of incident NSAID and GPA users was selected from all nonselective NSAID users (no prescribed NSAID dispensed 12 months before the index month and no GPA dispensed two months before the index prescription). Monthly coprescribing rates were calculated by dividing the number of patients in the cohort using GPAs by the number of NSAID users. GI prophylactic coprescribing was defined as the coprescribing rate present at the first month (index month) of prescribing an NSAID.RESULTS: The cohort consisted of 12,906 patients. Seventy-five per cent of the nonselective NSAID prescriptions dispensed were for up to two months duration, with only 2.3% longer than one year. GI prophylaxis was given to only 3.8% of patients starting NSAIDs who were not on a GPA in the two months before starting NSAIDs. Of this 3.8%, 92.7% of the patients received H2-receptor antagonists (H2RAs), and 7% received PPIs. The rate of H2RA coprescribing increased with the number of consecutive months on an NSAID from 3.5% in the first month to 24.1% at 48 months. For PPIs, the coprescribing rate increased from 0.3% to 1.9% of all NSAID users in the cohort. The rate of gastroprophylaxis coprescribing for patients receiving NSAIDs did not rise with increasing age.CONCLUSION: In Nova Scotian seniors using nonselective NSAIDs, the rate of GI prophylaxis was low. Most patients received H2RAs as GPAs despite evidence that they offer insufficient protection.

A Randomized Clinical Trial of Proton Pump Inhibitors Combined with Traditional Chinese Medicine in the Treatment of Laryngopharyngeal Reflux Disease

2021 ◽  
Author(s):  
Feng Pei ◽  
Wei Jia Hu ◽  
Yi Nan Mao ◽  
Yu Liang Zhao
Keyword(s):  
Proton Pump ◽  
Reflux Disease ◽  
Laryngopharyngeal Reflux ◽  
Short Form ◽  
Therapeutic Effects ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Laryngopharyngeal Reflux Disease ◽  
Group A ◽  
Group B

Background:To explore whether combined with TCM based on classical proton pumpinhibitors PPIs therapy can achieve better efficacy for patients withlaryngopharyngeal reflux disease. Methods: There were 150 laryngopharyngeal refluxpatients enrolled and divided into three groups randomly, with 50 cases in each group.Patients in group A were treated with the proton pump inhibitor (PPI) lansoprazole.Patients in group B were treated with lansoprazole combined with Banxia Houpudecoction, and patients in group C were treated with acupuncture treatments and acombination of Chinese and Western medicine. The reflux symptom index (RSI), refluxfinding score (RFS), and quality of life (36 item short form health survey questionnaire)were assessed before and 4 and 8 weeks after treatment. Results: The RSI and RFSscores of the three groups were significantly reduced after treatment (P < 0.001). Ingroup B and C, they were lower than in group A at 8 weeks (P < 0.01). The SF 36 scoreof 3 groups increased after treatment. At both 4 and 8 weeks (P < 0.001), and patientsin groups B and C scored higher than patients in group A (P < 0.001). The total effectiverate of group B and group C was higher than that of group A (P < 0.05). Conclusion:All three treatments have therapeutic effects on the disease, but the efficacy of a PPIalone is not as good as the combined treatments’ efficacies. Moreover, PPI combinedwith Banxia Houpu decoction and/or acupuncture treatment substantially affects lifeimprovement.

scholarly journals INTRAVENOUS REGIONAL ANESTHESIA (BIERS BLOCK);

2012 ◽  
Vol 19 (05) ◽  
pp. 710-714
Author(s):  
Muhammad ASGHER ◽  
ASIM GHAURI ◽  
MUHAMMAD ABDULLAH ◽  
Tariq Abassi
Keyword(s):  
Regional Anaesthesia ◽  
Military Hospital ◽  
P Value ◽  
Complete Evaluation ◽  
Intravenous Regional Anesthesia ◽  
Number Of Patients ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Intravenous Regional Anaesthesia

Objective: To compare the analgesic effects of combination of 0.5% Lidocaine plus Ketorolac in intravenous regionalanaesthesia technique with those of Lidocaine (0.5%) alone to prevent post operative pain after intravenous regional anaesthesia (Biersblock). Study design: Randomized Control Trial. Place and duration of study: The study was carried out at Department of Anaesthesiology,Intensive Care and pain management, Combined Military hospital, Rawalpindi from July 2008 to February 2009. Patients and Methods: Thestudy was conducted after complete evaluation of risk / benefit ratio to the patients. On the basis of random number method the patients weredivided into two equal groups (group A and group B). The number of patients in each group was 75. Group A was assigned Lidocaine in a dose of200mg 40ml of 0.5% solution and group B was assigned injection Ketorolac 30mg added to Lidocaine in a dose of 200mg 40ml of 0.5% solution.The patients were kept in post anaesthesia care unit for two hours and pain intensity was measured by visual analogue scale(VAS) on 15,30minutes,1hour, 1.5 and at 2 hours after the cuff deflation. The analgesic efficacy recorded on the basis of visual analog scale of two groups, wascompared using student’s t - test. p value of less than 0.05 was considered statistically significant. Results: In group A 33 males and 42 femaleswere enrolled for the study while in group B there were 38 males and 37 females. The mean age of the patients in group A was 34.31 ± 6.03years while in group B was 32.99 ± 6.08 years. Patients were also classified according to ASA classification in which 87 patients were classifiedas ASA – I and 63 patients as ASA – II. Group B which received Ketorolac in addition to Lidocaine for Bier’s block had low visual analogue scoresas compared to group A which received only Lidocaine for Bier’s block. P values obtained after the comparison of the mean VAS of two groupsat 15 minutes, 30 minutes, 1 hour, 1.5 hours and 2 hours were all less than 0.05 (0.002 for 15 minutes, 0.004 for 30 minutes, 0.001 for 1 hour,0.004 for 1.5 hours and 0.001 for 2 hours). Conclusions: Ketorolac improves the postoperative analgesia markedly when used with Lidocainein intravenous regional anaesthesia.

Minidose Bupivacaine–Fentanyl Spinal Anesthesia for Surgical Repair of Hip Fracture in the Aged

2000 ◽  
Vol 92 (1) ◽  
pp. 6-6 ◽  
Author(s):  
Bruce Ben-David ◽  
Roman Frankel ◽  
Tatianna Arzumonov ◽  
Yuri Marchevsky ◽  
Gershon Volpin
Keyword(s):  
Blood Pressure ◽  
Hip Fracture ◽  
Spinal Anesthesia ◽  
Surgical Repair ◽  
Systolic Pressure ◽  
The Elderly ◽  
Vasopressor Support ◽  
Group A ◽  
Blood Pressures ◽  
Group B

Background Spinal anesthesia for surgical repair of hip fracture in the elderly is associated with a high incidence of hypotension. The synergism between intrathecal opioids and local anesthetics may make it possible to achieve reliable spinal anesthesia with minimal hypotension using a minidose of local anesthetic. Methods Twenty patients aged &gt; or = 70 yr undergoing surgical repair of hip fracture were randomized into two groups of 10 patients each. Group A received a spinal anesthetic of bupivacaine 4 mg plus fentanyl 20 microg, and group B received 10 mg bupivacaine. Hypotension was defined as a systolic pressure of &lt; 90 mmHg or a 25% decrease in mean arterial pressure from baseline. Hypotension was treated with intravenous ephedrine boluses 5-10 mg up to a maximum 50 mg, and thereafter by phenylephrine boluses of 100-200 microg. Results All patients had satisfactory anesthesia. One of 10 patients in group A required ephedrine, a single dose of 5 mg. Nine of 10 patients in group B required vasopressor support of blood pressure. Group B patients required an average of 35 mg ephedrine, and two patients required phenylephrine. The lowest recorded systolic, diastolic, and mean blood pressures as fractions of the baseline pressures were, respectively, 81%, 84%, and 85% versus 64%, 69%, and 64% for group A versus group B. Conclusions A "minidose" of 4 mg bupivacaine in combination with 20 microg fentanyl provides spinal anesthesia for surgical repair of hip fracture in the elderly. The minidose combination caused dramatically less hypotension than 10 mg bupivacaine and nearly eliminated the need for vasopressor support of blood pressure.

scholarly journals The Impact of Unilateral or Bilateral Cataract Surgery on Visual Acuity and Life Quality of Elderly Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Lei Zuo ◽  
Haidong Zou ◽  
Xinfeng Fei ◽  
Weiqi Xu ◽  
Jianhong Zhang
Keyword(s):  
Visual Acuity ◽  
Elderly Patients ◽  
Cataract Surgery ◽  
Life Quality ◽  
Weighted Average ◽  
Bilateral Cataract ◽  
Surgical Methods ◽  
Group A ◽  
Group B ◽  
The Impact

In the current study, the CLVQOL was used to assess VRQOL before unilateral or bilateral cataract surgery and at the end of the follow-up period in order to determine the greater beneficial mode of surgery for patients, if one of the two surgical methods is more beneficial over the other. The patients were classified as receiving unilateral (group A) and bilateral cataract surgery (group B). There were no significant differences between groups A and B before the operation in terms of life quality scores, binocular weighted average LogMAR BCVA, age, educational level, gender, systematic and ocular comorbidities, and the complications of the operation. It was shown that visual acuity improved more significantly with bilateral cataract surgery than with unilateral surgery in elderly patients with a high preoperative disease burden in Shanghai city. However, the improvement in life quality was not different in patients receiving either bilateral or unilateral cataract surgery.

Chronic Proton Pump Inhibitor (PPI) Use and Risk of HIP Fracture: Results From the Nurses' Health Study

2011 ◽  
Vol 140 (5) ◽  
pp. S-134-S-135 ◽  
Author(s):  
Hamed Khalili ◽  
Edward S. Huang ◽  
Brian C. Jacobson ◽  
Carlos A. Camargo ◽  
Diane Feskanich ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Health Study

Energy-Based Devices Affect the Aesthetic Outcome of Cervical Thyroidectomy and Parathyroidectomy. A Retrospective Study

2021 ◽  
Vol 39 ◽  
Author(s):  
Antonella Pino ◽  
◽  
Lorenzo Gasco ◽  
Daqi Zhang ◽  
Paolo Carcoforo ◽  
...  
Keyword(s):  
Body Dysmorphic Disorder ◽  
The Body ◽  
University Hospital ◽  
Aesthetic Outcome ◽  
Aesthetic Result ◽  
Scar Assessment ◽  
Number Of Patients ◽  
Group A ◽  
Group B ◽  
The Impact

Introduction: Thyroid and parathyroid diseases are very common. Most of these cases are in women and may be amenable to surgery. The patient’s perception that these are not life-threatening diseases leads them to expect an excellent aesthetic result, since the surgical incision area is clearly visible. Objective: To evaluate different scarring outcomes using three different energy-based devices (Harmonic Focus®, Johnson & Johnson, New Brunswick, NJ; Thunderbeat Open Fine Jaw®, Olympus Medical, Tokyo, Japan; LigaSure Small Jaw®, Medtronic, Dublin, Ireland) and to determine the impact of post-thyroidectomy/parathyroidectomy scars on the patient’s quality of life. Methods: One hundred female patients who underwent thyroidectomy or parathyroidectomy between September 2017 and September 2019 at the Endocrine and Minimally Invasive Surgery Department of Messina University Hospital were recruited. A retrospective analysis assessed the thickness of the cervical scar via ultrasound imaging, and the patient’s degree of satisfaction through the Patient and Observer Scar Assessment Scale (POSAS) and the Body Dysmorphic Disorder Questionnaire (BDDQ). Results: The patients were divided into three groups according to the energy-device used: group A (LigaSure SJ (n=38), group B (Harmonic F, n=32) and group C (Thunderbeat OFJ, n=30). The three groups were homogeneous with respect to number of patients, age and surgical procedures. The best aesthetic result, which correlated with the lowest scar thickness, was observed in group A; these patients were more satisfied than those in the other two groups. Moreover, correlations between scar thickness and quantitative variables (such as age or BMI) were not found in any of the groups. Conclusions: Based on the data collected and our experience, the LigaSure Small Jaw® (Medtronic) seems to offer the best aesthetic outcome in patients who undergo transverse cervicotomy for thyroid and parathyroid diseases. However, further prospective studies involving a greater number of cases are needed.

scholarly journals Outcome of Post Esophageal Variceal Band Ligation with Sucralfate and Proton Pump Inhibitor vs. Proton Pump Inhibitor Alone in Cirrhotic Patients

2019 ◽  
Vol 2 (2) ◽  
pp. 209-214
Author(s):  
Binod Karki ◽  
Ramila Shrestha ◽  
Bidhan Nidhi Paudel ◽  
Sudhamshu KC ◽  
Dibas Khadka ◽  
...  
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Primary Prophylaxis ◽  
Upper Gastrointestinal Endoscopy ◽  
Ulcer Formation ◽  
Open Label ◽  
Esophageal Variceal ◽  
Band Ligation ◽  
Mean Size ◽  
Group B

Introduction: Endoscopic band ligation is the mainstay of treatment in bleeding varices in cirrhosis.  Subsequent bleeding from the band ulcers is a possible complication. Proton pump inhibitors and Sucralfate are commonly used post band ligation and often in combination. The aim of the study was to identify the advantage of combining Sucralfate to proton pump inhibitor in reducing the number and size of band ulcers.Materials and Methods: This was an open-label comparative study conducted in a tertiary level hospital of Nepal. Patients with cirrhosis after band ligation were included. Eligible patients were randomized into a proton pump inhibitor alone (Group A) or proton pump inhibitor and sucralfate group (Group B) and they underwent upper gastrointestinal endoscopy after two weeks. Baseline parameters, number and mean size of band ulcers were compared.Results: A total of 58 patients, 29 in each group, were evaluated. The baseline characteristics were comparable. EBL was done for bleeding varices in 51.7% and as primary prophylaxis in the rest of them. All the patients had band ulcers after two weeks. The mean size of the largest ulcer was 1.62±0.72 and 1.10±0.60 (p=0.78) respectively in groups A and B. Low albumin was significantly associated with OR of 8.7 (95% CI:1.68-44.99) for the formation of multiple (more than two) ulcers (p=0.01).Conclusions: The ulcer formation was universal after band application. The addition of sucralfate did not offer more benefits in terms of the number and mean size of the ulcer. Low albumin was the independent predictor for multiple ulcer formation.

scholarly journals A comparative study between dexmedetomidine and dexamethasone as an intrathecal adjuvant for prevention of perioperative shivering in cesarean section

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Mohamed Abdul Mohsen Abdul Naiem Ismaiel ◽  
Omar Mohamed Taha El Safty ◽  
Ashraf El Sayed El-Agamy ◽  
Omar Mohamed Zafer Mohamed ◽  
Mohamed Mourad Mohsen Mohamed Ali
Keyword(s):  
Cesarean Section ◽  
Statistical Difference ◽  
Sensory Block ◽  
List Type ◽  
Hyperbaric Bupivacaine ◽  
Analgesic Requirement ◽  
Number Of Patients ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract Background One of the most common problems in parturients receiving regional anesthesia during cesarean section is shivering. It usually interferes with the readings of the oxygen plethysmography (SpO2) and electrocardiogram (ECG). It expands the needs for oxygen and increases creation of carbon dioxide about four folds. The aim of this work is to compare the efficacy of dexamethasone and dexmedetomidine in prevention of perioperative shivering when added to hyperbaric bupivacaine intrathecally in cesarean sections (CS) and their effect on the intraoperative hemodynamics, intensity of the block, sedation, and postoperative analgesic requirement. Results Study included 60 obstetric patients who fulfilled all the inclusion criteria and were randomized into 2 equal groups, each consisting of 30 patients, namely group A (dexmedetomidine group) and B (dexamethasone group). Group A patients received 5 μg dexmedetomidine with 12.5 mg hyperbaric bupivacaine 0.5% intrathecally. Group B patients received 8 mg dexamethasone then 12.5 mg hyperbaric bupivacaine 0.5% intrathecally. The comparison included assessment of intra- and postoperative hemodynamics, duration of surgery, assessment of sensory and motor block, assessment for shivering and sedation, and assessment of adverse events. This study showed that there were a small number of patients complaining of shivering (five patients in group A and seven patients in group B) with no statistical difference between both groups in the incidence and intensity of shivering. Time to two segment regression (minutes) was longer in group B compared to group A, and also, time to first analgesic rescue was longer in group B compared to group A. For sedation intensity, there was statistical difference between both groups as all patients in group A were sedated compared to six patients only in group B. There was no statistical difference between both groups as regards incidence of adverse effects. Conclusion We concluded that both drugs can be added safely to bupivacaine, and both dexmedetomidine and dexamethasone decreased the incidence and the intensity of shivering. Dexamethasone was found to prolong the duration of sensory block and delay opioid requirements post-operatively, while dexmedetomidine is more effective in sedating the patients intra- and postoperatively.

Effect of selective beta-blockade with bisoprolol in the treatment of recent-onset atrial fibrillation

Folia Medica ◽  
2012 ◽  
Vol 54 (2) ◽  
pp. 27-31 ◽  
Author(s):  
Maria N. Negreva ◽  
Atanas P. Penev
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Combined Therapy ◽  
Beta Blockade ◽  
Recent Onset ◽  
Number Of Patients ◽  
Group A ◽  
Clinically Significant ◽  
Group B ◽  
Onset Atrial Fibrillation

ABSTRACT The incidence of atrial fibrillation has been rapidly increasing in recent years. The increased tonus of the sympathetic nervous system is related to the development of atrial fibrillation. OBJECTIVE: To study the effect of bisoprolol, a highly selective beta-blocker, on patients with recent-onset atrial fibrillation (< 48 hours) for regularization of the rhythm using propafenone. PATIENTS AND METHODS: The study includes 164 patients (81 women, 83 men, age 59.09 ± 10.81) with successfully restored sinus rhythm in recent-onset atrial fibrillation. The patients received either propafenone (group A, n = 82) or a combination of propafenone and bisoprolol (group B, n = 82). The studied patients were randomly allocated to the groups. Propafenone was administered intravenously as a 2 mg/kg bolus followed by infusion of 0.0078 mg/kg/min for 120 min and orally in dosage of 300 mg three times every 8 hours if arrhythmia persisted. Bisoprolol was administered in a single dose at the very beginning of propafenone treatment and only in patients from group B at a dose of 5 or 10 mg. Regularization of the rhythm was assessed at the 3rd, 6th, 12th and 24th hour. RESULTS: In the initial stages of regularization the combined therapy restored the sinus rhythm in a greater number of patients in comparison with the monotherapy (at the 6th hour 67.07% in group B versus 48.78% in group A, P < 0.05; at the 12th hour it was 87.80% versus 75.60%, respectively, P < 0.05). CONCLUSION: Early regularization of rhythm in patients with recent-onset atrial fibrillation reduces the likelihood of recurrent episodes of arrhythmia. This makes the application of selective beta-blockade clinically significant.

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