Evaluation of a Pharmacy-Driven Calcitonin Protocol for Treating Hypercalcemia in Hospitalized Patients: A Multisite Study

2021 ◽  
pp. 089719002110131
Author(s):  
Francheska Marte ◽  
Michael Sanchez ◽  
Scott Neel ◽  
Jay Pauly ◽  
James Valentine
Keyword(s):  
Partial Response ◽  
Primary Outcome ◽  
Complete Response ◽  
Hospitalized Patients ◽  
Treatment Modalities ◽  
Protocol Group ◽  
Before And After ◽  
Group A ◽  
Secondary Outcomes ◽  
Time To Relapse

Background: The dramatic increase in the acquisition cost of injectable calcitonin led to creating a pharmacy-driven calcitonin protocol to improve the appropriate use of calcitonin and other treatment modalities for hypercalcemia. Objective: This study aimed to characterize the use of calcitonin before and after implementation of a pharmacy-driven calcitonin protocol. Methods: This was a multi-center, retrospective study of the use of injectable calcitonin in adult hospitalized patients with hypercalcemia. The study included patients treated with calcitonin from October 2014 to September 2016 and from October 2017 to September 2019. The primary outcomes were percentage of patients with a complete response, partial response, and non-responders. The secondary outcomes were time to relapse, duration of partial response, number of doses, and associated costs of calcitonin. Results: Of the 131 patients included in this study, 93 were included in a pre-protocol group and 38 were included in a post-protocol group. The primary outcome of complete response by 3 days was met in 28% of patients in the pre-protocol group and 53% of patients in the post-protocol group ( P = 0.007). Calcitonin spending in dollars in the pre-protocol group was $818,956 compared to $224,320 in the post-protocol group; a difference of $594,636. Conclusion: Implementation of a pharmacy-driven calcitonin protocol effectively improved calcium levels, reduced inappropriate calcitonin use, and reduced calcitonin spending during a period of 2 fiscal years.

COMPARATIVE STUDY IN BETWEEN INTRALESIONAL VITAMIN D3 AND INTRALESIONAL BLEOMYCIN IN THE TREATMENT OF CUTANEOUS VERRUCAE

2020 ◽  
Vol 4 (8) ◽  
Author(s):  
Shrikant . ◽  
R.D. Mehta ◽  
B.C. Ghiya
Keyword(s):  
Partial Response ◽  
Comparative Study ◽  
Recurrence Rate ◽  
Vitamin D3 ◽  
Complete Response ◽  
Recurrence Rates ◽  
Additional Advantage ◽  
Cost Effective Treatment ◽  
Group A ◽  
Group B

Background: Verruca is one of the common dermatopathologies which has multiple therapeutic options but with variable success rates, refractory cases and high recurrence rates. Nowadays, treatment with intralesional injections has gained recognition due to its effectiveness in clearing verrucae. These act by stimulating the cell-mediated immunity. Out of scores of options available for intralesional therapeutics, Vitamin D3 appears to be more promising but least evaluated. Therefore, we planned to evaluate the efficacy of intralesional Vitamin D3 in various types of cutaneous verrucae. Simultaneously the results were compared with intralesional bleomycin, also. Methods: A total of 200 patients of cutaneous verrucae with varying size and duration were included in the experimental randomized comparative study. We divided them into two groups. Group A, comprising of 100 patients, received 0.2-0.5 ml intralesional Vitamin D3 (600,000 IU, 15mg/ml) and Group B, also of hundred subjects, received intralesional Bleomycin (1 mg/ml) into the base of verrucae. A maximum of 5 verrucae were injected per session at 3 weeks interval until resolution or for a maximum of 4 sessions. Patients were followed up for 6 months after the last injection to assess the clearance status and detect any recurrence. Results: In Group A (Vitamin D3), 'Complete response', 'Partial response' and 'No response' were observed in 85.07%, 6.74% and 8.17% respectively after 4 sessions. Recurrence rate was 0.81% after 6 months. In Group B (Bleomycin), 'Complete response', 'Partial response' and 'No response' were found in 77.99%, 10.47% and 11.53% in the series. Recurrence rate was 1.71%, comparatively higher in group B. Conclusion: The efficacy of intralesional Vitamin D3 was found significantly higher as compared to intralesional Bleomycin in the treatment of cutaneous verrucae with less recurrence rates. Vitamin D3 has an additional advantage of cost-effective treatment over Bleomycin. We purpose its use, as a primary mode of treatment in various types of cutaneous verrucae. Keywords: Bleomycin, Vitamin D3, Verrucae.

scholarly journals Does sensory relearning improve tactile function after carpal tunnel decompression? A pragmatic, assessor-blinded, randomized clinical trial

2016 ◽  
Vol 41 (9) ◽  
pp. 948-956 ◽  
Author(s):  
C. Jerosch-Herold ◽  
J. Houghton ◽  
L. Miller ◽  
L. Shepstone
Keyword(s):  
Carpal Tunnel ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Hand Function ◽  
Group Differences ◽  
Level Of Evidence ◽  
Significant Treatment ◽  
Significant Group ◽  
Group A ◽  
Secondary Outcomes

Despite surgery for carpal tunnel syndrome being effective in 80%–90% of cases, chronic numbness and hand disability can occur. The aim of this study was to investigate whether sensory relearning improves tactile discrimination and hand function after decompression. In a multi-centre, pragmatic, randomized, controlled trial, 104 patients were randomized to a sensory relearning ( n = 52) or control ( n = 52) group. A total of 93 patients completed a 12-week follow-up. Primary outcome was the shape-texture identification test at 6 weeks. Secondary outcomes were touch threshold, touch localization, dexterity and self-reported hand function. No significant group differences were seen for the primary outcome (Shape-Texture Identification) at 6 weeks or 12 weeks. Similarly, no significant group differences were observed on secondary outcomes, with the exception of self-reported hand function. A secondary complier-averaged-causal-effects analysis showed no statistically significant treatment effect on the primary outcome. Sensory relearning for tactile sensory and functional deficits after carpal tunnel decompression is not effective. Level of Evidence: II

scholarly journals A comparative study to evaluate the effects of intranasal steroid spray, isotonic saline nasal irrigation and combination therapy in patients with allergic rhinitis

2021 ◽  
Vol 7 (6) ◽  
pp. 1004
Author(s):  
Smitha Soubhagya Gangaraju ◽  
Nikitha Pillai ◽  
Vijaylaxmi Manthal
Keyword(s):  
Allergic Rhinitis ◽  
Combination Therapy ◽  
Isotonic Saline ◽  
Treatment Modalities ◽  
Nasal Irrigation ◽  
Intranasal Corticosteroids ◽  
Nasal Symptoms ◽  
Before And After ◽  
Group A ◽  
Group B

<p class="abstract"><strong>Background:</strong> Allergic rhinitis (AR) is characterized by inflammatory changes in the nasal mucosa caused by exposure to inhaled allergens. AR clinically having 2 or more symptoms of anterior or posterior rhinorrhea, sneezing, nasal blockage or itching of the nose during two or more consecutive days for more than 1 hour on most days which are caused by allergen exposure leading to an IgE mediated reaction. Nasal steroids and antihistamines are considered as gold standard treatment of choice in moderate to severe AR. This study was taken to evaluate the efficacy of intranasal steroid spray, isotonic saline nasal irrigation, combination therapy and to compare all 3 treatment modalities.</p><p class="abstract"><strong>Methods:</strong> 75 patients of AR who met inclusion criteria were sequentially divided into 3 groups. Group A was intranasal steroid spray, group B was isotonic saline nasal irrigation, group C was combination of both intranasal steroid spray and saline nasal irrigation. Total nasal symptoms score was compared before and after 1 month of treatment.</p><p class="abstract"><strong>Results:</strong> Mean total nasal symptoms score before treatment in groups A, B and C was found to be 13.72, 12.96 and 13.68 respectively and after 1 month of treatment total nasal symptoms score was seen 8.28, 8.76 and 3.72 respectively.</p><p class="abstract"><strong>Conclusions:</strong> The combined use of saline nasal irrigation along with intranasal corticosteroids is found to be more effective in reducing the symptoms of patients with allergic rhinitis when compared to individual therapies.</p>

scholarly journals Comparison of the efficacy of 3-weekly chop with CHOEP for treatment of patients with aggressive non-Hodgkin’s lymphoma.

2020 ◽  
Vol 27 (03) ◽  
pp. 631-634
Author(s):  
Tahir Mehmood ◽  
Muhammad Khalid ◽  
Nasir Mehmood ◽  
Shahbaz Ahmed ◽  
Saeed Ahmed ◽  
...  
Keyword(s):  
Partial Response ◽  
Hodgkin’S Lymphoma ◽  
Complete Response ◽  
Hodgkin's Lymphoma ◽  
Female Patients ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
Group A ◽  
Group B

Objectives: To compare the efficacy of 3-weekly CHOP with CHOEP for the treatment of patients with aggressive Non-Hodgkin’s Lymphoma. Study Design: Randomized control trial. Setting: Department of Medical Oncology, Jinnah Hospital Lahore. Period: From January 2016 to June 2016. Material & Methods: Conducted on 200 patients of biopsy confirmed aggressive non-Hodgkin’s lymphoma. The cases were allocated into two groups by using random numbers table i.e. group A & B having 100 patients each. Group A received CHOP-21 regimen which is defined as cyclophosphamide (750mg/m2 intravenously), doxorubicin (50mg/m2 intravenously), vincristine (2mg i/v) & prednisone (100mg/m2 d1-5 PO). Group B received CHOEP-21 regimen which is defined same as CHOP-21 but with the addition of etoposide 100mg/m2 intravenously for day 1-3. Observation regarding efficacy was including all the number of cases in which complete remission of disease was noted one month after completion of chemotherapy. Results: The mean age of the patients in group A was 44.6±13.9 years and in group B was 45.6±11.5 years. In group A, 74 (74%) male and 26 (26%) female patients and in group B, 72 (72%) male and 28 (28%) female patients. In the distribution of patients by complete response after 6 cycles, in group A, 66 (66%) patients had complete response, 30 (30%) patients had partial response, 1 (1%) patient expired, 2 (2%) patients had progressive disease (shifted to salvage therapy) and 1 (1%) patient lost the follow up. In group B, 80 (80%) patients had complete response, 16 (16%) patients had partial response, 2 (2%) patients expired, and 2 (2%) patients lost the follow up. Conclusion: It is concluded from this study that viability was accomplished in a greater number of patients treated with CHOEP-21 than those treated with CHOP-21 in the management of patients with aggressive Non hodgkin's lymphoma.

scholarly journals A prospective study to compare the efficacy of noradrenaline verses terlipressin in hepatorenal syndrome in patients with advanced cirrhosis

2021 ◽  
Author(s):  
Srishti Nayyar ◽  
Ranjeet Kaur ◽  
Gurinder Mohan ◽  
Manish Chandey
Keyword(s):  
Partial Response ◽  
Serum Creatinine ◽  
Hepatorenal Syndrome ◽  
Complete Response ◽  
Advanced Cirrhosis ◽  
Days Of Therapy ◽  
Daily Urine ◽  
Group A ◽  
Group B ◽  
A Prospective Study

Background: Hepatorenal syndrome (HRS) is functional renal failure occurring in advanced stage liver disease associated with poor prognosis. The best treatment is liver transplantation. Terlipressin is effective in treatment of HRS but noradrenaline has been suggested as cheaper and readily available alternative and we aimed to compare the efficacy of noradrenaline and terlipressin in patients with HRS.Methods: 30 patients were allocated to each group and group A received infusion of noradrenaline at dose of 0.5 mg/hr (maximum 3 mg/hr) and group B received terlipressin at dose 1 mg intravenously 6 hourly until reversal of HRS or completion of 7 days of therapy. Intravenous albumin (20 g/day) was given to both groups. Decrease in serum creatinine and increase in daily urine output and mean arterial pressure (MAP) helped us in comparison.Results: Out of 60 cirrhotics screened, 51 were randomised into group A (N=22) or group B (N=29). Baseline characteristics of both groups were similar. In group A, 0% showed complete response while 31.8% showed partial response but majority (68.2%) showed no response. In group B, 89.7% showed complete response and 6.9% showed partial response. Decrease in serum creatinine in both groups (group A- 3.91±1.58 mg/dl to 3.07±1.68 mg/dl; group B- 3.21±1.24 mg/dl to 1.36±0.87 mg/dl). Both groups showed an increase in MAP (group A- 76.93±6.18 mmHg to 89.49±6.93 mmHg; group B- 75.54±5.51 mmHg to 89.92±5.07 mmHg).Conclusions: Noradrenaline was not as effective as terlipressin in treatment of HRS.

Standardizing Second-Trimester Medical Termination: Effects on Clinical Outcomes

2018 ◽  
Vol 35 (08) ◽  
pp. 791-795
Author(s):  
Michelle Wyatt ◽  
Mary Tolcher
Keyword(s):  
Primary Outcome ◽  
Termination Of Pregnancy ◽  
Second Trimester ◽  
Medical Termination Of Pregnancy ◽  
Dilation And Curettage ◽  
Medical Termination ◽  
Significant Difference ◽  
Before And After ◽  
Baseline Characteristics ◽  
Secondary Outcomes

Objective The objective of this study was to evaluate length of induction and postdelivery complications before and after implementation of a standardized approach to second-trimester medical termination of pregnancy. Study Design This was a retrospective cohort study of all women undergoing medical termination of pregnancy between 130/7 and 266/7 weeks of gestation at a single, academic institution from July 1, 2012, through June 30, 2015. The primary outcome was the time from the start of induction of labor to delivery of the fetus. Postdelivery complications including the need for dilation and curettage (D&C), blood transfusion, and readmission to the hospital were secondary outcomes of interest. Results A total of 62 women met inclusion criteria; 38 before and 24 after the intervention. There were no differences in measured baseline characteristics (p > 0.05). There was a significant decrease in induction time after the intervention (12.3 compared with 8.6 hours, p = 0.031). There was no significant difference in rates of D&C or other measured complications (p > 0.05). Conclusion Implementation of a standardized clinical guideline for second-trimester medical termination was associated with a decrease in length of induction. There was no significant difference in need for D&C or postdelivery complications; however, we were underpowered for these secondary outcomes.

Evaluation of the reliability of MRSA screens in patients undergoing universal decolonization

2020 ◽  
Vol 77 (23) ◽  
pp. 1965-1972
Author(s):  
Amna Chaudhry ◽  
Bryan Allen ◽  
Meagan Paylor ◽  
Sarah Hayes
Keyword(s):  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Primary Outcome ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Pulmonary Infections ◽  
Before And After ◽  
Intranasal Mupirocin ◽  
Mrsa Infection ◽  
Secondary Outcomes ◽  
The Difference

Abstract Purpose Colonization of methicillin-resistant Staphylococcus aureus (MRSA) can be detected via nasal screens. Evidence indicates that negative MRSA nasal screens may be used to de-escalate anti-MRSA antibiotics in pulmonary infections. In the ICU, universal decolonization with intranasal mupirocin is implemented to reduce MRSA infection risk. This study aimed to determine whether mupirocin administration affects the reliability of MRSA PCR nasal screens. Methods This retrospective study divided subjects based on timing of intranasal mupirocin administration—before and after MRSA screen. Subjects with confirmed pulmonary infection that received vancomycin, blood/respiratory cultures, and had MRSA PCR screen collected were included. Subjects with concurrent infection requiring vancomycin or MRSA infection in prior 30 days were excluded. Primary outcome of this non-inferiority study was the negative predictive value (NPV) of the screen. Secondary outcomes included the positive predictive value (PPV), sensitivity, and specificity of the screen and duration of vancomycin. Results Ultimately, 125 subjects were included in each group. The NPV in the group receiving mupirocin before screen was 95.2%, whereas the NPV in the group receiving mupirocin after screen was 99%. The difference between groups was -3.8% (90% CI -7.8%-0.2%; p=0.31), which failed to meet non-inferiority criteria. The secondary outcomes of PPV, sensitivity and specificity of the screen were similar in both groups. The duration of vancomycin was significantly longer in subjects receiving mupirocin before screen (3 days vs. 2 days; p&lt;0.05). Conclusion Intranasal mupirocin prior to the screen may reduce NPV in pulmonary infections. Approach de-escalation of vancomycin based on screen results with caution.

scholarly journals Evaluation the success rate of extra corporal shock wave lithotripsy (ESWL) in patients with urinary stones

2018 ◽  
Vol 5 (5) ◽  
pp. 1192
Author(s):  
Ali Hoseinkhani ◽  
Firouz Amani ◽  
Hadi Hadi seddigh-namini
Keyword(s):  
Shock Wave ◽  
Partial Response ◽  
Success Rate ◽  
Shock Wave Lithotripsy ◽  
Renal Stones ◽  
Complete Response ◽  
Urinary Stones ◽  
Cross Sectional ◽  
Extracorporeal Shock Wave ◽  
Before And After

Background: Urinary stones are one of the most common and earliest known human diseases. Extracorporeal shock wave lithotripsy (ESWL) is known as the most common method for treating urinary stones less than 20-25 mm. The aim of this study was to evaluation the success rate of ESWL in patients with urinary stones.Methods: In this cross-sectional descriptive study 200 patients with urinary stones between 7-25 mm which were candidates for lithotripsy, enrolled in the study. Patients with coagulation disorders, urinary or other organ transplantation, pregnant women, uncontrolled blood pressure patients, and those who are contraindicated for drug use have been excluded from the study. The process was carried out by an operator and by the Dornier Compact Delta II lithotriptor. Two weeks later, the patients were re-visited, and ultrasound was performed, and the success rate of stones was measured and recorded and classified in three groups complete response, partial response and failure in treatment. Collected data analysed by statistical methods in SPSS version 19.Results: Efficacy of Arian 101 lithotriptor in removing of renal stones, were found to be 74% complete response, 25.5% partial response while 0.5% of subjects had no response. There was significant positive correlation between the size of stones before and after lithotripsy (r=0.49, p=0.001). In stones upper than 10 mm, the upper calices stones had 100% complete response. Also, in stones lower than 10 mm, the upper calices stones had 100% complete response.Conclusions: The results showed that Dornier Compact Delta II lithotriptor has more efficacy in treatment of stones. In stones below 10 mm, the success rate of treatment was generally higher, especially in the upper calices stones and pelvic. In stones larger than 10 mm, the success rate was slightly lower, but in the case of upper calices stones, the complete response was 100%.

scholarly journals The effectiveness of targeted therapy in the treatment of common forms of ovarian cancer

2018 ◽  
Vol 20 (4) ◽  
pp. 16-19
Author(s):  
V V Saevets ◽  
A V Vazhenin ◽  
L F Chernova ◽  
I G Shimotkina ◽  
O V Kurchenkova ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Partial Response ◽  
Statistical Processing ◽  
Complete Response ◽  
Control Group ◽  
Standard Drug ◽  
Surgical Interventions ◽  
Group A ◽  
Group Control Group

Purpose of the study. To evaluate the effectiveness of the targeted drug bevacizumab (Avegra®) in the complex treatment of patients with common forms of ovarian cancer after suboptimal cytoreductive surgical interventions. Materials and methods. For the period from January 2017 to November 2018. A clinical study included and treated 71 patients with a diagnosis of ovarian cancer, stage IIIC-IV disease. The prevalence of the tumor process was estimated according to the classification of FIGO and TNM (2009). Patients were randomized into two groups. The first group included 31 patients, the treatment was carried out according to the scheme: paclitaxel 175 mg/m2, carboplatin AUC 6, bevacizumab 15 mg/kg with an interval of 21 days. The second group (control group) included 40 patients who received standard drug therapy. Interval suboptimal cytoreductive surgery was performed in all patients - hysterectomy with appendages, epiploic resection, peritonectomy. Evaluation of the effectiveness of immediate and remote The results were carried out by the method of statistical processing using the program Statistic 6.0. Results. According to the criteria of RESIST 1.1 in the first group, a complete response was registered in 25.8%, a partial response in 51.6%, stabilization of the disease in 12.9%, progression of 9.6% of cases. In the second group, the complete response was in 20% of cases, a partial response was 45%, stabilization was 22.5%, progression was 12.5%. The median overall survival in the first group was 16.5 months аgainst 10.1 months in the second group.

scholarly journals Comparative Efficacy of 50% Trichloroacetic Acid Solution with 10% Potassium Hydroxide Solution in the Treatment of Plane Warts

2019 ◽  
pp. 1-10
Author(s):  
Reza Yaghoobi ◽  
Nader Pazyar ◽  
Bahareh Maleki
Keyword(s):  
Trichloroacetic Acid ◽  
Potassium Hydroxide ◽  
Potassium Hydroxide Solution ◽  
Complete Response ◽  
Treatment Modalities ◽  
Trichloroacetic Acid Solution ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Moderate Response

Background: Warts are very common disorders. Plane warts are caused by Human Papilloma Virus (HPV) occurring mostly in children and young adults. Among the treatment modalities, topical application of trichloroacetic acid (TCA) is age old. Potassium hydroxide (KOH) has a keratolytic effect on virus-infected cells. Aims: To compare the safety and efficacy of topical 10% KOH solution with 50% TCA solution in the treatment of plane warts. Materials and Methods: Sixty-four consecutive patients with plane warts were randomly assigned into two groups of thirty-two patients. Group A received 10% KOH solution and group B received 50% TCA solution once weekly until the complete clearance of warts in a maximum period of 12 weeks. Results: In group under treatment with 10% KOH, 24 patients (75.0%) complete response, 5 patients (15.6%) moderate response, 2 patients (6.3%) mild response, and 1 patient (3.1%) had no response. In group under treatment with 50% TCA, 28 patients (87.5%) showed complete response, 2 patients (6.3%) moderate response, 2 patients (6.3%) mild response. Statistically no significant difference was found between the therapeutic response to 10% KOH and 50% TCA (P=0.41). Conclusion: 10% KOH was found to be equally effective in the treatment of plane warts compared to 50% TCA with the advantage of fewer side effects.

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