Efficacy and Safety of Appetite-Stimulating Medications in the Inpatient Setting

2018 ◽  
Vol 53 (3) ◽  
pp. 261-267 ◽  
Author(s):  
Meredith L. Howard ◽  
Roya Hossaini ◽  
Catherine Tolar ◽  
Marian L. Gaviola
Keyword(s):  
Adverse Effects ◽  
Primary Outcome ◽  
Outpatient Setting ◽  
Hospitalized Patients ◽  
Inpatient Setting ◽  
Limited Information ◽  
Inclusion Criteria ◽  
Meal Intake ◽  
Significant Difference ◽  
Loss Of Appetite

Background: Hospitalized patients are subject to acute illness and stress which may impact appetite or weight. Loss of appetite may lead to increased morbidity or mortality. Medications such as dronabinol, megestrol, and mirtazapine are used for weight gain in the outpatient setting; however, there is limited information about safety or effectiveness when initiated inpatient. Objectives: To analyze the effectiveness and safety of appetite-stimulating medications in hospitalized patients. Methods: This was a retrospective cohort study of hospitalized patients initiated on dronabinol, megestrol, or mirtazapine for appetite. The primary outcome was change in meal intake between drug initiation and discontinuation. Secondary outcomes included documented improvement in appetite, change in weight and various laboratory parameters, and incidence of adverse effects. Results: A total of 38 patients met inclusion criteria, and mirtazapine was most commonly used (42%). There was no significant difference between groups of appetite-stimulating medications with regard to mean change in meal intake, weight, albumin, or documented improvement in diet. Within groups, each agent showed numerical improvement in percentage meal intake, with a mean change from initiation to discontinuation of 17.12%. Almost half (48%) of the patients experienced improvement in diet after the start of medications. No serious adverse effects were observed. Conclusion and Relevance: In inpatients, there was no difference in change in meal intake or weight between dronabinol, megestrol, or mirtazapine, but they may show numerical improvements in meal intake. To our knowledge, this is the first study to evaluate the use of dronabinol, megestrol, and mirtazapine initiated in the inpatient setting.

scholarly journals Hydroxychloroquine in the treatment of outpatients with mildly symptomatic COVID-19: A multi-center observational study

2020 ◽  
Author(s):  
Andrew Ip ◽  
Jaeil Ahn ◽  
Yizhao Zhou ◽  
Andre H Goy ◽  
Eric Hansen ◽  
...  
Keyword(s):  
Observational Study ◽  
Primary Outcome ◽  
Outpatient Setting ◽  
Hospitalized Patients ◽  
Sensitivity Analyses ◽  
Multivariable Logistic Regression Analysis ◽  
Propensity Matching ◽  
Effective Prophylaxis ◽  
Progression Of Disease

Background: Hydroxychloroquine has not been associated with improved survival among hospitalized COVID-19 patients in the majority of observational studies and similarly was not identified as an effective prophylaxis following exposure in a prospective randomized trial. We aimed to explore the role of hydroxychloroquine therapy in mildly symptomatic patients diagnosed in the outpatient setting. Methods: We examined the association between outpatient hydroxychloroquine exposure and the subsequent progression of disease among mildly symptomatic non-hospitalized patients with documented SARS-CoV-2 infection. The primary outcome assessed was requirement of hospitalization. Data was obtained from a retrospective review of electronic health records within a New Jersey USA multi-hospital network. We compared outcomes in patients who received hydroxychloroquine with those who did not applying a multivariable logistic model with propensity matching. Results: Among 1274 outpatients with documented SARS-CoV-2 infection 7.6% were prescribed hydroxychloroquine. In a 1067 patient propensity matched cohort, 21.6% with outpatient exposure to hydroxychloroquine were hospitalized, and 31.4% without exposure were hospitalized. In the primary multivariable logistic regression analysis with propensity matching there was an association between exposure to hydroxychloroquine and a decreased rate of hospitalization from COVID-19 (OR 0.53; 95% CI, 0.29, 0.95). Sensitivity analyses revealed similar associations. QTc prolongation events occurred in 2% of patients prescribed hydroxychloroquine with no reported arrhythmia events among those with data available. Conclusions: In this retrospective observational study of SARS-CoV-2 infected non-hospitalized patients hydroxychloroquine exposure was associated with a decreased rate of subsequent hospitalization. Additional exploration of hydroxychloroquine in this mildly symptomatic outpatient population is warranted.

The Effect of β-Blockers for Burn Patients on Clinical Outcomes: Systematic Review and Meta-Analysis

2020 ◽  
pp. 088506662094018
Author(s):  
Nasreen Hassoun-Kheir ◽  
Oryan Henig ◽  
Tomer Avni ◽  
Leonard Leibovici ◽  
Mical Paul
Keyword(s):  
Systematic Review ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Hospitalized Patients ◽  
Sufficient Evidence ◽  
Selective Reporting ◽  
Significant Difference ◽  
Β Blocker ◽  
Β Blockers

Objectives: To assess the effects and safety of β-blockers in hospitalized patients with burns. Methods: A systematic review and meta-analysis of the literature. A broad search was conducted to identify all randomized controlled trials (RCTs) comparing β-blockers to control in hospitalized patients with burns. The primary outcome was 3-month all-cause mortality. Secondary outcomes were clinical patient-relevant end points. We subgrouped results by children/adults and burn severity. Risk of bias was assessed using the individual domain approach. Results: Four RCTs reported in 11 publications were included. Primary outcome of mortality was assessed in children (2 trials, n = 424) and adults (2 trials, n = 148) with severe burns. No significant difference was found between propranolol and control for mortality (risk ratio [RR] = 0.82, 95% CI = 0.48-1.39, 4 trials with broad confidence intervals in adults and children), sepsis (RR = 0.81, 95% CI = 0.46-1.43, 2 trials), and survivors’ length of stay (absolute mean difference = 2.53, 95% CI = −2.58–7.63, 3 trials). There was no significant difference in bradycardia (RR = 1.33, 95% CI = 0.77-2.3, 2 trials), hypotension (RR = 1.26, 95% CI = 0.73-2.17, 3 trials), or cardiac arrhythmia (RR: 2.97, 95% CI: 0.12-71.87, 1 trial). The evidence was graded as very low certainty, due to trial’s internal risk of bias, imprecision, and possible selective reporting. Conclusions: No sufficient evidence was found to support or refute an advantage for β-blocker use in children or adults after burns. Additional studies are needed to create a consensus and formulate practice guidelines on the optimal β-blocker to use, indications for initiation, and duration of treatment.

Morphine or hydromorphone: which should be preferred? A systematic review

2021 ◽  
pp. archdischild-2020-319059
Author(s):  
Sarah Spénard ◽  
Charles Gélinas ◽  
Evelyne D. Trottier ◽  
Fannie Tremblay-Racine ◽  
Niina Kleiber
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
Intravenous Administration ◽  
Primary Outcome ◽  
Similar Rate ◽  
Pharmacokinetic Data ◽  
Epidural Administration ◽  
Inclusion Criteria ◽  
Routes Of Administration ◽  
Wide Range

AbstractObjectiveTo systematically review available paediatric literature on comparisons between morphine (Mo) and hydromorphone (Hm), to guide clinicians to rationally use these medications.DesignSystematic review within four databases for all studies published from 1963 to July 2019.SettingAll paediatric settings.EligibilityAll studies comparing Mo to Hm in individuals younger than 21 years.Main outcome measuresThe primary outcome was to compare clinical efficacy and side effects of Mo and Hm. The secondary outcomes were the comparison of pharmacokinetic profiles and the description of predefined Mo to Hm conversion ratios used across the paediatric literature.ResultsAmong 754 abstracts reviewed, 59 full-text articles met inclusion criteria and 24 studies were included in the analysis: 4 studies compared pharmacodynamics of Mo and Hm and 20 studies reported the use of a predefined Mo to Hm conversion ratio. Most studies had a poor methodological quality. Available evidence suggests that, when given intravenously, the equianalgesic ratio of Mo to Hm is 5:1. Intravenous administration with this ratio results in a similar rate of adverse effects, including pruritus and nausea. The epidural administration with a ratio of 10:1 results in more pruritus and urinary retention with Mo than Hm. Pharmacokinetic data were reported in only one study. A wide range of pre-established ratios for different routes of administration were reported, but few were based on evidence.ConclusionCurrent literature does not permit a rational choice between Mo and Hm. A ratio of 5:1 seems adequate for intravenous administration and leads to a similar rate of adverse effects.

Assessment of Apixaban Prescribing Patterns for Nonvalvular Atrial Fibrillation in Hospitalized Patients

2017 ◽  
Vol 52 (1) ◽  
pp. 54-59 ◽  
Author(s):  
Caitlin M. Gibson ◽  
Carmen B. Smith ◽  
Sondra Davis ◽  
Michael J. Scalese
Keyword(s):  
Atrial Fibrillation ◽  
Primary Outcome ◽  
Bleeding Risk ◽  
Hospitalized Patients ◽  
Prescribing Patterns ◽  
Inclusion Criteria ◽  
History Of Or ◽  
Nonvalvular Atrial Fibrillation ◽  
Off Label ◽  
History Of

Background: Apixaban is a direct oral anticoagulant (DOAC) for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF). Other DOACs require renal dose adjustments based solely on creatinine clearance. Apixaban differs in that its dose adjustments are more complex, potentially leading to prescribing errors. Objective: To determine if adherence to Food and Drug Administration (FDA)-approved dosing for apixaban is maintained in hospitalized patients with NVAF. Methods: Patients ≥18 years old with NVAF who received apixaban during admission to 1 of 3 hospitals were evaluated. The primary outcome was to determine if providers order apixaban in accordance with FDA-approved dosages. Secondary outcomes included determining if pharmacist review increased the number of orders in accordance with FDA-approved dosing, which of the 3 criteria (age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL) were met in patients receiving off-label dosing, and the rationale for off-label prescribing. Results: A total of 556 patients met inclusion criteria. Apixaban was dosed according to FDA labeling by providers in 83.4% (n = 464) of orders. After pharmacist review, 87.0% (n = 484) of orders were at the approved dose, 12.2% (n = 68) were underdosed, and 0.7% (n = 4) were overdosed. Most patients who were underdosed met only 1 dose reduction criterion—most commonly age ≥80 years (56.0%). Reasons for off-label dosing included home dose continuation (39.0%), history of or perceived bleeding risk (30.5%), or unspecified/other (30.5%). Conclusions: The majority of apixaban orders for NVAF were based on FDA-approved dosages after provider entry and pharmacist review.

scholarly journals Effect of bromhexine in hospitalized patients with COVID-19

2021 ◽  
pp. jim-2020-001747
Author(s):  
Ramin Tolouian ◽  
Zuber D Mulla ◽  
Hamidreza Jamaati ◽  
Abdolreza Babamahmoodi ◽  
Majid Marjani ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Clinical Improvement ◽  
Primary Outcome ◽  
Adverse Drug Events ◽  
Antiviral Effect ◽  
Hospitalized Patients ◽  
Secondary Outcome ◽  
Risk Of Death ◽  
Significant Difference ◽  
Transmembrane Serine Protease

BackgroundBromhexine is a potent inhibitor of transmembrane serine protease 2 and appears to have an antiviral effect in controlling influenza and parainfluenza infection; however, its efficacy in COVID-19 is controversial.MethodsA group of hospitalized patients with confirmed COVID-19 pneumonia were randomized using 1:1 allocation to either standard treatment lopinavir/ritonavir and interferon beta-1a or bromhexine 8 mg four times a day in addition to standard therapy. The primary outcome was clinical improvement within 28 days, and the secondary outcome measures were time to hospital discharge, all-cause mortality, duration of mechanical ventilation, the temporal trend in 2019-nCoV reverse transcription-polymerase chain reaction positivity and the frequency of adverse drug events within 28 days from the start of medication.ResultsA total of 111 patients were enrolled in this randomized clinical trial and data from 100 patients (48 patients in the treatment arm and 52 patients in the control arm) were analyzed. There was no significant difference in the primary outcome of this study, which was clinical improvement. There was no significant difference in the average time to hospital discharge between the two arms. There were also no differences observed in the mean intensive care unit stay, frequency of intermittent mandatory ventilation, duration of supplemental oxygenation or risk of death by day 28 noted between the two arms.ConclusionBromhexine is not an effective treatment for hospitalized patients with COVID-19. The potential prevention benefits of bromhexine in asymptomatic postexposure or with mild infection managed in the community remain to be determined.

scholarly journals Hydroxychloroquine in the treatment of outpatients with mildly symptomatic COVID-19: a multi-center observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Andrew Ip ◽  
Jaeil Ahn ◽  
Yizhao Zhou ◽  
Andre H. Goy ◽  
Eric Hansen ◽  
...  
Keyword(s):  
Observational Study ◽  
Primary Outcome ◽  
Outpatient Setting ◽  
Hospitalized Patients ◽  
Sensitivity Analyses ◽  
Multivariable Logistic Regression Analysis ◽  
Propensity Matching ◽  
Effective Prophylaxis ◽  
Progression Of Disease

Abstract Background Hydroxychloroquine has not been associated with improved survival among hospitalized COVID-19 patients in the majority of observational studies and similarly was not identified as an effective prophylaxis following exposure in a prospective randomized trial. We aimed to explore the role of hydroxychloroquine therapy in mildly symptomatic patients diagnosed in the outpatient setting. Methods We examined the association between outpatient hydroxychloroquine exposure and the subsequent progression of disease among mildly symptomatic non-hospitalized patients with documented SARS-CoV-2 infection. The primary outcome assessed was requirement of hospitalization. Data was obtained from a retrospective review of electronic health records within a New Jersey USA multi-hospital network. We compared outcomes in patients who received hydroxychloroquine with those who did not applying a multivariable logistic model with propensity matching. Results Among 1274 outpatients with documented SARS-CoV-2 infection 7.6% were prescribed hydroxychloroquine. In a 1067 patient propensity matched cohort, 21.6% with outpatient exposure to hydroxychloroquine were hospitalized, and 31.4% without exposure were hospitalized. In the primary multivariable logistic regression analysis with propensity matching there was an association between exposure to hydroxychloroquine and a decreased rate of hospitalization from COVID-19 (OR 0.53; 95% CI, 0.29, 0.95). Sensitivity analyses revealed similar associations. QTc prolongation events occurred in 2% of patients prescribed hydroxychloroquine with no reported arrhythmia events among those with data available. Conclusions In this retrospective observational study of SARS-CoV-2 infected non-hospitalized patients hydroxychloroquine exposure was associated with a decreased rate of subsequent hospitalization. Additional exploration of hydroxychloroquine in this mildly symptomatic outpatient population is warranted.

Evaluating the impact of CPAP weaning procedures on total days on nasal CPAP: A retrospective chart review

2021 ◽  
pp. 1-10
Author(s):  
Z.B. Puthattayil ◽  
G.P. Moore ◽  
K. Tang ◽  
N. Huneault-Purney ◽  
S.L. Lawrence
Keyword(s):  
Chart Review ◽  
Primary Outcome ◽  
Positive Airway Pressure ◽  
Retrospective Chart Review ◽  
Stability Criteria ◽  
Inclusion Criteria ◽  
Duration Of Hospital Stay ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Impact

BACKGROUND: There is no consensus on how to wean infants from Nasal Continuous Positive Airway Pressure (NCPAP). We hypothesized that ceasing NCPAP abruptly would decrease the duration required, compared with a gradual wean. METHODS: This retrospective chart review included preterm infants requiring NCPAP for over 48 hours. Cohort1 weaned NCPAP by cycling on and off, while cohort 2 ceased NCPAP abruptly. The primary outcome was total days on NCPAP. Secondary outcomes included rate of bronchopulmonary dysplasia, weight gain, duration of hospital stay, and compliance with the use of stability criteria. RESULTS: 81 infants met inclusion criteria in cohort one, and 89 in cohort two. Median days on NCPAP were 17.0 and 11.0 days, respectively, not significant. There was no significant difference in secondary outcomes. CONCLUSIONS: There was no significant association between the two NCPAP weaning protocols and the outcomes studied.

scholarly journals 204 A Systematic Review of Clinical Outcomes for Outpatient vs Inpatient Shoulder Arthroplasty

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
E Perera ◽  
B Flood ◽  
K Madden ◽  
D Goel ◽  
T Leroux ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
Outpatient Surgery ◽  
Care Pathway ◽  
Hospital Readmissions ◽  
Cost Effective ◽  
Outpatient Setting ◽  
Inpatient Setting ◽  
Operative Care ◽  
Significant Difference

Abstract Aim Outpatient shoulder arthroplasty is growing in popularity as a cost-effective and potentially equally safe alternative to inpatient arthroplasty. We investigated literature relating to outpatient shoulder arthroplasty, looking at clinical outcomes, complications, readmission, and cost compared to inpatient arthroplasty. Method We systematically searched Medline, Embase, PubMed using relevant search terms. Methodological quality of included studies was assessed using Methodological Index for Non-Randomised Studies score. Results We included 17 studies in our review with 11 included in the meta-analyses. A meta-analysis of hospital readmissions demonstrated that there was no statistically significant difference between outpatient and inpatient cohorts (OR = 0.89, 95% CI: 0.63-1.25, p = 0.49, I2=56%). Pooling results for all post-operative complications identified decreased complications in those undergoing outpatient surgery (OR = 0.70; 95% CI: 0.52-0.94, p = 0.02, I2=50%). No statistically significant difference was identified with respect to medical complications (OR = 0.86, 95% CI: 0.74-1.01, p = 0.07, I2=0%) or surgical complications (OR = 0.71, 95% CI: 0.45-1.12, p = 0.14, I2=26%). Considerable cost saving of between $3 614 – $53 202 (19.7 – 69.9%) per patient were present in the outpatient setting. Conclusions Shoulder arthroplasty in the outpatient setting is as safe as shoulder arthroplasty in the inpatient setting, with a significant reduction in cost. There is no demonstrable statistically significant difference with regards to readmissions between outpatient and inpatient shoulder arthroplasty. In the appropriately selected patient, outpatient shoulder arthroplasty is safe and cost-effective; however, we still need to work towards understanding who the appropriate patients are for this post-operative care pathway.

scholarly journals A systematic review of clinical outcomes for outpatient vs. inpatient shoulder arthroplasty

2021 ◽  
pp. 175857322110074
Author(s):  
Edward Perera ◽  
Breanne Flood ◽  
Kim Madden ◽  
Danny P Goel ◽  
Timothy Leroux ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
Outpatient Surgery ◽  
Hospital Readmissions ◽  
Outpatient Setting ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Inpatient Setting ◽  
Significant Difference

Background Outpatient shoulder arthroplasty is growing in popularity as a cost-effective and potentially equally safe alternative to inpatient arthroplasty. The aim of this study was to investigate literature relating to outpatient shoulder arthroplasty, looking at clinical outcomes, complications, readmission, and cost compared to inpatient arthroplasty. Methods We conducted a systematic review of Medline, Embase and Cochrane Library databases from inception to 6 April 2020. Methodological quality was assessed using MINORS and GRADE criteria. Results We included 17 studies, with 11 included in meta-analyses and 6 in narrative review. A meta-analysis of hospital readmissions demonstrated no statistically significant difference between outpatient and inpatient cohorts (OR = 0.89, p = 0.49). Pooled post-operative complications identified decreased complications in those undergoing outpatient surgery (OR = 0.70, p = 0.02). Considerable cost saving of between $3614 and $53,202 (19.7–69.9%) per patient were present in the outpatient setting. Overall study quality was low and presented a serious risk of bias. Discussion Shoulder arthroplasty in the outpatient setting appears to be as safe as shoulder arthroplasty in the inpatient setting, with a significant reduction in cost. However, this is based on low quality evidence and high risk of bias suggests further research is needed to substantiate these findings.

Evaluation of Dipeptidyl Peptidase-IV Inhibitor Use in Hospitalized Patients With Diabetes

2021 ◽  
pp. 106002802199633
Author(s):  
Sarah E. Petite ◽  
Maja C. Hill
Keyword(s):  
Basal Insulin ◽  
Dipeptidyl Peptidase ◽  
Hospitalized Patients ◽  
Dipeptidyl Peptidase Iv ◽  
Hospital Length Of Stay ◽  
Total Daily Dose ◽  
Inpatient Setting ◽  
Dpp Iv ◽  
Significant Difference ◽  
Bolus Insulin

Background: Glycemic control within goal blood glucose (BG) ranges is essential to minimize hospital complications for patients with type 2 diabetes mellitus (T2DM). Optimal treatment in the non–intensive care unit (ICU) setting includes a basal insulin containing regimen. Dipeptidyl peptidase-IV (DPP-IV) inhibitors have minimal hypoglycemia incidence and may be an appropriate bolus insulin replacement in the inpatient setting. Objective: To determine the effect of basal insulin plus DPP-IV inhibitor compared with basal plus bolus insulin in hospitalized patients with T2DM. Methods: This multicenter cohort study included adult patients with T2DM admitted to the non-ICU setting and prescribed either basal insulin plus DPP-IV inhibitor or basal plus bolus insulin. Propensity-score matching was performed for age, sex, Charlson Comorbidity Index, first BG reading during hospitalization, and hemoglobin A1C (A1C). The primary outcome was the difference in mean daily BG during hospitalization. Secondary outcomes included hospital length of stay (LOS), total daily dose (TDD) of insulin, hypoglycemic events, and mean daily BG in patients with an A1C >8%. Results: A total of 105 patients were included in each group. Mean daily BG during hospitalization was lower in the basal insulin plus DPP-IV inhibitor group (199.3 ± 52.5 vs 213.6 ± 45.8 mg/dL; P = 0.04). There was a significant difference in hospital LOS (5 [interquartile range = 3-8] vs 6 [4-11] days; P = 0.02) and short-acting insulin TDD (11.6 ± 9.1 vs 20.5 ± 21.2 units; P < 0.001). No differences were observed in basal insulin TDD and hypoglycemia. There was no difference in mean daily BG in the subgroup analysis of patients with a A1C >8%. Conclusions and Relevance: A significant difference in mean daily BG and hospital LOS was found with a basal insulin plus DPP-IV inhibitor regimen. Use of a DPP-IV inhibitor to replace bolus insulin in hospitalized patients with T2DM should be considered.

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