Prospective Surveillance of Imipenem/Cilastatin Use and Associated Seizures Using a Hospital Information System

1993 ◽  
Vol 27 (4) ◽  
pp. 497-501 ◽  
Author(s):  
Stanley L. Pestotnik ◽  
David C. Classen ◽  
R. Scott Evans ◽  
Lane E. Stevens ◽  
John P. Burke
Keyword(s):  
Risk Factors ◽  
Information System ◽  
Renal Function ◽  
Hospital Information System ◽  
Salt Lake ◽  
Treated Patient ◽  
Care Center ◽  
Tertiary Care ◽  
Salt Lake City ◽  
Computer Assisted

OBJECTIVE: To develop computerized methods to monitor and recommend dosage changes for patients treated with excessive dosages of imipenem/cilastatin (I/C) and to determine the incidence of I/C-associated seizures in our patient population. DESIGN: Prospective observational and interventional study of all patients admitted to LDS Hospital and treated with I/C from May 1, 1987, through June 30, 1991. SETTING: LDS Hospital, Salt Lake City, UT, a 520-bed, tertiary care center associated with the University of Utah School of Medicine. PATIENTS: Using a hospital information system we developed computerized algorithms to identify and monitor patients receiving I/C. These algorithms screened the computer-stored medical records of all inpatient admissions for I/C prescription orders. Computer-decision support algorithms estimated the renal function of each I/C-treated patient and provided suggestions when dosages were determined to be excessive. Additional computer-generated alerts identified patients who were receiving anticonvulsants concomitantly with I/C or whose therapy reflected dosage changes in the previous 24 hours. A list of all I/C-treated patients with alerts was reviewed daily by a clinical pharmacist and prescribing physicians were contacted if the computer-generated suggestions were clinically relevant. MAIN OUTCOME MEASURE: The number and characterization of I/C-associated seizures. RESULTS: From May 1, 1987, through June 30, 1991, we prospectively monitored 107 600 patients of whom 1951 were treated with I/C. The following risk factors for I/C-associated seizures were observed in the I/C-treated population: CNS disease (6 percent), seizure disorders (0.6 percent), and abnormal renal function (70 percent). The observational and interventional methods employed in this study resulted in 79 percent of the patients receiving I/C dosages appropriate for their corresponding renal function. During the 50-month study period, we detected four seizures (0.20 percent) in the I/C-treated patients. All 4 patients were receiving I/C dosages that were excessive with respect to their renal function. CONCLUSIONS: Our rate of seizure (0.2 percent) was lower than the 1–2 percent rate reported in the literature despite the fact that more than 70 percent of the patients who received I/C had risk factors for seizure. We believe that appropriate dosing of I/C results in a low rate of associated seizures. Computer-assisted monitoring of I/C dosages in relation to renal function resulted in a reduced incidence of seizures.

Preventing Adverse Drug Events in Hospitalized Patients

1994 ◽  
Vol 28 (4) ◽  
pp. 523-527 ◽  
Author(s):  
R. Scott Evans ◽  
Stanley L. Pestotnik ◽  
David C. Classen ◽  
Susan D. Horn ◽  
Sheron B. Bass ◽  
...  
Keyword(s):  
Adverse Drug Events ◽  
Salt Lake ◽  
Care Center ◽  
Tertiary Care ◽  
Salt Lake City ◽  
Hospitalized Patients ◽  
Drug Event ◽  
Antibiotic Administration ◽  
Type B ◽  
Lake City

OBJECTIVE: To use computerized adverse drug event (ADE) surveillance to help identify methods to reduce the number of ADEs in hospitalized patients. DESIGN: Prospective study of 79 719 hospitalized patients during a 44-month period. SETTING: LDS Hospital, a 520-bed tertiary care center affiliated with the University of Utah School of Medicine, Salt Lake City. INTERVENTION: Sequential study periods of at least one year each were compared. In the first period, data were collected but not reported to physicians, pharmacists, or nurses. In the subsequent study periods, three interventions (computerized alerts of drug allergies, standardized antibiotic administration rates, and timely physician notification of all ADEs) were made to reduce the number of type B (allergic or idiosyncratic reactions) and severe ADEs. RESULTS: In the first study period, we identified 56 type B ADEs during 120 213 patient days. During two subsequent study periods that included alerts to physicians of known drug allergies and standardized antibiotic administration rates, 8 type B events were identified during 113 237 patient days and 18 during 107 868 patient days, respectively (p<0.OO2). Early notification of physicians of all confirmed ADEs regardless of severity was associated with asignificant reduction of ADEs classified as severe from 41 during 113 859 patient days in the first study period to 12 during 103 071 patient days and 15 during 108 320 patient days in two subsequent study periods, respectively (p<0.00 1). CONCLUSIONS: Prospective surveillance of computer-based medical records for known drug allergies and appropriate drug administration rates can reduce the number of type B ADEs. Early ADE detection and notification of physicians permit drug and dosage changes that reduce the progression of mild and moderate ADEs to more severe conditions.

Surveillance for Quality Assessment: IV. Surveillance Using a Hospital Information System

1991 ◽  
Vol 12 (4) ◽  
pp. 239-244 ◽  
Author(s):  
William Crede ◽  
Walter J. Hierholzer ◽  
David C. Classen ◽  
John F! Burke ◽  
Stanley L. Pestotnik ◽  
...  
Keyword(s):  
Information System ◽  
Infection Control ◽  
Hospital Information System ◽  
Salt Lake ◽  
Salt Lake City ◽  
Hospital Data ◽  
Control Programs ◽  
Surveillance Programs ◽  
Lake City ◽  
Efficient Hospital

The first two articles in this series outlined the widespread use of hospital surveillance for infection control programs and the potential use of surveillance for monitoring noninfectious nosocomial events. The third article focused on quality indicators as potential targets for hospital surveillance. Surveillance has been defined as the collection, collation, analysis, and dissemination of data. Several methods have been developed to perform this task in hospitals; the traditional method includes collection of data through extensive chart review, a very time- and labor-intensive process. Computerized methods have been developed for hospital surveillance: several personal computer-based programs in infection control are available, including NOSO 3 (Epi Systematics, Inc., Ft. Myers, Florida) and AICE (ICPA, Inc., Austin, Texas). In addition, the Centers for Disease Control (CDC) offer an IDEAS software program to facilitate collection of hospital data for inclusion in the National Nosocomial Infection Surveillance System. These systems offer added efficiencies in the analysis of data, but not in the collection of data. As surveillance in hospitals is expanded from infection control to other areas, more efficient means of data collection will be essential. The development and implementation of comprehensive hospital information systems offer the potential for improving, enlarging, and conducting more efficient hospital-wide surveillance. This article will review the hospital surveillance programs conducted with a hospital information system currently in use at LDS Hospital in Salt Lake City, Utah.

Study of risk factors of eclampsia in a tertiary care center

2019 ◽  
Vol 12 (2) ◽  
pp. 31-35
Author(s):  
Padma Chandavathu ◽  
◽  
Akurathi Krishna Rao ◽  
Keyword(s):  
Risk Factors ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center

scholarly journals Prevalence and risk factors of anemia among pregnant women attending a high-volume tertiary care center for delivery

2015 ◽  
Vol 16 (4) ◽  
pp. 231-236 ◽  
Author(s):  
Cuneyt Eftal Taner ◽  
Atalay Ekin ◽  
Ulas Solmaz ◽  
Cenk Gezer ◽  
Birgul Cetin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Care Center ◽  
Tertiary Care ◽  
High Volume ◽  
Tertiary Care Center

scholarly journals Risk factors associated with birth defects at a tertiary care center in Pakistan

2012 ◽  
Vol 38 (1) ◽  
pp. 68 ◽  
Author(s):  
Mohammad Zeeshan Raza ◽  
Asfandyar Sheikh ◽  
Syed Salman Ahmed ◽  
Sajid Ali ◽  
Syed Mumtaz Ali Naqvi
Keyword(s):  
Risk Factors ◽  
Birth Defects ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Factors Associated

GASTRIC CANCER: A 5 YEAR RETROSPECTIVE ANALYSIS OF CLINICAL, PATHOLOGICAL AND TREATMENT ASPECTS FROM A TERTIARY CARE CENTER IN SOUTH INDIA.

2021 ◽  
pp. 129-132
Author(s):  
B. Ramkumar ◽  
J. Kannan ◽  
Ingersal. N ◽  
Srigopal mohanty ◽  
Amit saklani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
South India ◽  
Care Center ◽  
Tertiary Care ◽  
Tumor Location ◽  
Advanced Stage ◽  
Tertiary Care Center ◽  
Nodal Disease ◽  
Female Ratio

Context: Gastric cancer(GC) is fth most common cancer worldwide. Mostly presents with advanced stage and poor overall survival. Methods: Retrospective study on clinical, pathological, pattern of distant metastasis(DM) , treatment aspect of GC treated between January 2014 to December 2018 in a tertiary care center in south India. Statistical analysis : Chi square test and multivariate analysis (MVA) were used for analysis. P <0.05 was considered signicant. Results: Median age at diagnosis is 57 years. Higher male : female ratio. Most common presentation was abdominal pain followed vomiting. Malignant Gastric outlet obstruction(MGOO) was present in 22.7%. Histologically , all patients had adenocarcinoma with predominantly moderate differentiation (51.1%). Liver (19.1%)was most common site of metastasis . Curative surgery was done in 35.5% of patients. D2 lymph node dissection was performed in 12.4% of patient. Patients were given perioperative /preoperative/ adjuvant / palliative chemotherapy. MVA revealed history of tobacco use, body of stomach tumor location, nodal disease were risk factors for DM. Conclusion : The present analysis revealed use of tobacco, alcohol intake were main risk factors for GC. Most of the patients present in advanced stage , so prevention by avoiding risk factors and early detection by signs , symptoms and endoscopy are necessary. Use of tobacco,site of tumor location, nodal disease were factors associated with DM. Aggressive management with both surgery and chemotherapy is warranted for locally advanced disease.

scholarly journals Preoperative Albuminuria and Intraoperative Chloride Load: Predictors of Acute Kidney Injury Following Major Abdominal Surgery

2018 ◽  
Vol 7 (11) ◽  
pp. 431 ◽  
Author(s):  
Diamantina Marouli ◽  
Kostas Stylianou ◽  
Eleftherios Papadakis ◽  
Nikolaos Kroustalakis ◽  
Stavroula Kolyvaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Abdominal Surgery ◽  
Care Center ◽  
Chronic Kidney Disease Stage ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Major Abdominal Surgery ◽  
Disease Stage ◽  
Postoperative Aki

Background: Postoperative Acute Kidney Injury (AKI) is a common and serious complication associated with significant morbidity and mortality. While several pre- and intra-operative risk factors for AKI have been recognized in cardiac surgery patients, relatively few data are available regarding the incidence and risk factors for perioperative AKI in other surgical operations. The aim of the present study was to determine the risk factors for perioperative AKI in patients undergoing major abdominal surgery. Methods: This was a prospective, observational study of patients undergoing major abdominal surgery in a tertiary care center. Postoperative AKI was diagnosed according to the Acute Kidney Injury Network criteria within 48 h after surgery. Patients with chronic kidney disease stage IV or V were excluded. Logistic regression analysis was used to evaluate the association between perioperative factors and the risk of developing postoperative AKI. Results: Eleven out of 61 patients developed postoperative AKI. Four intra-operative variables were identified as predictors of AKI: intra-operative blood loss (p = 0.002), transfusion of fresh frozen plasma (p = 0.004) and red blood cells (p = 0.038), as well as high chloride load (p = 0.033, cut-off value > 500 mEq). Multivariate analysis demonstrated an independent association between AKI development and preoperative albuminuria, defined as a urinary Albumin to Creatinine ratio ≥ 30 mg·g−1 (OR = 6.88, 95% CI: 1.43–33.04, p = 0.016) as well as perioperative chloride load > 500 mEq (OR = 6.87, 95% CI: 1.46–32.4, p = 0.015). Conclusion: Preoperative albuminuria, as well as a high intraoperative chloride load, were identified as predictors of postoperative AKI in patients undergoing major abdominal surgery.

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