Mannitol for the prevention of cisplatin-induced nephrotoxicity: A retrospective comparison of hydration plus mannitol versus hydration alone in inpatient and outpatient regimens at a large academic medical center

2016 ◽  
Vol 23 (6) ◽  
pp. 422-428 ◽  
Author(s):  
Robert P Williams ◽  
Brandon W Ferlas ◽  
Paul C Morales ◽  
Andy J Kurtzweil
Keyword(s):  
Serum Creatinine ◽  
Primary Outcome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Toxicity Data ◽  
Average Increase ◽  
Institutional Review ◽  
Academic Medical ◽  
Retrospective Comparison ◽  
Quasi Experimental

Background Cisplatin-induced nephrotoxicity is a dose limiting adverse effect that occurs in nearly one-third of patients. Mannitol administration has been used as a means to negate this toxicity. Data regarding the efficacy of mannitol use in this context are conflicting and limited. Objective The aim of this study is to evaluate the effect of mannitol on renal function and describe the incidence of cisplatin-induced nephrotoxicity. Methods This study is a quasi-experimental retrospective analysis approved by the Institutional Review Board of inpatient and outpatient adults receiving cisplatin doses ≥40 mg/m2. The primary outcome was mean change in serum creatinine from baseline. Secondary outcomes included incidences of various grades of nephrotoxicity. Results A total of 313 patients (95 treated with mannitol and 218 without) were evaluated. The average increase in serum creatinine (mg/dL) was lower in patients who received mannitol versus those who did not (0.30 vs. 0.47; 95% confidence interval for difference, 0.03 to 0.31; P = 0.02). Grade 2 or higher nephrotoxicity occurred less frequently in patients who received mannitol versus those who did not (8% vs. 17%; P = 0.04). Non-gynecologic regimens and those who received doses ≥70 mg/m2 of cisplatin had lower rates of grade 2 or higher nephrotoxicity with mannitol (6% vs. 23%; P = 0.001, and 7% vs. 22%; P = 0.03, respectively). Conclusion The use of mannitol reduces the incidence and severity of nephrotoxicity in patients treated with cisplatin. The results of the study suggest mannitol may be most effective when used with non-gynecologic regimens and with cisplatin doses ≥70 mg/m2.

Hemodynamic Response to Vasopressin Dosage of 0.03 Units/Min vs. 0.04 Units/Min in Patients With Septic Shock

2020 ◽  
pp. 088506662097718 ◽  
Author(s):  
Seth R. Bauer ◽  
Gretchen L. Sacha ◽  
Simon W. Lam ◽  
Lu Wang ◽  
Anita J. Reddy ◽  
...  
Keyword(s):  
Septic Shock ◽  
Primary Outcome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Initial Dosage ◽  
Hemodynamic Response ◽  
Adjusted Relative Risk ◽  
Covariate Balance ◽  
Academic Medical ◽  
Medical Intensive Care

Background: Arginine vasopressin (AVP) is suggested as an adjunct to norepinephrine in patients with septic shock. Guidelines recommend an AVP dosage up to 0.03 units/min, but 0.04 units/min is commonly used in practice based on initial studies. This study was designed to compare the incidence of hemodynamic response between initial fixed-dosage AVP 0.03 units/min and AVP 0.04 units/min. Methods: This retrospective, multi-hospital health system, cohort study included adult patients with septic shock receiving AVP as an adjunct to catecholamine vasopressors. Patients were excluded if they received an initial dosage other than 0.03 units/min or 0.04 units/min, or AVP was titrated within the first 6 hours of therapy. The primary outcome was hemodynamic response, defined as a mean arterial pressure ≥65 mm Hg and a decrease in catecholamine dosage at 6 hours after AVP initiation. Inverse probability of treatment weighting (IPTW) based on the propensity score for initial AVP dosage receipt was utilized to estimate adjusted exposure effects. Results: Of the 1536 patients included in the observed data, there was a nearly even split between initial AVP dosage of 0.03 units/min (n = 842 [54.8%]) and 0.04 units/min (n = 694 [45.2%]). Observed patients receiving AVP 0.03 units/min were more frequently treated at the main campus academic medical center (96.3% vs. 52.2%, p < 0.01) and in a medical intensive care unit (87.4% vs. 39.8%, p < 0.01). The IPTW analysis included 1379 patients with achievement of baseline covariate balance. There was no evidence for a difference between groups in the incidence of hemodynamic response (0.03 units/min 50.0% vs. 0.04 units/min 53.1%, adjusted relative risk 1.06 [95% CI 0.94, 1.20]). Conclusions: Initial AVP dosing varied by hospital and unit type. Although commonly used, an initial AVP dosage of 0.04 units/min was not associated with a higher incidence of early hemodynamic response to AVP in patients with septic shock.

Comparing successful insertions, dwell time, reinsertions and the costs of supplies between integrated and simple short peripheral catheters

2021 ◽  
pp. 112972982110548
Author(s):  
Jonathan D Cura
Keyword(s):  
Patient Safety ◽  
Dwell Time ◽  
Clinical Performance ◽  
Medical Center ◽  
Academic Medical Center ◽  
Insertion Site ◽  
The Philippines ◽  
Adult Patients ◽  
Academic Medical ◽  
Quasi Experimental

Background: Along with the challenges to strengthen patient safety in the use of short peripheral catheters (SPCs), various studies have been conducted in the past to explore differences between two main types of SPCs—integrated SPC (ISPC) and simple SPC (SSPC) in terms of clinical performance. The accumulated evidence from the literature lean toward the benefits of ISPC use in preventing complications leading to longer dwell time and more economical savings than SSPC use. The study aimed to compare ISPC and SSPC in terms of first-attempt successful insertions, number of attempts before successful insertion, perceived ease of insertion, dwell time, reinsertion rate, reasons for removal, and costs of supplies used for the insertions. Furthermore, it aimed to verify whether the previous results of referenced work in the use of ISPC were similar, and its use provided more foreseeable benefit for patient safety and cost-efficiency. Methods: This quasi-experimental study was conducted in a 650-bed tertiary academic medical center in the Philippines. Eligible participants were adult patients who were required SPC for at least 72 h by the physician. Using inferential statistics, comparisons were done among adult patients with integrated ( n = 350) and simple ( n = 350) SPC. Comparisons were also made according to insertion site and gauge of SPC. Results: The successful first-attempt insertions did not vary significantly at around 80% in both groups ( p = 0.428). No significant differences were found in terms of attempts before successful insertion ( p = 0.677), dwell time ( p = 0.144), reinsertions ( p = 0.934), and reasons for removal ( p = 0.424). Meanwhile, comparable differences were noted in terms of perceived ease of insertion ( p < 0.001) and cost of supplies used during the insertions ( p < 0.001). Conclusion: ISPCs can yield the same results with that of SSPCs while being easier to use and less costly.

Impact of Telemedicine Use on Blood Pressure Control During the Covid-19 Pandemic: A Cohort Study (Preprint)

2021 ◽  
Author(s):  
Siqin Ye ◽  
D. Edmund Anstey ◽  
Anne Grauer ◽  
Gil Metser ◽  
Nathalie Moise ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Pressure Control ◽  
Care Quality ◽  
Academic Medical ◽  
Cardiovascular Care

BACKGROUND Telemedicine use vastly expanded during the Covid-19 pandemic, with uncertain impact on cardiovascular care quality. OBJECTIVE We sought to examine the association between telemedicine use and blood pressure (BP) control. METHODS This is a retrospective cohort study of 32,727 adult patients with hypertension (HTN) seen in primary care and cardiology clinics at an urban, academic medical center from February to December, 2020. The primary outcome was poor BP control, defined as having no BP recorded OR if the last recorded BP was ≥140/90 mmHg. Multivariable logistic regression was used to assess the association between telemedicine use during the study period (none, 1 telemedicine visit, 2+ telemedicine visits) and poor BP control, adjusting for demographic and clinical characteristics. RESULTS During the study period, no BP was recorded for 486/20,745 (2.3%) patients with in-person visits only, for 1,863/6,878 (27.1%) patients with 1 telemedicine visit, and for 1,277/5,104 (25.0%) patients with 2+ telemedicine visits. After adjustment, telemedicine use was associated with poor BP control (odds ratio [OR], 2.06, 95% confidence interval [CI] 1.94 to 2.18, p<.001 for 1 telemedicine visit, and OR 2.49, 95% CI 2.31 to 2.68, p<.001 for 2+ telemedicine visits; reference, in-person visit only). This effect disappears when analysis was restricted to patients with at least one recorded BP (OR 0.89, 95% CI 0.83 to 0.95, p=.001 for 1 telemedicine visit, and OR 0.91, 95% CI 0.83 to 0.99, p=.03 for 2+ telemedicine visits). CONCLUSIONS BP is less likely to be recorded during telemedicine visits, but telemedicine use does not negatively impact BP control when BP is recorded. CLINICALTRIAL NA

Nurses’ perception of ethical climate at a large academic medical center

2016 ◽  
Vol 25 (6) ◽  
pp. 724-733 ◽  
Author(s):  
Donna Lemmenes ◽  
Pamela Valentine ◽  
Patricia Gwizdalski ◽  
Catherine Vincent ◽  
Chuanhong Liao
Keyword(s):  
Ethical Climate ◽  
Ethical Issues ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Hospital ◽  
Specialty Area ◽  
Work Settings ◽  
Institutional Review ◽  
Academic Medical ◽  
Nurses Perceptions

Background: Nurses are confronted daily with ethical issues while providing patient care. Hospital ethical climates can affect nurses’ job satisfaction, organizational commitment, retention, and physician collaboration. Purpose: At a metropolitan academic medical center, we examined nurses’ perceptions of the ethical climate and relationships among ethical climate factors and nurse characteristics. Design/participants: We used a descriptive correlational design and nurses ( N = 475) completed Olson’s Hospital Ethical Climate Survey. Data were analyzed using STATA. Ethical considerations: Approvals by the Nursing Research Council and Institutional Review Board were obtained; participants’ rights were protected. Results: Nurses reported an ethical climate total mean score of 3.22 ± 0.65 that varied across factors; significant differences were found for ethical climate scores by nurses’ age, race, and specialty area. Conclusion: These findings contribute to what is known about ethical climate and nurses’ characteristics and provides the foundation to develop strategies to improve the ethical climate in work settings.

scholarly journals Evaluation of Antibiotic Prophylaxis and Postsurgery Antibiotics for Urological Surgeries at an Academic Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s227-s227
Author(s):  
Emily Drwiega ◽  
Saira Rab ◽  
Sheetal Kandiah ◽  
Jane Kriengkauykiat ◽  
Jordan Wong
Keyword(s):  
Clostridium Difficile ◽  
Antibiotic Prophylaxis ◽  
Primary Outcome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Composite Outcome ◽  
Academic Medical ◽  
Perioperative Antibiotics ◽  
Urological Procedures

Objective: The purpose of this study was to evaluate antibiotic use in patients undergoing urological procedures. Methodology: This single-center, IRB-approved, retrospective, observational study was conducted at Grady Health System. Patients were included if they underwent their first inpatient urologic procedure between April 1, 2016, and April 1, 2018. Patients were excluded if they were <18 years old, pregnant, or a prisoner. The primary outcome was percentage of overall adherence to our institutional guidelines for surgical prophylaxis as a composite of antibiotic selection, dose, preoperative timing, and postoperative duration. Secondary outcomes include individual components of the composite outcome, nephrotoxicity, Clostridium difficile infection, and discharge antibiotic prescriptions. Descriptive statistics were used. Results: Of the 100 patients evaluated, 11% achieved adherence with the primary outcome. Of the 89 patients who did not achieve composite outcome, only 8 selected the appropriate perioperative antibiotic. Overall, 30% were dosed appropriately, 47% were administered at the appropriate time with respect to time of incision, and 46% received perioperative antibiotics for no more than 24 hours. Also, 19 patients did not receive perioperative antibiotics. Overall, 14 different perioperative antibiotic regimens were utilized, despite institutional guidelines recommending 1 of 3 options. All 9 patients who developed nephrotoxicity received noncompliant perioperative prophylaxis. No patient developed Clostridium difficile infection within 30 days of surgery. Moreover, 58 patients were discharged with a prescription for at least 1 antibiotic. Conclusions: Most perioperative antibiotic prophylaxes for genitourinary surgeries are not compliant with institution guideline recommendations. Despite having institutional guidelines, there was a large variety in the antibiotic regimens that patients received. All of the patients identified as having an evaluated antibiotic-related adverse effect did not receive appropriate perioperative antibiotic prophylaxis. More than half of the patients received a prescription at discharge for at least 1 antibiotic.Funding: NoneDisclosures: None

scholarly journals Optimizing Inpatient Urine Culture Ordering Practices Using the Electronic Medical Record: A Pilot Study

2016 ◽  
Vol 38 (4) ◽  
pp. 486-488 ◽  
Author(s):  
Daniel Shirley ◽  
Harry Scholtz ◽  
Kurt Osterby ◽  
Jackson Musuuza ◽  
Barry Fox ◽  
...  
Keyword(s):  
Pilot Study ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Urine Culture ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Before And After ◽  
Quasi Experimental ◽  
Before And After Study

A prospective quasi-experimental before-and-after study of an electronic medical record–anchored intervention of embedded education on appropriate urine culture indications and indication selection reduced the number of urine cultures ordered for catheterized patients at an academic medical center. This intervention could be a component of CAUTI-reduction bundles.Infect Control Hosp Epidemiol 2017;38:486–488

scholarly journals Outcomes Associated with Lower Doses of Ketamine by Emergency Medical Services for Profound Agitation

2021 ◽  
Vol 22 (5) ◽  
pp. 1183-1189
Author(s):  
Shaila Coffey ◽  
J. Priyanka Vakkalanka ◽  
Haley Egan ◽  
Kelli Wallace ◽  
Karisa Harland ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Prehospital Setting ◽  
Airway Protection ◽  
Not Otherwise Specified ◽  
Academic Medical ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Improved Methods

Introduction: Ketamine is commonly used to treat profound agitation in the prehospital setting. Early in ketamine’s prehospital use, intubation after arrival in the emergency department (ED) was frequent. We sought to measure the frequency of ED intubation at a Midwest academic medical center after prehospital ketamine use for profound agitation, hypothesizing that intubation has become less frequent as prehospital ketamine has become more common and prehospital dosing has improved. Methods: We conducted a retrospective cohort study of adult patients receiving ketamine in the prehospital setting for profound agitation and transported to a midwestern, 60,000-visit, Level 1 trauma center between January 1, 2017–- March 1, 2021. We report descriptive analyses of patient-level prehospital clinical data and ED outcomes. The primary outcome was proportion of patients intubated in the ED. Results: A total of 78 patients received ketamine in the prehospital setting (69% male, mean age 36 years). Of the 42 (54%) admitted patients, 15 (36% of admissions) were admissions to the intensive care unit. Overall, 12% (95% confidence interval [CI]), 4.5-18.6%)] of patients were intubated, and indications included agitation (n = 4), airway protection not otherwise specified (n = 4), and respiratory failure (n = 1). Conclusion: Endotracheal intubation in the ED after prehospital ketamine use for profound agitation in our study sample was found to be less than previously reported.

Abstract WP324: Stroke Recognition Among Inpatient Staff at an Academic Medical Center

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Eric E Adelman ◽  
William J Meurer ◽  
Dorinda K Nance ◽  
Mary Jo Kocan ◽  
Kate E Maddox ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Signs And Symptoms ◽  
Rapid Identification ◽  
Warning Signs ◽  
Free Text ◽  
Staff Members ◽  
Academic Medical ◽  
Stroke Knowledge

Background About 10% of all strokes occur in hospitalized patients. The goal of this work was to evaluate the knowledge of stroke signs and to determine predictors of that knowledge among inpatient staff at an academic medical center. Methods Stroke education was the topic of a mandatory in-service for all adult inpatient medical, surgical, and ICU nursing unit clinical staff; including nurses, techs, and aides. The staff members anonymously completed an optional web-survey which included free text responses for stroke signs and symptoms, along with additional multiple choice questions regarding experience and training. The primary outcome was stroke knowledge which was defined as correct naming of 2 or more stroke warning signs or symptoms. Logistic regression was used to determine predictors of the primary outcome. Results The survey was offered to 1,593 staff members and 875 (55%) completed the survey. Eighty-seven percent of inpatient staff members correctly identified 2 or more stroke warning signs or symptoms while 31% identified 3 stroke warning signs or symptoms. Individual level predictors of stroke knowledge are shown in the Table. Greater self-reported confidence in identifying stroke symptoms and higher ratings for the importance of rapid identification of stroke symptoms were associated with stroke knowledge. Clinical experience, educational experience, work location, and personal knowledge of a stroke patient were not associated with stroke knowledge. Conclusion More than 80% of adult clinical inpatient staff members have knowledge of two or more stroke signs and symptoms. Future nursing education should emphasize the importance of rapid identification of stroke signs and symptoms and increasing confidence in knowledge of stroke symptoms.

Comparison of two different intravenous serotonin antagonists used for chemotherapy-induced nausea and vomiting prophylaxis in patients treated with moderately emetogenic risk regimens: A retrospective analysis from a large academic medical center

2020 ◽  
Vol 26 (8) ◽  
pp. 1964-1969
Author(s):  
Melissa Gamble ◽  
Elisabeth Carroll ◽  
Garth C Wright ◽  
Ashley E Glode
Keyword(s):  
Retrospective Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Emetogenic Chemotherapy ◽  
Nausea And Vomiting ◽  
Moderately Emetogenic Chemotherapy ◽  
Prophylactic Regimen ◽  
Nccn Guidelines ◽  
Institutional Review ◽  
Academic Medical

Introduction Chemotherapy-induced nausea and vomiting (CINV) can be a serious and debilitating adverse effect that is highly feared by cancer patients. For patients receiving moderately emetogenic chemotherapy regimens at our institution in the ambulatory infusion center, palonosetron was selected as the preferred serotonin (5-HT3) antagonist for CINV prophylaxis per the 2016 NCCN Guidelines, when a neurokinin1 antagonist was not included in the prophylactic regimen. The purpose of this study was to evaluate the efficacy of dexamethasone and palonosetron versus granisetron for the prevention of CINV in patients receiving moderately emetogenic chemotherapy regimens. Methods This study is an Institutional Review Board-approved, single-center retrospective review of electronic health records including patients who received moderately emetogenic chemotherapy regimens with CINV prophylaxis with dexamethasone and either palonosetron or granisetron. Results A total of 268 eligible patients were included in the study. Eighty-eight patients received palonosetron and 180 patients received granisetron as their 5-HT3 receptor antagonist between October 31, 2014 and October 31, 2016. There were no statistically significant differences between the two antiemetic groups for the primary outcome of presence of any change in day 1 intravenous prophylactic antiemetics. Nine (10.23%) palonosetron patients and 15 (8.33%) granisetron patients required a change in their day 1 intravenous prophylactic antiemetics ( P = 0.610). Conclusions Despite palonosetron’s better efficacy, longer half-life, and higher binding affinity, the results of this retrospective review demonstrates that the choice of serotonin antagonist, palonosetron or granisetron, did not result in a change in day 1 intravenous prophylactic antiemetics or antiemetic outpatient medications for patients undergoing moderately emetogenic chemotherapy regimens.

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