Use of Digoxin Monitoring in a Hospital Setting as an Essential Tool in Optimizing Therapy

2002 ◽  
Vol 18 (3) ◽  
pp. 133-137
Author(s):  
Haim Mayan ◽  
Einat Bloom ◽  
Amnon Hoffman
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Digoxin Concentration ◽  
Therapeutic Drug ◽  
Concentration Data ◽  
Drug Concentrations ◽  
Digoxin Dose ◽  
Cardiac Care Unit ◽  
Digoxin Therapy

Objective To determine what triggers the use of digoxin therapeutic drug monitoring (TDM) that adheres to established indications and the change in digoxin dosage after the result of monitoring is obtained. Methods This prospective study included 86 patients admitted to 6 medicine wards and 2 intensive cardiac care unit wards in a tertiary-care center. Data on patients' demographics, drug therapy, serum chemistry values, indications for digoxin therapy, indications for ordering the drug assay, timing of the blood sample relative to administration of the last dose, and physicians' decisions after attaining serum digoxin concentrations were collected. Results Eighty-six digoxin assays were evaluated. Indications for the use of a digoxin assay were mostly routine without a clear indication (66%); in only 22% of the assays were orders considered clinically justified. Eleven patients had concentrations >2 ng/mL, but only 8 patients had digoxin intoxication. In only 31% of patients did the medical staff respond to the results. In only 21% of patients with subtherapeutic drug concentrations was there a change in digoxin dose. Conclusions Although there are clear indications for the use of digoxin TDM, physicians seem to routinely order these blood tests. The clinicians did not adequately use the digoxin concentration data to optimize therapy. The assistance of a clinical pharmacist or pharmacologist is warranted for use of the assays, to optimize digoxin therapy.

Pre-hospital hypothermia is associated with transfusion risk after traumatic injury

CJEM ◽  
2020 ◽  
Vol 22 (S2) ◽  
pp. S12-S20
Author(s):  
Naheed K. Jivraj ◽  
Lilia Kaustov ◽  
Kennedy Ning Hao ◽  
Rachel Strauss ◽  
Jeannie Callum ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Traumatic Injury ◽  
Multivariable Analysis ◽  
Hospital Setting ◽  
Multivariable Logistic Regression Analysis ◽  
Trauma Patients ◽  
Injured Patients ◽  
Emergent Surgery ◽  
Rbc Transfusion

ABSTRACTObjectivesIn traumatically injured patients, excessive blood loss necessitating the transfusion of red blood cell (RBC) units is common. Indicators of early RBC transfusion in the pre-hospital setting are needed. This study aims to evaluate the association between hypothermia (<36°C) and transfusion risk within the first 24 hours after arrival to hospital for a traumatic injury.MethodsWe completed an audit of all traumatically injured patients who had emergent surgery at a single tertiary care center between 2010 and 2014. Using multivariable logistic regression analysis, we evaluated the association between pre-hospital hypothermia and transfusion of ≥1 unit of RBC within 24 hours of arrival to the trauma bay.ResultsOf the 703 patients included to evaluate the association between hypothermia and RBC transfusion, 203 patients (29%) required a transfusion within 24 hours. After controlling for important confounding variables, including age, sex, coagulopathy (platelets and INR), hemoglobin, and vital signs (blood pressure and heart rate), hypothermia was associated with a 68% increased odds of transfusion in multivariable analysis (OR: 1.68; 95% CI: 1.11-2.56).ConclusionsHypothermia is strongly associated with RBC transfusion in a cohort of trauma patients requiring emergent surgery. This finding highlights the importance of early measures of temperature after traumatic injury and the need for intervention trials to determine if strategies to mitigate the risk of hypothermia will decrease the risk of transfusion and other morbidities.

scholarly journals Detection of bla NDM-1 Encoding Imepenemase among the Imipenem-Resistant Gram-Negative Bacilli Isolated from Various Clinical Samples at a Tertiary Care Hospital of Eastern Nepal: A Descriptive Cross-Sectional Study

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
S. Gautam ◽  
N. R. Bhattarai ◽  
K. Rai ◽  
A. Poudyal ◽  
B. Khanal
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Clinical Samples ◽  
Care Hospital ◽  
Disc Diffusion ◽  
Diffusion Test ◽  
Cross Sectional ◽  
Gram Negative ◽  
Synergy Test

Background. Carbapenem resistance among Gram-negative isolates caused by the production of the metallo-β-lactamase (MBL) enzyme is being increasingly reported worldwide. One of the newly emerged metallo-β-lactamases is New Delhi metallo-β-lactamase. Data regarding its occurrence in hospital setting and percentage prevalence among different Gram-negative bacterial isolates are lacking in our part. This study has been undertaken for determining the presence of the bla NDM-1 gene among the clinical isolates of imipenem-resistant Gram-negative bacteria in a tertiary care center in Dharan, Nepal. Methods. A total of 75 imipenem-resistant Gram-negative isolates were studied. These were screened for metallo-β-lactamase (MBL) production by phenotypic assays such as double-disc synergy test (DDST) and combined disc diffusion test (CDDT). PCR was performed for the molecular detection of gene NDM-1. Ten-disc method was performed to detect the presence of ESBL, AmpC, carbapenamase, and K1 β-lactamase production. Results. Using the molecular method, bla NDM-1 was detected in 36% of the isolates. Phenotypically, double-disc synergy test (DDST) and combined disc diffusion test (CDST) detected MBL production in 38.7% and 37.3% of the isolates, respectively. Ten-disc method detected ESBL in 26.6% of the isolates, but none of the isolates was found to be AmpC, carbapenamase, and K1 β-lactamase producers. Conclusion. A high percentage of the NDM-1 producer was noted among imipenem-resistant GNB. Apart from performing only antimicrobial sensitivity test, phenotypic and molecular screening should be employed to find out the actual number of metallo-β-lactamase producers and the existence of the resistance gene.

scholarly journals Therapeutic Drug Monitoring of Voriconazole in Children from a Tertiary Care Center in China

2018 ◽  
Vol 62 (12) ◽  
Author(s):  
Lin Hu ◽  
Ting-ting Dai ◽  
Le Zou ◽  
Tao-ming Li ◽  
Xuan-sheng Ding ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Care Center ◽  
Tertiary Care ◽  
Target Range ◽  
Therapeutic Drug ◽  
Affecting Factors ◽  
Administration Routes ◽  
Asian Children ◽  
Trough Concentrations

ABSTRACT Voriconazole is a broad-spectrum triazole antifungal and the first-line treatment for invasive aspergillosis (IA). The aim of this research was to study the dose adjustments of voriconazole as well as the affecting factors influencing voriconazole trough concentrations in Asian children to optimize its daily administration. Clinical data were analyzed of inpatients 2 to 14 years old who were subjected to voriconazole trough concentration monitoring from 1 June 2015 to 1 December 2017. A total of 138 voriconazole trough concentrations from 42 pediatric patients were included. Voriconazole trough concentrations at steady state ranged from 0.02 to 9.35 mg/liter, with high inter- and intraindividual variability. Only 50.0% of children achieved the target range (1.0 to 5.5 mg/liter) at initial dosing, while 35.7% of children were subtherapeutic, and 14.3% of children were supratherapeutic at initial dosing. There was no correlation between initial trough concentrations and initial dosing. A total of 28.6% of children (12/42) received an adjusted dose according to trough concentrations. Children <6, 6 to 12, and >12 years old required a median oral maintenance dose to achieve the target range of 11.1, 7.2, and 5.3 mg/kg twice daily, respectively (P = 0.043). The average doses required to achieved the target range were 7.7 mg/kg and 5.6 mg/kg, respectively, and were lower than the recommended dosage (P = 0.033 and 0.003, respectively). Affecting factors such as administration routes and coadministration with proton pump inhibitors (PPIs) explained 55.3% of the variability in voriconazole exposure. Therapeutic drug monitoring (TDM) of voriconazole could help to individualize antifungal therapy for children and provide guidelines for TDM and dosing optimization in Asian children.

scholarly journals Comparison of accidental pediatric scald burns in a tertiary care center: hot cauldron burns versus accidental spill burns

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 1086
Author(s):  
Kiran Kishor Nakarmi ◽  
Bishnu Deep Pathak ◽  
Dhan Shrestha ◽  
Pravash Budhathoki ◽  
Shankar Man Rai
Keyword(s):  
Regression Analysis ◽  
Multinomial Logistic Regression ◽  
Care Center ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Secondary Data ◽  
Cross Sectional Study ◽  
Tertiary Care Center ◽  
Cross Sectional ◽  
Multinomial Logistic Regression Analysis

Background: Scald burns result from exposure to high-temperature fluids and are more common in the pediatric age group. They occur mainly by two mechanisms: (i) spill and (ii) immersion (hot cauldron) burns. These two patterns differ in clinical characteristics and outcomes. Scalds cause significant morbidity and mortality in children. The objective of this study was to compare accidental spill burns and hot cauldron burns in a hospital setting. Methods: An analytical cross-sectional study was conducted by reviewing the secondary data of scald cases admitted during the years 2019 and 2020 in a burn-dedicated tertiary care center. Total population sampling was adopted. Data analysis was done partly using SPSS, version-23, and Stata-15. Mann Whitney U-test and Chi-square/Fisher's exact test were done appropriately to find associations between different variables. Regression analysis was performed taking mortality events as the outcome of interest. Results: Out of 108 scald cases, 43 (39.8%) had hot cauldron burns and 65 (60.2%) had accidental spill burns. Overall mortality was 16 (14.8%), out of which hot cauldron burns and accidental spill burns comprised 12 (75.0%) and 4 (25.0%), respectively. Multinomial logistic regression analysis showed the type of scald, age, and Baux score found to be associated with mortality. Every one-year increment in age had a 29% lower odds of occurrence of mortality event (adjusted odds ratio [OR], 0.71; 95% confidence interval [CI], 0.50-0.99, p=0.042). Likewise, every one-point increment in Baux score was associated with 19% higher odds of mortality (adjusted OR, 1.190; 95% CI, 1.08-1.32; p<0.001). Conclusions: Accidental spill burns were more common but mortality was significantly higher for hot cauldron burns. The majority of burn injuries occurred inside the kitchen emphasizing appropriate parental precautions. The risk of mortality was significantly higher in burn events occurring outside the house, and burns involving back, buttocks, perineum, and lower extremities.

scholarly journals High Frequency of Depressive Symptoms among Adults with Epilepsy: Results from a Hospital-based Study

2017 ◽  
Vol 08 (S 01) ◽  
pp. S013-S019
Author(s):  
Syam C. Chandrasekharan ◽  
Vikas Menon ◽  
Vaibhav Wadwekar ◽  
Pradeep Pankajakshan Nair
Keyword(s):  
Depressive Symptoms ◽  
Statistical Analysis ◽  
Outpatient Clinic ◽  
Care Center ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Multivariate Regression Analysis ◽  
Care Hospital ◽  
Cross Sectional

ABSTRACT Context: Assessment of comorbid burden of depression and associated factors among adult people living with epilepsy (PWE) has the potential to inform clinical evaluation and management to improve outcomes. Aim: The aim of this study is to determine frequency of depressive symptoms and factors associated with it among PWE attending a tertiary care hospital. Setting and Design: This was a cross-sectional observational study conducted in the outpatient clinic of a tertiary care center. Subjects and Methods: One hundred and fifty patients with epilepsy were recruited between May 2016 and August 2016. For assessing depression, Tamil validated version of Patient Health Questionnaire-12 was used. Frequency of depression and its association with various sociodemographic and clinical factors were assessed. Statistical Analysis Used: Student t-test and Chi-square test for univariate analysis and logistic regression for multivariate analysis were used for statistical analysis. Results: Of the 150 subjects, 89 (59.3%) were males. Generalized tonic–clonic seizures were present in 131 people (87.3%). Genetic and unknown epilepsies contributed higher proportion (44.7%) as compared to structural epilepsies (37.3%). Majority (88%) were on one or two antiepileptic drugs. Thirty-one people (20.3%) had less than one seizure per year. Depressive symptoms were present in 95 patients (63.3%). In multivariate regression analysis, secondary generalized seizures and seizure frequency >1/month emerged as significant predictors of depression ([OR]: 5.48 [95% (CI): 1.35–22.28] and OR: 2.53 [95% CI: 1.11–5.75], respectively). Conclusion: Depression is prevalent in a majority of adult PWE. Hence, a routine screening for depression as part of comprehensive epilepsy care is advisable for PWE attending the outpatient clinic.

scholarly journals Knowledge and Attitude of Nursing Staff on Baby-friendly Hospital Initiative Practices in a Tertiary Hospital

2020 ◽  
Vol 9 (2) ◽  
pp. 87-91
Author(s):  
Smriti Mathema ◽  
Sabina Shrestha
Keyword(s):  
Nursing Staff ◽  
Care Center ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Structured Interview ◽  
Tertiary Hospital ◽  
Study Data ◽  
Baby Friendly Hospital Initiative ◽  
Knowledge And Attitude ◽  
The Right

Background: Within a hospital setting, health professionals play a key role in providing the right information on breastfeeding and often this source are the nurses who have the primary opportunity to counsel, support and educate mothers on breastfeeding. The Baby Friendly Health Initiative (BFHI) has helped to motivate facilities providing maternity and newborn services worldwide to better support breastfeeding. Objective: The aim of this study is to help identify the knowledge gaps on the BFHI practices among nursing staff in a tertiary care center in Kathmandu. Methodology: A total of 27 nursing staff who encounter pregnant women admitted in the hospital up until post-delivery discharge were selected for the study. Data on knowledge of baby-friendly hospital initiative and attitude towards breastfeeding practices was collected using a structured interview between October and December 2019. Statistical analysis was done using SPSS version 20. Results: Only 41% were acquainted with the ten steps to successful breastfeeding of BFHI, out of whom more than half (55%) had a good level of knowledge. Majority of the participants showed a fairly correct attitude towards BFHI practices, except for the belief that there is no harm in introducing pre-lacteal feeds to babies. The opinion on demand feeding and the time of introduction of complementary feeding seemed to vary.  Conclusion:  There is an urgent need to re-evaluate the present knowledge of our nursing staff and to ensure they impart the right information. The only way to achieve this is through advocacy and training to promote, support and protect breastfeeding.

scholarly journals 1548. Characterizing Cefepime Neurotoxicity: Experience from a Tertiary Care Center Performing β-lactam Therapeutic Drug Monitoring

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S565-S565
Author(s):  
Cara Nys ◽  
Natalie Hurst ◽  
Jiajun Liu ◽  
Kartikeya Cherabuddi ◽  
Nicole M Iovine ◽  
...  
Keyword(s):  
Renal Function ◽  
Trough Concentration ◽  
Additional Data ◽  
Care Center ◽  
Tertiary Care ◽  
Therapeutic Drug ◽  
High Likelihood ◽  
Serum Trough ◽  
Trough Concentrations ◽  
New Onset

Abstract Background Based on prior studies, elderly patients and those with renal dysfunction are prone to cefepime (CFP) toxicity. The toxicokinetics and toxicodynamics for CFP are not well established. Lamoth et al. reported a 50% probability of CFP neurotoxicity at a serum trough concentration of ≥22 mg/L, whereas Huwyler et al. observed CFP neurotoxicity when concentrations exceeded 35 mg/L. The objectives of this study were to quantify the incidence of CFP neurotoxicity and to assess the association between CFP concentrations and neurotoxicity. Methods We conducted a retrospective review between March 2016 and May 2018, of adult patients with serum CFP trough concentrations ≥25 mg/L. To be considered a CFP neurotoxicity case, patients were required to fulfill at least two of the NCI criteria for neurological toxicity such as, presence of new-onset confusion, delirium, or drowsiness. Following this, cases were classified as (1) high likelihood of toxicity (HLT) if they either had a neurology consult or EEG findings consistent with CFP toxicity and if their symptoms improved after discontinuation of CFP, (2) possible toxicity (PT) if neurology consult or EEG was absent or if we were unable to assess improvement after CFP was discontinued, or (3) nontoxicity (NT). Cases were independently reviewed by an ID pharmacist and physician. Additional data such as comorbidities, renal function, and use of anti-epileptics were collected. Results One hundred and forty-two patients were included in the analysis. Neurotoxicity (HLT+PT) related to CFP occurred in 18/142 (13%) patients; 67% (12/18) were considered HLT. The median age in the HLT cohort was 68 years (interquartile range [IQR], 57–74), with toxicity occurring a median of 6 days (IQR, 5–8) after starting CFP. At the time of neurotoxicity, HLT patients had diminished renal function with a median SCr of 1.6 mg/dL (IQR, 1.2–2.4) and a corresponding CrCl of 35.8 mL/minute (IQR, 19.2–50.9). The median CFP trough concentration in the HLT patients was 62 mg/L (IQR, 50–73) vs. 70mg/L (IQR, 41–115) in the PT and 42 mg/L (IQR, 31–61) in the NT groups. Conclusion Our data emphasize the need for careful dosing in older patients with renal insufficiency. Interestingly, our study reveals higher cefepime troughs (~3-fold higher) associated with neurotoxicity than previously reported. Disclosures All authors: No reported disclosures.

scholarly journals Population Pharmacokinetics and Use of Monte Carlo Simulation To Evaluate Currently Recommended Dosing Regimens of Ciprofloxacin in Adult Patients with Cystic Fibrosis

2001 ◽  
Vol 45 (12) ◽  
pp. 3468-3473 ◽  
Author(s):  
Megan J. Montgomery ◽  
Paul M. Beringer ◽  
Amir Aminimanizani ◽  
Stan G. Louie ◽  
Bertrand J. Shapiro ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Monte Carlo Simulation ◽  
Monte Carlo ◽  
Half Life ◽  
Volume Of Distribution ◽  
Therapeutic Drug ◽  
Serum Drug Concentration ◽  
Concentration Data ◽  
Drug Concentrations ◽  
Dosing Regimens

ABSTRACT Pharmacodynamic data on ciprofloxacin indicate that a target area under the concentration-time curve from 0 to 24 h (AUC0–24)/MIC ratio of ≥125 is necessary to achieve optimal bactericidal activity for the treatment of gram-negative pneumonia. The purpose of this prospective study was to (i) develop a pharmacokinetic (PK) model to be utilized for therapeutic drug monitoring (TDM) of ciprofloxacin and (ii) evaluate current ciprofloxacin dosing regimens for pneumonias in cystic fibrosis (CF) patients. Twelve adult CF patients received a single 400-mg dose of IV ciprofloxacin. Six blood samples were obtained over a 12-h interval. Serum drug concentrations were determined by high-pressure liquid chromotography and were fitted to one- and two-compartment models by using NPEM2. Ciprofloxacin MIC data for Pseudomonas aeruginosa were obtained from 1,213 CF patients enrolled in a large clinical trial. A Monte Carlo simulation was performed to estimate the fractional attainment of an AUC0–24/MIC ratio of ≥125. A two-compartment model best describes the serum drug concentration data. The mean fitted PK parameter values are volume of distribution in the central compartment, 0.29 liter/kg; volume of distribution at steady state, 1.1 liters/kg; total clearance, 0.34 liter/h/kg; distributional clearance, 0.89 liter/h/kg; half-life at α phase, 0.16 h; and half-life at β phase, 2.9 h. The overall fractional attainment of achieving an AUC0–24/MIC ratio of ≥125 against P. aeruginosa isolates with ciprofloxacin (400 mg every 12 h [q12h] and 8 qh) were 10 and 30%, respectively. A clinical breakpoint MIC of <0.5 μg/ml for susceptibility is suggested, based on an examination of the fractional attainment of the AUC0–24/MIC target at each MIC. The recommended doses of 400 mg q8h or q12h may be inadequate to treat an acute pulmonary exacerbation when given alone. The poor and variable AUC0–24/MIC ratios support the use of TDM to monitor and adjust the dosage to optimize the efficacy of ciprofloxacin therapy in these patients.

scholarly journals Comparison of accidental pediatric scald burns in a tertiary care center: hot cauldron burns versus accidental spill burns

F1000Research ◽  
2022 ◽  
Vol 10 ◽  
pp. 1086
Author(s):  
Kiran Kishor Nakarmi ◽  
Bishnu Deep Pathak ◽  
Dhan Shrestha ◽  
Pravash Budhathoki ◽  
Shankar Man Rai
Keyword(s):  
Regression Analysis ◽  
Care Center ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Secondary Data ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Binary Logistic Regression Analysis ◽  
Tertiary Care Center ◽  
Cross Sectional

Background: Scald burns result from exposure to high-temperature fluids and are more common in the pediatric age group. They occur mainly by two mechanisms: (i) spill and (ii) immersion (hot cauldron) burns. These two patterns differ in clinical characteristics and outcomes. Scalds cause significant morbidity and mortality in children. The objective of this study was to compare accidental spill burns and hot cauldron burns in a hospital setting. Methods: An analytical cross-sectional study was conducted by reviewing the secondary data of scald cases admitted during the years 2019 and 2020 in a burn-dedicated tertiary care center. Total population sampling was adopted. Data analysis was done partly using SPSS, version-23, and Stata-15. Mann Whitney U-test and Chi-square/Fisher's exact test were done appropriately to find associations between different variables. Binary regression analysis was performed taking mortality events as the outcome of interest. Results: Out of 108 scald cases, 43 (39.8%) had hot cauldron burns and 65 (60.2%) had accidental spill burns. Overall mortality was 16 (14.8%), out of which hot cauldron burns and accidental spill burns comprised 12 (75.0%) and 4 (25.0%), respectively. Binary logistic regression analysis showed the type of scald, age, and Baux score found to be associated with mortality. Every one-year increment in age had a 29% lower odds of occurrence of mortality event (adjusted odds ratio [OR], 0.71; 95% confidence interval [CI], 0.50-0.99, p=0.042). Likewise, every one-point increment in Baux score was associated with 19% higher odds of mortality (adjusted OR, 1.190; 95% CI, 1.08-1.32; p<0.001). Conclusions: Accidental spill burn was more common but mortality was significantly higher for hot cauldron burns. The risk of mortality was significantly higher in burn events occurring outside the house, and burns involving back, buttocks, perineum, and lower extremities.

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