scholarly journals Tolvaptan Use in SIAD (Syndrome of Inappropriate Antidiuresis)

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A615-A616
Author(s):  
Sushma Burri ◽  
Sathish Babu Parthasarathy
Keyword(s):  
Hospital Admission ◽  
Serum Sodium ◽  
Low Dose ◽  
Cost Effective ◽  
Cost Comparison ◽  
Fluid Restriction ◽  
Lung Pathology ◽  
Hospitalised Patients ◽  
Cost Effective Treatment ◽  
Inappropriate Antidiuresis

Abstract Background: SIAD (Syndrome of Inappropriate Antidiuresis) is the commonest cause of hyponatraemia in hospital inpatients. Hyponatraemia is associated with increased length of stay and worse primary clinical outcomes. Our study aimed to evaluate the effectiveness of Tolvaptan, a selective, non-peptide, Vasopressin receptor antagonist, treatment in hospitalised patients with SIAD. Method and Baseline Characteristics: A Retrospective analysis of 9 patients treated with Tolvaptan for a confirmed diagnosis of SIAD was carried out. Information was collected from the inpatient records and biochemical test results. Serum Sodium levels on admission ranged between 104- 124mmol/ L (Normal range 136 -145 mmol/L). Average inpatient days solely due to hyponatraemia was 24 days. The number of in-patient days on fluid restriction ranged from 8-22 days depending on timing of referral to endocrine department. Tolvaptan was only started at a stable serum sodium at 118 mmol/L or greater. Four patients also had a prior trial of demeclocycline. Tolvaptan was started at its smallest dose of 7.5mg OD under strict monitoring of serum sodium with locally agreed protocol. Aetiology of SIAD included lung malignancy, acute demyelinating polyneuropathy, listeria meningitis, autoimmune encephalitis, SSRI (Selective Serotonin Reuptake inhibitor) use, Aspergillosis and Idiopathic (n=3). Results: Serum sodium level improved to >128 mmol/L in 2 days of starting Tolvaptan in all cases. After discharge, there was remote virtual clinic monitoring from the endocrinology team at 2 weeks, 4- 6 weeks and 3 months with a view to stop the medication. No adverse events were observed during use of Tolvaptan in the patient population. Tolvaptan 7.5mg OD was either stopped completely after 4-6 weeks or switched to 7.5mg alternate days depending on the clinical course of underlying pathology. Average duration of Tolvaptan treatment was 4.5 months excluding one patient with chronic lung pathology. 3 patients had further hospital admission on stopping Tolvaptan treatment and treatment with Tolvaptan had to be re-initiated. Conclusion: This study confirms the efficacy of Tolvaptan use in SIAD related hyponatremia. Tolvaptan serves as a cost effective treatment option for hospitalised patients who have either failed to respond to demeclocycline or fluid restriction. In our case cohorts, cost comparison of Low dose Tolvaptan with retrospective calculation of total inpatient days of fluid restriction and use of demeclocycline showed a better outcome and clinical effectiveness with low dose Tolvaptan. We recommend earlier use of Tolvaptan in SIAD under guidance from specialist team as a safe, cost effective and in some cases, as a hospital admission-avoidance strategy.

scholarly journals MODEL-BASED COST-EFFECTIVENESS OF CONVENTIONAL AND INNOVATIVE CHEMO-RADIATION IN LUNG CANCER

2017 ◽  
Vol 33 (6) ◽  
pp. 681-690 ◽  
Author(s):  
Mathilda L. Bongers ◽  
Dirk de Ruysscher ◽  
Cary Oberije ◽  
Philippe Lambin ◽  
Carin A. Uyl-de Groot ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cost Effectiveness ◽  
Low Dose ◽  
Locally Advanced ◽  
Cost Effective ◽  
Effective Treatment Option ◽  
Life Years ◽  
Cost Effective Treatment ◽  
Nsclc Patients ◽  
The Impact

Introduction:Optimizing radiotherapy with or without chemotherapy through advanced imaging and accelerated radiation schemes shows promising results in locally advanced non–small-cell lung cancer (NSCLC). This study compared the cost-effectiveness of positron emission tomography-computed tomography based isotoxic accelerated sequential chemo-radiation (SRT2) and concurrent chemo-radiation with daily low-dose cisplatin (CRT2) with standard sequential (SRT1) and concurrent chemo-radiation (CRT1).Methods:We used an externally validated mathematical model to simulate the four treatment strategies. The model was built using data from 200 NSCLC patients treated with curative sequential chemo-radiation. For concurrent strategies, data from a meta-analysis and a single study were included in the model. Costs, utilities, and resource use estimates were obtained from literature. Primary outcomes were the incremental cost-effectiveness and cost-utility ratio (ICUR) of each strategy. Scenario analyses were carried out to investigate the impact of uncertainty.Results:Total undiscounted costs and quality-adjusted life-years (QALYs) for SRT1, CRT1, SRT2, and CRT2 were EUR 17,288, EUR 18,756, EUR 19,072, EUR 17,360 and QALYs 1.10, 1.15, 1.40, and 1.40, respectively. Compared with SRT1, the ICURs were EUR 38,024/QALY for CRT1, EUR 6,249/QALY for SRT2, and EUR 346/QALY for CRT2. CRT2 was highly cost-effective compared with SRT1. Moreover, CRT2 was more effective and less costly than CRT1 and SRT2. Therefore, these strategies were dominated by CRT2.Conclusion:Optimized sequential and concurrent chemo-radiation strategies are more effective and cost-effective than the current conventional sequential and concurrent strategies. Concurrent chemo-radiation with a daily low dose cisplatin regimen is the most cost-effective treatment option for locally advanced inoperable NSCLC patients.

Physical and Psychological Benefits of Written Emotional Expression

2015 ◽  
Vol 20 (4) ◽  
pp. 242-251 ◽  
Author(s):  
Éva Kállay
Keyword(s):  
Mental Health ◽  
Expressive Writing ◽  
Mental Health Problems ◽  
Cost Effective ◽  
Health Problems ◽  
Future Research ◽  
Psychological Benefits ◽  
Cost Effective Treatment ◽  
Meta Analyses

Abstract. The last several decades have witnessed a substantial increase in the number of individuals suffering from both diagnosable and subsyndromal mental health problems. Consequently, the development of cost-effective treatment methods, accessible to large populations suffering from different forms of mental health problems, became imperative. A very promising intervention is the method of expressive writing (EW), which may be used in both clinically diagnosable cases and subthreshold symptomatology. This method, in which people express their feelings and thoughts related to stressful situations in writing, has been found to improve participants’ long-term psychological, physiological, behavioral, and social functioning. Based on a thorough analysis and synthesis of the published literature (also including most recent meta-analyses), the present paper presents the expressive writing method, its short- and long-term, intra-and interpersonal effects, different situations and conditions in which it has been proven to be effective, the most important mechanisms implied in the process of recovery, advantages, disadvantages, and possible pitfalls of the method, as well as variants of the original technique and future research directions.

Predictors of response to fluid restriction in hyponatremic patients due to the syndrome of inappropriate antidiuresis

2015 ◽  
Author(s):  
Sophia Lengsfeld ◽  
Bettina Winzeler ◽  
Nicole Nigro ◽  
Isabelle Suter-Widmer ◽  
Philipp Schutz ◽  
...  
Keyword(s):  
Fluid Restriction ◽  
Predictors Of Response ◽  
Inappropriate Antidiuresis

scholarly journals Rationales and uncertainties for aspirin use in COVID-19: a narrative review

2021 ◽  
Vol 9 (2) ◽  
pp. e000741
Author(s):  
Hazem A Sayed Ahmed ◽  
Eric Merrell ◽  
Mansoura Ismail ◽  
Anwar I Joudeh ◽  
Jeffrey B Riley ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Low Dose ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Narrative Review ◽  
Cochrane Library ◽  
Atherosclerotic Cardiovascular Disease ◽  
Dose Aspirin ◽  
Hospitalised Patients ◽  
Low Dose Aspirin

ObjectivesTo review the pathophysiology of COVID-19 disease, potential aspirin targets on this pathogenesis and the potential role of aspirin in patients with COVID-19.DesignNarrative review.SettingThe online databases PubMed, OVID Medline and Cochrane Library were searched using relevant headlines from 1 January 2016 to 1 January 2021. International guidelines from relevant societies, journals and forums were also assessed for relevance.ParticipantsNot applicable.ResultsA review of the selected literature revealed that clinical deterioration in COVID-19 is attributed to the interplay between endothelial dysfunction, coagulopathy and dysregulated inflammation. Aspirin has anti-inflammatory effects, antiplatelet aggregation, anticoagulant properties as well as pleiotropic effects on endothelial function. During the COVID-19 pandemic, low-dose aspirin is used effectively in secondary prevention of atherosclerotic cardiovascular disease, prevention of venous thromboembolism after total hip or knee replacement, prevention of pre-eclampsia and postdischarge treatment for multisystem inflammatory syndrome in children. Prehospital low-dose aspirin therapy may reduce the risk of intensive care unit admission and mechanical ventilation in hospitalised patients with COVID-19, whereas aspirin association with mortality is still debatable.ConclusionThe authors recommend a low-dose aspirin regimen for primary prevention of arterial thromboembolism in patients aged 40–70 years who are at high atherosclerotic cardiovascular disease risk, or an intermediate risk with a risk-enhancer and have a low risk of bleeding. Aspirin’s protective roles in COVID-19 associated with acute lung injury, vascular thrombosis without previous cardiovascular disease and mortality need further randomised controlled trials to establish causal conclusions.

scholarly journals Risk of infection in antimicrobial-resistant Gram-negative bacteria carriers: A systematic review

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
G Arzilli ◽  
G Scardina ◽  
V Casigliani ◽  
M Moi ◽  
E Lucenteforte ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hospital Admission ◽  
Infection Rate ◽  
High Income ◽  
Attributable Mortality ◽  
Gram Negative Bacteria ◽  
Term Care ◽  
Gram Negative ◽  
Hospitalised Patients ◽  
Risk Of Progression

Abstract Background Antimicrobial-resistant Gram-negative bacteria (AMR-GNB) have emerged as important health care-associated pathogens. Infections with AMR-GNB are associated with high patient morbidity and attributable mortality. Colonization is a prerequisite for infection, however the extent to which colonized patients develop infection is unclear. This systematic review explored the risk of developing infection during hospitalisation among AMR-GNB faecal carriers. Also, we investigated the acquisition rate for AMR-GNB colonization among patients not colonized at admission. Methods We searched on PubMed, Scopus and Cochrane databases for studies published from 2010 up to April 2019. We included studies reporting on hospitalised patients ≥18 years old in high-income countries (excluding long-term care facilities). Results Out of 9496 articles, 55 studies fulfilled our inclusion criteria. Forty-two studies reported data from EU/EEA, 6 from USA and 7 from other regions. Almost all studies (n = 45) were conducted in university hospitals. Most studies (n = 41;74.5%) were performed in high-risk wards (ICU, haematology, burn units and transplant units). Out of 55 studies, 8 examined AMR-GNB, 27 Enterobacteriaceae, while the others investigated specific pathogens: Klebsiella spp. (n = 11), E. Coli (n = 2), A. Baumannii (n = 3) and P. Aeruginosa (n = 4). The rate of AMR-GNB carriage acquisition was 10.5% (n = 40 studies; 95% CI:8.2-13.1). The risk of progression to infection among patients colonized at hospital admission was 13.9% (n = 15; 5.4-24.9), while the infection rate in patients who acquired carriage during hospitalization was 23.0% (n = 7; 5.9-45.2). Patients with an undefined time of colonization presented an infection rate of 16.9% (n = 13; 11.2-23.4). Considering these three populations as a whole, the risk of developing infection was 16.0% (11.0-21.0). Conclusions Our results suggest that risk of progression to infection in AMR-GNB colonized patients in hospital setting is high. Key messages The aim of our study was to estimate the risk of progression to infection, during hospital stay, in patients colonized by AMR-GNB at hospital admission in high-income countries. Our results suggest that faecal colonization with AMR-GNB poses a 16.0% risk of subsequent AMR-GNB infection. This risk in higher (23.0%) in patients who acquired colonization during hospitalisation.

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