scholarly journals TRENDS IN PRESCRIPTION PATTERN IN MEDICAL INDIAN ICU AND IT’S IMPACT ON PATIENT OUTCOME

2022 ◽  
pp. 50-56
Author(s):  
VENKAT RAMAN KOLA ◽  
MEDA HEMASREE ◽  
SHARON ROSE KISHORE
Keyword(s):  
Patient Outcomes ◽  
Respiratory Diseases ◽  
Antimicrobial Agents ◽  
Prescribing Pattern ◽  
Prescription Pattern ◽  
Drug Classes ◽  
Common Causes ◽  
Male Patients ◽  
The Mean ◽  
Improve Patient

Objective: The objective of this study is to evaluate the trends in prescribing pattern in medical ICU concerning patient age, gender, past, and current illness along with comorbidities for the evasion of polypharmacy and to improve patient outcomes. Methods: A prospective analysis of the case records of patients admitted to the ICU of Yashoda hospital in India was carried out.  Results: 120 patients were evaluated, consisting of 77% male patients. The mean±SD of age is 53.81±14.63. The majority of the study subjects belonged to the age group of 50-67 y (32%) Most common causes for admission to the ICU were Respiratory diseases and Stroke. Diabetes mellitus and Hypertension are the most common co-morbidities identified. The total number of drugs used were 1502 during this study period. The average number of drugs per prescription is 12. The range is between 2-30. The average number of antibiotics per prescription is 3. Commonly prescribed drug classes were the GI agents in 100% of patients, followed by antimicrobial agents (AMAs) in 95.8% of patients. About 42.5% of patients received 3 antibiotics per day. 55 potential drug-drug interactions were interpreted in 46 patients. 30(55%) were moderate interactions 25(45%) were major interactions, which were addressed. De-escalation of antibiotics was seen in 29% of patients while escalation in 13%. The death rate is only 5% in our ICU setting. Conclusion: This prescription pattern study can provide a framework for continuous prescription audit in the ICU 

scholarly journals 028 Delayed CT imaging leading to delays in acute stroke management in regional australia

2019 ◽  
Vol 90 (e7) ◽  
pp. A10.2-A10
Author(s):  
Udit Nindra ◽  
Toni M Wonson ◽  
Karen Fuller
Keyword(s):  
Acute Stroke ◽  
Patient Outcomes ◽  
Ct Imaging ◽  
Stroke Management ◽  
Endovascular Thrombectomy ◽  
Positive Correlation ◽  
Service Delays ◽  
The Mean ◽  
Regional Australia ◽  
Improve Patient

IntroductionUrgent CT imaging is crucial for acute stroke management to allow for timely thrombolysis and early referral to a peripheral endovascular thrombectomy (ECR) service. Delays in CT imaging are suspected to correlate with lengthening door-to-needle time (DNT) and arrival-to-referral time (ART) in regional Australia.Methods and resultsWe retrospectively analysed 656 acute stroke admissions between 2016 and 2018 to determine mean DNT and ART in addition to influencing factors such as age, gender, onset to arrival time & baseline National Institute of Health Stroke Scale (NIHSS) score. Over 3 years, 70 patients underwent thrombolysis and 56 ECR. The mean DNT was 108 minutes with mean arrival to CT time of 30 minutes. Multiple linear regression displayed a positive correlation between arrival to CT time and DNT (p<0.01). For every 10-minute delay in CT imaging, there was a 6-minute delay in DNT (95% CI 2 – 11 minutes). The mean ART was 150 minutes. A positive correlation was again seen between ART and arrival to CT Time (p=0.02). For every 10-minute delay in CT imaging, there was a 9-minute delay in ART (95% CI 1 – 16 minutes).ConclusionsIt is known that early initiation of both thrombolysis and ECR are associated with positive patient outcomes. There is a need to reduce time taken to complete CT imaging in regional Australia, as it is clearly shown to be associated with lengthened time for treatment initiation and timely referral. Reduction in this arrival to CT time will likely improve patient outcomes.

scholarly journals Cystic Fibrosis: Recent Insights into Inhaled Antibiotic Treatment and Future Perspectives

Antibiotics ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 338
Author(s):  
Giovanni Taccetti ◽  
Michela Francalanci ◽  
Giovanna Pizzamiglio ◽  
Barbara Messore ◽  
Vincenzo Carnovale ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Patient Outcomes ◽  
Respiratory Diseases ◽  
Antimicrobial Agents ◽  
High Concentration ◽  
Infection Treatment ◽  
Inhaled Antibiotics ◽  
Lung Infections ◽  
Pulmonary Exacerbations

Although new inhaled antibiotics have profoundly improved respiratory diseases in cystic fibrosis (CF) patients, lung infections are still the leading cause of death. Inhaled antibiotics, i.e., colistin, tobramycin, aztreonam lysine and levofloxacin, are used as maintenance treatment for CF patients after the development of chronic Pseudomonas aeruginosa (P. aeruginosa) infection. Their use offers advantages over systemic therapy since a relatively high concentration of the drug is delivered directly to the lung, thus, enhancing the pharmacokinetic/pharmacodynamic parameters and decreasing toxicity. Notably, alternating treatment with inhaled antibiotics represents an important strategy for improving patient outcomes. The prevalence of CF patients receiving continuous inhaled antibiotic regimens with different combinations of the anti-P. aeruginosa antibiotic class has been increasing over time. Moreover, these antimicrobial agents are also used for preventing acute pulmonary exacerbations in CF. In this review, the efficacy and safety of the currently available inhaled antibiotics for lung infection treatment in CF patients are discussed, with a particular focus on strategies for eradicating P. aeruginosa and other pathogens. Moreover, the effects of long-term inhaled antibiotic therapy for chronic P. aeruginosa infection and for the prevention of pulmonary exacerbations is reviewed. Finally, how the mucus environment and microbial community richness can influence the efficacy of aerosolized antimicrobial agents is discussed.

scholarly journals Clinical Complications of Hemoglobinopathies in Western Saudi Arabia and the Need for Specialized Care Centers

2019 ◽  
Vol 26 (1) ◽  
pp. 29-36
Author(s):  
Maha A. Badawi ◽  
Soheir Adam ◽  
Abdulrahman Ghoneim ◽  
Ahmed Jamjoom ◽  
Ahmed Sahly ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Patient Outcomes ◽  
Ferritin Level ◽  
University Hospital ◽  
Clinical Complications ◽  
Specialized Care ◽  
King Abdulaziz University ◽  
The Mean ◽  
Record Review ◽  
Improve Patient

In the absence of specialized care centers for hemoglobinopathies in Saudi Arabia, there are insufficient data on prevalence of clinical complications in this population. This is a retrospective record review about the clinical complications associated with hemoglobinopathies at King Abdulaziz University Hospital, for patients followed between January 1st 2010 through June 30th 2016. A total of 349 patients were included, with a mean age of 25.45 years, including 266 with sickle cell disease and 80 with thalassemia. Of those receiving regular transfusions, 17.5% developed alloantibodies, 16.6% tested positive for hepatitis C virus antibodies and the mean ferritin level was 2487 ng/ml. Almost half of the patients were screened for renal disease, and more than 50% were found to have proteinuria. Of 203 patients with recent echocardiograms, 15.8% had pulmonary hypertension. Thirty-one (8.9%) patients died at a mean age of 28.5 years. In conclusion, the prevalence of disease related complications is high in hemoglobinopathies. Our results reiterate the need for specialized care hemoglobinopathy centers, which can further improve patient outcomes.

A STUDY ON FREQUENCY OF ANTIBIOTIC DE-ESCALATION PRACTICES AND IMPLEMENTATION OF ANTIMICROBIAL STEWARDSHIP PROGRAMMES IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 56-59
Author(s):  
K.Ravi sankar
Keyword(s):  
Patient Outcomes ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Agents ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Healthcare Settings ◽  
Study Results ◽  
Outpatient Settings ◽  
Improve Patient

Introduction: De-escalation of empirical antibiotic therapy is an essential part of antimicrobial stewardship programmes. It involves streamlining antibiotics to lower broad-spectrum antibiotic exposure based on microbiological cultures. This leads to effective targeting of the causative pathogen and at the same time, reduce the development of resistant microorganisms. As antibiotic-resistant microorganisms have become a clinical challenge in both inpatient and outpatient settings, such practices are increasingly employed in healthcare settings. Aim: The study aims to promote and measure the use of an appropriate agent, dose, duration, and route of administration of antimicrobial agents in order to improve patient outcomes while minimizing adverse events, including toxicity. Methods:Aprospective observational study was conducted in a tertiary care hospital. The sample size was 500 patients. The study was performed from October 2019 to September 2020. The participant's details were collected from patient medical records. The data obtained was analysed with MS Excel and the study results were expressed in number and percentages. Results and discussion: The number of blood samples and cultures obtained during the study period was noted. In our study, the percentage of single antibiotic prescriptions was highest in July 2020 (68.75%) as compared to other months while multiple antibiotic prescriptions were highest in January 2020 (82.75%). The number of antibiotics continued after obtaining the culture report was highest in February (30) while the highest percentage was seen in August 2020 (89.65%). The percentage appropriate de-escalation was highest in the month of April (82.35%) while September saw the highest number of multiple antibiotic prescriptions (25). Conclusion: The present study revealed positive results towards antibiotic de-escalating practices in the clinical settings to improve patient outcomes and reduce the use of antimicrobials which, in turn, can contribute to slowing down the further development of antibiotic resistance in hospitals.

scholarly journals AB0316 MULTIPLE SWITCH BETWEEN BIOSIMILARS DMARDs (BSDMARDS) IN PATIENTS WITH INFLAMMATORY ARTHRITIDES: EXPERIENCE OF A SINGLE ITALIAN CENTRE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1457.1-1457
Author(s):  
M. Riva ◽  
V. Varisco ◽  
L. Riva ◽  
F. Rumi ◽  
M. R. Pozzi
Keyword(s):  
Disease Activity ◽  
Patient Outcomes ◽  
Respiratory Infections ◽  
Patient Consent ◽  
Daily Dose ◽  
Before And After ◽  
The Mean ◽  
Double Switch ◽  
Improve Patient ◽  
Automatic Switching

Background:The availability of bsDMARDs since some years represents an opportunity to improve patient access to effective biologic therapy, to better accommodate restraints within healthcare budgets and to improve overall patient outcomes. Different policies are followed in different countries to implement the use of bsDMARDs. Although the latest position paper of AIFA (Agenzia Italiana del Farmaco) envisions the automatic sostitution between the originator and biosimilar, until now the prescriber decision and the patient consent are strongly advised. The question around biosimilar to biosimilar switching is overlooked. Nevertheless different rules are established at regional level and in our Hospital automatic switching between originator/biosimilar and biosimilar/biosimilar was applied.Objectives:To analyze the efficacy and safety of switch from originator to biosimilar (O/B) and/or biosimilar to biosimilar (B/B) in patients with RA, PsA and SpA.Methods:We retrospectively analyzed in 63 patients (30 F, mean age 58.3 yr, 21 RA, 26 PsA, 16 SpA), treated with Infliximab, Etanercept and Adalimumab, disease activity (DAS28 CRP for RA, Tender/Swollen joint count for PsA, BASDAI for SpA, CRP for all) and adverse events/infections (AE). The time points considered were 3rdmonth before the switch and 3rdand 6thmonth after.Results:45 patients underwent sigle switch (35 O/B, 9 B/B) and 18 (28.5%) double switch (O/B/B). 27 B/B switch were done. No differences in disease activity were observed before and after switch (8 RA patients: mDAS28 CRP 2.86>3.23, 11 PsA patients: mTJ count 2.5 > 3.43, 8 SpA patients: BASDAI 2.88 > 2.84). The mean number of swollen joints was very low in PsA group and we decided to exclude this variable. The CRP level was low and stable along all period examined in the three groups. No increase in steroid daily dose, nor in concomitant DMARDs therapy was reported. In the Etanercept B/B switch (14 pts) the number of infections was the same before (3) and after (3). In Infliximab B/B switch (13 pts) 3 infections were reported only before the switch. The severity was mild/moderate with prevalence of respiratory infections (57%). No remarkable variation of transaminases and blood counts were observed.Conclusion:Althoug the population we examined was eterogeneous and quite small, we observed that the efficay and safety of Infliximab and Etanercept are maintained with biosimilar to biosimilar switch, also after double switch (originator>biosimilar>biosimilar). We also can confirm that the switch from originator to biosimilar Infliximab, Etanercept and Adalimumab is safe in our experience.Disclosure of Interests:None declared

Combined Approaches to the Skull Base for Intracranial Extension of Tumors via Perineural Spread can Improve Patient Outcomes

2016 ◽  
Vol 77 (S 01) ◽  
Author(s):  
Sheri Palejwala ◽  
Jonnae Barry ◽  
Crystal Rodriguez ◽  
Chandni Parikh ◽  
Stephen Goldstein ◽  
...  
Keyword(s):  
Skull Base ◽  
Patient Outcomes ◽  
Intracranial Extension ◽  
Perineural Spread ◽  
Improve Patient

Microporous Polysaccharide Hemosphere Absorbable Hemostat (AristaAH®) in Re-Operative Cardiac Surgical Procedures

2012 ◽  
Vol 9 (2) ◽  
pp. 96-98
Author(s):  
Brian A Bruckner ◽  
Matthias Loebe
Keyword(s):  
Patient Outcomes ◽  
Surgical Procedures ◽  
Systematic Approach ◽  
Surgical Intervention ◽  
Transfusion Requirement ◽  
Cardiac Surgical Procedures ◽  
Platelet Inhibitors ◽  
Hemostatic Agents ◽  
Surgical Field ◽  
Improve Patient

Patients undergoing re-operative cardiac surgical procedures present a great challenge with regard to obtaining hemostasis in the surgical field. Adhesions are ever-present and these patients are often on oral anti-coagulants and platelet inhibitors. As part of a well-planned surgical intervention, a systematic approach to hemostasis should be employed to decrease blood transfusion requirement and improve patient outcomes. Topical hemostatic agents can be a great help to the surgeon in achieving surgical field hemostasis and are increasingly being employed. Our approach, to these difficult patients, includes the systematic and planned use of AristaAH, which is a novel hemostatic agent whose use has proven safe and efficacious in our patient population.

Antimicrobial Effects of Zataria multiflora and Ocimum basilicum on Escherichia coli O157:H7 During Ripening of Traditional Lighvan Cheese

2020 ◽  
Vol 16 (3) ◽  
pp. 373-380
Author(s):  
Mohammad B. Zendeh ◽  
Vadood Razavilar ◽  
Hamid Mirzaei ◽  
Khosrow Mohammadi
Keyword(s):  
Escherichia Coli ◽  
Essential Oils ◽  
Dairy Products ◽  
Antimicrobial Agents ◽  
Escherichia Coli O157 ◽  
Zataria Multiflora ◽  
Antimicrobial Effects ◽  
E Coli ◽  
Common Causes ◽  
Lighvan Cheese

Background: Escherichia coli O157:H7 is one of the most common causes of contamination in Lighvan cheese processing. Using from natural antimicrobial essential oils is applied method to decrease the rate of microbial contamination of dairy products. The present investigation was done to study the antimicrobial effects of Z. multiflora and O. basilicum essential oils on survival of E. coli O157:H7 during ripening of traditional Lighvan cheese. Methods: Leaves of the Z. multiflora and O. basilicum plants were subjected to the Clevenger apparatus. Concentrations of 0, 100 and 200 ppm of the Z. multiflora and 0, 50 and 100 ppm of O. basilicum essential oils and also 103 and 105 cfu/ml numbers of E. coli O157:H7 were used. The numbers of the E. coli O157:H7 bacteria were analyzed during the days 0, 30, 60 and 90 of the ripening period. Results: Z. multiflora and O. basilicum essential oils had considerable antimicrobial effects against E. coli O157:H7. Using the essential oils caused decrease in the numbers of E. coli O157:H7 bacteria in 90th days of ripening (P <0.05). Using from Z. multiflora at concentration of 200 ppm can reduce the survival of E. coli O157:H7 in Lighvan cheese. Conclusion: Using Z. multiflora and O. basilicum essential oils as good antimicrobial agents can reduce the risk of foodborne bacteria and especially E. coli O157:H7 in food products.

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