scholarly journals Carbamazepine and carbamazepine-10, 11-epoxide therapeutic drug monitoring and biochemical and hematological evaluation in bipolar disorder outpatients

2021 ◽  
Vol 10 (11) ◽  
pp. e377101119640
Author(s):  
Luiz Carlos da Cunha ◽  
Ramias Vieira Calixto Freire ◽  
Carla Maria de Sousa Silva ◽  
Vania Cristina Rodriguez Salazar ◽  
Alessandro de Carvalho Cruz ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Therapeutic Monitoring ◽  
Therapeutic Drug ◽  
Biochemical Tests ◽  
Analytical Technique ◽  
The Public ◽  
Plasma Measurement ◽  
Validation Criteria ◽  
Hematological And Biochemical Parameters ◽  
Hematological Evaluation

The objective of this study was to validate an analytical technique with HPLC-PDA for plasma measurement of carbamazepine (CBZ) and its metabolite carbamazepine-10, 11-epoxide (CBZ-E) for therapeutic monitoring (TM) of patients diagnosed with bipolar disorder (BD), as well as evaluating hematological and biochemical parameters of patients using CBZ. Sixteen patients registered with the Public Service of Psychiatry were selected. CBZ and CBZ-E measurements were performed with HPLC-PDA shimadzu LC-20 AT Prominence, under concentration gradient. Validation criteria: selectivity, linearity, precision, accuracy, recovery, stability. Hematological and biochemical tests were performed using conventional methods. As a result, it was obtained: accuracy >85% and precision <15%, good selectivity, robustness and stability, LOQ = 250 ng.mL-1 and HQL = 60,000 ng.mL-1. Among patients, 25% and 6.25% had CBZ and CBZ-E levels within the therapeutic range, respectively. There were hematological and biochemical changes related to the drug. The validated method is reliable for its intended purpose. TM proved to be extremely useful for detecting therapeutic failure.

scholarly journals 182. Missed Opportunities to Discontinue Unnecessary Vancomycin During Pharmacist Therapeutic Monitoring

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S98-S98
Author(s):  
Corey J Medler ◽  
Mary Whitney ◽  
Juan Galvan-Cruz ◽  
Ron Kendall ◽  
Rachel Kenney ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Adverse Drug Events ◽  
Academic Medical Center ◽  
Total Duration ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Therapeutic Monitoring ◽  
Resistant Bacteria ◽  
Therapeutic Drug ◽  
Missed Opportunities

Abstract Background Unnecessary and prolonged IV vancomycin exposure increases risk of adverse drug events, notably nephrotoxicity, which may result in prolonged hospital length of stay. The purpose of this study is to identify areas of improvement in antimicrobial stewardship for vancomycin appropriateness by clinical pharmacists at the time of therapeutic drug monitoring (TDM). Methods Retrospective, observational cohort study at an academic medical center and a community hospital. Inclusion: patient over 18 years, received at least three days of IV vancomycin where the clinical pharmacy TDM service assessed for appropriate continuation for hospital admission between June 19, 2019 and June 30, 2019. Exclusion: vancomycin prophylaxis or administered by routes other than IV. Primary outcome was to determine the frequency and clinical components of inappropriate vancomycin continuation at the time of TDM. Inappropriate vancomycin continuation was defined as cultures positive for methicillin-susceptible Staphylococcus aureus (MRSA), vancomycin-resistant bacteria, and non-purulent skin and soft tissue infection (SSTI) in the absence of vasopressors. Data was reported using descriptive statistics and measures of central tendency. Results 167 patients met inclusion criteria with 38.3% from the ICU. SSTIs were most common indication 39 (23.4%) cases, followed by pneumonia and blood with 34 (20.4%) cases each. At time of vancomycin TDM assessment, vancomycin continuation was appropriate 59.3% of the time. Mean of 4.22 ± 2.69 days of appropriate vancomycin use, 2.18 ± 2.47 days of inappropriate use, and total duration 5.42 ± 2.94. 16.4% patients developed an AKI. Majority of missed opportunities were attributed to non-purulent SSTI (28.2%) and missed MRSA nares swabs in 21% pneumonia cases (table 1). Conclusion Vancomycin is used extensively for empiric treatment of presumed infections. Appropriate de-escalation of vancomycin therapy is important to decrease the incidence of adverse effects, decreasing hospital length of stay, and reduce development of resistance. According to the mean duration of inappropriate therapy, there are opportunities for pharmacy and antibiotic stewardship involvement at the time of TDM to optimize patient care (table 1). Missed opportunities for vancomycin de-escalation Disclosures All Authors: No reported disclosures

scholarly journals Standards of laboratory practice: cardiac drug monitoring

1998 ◽  
Vol 44 (5) ◽  
pp. 1096-1109 ◽  
Author(s):  
Roland Valdes ◽  
Saeed A Jortani ◽  
Mihai Gheorghiade
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Drug Monitoring ◽  
Free Fraction ◽  
Therapeutic Index ◽  
Therapeutic Monitoring ◽  
Therapeutic Drug ◽  
Laboratory Practice ◽  
Clinical Complications ◽  
The Impact

Abstract In this Standard of Laboratory Practice we recommend guidelines for therapeutic monitoring of cardiac drugs. Cardiac drugs are primarily used for treatment of angina, arrhythmias, and congestive heart failure. Digoxin, used in congestive heart failure, is widely prescribed and therapeutically monitored. Monitoring and use of antiarrhythmics such as disopyramide and lidocaine have been steadily declining. Immunoassay techniques are currently the most popular methods for measuring cardiac drugs. Several reasons make measurement of cardiac drugs in serum important: their narrow therapeutic index, similarity in clinical complications and presentation of under- and overmedicated patients, need for dosage adjustments, and confirmation of patient compliance. Monitoring may also be necessary in other circumstances, such as assessment of acetylator phenotypes. We present recommendations for measuring digoxin, quinidine, procainamide (and N-acetylprocainamide), lidocaine, and flecainide. We discuss guidelines for measuring unbound digoxin in the presence of an antidote (Fab fragments), for characterizing the impact of digoxin-like immunoreactive factor (DLIF) and other cross-reactants on immunoassays, and for monitoring the unbound (free fraction) of drugs that bind to α1-acid glycoprotein. We also discuss logistic, clinical, hospital, and laboratory practice guidelines needed for implementation of a successful therapeutic drug monitoring service for cardiac drugs.

Therapeutic Drug Monitoring: Psychotropic Drugs

1989 ◽  
Vol 2 (6) ◽  
pp. 403-415 ◽  
Author(s):  
Randall D. Seifert
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Antipsychotic Drugs ◽  
Practical Knowledge ◽  
Therapeutic Monitoring ◽  
Therapeutic Drug ◽  
Clinical Use ◽  
Careful Patient ◽  
Recovery Expectations ◽  
Positive Results

The therapeutic monitoring of patients who take antipsychotic drugs can be both challenging and rewarding. Antipsychotics have been in clinical use for over 30 years; yet, their complex pharmacology is not fully understood and parallels our infant knowledge of human brain chemistry. The art of successful therapeutic drug monitoring depends on the clinician's knowledge of basic pharmacology, an understanding of psychiatric disorders, and a sensitivity for careful patient observation. In addition, a thorough history, well thought out goals, and reasonable recovery expectations are essential. Antipsychotic drugs are never curative and should be used judiciously for indications where positive results outweigh the risks of adverse effects. This article will provide the reader with sound, practical knowledge of how to monitor these drugs in any clinical setting. © 1989 by W.B. Saunders Company.

Therapeutic drug and cardiovascular disease risk monitoring in patients with bipolar disorder

2007 ◽  
Vol 102 (1-3) ◽  
pp. 145-151 ◽  
Author(s):  
Amy M. Kilbourne ◽  
Edward P. Post ◽  
Mark S. Bauer ◽  
John E. Zeber ◽  
Laurel A. Copeland ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Bipolar Disorder ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Therapeutic Drug ◽  
Risk Monitoring

scholarly journals A retrospective study of a pre-travel consultation in the Lisbon Metropolitan Area, Portugal

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Galhano Lopes ◽  
M Bragança Pereira ◽  
M Machado Gil ◽  
S Duarte ◽  
A Moreira ◽  
...  
Keyword(s):  
Individual Characteristics ◽  
Yellow Fever Vaccine ◽  
Medical Community ◽  
Therapeutic Drug ◽  
Protective Measures ◽  
The Public ◽  
Related Risk ◽  
Medical Referral ◽  
The Impact

Abstract Background Travel from Portugal to other countries has increased in the past 5 years. A pre-travel health consultation is advised to all travellers to raise awareness and reduce travel-related risk. We describe the experience of a pre-travel consultation centre in the public health service. Methods A retrospective observational study about consultations in an international vaccination centre between 2014-2018. Variables included were: sex, age, destination, purpose, referral, and prescriptions. Descriptive analyses were performed for all variables. Results Between 2014 and 2018, there were 1,546 consultations. Regarding individual characteristics, 54% were female, and 80% had between 15 and 64 years of age. There was no referral in 66% of the consultations, followed by 16% from general practitioners in the Primary Care Centres Group. The leading destination was Africa (54%), in a downward trend (74% in 2015 and 32% in 2018) followed by Asia (18%) with an upward trend (12% to 28% in the same period). The primary purpose was tourism (83%), followed by work (9%). In total, 3,287 vaccines were prescribed with typhoid fever vaccine accounting for 26%, hepatitis A vaccine 22%, and yellow fever vaccine 15%. Mefloquine was the primary therapeutic drug prescribed for destinations with risk for malaria (41%). Regarding destinations with low risk for malaria, in 42% of the consultations, personal protective measures were the only recommendation. Conclusions Our data show that pre-travel consultations seem to be valued and actively asked for by travellers, but medical referral is still insufficient. Regarding health promotion and prevention of diseases, tracking trends in the most common destinations allows to optimize the information provided in the consultation, effectively capacitating the traveller to recognize and act on the most common travel-related health risks. In further studies, a post-travel follow-up should be carried out to determine the impact of the consultation. Key messages Pre-travel consultation is an actively sought-after service by the community, but awareness should be promoted in the medical community. Pre-travel consultation can have an important role in the health literacy of travellers.

Risk and coaggregation of major psychiatric disorders among first-degree relatives of patients with bipolar disorder: a nationwide population-based study

2018 ◽  
Vol 49 (14) ◽  
pp. 2397-2404 ◽  
Author(s):  
Mu-Hong Chen ◽  
Ju-Wei Hsu ◽  
Kei-Lin Huang ◽  
Tung-Ping Su ◽  
Cheng-Ta Li ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Psychiatric Disorders ◽  
Population Based ◽  
Autism Spectrum ◽  
The Public ◽  
First Degree Relatives ◽  
Relative Risks ◽  
Dependent Relationship ◽  
Increased Risk ◽  
Bipolar Patients

AbstractBackgroundBipolar disorder is a highly heritable mental illness that transmits intergeneratively. Previous studies supported that first-degree relatives (FDRs), such as parents, offspring, and siblings, of patients with bipolar disorder, had a higher risk of bipolar disorder. However, whether FDRs of bipolar patients have an increased risk of schizophrenia, major depressive disorder (MDD), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD) remains unclear.MethodsAmong the entire population in Taiwan, 87 639 patients with bipolar disorder and 188 290 FDRs of patients with bipolar disorder were identified in our study. The relative risks (RRs) of major psychiatric disorders were assessed among FDRs of patients with bipolar disorder.ResultsFDRs of patients with bipolar disorder were more likely to have a higher risk of major psychiatric disorders, including bipolar disorder (RR 6.12, 95% confidence interval (CI) 5.95–6.30), MDD (RR 2.89, 95% CI 2.82–2.96), schizophrenia (RR 2.64, 95% CI 2.55–2.73), ADHD (RR 2.21, 95% CI 2.13–2.30), and ASD (RR 2.10, 95% CI 1.92–2.29), than the total population did. These increased risks for major psychiatric disorders were consistent across different familial kinships, such as parents, offspring, siblings, and twins. A dose-dependent relationship was also found between risk of each major psychiatric disorder and numbers of bipolar patients.ConclusionsOur study was the first study to support the familial coaggregation of bipolar disorder with other major psychiatric disorders, including schizophrenia, MDD, ADHD, and ASD, in a Taiwanese (non-Caucasian) population. Given the elevated risks of major psychiatric disorders, the public health government should pay more attention to the mental health of FDRs of patients with bipolar disorder.

scholarly journals ANALISIS HASIL INVESTASI, PENDAPATAN PREMI, DAN BEBAN KLAIM TERHADAP LABA PERUSAHAAN PERASURANSIAN DI INDONESIA

2017 ◽  
Vol 5 (2) ◽  
pp. 213
Author(s):  
Sofyan Marwansyah ◽  
Ambar Novi Utami
Keyword(s):  
Linear Regression ◽  
Multiple Linear Regression ◽  
Significant Relationship ◽  
Secondary Data ◽  
Strong Relationship ◽  
Fund Raising ◽  
Analytical Technique ◽  
The Public ◽  
Investment Returns ◽  
Premium Income

Insurance is a fund raising agency sourced from the receipt of insurance premiums from the public and distributed by claims. In addition to premium receipts, the company also puts its funds in the form of investments. This aims of this paper is to analyze the investment returns, premium income, and claims expense to profit using partial correlation, determination and multiple linear regression. The methods that use to collects the data for this final task are using observation and study documentation using quantitative analysis. Analytical technique is multiple linear regression using IBM SPSS 21 software. The used data in this paper is secondary data that obtained from the website of Otoritas Jasa Keuangan. From the results of the correlation coefficient test partially obtained investment returns and premium income has a significant relationship to profit, a positive value of 0.657 and 0.737 means the relationship is strong and unidirectional whereas, claims load has a significant relationship to profit, negative value of -0.786 means strong relationship And counterclockwise, simultaneously (together) shows that investment returns, premium income, claims expenses have significant relationship to profit, and a positive value of 0.881. The result of determination coefficient test shows that there is a significant influence of 77.6% and the remaining 22.4% influenced by other factors. The regression equation formed is Y = -2,682 +  +  – 2,369 + e.

scholarly journals Evidence-based Implementation of Free Phenytoin Therapeutic Drug Monitoring

2000 ◽  
Vol 46 (8) ◽  
pp. 1132-1135 ◽  
Author(s):  
Martha Burt ◽  
David C Anderson ◽  
Julie Kloss ◽  
Fred S Apple
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Medical Center ◽  
Clinical Findings ◽  
Therapeutic Monitoring ◽  
Therapeutic Drug ◽  
Clinical Indicator ◽  
Interindividual Variations ◽  
Data Points ◽  
Pharmacologically Active

Abstract Background: The majority of laboratories measure total phenytoin concentration for therapeutic drug monitoring. However, there are substantial interindividual variations in free phenytoin concentrations, the pharmacologically active component. Methods: We describe the process and data used to implement monitoring of free phenytoin only in an urban medical center. Over a 6-week period, total and free phenytoin concentrations were measured, clinical charts reviewed, and indications for alterations in the percentage of free phenytoin fraction were determined. Results: Of the 189 phenytoin requests from 139 patients, 136 data points were analyzed. Free phenytoin concentrations were 6.8–35.3%, with 50% outside the expected range of 8–12%. Clinical indications likely responsible for variations were hypoalbuminemia, drug interactions, uremia, pregnancy, and age. Overall, 30% of patients demonstrated a discrepancy between therapeutic, subtherapeutic, or supratherapeutic concentrations between free and total phenytoin concentrations. The largest discordance (53%) occurred in the patient group with free phenytoin &lt;8% or &gt;12%. Conclusions: This study supports previous clinical findings that monitoring total phenytoin is not as reliable as free phenytoin as a clinical indicator for therapeutic and nontherapeutic concentrations. Thus, we recommend that therapeutic monitoring should use free phenytoin concentrations only.

Data Mining in Public Administration

2010 ◽  
pp. 302-314
Author(s):  
John Wang ◽  
Xiaohua Hu ◽  
Dan Zhu
Keyword(s):  
Data Mining ◽  
Nonprofit Organizations ◽  
Inductive Learning ◽  
Analytical Technique ◽  
The Public ◽  
Analytical Skills ◽  
Information Construction ◽  
Knowledge Rules ◽  
General Data ◽  
Analytical Technology

Data mining involves searching through databases for potentially useful information such as knowledge rules, patterns, regularities, and other trends hidden in the data. In order to complete these tasks, the contemporary data mining packages offer techniques such as neural networks, inductive learning decision trees, cluster analysis, link analysis, genetic algorithms, visualization, and so forth (Hand, Mannila, & Smyth, 2001; Wang, 2006). In general, data mining is a data analytical technique that assists businesses in learning and understanding their customers so that decisions and strategies can be implemented most accurately and effectively to maximize profitability. Data mining is not general data analysis, but a comprehensive technique that requires analytical skills, information construction, and professional knowledge. Businesses are now facing globalized competition and are being forced to deal with an enormous amount of data. The vast amounts of data and the increasing technological ability to store them also facilitated data mining. In order to gain a certain level of competitive advantage, businesses now commonly adopt a data analytical technology called data mining. Nowadays, data mining is more widely used than ever before, not only by businesses who seek profits, but also by nonprofit organizations, government agencies, private groups, and other institutions in the public sector. Organizations use data mining as a tool to forecast customer behavior, reduce fraud and waste, and assist in medical research.

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