scholarly journals Vancomycin Dosing and Monitoring in the Treatment of Cystic Fibrosis: Results of a National Practice Survey

2017 ◽  
Vol 22 (6) ◽  
pp. 406-411 ◽  
Author(s):  
Rebecca S. Pettit ◽  
Stacy J. Peters ◽  
Erin J. McDade ◽  
Kaci Kreilein ◽  
Radha Patel ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Trough Concentration ◽  
Pediatric Population ◽  
Area Under The Curve ◽  
Monitoring Strategy ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Monitoring Strategies ◽  
Cystic Fibrosis Foundation ◽  
Initial Starting

OBJECTIVES Vancomycin is commonly used in patients with cystic fibrosis (CF) to treat acute pulmonary exacerbations, but few guidelines exist to help dose and monitor patients. The objective of this study was to assess vancomycin use and monitoring strategies at Cystic Fibrosis Foundation (CFF)–accredited centers in hopes of developing and implementing vancomycin dosing and monitoring standards. METHODS An anonymous national cross-sectional survey of pharmacists affiliated with CFF-accredited pediatric and/or adult centers was performed by using Surveymonkey.com. The survey consisted of 3 sections: (1) CF Center Demographic Information (10 questions); 2) vancomycin use in pediatric CF patients (31 questions); and 3) vancomycin use in adult CF patients (29 questions); it was administered from March 9, 2015, to April 13, 2015. RESULTS The survey was completed by 31/69 (45%) pharmacists and 28 (90.3%) reported using vancomycin in the pediatric population. The most common initial starting dose for pediatric patients was 15 mg/kg/dose (57.1%) and every 6 hours was the most common dosing frequency (67.9%). The most common monitoring strategy was collection of a trough concentration (92.9%) with 57.7% of pharmacist targeting a range of 15 to 20 mg/L. The most common initial starting vancomycin dose in adults with CF was 15 mg/kg/dose (61.5%), and initial frequency of every 8 hours (73.1%). The most common monitoring strategy was a trough concentration (96.2%) with 83.3% of pharmacists reporting a goal trough range of 15 to 20 mg/L. CONCLUSIONS The most common vancomycin dosing reported was 15 to 20 mg/kg/dose every 6 hours (pediatric) and 15 to 20 mg/kg/dose every 8 to 12 hours (adults). Serum concentrations measured to meet monitoring parameters of trough concentrations of 15 to 20 mg/L, or area under the curve to minimum inhibitory concentration ratio > 400, were the same in both pediatric and adult patients.

scholarly journals Tobramycin and Beta-Lactam Antibiotic Use in Cystic Fibrosis Exacerbations: A Pharmacist Approach

2016 ◽  
Vol 21 (3) ◽  
pp. 239-246 ◽  
Author(s):  
Jeffery T. Zobell ◽  
Kevin Epps ◽  
Frederick Kittell ◽  
Clarissa Sema ◽  
Erin J. McDade ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Initial Dosage ◽  
Area Under The Curve ◽  
Antibiotic Use ◽  
Beta Lactam ◽  
Beta Lactams ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Maximum Serum ◽  
Lactam Antibiotic

OBJECTIVES: Survey suggests that recommended doses and dosage regimens for antipseudomonal antibiotics for the treatment of acute pulmonary exacerbations in cystic fibrosis (CF) patients are not used, and one way to address these disparities is the involvement of pharmacists who are dedicated to CF. This is the first survey specifically designed for pharmacists at Cystic Fibrosis Foundation (CFF)–accredited centers to identify how tobramycin and antipseudomonal beta-lactams are being used. The purpose of this survey is to quantify this information and to promote future study to allow for implementation of tobramycin and beta-lactam dosage and monitoring standardization. METHODS: An anonymous national cross-sectional survey of pharmacists that are affliated with CFF-accredited programs was performed using Qualtrics.com. RESULTS: The survey had a 48.5% response rate. Most pediatric pharmacists (78.6%) report using extended-interval tobramycin dosage. The most common reported starting dosage was 10 mg/kg every 24 hours; most centers aim for a maximum serum concentration (Cmax) between 20 and 40 mg/L (78.6%). A total of 26 adult pharmacists reported using extended-interval dosage (96%), using an initial dosage of 10 mg/kg/day. The most common parameters used to adjust dosage were Cmax and area under the curve (AUC; 31%); the Cmax goal was 20 to 40 mg/L (84.2%). Most respondents (79%) report using beta-lactams in combination with tobramycin. Extended-infusion and continuous-infusion beta-lactams were used more in adults than pediatric patients. CONCLUSIONS: Most CF pharmacists report using extended-interval tobramycin. With the information from this survey, the establishment of future consensus recommendations by pharmacists for optimal and consistent tobramycin and antipseudomonal beta-lactam dosage and monitoring strategies needs to be considered.

scholarly journals The Economic Cost of Diet and Its Association with Adherence to the Mediterranean Diet in a Cohort of Spanish Primary Schoolchildren

2021 ◽  
Vol 18 (3) ◽  
pp. 1282
Author(s):  
Rosario Pastor ◽  
Noemi Pinilla ◽  
Josep A. Tur
Keyword(s):  
Mediterranean Diet ◽  
Fast Food ◽  
Area Under The Curve ◽  
Economic Cost ◽  
Food Prices ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Old Spanish ◽  
Total Economic Cost ◽  
Data Frequency

Background: Adoption of a certain dietary pattern is determined by different factors such as taste, cost, convenience, and nutritional value of food. Objective: To assess the association between the daily cost of a diet and its overall quality in a cohort of 6–12-year-old Spanish schoolchildren. Methods: A cross-sectional survey was conducted on a cohort (n = 130; 47% female) of 6–12-year-old children schooled in primary education in the central region of Spain. Three-day 24 h records were administered, and the nutritional quality of the diet was also determined by means of Mediterranean Adequacy Index (MAI). A questionnaire on sociodemographic data, frequency of eating in fast-food restaurants, and supplement intake were also recorded. The person responsible for the child’s diet and the schooler himself completed the questionnaires, and homemade measures were used to estimate the size of the portions. Food prices were obtained from the Household Consumption Database of the Spanish Ministry of Agriculture, Fisheries and Food. The economic cost of the diet was calculated by multiplying the amount in grams of the food consumed by each child by the corresponding price in grams and adding up the total amount for each participant. The total economic cost of the diet was calculated in €/day and in €/1000 kcal/day. Results: The area under the curve (AUC) for €/day and €/1000 kcal/day represent 62.6% and 65.6%, respectively. According to AUC values, adherence to Mediterranean diet (MD) is a moderate predictor of the monetary cost of the diet. A direct relationship between the cost of the diet and the adherence to MD was observed [OR (€/1000 kcal/day) = 3.012; CI (95%): 1.291; 7.026; p = 0.011]. Conclusions: In a cohort of Spanish schoolchildren with low adherence to the MD, a higher cost of the diet standardized to 1000 kcal was associated with above-average MAI values.

scholarly journals PvMSP8 as a Novel Plasmodium vivax Malaria Sero-Marker for the Peruvian Amazon

Pathogens ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 282
Author(s):  
Elizabeth Villasis ◽  
Katherine Garro ◽  
Angel Rosas-Aguirre ◽  
Pamela Rodriguez ◽  
Jason Rosado ◽  
...  
Keyword(s):  
Plasmodium Vivax ◽  
Area Under The Curve ◽  
Surface Protein ◽  
Merozoite Surface Protein ◽  
Population Based ◽  
Peruvian Amazon ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Malaria Exposure ◽  
Plasmodium Vivax Malaria

The measurement of recent malaria exposure can support malaria control efforts. This study evaluated serological responses to an in-house Plasmodium vivax Merozoite Surface Protein 8 (PvMSP8) expressed in a Baculovirus system as sero-marker of recent exposure to P. vivax (Pv) in the Peruvian Amazon. In a first evaluation, IgGs against PvMSP8 and PvMSP10 proteins were measured by Luminex in a cohort of 422 Amazonian individuals with known history of Pv exposure (monthly data of infection status by qPCR and/or microscopy over five months). Both serological responses were able to discriminate between exposed and non-exposed individuals in a good manner, with slightly higher performance of anti-PvMSP10 IgGs (area under the curve AUC = 0.78 [95% CI = 0.72–0.83]) than anti-PvMSP8 IgGs (AUC = 0.72 [95% CI = 0.67–0.78]) (p = 0.01). In a second evaluation, the analysis by ELISA of 1251 plasma samples, collected during a population-based cross-sectional survey, confirmed the good performance of anti-PvMSP8 IgGs for discriminating between individuals with Pv infection at the time of survey and/or with antecedent of Pv in the past month (AUC = 0.79 [95% CI = 0.74–0.83]). Anti-PvMSP8 IgG antibodies can be considered as a good biomarker of recent Pv exposure in low-moderate transmission settings of the Peruvian Amazon.

Chronic rhino-sinusitis treatment in children with cystic fibrosis: A cross-sectional survey of pediatric pulmonologists and otolaryngologists

2019 ◽  
Vol 124 ◽  
pp. 139-142 ◽  
Author(s):  
Anne S. Lowery ◽  
Jean-Nicolas Gallant ◽  
Bradford A. Woodworth ◽  
Rebekah F. Brown ◽  
Gregory S. Sawicki ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Chronic Rhino Sinusitis

scholarly journals The Finnish Diabetes Risk Score Is Associated with Insulin Resistance and Progression towards Type 2 Diabetes

2009 ◽  
Vol 94 (3) ◽  
pp. 920-926 ◽  
Author(s):  
Peter E. H. Schwarz ◽  
Jiang Li ◽  
Manja Reimann ◽  
Alta E. Schutte ◽  
Antje Bergmann ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Cohort Study ◽  
Glucose Tolerance ◽  
Area Under The Curve ◽  
Diabetes Risk ◽  
Operating Characteristics ◽  
Cross Sectional Survey ◽  
Cross Sectional

Abstract Objective: The Finnish Diabetes Risk Score (FINDRISC) questionnaire is a practical screening tool to estimate the diabetes risk and the probability of asymptomatic type 2 diabetes. In this study we evaluated the usefulness of the FINDRISC to predict insulin resistance in a population at increased diabetes risk. Design: Data of 771 and 526 participants in a cross-sectional survey (1996) and a cohort study (1997–2000), respectively, were used for the analysis. Data on the FINDRISC and oral glucose tolerance test parameters were available from each participant. The predictive value of the FINDRISC was cross-sectionally evaluated using the area under the curve-receiver operating characteristics method and by correlation analyses. A validation of the cross-sectional results was performed on the prospective data from the cohort study. Results: The FINDRISC was significantly correlated with markers of insulin resistance. The receiver operating characteristics-area under the curve for the prediction of a homeostasis model assessment insulin resistance index of more than five was 0.78 in the cross-sectional survey and 0.74 at baseline of the cohort study. Moreover, the FINDRISC at baseline was significantly associated with disease evolution (P < 0.01), which was defined as the change of glucose tolerance during the 3 yr follow-up. Conclusions: The results indicate that the FINDRISC can be applied to detect insulin resistance in a population at high risk for type 2 diabetes and predict future impairment of glucose tolerance.

scholarly journals Clinical, genetic and microbiological characterization of pediatric patients with Cystic Fibrosis in a Public Hospital in Ecuador

2020 ◽  
Author(s):  
Yazmina Lascano-Vaca ◽  
Esteban Ortiz-Prado ◽  
Lenin Gomez-Barreno ◽  
Katherine Simbaña-Rivera ◽  
Eduardo Vasconez ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Public Hospital ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Clinical Genetic ◽  
Cross Sectional ◽  
Genetic Feature ◽  
Bacteriological Profile ◽  
Sectional Analysis

Abstract Background: To carry out a complete clinical, pathological, genetic and microbiological characterization of pediatric patients with molecular confirmed cystic fibrosis (CF) attending the Carlos Andrade Marín Hospital (HCAM) within the study period. Methods: A cross-sectional analysis of the pediatric population with a confirmed diagnosis of CF disease who attended HCAM , one of the largest tertiary-level hospitals in Ecuador, between 2017 and 2018 was performed. All demographic, clinical and genetic variables were obtained from the electronic medical records (EMR) stored by the hospital. Results: 47 patients with CF were included in the study. Gender distribution was similar between male (48.9%, n = 23) and female patients (51.1%, n = 24). The Tiffeneau-Pinelli index (FEV 1 /FVC) changed significantly after nine months post-diagnosis (85.55 ± 13.26; p < 0.05). The most common pathogenic genetic variants were F508del, found in 52.78% of the cohort (n = 19); H609R, found in 36.11% (n = 13); g.204099A>C, found in 14.1% (n = 7), followed by G85E and the N1303K with 11.11% (n = 3) each. Conclusions: To our best knowledge, this is the first study exploring the clinical, genetic and bacteriological profile of CF’s patients in Ecuador. Within the cohort of patients, an important and unique genetic feature was characterized by the presence of the g.204099A> C and the c.206359C>A homozygous polymorphism as well as the presence of the H609R variant, a mutation only reported among Ecuadorians.

scholarly journals Understanding of and Barriers to Electronic Health Record Patient Portal Access in a Culturally Diverse Pediatric Population (Preprint)

2018 ◽  
Author(s):  
Daniel J Miklin ◽  
Sameera S Vangara ◽  
Alan M Delamater ◽  
Kenneth W Goodman
Keyword(s):  
Culturally Diverse ◽  
Parental Education ◽  
Pediatric Population ◽  
Patient Portal ◽  
Cross Sectional Survey ◽  
Adult Care ◽  
Cross Sectional ◽  
Parental Education Level ◽  
Doctor Patient Communication ◽  
Electronic Health

BACKGROUND Electronic health records (EHRs) have become a standard in the health care setting. In an effort to improve health literacy, foster doctor-patient communication, and ease the transition from adolescent to adult care, our institution created a policy that allows patients aged between 13 and 17 years to have EHR portal access. A literature review revealed predictable differences in portal registration among different ethnicities and socioeconomic statuses. Consequently, a cross-sectional survey was developed to investigate barriers to EHR portal access in a sample of culturally diverse adolescents. OBJECTIVE The aim of this study was to assess for barriers to EHR portal access in a culturally diverse adolescent population. METHODS A 42-item anonymous survey was completed by 97 adolescents aged between 13 and 18 years, attending general pediatrics clinics. The results were analyzed using descriptive statistics and t tests. RESULTS The average participant age was 15.5 (SD 1.5) years with 60% (58/97) male and 40% (39/97) female. Participants were 44% (43/97) black, 41% (40/97) Hispanic, 9% (9/97) Caucasian, 3% (3/97) Asian, and 2% (2/97) others. There were statistically significant differences in perceptions of confidentiality in age (13 to 15 years vs 16 to 18 years; P=.001) and insurance status (government vs private; P=.012) but not in gender, ethnicity, or parental education level. Younger adolescents with governmental insurance were more confident in the level of confidentiality with their physician. A total of 94% of participants had heard of the term EHR, but only 55% were familiar with its function. Furthermore, 77% of patients primarily accessed the internet through phones, and 50% of participants knew that patients aged under 18 years could obtain care for mental health, substance abuse, sexual health, and pregnancy. CONCLUSIONS This research has identified gaps in EHR technology with regard to the pediatric patient population. The results of our survey show that adolescents may have misconceptions regarding the doctor-patient relationship, their ability to obtain care, and the modalities present in an EHR. As technology progresses, it is essential to have a deeper understanding of adolescents’ perceptions of confidentiality, technology, and available resources to design an EHR system that encourages patient education and communication while limiting barriers to care.

Global and Specific Disease-Related Information Needs of Cystic Fibrosis Patients and Their Families

PEDIATRICS ◽  
1990 ◽  
Vol 85 (6) ◽  
pp. 1015-1021
Author(s):  
Lesley D. Henley ◽  
Ivor D. Hill
Keyword(s):  
Cystic Fibrosis ◽  
Social Life ◽  
Information Needs ◽  
Medical Information ◽  
Family Members ◽  
Reproductive Capacity ◽  
Specific Information ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Information Index

A cross-sectional survey of 60 families with a child with cystic fibrosis was undertaken to assess how much family members wanted to be told about the illness, to determine specific information needs concerning selected medical and psychosocial topics, and to determine whether this information had been provided in the past. Self-administered index measures were designed for this purpose. Most family members wanted complete and comprehensive information about cystic fibrosis. A minority of family members claimed they had not received basic medical information. Fathers and siblings wanted more medical information than mothers and patients. The majority of parents and patients wanted a great deal more information on the possible effects of cystic fibrosis on the patient's career, social life, marriage, and reproductive capacity. In general, family members had been given more medical than psychosocial information. Index measures were independent of the effects of patients' age, Shwachman score, and period since diagnosis. Social class was significantly associated with fathers' index measures of their specific information needs and information not given previously.

scholarly journals Clinical, genetic and microbiological characterization of pediatric patients with Cystic Fibrosis in a Public Hospital in Ecuador

2019 ◽  
Author(s):  
Yazmina Lascano-Vaca ◽  
Esteban Ortiz-Prado ◽  
Lenin Gomez-Barreno ◽  
Katherine Simbaña-Rivera ◽  
Eduardo Vasconez ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Public Hospital ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Homozygous Mutation ◽  
Clinical Genetic ◽  
Cross Sectional ◽  
Bacteriological Profile ◽  
Sectional Analysis

Abstract Objective: To carry out a complete clinical, pathological, genetic and microbiological characterization of pediatric patients with molecular confirmed CF attending the Carlos Andrade Marín Hospital within the study period. Methods: A cross-sectional analysis of the pediatric population with a confirmed diagnosis of cystic fibrosis (CF) disease, who attended one of the largest tertiary-level hospitals in Ecuador between 2017 and 2018 was conducted. All demographic, clinical and genetic variables were obtained from the electronic medical records (EMR) stored by the hospital. Results: 47 patients with CF were included in the study. Gender distribution was similar between male (48.9%, n = 23) and female patients (51.1%, n = 24). The Tiffeneau-Pinelli index (FEV1/FVC) changed significantly after nine months post-diagnosis (85.55 ± 13.26; p <0.05). The most common pathogenic genetic mutations were F508del, found in 52.78% of the cohort (n = 19); H609R, found in 36.11% (n = 13); g.204099A>C, found in 14.1% (n = 7), followed by G85E and the N1303K with 11.11% (n = 3) each. Conclusions: To our best knowledge, this is the first study exploring the clinical, genetic and bacteriological profile of CF’s patients in Ecuador. Due to the lack of universal screening in the country, a large proportion of individuals are being diagnosed or misdiagnosed later than expected, jeopardizing their treatments and prognosis. It is relevant to establish that the presence of the g.204099A> C and the c.206359C>A homozygous mutation variants have only been reported among Ecuadorians. These patients appear to show a less severe CF disease and a better prognosis.

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