2009 February 21

Economic evaluations of maintaining patient safety systems in teaching hospitals.

Feb 212009

Economic evaluations of maintaining patient safety systems in teaching hospitals.

Health Policy. 2008 Dec;88(2-3):381-91

Authors: Fukuda H, Imanaka Y, Hirose M, Hayashida K

OBJECTIVE: The aim of this study was to assess the status and the cost of hospital patient safety systems. METHODS: We conducted a national questionnaire survey of all the 1039 teaching hospitals in Japan. The study was constructed to evaluate the costs of the systems for patient safety focused on staff assignment, meetings and conferences, internal audit, staff education and training, incident reporting, infection surveillance, infectious disposal, management of medication use, clinical engineering, and patient counseling. RESULTS: The status to maintain patient safety systems might be at least as decent. The mean estimated total cost of systems for patient safety was US$ 20,449 (95% confidence interval [CI], 19,632-21,266) per 100 bed-months or US$ 8.52 (95% CI, 8.18-8.86) per inpatient-day. The ratio of costs to revenue was 1.68% (95% CI, 1.61-1.75). The annual necessary costs occurring in hospitals where the costs of patient safety were under the average level across all the 1032 teaching hospitals in Japan was US$ 259.7 million. CONCLUSIONS: Our results show that hospital-wide activities for patient safety pose significant costs to hospitals and national healthcare systems. Our data may provide financial information for designing and improving patient safety systems.

PMID: 18514966 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Treatment of critically ill patients with candidemia.

Int J Antimicrob Agents Start a Discussion »

Feb 212009

Treatment of critically ill patients with candidemia.

Int J Antimicrob Agents. 2008 Nov;32 Suppl 2:S93-7

Authors: Mensa J, Pitart C, Marco F

Early initiation of effective antimicrobial therapy is crucial for the prognosis of any infection, especially in the critically ill patient. This is particularly true in the case of candidemia. However, the earlier an empirical antimicrobial regimen is started, the greater the probability of diagnostic error and the possibility of side-effects. Recent experience of the clinical efficacy and good tolerance of echinocandins in the treatment of candidemia obliges us to review the indications for empirical antifungal treatment and the choice of antifungal agent in the critically ill patient.

PMID: 19013347 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Anidulafungin in the treatment of patients with invasive candidiasis.

Int J Antimicrob Agents Start a Discussion »

Feb 212009

Anidulafungin in the treatment of patients with invasive candidiasis.

Int J Antimicrob Agents. 2008 Nov;32 Suppl 2:S99-S102

Authors: Kett DH, Cubillos GF

Echinocandins have emerged as important agents for the treatment of invasive candidiasis. Forthcoming guidelines are expected to recommend an echinocandin agent as initial primary therapy in patients who are severely ill and/or have risk factors for azole resistance. Amphotericin B deoxycholate and fluconazole should be considered for initial therapy in specific populations. The echinocandin, anidulafungin, has been shown to have higher response rates compared with fluconazole in patients with invasive candidiasis. Additionally, patients treated with anidulafungin compared with patients receiving fluconazole have exhibited a trend toward improved survival. The three echinocandins (anidulafungin, caspofungin and micafungin) offer proven efficacy along with excellent side-effect profiles. While these three drugs have important differences, the empirical selection of an echinocandin should be based on the specific patient population, including clinical status, the suspected pathogen, and the susceptibility pattern at the institution. Once the Candida species is identified and its susceptibility is determined, clinicians should consider step-down therapy to either fluconazole or voriconazole, with possible conversion from intravenous to oral therapy.

PMID: 19013348 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Review article: The use of potentially hepatotoxic drugs in patients with liver disease.

Aliment Pharmacol Ther Start a Discussion »

Feb 212009

Review article: The use of potentially hepatotoxic drugs in patients with liver disease.

Aliment Pharmacol Ther. 2008 Nov 1;28(9):1021-41

Authors: Gupta NK, Lewis JH

BACKGROUND: Misconceptions surround the use of hepatotoxic drugs in chronic liver disease. While many prescription and over-the-counter (OTC) agents can be used safely, this often runs counter to labelled warnings/contraindications, especially for the statins and other commonly used agents. AIM: To evaluate published data on the use of hepatotoxic drugs in chronic liver disease including pharmacokinetic changes in cirrhosis and drug interactions, where available, to formulate recommendations on their use. METHODS: Using a combination of PubMed searches, review texts, the Physicians' Desk Reference and expert opinion, drugs considered at higher risk of hepatotoxicity in chronic liver disease were evaluated. RESULTS: Most drugs and OTC products including herbals have not been formally studied in chronic liver disease, but available data suggest that several of the most commonly used agents, especially the statins, can be used safely. While there is an increased risk of drug-induced liver injury for drugs used in the treatment of tuberculosis and HIV patients with hepatitis B or C, recommendations for their safe use are emerging. CONCLUSIONS: Although many clinicians remain hesitant to use hepatotoxic drugs in chronic liver disease, the database supporting this view is limited to just a few agents. Most medications can be used safely in patients with chronic liver disease with appropriate monitoring.

PMID: 18671777 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Review article: the evaluation of solitary liver masses.

Aliment Pharmacol Ther Start a Discussion »

Feb 212009

Review article: the evaluation of solitary liver masses.

Aliment Pharmacol Ther. 2008 Oct 15;28(8):953-65

Authors: Bahirwani R, Reddy KR

BACKGROUND: The increasing use of imaging modalities has led to the detection of more liver masses. The differential diagnosis of a focal liver mass includes a host of benign as well as malignant conditions. AIM: To provide a comprehensive review on the commonly encountered liver masses, and to help guide an approach to their evaluation and management. METHODS: Pertinent literature that was identified through PubMed search and senior author's experience formed the basis of this review. RESULTS: While most incidentally noted liver masses are benign, it may be difficult to differentiate them from those that are malignant. Furthermore, some benign lesions have malignant potential. Certain lesions such as focal nodular hyperplasia, haemangiomas and focal steatosis are often distinctly diagnosed by an imaging modality alone. The less frequently encountered hepatic adenomas are diagnosed radiologically in those with the appropriate clinical background and the absence of radiological features to suggest haemangioma or focal nodular hyperplasia. CONCLUSIONS: A reasonable approach to the diagnosis, follow-up and management of liver masses is based on a rudimentary knowledge of their presentation, associated clinical and laboratory features, natural history and available treatment options. Most often, the so called 'incidentalomas' are benign and require patient reassurance.

PMID: 18643922 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Long-term antihypertensive efficacy and safety of the oral direct renin inhibitor aliskiren: a 12-month randomized, double-blind comparator trial with hydrochlorothiazide.

Circulation Start a Discussion »

Feb 212009

Long-term antihypertensive efficacy and safety of the oral direct renin inhibitor aliskiren: a 12-month randomized, double-blind comparator trial with hydrochlorothiazide.

Circulation. 2009 Jan 27;119(3):417-25

Authors: Schmieder RE, Philipp T, Guerediaga J, Gorostidi M, Smith B, Weissbach N, Maboudian M, Botha J, van Ingen H

BACKGROUND: Diuretics are recommended as first-line agents for the treatment of hypertension. This randomized, double-blind, multicenter study assessed the long-term efficacy and safety of the direct renin inhibitor aliskiren in comparison with the diuretic hydrochlorothiazide in patients with essential hypertension. METHODS AND RESULTS: After a 2- to 4-week placebo run-in, 1124 patients (mean sitting diastolic blood pressure [BP] 95 to 109 mm Hg) were randomized to aliskiren 150 mg (n=459), hydrochlorothiazide 12.5 mg (n=444), or placebo (n=221) once daily. Forced titration (to aliskiren 300 mg or hydrochlorothiazide 25 mg) occurred at week 3; at week 6, patients receiving placebo were reassigned (1:1 ratio) to aliskiren 300 mg or hydrochlorothiazide 25 mg. From week 12, amlodipine 5 mg was added and titrated to 10 mg from week 18 for patients whose BP remained uncontrolled. Efficacy variables were analyzed for the intent-to-treat population with the use of the last observation carried forward method. BP reductions (mean sitting systolic BP/mean sitting diastolic BP) were significantly greater with aliskiren- versus hydrochlorothiazide-based treatment at week 26 (-20.3/-14.2 versus -18.6/-13.0 mm Hg; P<0.05) and were also greater at week 52 (-22.1/-16.0 versus -21.2/-15.0 mm Hg; P<0.05 for mean sitting diastolic BP). At the end of the monotherapy period (week 12), aliskiren 300 mg was superior to hydrochlorothiazide 25 mg in reducing BP (-17.4/-12.2 versus -14.7/-10.3 mm H; P<0.001). Adverse event rates were similar with aliskiren- (65.2%) and hydrochlorothiazide-based therapy (61.5%). Hypokalemia was more frequent with hydrochlorothiazide-based therapy than aliskiren-based therapy (17.9% versus 0.9%; P<0.0001). CONCLUSIONS: Aliskiren treatment, both as monotherapy and with optional addition of amlodipine, provided significantly greater BP reductions than the respective hydrochlorothiazide regimens. Aliskiren-based therapy was well tolerated. Direct renin inhibition with aliskiren therefore represents an effective option for the long-term treatment of essential hypertension.

PMID: 19139391 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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