2011 December 13

The effect of a clinical pharmacist discharge service on medication discrepancies in patients with heart failure.

Dec 132011

The effect of a clinical pharmacist discharge service on medication discrepancies in patients with heart failure.

Pharm World Sci. 2010 Dec;32(6):759-66

Authors: Eggink RN, Lenderink AW, Widdershoven JW, van den Bemt PM

Abstract
OBJECTIVE: Heart failure patients are regularly admitted to hospital and frequently use multiple medication. Besides intentional changes in pharmacotherapy, unintentional changes may occur during hospitalisation. The aim of this study was to investigate the effect of a clinical pharmacist discharge service on medication discrepancies and prescription errors in patients with heart failure.
SETTING: A general teaching hospital in Tilburg, the Netherlands.
METHOD: An open randomized intervention study was performed comparing an intervention group, with a control group receiving regular care by doctors and nurses. The clinical pharmacist discharge service consisted of review of discharge medication, communicating prescribing errors with the cardiologist, giving patients information, preparation of a written overview of the discharge medication and communication to both the community pharmacist and the general practitioner about this medication. Within 6 weeks after discharge all patients were routinely scheduled to visit the outpatient clinic and medication discrepancies were measured.
MAIN OUTCOME MEASURE: The primary endpoint was the frequency of prescription errors in the discharge medication and medication discrepancies after discharge combined.
RESULTS: Forty-four patients were included in the control group and 41 in the intervention group. Sixty-eight percent of patients in the control group had at least one discrepancy or prescription error against 39% in the intervention group (RR 0.57 (95% CI 0.37-0.88)). The percentage of medications with a discrepancy or prescription error in the control group was 14.6% and in the intervention group it was 6.1% (RR 0.42 (95% CI 0.27-0.66)).
CONCLUSION: This clinical pharmacist discharge service significantly reduces the risk of discrepancies and prescription errors in medication of patients with heart failure in the 1st month after discharge.

PMID: 20809276 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Beta-blockers cause paracentesis-induced circulatory dysfunction in patients with cirrhosis and refractory ascites: a cross-over study.

J Hepatol Start a Discussion »

Dec 132011

Beta-blockers cause paracentesis-induced circulatory dysfunction in patients with cirrhosis and refractory ascites: a cross-over study.

J Hepatol. 2011 Oct;55(4):794-9

Authors: Sersté T, Francoz C, Durand F, Rautou PE, Melot C, Valla D, Moreau R, Lebrec D

Abstract
BACKGROUND & AIMS: In patients with cirrhosis and refractory ascites the role of beta-blockers in the development of paracentesis-induced circulatory dysfunction (PICD) is unknown. The aim of this study was to investigate the incidence of PICD before and after discontinuation of beta-blockers in patients with cirrhosis and refractory ascites. A self control cross-over study was performed.
METHODS: Patients with cirrhosis and refractory ascites treated with beta-blockers were selected. Heart rate, arterial pressure, and plasma renin concentrations (PRC) were collected before, immediately after and 1 week after large-volume paracentesis associated with intravenous albumin administration. Beta-blocker therapy was progressively discontinued after complete endoscopic eradication of varices. The clinical and biological evaluation was then repeated. The presence of PICD was defined as an increase in PRC of at least 50% above baseline 1 week after paracentesis.
RESULTS: Ten patients were included (nine men, mean age 59.1 ± 10.7 years old). The MELD score was 17.7 ± 4.4 and eight patients were Child-Pugh C. When patients were given beta-blockers, the heart rate did not change immediately after paracentesis while mean arterial pressure significantly decreased; PICD developed in eight patients. After beta-blockers were discontinued, the heart rate significantly increased immediately after paracentesis and mean arterial pressure significantly decreased; PICD only developed in one patient; the difference in the incidence of PICD was significant when these same patients were treated with beta-blockers.
CONCLUSIONS: The use of beta-blockers may be associated with a high risk of PICD in patients with cirrhosis and refractory ascites.

PMID: 21354230 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Reexpansion pulmonary edema after large-volume thoracentesis.

Ann Thorac Surg Start a Discussion »

Dec 132011

Reexpansion pulmonary edema after large-volume thoracentesis.

Ann Thorac Surg. 2011 Oct;92(4):1550-1

Authors: Lin YJ, Yu YH

PMID: 21958824 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis.

JAMA Start a Discussion »

Dec 132011

Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis.

JAMA. 2011 Nov 23;306(20):2248-54

Authors: Walkey AJ, Wiener RS, Ghobrial JM, Curtis LH, Benjamin EJ

Abstract
CONTEXT: New-onset atrial fibrillation (AF) has been reported in 6% to 20% of patients with severe sepsis. Chronic AF is a known risk factor for stroke and death, but the clinical significance of new-onset AF in the setting of severe sepsis is uncertain.
OBJECTIVE: To determine the in-hospital stroke and in-hospital mortality risks associated with new-onset AF in patients with severe sepsis.
DESIGN AND SETTING: Retrospective population-based cohort of California State Inpatient Database administrative claims data from nonfederal acute care hospitals for January 1 through December 31, 2007.
PATIENTS: Data were available for 3,144,787 hospitalized adults. Severe sepsis (n = 49,082 [1.56%]) was defined by validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 995.92. New-onset AF was defined as AF that occurred during the hospital stay, after excluding AF cases present at admission.
MAIN OUTCOME MEASURES: A priori outcome measures were in-hospital ischemic stroke (ICD-9-CM codes 433, 434, or 436) and mortality.
RESULTS: Patients with severe sepsis were a mean age of 69 (SD, 16) years and 48% were women. New-onset AF occurred in 5.9% of patients with severe sepsis vs 0.65% of patients without severe sepsis (multivariable-adjusted odds ratio [OR], 6.82; 95% CI, 6.54-7.11; P < .001). Severe sepsis was present in 14% of all new-onset AF in hospitalized adults. Compared with severe sepsis patients without new-onset AF, patients with new-onset AF during severe sepsis had greater risks of in-hospital stroke (75/2896 [2.6%] vs 306/46,186 [0.6%] strokes; adjusted OR, 2.70; 95% CI, 2.05-3.57; P < .001) and in-hospital mortality (1629 [56%] vs 18,027 [39%] deaths; adjusted relative risk, 1.07; 95% CI, 1.04-1.11; P < .001). Findings were robust across 2 definitions of severe sepsis, multiple methods of addressing confounding, and multiple sensitivity analyses.
CONCLUSION: Among patients with severe sepsis, patients with new-onset AF were at increased risk of in-hospital stroke and death compared with patients with no AF and patients with preexisting AF.

PMID: 22081378 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Latex medical gloves: time for a reappraisal.

int arch allergy immunol Start a Discussion »

Dec 132011

Latex medical gloves: time for a reappraisal.

Int Arch Allergy Immunol. 2011;156(3):234-46

Authors: Palosuo T, Antoniadou I, Gottrup F, Phillips P

Abstract
Many hospitals have implemented policies to restrict or ban the use of devices made of natural rubber latex (NRL) in healthcare as precautionary measures against the perceived risk of NRL allergy. Changes in glove technology, progress in measuring the specific allergenic potential of gloves and a dramatic decrease in the prevalence of NRL allergies after interventions and education prompted us to revisit the basis for justifiable glove selection policies. The published Anglophone literature from 1990 to 2010 was reviewed for original articles and reviews dealing with the barrier and performance properties of NRL and synthetic gloves and the role of glove powder. The review shows that NRL medical gloves, when compared with synthetic gloves, tend to be stronger, more flexible and better accepted by clinicians. The introduction of powder-free gloves has been associated with reductions in protein content and associated allergies. Recently, new methods to quantify clinically relevant NRL allergens have enabled the identification of gloves with low allergenic potential. The use of low-protein, low-allergenic, powder-free gloves is associated with a significant decrease in the prevalence of type I allergic reactions to NRL among healthcare workers. Given the excellent barrier properties and operating characteristics, dramatically reduced incidences of allergic reactions, availability of specific tests for selection of low-allergen gloves, competitive costs and low environmental impact, the use of NRL gloves within the hospital environment warrants reappraisal.

PMID: 21720169 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Preoperative tests: an Irish perspective.

Ir J Med Sci Start a Discussion »

Dec 132011

Preoperative tests: an Irish perspective.

Ir J Med Sci. 2011 Sep;180(3):683-6

Authors: Flynn C, Moran T, Cunningham AJ, O Riain S

Abstract
INTRODUCTION: We sought to investigate whether hospital doctors in Ireland order too many expensive, unnecessary tests and analyse their motives for so doing.
METHODS: A series of test patients modelled along guidelines as outlined by the National Institute for Clinical Excellence were presented to doctors in two university teaching hospitals. For each case, they were asked to identify the appropriate investigations.
RESULTS: Fifty-three interns on a surgical rotation completed the questionnaires. Forty-four percent (n = 50) of interns ordered the tests based on influences from the consultant leading their team, with only 24% citing their medical training as the critical reason for ordering a preoperative investigation. No intern considered cost to have any influence on their decision to book preoperative tests.
DISCUSSION: This study demonstrates that the previously well-documented international practice of overuse and unexplained variation in preoperative testing is also the norm in Ireland.

PMID: 21472494 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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