2012 July

Effect of magnesium supplementation on blood pressure: a meta-analysis.

Jul 312012

Effect of magnesium supplementation on blood pressure: a meta-analysis.

Eur J Clin Nutr. 2012 Apr;66(4):411-8

Authors: Kass L, Weekes J, Carpenter L

Abstract

To date, there has been inconclusive evidence regarding the effect of magnesium supplements on blood pressure (BP). This meta-analysis was conducted to assess the effect of magnesium supplementation on BP and to establish the characteristics of trials showing the largest effect size. Primary outcome measures were systolic blood pressure (SBP) and diastolic blood pressure (DBP) at the end of the follow-up period. One hundred and forty-one papers were identified, of which 22 trials with 23 sets of data (n=1173), with 3 to 24 weeks of follow-up met the inclusion criteria, with a supplemented elemental magnesium range of 120-973?mg (mean dose 410?mg). 95% confidence intervals (CI) were calculated using DerSimonian and Laird's random-effects model, with effect size calculated using Hedges G. Combining all data, an overall effect of 0.36 and 0.32 for DBP and SBP, respectively, was observed (95% CI 0.27-0.44 for DBP and 0.23-0.41 for SBP), with a greater effect being seen for the intervention in crossover trials (DBP 0.47, SBP 0.51). Effect size increased in line with increased dosage. Although not all individual trials showed significance in BP reduction, combining all trials did show a decrease in SBP of 3-4?mm?Hg and DBP of 2-3?mm?Hg, which further increased with crossover designed trials and intake >370?mg/day. To conclude, magnesium supplementation appears to achieve a small but clinically significant reduction in BP, an effect worthy of future prospective large randomised trials using solid methodology.

PMID: 22318649 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Errors in fluid therapy in medical wards.

Int J Clin Pharm Start a Discussion »

Jul 312012

Errors in fluid therapy in medical wards.

Int J Clin Pharm. 2012 Apr;34(2):374-81

Authors: Mousavi M, Khalili H, Dashti-Khavidaki S

Abstract

BACKGROUND: Intravenous fluid therapy remains an essential part of patients' care during hospitalization. There are only few studies that focused on fluid therapy in the hospitalized patients, and there is not any consensus statement about fluid therapy in patients who are hospitalized in medical wards.

OBJECTIVE: The aim of the present study was to assess intravenous fluid therapy status and related errors in the patients during the course of hospitalization in the infectious diseases wards of a referral teaching hospital.

SETTING: This study was conducted in the infectious diseases wards of Imam Khomeini Complex Hospital, Tehran, Iran.

METHODS: During a retrospective study, data related to intravenous fluid therapy were collected by two clinical pharmacists of infectious diseases from 2008 to 2010. Intravenous fluid therapy information including indication, type, volume and rate of fluid administration was recorded for each patient. An internal protocol for intravenous fluid therapy was designed based on literature review and available recommendations. The data related to patients' fluid therapy were compared with this protocol. The fluid therapy was considered appropriate if it was compatible with the protocol regarding indication of intravenous fluid therapy, type, electrolyte content and rate of fluid administration.

MAIN OUTCOME MEASURE: Any mistake in the selection of fluid type, content, volume and rate of administration was considered as intravenous fluid therapy errors.

RESULTS: Five hundred and ninety-six of medication errors were detected during the study period in the patients. Overall rate of fluid therapy errors was 1.3 numbers per patient during hospitalization. Errors in the rate of fluid administration (29.8%), incorrect fluid volume calculation (26.5%) and incorrect type of fluid selection (24.6%) were the most common types of errors. The patients' male sex, old age, baseline renal diseases, diabetes co-morbidity, and hospitalization due to endocarditis, HIV infection and sepsis are predisposing factors for the occurrence of fluid therapy errors in the patients.

CONCLUSION: Our result showed that intravenous fluid therapy errors occurred commonly in the hospitalized patients especially in the medical wards. Improvement in knowledge and attention of health-care workers about these errors are essential for preventing of medication errors in aspect of fluid therapy.

PMID: 22392405 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Hyponatremia, heart failure, and the role of tolvaptan.

Postgrad Med Start a Discussion »

Jul 282012

Hyponatremia, heart failure, and the role of tolvaptan.

Postgrad Med. 2012 Mar;124(2):29-39

Authors: O'Connell JB, Alemayehu A

Abstract

Hyponatremia-usually defined by serum sodium < 135 mEq/L-is common in heart failure (HF); it remains unclear whether it worsens HF or is merely a marker of more severe disease. Hyponatremia may develop from causes besides HF and symptoms may be mistakenly attributed to HF. Hyponatremia correction may be required for optimal HF management in some cases, and it can prevent neurologic complications. Symptoms, volume status, and onset timing determine treatment, which should correct serum sodium in a controlled manner. Arginine vasopressin is elevated in hypervolemic/euvolemic hyponatremia, favoring water reabsorption despite low serum osmolality. The oral selective V(2)-receptor antagonist tolvaptan blocks arginine vasopressin effects in the renal collecting ducts, promoting aquaresis without increasing sodium/potassium excretion. In clinical trials, tolvaptan significantly increased serum sodium in patients with euvolemic/hypervolemic hyponatremia, including HF. When added to conventional HF treatment, tolvaptan produced early symptomatic benefit, without long-term improvement in an HF population consisting primarily of normonatremic patients. Tolvaptan is approved for treatment of clinically significant hypervolemic/euvolemic hyponatremia (serum sodium < 125 mEq/L or less marked symptomatic hyponatremia that has resisted correction with fluid restriction), but not HF without hyponatremia.

PMID: 22437213 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Evaluation of drug administration errors in a teaching hospital.

BMC Health Serv Res Start a Discussion »

Jul 282012

Evaluation of drug administration errors in a teaching hospital.

BMC Health Serv Res. 2012;12:60

Authors: Berdot S, Sabatier B, Gillaizeau F, Caruba T, Prognon P, Durieux P

Abstract

BACKGROUND: Medication errors can occur at any of the three steps of the medication use process: prescribing, dispensing and administration. We aimed to determine the incidence, type and clinical importance of drug administration errors and to identify risk factors.

METHODS: Prospective study based on disguised observation technique in four wards in a teaching hospital in Paris, France (800 beds). A pharmacist accompanied nurses and witnessed the preparation and administration of drugs to all patients during the three drug rounds on each of six days per ward. Main outcomes were number, type and clinical importance of errors and associated risk factors. Drug administration error rate was calculated with and without wrong time errors. Relationship between the occurrence of errors and potential risk factors were investigated using logistic regression models with random effects.

RESULTS: Twenty-eight nurses caring for 108 patients were observed. Among 1501 opportunities for error, 415 administrations (430 errors) with one or more errors were detected (27.6%). There were 312 wrong time errors, ten simultaneously with another type of error, resulting in an error rate without wrong time error of 7.5% (113/1501). The most frequently administered drugs were the cardiovascular drugs (425/1501, 28.3%). The highest risks of error in a drug administration were for dermatological drugs. No potentially life-threatening errors were witnessed and 6% of errors were classified as having a serious or significant impact on patients (mainly omission). In multivariate analysis, the occurrence of errors was associated with drug administration route, drug classification (ATC) and the number of patient under the nurse's care.

CONCLUSION: Medication administration errors are frequent. The identification of its determinants helps to undertake designed interventions.

PMID: 22409837 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Peripherally inserted central catheters are equivalent to centrally inserted catheters in intensive care unit patients for central venous pressure monitoring.

J Clin Monit Comput Start a Discussion »

Jul 282012

Peripherally inserted central catheters are equivalent to centrally inserted catheters in intensive care unit patients for central venous pressure monitoring.

J Clin Monit Comput. 2012 Apr;26(2):85-90

Authors: Latham HE, Rawson ST, Dwyer TT, Patel CC, Wick JA, Simpson SQ

Abstract

To determine the equivalency of pressure measurements from peripherally inserted central catheters(PICCs) versus centrally inserted central venous catheters(CVCs) in vitro as well as in vivo. The in vitro study was performed in a clinical laboratory. Static pressure measurements from PICCs and CVCs were obtained in vitro over a physiologic range of 5–25 mmHg. Triple and dual lumen PICCs were directly compared to CVC controls.Dynamic pressure waveforms were recorded to simulate physiologic intravascular pressure variation. The in vivo study was executed in the medical intensive care unit(MICU) of a tertiary-level academic medical center. Data was collected from ten adult patients with both a PICC and a CVC in place for on-going clinical care. Measurements of central venous pressure (CVP) were recorded simultaneously from PICCs and CVCs. Duplicate measurements were taken after a stable waveform was recorded. For the in vitro study, a total of 540 pressure measurements were recorded. The average bias determined by Bland–Altman plot was 0 mmHg for the 5Fr PICC and 0.071 mmHg for the 6Fr PICC. The correlation coefficient for both catheters was 1.0 (P<0.001). Dynamic pressure waveforms revealed equivalent amplitude. During the in vivo trial, 70CVP measurements were collected. The paired CVP measurements were found to be highly reliable across subjects (r = 0.99, P<0.0001). No significance in the average difference in CVP measurement (PICC–CVC) was determined by the Wilcoxon Signed Rank test (S = 1,P = 0.93). In conclusion, PICCs are equivalent to CVCs when measuring static and dynamic pressure in vitro and CVP in ICU patients.

PMID: 22290064 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Eradicating Medical Student Mistreatment: A Longitudinal Study of One Institution’s Efforts.

Acad Med Start a Discussion »

Jul 282012

Eradicating Medical Student Mistreatment: A Longitudinal Study of One Institution's Efforts.

Acad Med. 2012 Jul 25;

Authors: Fried JM, Vermillion M, Parker NH, Uijtdehaage S

Abstract

PURPOSE: Since 1995, the David Geffen School of Medicine at UCLA (DGSOM) has created policies to prevent medical student mistreatment, instituted safe mechanisms for reporting mistreatment, provided resources for discussion and resolution, and educated faculty and residents. In this study, the authors examined the incidence, severity, and sources of perceived mistreatment over the 13-year period during which these measures were implemented. METHOD: From 1996 to 2008, medical students at DGSOM completed an anonymous survey after their third-year clerkships and reported how often they experienced physical, verbal, sexual harassment, ethnic, and power mistreatment, and who committed it. The authors analyzed these data using descriptive statistics and the students' descriptions of these incidents qualitatively, categorizing them as "mild," "moderate," or "severe." They compared the data across four periods, delineated by milestone institutional measures to eradicate mistreatment. RESULTS: Of 2,151 eligible students, 1,946 (90%) completed the survey. More than half (1,166/1,946) experienced some form of mistreatment. Verbal and power mistreatment were most common, but 5% of students (104/1,930) reported physical mistreatment. The pattern of incidents categorized as "mild," "moderate," or "severe" remained across the four study periods. Students most frequently identified residents and clinical faculty as the sources of mistreatment. CONCLUSIONS: Despite a multipronged approach at DGSOM across a 13-year period to eradicate medical student mistreatment, it persists. Aspects of the hidden curriculum may be undermining these efforts. Thus, eliminating mistreatment requires an aggressive approach both locally at the institution level and nationally across institutions.

PMID: 22836847 [PubMed - as supplied by publisher]

Link to Article at PubMed

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