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https://www.readbyqxmd.com/read/29739825/safety-ii-behavior-in-a-pediatric-intensive-care-unit
#1
Jenna Merandi, Kathryn Vannatta, J Terrance Davis, Richard E McClead, Richard Brilli, Thomas Bartman
: media-1vid110.1542/5763093009001PEDS-VA_2018-0018 Video Abstract BACKGROUND AND OBJECTIVE: Safety I error elimination concepts are focused on retrospectively investigating what went wrong and redesigning system processes and individual behaviors to prevent similar future occurrences. The Safety II approach recognizes complex systems and unpredictable circumstances, mandating flexibility and resilience within systems and among individuals to avoid errors. We hypothesized that in our high-complexity and high-risk PICU, Safety II concepts contribute to its remarkably low adverse drug event rate...
May 8, 2018: Pediatrics
https://www.readbyqxmd.com/read/29736044/improving-the-clinical-pharmacist-handover-process-in-the-intensive-care-unit-with-a-pharmacotherapy-specific-tool-the-i-happy-study
#2
Emma Attfield, Matthew P Swankhuizen, Nicole Bruchet, Richard Slavik, Sean K Gorman
Background: Pharmacists in the intensive care unit (ICU) provide pharmaceutical care to critically ill patients. Identification and resolution of drug therapy problems improves outcomes for these patients. To maintain continuity of care, pharmacotherapy plans should be transferred to a receiving pharmacist upon discharge of patients from the ICU. No previous studies have addressed the development or evaluation of a systematic, standardized clinical handover tool and process for pharmacists...
March 2018: Canadian Journal of Hospital Pharmacy
https://www.readbyqxmd.com/read/29695013/determining-inappropriate-medication-alerts-from-inaccurate-warning-overrides-in-the-intensive-care-unit
#3
Christine A Rehr, Adrian Wong, Diane L Seger, David W Bates
OBJECTIVE:  This article aims to understand provider behavior around the use of the override reason "Inaccurate warning," specifically whether it is an effective way of identifying unhelpful medication alerts. MATERIALS AND METHODS:  We analyzed alert overrides that occurred in the intensive care units (ICUs) of a major academic medical center between June and November 2016, focused on the following high-significance alert types: dose, drug-allergy alerts, and drug-drug interactions (DDI)...
April 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/29625940/incidence-of-drug-interactions-in-intensive-care-units-in-tertiary-care-settings-classification-facts-and-measures
#4
Hina Hasnain, Huma Ali, Farya Zafar, Ali Akbar Sial, Shazia Alam, Anwar Ejaz Beg, Rabia Bushra, Mehwish Rizvi, Maqsood Ahmed Khan, Huma Shareef, Ghazala R Naqvi, Anum Tariq
Drug-drug interactions (DDIs) are extremely significant concern, particularly in sensitive population including pediatric and geriatric. Propensity for the development of DDIs is high in patients admitted at intensive care units (ICU). This study was conducted to evaluate the DDIs incidence, facts and measures in ICU. From a total of 150 cases studied for ICU patients, with the mean age of 56.37±12.45 years, 55.33% were male and the rest were female 44.66%. The demographic information like age, gender and main diagnosis details of study participants that were extracted from the patients' clinical record...
March 2018: Pakistan Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/29603074/impact-of-the-clinical-pharmacist-interventions-on-prevention-of-pharmacotherapy-related-problems-in-the-paediatric-intensive-care-unit
#5
Márcia Malfará, Maria Pernassi, Davi Aragon, Ana Carlotti
Background Problems related to pharmacotherapy are common in patients admitted to the paediatric intensive care unit (PICU) and are associated with increased healthcare costs. Data on the impact of clinical pharmacist interventions to prevent pharmacotherapy-related problems and to minimize costs in the PICU are limited. Objectives To evaluate the number and type of clinical pharmacist interventions in the PICU and to determine cost savings associated with them. Setting a ten bed PICU of a tertiary-care university hospital in Brazil...
March 30, 2018: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/29581122/pharmacokinetics-of-intravenous-posaconazole-in-critically-ill-patients
#6
Fekade B Sime, Janine Stuart, Jenie Butler, Therese Starr, Steven C Wallis, Saurabh Pandey, Jeffrey Lipman, Jason A Roberts
To date, there is no information on the IV posaconazole pharmacokinetics in ICU patients. This prospective observational study aimed to describe the pharmacokinetics of a single dose of IV posaconazole in critically ill patients. Patients with no history of allergy to triazole antifungals and requiring systemic antifungal therapy were enrolled if aged ≥ 18 years, central venous access was available, were not pregnant, and didn't receive prior posaconazole or drugs interacting with posaconazole. A single dose of 300 mg posaconazole was administered over 90 minutes...
March 26, 2018: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/29474357/effects-of-flow-rate-on-the-migration-of-different-plasticizers-from-pvc-infusion-medical-devices
#7
Lise Bernard, Teuta Eljezi, Hélène Clauson, Céline Lambert, Yassine Bouattour, Philip Chennell, Bruno Pereira, Valérie Sautou
Infusion medical devices (MDs) used in hospitals are often made of plasticized polyvinylchloride (PVC). These plasticizers may leach out into infused solutions during clinical practice, especially during risk-situations, e.g multiple infusions in Intensive Care Units and thus may enter into contact with the patients. The migrability of the plasticizers is dependent of several clinical parameters such as temperature, contact time, nature of the simulant, etc… However, no data is available about the influence of the flow rate at which drug solutions are administrated...
2018: PloS One
https://www.readbyqxmd.com/read/29473523/drug-induced-qt-interval-prolongation-in-the-intensive-care-unit
#8
Cecilia Villa Etchegoyen, Guillermo Alberto Keller, Sebastian Mrad, Sixuan Cheng, Guillermo Di Girolamo
BACKGROUND: The most common acquired cause of Long QT syndrome (LQTS) is drug induced QT interval prolongation. It is an electrophysiological entity, which is characterized by an extended duration of the ventricular repolarization. Reflected as a prolonged QT interval in a surface ECG, this syndrome increases the risk for polymorphic ventricular tachycardia (Torsade de Pointes) and sudden death. METHOD: Bibliographic databases as MEDLINE and EMBASE, reports and drug alerts from several regulatory agencies (FDA, EMEA, ANMAT) and drug safety guides (ICH S7B, ICH E14) were consulted to prepare this article...
2017: Current Clinical Pharmacology
https://www.readbyqxmd.com/read/29466493/preventable-adverse-drug-events-in-critically-ill-hiv-patients-is-the-detection-of-potential-drug-drug-interactions-a-useful-tool
#9
Grazielle Viana Ramos, André Miguel Japiassú, Fernando Augusto Bozza, Lusiele Guaraldo
OBJECTIVES: The aim of this study was to develop a strategy to identify adverse drug events associated with drug-drug interactions by analyzing the prescriptions of critically ill patients. METHODS: This retrospective study included HIV/AIDS patients who were admitted to an intensive care unit between November 2006 and September 2008. Data were collected in two stages. In the first stage, three prescriptions administered throughout the entire duration of these patients' hospitalization were reviewed, with the Micromedex database used to search for potential drug-drug interactions...
February 19, 2018: Clinics
https://www.readbyqxmd.com/read/29464690/bis-monitoring-versus-clinical-assessment-for-sedation-in-mechanically-ventilated-adults-in-the-intensive-care-unit-and-its-impact-on-clinical-outcomes-and-resource-utilization
#10
REVIEW
Rajesh M Shetty, Antonio Bellini, Dhuleep S Wijayatilake, Mark A Hamilton, Rajesh Jain, Sunil Karanth, ArunKumar Namachivayam
BACKGROUND: Patients admitted to intensive care and on mechanical ventilation, are administered sedative and analgesic drugs to improve both their comfort and interaction with the ventilator. Optimizing sedation practice may reduce mortality, improve patient comfort and reduce cost. Current practice is to use scales or scores to assess depth of sedation based on clinical criteria such as consciousness, understanding and response to commands. However these are perceived as subjective assessment tools...
February 21, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29440481/prospective-evaluation-of-medication-related-clinical-decision-support-over-rides-in-the-intensive-care-unit
#11
Adrian Wong, Mary G Amato, Diane L Seger, Christine Rehr, Adam Wright, Sarah P Slight, Patrick E Beeler, E John Orav, David W Bates
BACKGROUND: Clinical decision support (CDS) displayed in electronic health records has been found to reduce the incidence of medication errors and adverse drug events (ADE). Recent data suggested that medication-related CDS alerts were frequently over-ridden, often inappropriately. Patients in the intensive care unit (ICU) are at an increased risk of ADEs; however, limited data exist on the benefits of CDS in the ICU. This study aims to evaluate potential harm associated with medication-related CDS over-rides in the ICU...
February 9, 2018: BMJ Quality & Safety
https://www.readbyqxmd.com/read/29434539/sleep-and-sedative-states-induced-by-targeting-the-histamine-and-noradrenergic-systems
#12
REVIEW
Xiao Yu, Nicholas P Franks, William Wisden
Sedatives target just a handful of receptors and ion channels. But we have no satisfying explanation for how activating these receptors produces sedation. In particular, do sedatives act at restricted brain locations and circuitries or more widely? Two prominent sedative drugs in clinical use are zolpidem, a GABAA receptor positive allosteric modulator, and dexmedetomidine (DEX), a selective α2 adrenergic receptor agonist. By targeting hypothalamic neuromodulatory systems both drugs induce a sleep-like state, but in different ways: zolpidem primarily reduces the latency to NREM sleep, and is a controlled substance taken by many people to help them sleep; DEX produces prominent slow wave activity in the electroencephalogram (EEG) resembling stage 2 NREM sleep, but with complications of hypothermia and lowered blood pressure-it is used for long term sedation in hospital intensive care units-under DEX-induced sedation patients are arousable and responsive, and this drug reduces the risk of delirium...
2018: Frontiers in Neural Circuits
https://www.readbyqxmd.com/read/29358719/investigation-of-candida-parapsilosis-virulence-regulatory-factors-during-host-pathogen-interaction
#13
Renáta Tóth, Vitor Cabral, Ernst Thuer, Flóra Bohner, Tibor Németh, Csaba Papp, Leonardo Nimrichter, Gergő Molnár, Csaba Vágvölgyi, Toni Gabaldón, Joshua D Nosanchuk, Attila Gácser
Invasive candidiasis is among the most life-threatening infections in patients in intensive care units. Although Candida albicans is the leading cause of candidaemia, the incidence of Candida parapsilosis infections is also rising, particularly among the neonates. Due to differences in their biology, these species employ different antifungal resistance and virulence mechanisms and also induce dissimilar immune responses. Previously, it has been suggested that core virulence effecting transcription regulators could be attractive ligands for future antifungal drugs...
January 22, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29181890/pediatric-acute-kidney-injury-induced-by-concomitant-vancomycin-and-piperacillin-tazobactam
#14
Manal Abouelkheir, Sarah Alsubaie
BACKGROUND: Vancomycin is very commonly used in combination with piperacillin-tazobactam (PTZ) as the initial empiric treatment for moderate-severe infection, whenever coverage for both methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa is required. The combination of vancomycin and PTZ in adults has recently been reported to significantly increase the risk of acute kidney injury (AKI) relative to vancomycin monotherapy; such reports in pediatrics, however, are sparse...
February 2018: Pediatrics International: Official Journal of the Japan Pediatric Society
https://www.readbyqxmd.com/read/29027654/pharmacokinetic-drug-drug-interactions-in-the-intensive-care-unit-single-centre-experience-and-literature-review
#15
Piotr Łój, Aleksanda Olender, Weronika Ślęzak, Łukasz J Krzych
BACKGROUND: Drug-drug interactions constitute a serious health hazard in everyday clinical practice in critically ill patients. Drug-drug interactions may be pharmacokinetic or pharmacodynamic in their nature. We aimed to investigate the quantity and quality of possible drug-drug interactions, and their possible side effects in intensive care unit patients in a 12-month period. METHODS: This retrospective study covered data on pharmacological treatment of 43 consecutive patients (11 females, 32 males) aged 62 ± 15 years, hospitalized between January 2015 and February 2016...
2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/28982305/advanced-modes-of-mechanical-ventilation-introduction-for-the-critical-care-pharmacist
#16
Michael J Cawley
Mechanical ventilation continues to be an evolving modality in the critical care environment. Technological advances in microprocessor-controlled ventilation integrated with the complexity of new ventilator modes has provided the multidisciplinary team opportunities to further improve the care of the critically ill ventilator patients. As members of the critical care multidisciplinary team, pharmacists require a basic understanding of both conventional and advanced modes of mechanical ventilation in order to assist in optimizing medication use and ultimately patient health-care outcomes...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28834562/potential-drug-drug-interactions-among-critically-ill-pediatric-patients-in-a-tertiary-pulmonary-center
#17
Maryam Hassanzad, Sara Arenas-Lopez, Shadi Baniasadi
Patients in the pediatric intensive care unit (PICU) are at increased risk of potential drug-drug interactions (pDDIs) because of the complexity of pharmacotherapy. The current study aimed to assess the rate, pattern, risk factors, and management of pDDIs in the PICU of an academic pulmonary hospital. A prospective observational study was conducted for 6 months. Pharmacotherapy data of PICU-admitted patients were evaluated by a clinical pharmacologist. Interacting drugs, reliability, mechanism, potential outcome, and clinical management of pDDIs were identified using the Lexi-Interact database...
February 2018: Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28832067/comparison-of-overridden-medication-related-clinical-decision-support-in-the-intensive-care-unit-between-a-commercial-system-and-a-legacy-system
#18
Adrian Wong, Adam Wright, Diane L Seger, Mary G Amato, Julie M Fiskio, David Bates
BACKGROUND: Electronic health records (EHRs) with clinical decision support (CDS) have shown to be effective at improving patient safety. Despite this, alerts delivered as part of CDS are overridden frequently, which is of concern in the critical care population as this group may have an increased risk of harm. Our organization recently transitioned from an internally-developed EHR to a commercial system. Data comparing various EHR systems, especially after transitions between EHRs, are needed to identify areas for improvement...
August 23, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28823018/prevalence-and-nature-of-potential-drug-drug-interactions-among-kidney-transplant-patients-in-a-german-intensive-care-unit
#19
Julia Amkreutz, Alexander Koch, Lukas Buendgens, Anja Muehlfeld, Christian Trautwein, Albrecht Eisert
Background Complex polypharmacotherapy makes kidney transplant patients vulnerable to drug-drug interactions (DDIs). Objective To study prevalence and nature of potential DDIs (pDDIs) in kidney transplant patients. Setting Internal medicine ICU, University Hospital RWTH Aachen. Method In this retrospective observational study, pDDIs were identified in the first week after transplant from 1999 to 2010. Patients aged at least 18 years with prescription of at least two drugs were included. Patients with incomplete data were excluded...
October 2017: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/28822348/risk-factors-for-potential-drug-drug-interactions-in-intensive-care-unit-patients
#20
Slobodan M Janković, Ana V Pejčić, Miloš N Milosavljević, Valentina D Opančina, Nikola V Pešić, Tamara T Nedeljković, Goran M Babić
PURPOSE: To determine risk factors for each severity-based category of potential drug-drug interactions (DDIs) encountered at intensive care unit (ICU) patients. METHODS: This was a retrospective cohort analysis of patients treated at the ICU of the Clinical Center Kragujevac, a public tertiary care hospital in Kragujevac, Serbia. Three interaction checkers were used to reveal drug-drug interactions: Medscape, Epocrates and Micromedex. RESULTS: The study included 201 patients, 66...
February 2018: Journal of Critical Care
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