International journal of clinical pharmacy
-
Meta Analysis
Influence of dexmedetomidine on cardiac complications in non-cardiac surgery: a meta-analysis of randomized trials.
Background The cardiac protection of dexmedetomidine (Dex) in peri-operative period of patients with non-cardiac surgery is still controversial. Aim of the Review We aimed to evaluate the influence of Dex on cardiac complications in peri-operative period of non-cardiac surgery by using a meta-analysis. Methods PubMed, Embase, the Cochrane library and Springer databases were searched for relevant studies. ⋯ In subgroup analysis, the risk of bradycardia was significantly higher in 1.0 μg/kg Dex group than that in placebo group. Besides, a higher risk of hypotension in 0.5 μg/kg Dex group than that in placebo group was found. Conclusions Dex supplement might not reduce the risk of cardiac complications but increases the risk of hypotension and bradycardia in peri-operative period of patients who underwent non-cardiac surgeries.
-
Observational Study
A retrospective study of antibiotic de-escalation in patients with ventilator-associated pneumonia in Malaysia.
Background Antibiotic de-escalation is an important strategy to conserve the effectiveness of broad-spectrum antibiotics. However, the outcome of this strategy for the treatment of ventilator-associated pneumonia (VAP) has not been widely studied in developing countries. Objectives To evaluate the outcome on intensive care unit (ICU) mortality, 28 days mortality, and length of ICU stay among VAP patients who receive de-escalation therapy. ⋯ There was no statistically significant difference in mortality rate, survival probability and the mean length of ICU stay between the de-escalation and the non-de-escalation group. However, patients with Simplified Acute Physiology Score II of ≥50 were significantly associated with ICU mortality and 28 days mortality. Conclusions In VAP patients, antibiotic de-escalation provides an opportunity to promote the judicious use of antibiotics without affecting the clinical outcomes.
-
Background This project is part of the prospective quasi experimental proof-of-concept investigation of clinical pharmacist intervention study to reduce drug-related problems among people admitted to a ward in a rural hospital in northern Sweden. Objective To explore doctors' and nurses' perceptions and expectations of having a ward-based pharmacist providing clinical pharmacy services. Setting Medical ward in a rural hospital in northern Sweden. ⋯ Conclusion This study provided an opportunity to explore doctors' and nurses' expectations of the role of clinical pharmacists before a clinical pharmacy service was implemented. To successfully implement a clinical pharmacy service, roles, clinical competence and responsibilities should be clearly described. Furthermore, it is important to focus on collaborative working relationships between doctors, nurses and pharmacists.
-
Background Analgesics are used in the management of chronic non-malignant pain (CNMP), a condition which is highly prevalent among older adults. CNMP may not only be physically distressing but also complicated by psychosocial and economic factors. An individual's perception and use of analgesics may be influenced by a range of factors such as perceptions of risk or benefits, ability to purchase medication or access to non-pharmacological therapies or specialist care. ⋯ External factors included views of family members, access to specialised care and the individual's interaction with healthcare professionals (HCPs). Conclusion Individuals with CNMP regard analgesics as an important method for managing pain and are relied upon when other interventions are difficult to access. HCPs in primary care, who are the main point of contact for patients, need to take into account the various factors that may influence analgesic use when consulting with this patient group.
-
Background Current reports of outpatient antimicrobial prescribing practices may overestimate guideline concordance since they address only drug selection. Appropriate stewardship should consider all prescribing criteria (i.e., dose, frequency, duration, and route of administration) to fully assess guideline concordance. Objective Using a community-acquired pneumonia (CAP) example, the aims of this pilot study were to estimate guideline concordance in adult patients 18 years or older when all prescribing criteria are considered, and provide recommendations to optimize treatment. ⋯ Conclusion Concordance with current guidelines in this local sample is suboptimal. In the low-risk group, when the correct medication was chosen, dose, duration, and frequency were appropriate. Consideration of dose and duration of treatment decreased the rate of concordant prescribing in the high-risk group.