Clinical therapeutics
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Clinical therapeutics · Nov 2011
Institutional perspective on the impact of positive blood cultures on the economic and clinical outcomes of patients with complicated skin and skin structure infections: focus on gram-positive infections.
Traditionally, skin and skin structure infections (SSSIs) have been viewed as having a lower risk of mortality, morbidity, and cost compared with other types of infection. The influence of secondary bacteremia on the medicoeconomic outcomes of patients with SSSIs has not been well described. ⋯ Bacteremia complicating SSSIs occurred in almost 50% of patients infected with gram-positive bacteria in our institution. Beyond its impact on mortality, bacteremia is associated with increased length of stay, hospital costs, and readmission. However, these data are from a single academic medical center and may not be adjusted for all applicable confounders.
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Clinical therapeutics · Nov 2011
Dosing patterns for duloxetine and predictors of high-dose prescriptions in patients with major depressive disorder: analysis from a United States third-party payer perspective.
Major depressive disorder (MDD) is a common illness that affects ∼7% of adults in the United States each year. Duloxetine is a dual reuptake inhibitor of serotonin and norepinephrine that has demonstrated efficacy and tolerability in the treatment of MDD. ⋯ Most of the commercially insured patients in this dataset were initiated and maintained on a duloxetine dose of 60 mg/d. Although the data are limited in their generalizability, the characteristics associated with higher dose therapy describe a complex group of patients who may require more intensive drug treatment and monitoring.
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Clinical therapeutics · Nov 2011
Case ReportsThe economic impact and cost-effectiveness of urinary neutrophil gelatinase-associated lipocalin after cardiac surgery.
Acute kidney injury (AKI) is common after cardiac surgery, and expeditious recognition with specific biomarkers may help improve outcome. ⋯ The use of urinary NGAL after cardiac surgery appears to be cost-effective in the early diagnosis of AKI.
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Clinical therapeutics · Nov 2011
Population pharmacokinetic and pharmacodynamic modeling of high-dose intermittent ticarcillin-clavulanate administration in pediatric cystic fibrosis patients.
The Intermountain Cystic Fibrosis Pediatric Center utilizes ticarcillin-clavulanate 400 mg/kg/d divided every 6 hours, (maximum 24 g/d). This dosing strategy is higher than the Food and Drug Administration (FDA)-approved package labeling. We evaluated the microbiologic efficacy of this dosing regimen. ⋯ The results of our simulation suggest that in this select pediatric population, higher than FDA-approved doses of ticarcillin-clavulanate were effective in achieving bactericidal effects among pseudomonal isolates with MICs <16 μg/mL. Bacteriostatic and bactericidal effects were not frequently achieved among P. aeruginosa isolates with MICs >32 μg/mL. Additional studies are warranted to determine the clinical effectiveness of this dosing regimen.
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Clinical therapeutics · Oct 2011
ReviewIncidence and US costs of corticosteroid-associated adverse events: a systematic literature review.
The objective of this systematic literature review was to evaluate the incidences and risks for adverse events (AEs) associated with oral and parenteral corticosteroids. An assessment was performed to estimate the costs of such AEs. ⋯ Based on the findings from this review, systemic corticosteroids are a common cause of AEs that may be costly to payers.