Pharmacotherapy
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Review
Antimicrobial resistance in the hospital setting: impact, trends, and infection control measures.
The growing threat posed by antibiotic-resistant pathogens is a major challenge for infectious disease practitioners and public health officials. In recent years, the prevalence of resistance among key bacterial pathogens, including Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Streptococcus pneumoniae, and Enterococcus sp, has increased at an alarming rate. ⋯ To control the spread of resistance and subsequent impact, a multifaceted approach is warranted. Awareness and surveillance of antimicrobial resistance, prudent use of antibiotics, and compliance with infection control techniques may help contain the emergence and spread of resistant organisms.
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To compare the expected costs of short-, intermediate-, and long-term sedation (< 24, 24-72, and > 72 hrs, respectively) with propofol, lorazepam, and midazolam in an intensive care unit. ⋯ Propofol, midazolam, and lorazepam had the lowest expected costs for short-, intermediate-, and long-term sedation, respectively. Many factors aside from drug costs influenced the cost of sedation.
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To compare the international normalized ratio (INR) measured by a point-of-care testing device with that measured by a reference laboratory method for patients receiving either warfarin only or warfarin plus low-molecular-weight heparin (LMWH). ⋯ The INR measured with the point-of-care device in patients receiving concurrent LMWH and warfarin therapy may be inaccurate. Patients receiving LMWH in addition to warfarin should have INRs checked by means of the standard reference laboratory method.
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To determine the frequency of adverse effects, clinical outcomes, and possible dose-response relationships associated with inadvertent extra doses of bupropion. ⋯ Adverse effects were common with extra doses of bupropion, and clinically significant effects occurred in approximately 10% of patients. Seizures were present twice as often as reported with therapeutic dosing. Extra doses of bupropion appear to increase the risk of adverse effects. Patients should be educated about these risks to minimize them.
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To characterize the frequency, severity, risk factors, and clinician response to propofol-associated hypertriglyceridemia and hypertriglyceridemia-associated pancreatitis. ⋯ Hypertriglyceridemia and hypertriglyceridemia-associated pancreatitis are often seen in intensive care patients receiving propofol. Serum triglyceride concentrations should be routinely monitored in these patients. In addition, alternative sedation strategies should be considered when hypertriglyceridemia is detected.