Pharmacotherapy
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To determine the success of an outpatient smoking-cessation clinic by assessing smoking abstinence rates and factors associated with lower abstinence rates. We also sought to determine whether smoking abstinence rates differed among various smoking-cessation products. ⋯ Although statistically significant differences between products were noted at 6 weeks, no sustained difference in smoking abstinence rates was observed between products. At 6 months, point prevalence and continuous abstinence rates were small, but the decline in success noted over time and the limited overall success rates are consistent with rates for the United States. Our findings suggest that when smokers are assisted in quitting, initial contact as well as follow-up evaluation and monitoring must be intense and sustained to increase the likelihood of successful abstinence. Tobacco dependence is clearly a chronic condition warranting repeated treatment and monitoring until continuous abstinence is achieved.
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Clinical Trial
Predictors of hospital mortality for patients with severe sepsis treated with Drotrecogin alfa (activated).
To identify predictors of hospital mortality among patients with severe sepsis who were treated with drotrecogin alfa (activated). ⋯ Number of acquired organ-system derangements, vasopressin administration, and treatment with an inappropriate initial antimicrobial regimen are independently associated with an increased risk of hospital mortality among patients treated with drotrecogin alfa (activated) for severe sepsis. These findings suggest that other specific medical interventions may increase survival in this patient population.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Analgesic and hemodynamic effects of a single 7.5-mg intravenous dose of morphine in patients with moderate-to-severe postoperative pain.
To evaluate the analgesic and hemodynamic effects of a single dose of intravenous morphine 7.5 mg in patients experiencing moderate-to-severe postoperative pain, and to determine any gender differences in analgesic response. ⋯ A single 7.5-mg intravenous bolus dose of morphine did not appear to provide adequate reduction in perceived pain intensity in patients with moderate-to-severe postoperative pain. In addition, in contrast to the findings of other experimental pain studies, our data suggest that women are more tolerant of postoperative pain than are men.
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To determine which of four commonly used equations to estimate energy expenditure is precise and unbiased compared with energy expenditure as measured by indirect calorimetry. ⋯ The Harris-Benedict equation multiplied by an activity factor of 1.2 is suitable for predicting REE and may be used in the absence of indirect calorimetry.
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Approximately 40% of patients who receive lepirudin for 5-10 days develop antihirudin antibodies. These antibodies lead to decreased renal elimination of lepirudin, ultimately resulting in elevated activated partial thromboplastin times (aPTTs). A small percentage of patients with antihirudin antibodies develop hypersensitivity reactions to lepirudin with reexposure. ⋯ After lepirudin infusion was restarted, the patient developed an anaphylactic reaction. She was treated appropriately with an antihistamine, a corticosteroid, and an anxiolytic agent. After the reaction resolved, the patient was rechallenged with lepirudin, and the anaphylactic reaction recurred.