Pharmacotherapy
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparison of length of hospital stay for patients with known or suspected methicillin-resistant Staphylococcus species infections treated with linezolid or vancomycin: a randomized, multicenter trial.
To compare hospital length of stay (LOS), weekly discharges, and days of antibiotic treatment with linezolid (intravenous with oral follow-up) and vancomycin (intravenous only). ⋯ Our results support linezolid's ability to reduce medical resource use.
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We evaluated interrelationships and associations among mortality rates, drug costs, total cost of care, and length of stay in United States hospitals. Relationships between these variables and the presence of clinical pharmacy services and pharmacy staffing also were explored. A database was constructed from the 1992 American Hospital Association's Abridged Guide to the Health Care Field, the 1992 National Clinical Pharmacy Services database, and 1992 Health Care Finance Administration mortality data. ⋯ As drug costs/occupied bed/year increased, severity of illness-adjusted mortality rates decreased (slope -38609852, R(2) 8.2%, p<0.0001). As the total cost of care/occupied bed/year increased, those same mortality rates decreased (slope -5846720642, R(2) 14.9%, p<0.0001). Seventeen clinical pharmacy services were associated with improvements in the four variables.
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Compared with parenteral nutrition, early administration of enteral nutrition (EN) to critically ill patients improves clinical outcomes and reduces infection rates. Intragastric EN often is complicated by intolerance, as indicated by elevated volumes of aspirated gastric residuals. Conflicting data are available for the volume of residual that represents intolerance, but most clinicians use 150-200 ml to signify gastrointestinal motility dysfunction. ⋯ Results of most studies are limited because patients did not receive or tolerated intragastric EN. Metoclopramide is the agent of choice for treating intolerance. Further studies are necessary before prokinetic drugs can be recommended for preventing intragastric EN-associated aspiration pneumonia.
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Observational studies in patients have shown a dose-dependent enhancement of the anticoagulant effect of warfarin by acetaminophen whereas pharmacodynamic studies in healthy human volunteers have shown no such effect. This controversy is further intensified because any interaction between acetaminophen and racemic warfarin can involve only the weaker R-warfarin enantiomer. Certain drugs exclusively competing for the metabolism of R-warfarin enhance the anticoagulant effect of racemic warfarin and others do not. ⋯ Conditions such as aging and tissue hypoxia alter the relative activity of these enzymatic pathways in vitro and in small human studies. These phenomena may be manifested clinically when acetaminophen is administered to older anticoagulated patients and those with conditions that affect cardiac output such as atrial fibrillation and congestive heart failure. Verifying this hypothesis may provide insight into the clinically relevant interplay between common conditions as they affect oxidative and nonoxidative pathways of drug metabolism.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Randomized, multicenter comparison of oral granisetron and oral ondansetron for emetogenic chemotherapy.
To compare the antiemetic effectiveness and safety of oral granisetron plus dexamethasone with those of oral ondansetron plus dexamethasone administered before emetogenic chemotherapy. ⋯ Oral granisetron 1 mg and ondansetron 16 mg plus dexamethasone are safe and effective in preventing nausea and vomiting related to emetogenic chemotherapy.