Pharmacotherapy
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Case Reports Comparative Study
Prolonged neuromuscular blockade in two critically ill patients treated with atracurium.
Recent literature suggests that the risk of prolonged neuromuscular blockade associated with atracurium compared with other nondepolarizing neuromuscular blocking agents may be minimal. Two patients experienced prolonged weakness associated with the administration of atracurium. Both received atracurium 0.5-0.7 mg/kg/hour in combination with methylprednisolone 500-600 mg/day. ⋯ Despite high-dose corticosteroid therapy, the electromyographic evidence supporting prolonged weakness did not suggest typical corticosteroid myopathy. Although some clinicians advocate routine administration of atracurium in critically ill patients due to the relative lack of reports of prolonged weakness, this may be premature. Although there are fewer reports of atracurium-associated prolonged weakness compared with pancuronium and vecuronium, the patients we describe suggest that it may occur.
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Comparative Study
A computerized system to improve documentation and reporting of pharmacists' clinical interventions, cost savings, and workload activities.
A major factor in delivering patient care is documenting activities by pharmacists. This documentation is not only essential to sustain existing programs but necessary to justify future growth of resources. A computerized documentation system for clinical interventions and workload activities was developed in a 340-bed university teaching hospital. ⋯ A software program was developed to alleviate the problems inherent with manual documentation. This "user-friendly" program tracks clinical recommendations and interventions by pharmacists, and calculates cost savings/avoidance. It also facilitates monthly and annual reporting for department managers.
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Randomized Controlled Trial Comparative Study Clinical Trial
The effect of three different ranitidine dosage regimens on reducing gastric acidity and volume in ambulatory surgical patients.
To evaluate three different preoperative oral dosing regimens of ranitidine in ambulatory patients who had significant risk of aspiration pneumonitis (gastric pH < or = 2.5 or volume > or = 25 ml at intubation or extubation). ⋯ Ranitidine 150 mg twice/day preoperatively reduced to the greatest degree the percentage of patients who developed significant risk factors for aspiration pneumonitis after surgery under general anesthesia.
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Review
Update on talc, bleomycin, and the tetracyclines in the treatment of malignant pleural effusions.
Talc has been used to treat malignant pleural effusions (MPE) for over 30 years and is usually considered to be the most effective chemical agent for pleurodesis. Clinicians, aware of limited reports of serious adverse effects attributed to talc, have generally reserved it for selected patients who are refractory to first-line chemical sclerosants. ⋯ Comparisons with other agents are necessary to evaluate further the application of talc insufflation in the thoracoscopy suite and talc slurry at the patient's bedside. As clinicians continue to debate the relative merits of various pleurodesis agents, talc appears to be a reasonable choice for the treatment of MPE.
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Comparative Study
Sepsis syndrome and associated sequelae in patients at high risk for gram-negative sepsis.
We conducted a prospective surveillance study of 80 hospitals across the United States to determine the incidence of sepsis syndrome and its associated sequelae in hospitalized patients over age 18 years who were administered antibiotics for suspected or documented gram-negative infection. A sample of 1754 hospitalized patients were followed from onset of antimicrobial therapy to discharge or death. Mortality rates (MR) varied depending on the suspected source of sepsis syndrome. ⋯ More than two complications occurred in 65.2% of patients under age 60 years (MR 31%), 40.8% of those age 60-80 (MR 42%), and 35.6% of patients older than 80 years (MR 33.3%, p > 0.05). Various patient populations had significant differences in both the incidence of the syndrome and its complications, and consequent mortality. Perhaps morbidity as well as mortality should be used as outcomes when testing the efficacy of innovative therapies for sepsis.