Pharmacotherapy
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Multicenter Study Comparative Study
The Retrospective Cohort of Extended-Infusion Piperacillin-Tazobactam (RECEIPT) study: a multicenter study.
To compare the effectiveness of extended-infusion piperacillin-tazobactam with that of similar-spectrum, nonextended-infusion [H9252]-lactam antibiotics in the treatment of gram-negative infections. ⋯ Pharmacodynamic dosing using extended-infusion piperacillintazobactam demonstrated favorable outcomes, including mortality, when compared with nonextended-infusion, similar-spectrum [H9252]-lactams in the treatment of patients with documented gram-negative infections. Prospective, randomized trials are needed to further corroborate these findings.
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Controlled Clinical Trial
Effects of an inhaled β2-agonist on cardiovascular function and sympathetic activity in healthy subjects.
To determine the effect of a short-acting, inhaled β(2)-adrenergic receptor agonist, albuterol sulfate, administered by nebulization, on cardiovascular function and sympathetic activity in healthy individuals. ⋯ In these healthy subjects, administration of a nebulized β(2)-agonist resulted in enhanced ventricular function and a decrease in SVR, suggesting peripheral vasodilation. In addition, the increase in norepinephrine level with albuterol, but not placebo, may have important implications in patients with known cardiovascular disease.
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To determine dosing options for decreasing the time to achieve a therapeutic international normalized ratio (INR) threshold of 2.0 when restarting warfarin in an ambulatory population whose previous warfarin maintenance doses are known, and to identify thromboembolic and major bleeding events up to 90 days after disruption of warfarin therapy. ⋯ In select patients, the option of administering a warfarin loading dose of approximately 40% greater than the previous daily maintenance dose for 2 or 3 days shortens the time to achieving therapeutic anticoagulation.
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To assess the effect of substituting dexmedetomidine for propofol during a nationwide propofol shortage on postoperative time to extubation and opioid requirements in patients who underwent coronary artery bypass graft (CABG) surgery. ⋯ No statistically significant differences were noted between the propofol and dexmedetomidine groups when assessing the outcomes of opioid requirements and the time to extubation. A multicenter, prospective, randomized, blinded study is needed to determine the optimal sedative after CABG surgery.
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To determine the incidence of Clostridium difficile infection (CDI) at one community hospital by identifying patients with stool samples positive for C. difficile toxin A or B, and to compare the incidence with a 2008 national estimate; and to determine which patient characteristics and concomitant antimicrobial and acid-suppression drugs are risk factors for the development of CDI. ⋯ The incidence of CDI in 2009 at one community hospital was significantly lower than a 2008 national estimate. Antimicrobial and acid-suppression therapies--in particular, combinations of fluoroquinolones, cephalosporins, carbapenems, and proton pump inhibitors--were found to be risk factors for the development of CDIs in hospitalized patients.