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Mancia, Giuseppe. "Strengths and limitations of the JNC 8 hypertension guidelines." Nature Reviews Cardiology 11, no. 4 (February 11, 2014): 189–90. http://dx.doi.org/10.1038/nrcardio.2014.12.
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Thomas, Riny, Sini Sam, P. Neelaphar, P. Shabeeb, and B. A. Vishwanath. "A Study on Prescribing Pattern of Antihypertensive in Chronic Kidney Disease Patients." Journal of Drug Delivery and Therapeutics 10, no. 3-s (June 15, 2020): 75–81. http://dx.doi.org/10.22270/jddt.v10i3-s.4139.
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Background: Chronic kidney disease causes progressive loss of function which gradually occur overtime leading to decrease in GFR levels leading to dysfunction of renal system. Hypertension is found to be intermingled cause and overlapping complication in CKD. It is important to intervene the progression by controlling the blood pressure to prevent kidney failure by administration of anti-hypertensive. Objectives: To study current trends in anti-hypertensive prescription pattern in CKD patient and to evaluate the concurrent patterns are in adherence according to the guidelines mentioned. Methods: Prospective observational study was undertaken in patients who were satisfying the inclusion criteria and was enrolled into the study conducted for a 6months period in a tertiary care hospital in Bangalore. Results: 150 CKD patients were examined out of which 72% prevalence seen in males compared to females 28%. Dual drug therapy was most preferred combination seen in 48% of the prescriptions. CCB was the most preferred class of drug and least preferred class of drug was ACE. More than 85% deviation from JNC-8 was seen. 20% of mono-therapy was found in adherence to JNC-8. Conclusion: A 15% adherence to JNC-8 guidelines was observed in the treatment indicating need for clinical pharmacist who play vital role in management of CKD by adherence to JNC-8 to ensure safety, efficacy and rationality.
Keywords: Chronic kidney disease, Hypertension, Prescription pattern, JNC-8 guidelines, Compliance, Anti-Hypertensive.
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Varakantham, Varsha, Ashok Kumar Kurakula Sailoo, and Dinesh Kumar Bharatraj. "Antihypertensive Prescription Pattern and Compliance to JNC 7 and JNC 8 at Tertiary Care Government Hospital, Hyderabad, India: A Cross-sectional Retrospective Study." Hospital Pharmacy 53, no. 2 (November 1, 2017): 107–12. http://dx.doi.org/10.1177/0018578717738080.
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Background: The monitoring of hypertension treatment can provide insight into the rational drug use pattern. The objective of this study was to examine the antihypertensive medication use among South Indian adults with hypertension in compliance with the hypertension treatment guidelines (Seventh Joint National Committee [JNC 7] and JNC 8). Methods and Results: A total of 550 hypertensive people aged >25 years were included in this retrospective cross-sectional study. The order of drugs prescribed in the year 2012 was beta blockers (BB) > calcium channel blockers (CCB) > CCB + BB > angiotensin receptor blockers (ARB) > angiotensin-converting enzyme inhibitors (ACEI) > thiazide diuretics, whereas in the year 2014, the order has changed drastically, namely, ACEI > CCB > ARB > BB > thiazide diuretics ( P < .001). Most notably, there was a large increase in the use of monotherapy (from 56.9% to 82.5%, P < .001). The usage of BB has simply moved from the first position to the last position in concordance with JNC 8 guidelines, whereas use of thiazide diuretics was found to be the least preferred drug in the 2012 prescriptions, thus deviating from JNC 7 guidelines. The use of generic names (28.3% vs 11.3%) and National List of Essential Medicines (NLEM) compliance (79.3% vs 60.9%) were significantly more in the calendar year 2012 than in the calendar year 2014 ( P < .001). Conclusions: Antihypertensive medication use has gone through wide variations among south Indian adults with hypertension. Combination therapy regimens must be adopted as per the guidelines for achievement of blood pressure goals.
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Myers, Martin G., and Sheldon W. Tobe. "A Canadian Perspective on the Eighth Joint National Committee (JNC 8) Hypertension Guidelines." Journal of Clinical Hypertension 16, no. 4 (March 19, 2014): 246–48. http://dx.doi.org/10.1111/jch.12307.
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Verma, Vikash, Mukesh Kumar, Arvind Gupta, Kavita Dhar, and Jyotshana Sharma. "A study on drug utilization pattern of antihypertensive drugs in hypertensive diabetic patients." International Journal of Basic & Clinical Pharmacology 8, no. 10 (September 25, 2019): 2242. http://dx.doi.org/10.18203/2319-2003.ijbcp20194264.
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Background: Hypertension management is of paramount importance in diabetic patients for reduction of cardiovascular and other complications. The objective of the present study was to assess prescribing pattern of antihypertensive drugs in hypertensive type 2 diabetic patients and evaluate them by comparing with Eighth Joint National Committee (JNC-8) hypertension treatment guidelines.Methods: A prospective observational study was carried out on 110 hypertensive type 2 diabetic patients of age 41-80 years visiting outpatient department of Medicine at G.S. Medical College and Hospital, UP, India for 4 months. JNC-8 hypertension management guideline was considered while evaluating the prescribed drugs. All the relevant data was collected from the prescription card of the patient on a preformed performa and analyzed using descriptive statistics.Results: Total of 176 drugs was prescribed to the study patients among which two drug combination therapy (55.45%) was mostly used. The most common group prescribed was angiotensin receptor blocker (ARB) (29.45%) and ARB+CCB (calcium channel blockers) (34.92%) were the commonest fixed drug combination. Overall, it was amlodipine (21.47%) that was most frequently prescribed among all antihypertensive drugs.Conclusions: ARB was the most commonest class, ARB+CCB was the most frequent fixed drug combination prescribed to the study patient while amlodipine was the highly utilized individual antihypertensive drug in the study. Prescriptions evaluation revealed that 94.88% prescription were rational and were in accordance with the JNC-8 hypertension treatment guidelines except the use of beta blockers (5.12%).
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Goldstein, Felicia C., Ihab M. Hajjar, Callie B. Dunn, Allan I. Levey, and Whitney Wharton. "The Relationship Between Cognitive Functioning and the JNC-8 Guidelines for Hypertension in Older Adults." Journals of Gerontology Series A: Biological Sciences and Medical Sciences 72, no. 1 (September 27, 2016): 121–26. http://dx.doi.org/10.1093/gerona/glw181.
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Raju, Sivasakthi, Sam Solomon, Nithiyan N, Karthik K, Anns Clara Joseph, and Venkatanarayanan V. "Assessment of Prescribing Pattern for Hypertension and Comparison with JNC-8 Guidelines-Proposed Intervention by Clinical Pharmacist." Journal of Young Pharmacists 8, no. 2 (April 1, 2016): 133–35. http://dx.doi.org/10.5530/jyp.2016.2.14.
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Bhore, A. S., Kalyani Khandare, and K. A. Bansod. "Prescription pattern and rationality of antihypertensive drugs in patients of type 2 diabetes with hypertension: a pilot study." International Journal of Research in Medical Sciences 7, no. 4 (March 27, 2019): 982. http://dx.doi.org/10.18203/2320-6012.ijrms20191299.
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Background: As presence of hypertension (HTN) in type 2 diabetes significantly increases risk of morbidity and mortality, its control with rational use of antihypertensives is essential. Authors performed this study to understand the current prescribing pattern of antihypertensives in patients of type 2 diabetes and their assess the rationality to recommendations of JNC-8 guidelines.Methods: Authors performed a cross sectional survey of prescription of diagnosed patients of diabetes with HTN at a tertiary care hospital. Prescription of patients attending medicine OPD were scanned. Data was collected over 2 month and analyzed with descriptive statistics.Results: In 76 patients analysed, mean age was 54.9±9.3 years and 51.3% were females. Insulin and oral antidiabetic agents were prescribed in 16 (21.1%) and 73 (96.1%) patients respectively. One, two, three and four antihypertensive drugs were prescribed in 44 (57.9%), 28 (36.8%), 3 (3.9%) and 1 (1.3%) patients respectively and 24 (31.6%) of them were fixed dose combinations. Among antihypertensives, angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), thiazide diuretics, beta blockers (BBs) and calcium channel blockers (CCBs) were present in 29 (38.2%), 26 (34.2%), 22 (28.9%), 21 (27.6%) and 14 (18.4%) respectively. In individual drugs, ramipril (28.9%) was most common followed by telmisartan (26.3%), hydrochlorothiazide (26.3%), atenolol (16, 21.1%) and amlodipine (17.1%) were frequently prescribed. In adjuvant drugs, antiplatelet (52.6%) and statins (56.6%) were common. This pattern of prescription was as per the recommendations of recent JNC-8 guidelines for treatment of hypertension.Conclusions: ACEIs/ARB are the most preferred for HTN treatment in type 2 diabetes mellitus. Prescription of antihypertensives in our set up was rational as per JNC-8 recommendations.
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Reisin, Efrain, Raymond C. Harris, and Mahboob Rahman. "Commentary on the 2014 BP Guidelines from the Panel Appointed to the Eighth Joint National Committee (JNC 8)." Journal of the American Society of Nephrology 25, no. 11 (August 11, 2014): 2419–24. http://dx.doi.org/10.1681/asn.2014040371.
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Abel, Nicole, Krysta Contino, Navjot Jain, Navjot Grewal, Elizabeth Grand, Iris Hagans, Krystal Hunter, and Satyajeet Roy. "Eighth joint national committee (JNC-8) guidelines and the outpatient management of hypertension in the African-American population." North American Journal of Medical Sciences 7, no. 10 (2015): 438. http://dx.doi.org/10.4103/1947-2714.168669.
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K. Deepak Maharshi, T. Vani, M. Navaneetha, G. Jyothi, Shantveer Halcher, and Gururaj V Wadageri. "Prescription pattern of anti-hypertensive drugs among hypertensive patients at district hospital." International Journal of Research in Hospital and Clinical Pharmacy 1, no. 2 (May 30, 2019): 57–61. http://dx.doi.org/10.33974/ijrhcp.v1i2.86.
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Background: To conduct a prospective observational study on prescribing pattern of anti-hypertensive drug in the department of general medicine in Government District hospital, Gulbarga. In this study it was aimed to evaluate the current practice of anti-hypertensive drug by comparing with JNC-8 guidelines in population. Objectives: The objective of our study is to determine the prescription pattern of antihypertensive drugs and adherence to JNC8 guidelines and to find out the most prescribed anti-hypertensive drugs. Methods: A Prospective Observational Study of 06 months was conducted. Undertaken 174 patients data collection form of all the patients of inpatient department of age 18 ≥ years of hypertensive with or without co-morbidities. Result: The results of this analysis suggests that out of the total 174 hypertensive patients included in the study, 92 patients were males while 82 patients were females, indicating the higher prevalence of hypertension in male population than in female population, that is 10% higher prevalence in males than in females. Out of the total study subjects, 169 hypertensive patients were found to have other co morbid conditions. Considering out of the total 174 patients, majority of the patients received monotherapy (129) while remaining patients receiving the Combinational therapy are 45. However in the case of overall utilization pattern of antihypertensive agents, CCBs are the most frequently prescribed class of drugs, followed by ARBs , BBs and finally ACEIs.
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Kareem, Thasvi. "PRESCRIPTION PATTERN OF ANTI-HYPERTENSIVE DRUGS IN A TERTIARY CARE HOSPITAL IN KERALA AND ADHERENCE TO JNC-8 GUIDELINES." Universal Journal of Pharmaceutical Research 3, no. 3 (July 15, 2018): 1–3. http://dx.doi.org/10.22270/ujpr.v3i3.158.
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Malpani, Ashok Kumar, Manjunath Waggi, Palash Panja, and Thella Monica Christien. "Study of Prescribing Pattern of Antihypertensive Drugs and Evaluation of the Prescription with JNC 8 Guidelines in North Karnataka Hospital." Indian Journal of Pharmacy Practice 11, no. 4 (December 3, 2018): 193–97. http://dx.doi.org/10.5530/ijopp.11.4.40.
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Lough, L., A. Seixas, G. Avirappattu, R. Robbins, A. Rogers, S. Williams, and G. Jean-Louis. "1046 Assessing Sleep-Related Hypertension Risks Using JNC 8 Guidelines: Analysis Of The National Health And Nutrition Examination Survey Data." Sleep 43, Supplement_1 (April 2020): A397. http://dx.doi.org/10.1093/sleep/zsaa056.1042.
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Abstract Introduction Associations between self-reported sleep duration and risk of hypertension (HTN) are well established. The level of sleep-related HTN risk based on the new JNC 8 classification guidelines requires further research. In this study, we modeled the associations of insufficient sleep with HTN using the National Health and Nutrition Examination Survey (NHANES). Methods Data were extracted from the 2006-2016 NHANES (n=38,540), a nationally representative study of the US civilian population. Self-reported demographic and sleep duration were determined from household interview questions. Insufficient sleep was categorized as sleeping <7hrs. Using 2017 ACC/AHA guidelines, HTN was classified as elevated (SBP:120-129mmHg and DBP <80mmHg, Stage I (SBP:130-139mmHg and DBP:80-89mmHg), or Stage II (SBP ≥140mmHg and DBP ≥90mmHg). Logistic regression modeling was performed using R. Results Participants’ ages ranged from 18-85 years. Of the sample, 51% were female, 41% white, 22% black, 26% Hispanic, 8% others; 46% were married, and 25% completed <high school. The model showed strong age and BMI-adjusted associations of insufficient sleep with HTN at all levels: (elevated: OR=1.079, CI=1.03-1.13; Stage I: OR=1.127, CI=1.07-1.18, and Stage II: OR=1.334, CI=1.17-1.52). Important sex and race/ethnicity differences in sleep-related HTN risks were observed: males (elevated: OR=1.024, CI=0.95-1.10; Stage I: OR=1.077, CI=1.01-1.15, and Stage II: OR=1.254, CI=1.06-1.48); females (elevated: OR=1.125, CI=1.05-1.21; Stage I: OR=1.170, CI=1.08-1.26, and Stage II: OR=1.445, CI=1.17-1.79); whites (elevated: OR=1.007, CI=0.93-1.08; Stage I: OR=1.030, CI=0.95-1.12, and Stage II: OR=1.131, CI=0.90-1.43); blacks (elevated: OR=1.047, CI=0.94-1.16; Stage I: OR=1.080, CI=0.97-1.20, and Stage II: OR=1.179, CI=0.95-1.46); and Hispanics (elevated: OR=1.066, CI=0.94-1.21; State I: OR=1.089, CI=0.96-1.24, and Stage II: OR=1.337, CI=0.92-1.92). Conclusion Our analyses showed that sleep-related HTN risks vary as a function of individual’s sex and race/ethnicity. Increasing sleep duration at all HTN severity level is important and males and Hispanics at Stage II HTN might benefit the most. Support This study was supported by funding from the NIH: R01MD007716,R01HL142066, R01AG056531, T32HL129953, K01HL135452 and K07AG052685
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Helmidanora, Rusdiati, and Triswanto Sentat. "EFEK HIPOTENSIF DARI ACEi DAN ARB PADA PASIEN DIABETES MELLITUS DAN HIPERTENSI DI RSUD. ABDUL WAHAB SYAHRANIE SAMARINDA." Jurnal Ilmiah Manuntung 3, no. 2 (January 23, 2018): 186. http://dx.doi.org/10.51352/jim.v3i2.126.
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More than two-thirds of patients with type 2 diabetes also experience hypertension whose development coincides with hyperglycemia, where each disease has a tendency to influence the increased risk of other diseases. Sundry new guidelines, such as the National Joint Committee 8, the American Diabetes Association recommend blood pressure targets in the diabetic population of <140/90 mmHg to reduce cardiovascular risk and prevent the progression of nephropathy. This study aims to determine whether there is a difference in achieving blood pressure target < 140/90 mmHg according to Join National Committee 8 between ACEi and ARB in patients with type 2 diabetes with hypertension. This research was conducted using a retrospective at internist clinic of Abdul Wahab Syahranie hospital, by taking secondary data from the medical record from blood pressure o 49 outpatients received a single antihypertensive either drug ACEi 29 people or ARB 34 people. This study showed that the achievement of target blood pressure by <140/90 mmHg (JNC 8 guideline) between ACEi 7 (28%) and ARB 5 (20,8%) group and it can be concluded that between ACEi and ARB drugs(P=0.5) there was no differsignificantly in achievement blood pressure target on type 2 diabetes with hypertension.
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Siddiqua, Ayesha, Afaf Alshehri, Amal M. Alahmari, Rawan A. Alshehri, and Somayh S. Badawy. "A Study of Prescription Pattern and Compliance of Anti-hypertensives with the Treatment Guidelines in Aseer Region; Saudi Arabia." Current Drug Therapy 14, no. 3 (October 23, 2019): 261–66. http://dx.doi.org/10.2174/1574885514666190424155014.
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Background: A prescription study is an effective method to evaluate irrational prescribing practice. Hypertension is one such major chronic disease. Compliance to guidelines like the JNC-8 (Eighth Joint National Committee) and Saudi Hypertension guidelines is highly recommended to prevent future complications. Objective: We conducted this study to assess prescribing pattern and their compliance with the guidelines in the patients. Methods: A Retrospective cross-sectional study was carried out for 7 weeks in 2017 in Aseer region, Abha, Saudi Arabia on 122 outpatient prescriptions which were included by Non-probability convenience sampling technique. Data from patients aged above 18 years with any stage of Hypertension with or without Diabetes Mellitus was collected. Results: It was found that Angiotensin converting enzyme inhibitors were frequently prescribed as monotherapy in patients with Hypertension with or without Diabetes Mellitus which is in compliance to the guidelines. Beta-blockers were most commonly used in 2 and 3 drug therapy of patients with only Hypertension which was not in accordance with the guidelines. Conclusion: By this it could be concluded that the Prescription pattern of Antihypertensive in Aseer Region was in compliance with both the guidelines to a partial extent. Though most of the prescriptions were rational, further improvement was required. Studies that focus on demographic data, economic status, associated conditions and complications would give additional insights into prescribing patterns in hypertension.
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Galán, Isabel, Úrsula Verdalles, Marisol García de Vinuesa, Borja Quiroga, Marian Goicoechea, Ana Pérez, Eduardo Verde, and José Luño. "Impact of the application of the JNC 8 and KDIGO-2013 guidelines on hypertension and lipid control in a nephrology outpatient clinic." Nefrología (English Edition) 38, no. 4 (July 2018): 373–79. http://dx.doi.org/10.1016/j.nefroe.2018.05.003.
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Severova-Andreevska, Galina, Ilina Danilovska, Aleksandar Sikole, Zivko Popov, and Ninoslav Ivanovski. "Hypertension after Kidney Transplantation: Clinical Significance and Therapeutical Aspects." Open Access Macedonian Journal of Medical Sciences 7, no. 7 (April 14, 2019): 1241–45. http://dx.doi.org/10.3889/oamjms.2019.264.
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Most of the kidney transplanted patients develop arterial hypertension after renal transplantation. Together with very well-known and usual risk factors, post-transplant hypertension contributes to the whole cardiovascular morbidity and mortality in the kidney transplant population. The reasons of post-transplant hypertension are factors related to donors and recipients, immunosuppressive therapy like Calcineurin Inhibitors (CNI) and surgery procedures (stenosis and kinking of the renal artery and ureteral obstruction). According to Eighth National Committee (JNC 8) recommendations, blood pressure > 140/90 mmHg is considered as hypertension. The usual antihypertensive drugs used for the control of hypertension are Calcium channel blockers (CCB), Angiotensin-converting enzyme (ACE) inhibitors, Angiotensin –II receptor blockers (ARB), B- blockers and diuretics. Follow the KDIGO guidelines the target blood pressure < 140/90 mmHg for patients without proteinuria and < 125/75 mmHg in patients with proteinuria is recommended. Better control of post-transplant hypertension improves the long-term graft and patient’s survival.
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Singh, Parminder, Rahat Kumar Sharma, and Jaswinder Singh. "Study of Prescribing Pattern and Adverse Drug Reactions in Hypertensive Patients with Comorbidities as per JNC 8 Hypertension Guidelines in a Tertiary Care Hospital of Punjab." Journal of Evidence Based Medicine and Healthcare 7, no. 19 (May 6, 2020): 931–37. http://dx.doi.org/10.18410/jebmh/2020/204.
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Shah, Jay, and Avinash Balraj. "Drug utilization pattern of antihypertensive agents in patients of hypertensive nephropathy in a tertiary care hospital: a cross sectional study." International Journal of Basic & Clinical Pharmacology 6, no. 9 (August 22, 2017): 2131. http://dx.doi.org/10.18203/2319-2003.ijbcp20173636.
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Background: Objective of the study was to determine the drug utilization pattern of antihypertensive agents in patients of hypertensive nephropathy in a tertiary care teaching hospital.Methods: This was a prospective observational study carried out in Index medical college and Hospital, Indore over a period of three 4 months. A total of 60 patients aged 40-79 years taking treatment for hypertension with associated nephropathy were enrolled in the study. All the relevant data were collected and drug utilization pattern of antihypertensive agents was determined. The study evaluated the percentage of use of multidrug therapy, drugs prescribed from Essential Drug List (EDL) and prescriptions with generic name. The cost of antihypertensive drugs used per day was calculated and linked with socioeconomic status of the patients.Results: Evaluation of the prescriptions demonstrates that a total of 63.3% males and 36.7% females with mean age of 58.9±11.9 years were enrolled out of which 70% patients were on multidrug therapy while only 30% were on monotherapy. Though only 16.67% patients were prescribed generic drugs but it did not affect the economic condition of the patient as most of enrolled patients belong to upper middle class.Conclusions: The prescriptions analysed were in accordance to guidelines of JNC-8 (Joint National Committee - 8) and most of the prescriptions were found to be rational and it also shows that management of hypertensive nephropathy needs combination therapy.
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Anggraini, Truly Dian, Eka Wisnu Kusuma, and Deswinda Diandari. "Pengaruh Rasionalitas Penggunaan Antihipertensi dengan Standart Guideline JNC 8 Terhadap Keberhasilan Terapi Hipertensi di RS Panti Waluyo Surakarta." Jurnal Farmasi (Journal of Pharmacy) 6, no. 1 (May 29, 2019): 6–9. http://dx.doi.org/10.37013/jf.v6i1.39.
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AbstrackHipertensi merupakan masalah utama kesehatan publik di seluruh dunia dan merupakan faktor resiko penyakit kardiovaskuler tersering. Prevalensi hipertensi pada penduduk umur 18 tahun ke atas sebesar 29,8%. Data epidemiologi menunjukkan bahwa peningkatan tekanan darah akan meningkatkan kejadian kardiovaskuler, sehingga hipertensi harus diobati dengan tepat. Penelitian ini bertujuan untuk mengetahui pengaruh rasionalitas penggunaan antihipertensi dengan standar guideline JNC 8 terhadap keberhasilan terapi hipertensi di RS Panti Waluyo Surakarta tahun 2016. Penelitian ini merupakan penelitian cohortdimana pengambilan data dilakukan secara retrospektif dari catatan rekam medik pasien hipertensi rawat inap pada tahun 2016. Setelah diperoleh sampel maka akan dianalisis pola penggunaan antihipertensi serta rasionalitas penggunaan antihipertensi dengan standar guideline JNC 8 dianalisis secara diskriptif, pengaruh rasionalitas penggunaan antihipertensi dengan standar guideline JNC 8 terhadap keberhasilan terapi (dilihat dari tercapainya target tekanan darah pasien) dianalisis secara statistik menggunakan Chi-square. Hasil penelitian, 84 pasien mendapatkan terapi hipertensi yang rasional sesuai dengan guideline JNC 8 dan 16 pasien mendapatkan terapi hipertensi yang tidak rasional dengan guideline JNC 8. Pola obat antihipertensi, 52 pasien diresepkan obat antihipertensi tunggal, 43 pasien kombinasi 2 obat antihipertensi, selebihnya pasien diresepkan lebih dari 2 antihipertensi. Keberhasilan terapi, 65 pasien dari 84 pasien yang mendapatkan terapi hipertensi yang rasional mampu mencapai target tekanan darah sehingga terapi dikatakan berhasil. Ada hubungan yang signifikan antara rasionalitas terapi hipertensi dengan guideline JNC 8 terhadap ketercapaian keberhasilan terapi (p<0,05).
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Agustina, Putri S., Em Yunir, Pukovisa Prawiroharjo, Johanda Damanik, and Rani Sauriasari. "Comparison of Effects of ACEIs and ARBs on Albuminuria and Hyperkalemia in Indonesian Hypertensive Type 2 Diabetes Mellitus Patients." International Journal of Hypertension 2020 (July 30, 2020): 1–8. http://dx.doi.org/10.1155/2020/5342161.
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Purpose. Due to economic consideration, Indonesia’s formulary restrictions are at odds with the treatment guidelines of the American Diabetes Association (ADA) and the Eighth Joint National Committee (JNC 8). ADA and JNC 8 equally recommend the prescription of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) for hypertensive patients with type 2 diabetes mellitus (T2DM) with overt proteinuria (urine albumin to creatinine ratio (UACR) ≥ 300 mg/g creatinine). However, since 1 April 2018, Indonesian formulary restricted telmisartan and valsartan only for T2DM patients with declined renal function as shown by eGFR value. There is no compelling evidence in favor of ACEI over ARB or vice versa except for data supporting the early use of both drugs in patients with overt proteinuria. However, ARB is a choice if ACEI’s side effects, that is, coughing, occurs. Therefore, it necessitates a detailed evaluation of the effects of ACEIs and ARBs on albuminuria and their side effect, hyperkalemia, specific to Indonesian T2DM patients. Methods. This cross-sectional study involved 134 T2DM patients whose treatment was restricted to either ACEIs (n = 57) or ARBs (n = 77) for at least two months before the study during May–October 2018. Patients with known end-stage renal disease and those receiving dialysis were excluded. UACR and blood potassium levels were compared between the two study groups. Also, the risk factors of albuminuria and hyperkalemia were estimated using multivariate analysis. Results. T2DM patients in the ACEI and ARB groups had similar characteristics except for a higher body mass index (p=0.008), lower glomerular filtration rate (p=0.04), and a longer duration of prior treatment (p<0.001) in the ARB group. This study showed no differences between the ACEI and ARB groups in the proportion of cases with albuminuria (p=0.97) and hyperkalemia (p=0.86), even after adjustment for confounders. In addition, uncontrolled diastolic blood pressure was a significant factor associated with albuminuria (OR: 4.897, 95% CI: 1.026–23.366; p=0.046), whereas a female was 70.1% less likely to develop hyperkalemia than a male (OR: 0.299, 95% CI: 0.102–0.877; p=0.028). Conclusion. This cross-sectional study demonstrated that ACEIs and ARBs have a similar effect on albuminuria and hyperkalemia in Indonesian hypertensive T2DM patients, even after correction for potentially confounding variables.
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Hernandez-Vila, Eduardo. "A Review of the JNC 8 Blood Pressure Guideline." Texas Heart Institute Journal 42, no. 3 (June 1, 2015): 226–28. http://dx.doi.org/10.14503/thij-15-5067.
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Weber, Michael A. "Recently Published Hypertension Guidelines of the JNC 8 Panelists, the American Society of Hypertension/International Society of Hypertension and Other Major Organizations: Introduction to a Focus Issue of The Journal of Clinical Hypertension." Journal of Clinical Hypertension 16, no. 4 (March 26, 2014): 241–45. http://dx.doi.org/10.1111/jch.12308.
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Feldman, Harvey, Kim Zuber, and Jane S. Davis. "Staying up to date with the JNC 8 hypertension guideline." Journal of the American Academy of Physician Assistants 27, no. 8 (August 2014): 44–49. http://dx.doi.org/10.1097/01.jaa.0000451865.17954.9b.
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Djikic, Dijana, Nebojsa Mujovic, Vojislav Giga, Milan Marinkovic, Goran Trajkovic, Snezana Lazic, Vedrana Pavlovic, Vladan Peric, and Dragan Simic. "Interatrial conduction time is early marker of disturbed impulse propagation in adults with slightly elevated blood pressure." Vojnosanitetski pregled 77, no. 6 (2020): 569–74. http://dx.doi.org/10.2298/vsp180417101d.
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Background/Aim. Interatrial conduction time is early marker of disturbed impulse propagation in adult with elevated blood pressure. The aim of our study was to evaluate significance of noninvasive echocardiographic marker of slow sinus impulse propagation (atrial conduction time) for the identification of persons with slightly elevated blood pressure and hypertension in adults. Methods. One hundred and forty nine adults with normal and elevated blood pressure were studied: 46 normotensive adults (group 1), 28 adults with elevated blood pressure and hypertension stage 1 (group 2) and 75 adults with hypertension stage 2 (group 3), based on the Joint National Committee 8 (JNC-8) hypertension guidelines. We studied P wave dispersion, reservoir function of the left atrium (LA), total emptying volume of the LA and total emptying fraction of the LA (LATEF). The atrial conduction time (ACT) was evaluated by the pulsed tissue Doppler, and expressed as interatrial and intraatrial conduction time. Results. The LATEF decreased progressively from the group 3 (64.8 ? 4.4%) to the group 2 (59.8 ? 5.2%) and the group 1 (55.6 ? 7.3%) (p < 0.001). The P wave dispersion (55.1 ? 9.8 ms vs. 46.8 ? 3.1 ms vs. 43.1 ? 2.6 ms; p < 0.01) and intra ACT were significantly prolonged only in the group 3 compared to the other groups (22.7 ? 11.0 ms vs. 8.4 ? 4.7ms vs. 5.6 ? 2.4 ms, respectively; p < 0.001). Inter ACT significantly increased from the group 1 to the group 2 and the group 3 (15.6 ? 3.9 ms vs. 24.6 ? 5.7 ms vs. 50.4 ? 20 ms, respectively; p < 0.05). Using a cut-off level of 19.5 ms, inter ACT could separate adults in the group 2 from the group 1 with a sensitivity of 85%, and specificity of 89% [area under receiver operating characteristic (ROC) curve 0.911]. Conclusion. Prolonged ACT estimated with the tissue Doppler may be useful for identification persons with slighty elevated blood pressure, and hypertension stage 1.
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Islam, Quazi Tarikul. "JNC 8: Evidence-Based Guideline for the Management of High Blood Pressure in Adults in 2014." Bangladesh Journal of Medicine 25, no. 1 (September 20, 2015): 1–2. http://dx.doi.org/10.3329/bjmed.v25i1.25069.
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Bajracharya, Mijala, and S. Nakarmi. "Study of Drug Prescription Pattern of Obese and Non-Obese Patients with Type-II Diabetes with or without Hypertension." Journal of Manmohan Memorial Institute of Health Sciences 6, no. 1 (August 7, 2020): 81–93. http://dx.doi.org/10.3126/jmmihs.v6i1.30543.
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Correction: The page numbers were changed from 98-100 to 81-93 on 31/08/2020.
Background: Obesity is regarded as worldwide health problems which may put a person at a higher risk of serious health conditions leading to morbidity and mortality. Obesity is a risk factor for many diseases of which hypertension and type-2 diabetes mellitus are the most important. Hypertension, diabetes mellitus and obesity together form 24% of the global risk for mortality. Cardiovascular diseases related to these life-style disorders has major effect on life expectancy and impaired quality of life.
Objectives: The study was done to evaluate the drug prescribing pattern of type - 2 diabetes and hypertension in both obese and non-obese patients. Along with it, this study also attempt to find the contributing factors associated with it and different types of drugs selected in those conditions respectively.
Method: A descriptive cross-sectional study was conducted in 2074 at Manmohan memorial teaching hospital. A total of 101 out-patient were interviewed, measurements were done to calculate BMI and waist to hip ratio and their prescriptions were reviewed. For Treatment Guideline of HTN, JNC 8[20] was followed and Updated Treatment Guidelines for Type 2 Diabetes by the American Diabetes Association (ADA) [21] was followed in case of diabetes.
Result: Among 101 patients studied, 58 were males and 43 were females. Regarding physical activity, only 26.7% of total patients were involved in morning walk and 3% in yoga, remaining 71% of study patients did not involve in any kind of physical exercise. Regarding food habits, 22.8% were smokers, 49.5% were alcoholics and 96% were non-vegetarians. Waist to hip ratio was also observed higher in both males (35.6%) and females (39.6%). Among the101 total participants, the age group of 41-55 years were found to be more obese than other age group (34 in numbers) followed by age group 56-70 which were 16 in numbers. Male patients were more obese (41) than female patients (31). Highest number (31) of the obese patients were diagnosed with type 2 diabetes mellitus, followed by second highest number (26) of patients diagnosed with hypertension and 15 patients with both the conditions. The commonly prescribed oral hypoglycemic drugs were metformin (35.60%) followed by glimepiride (24.80%). Among anti-hypertensive drugs, amlodipine (22.80%) was most common in prescriptions followed by losartan (18.80%) and Telmisartan (17.80%).
Conclusion: The results of the present study show that higher number of male patients (41) were obese than female patients (31). About 30% of patients were found obese-diabetic, 26% were obese-hypertensive and 15% were with both obese diabetic and hypertensive condition. Among oral hypoglycemic drugs, metformin (35.60%) was mostly prescribed followed by glimepiride (24.80%). Among antihypertensives, amlodipine (22.8%) was mostly prescribed followed by losartan (18.80%). Atorvastatin (11.9%) was mostly prescribed oral hypolipidemic agent.
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Halboup, Abdulsalam M., Gamil Q. Othman, Mohammed M. Battah, Karem H. Alzoubi, and Hebah Sallom. "Awareness of Physicians in Yemen Toward High Blood Pressure Management According to the Eighth Joint National Committee (JNC 8) Guideline." International Journal of General Medicine Volume 13 (August 2020): 529–37. http://dx.doi.org/10.2147/ijgm.s265118.
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Ogunbeku, A., S. J. Showande, R. Adisa, and T. O. Fakeye. "Tailored intervention to implement the management of hypertensive and type 2 diabetes mellitus patients in community pharmacies – a pilot study." International Journal of Pharmacy Practice 29, Supplement_1 (March 26, 2021): i47—i48. http://dx.doi.org/10.1093/ijpp/riab015.058.
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Abstract Introduction Uncontrolled blood pressure and poor glycaemic control may lead to increased morbidity and mortality (1). A systematic review of 40 studies reported beneficial effects of interventions conducted in community pharmacies in the management of diabetes and cardiovascular diseases (2). Aim To evaluate the impact of a tailored intervention on clinical outcomes in the management of hypertensive and/or type 2 diabetes mellitus (T2DM) patients in community pharmacies in a pilot implementation study. Methods The study (April to July 2019) utilized a mixed-method design. This included a cross-sectional survey among 133 consented community pharmacists and 390 T2DM and/or hypertensive patients at the pharmacies. Thirty-one item (pharmacists) and 29-item (patients) semi-structured questionnaires were used to gather information on their perception of pharmacists’ roles in the management of T2DM and/or hypertension. Barriers to implement identified roles by the pharmacists were documented. Thereafter, a prospective before- and after-intervention study was conducted in four consented pharmacies to address the barriers. Two pharmacists per pharmacy and 34 consented T2DM and/or hypertensive adult patients who had been on medications for ≥3 months participated. Pharmacists were provided with 2-hr one-on-one training on the management of T2DM and hypertension based on standard guidelines pre-intervention and at 4 weeks. Components of the pharmacist’s intervention included patient’s education, medication counselling , lifestyle modifications and self-care use of point of care devices. Systolic and diastolic blood pressure (SBP and DBP), fasting blood glucose (FBG) and body mass index (BMI) of all patients were measured at baseline, 4- and 8-week post-intervention. Weekly patient follow-up visits to the pharmacies were mandatory. Telephone calls and referral were incorporated, when necessary. Failure to show up for two consecutive visits disqualified patients from completing the study. Descriptive statistics (to summarise data), and paired t-test to compare mean differences in the measured parameters at α=0.05. Results Hypertensive and/or T2DM patients (374) and 71 pharmacists participated in the survey. The patients expected pharmacists to provide medication counselling (81;27.1%), education (47;12.6%), follow-up (18;4.8%), health outcomes monitoring (17;4.5%), and collaboration with physicians (12;3.2%). Sixty-nine (97.2%) pharmacists agreed that patients’ follow-up, patient counselling (71;100.0%), therapeutic plan design to achieve goals (67;94.4%) and collaboration with physicians (61;85.9%) were important. Barriers to providing adequate counsel to these patients were time constraints (23;32.4%), unconducive environment (7;9.9%) and patient’s impatience (33;46.5%). For the intervention component, 16 of the 34 patients enrolled were lost to follow-up (one hospitalized, seven failed two consecutive visits, and eight lost to referral). Effects of the tailored intervention on the parameters are in Table 1. Conclusion The patients’ and pharmacists’ perceived roles of the pharmacist in the management of hypertension and T2DM were in tandem. The 8-week tailored pharmacists’ intervention resulted in better control of blood pressure but increased FBG. This pilot study is limited by the small sample size of patients and pharmacists, as well as the lack of appropriate comparator. Future large-scale multi-site study with relevant comparator is required for a far-reaching conclusion on the impact of the tailored pharmacist intervention in the management of diabetes and hypertension. References 1. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report. JAMA. 2003;289:2560–72. 2. Evans CD, Watson E, Eurich DT, Taylor JG, Yakiwchuk EM, Shevchuk YM, et al. Diabetes and cardiovascular disease interventions by community pharmacists: a systematic review. Ann Pharmacother. 2011;45(5):615–28.
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Palin, Victoria, Anna Mölter, Miguel Belmonte, Darren M. Ashcroft, Andrew White, William Welfare, and Tjeerd van Staa. "Antibiotic prescribing for common infections in UK general practice: variability and drivers." Journal of Antimicrobial Chemotherapy 74, no. 8 (April 30, 2019): 2440–50. http://dx.doi.org/10.1093/jac/dkz163.
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Abstract Objectives To examine variations across general practices and factors associated with antibiotic prescribing for common infections in UK primary care to identify potential targets for improvement and optimization of prescribing. Methods Oral antibiotic prescribing for common infections was analysed using anonymized UK primary care electronic health records between 2000 and 2015 using the Clinical Practice Research Datalink (CPRD). The rate of prescribing for each condition was observed over time and mean change points were compared with national guideline updates. Any correlation between the rate of prescribing for each infectious condition was estimated within a practice. Predictors of prescribing were estimated using logistic regression in a matched patient cohort (1:1 by age, sex and calendar time). Results Over 8 million patient records were examined in 587 UK general practices. Practices varied considerably in their propensity to prescribe antibiotics and this variance increased over time. Change points in prescribing did not reflect updates to national guidelines. Prescribing levels within practices were not consistent for different infectious conditions. A history of antibiotic use significantly increased the risk of receiving a subsequent antibiotic (by 22%–48% for patients with three or more antibiotic prescriptions in the past 12 months), as did higher BMI, history of smoking and flu vaccinations. Other drivers for receiving an antibiotic varied considerably for each condition. Conclusions Large variability in antibiotic prescribing between practices and within practices was observed. Prescribing guidelines alone do not positively influence a change in prescribing, suggesting more targeted interventions are required to optimize antibiotic prescribing in the UK.
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Gupta, N., B. E. Sands, M. Regueiro, M. Dubinsky, D. Rubin, J. Hanson, F. Aberra, et al. "P428 Oral mesalamine use in Crohn’s disease after implementation of the American College of Gastroenterology guidelines: a TARGET-IBD cohort study." Journal of Crohn's and Colitis 14, Supplement_1 (January 2020): S389—S390. http://dx.doi.org/10.1093/ecco-jcc/jjz203.557.
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Abstract Background American College of Gastroenterology (ACG) guidelines for the management of adults with Crohn’s disease (CD) in March 2018 state that oral mesalamine, ‘should not be used…to treat CD.’ 1 This abstract estimates the prevalence of any use of mesalamine among patients with CD before and after the implementation of the guideline. It also aims to describe current utilisation patterns of mesalamine in CD by disease phenotype, location, and concomitant use of biologic agents. Methods TARGET-IBD is a longitudinal cohort of IBD patients receiving usual care in the USA; this abstract includes CD patients enrolled between March 2017 and December 2018. Medication use was captured as any use in the follow-up period. Use of mesalamine was stratified into patients who were on mesalamine alone or patients on mesalamine and a biologic. The proportion of patients on mesalamine was estimated in time windows after the policy change to discern penetration into usual practice. Results 732 patients from TARGET-IBD who had baseline data prior to the new recommendation were included. Of these, 14% used mesalamine only, 8% used mesalamine plus a biologic, and 78% did not use mesalamine. A total of 65% received care in academic centres and the median duration of disease at enrolment was 12 years. The distribution of patient characteristics was similar after the policy change. Six months after the ACG recommendation, 11% of patients used mesalamine only, 7% of patients were on mesalamine plus a biologic, and 82% did not use mesalamine. Prevalence of use for the 3 and 6 month time windows was similar. Subsequent therapy changes and additions in patients on mesalamine are shown in Figure 1. Location (colon vs. ileum) and type of CD (inflammatory vs. fistulising) were statistically significant predictors of the odds of any mesalamine use both before and after the policy change (OR 3.233 (CI 1.725–6.061) and 3.334 (CI 1.931–5.755, respectively)). Conclusion Mesalamine use remained stable in the TARGET-IBD CD population, despite the release of the ACG guideline. Individuals with colonic, inflammatory disease were more likely to receive mesalamine, as were Medicare recipients. There was little difference between academic and community practice in implementation of the new standards. Given that the guidelines are relatively new, it is important to follow these participants over a longer period and monitor practice differences and ways to reinforce the practice recommendations to improve the quality and cost of care.
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Singh, Kelita, Alex Al Khoury, Zsuzsanna Kurti, Lorant Gonczi, Jason Reinglas, Christine Verdon, Rita Kohen, et al. "High Adherence to Surveillance Guidelines in Inflammatory Bowel Disease Patients Results in Low Colorectal Cancer and Dysplasia Rates, While Rates of Dysplasia are Low Before the Suggested Onset of Surveillance." Journal of Crohn's and Colitis 13, no. 10 (March 28, 2019): 1343–50. http://dx.doi.org/10.1093/ecco-jcc/jjz066.
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Abstract Background Patients with Crohn’s disease [CD] and ulcerative colitis [UC] are at increased risk for colorectal dysplasia [CRD] and colorectal cancer [CRC]. Adherence to CRC surveillance guidelines is reportedly low internationally. Aim To evaluate surveillance practices at the tertiary IBD Center of the McGill University Health Center [MUHC] and to determine CRD/CRC incidence. Methods A representative inflammatory bowel disease cohort with at least 8 years of disease duration [or with primary sclerosing cholangitis] who visited the MUHC between July 1 and December 31, 2016 were included. Adherence to surveillance guidelines was compared to modified 2010 British Society of Gastroenterology guidelines. Incidence rates of CRC, high-grade dysplasia [HGD], low-grade dysplasia [LGD] and colorectal adenomas [CRA] were calculated based on pathology. Results In total, 1356 CD and UC patients (disease duration: 12 [interquartile range: 6–22) and 10 [interquartile range: 5–19] years) were identified. The surveillance cohort consisted of 680 patients [296 UC and 384 CD]. Adherence to surveillance guidelines was 76/82% in UC/colonic CD. An adequate number of biopsies were taken in 54/54% of UC/colonic CD patients. The incidence of CRC/HGD in UC and CD with colonic involvement was 19.5/58.5 and 25.1/37.6 per 100,000 patient-years, respectively. The incidence of dysplasia before 8 years of disease duration was low in both UC/CD [19.5 and 12.5/100,000 patient-years] with no CRC detected. The CRA rate was 30/38% in UC/colonic CD. Conclusion High adherence to surveillance guidelines and low CRC and dysplasia, but not CRA rates were found, suggesting that adhering to updated, stratified, surveillance recommendations may result in low advanced neoplasia rates. The incidence of dysplasia before the start of surveillance was low.
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Semple, Yvonne, Marion Bennie, Jacqueline Sneddon, Alison Cockburn, R. Andrew Seaton, and Alison H. Thomson. "Development and evaluation of a national gentamicin and vancomycin quality improvement programme." Journal of Antimicrobial Chemotherapy 75, no. 7 (April 11, 2020): 1998–2003. http://dx.doi.org/10.1093/jac/dkaa096.
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Abstract Background Scottish Antimicrobial Prescribing Group (SAPG) recommendations to reduce broad-spectrum antimicrobial use led to an increase in gentamicin and vancomycin prescribing. In 2009, SAPG introduced national guidance to standardize dosage regimens, reduce calculation errors and improve the monitoring of these antibiotics. Studies conducted in 2010 and 2011 identified limitations in guideline implementation. Objectives To develop, implement and assess the long-term impact of quality improvement (QI) resources to support gentamicin and vancomycin prescribing, administration and monitoring. Methods New resources, comprising revised guidelines, online and mobile app dose calculators, educational material and specialized prescribing and monitoring charts were developed in collaboration with antimicrobial specialists and implemented throughout Scotland during 2013–16. An online survey in 2017 evaluated the use of these resources and a before (2011) and after (2018) point prevalence study assessed their impact. Results All 12 boards who responded to the survey (80%) were using the guidance, electronic calculators and gentamicin prescription chart; 8 used a vancomycin chart. The percentage of patients who received the recommended gentamicin dose increased from 44% to 89% (OR 10.99, 95% CI = 6.37–18.95) between 2011 and 2018. For vancomycin, the correct loading dose increased from 50% to 85% (OR = 5.69, CI = 2.76–11.71) and the correct maintenance dose from 55% to 90% (OR = 7.17, CI = 3.01–17.07). Conclusions This study demonstrated improvements in the national prescribing of gentamicin and vancomycin through the development and coordinated implementation of a range of QI resources and engagement with local and national multidisciplinary teams.
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Fenech, V. A., N. Kamperidis, T. Tyrrell, L. Dyall, R. Misra, S. Barber, S. Randall, and N. Arebi. "P179 The acceptability and utility of United Registries for Clinical Assessment and Research (UR-CARE) database to improve clinical care in a single centre setting." Journal of Crohn's and Colitis 14, Supplement_1 (January 2020): S227—S228. http://dx.doi.org/10.1093/ecco-jcc/jjz203.308.
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Abstract Background The United Registries for Clinical Assessment and Research (UR-CARE) is a validated pan-European database developed by the European Crohn’s and Colitis Organisation (ECCO) to support clinical practice for patients with inflammatory bowel disease (IBD). ECCO has published guidelines to reduce variation in care. We examined the value of UR-CARE database to improve care in a cohort of newly-diagnosed IBD patients. Methods All patients with a new diagnosis of IBD within 6 months attended a New Diagnosis Clinic (NDC). Prior to registering patients, the purpose of UR-CARE database was explained. Patients who consented to have their clinical data added to the database signed a consent form. Mandatory fields and additional data that reflected quality of care were inputted. Descriptive statistics summarised the findings. The association between consent and disease activity or gender was examined using a chi-square test and for age using a two-sample t-test. Results Twenty-five out of 29 newly diagnosed patients consented for data inclusion in UR-CARE (13 males). Median age was 44 (range 18–77). Fourteen had ulcerative colitis (UC), 8 had Crohn’s disease (CD) and 3 had unclassified IBD. 8.3% reported extra-intestinal manifestations within 6 months of diagnosis. 17/25 patients had active disease. The patients that did not consent consisted of 2 males, 3/4 had active disease and mean age was 44.4 (SD 16.1) compared with 36.3 (SD 19.4) consenters. Through the database we noted that not all mandatory diagnostic tests were requested at the time of hospital visit: 4/14 UC patients did not have a full colonoscopy and 3/8 CD patients lacked a small bowel imaging or capsule endoscopy. Only 4 out of 14 UC patients and 2 out of 8 CD patients were prescribed steroids within 6 months of their diagnosis. The 7 patients with missing investigations were identified and tests subsequently booked in line with guidelines. There was no association between consent and disease activity (p = 0.78), gender (p = 0.94) and age (p = 0.37). Conclusion In newly diagnosed IBD cohort, most patients consented to inclusion in UR-CARE database. There were no contributing factors associated with patient consent. The easily accessible visualisation of our data detected incomplete diagnostic tests and initiated actions to improve care early on in the disease course. UR-CARE offers potential to deliver high quality IBD care by aligning practice against ECCO guidelines. Attention to data-sharing legal and administrative barriers offers a promise for large scale studies and foster collaborative research networks.
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Kaakaji, Wayel, Gene H. Barnett, Diane Bernhard, Ann Warbel, Karen Valaitis, and Sarah Stamp. "Clinical and economic consequences of early discharge of patients following supratentorial stereotactic brain biopsy." Journal of Neurosurgery 94, no. 6 (June 2001): 892–98. http://dx.doi.org/10.3171/jns.2001.94.6.0892.
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Object. The goal of this study was to determine the clinical and economic consequences of early discharge (< 8 hours) of patients following stereotactic brain biopsy (SBB). Methods. The records of all patients who underwent percutaneous SBB at The Cleveland Clinic Foundation, a tertiary care teaching hospital, during 1994 and 1995 (Group A) were retrospectively reviewed to collect data on the nature and timing of perioperative (< 48 hours) clinical and radiological complications. Biopsies were performed using image-guided stereotaxy either with or without a frame. Based on the results, guidelines for early discharge of patients following SBB were implemented. Information on the nature and timing of perioperative complications was also collected prospectively in all patients who underwent percutaneous SBB from January 1996 through July 1998 (Group B). Hospital financial records for patients who underwent SBB in 1997 and 1998 were also reviewed and assessed for net revenue stratified by discharge status: early discharge (< 8 hours), extended outpatient observation (≥ 8 and < 24 hours), and inpatient hospitalization (≥ 24 hours). In Group A, 130 biopsies were performed. There were five serious complications (3.8%), of which four were transient, and there was one death (0.8%). The death and any sustained deficit occurred in patients in whom a clot had been demonstrated on postoperative CT scans. All complications were detected within 6 hours after surgery. Intraoperative bleeding occurred in 12 patients (9.2%), but was associated with only 40% of cases in which hemorrhage appeared on postoperative CT scans. Guidelines for early discharge (< 8 hours) following SBB were developed and stipulated the absence of the following: 1) intraoperative hemorrhage; 2) new postoperative deficit; and 3) clot on a postoperative CT scan. In Group B, 139 biopsies were performed. There were three serious complications (2.2%), one of which was sustained due to a clot that had been demonstrated on the postoperative CT scan. All complications were detected within 6 hours postsurgery. There were no deaths in this group. Intraoperative bleeding occurred in 11 patients (7.9%), requiring intraoperative craniotomy to control bleeding in one case. Hospital financial records were available for 96 patients, of whom 22 were discharged from the hospital early, 11 were observed for an extended outpatient period, and the remainder were retained for inpatient hospitalization. Average net hospital incomes on technical charges for patients in the inpatient hospitalization, extended outpatient observation, and short-stay (early discharge) groups were $1778, $1175, and $1219, respectively, in 1997, but declined to −$889, −$1339, and $671, respectively, in 1998. The ratios of indirect costs to direct technical costs were 132.5%, 128.7%, and 103.7%, respectively. Conclusions. Early discharge of patients following SBB of supratentorial lesions is safe in the absence of excessive intraoperative bleeding, new postoperative deficit, and clot on a postoperative CT scan. Extended outpatient observation (8–23 hours) is not clinically necessary and may be economically prohibitive in the setting of a teaching hospital.
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PARIGI, T. L., G. Roda PhD, M. Allocca, F. Furfaro, L. Loy, A. Zilli, S. Bonovas, S. Danese, and G. Fiorino. "P747 Adherence to ECCO guidelines for cancer surveillance is associated to the detection of early cancer: A retrospective, single-centre, cohort study." Journal of Crohn's and Colitis 14, Supplement_1 (January 2020): S598—S599. http://dx.doi.org/10.1093/ecco-jcc/jjz203.875.
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Abstract Background Patients with inflammatory bowel disease (IBD), such as ulcerative colitis (UC) and Crohn’s disease (CD) are at increased risk of developing gastrointestinal (GI) malignancies. The aim of this study is to assess the risk of malignancies in IBD patients and the impact of cancer screening according to the ECCO guidelines in a tertiary referral centre. Methods We retrospectively analysed the electronic database of all IBD patients followed by the IBD Centre of Humanitas Research Hospital, Milan, from January 2010 to October 2019, and collected all new diagnoses of solid and haematological tumours since 2010. The annual standardised incidence rate (SIR), rate of mortality and early cancer diagnosis were calculated and a descriptive analysis of drug exposure, disease duration, family history of any cancer, smoking habits was made. Results We included 5239 patients, with a total 19820 patient-years follow-up. Eighty-four malignancies in 81 patients were retrieved, 71 were included in the final analysis (38 CD, 32 UC, 31 females). Average age at tumour diagnosis was 52.9 years (range 19–78). 64% of patients were former or active smokers, 31% had a family history of cancer or IBD. Sixty-two per cent of patients were previously exposed or had 5-ASA at the time of cancer, 40% azathioprine, 43% anti-TNF or vedolizumab. The annual SIR for all kinds of malignancy was 0.358%. GI malignancies were the most frequent (n = 17, 23.9%, 47% UC, 53% in CD). Six over 8 GI tract malignancies in UC patients were found in the colon or rectum (mean disease duration 22.5 years), whereas in CD patients 5/9 were in the small-bowel (mean disease duration 7.0 years). Melanoma and breast cancer (n = 8 each) were the most common non-GI cancers, followed by prostate (n = 7) and bladder (n = 6). No significant difference in incidence was found between CD or UC. Non-Hodgkin lymphomas and leukaemia (3 and 1, respectively) only occurred in CD patients. Other tumours included thyroid (n = 5), lungs (n = 4), testicle (n = 3), ovary (n = 2), kidney (n = 2), head-nose-throat (n = 2), pancreas (n = 1), brain (n = 1), and non-melanoma skin cancer (n = 1). Death occurred in 11% of patients, 8 of them for late stage cancer. Only 2 were related to the concomitant IBD (1 colo-rectal and 1 anal cancer). In patients regularly screened according to the ECCO Guidelines (GI cancer, haematological and skin cancer), there was a significantly higher number of detection of early cancer (28 vs. 1, p = 0.003), although no differences in mortality rates were reported in the two groups (2 vs. 2, p = 0.10). Conclusion The overall incidence of cancer in our cohort was not different from the current literature available. Adherence to the ECCO Guidelines for cancer surveillance improves the detection of early cancer in IBD patients.
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Salmerón, Paula, Belén Viñado, Maider Arando, Eva Alcoceba, Beatriz Romero, Blanca Menéndez, Samuel Bernal, et al. "Neisseria gonorrhoeae antimicrobial resistance in Spain: a prospective multicentre study." Journal of Antimicrobial Chemotherapy 76, no. 6 (February 11, 2021): 1523–31. http://dx.doi.org/10.1093/jac/dkab037.
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Abstract Objectives Gonococcal infection is one of the most reported sexually transmitted infections and antimicrobial resistance in Neisseria gonorrhoeae (NG) is challenging for the treatment of this infection. This observational study aimed to describe antimicrobial resistance of NG and epidemiological data from patients with gonococcal infection in eight regions of Spain, for updating the local therapeutic guidelines. Methods MICs of penicillin, cefixime, ceftriaxone, azithromycin, ciprofloxacin, fosfomycin and gentamicin were determined by Etest for all NG isolates recovered from 1 April 2018 to 30 September 2019 from 10 hospitals in Spain. Resistance determinants were identified using logistic regression analysis. Differences with a P value <0.05 were considered statistically significant. Results Antimicrobial susceptibility testing was performed for 2571 gonococci isolated from 2429 patients. 44.5% (945/2124) of patients were MSM. The resistance rate to extended-spectrum cephalosporins was low, with 0.2% (6/2561) of isolates resistant to ceftriaxone and 1.7% (44/2517) of isolates resistant to cefixime. The overall azithromycin resistance rate was 12.1% (310/2560), but differed greatly depending on the area. 56.2% (1366/2429) of the strains studied were ciprofloxacin resistant. MIC50 and MIC90 values of gentamicin and fosfomycin were 4 and 8 mg/L and 24 and 48 mg/L, respectively. Conclusions Our study shows that NG susceptibility to extended-spectrum cephalosporins remains high in Spain. The azithromycin resistance rate questions the suitability of dual therapy. This study provides data of interest for updating the national treatment guidelines and highlights the need to develop and implement a national sentinel gonococcal antimicrobial susceptibility programme.
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Kularatne, Ranmini, Tendesayi Kufa, Lindy Gumede, and Venessa Maseko. "Comparison of gentamicin MICs by agar dilution and Etest for clinical isolates of Neisseria gonorrhoeae." Journal of Antimicrobial Chemotherapy 75, no. 9 (June 16, 2020): 2599–604. http://dx.doi.org/10.1093/jac/dkaa202.
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Abstract Background In South Africa, Neisseria gonorrhoeae (NG) is the predominant cause of male urethritis syndrome (MUS). The national MUS treatment guidelines recommend gentamicin as salvage therapy for ceftriaxone treatment failures. We ascertained and compared gentamicin MICs obtained by agar dilution and Etest for clinical isolates of NG. Methods Gentamicin MICs for NG culture isolates obtained from 272 MUS cases in 2017 were determined using agar dilution, as per CLSI agar dilution methods, and Etest® (bioMérieux, Marcy-l’Étoile, France). Previously published interpretive criteria were used: MIC ≤4 mg/L, susceptible (S); MIC 8–16 mg/L, intermediately resistant (IR); and MIC ≥32 mg/L, resistant (R). WHO 2008 NG reference strains were used as comparison standards. Results Gentamicin agar dilution versus Etest MIC results (mg/L) were as follows: MIC50 = 16 versus 4; MIC90 = 16 versus 8; minimum MIC = 4 versus 1; and maximum MIC = 32 versus 16. Interpretive categories for agar dilution versus Etest were as follows: S, 4.4% versus 86.8%; IR, 86.0% versus 13.4%; and R, 9.6% versus 0%. The gentamicin MIC50 by agar dilution was significantly higher than by Etest (sign test P value <0.001); overall MIC agreement was 7.4% [kappa statistic (κ) = −0.014 (95% CI −0.039 to 0.010)]. Correlation with expected MICs for WHO reference strains was consistently better with Etest than with agar dilution. Conclusions There was a significant discordance between NG gentamicin MICs by agar dilution versus Etest. NG gentamicin AST methodology must be standardized and interpretive criteria established to optimize the monitoring of susceptibility trends.
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Hatton, Jimmi, Bonnie Rosbolt, Philip Empey, Richard Kryscio, and Byron Young. "Dosing and safety of cyclosporine in patients with severe brain injury." Journal of Neurosurgery 109, no. 4 (October 2008): 699–707. http://dx.doi.org/10.3171/jns/2008/109/10/0699.
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Object Cyclosporine neuroprotection has been reported in brain injury models but safety and dosing guidelines have not been determined in humans with severe traumatic brain injury (TBI). The purpose of this investigation was to establish the safety of cyclosporine using 4 clinically relevant dosing schemes. Methods The authors performed a prospective, blinded, placebo-controlled, randomized, dose-escalation trial of cyclosporine administration initiated within 8 hours of TBI (Glasgow Coma Scale score range 4–8; motor score range 2–5). Four dosing cohorts (8 patients treated with cyclosporine and 2 receiving placebo treatment per cohort) received cyclosporine (1.25–5 mg/kg/day) or placebo in 2 divided doses (Cohorts I–III) or continuous infusion (Cohort IV) over 72 hours. Adverse events and outcome were monitored for 6 months. Results Forty patients were enrolled over 3 years (cyclosporine cohorts, 24 male and 8 female patients; placebo group, 8 male patients). Systemic trough concentrations were below 250 ng/ml during intermittent doses. Higher blood concentrations were observed in Cohorts III and IV. There was no significant difference in immunological effects, adverse events, infection, renal dysfunction, or seizures. Mortality rate was not affected by cyclosporine administration, independent of dose, compared with placebo (6 of 32 patients receiving cyclosporine and 2 of 8 receiving placebo died, p > 0.05). At 6 months, a dose-related improvement in favorable outcome was observed in cyclosporine-treated patients (p < 0.05). Conclusions In patients with acute TBI who received cyclosporine at doses up to 5 mg/kg/day, administered intravenously, with treatment initiated within 8 hours of injury, the rate of mortality or other adverse events was not significantly different from that of the placebo group.
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Malessy, Martijn J. A., Carel F. E. Hoffmann, and Ralph T. W. M. Thomeer. "Initial report on the limited value of hypoglossal nerve transfer to treat brachial plexus root avulsions." Journal of Neurosurgery 91, no. 4 (October 1999): 601–4. http://dx.doi.org/10.3171/jns.1999.91.4.0601.
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Object. Hypoglossal nerve (12th cranial nerve) transfer was performed to treat the sequelae of brachial plexus root avulsion in 12 adults and two infants, and the patients were followed to assess the effectiveness of the surgery.Methods. The 12th cranial nerve was transected at the base of the tongue, and a sural nerve graft was used to bridge the gap between the donor (12th) and recipient nerves: C-5 spinal, axillary, suprascapular, or musculocutaneous nerve. The mean graft length in adult patients was 15.75 ± 5.5 cm (± standard deviation, median 14.5 cm) and in the two infants the graft lengths were 7 and 8 cm, respectively. After a mean postoperative interval of 1138 ± 254 days, electromyographic examination of the target muscles showed tongue movement—related activity in all patients. Muscle force strength measured according to the Medical Research Council's guidelines, was Grade 3 or higher in 21% of patients. Contraction, however, could only be attained by tongue movements, and volitional control was not achieved.Conclusions. Although recovery of muscle strength was obtained by 12th cranial nerve transfer, the functional gain remained virtually nonexistent because central control was missing.
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Atalaia, Antonio, Rabah Ben Yaou, Karim Wahbi, Annachiara De Sandre-Giovannoli, Corinne Vigouroux, and Gisèle Bonne. "Laminopathies’ Treatments Systematic Review: A Contribution Towards a ‘Treatabolome’." Journal of Neuromuscular Diseases 8, no. 3 (May 13, 2021): 419–39. http://dx.doi.org/10.3233/jnd-200596.
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Background: Variants in the LMNA gene, encoding lamins A/C, are responsible for a growing number of diseases, all of which complying with the definition of rare diseases. LMNA-related disorders have a varied phenotypic expression with more than 15 syndromes described, belonging to five phenotypic groups: Muscular Dystrophies, Neuropathies, Cardiomyopathies, Lipodystrophies and Progeroid Syndromes. Overlapping phenotypes are also reported. Linking gene and variants with phenotypic expression, disease mechanisms, and corresponding treatments is particularly challenging in laminopathies. Treatment recommendations are limited, and very few are variant-based. Objective: The Treatabolome initiative aims to provide a shareable dataset of existing variant-specific treatment for rare diseases within the Solve-RD EU project. As part of this project, we gathered evidence of specific treatments for laminopathies via a systematic literature review adopting the FAIR (Findable, Accessible, Interoperable, and Reusable) guidelines for scientific data production. Methods: Treatments for LMNA-related conditions were systematically collected from MEDLINE and Embase bibliographic databases and clinical trial registries (Cochrane Central Registry of Controlled Trials, clinicaltrial.gov and EudraCT). Two investigators extracted and analyzed the literature data independently. The included papers were assessed using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. Results: From the 4783 selected articles by a systematic approach, we identified 78 papers for our final analysis that corresponded to the profile of data defined in the inclusion and exclusion criteria. These papers include 2 guidelines/consensus papers, 4 meta-analyses, 14 single-arm trials, 15 case series, 13 cohort studies, 21 case reports, 8 expert reviews and 1 expert opinion. The treatments were summarized electronically according to significant phenome-genome associations. The specificity of treatments according to the different laminopathic phenotypical presentations is variable. Conclusions: We have extracted Treatabolome-worthy treatment recommendations for patients with different forms of laminopathies based on significant phenome-genome parings. This dataset will be available on the Treatabolome website and, through interoperability, on genetic diagnosis and treatment support tools like the RD-Connect’s Genome Phenome Analysis Platform.
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Bindal, Rajesh K., Raymond Sawaya, Milam E. Leavens, and J. Jack Lee. "Surgical treatment of multiple brain metastases." Journal of Neurosurgery 79, no. 2 (August 1993): 210–16. http://dx.doi.org/10.3171/jns.1993.79.2.0210.
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✓ The authors conducted a retrospective review of the charts of 56 patients who underwent resection for multiple brain metastases. Of these, 30 had one or more lesions left unresected (Group A) and 26 underwent resection of all lesions (Group B). Twenty-six other patients with a single metastasis who underwent resection (Group C) were selected to match Group B by type of primary tumor, time from first diagnosis of cancer to diagnosis of brain metastases, and presence or absence of systemic cancer at the time of surgery. Statistical analysis indicated that Groups A and B were also homogeneous for these prognostic indicators. Median survival duration was 6 months for Group A, 14 months for Group B, and 14 months for Group C. There was a statistically significant difference in survival time between Groups A and B (p = 0.003) and Groups A and C (p = 0.012) but not between Groups B and C (p > 0.5). Brain metastasis recurred in 31% of patients in Group B and in 35% of those in Group C; this difference was not significant (p > 0.5). Symptoms improved after surgery in 65% of patients in Group A, 83% in Group B, and 84% in Group C. Symptoms worsened in 13% of patients in Group A, 6% in Group B, and 0% in Group C. Groups A, B, and C had complication rates per craniotomy of 8%, 9%, and 8%, and 30-day mortality rates of 3%, 4%, and 0%, respectively. Guidelines for management of patients with multiple brain metastases are discussed. The authors conclude that surgical removal of all lesions in selected patients with multiple brain metastases results in significantly increased survival time and gives a prognosis similar to that of patients undergoing surgery for a single metastasis.
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Delgado-Valverde, Mercedes, M. del Carmen Conejo, Lara Serrano, Felipe Fernández-Cuenca, and Álvaro Pascual. "Activity of cefiderocol against high-risk clones of multidrug-resistant Enterobacterales, Acinetobacter baumannii, Pseudomonas aeruginosa and Stenotrophomonas maltophilia." Journal of Antimicrobial Chemotherapy 75, no. 7 (April 11, 2020): 1840–49. http://dx.doi.org/10.1093/jac/dkaa117.
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Abstract Background Cefiderocol is a novel siderophore cephalosporin, developed for activity against MDR Gram-negative bacilli (MDR-GNB). Objectives To assess the in vitro antibacterial activity of cefiderocol against a collection of MDR-GNB clinical isolates from hospitals in southern Spain. Methods Two hundred and thirty-one isolates of successful clones were tested: 125 Enterobacterales (121 ESBL- and/or carbapenemase-producing Klebsiella pneumoniae and 4 carbapenemase-producing Enterobacter cloacae), 80 Acinetobacter baumannii, 6 Pseudomonas aeruginosa and 20 Stenotrophomonas maltophilia. Ceftolozane/tazobactam, ceftazidime, ceftazidime/avibactam, cefepime, aztreonam, meropenem, amikacin, ciprofloxacin, colistin and tigecycline were used as comparators against Enterobacterales, P. aeruginosa and A. baumannii. Minocycline, levofloxacin and trimethoprim/sulfamethoxazole were studied against S. maltophilia instead of aztreonam, ciprofloxacin and cefepime. MICs were determined by broth microdilution according to CLSI guidelines. MIC determination was performed in CAMHB for all antimicrobials except cefiderocol, where iron-depleted CAMHB was used. Results Cefiderocol showed potent in vitro activity against the isolates analysed. MIC50 and MIC90 values were in the ranges 0.125–8 mg/L and 0.5–8 mg/L, respectively, and 98% of isolates were inhibited at ≤4 mg/L. Only five isolates showed cefiderocol MICs of >4 mg/L: three ST2/OXA-24/40-producing A. baumannii, one ST114/VIM-1-producing E. cloacae and one ST114/VIM-1 + OXA-48-producing E. cloacae. All KPC-3-producing K. pneumoniae were susceptible to cefiderocol, even those resistant to ceftazidime/avibactam. P. aeruginosa isolates showed cefiderocol MICs of <4 mg/L, including those resistant to ceftolozane/tazobactam. S. maltophilia isolates displayed cefiderocol MICs of <4 mg/L, including those resistant to levofloxacin and/or trimethoprim/sulfamethoxazole. Conclusions Cefiderocol showed excellent activity against MDR-GNB, including carbapenem-resistant isolates, and was the most active antimicrobial tested against this collection.
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Grossi, O., N. Asseray, C. Bourigault, S. Corvec, M. Valette, D. Navas, L. Happi-Djeukou, S. Touchais, P. Bémer, and D. Boutoille. "Gram-negative prosthetic joint infections managed according to a multidisciplinary standardized approach: risk factors for failure and outcome with and without fluoroquinolones." Journal of Antimicrobial Chemotherapy 71, no. 9 (June 7, 2016): 2593–97. http://dx.doi.org/10.1093/jac/dkw202.
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Abstract Objectives To describe the outcome and risk factors for treatment failure of 76 Gram-negative bacilli (GNB) prosthetic joint infections (PJIs) managed with a curative intent according to a standardized protocol derived from published guidelines. Methods We analysed data from all the cases of GNB-PJI treated surgically over an 8 year period. Treatment failure was defined as persistence or recurrence of PJI signs during follow-up, resulting in additional surgery and/or antibiotic administration or death. Results Treatment failure within the follow-up period (median = 2.6 years) was observed in 16 of 76 (21.1%) patients. The failure rate was similar whether the patients were treated with fluoroquinolones in the whole cohort (22.4% versus 16.7%, P = 0.75) and after stratification according to the surgical procedure. The low failure rate observed in patients not receiving fluoroquinolones might be explained by the standardized attitude of maintaining intravenous β-lactams throughout treatment duration (median = 90 days). In multivariate analysis, C-reactive protein level ≥175 mg/L was significantly associated with treatment failure (adjusted HR = 7.75, 95% CI = 2.66–22.59, P < 0.0001). Conclusions Management according to standardized procedures may improve the prognosis of GNB-PJI. Intravenous β-lactams, continued for 3 months, should be considered an effective alternative to fluoroquinolones.
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Waters, Stacey K., Leanne Lester, Elizabeth Wenden, and Donna Cross. "A Theoretically Grounded Exploration of the Social and Emotional Outcomes of Transition to Secondary School." Australian Journal of Guidance and Counselling 22, no. 2 (December 2012): 190–205. http://dx.doi.org/10.1017/jgc.2012.26.
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Adolescent development involves a complex interplay between genetics, biology, and social and emotional relationships within multiple contexts of home, school and the broader community. The transition from primary to secondary school, coupled with the onset of puberty, can therefore be a difficult period for young people to negotiate at a critical period of their developmental pathway. Using a social ecological perspective, this article examines the impact of the transition experience on adolescent social and emotional health, both immediately following transition to secondary school and at the end of the first year in this new school environment. This 1-year prospective study involving 1,500 Australian Grade 8 secondary school students found that 31% of students in the sample experienced a ‘difficult’ or ‘somewhat difficult’ transition to their new school. This third of the student sample were consequently more likely to experience poorer social and emotional health, including higher levels of depression and anxiety at the end of their first year of secondary school, while controlling for these variables at the time of transition. A central message from this work exemplifies the urgent need for a longitudinal intervention trial to develop best practice guidelines for activities that help ameliorate the negative impact a change in education context can create for adolescents negotiating a rapid metamorphosis from childhood to adulthood.
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Carvalhaes, Cecilia G., Hélio S. Sader, Robert K. Flamm, and Rodrigo E. Mendes. "Tedizolid in vitro activity against Gram-positive clinical isolates causing bone and joint infections in hospitals in the USA and Europe (2014–17)." Journal of Antimicrobial Chemotherapy 74, no. 7 (April 1, 2019): 1928–33. http://dx.doi.org/10.1093/jac/dkz120.
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Abstract Background Despite the advances in current healthcare, bone and joint infections (BJIs) are a major clinical challenge that frequently involve prolonged systemic antibiotic use. Healthcare providers consider tedizolid an attractive candidate for therapy in adults and children with BJI. Objectives We tested tedizolid against a US and European collection of Gram-positive BJI isolates (n = 797) consecutively collected from 2014 to 2017. Methods Organisms were tested by broth microdilution susceptibility methods following current CLSI guidelines and interpreted by both CLSI and EUCAST breakpoint criteria. Results Staphylococcus aureus (59.3%; 58.6% in the USA and 60.4% in Europe) was the most common pathogen with a 29.6% MRSA rate and tedizolid MIC50/90 of 0.12/0.25 mg/L (100% susceptible). CoNS (15.0% of BJI in adults and <5% in children) had tedizolid MIC50/90 values of 0.12/0.12 mg/L (99.1% susceptible). Tedizolid exhibited MIC50/90 values of 0.12/0.25 mg/L for all streptococci and enterococci. Overall, high susceptibility rates (>95%) for vancomycin, daptomycin and linezolid were observed and, based on MIC90 values, tedizolid (MIC90 0.12–0.25 mg/L) was 4- to 8-fold more potent than linezolid (MIC90 0.5–2 mg/L) against this collection of Gram-positive pathogens causing BJI. Conclusions This study showed that tedizolid had potent in vitro activity against contemporary Gram-positive cocci causing BJI in adults and children in US and European hospitals.
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Kim, Daniel H., Yong-Jun Cho, Robert L. Tiel, and David G. Kline. "Outcomes of surgery in 1019 brachial plexus lesions treated at Louisiana State University Health Sciences Center." Journal of Neurosurgery 98, no. 5 (May 2003): 1005–16. http://dx.doi.org/10.3171/jns.2003.98.5.1005.
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Object. Outcomes of 1019 brachial plexus lesions in patients who underwent surgery at Louisiana State University Health Sciences Center during a 30-year period are reviewed in this paper to provide management guidelines. Methods. Causes of brachial plexus lesions included 509 stretches/contusions (50%), 161 plexus tumors (16%), 160 thoracic outlet syndromes (TOSs, 16%), 118 gunshot wounds (12%), and 71 lacerations (7%). Many features of clinical presentation, including prior treatment, patient's neurological status, results of electrophysiological studies, intraoperative findings, and postoperative level of function, were studied. The minimum follow-up period was 18 months and the mean follow-up period was 42 months. Repairs were best for injuries located at the C-5, C-6, and C-7 levels, the upper and middle trunk, the lateral cord to the musculocutaneous nerve, and the median and posterior cords to the axillary and radial nerves. Conversely, results were poor for injuries at the C-8 and T-1 levels, and for lower trunk and medial cord lesions, with the exception of injuries of the medial cord to the median nerve. Outcomes were most favorable when patients were carefully evaluated and selected for surgery, although variables such as lesion type, location, and severity, as well as time since injury also affected outcome. This was true also of TOSs and tumors arising from the plexus, especially if they had not been surgically treated previously. Conclusions. Surgical exploration and repair of brachial plexus lesions is technically feasible and favorable outcomes can be achieved if patients are thoroughly evaluated and appropriately selected.
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Wang, Yuanyuan, Muh Akbar Bahar, Anouk M. E. Jansen, Janwillem W. H. Kocks, Jan-Willem C. Alffenaar, Eelko Hak, Bob Wilffert, and Sander D. Borgsteede. "Improving antibacterial prescribing safety in the management of COPD exacerbations: systematic review of observational and clinical studies on potential drug interactions associated with frequently prescribed antibacterials among COPD patients." Journal of Antimicrobial Chemotherapy 74, no. 10 (May 24, 2019): 2848–64. http://dx.doi.org/10.1093/jac/dkz221.
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Abstract Background Guidelines advise the use of antibacterials (ABs) in the management of COPD exacerbations. COPD patients often have multiple comorbidities, such as diabetes mellitus and cardiac diseases, leading to polypharmacy. Consequently, drug–drug interactions (DDIs) may frequently occur, and may cause serious adverse events and treatment failure. Objectives (i) To review DDIs related to frequently prescribed ABs among COPD patients from observational and clinical studies. (ii) To improve AB prescribing safety in clinical practice by structuring DDIs according to comorbidities of COPD. Methods We conducted a systematic review by searching PubMed and Embase up to 8 February 2018 for clinical trials, cohort and case–control studies reporting DDIs of ABs used for COPD. Study design, subjects, sample size, pharmacological mechanism of DDI and effect of interaction were extracted. We evaluated levels of DDIs and quality of evidence according to established criteria and structured the data by possible comorbidities. Results In all, 318 articles were eligible for review, describing a wide range of drugs used for comorbidities and their potential DDIs with ABs. DDIs between ABs and co-administered drugs could be subdivided into: (i) co-administered drugs altering the pharmacokinetics of ABs; and (ii) ABs interfering with the pharmacokinetics of co-administered drugs. The DDIs could lead to therapeutic failures or toxicities. Conclusions DDIs related to ABs with clinical significance may involve a wide range of indicated drugs to treat comorbidities in COPD. The evidence presented can support (computer-supported) decision-making by health practitioners when prescribing ABs during COPD exacerbations in the case of co-medication.
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Saravolatz, Louis D., Joan M. Pawlak, and Corinne Wegner. "Delafloxacin activity against Staphylococcus aureus with reduced susceptibility or resistance to methicillin, vancomycin, daptomycin or linezolid." Journal of Antimicrobial Chemotherapy 75, no. 9 (June 15, 2020): 2605–8. http://dx.doi.org/10.1093/jac/dkaa209.
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Abstract Background Delafloxacin is a recently approved anionic fluoroquinolone antibiotic with broad-spectrum activity against Gram-positive and Gram-negative organisms. The drug has been approved for patients with acute bacterial skin and skin structure infections including those caused by MRSA. There are limited data available against MRSA blood isolates (MRSABIs), vancomycin-intermediate strains (VISA), vancomycin-resistant strains (VRSA), daptomycin-non-susceptible strains (DNSSA) and linezolid-resistant Staphylococcus aureus (LRSA). Methods Antimicrobial activity of delafloxacin, levofloxacin, vancomycin, daptomycin and linezolid was determined against 110 MRSABIs, 15 VRSA, 35 VISA, 40 DNSSA and 6 LRSA. Microdilution testing using CAMHB was used to determine MIC according to CLSI guidelines. FDA breakpoints were used to determine delafloxacin susceptibility, and CLSI breakpoints were used for all other antibiotics. PCR testing for molecular markers was performed. Results Delafloxacin demonstrated activity against MRSABIs with an MIC90 of 1 mg/L and 68% susceptibility. Against the other groups the MIC90 and susceptibility were 1 mg/L and 40%, respectively, for VISA, 4 mg/L and 7% for VRSA and 1 mg/L and 38% for DNSSA. None of the LRSA isolates was susceptible to delafloxacin. Delafloxacin was active against 94% of MRSA blood isolates that were genotype SCC IVa. For MRSABIs with a levofloxacin MIC ≥8 mg/L (55/110), suggesting multiple mutations in the QRDR, delafloxacin MIC90 was 1 mg/L with a 36.4% susceptibility rate. Conclusions Delafloxacin demonstrates superior activity to levofloxacin against recent MRSA blood isolates, VISA, VRSA and DNSSA, and demonstrates good activity against blood isolates most commonly found in the community.