Archive for November, 2010
Posted by James
A total of 37 patients were included in the study: 17 during phase 1 and 20 during phase 2 (Table 2). A total of 42 episodes of ventilator-associated pneumonia occurred: 20 (48%) during phase 1 and 22 (52%) during phase 2. Five (12%) of the 42 episodes were second episodes in patients who had completed a course of therapy for an earlier episode. Late-onset episodes were more common than early-onset episodes (29 [69%] and 13 [31%], respectively).
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Posted by James
Two methods were also used to evaluate dosing. First, empiric dosing for agents available at this institution was compared with the dosing recommended in the guidelines (ceftazidime 2 g q8h, meropenem 1 g q8h, piperacillin-tazobactam 4.5 g q6h, gentamicin 7 mg/kg per day, ciprofloxacin 400 mg q8h, and vancomycin 15 mg/kg q12h). Then, empiric dosing was compared with dosing considered clinically appropriate on the basis of practice at local hospitals; these locally accepted dosing practices did not have an evidentiary basis. Regimens considered clinically appropriate that were different from those recommended in the guidelines included ciprofloxacin 400 mg q12h and, for patients with body weight less than 100 kg, cefotaxime and ceftazidime 1 g q8h and piperacillin-tazobactam 3.375 g q6h. Dosing adjustments for renal dysfunction were considered in evaluating the appropriateness of dosing.
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Posted by James
ICU charts were reviewed to identify patients older than 18 years of age with a diagnosis of ventilator- associated pneumonia, which was defined as mechanical ventilation (continuous or intermittent) for a minimum of 48 h; new, worsening, or persistent infiltrate evident on chest radiography combined with 2 or more of the following criteria: fever (rectal temperature > 38°C, oral temperature > 37.5°C, or axillary temperature > 37.0°C), leukocyte count > 11 x 109/L or < 3.5 x 109/L, purulent endotracheal secretions, increasing oxygen requirements, or positive results on culture of endotracheal aspirate obtained within the preceding 48 h. Each episode of ventilator-associated pneumonia during a patient’s ICU stay was evaluated to characterize both early-onset and late-onset episodes and the pathogens responsible for each type. A second episode was considered to have occurred if it was diagnosed at least 48 h after completion of the course of antibiotic treatment for the first episode. There were no specific exclusion criteria.
The ICU where the study was conducted is a 9-bed medical-surgical unit in a community acute care hospital that is staffed by attending physicians only; the hospital has clinical pharmacy services but no infectious diseases service. Ethics approval was granted by the University of British Columbia Clinical Research Ethics Board.
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Posted by James
INTRODUCTION
Ventilator-associated pneumonia, defined as т pneumonia that arises more than 48-72 h after endotracheal intubation, occurs in 9% to 27% of all patients who have been intubated. This condition prolongs time on the ventilator and length of stay in the intensive care unit (ICU) and in the hospital after discharge from the ICU.1 It accounts for approximately half of all infections in the ICU and is a major reason for the use of antibiotics in the ICU. Previous studies have demonstrated that adequate empiric antibiotic therapy, as well as timely initiation of therapy, is associated with lower rates of in-hospital mortality and morbidity and lower costs.
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Posted by James
Vancouver’s Downtown Eastside is well known as a y poor neighbourhood with a large open drug scene and an estimated 18% HIV infection prevalence rate. Although HIV medications are free in British Columbia and available to all HIV-positive people who require them, many do not take advantage of this availability. Barriers to antiretroviral uptake and sustained treatment in the Downtown Eastside population include drug dependency, unstable housing, mental illness, lack of patient education or misinformation, and poor access to medical care. The Maximally Assisted Therapy (MAT) program was started in 1999 by the BC Centre for Excellence in HIV/AIDS to address these barriers and to improve access and adherence to antiretrovirals by HIV-positive people living in the Downtown Eastside.
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Posted by James
This pilot program was deemed successful, and the clinical summer student program has been expanded to include additional positions at Capital Health. In addition, this model and the lessons learned from the pilot have been incorporated into both second- and fourth-year experiential rotations in the undergraduate program at the University of Alberta. Pharmacists’ appreciation of the student’s role on the pharmacy clinical team and integration of the student into the team are important components of the success of the program. We feel that we have achieved these goals and have taken steps toward a cultural change regarding the role of students in hospital pharmacy practice and how pharmacists view students. At the conclusion of this pilot program, we felt it was important to consider what had been learned in an effort to improve future programs.
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Posted by James
In preparation for the pilot program, the role of the student and the preceptors’ expectations were discussed extensively with the pharmacists. The pharmacists felt that their expectations for the students were clearly outlined at the beginning of the program and that those expectations were reasonable. At the conclusion of the pilot program, the majority of the pharmacists and the students were comfortable with the students’ ability to perform assigned patient care activities and professional tasks.
One pharmacist conveyed support for the training program by noting that overall he “saw great improvement over the summer in terms of familiarity [with] the pharmacist’s role in [hospital pharmacy practice]“.
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