Asunto(s)
Farmacias , Farmacia , Humanos , Antifúngicos/uso terapéutico , Cuidados a Largo Plazo , Instituciones de Salud , FarmacéuticosRESUMEN
BACKGROUND: Commonly prescribed antidepressants (paroxetine, fluoxetine, duloxetine, bupropion) inhibit bioconversion of several prodrug opioid medications to their active metabolite, potentially decreasing analgesic effect. There is a paucity of studies assessing the risk-benefit of concomitant administration of antidepressants and opioids. RESEARCH DESIGN AND METHODS: Observational study of adult patients taking antidepressants prior to scheduled surgery using 2017-2019 electronic medical record data to assess perioperative use of opioids and to determine the incidence and risk factors for developing postoperative delirium. We conducted a generalized linear regression with the Gamma log-link to assess the association between use of antidepressants and opioids and a logistic regression to assess the association between antidepressants use and the likelihood of developing postoperative delirium. RESULTS: After controlling for patient demographic and clinical characteristics, and postoperative pain, use of inhibiting antidepressants was associated with 1.67 times greater use of opioids per hospitalization day (p = 0.00154), a two-fold increase in the risk for developing postoperative delirium (p = 0.0224), and an estimated average of four additional days of hospitalization (p < 0.00001) compared to use of non-inhibiting antidepressants. CONCLUSIONS: Careful consideration to drug-drug interactions and risk of related adverse events remains critical in the safe and optimal management of postoperative pain in patients taking concomitantly antidepressants.
Asunto(s)
Analgésicos Opioides , Delirio del Despertar , Adulto , Humanos , Analgésicos Opioides/efectos adversos , Delirio del Despertar/inducido químicamente , Delirio del Despertar/tratamiento farmacológico , Dolor Postoperatorio/tratamiento farmacológico , Antidepresivos/efectos adversos , Factores de Riesgo , Analgésicos/efectos adversosRESUMEN
Influenza acquisition occurs in hospitals and nursing homes (NHs), highlighting the need for infection prevention. We used administrative data to quantify influenza exposure and facility-onset influenza rates for California hospitals and NHs during the 2015-2016 influenza season. Higher facility-onset influenza rates were identified in NHs compared with hospitals, despite fewer influenza exposure-days in NHs. Validation of administrative data are needed.
Asunto(s)
Vacunas contra la Influenza , Gripe Humana , California/epidemiología , Brotes de Enfermedades , Hospitales , Humanos , Gripe Humana/epidemiología , Casas de SaludRESUMEN
We performed systematic review on 40 paired hospital and nursing home charts from a clinical trial to evaluate the fidelity of transitions of care among those discharged on antibiotics. We found that 30% of transitions included an inappropriate change to the patient's antibiotic plan of care.