ABSTRACT
Background: Post-traumatic stress disorder (PTSD) and chronic pain are highly prevalent comorbid conditions. Veterans dually burdened by PTSD and chronic pain experience more severe outcomes compared to either disorder alone. Few studies have enrolled enough women Veterans to test gender differences in pain outcomes [catastrophizing, intensity, interference] by the severity of PTSD. Aim: Examine gender differences in the association between PTSD symptoms and pain outcomes among Veterans enrolled in a chronic pain clinical trial. Methods: Participants were 421 men and 386 women Veterans with chronic pain who provided complete data on PTSD symptoms and pain outcomes. We used hierarchical linear regression models to examine gender differences in pain outcomes by PTSD symptoms. Results: Adjusted multivariable models indicated that PTSD symptoms were associated with higher levels of pain catastrophizing (0.57, 95% CI [0.51, 0.63]), pain intensity (0.30, 95% CI [0.24, 0.37]), and pain interference (0.46, 95% CI [0.39, 0.52]). No evidence suggesting differences in this association were found in either the crude or adjusted models (all interaction p-values<0.05). Conclusion: These findings may reflect the underlying mutual maintenance of these conditions whereby the sensation of pain could trigger PTSD symptoms, particularly if the trauma and pain are associated with the same event. Clinical implications and opportunities testing relevant treatments that may benefit both chronic pain and PTSD are discussed.
Subject(s)
Carcinoma , Medicare , Aged , Cohort Studies , Humans , Keratinocytes , Patient Reported Outcome Measures , United States/epidemiologyABSTRACT
BackgroundThe 2016 point prevalence survey (PPS) of healthcare-associated infections (HAI) and antimicrobial use (AMU) in Irish long-term care facilities (LTCF) (HALT) showed a 9.8% AMU and 4.4% HAI prevalence, based on aggregated data analysis.AimOur aim was to identify institutional and resident risk factors of AMU and HAI.MethodsHALT 2016 gathered information using institutional and resident questionnaires, for residents who met the surveillance definition of active HAI and/or AMU, limiting analysis to the aggregated institutional level. In January 2017, we requested additional data on age, sex, urinary catheter use and disorientation of current residents from HALT 2016 LTCF and matched to 2016 HALT data.ResultsOf 224 HALT 2016 LTCF, 80 provided additional information on 3,816 residents; prevalence of AMU was 10.6% and HAI was 4.7%. Presence of a coordinating physician (Odds ratio (OR): 0.3; 95% confidence interval (CI): 0.2-0.6), antimicrobial stewardship committee (OR: 0.2; 95%; CI: 0.1-0.6), healthcare assistants (OR: 0.9; 95% CI: 0.9-1.0), antimicrobial consumption feedback (OR: 0.3; 95% CI: 0.1-0.6) and medical care by personal general practitioner (OR: 0.6; 95% CI: 0.7-1.0) were associated with less AMU and feedback on surveillance of infection prevention and control (IPC) practices (OR: 0.6; 95% CI: 0.3-1.0) with less HAI. AMU and HAI varied significantly between LTCF.ConclusionsMultilevel modelling identified significant inter-facility variation, as well as institutional factors associated with AMU and HAI. An antimicrobial stewardship committee linked with feedback on IPC and prescribing was associated with reduced AMU and HAI.
Subject(s)
Anti-Infective Agents/therapeutic use , Cross Infection/drug therapy , Cross Infection/microbiology , Drug Prescriptions/statistics & numerical data , Drug Utilization/statistics & numerical data , Long-Term Care/statistics & numerical data , Nursing Homes/statistics & numerical data , Practice Patterns, Physicians' , Aged , Cross Infection/epidemiology , Female , Humans , Ireland/epidemiology , Male , Multilevel Analysis , PrevalenceABSTRACT
The Newborn Hearing Screening Programme (NHSP) was established in Cork University Maternity Hospital (CUMH) in April 2011. Between April 2011 and July 2014, 42 infants were identified with a Permanent Childhood Hearing Impairment (PCHI). Following this diagnosis, infants underwent a paediatric assessment according to recognised guidelines with the intention of identifying the underlying aetiology of the PCHI. The aim of this study was to assess the findings of this aetiological workup via retrospective chart review. PCHI data was obtained from the eSP database. This is a web based information system (eSP) used to track each baby through the screening and referral process A retrospective chart review of these patients was performed. Sixteen (38%) infants were diagnosed with a bilateral sensorineural hearing loss. Two infants had congenital CMV infection. A Connexin 26 gene mutation was detected in one infant. Two infants were diagnosed with Waardenburg syndrome, One with Pendred syndrome and one with Pfeiffer syndrome. Five babies underwent cochlear implantation. Through adherence to the recommended protocol a possible cause of PCHI may be determined. This study has identified areas of future improvement for this service in Ireland.
Subject(s)
Hearing Loss, Bilateral/etiology , Hearing Loss, Sensorineural/etiology , Neonatal Screening , Acrocephalosyndactylia/diagnosis , Connexin 26/genetics , Cytomegalovirus Infections/diagnosis , Hearing Loss, Bilateral/diagnosis , Hearing Loss, Sensorineural/diagnosis , Hearing Tests , Humans , Infant, Newborn , Ireland , Mutation , Retrospective Studies , Waardenburg Syndrome/diagnosisABSTRACT
The US Food and Drug Administration's Sentinel system has developed the capability to conduct active safety surveillance of marketed medical products in a large network of electronic healthcare databases. We assessed the extent to which the newly developed, semiautomated Sentinel Propensity Score Matching (PSM) tool could produce the same results as a customized protocol-driven assessment, which found an adjusted hazard ratio (HR) of 3.04 (95% confidence interval [CI], 2.81-3.27) comparing angioedema in patients initiating angiotensin-converting enzyme (ACE) inhibitors vs. beta-blockers. Using data from 13 Data Partners between 1 January 2008, and 30 September 2013, the PSM tool identified 2,211,215 eligible ACE inhibitor and 1,673,682 eligible beta-blocker initiators. The tool produced an HR of 3.14 (95% CI, 2.86-3.44). This comparison provides initial evidence that Sentinel analytic tools can produce findings similar to those produced by a highly customized protocol-driven assessment.
Subject(s)
Adrenergic beta-Antagonists/adverse effects , Angioedema/chemically induced , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Drug-Related Side Effects and Adverse Reactions , Product Surveillance, Postmarketing/statistics & numerical data , Databases, Factual , Humans , Models, Statistical , United States , United States Food and Drug AdministrationABSTRACT
Drug-drug interactions causing severe hypoglycemia due to antidiabetic drugs is a major clinical and public health problem. We assessed whether sulfonylurea use with a statin or fibrate was associated with severe hypoglycemia. We conducted cohort studies of users of glyburide, glipizide, and glimepiride plus a statin or fibrate within a Medicaid population. The outcome was a validated, diagnosis-based algorithm for severe hypoglycemia. Among 592,872 persons newly exposed to a sulfonylurea+antihyperlipidemic, the incidence of severe hypoglycemia was 5.8/100 person-years. Adjusted hazard ratios (HRs) for sulfonylurea+statins were consistent with no association. Most overall HRs for sulfonylurea+fibrate were elevated, with sulfonylurea-specific adjusted HRs as large as 1.50 (95% confidence interval (CI): 1.24-1.81) for glyburide+gemfibrozil, 1.37 (95% CI: 1.11-1.69) for glipizide+gemfibrozil, and 1.63 (95% CI: 1.29-2.06) for glimepiride+fenofibrate. Concomitant therapy with a sulfonylurea and fibrate is associated with an often delayed increased rate of severe hypoglycemia.
Subject(s)
Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Hypoglycemia/chemically induced , Hypoglycemic Agents/adverse effects , Hypolipidemic Agents/adverse effects , Aged , Algorithms , Cohort Studies , Drug Interactions , Female , Fenofibrate/administration & dosage , Fenofibrate/adverse effects , Glipizide/administration & dosage , Glipizide/adverse effects , Glyburide/administration & dosage , Glyburide/adverse effects , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Hypoglycemia/epidemiology , Hypoglycemic Agents/administration & dosage , Hypolipidemic Agents/administration & dosage , Incidence , Male , Middle Aged , Retrospective Studies , Severity of Illness Index , Sulfonylurea Compounds/administration & dosage , Sulfonylurea Compounds/adverse effectsABSTRACT
A drug-drug interaction (DDI) occurs when one or more drugs affect the pharmacokinetics (the body's effect on the drug) and/or pharmacodynamics (the drug's effect on the body) of one or more other drugs. Pharmacoepidemiologic studies are the principal way of studying the health effects of potential DDIs. This article discusses aspects of pharmacoepidemiologic research designs that are particularly salient to the design and interpretation of pharmacoepidemiologic studies of DDIs.
Subject(s)
Drug Interactions , Epidemiologic Research Design , Pharmacoepidemiology/methods , HumansABSTRACT
Heart failure (HF) is the most common cause for admission in patients over 65 and hospitalisations account for almost 1% of the health care budget in Ireland. A need to understand the epidemiological data in relation to hospitalisations for HF plays an important part in the planning and distribution of heart care services. The aim of this study was to analyse the temporal trends in hospitalisations for HF and look at potential areas for improvement. Cross sectional data was obtained from the Eurostat database. Data was extracted with the ICD 10 code for heart failure (1-50). The years 2002-2010 were analysed between the ages of 0-105. Between 2002 and 2010 there were 51369 admissions for HF in Irish hospitals. Of these, 54.7% were males and 87% were older than 65 years. The age standardised hospitalisation rates decreased from 157.5 per 100,000 to 127.2 per 100,000, a relative decrease of 19.2% (p = 0.02). There was an increase in HF hospitalizations for those aged > 85 from 17.9% to 26.7% (p = 0.001). There was no significant change in length of stay (12.0 days in 2002 and 12.4 days in 2010). This study of epidemiological surveillance data on Irish HF hospitalisations has shown a 19% reduction in hospitalisations between 2002 and 2010. Although this study shows an overall successful reduction in HF admission rates, the challenges remain in ensuring we manage the burden of those > 65 years, in particular those > 85 years.
Subject(s)
Disease Management , Heart Failure , Hospitalization , Patient Acceptance of Health Care/statistics & numerical data , Age Factors , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Health Care Rationing/methods , Health Care Rationing/statistics & numerical data , Heart Failure/epidemiology , Heart Failure/therapy , Hospitalization/statistics & numerical data , Hospitalization/trends , Humans , International Classification of Diseases , Ireland/epidemiology , Length of Stay , Male , Needs Assessment , Quality Improvement/trends , Sex FactorsABSTRACT
HIV and hepatitis B virus (HBV) infections are each associated with reduced bone mineral density, but it is unclear whether HIV/HBV coinfection is associated with an increased risk of fracture. We determined whether dually treated HIV/HBV patients had a higher incidence of hip fracture compared to treated HBV-monoinfected, antiretroviral therapy (ART)-treated HIV-monoinfected and HIV/HBV-uninfected patients. We conducted a cohort study among 4156 dually treated HIV/HBV-coinfected, 2053 treated HBV-monoinfected, 96,253 ART-treated HIV-monoinfected, and 746,794 randomly sampled uninfected persons within the US Medicaid populations of California, Florida, New York, Ohio and Pennsylvania (1999-2007). Coinfected patients were matched on propensity score to persons in each comparator cohort. Weighted survival models accounting for competing risks were used to estimate cumulative incidences and hazard ratios (HRs) with 95% confidence intervals (CIs) of incident hip fracture for dually treated coinfected patients compared to (i) HBV-monoinfected receiving nucleos(t)ide analogue or interferon alfa therapy, (ii) HIV-monoinfected on ART and (iii) uninfected persons. Dually treated coinfected patients had a higher cumulative incidence of hip fracture compared to ART-treated HIV-monoinfected (at 5 years: 1.70% vs 1.24%; adjusted HR, 1.37 [95% CI, 1.03-1.83]) and uninfected (at 5 years: 1.64% vs 1.22%; adjusted HR, 1.35 [95% CI, 1.03-1.84]) persons. The cumulative incidence of hip fracture was higher among coinfected than treated HBV-monoinfected patients (at 5 years: 0.70% vs 0.27%), but this difference was not statistically significant in competing risk analysis (adjusted HR, 2.62 [95% CI, 0.92-7.51]). Among Medicaid enrollees, the risk of hip fracture was higher among dually treated HIV/HBV-coinfected patients than ART-treated HIV-monoinfected and uninfected persons.
Subject(s)
Coinfection/complications , Coinfection/drug therapy , HIV Infections/complications , HIV Infections/drug therapy , Hepatitis B, Chronic/complications , Hepatitis B, Chronic/drug therapy , Hip Fractures/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Incidence , Male , Middle Aged , Retrospective Studies , Risk Assessment , United States/epidemiology , Young AdultABSTRACT
The use of antibiotics in livestock can pose a public health threat, especially if antibiotic residues remain in the food product. Understanding how often and why farmers sell products with antibiotic residues is critical to improving the quality of these products. To understand how often milk with antibiotic residues is sold on small farms in a major dairy-producing region of Peru and identify factors associated with selling milk with antibiotic residues, we tested milk samples for antibiotic residues from every provider on three routes of commercial milk companies and from bulk tanks of farmers currently treating cows with antibiotics. We also asked farmers if they sold milk from treated cows and examined factors associated with the tendency to do so. The prevalence of milk contamination with antibiotic residues on commercial routes was low (0-4.2%); however, 33/36 farmers treating their animals with antibiotics sold milk that tested positive for antibiotic residues. The self-reported sale of milk from treated cows had a sensitivity, specificity, and positive and negative predictive values of 75.8%, 100%, 100% and 27.2%, respectively (with testing of milk for residues as the gold standard). Finally, 69/156 randomly selected farmers reported selling milk from treated cows, and farmers' knowledge of antibiotics and the milk purchaser were significantly associated with a farmer's tendency to report doing so. Educating farmers on the risks associated with antibiotics and enforcement of penalties for selling contaminated milk by milk companies are needed to improve milk quality.
Subject(s)
Anti-Bacterial Agents/analysis , Dairying , Drug Residues/analysis , Food Contamination/analysis , Milk/chemistry , Adult , Animals , Anti-Bacterial Agents/toxicity , Dairying/methods , Dairying/standards , Data Collection , Developing Countries , Drug Residues/toxicity , Female , Humans , Male , Middle Aged , Milk/toxicity , Peru , Rural PopulationABSTRACT
Antibiotics are commonly used in animal agriculture; they can improve animal health and productivity, but their use may also represent a public health threat. Very little is known about antibiotic use on small farms in lower/middle income countries. To understand antibiotic use on these farms and promote the judicious use of these drugs, pharmacoepidemiologic data are necessary. However, acquiring such data can be difficult, as farmers are often illiterate (and therefore cannot participate in written surveys or keep treatment records), antibiotics can be obtained over-the-counter (in which case no prescriptions are generated) and monitoring and surveillance systems for drug use are often non-existent. The goal of this study was to compare two methods of acquiring pharmacoepidemiologic data pertaining to antibiotics that are well-adapted to farms in lower-middle income countries: self-report and the collection of discarded drug packaging. A convenience sample of 20 farmers in Cajamarca, Peru, participated in the study. Farmers placed discarded antibiotic packaging in bins for six months. At the end of the six-month period, farmers were interviewed and asked to recall the antibiotic usage that occurred on their farm over the past month and past six months; these self-reported data were quantitatively and qualitatively compared to the bin contents collected in the last month and previous six months. We found that the agreement between the bins and self-report was relatively poor for both the quantity and types of antibiotics used. The bins appeared to perform better than self-report when bottles and mLs of antibiotics were measured, while self-report appeared to perform better for intra-mammary infusions. The bins also appeared to perform better when data pertaining to an extended time period (six months) were collected. The results of this study will provide guidance to investigators seeking to collect pharmacoepidemiologic data in similar environments.
Subject(s)
Animal Husbandry , Anti-Bacterial Agents/administration & dosage , Cattle , Dairying , Data Collection/methods , Drug Utilization , Animals , Peru/epidemiology , Rural Population , Socioeconomic FactorsABSTRACT
Very little is known about the use of antibiotics on small dairy farms in lower/middle-income countries. The use of these drugs can have profound impacts on animal health, farmer income and public health. A survey of 156 farmers was conducted in Cajamarca, a major dairy-producing center in the highlands of Peru characterized by small farms (<15 cows) to assess patterns and determinants of antibiotic use and farmers' knowledge of antibiotics. The reported incidence of disease on these farms was relatively low (0.571 episodes of disease per cow-year), but more than 83% of the reported episodes were treated with antibiotics. The most commonly used antibiotics were oxytetracycline, penicillin and trimethoprim-sulfamethoxazole drugs; antiparasitic drugs were also used to treat what were likely bacterial infections. An increased incidence of treated disease was significantly associated with smaller farm size, lower farmer income, the previous use of the Californian Mastitis test on the farm and antibiotic knowledge. Farmers' knowledge of antibiotics was assessed with a series of questions on antibiotics, resulting in a "knowledge score". Increased knowledge was significantly associated with the use of antibiotics for preventative reasons, the purchase of antibiotics from feed-stores, the experience of complications in animals after having administered antibiotics, the number of workers on the farm and the educational level of the farmer. Overall, antibiotics appeared to be used infrequently, most likely because therapeutic interventions were sought only when the animal had reached an advanced stage of clinical disease. Few farmers were able to define an antibiotic, but many farmers understood that the use of antibiotics carried inherent risks to their animals and potentially to the consumers of dairy products from treated animals. The results of this study are useful for understanding the patterns of antibiotic use and associated management, demographic and knowledge factors of farmers on small dairy farms in rural Peru.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Cattle , Agriculture , Animals , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Peru , Regression Analysis , Rural Population , Socioeconomic Factors , Surveys and QuestionnairesABSTRACT
This study aimed to describe and compare the role of veterinarians and feed-store vendors in the use of antibiotics on small dairy farms in Cajamarca, Peru, a major dairy-producing center characterized by small, rural farms with poor, mostly uneducated farmers. We used a purposive sampling strategy to recruit 12 veterinarians into 2 focus group discussions and supplemented these data with 8 semi-structured interviews with feed-store vendors. Participants reported that inappropriate antibiotic usage was widespread among their clients, which may prevent the efficient use of drugs on farms where animal disease can be devastating to the livelihood of the farmer. Participants also identified many barriers to appropriate prescribing and use, including availability of drugs, competition from other prescribers, economic constraints and habits of farmers, and limited farmer knowledge of drugs and disease. Veterinarians expressed mistrust toward nonprofessional prescribers, whereas feed-store vendors felt that veterinarians were important partners in promoting the health of their clients' animals.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Commerce , Dairy Products/standards , Dairying/standards , Drug Prescriptions/veterinary , Drug Utilization , Veterinarians/psychology , Veterinary Drugs/administration & dosage , Animals , Female , Male , Peru , Professional Role , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To evaluate the long-term racing prognosis for Thoroughbred racehorses with displaced versus non-displaced fractures of the pelvis identified by scintigraphy. DESIGN: Retrospective case analysis. METHODS: Medical records of 31 Thoroughbred racehorses presenting to the University of Melbourne Equine Centre with fractures of the pelvis that were identified by scintigraphy were reviewed. Pelvic fracture site was determined and defined as displaced or non-displaced based on ultrasound and/or radiographic findings. Race records were analysed for each horse, with a minimum of 24 months' follow-up, and correlated with fracture type to determine long-term prognosis for racing. Results are expressed as median and range. RESULTS: Fractures at a single site were more common (n = 22) than fractures involving two sites (n = 9) and the ilial wing was the most commonly affected (n = 12). Thoroughbred racehorses with displaced pelvic fractures at any site (n = 12) raced fewer times within 24 months of diagnosis than horses with non-displaced fractures (n = 19) (median 0.5, range 0-13 vs 7, 0-24; P = 0.037), but there was no clear statistical difference in race earnings between the two groups (median A$0, range A$0-$123,250 vs A$14,440, A$0-$325,500, respectively; P = 0.080). Four horses with displaced fractures (33%) were euthanased on humane grounds because of persistent severe pain. When these horses were excluded from the analysis, there were no differences in performance variables between horses with a displaced or non-displaced pelvic fracture. CONCLUSION: Thoroughbred racehorses with a displaced or non-displaced pelvic fracture that survive the initial post-injury period have a good prognosis for racing.
Subject(s)
Fractures, Bone/veterinary , Horses/injuries , Pelvis/injuries , Running/physiology , Animals , Female , Kaplan-Meier Estimate , Male , Proportional Hazards Models , Retrospective Studies , SportsABSTRACT
Aims. To assess the breadth of mental and substance coverage in the Cochrane review system. Methods. All mental health and substance entries were identified from the 2005 to April 2012 Cochrane Database of Systematic Reviews. Results. A total of 1019 entries focused on mental health or substance misuse, with 698 (68.5%) being completed reviews. One out of every five entries focused on serious mental illness/psychosis. Systematic reviews addressing unipolar depression, dementia and certain substance disorders also appeared well-represented. In contrast, a number of impairing disorders frequently seen in practice received less attention, with bipolar disorder, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and autism spectrum disorders each accounting for less than 2% of the entries. The majority of interventions reviewed involved medication (57.1%), although this was not the case for a number of childhood-onset disorders. Some diagnostic areas (sleep, anxiety, mood and substance) were addressed by multiple Cochrane review groups (CRGs). Conclusions. The Cochrane Collaboration is well poised to be a strong guiding influence to those seeking to employ evidence-based mental health care. Broadening its diagnostic coverage and diversifying types of intervention reviewed would probably further maximize its impact. A more centralized and directed approach of prioritizing topics could help ensure more comprehensive coverage.
Subject(s)
Mental Health , Stress Disorders, Post-Traumatic , Anxiety Disorders , Bipolar Disorder , Humans , Mental Disorders , Obsessive-Compulsive DisorderABSTRACT
CASE HISTORY: Over a 3-year period between July 2008 and July 2011, 10 exploratory laparotomies were performed on foals in a Waikato referral facility in New Zealand. CLINICAL FINDINGS: Right dorsal displacement of the large colon (RDDLC) was identified during four exploratory laparotomies in three foals that presented for mild-to-moderate colic that was non-responsive to medical management. One foal required a repeat laparotomy 7 weeks post initial surgery, and RDDLC was again diagnosed. DIAGNOSIS: Right dorsal displacement of the large colon in foals. CLINICAL RELEVANCE: Further investigation may identify risk factors or management practices contributing to this condition. This is an important and uncommonly reported cause of surgical colic in foals, that is also important to consider in non-responsive medical colic cases that do not appear to be associated with severe pain, but may still require prompt surgical intervention to avoid a strangulating obstruction. The incidence of the condition in one Waikato referral facility appears higher than what could be expected based on the current literature.
Subject(s)
Colic/veterinary , Colonic Diseases/veterinary , Horse Diseases/pathology , Animals , Colic/pathology , Colic/surgery , Colonic Diseases/epidemiology , Colonic Diseases/surgery , Female , Horse Diseases/epidemiology , Horse Diseases/surgery , Horses , Male , New Zealand/epidemiologyABSTRACT
Drug-drug interactions (DDIs) are an important clinical and public health concern. Although DDI screening now occurs during drug development, it is difficult to predict clinical importance based on in vitro experiments. Furthermore, older drugs that were not screened may have interactions that have not yet been identified. In this Commentary, we review the importance of DDIs and argue that a translational research approach is needed to produce clinically actionable information as well as generalizable biological knowledge.
Subject(s)
Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Platelet Aggregation Inhibitors/adverse effects , Pyridines/adverse effects , Ticlopidine/analogs & derivatives , Clopidogrel , Female , Humans , Male , Ticlopidine/adverse effectsABSTRACT
The demand for data from randomized comparative-effectiveness trials will always outstrip supply. Given their susceptibility to bias, several factors should be considered when examining nonrandomized comparative-effectiveness studies. These include comparability of treatments, magnitude of difference observed, sufficient attention to the underlying biology, examination of relationships supporting the main findings, whether the study includes only new users of the study treatments, whether the study end point is validly recorded, and replication of results.
Subject(s)
Clinical Trials as Topic/methods , Comparative Effectiveness Research/methods , Endpoint Determination , Bias , Clinical Trials as Topic/standards , Humans , Reproducibility of ResultsABSTRACT
OBJECTIVE: The importance of adherence to aminoglycoside dosing recommendations by a pharmacokinetic monitoring service for preventing acute kidney injury (AKI) is unknown. We aimed to examine the association between AKI and discordance in aminoglycoside dosing between physician orders and recommendations by a pharmacokinetic monitoring service. MATERIALS: We utilized 2000 - 2003 data from a large quaternary care academic medical center, including: hand-written pharmacokinetic monitoring service recommendations; computerized physician order entry inpatient medication orders; and electronic inpatient laboratory orders and results. METHODS: We conducted a case-control study, nested within users of intravenous aminoglycosides. Outcomes of interest were cases of AKI, as determined by changes in serum creatinine. Exposures of interest were discordances between pharmacokinetic monitoring service recommendations and physician orders in the past 2 days with regard to total daily aminoglycoside dose. RESULTS: Most patients received once-daily or less frequent aminoglycoside dosing. In 1,414 evaluable aminoglycoside courses, 220 patients developed AKI, for a cumulative incidence of 15.6%. We identified 690 controls, matched these to 220 cases, and found adjusted odds ratios of 0.72 (95% CI: 0.37 - 1.39) for overdose discordance and of 0.83 (0.51 - 1.34) for underdose discordance, suggesting that discordance in dosing is not associated with AKI. CONCLUSION: Non-adherence to dosing recommendations for aminoglycosides was not associated with risk of AKI in a setting primarily of once-daily aminoglycoside administration.
Subject(s)
Acute Kidney Injury/chemically induced , Aminoglycosides/administration & dosage , Anti-Bacterial Agents/administration & dosage , Drug Monitoring , Pharmacy Service, Hospital , Adult , Aged , Aminoglycosides/pharmacokinetics , Case-Control Studies , Female , Humans , Male , Middle Aged , PharmacistsABSTRACT
The objective of this study was to evaluate whether orally administered anti-infectives increase the risk of severe hypoglycemia in users of glipizide or glyburide. We performed two case-control studies and two case-crossover studies using US Medicaid data. All the anti-infectives examined were associated with an elevated risk of severe hypoglycemia. Using cephalexin as the reference category, in glipizide users, statistically significant associations were found with co-trimoxazole (odds ratio (OR) = 3.14; 95% confidence interval (CI): 1.83-5.37); clarithromycin (OR = 2.90; 95% CI: 1.69-4.98); fluconazole (OR = 2.53; 95% CI: 1.23-5.23); and levofloxacin (OR = 2.09; 95% CI: 1.35-3.25). In glyburide users, with cephalexin as the reference, statistically significant associations were found with clarithromycin (OR = 5.02; 95% CI: 3.35-7.54); levofloxacin (OR = 2.83; 95% CI: 1.73-4.62); co-trimoxazole (OR = 2.68; 95% CI: 1.59-4.52); fluconazole (OR = 2.20; 95% CI: 1.04-4.68); and ciprofloxacin (OR = 2.08; 95% CI: 1.23-3.52). In conclusion, exposure to all studied anti-infective agents were associated with subsequent severe hypoglycemia. Using cephalexin as the reference, drug-drug interactions were evident with ciprofloxacin (in glyburide users only), clarithromycin, co-trimoxazole, fluconazole, and levofloxacin.