RESUMEN
We implemented a post prescribing review and feedback program to investigate its effect on appropriateness of antimicrobial use and antimicrobial consumption rate. A pre-post interventional study conducted in internal ward of Imam Hossein teaching hospital. For nine months of intervention phase, medical file of all patients who received intravenous antibiotic were reviewed by a clinical pharmacy specialist. Discrepancies from international and local guidelines were discussed with physicians. Outcome measures included appropriateness of antimicrobial usage, length of stay, and broad-spectrum antimicrobial usage rate. A total of 198 antibiotic courses (154 in intervention phase and 44 in pre-intervention phase) were reviewed. One-hundred sixty-seven recommendations in treatment course of 75.3% of patients were made. The most common recommendations were discontinuing antibiotics and changing from intravenous to oral therapy (35% and 22%). The acceptance rate was 80.2%. Rate of discrepancies from guidelines was compared between pre-intervention and two last months of intervention period which showed a significant reduction in antibiotic choosing (47%, P-value < 0.001), de-escalation (48%, P-value < 0.001), on time changing intravenous to oral therapy (60%, P-value < 0.001) and dosing schedule (30%, P-value = 0.003). Hospital length of stay showed a significant reduction from 16.1 days to 11.6 days (P-value < 0.05) between pre-intervention and post-intervention group. Mortality rate was not different in the patients that intervention in their treatment was accepted vs. rejected (P-value = 1.00). There was a reduction trend in consumption rate of Carbapenems, Vancomycin, and Ciprofloxacin. Therefore, prospective audit and feedback program effectively decreased inappropriate treatment and hospital length of stay with no effect on mortality.
RESUMEN
The purpose of this study was to examine the effect of intravenous magnesium sulfate on patients with COPD exacerbation requiring hospitalization. In this randomized clinical trial 30 patients with COPD exacerbation were studied. Patients were randomly assigned to group A (case) who concurrent with standard therapy received 2 g magnesium sulfate in normal saline infused in 20 minutes on days one to three and group B (control) who received standard medications and placebo. PEFR and FEV1 were measured by before, 45 minutes and third day of entering the study. Vital signs HR, BP, RR, temperature and SpO2 were monitored during hospitalization. 21 males and 9 females patients with mean age of 68 ± 9 years, case 67 ± 10 and control 70 ± 8 were studied (15 patients in each arm of study). The mean pretreatment FEV1 was 26% ± 12, and 35% ± 18 in case and control groups respectively (P=0.137). FEV1 after 45 minutes in case group was 27% ± 9 and control group 36% ± 20 (p=0.122). FEV1 after 3 days of study was 32% ± 17 in case and 41% ± 22 in control groups (P=0.205). The mean pretreatment PEFR was 126 ± 76 l/min in case and 142 ± 62 l/min in control groups (P=0.46). Changes in PEFR were not significant 45 min (p=0.540) and 3 days (p=0.733) of the administration of intravenous magnesium sulfate. Duration of hospital stay between the two groups did not show any significant difference. This study showed that administration of intravenous magnesium sulfate in hospitalized patients with COPD exacerbation neither revealed any significant bronchodilating effect nor reduced duration of hospital stay.
RESUMEN
BACKGROUND: Blind percutaneous pleural biopsy has traditionally been performed to investigate the etiology of exudative pleural effusion in which the initial thoracocentesis has been non- diagnostic. In view of the increasing use of image-guided and thoracoscopic pleural biopsies, this study examined the role of blind Abrams pleural biopsy in the investigation of the exudative pleural effusion in the largest tertiary pulmonary center in Tehran, Iran. METHODS: All patients with pleural effusion admitted from September 2007 to April 2009 entered in this study. The patients with exudative pleural effusion underwent blind Abrams pleural biopsy when the initial thoracocentesis was non-diagnostic. The patients with non-diagnostic blind biopsy underwent surgical biopsy or other investigations based on the physician's decision. The data were collected and analyzed. RESULTS: Blind percutaneous pleural biopsy was performed in 171 patients. Malignancy was diagnosed in 56 and tuberculosis in 52 cases with blind biopsy. For all the diagnoses, blind biopsy had a sensitivity of 70.1% and negative predictive value of 14.8%. For malignant diagnosis, the sensitivity value was 58.9%, specificity 100% and negative predictive value 63.2%. For TB diagnosis, sensitivity value was 88.1%, specificity 100% and negative predictive value 93.6%. The overall malignancy was diagnosed in 95 (58.6%) and TB in 59 (36.4%) patients. CONCLUSION: Blind Abrams needle biopsy was diagnostic in approximately three out four patients presented with undiagnosed exudative pleural effusion. The data support the use of the Abrams needle in the investigation of pleural effusion especially in the less developed countries.
