Baseline Quality-of-Life of Caregivers of Patients With Heart Failure Prior to Advanced Therapies: Findings From the Sustaining Quality of Life of the Aged: Transplant or Mechanical Support (SUSTAIN-IT) Study.

BACKGROUND: We compared health-related quality of life (HRQOL), depressive symptoms, anxiety, and burden in caregivers of older patients with heart failure based on the intended therapy goal of the patient: awaiting heart transplantation (HT) with or without mechanical circulatory support (MCS) or prior to long-term MCS; and we identified factors associated with HRQOL. METHODS: Caregivers (n = 281) recruited from 13 HT and MCS programs in the United States completed measures of HRQOL (EQ-5D-3L), depressive symptoms (PHQ-8), anxiety (STAI-state), and burden (Oberst Caregiving Burden Scale). Analyses included ANOVA, Kruskal-Wallis tests, χ2 tests, and linear regression. RESULTS: The majority of caregivers were female, white spouses with ≤ 2 comorbidities, median [Q1,Q3] age = 62 [57.8, 67.0] years. Caregivers (HT with MCS = 87, HT without MCS = 98, long-term MCS = 96) reported similarly high baseline HRQOL (EQ-5D-3L visual analog scale median score = 90; P = 0.67 for all groups) and low levels of depressive symptoms. STAI-state median scores were higher in the long-term MCS group vs the HT groups with and without MCS, (38 vs 32 vs 31; P < 0.001), respectively. Burden (task: time spent/difficulty) differed significantly among groups. Caregiver factors (number of comorbidities, diabetes and higher anxiety levels) were significantly associated with worse caregiver HRQOL, R2 = 26%. CONCLUSIONS: Recognizing caregiver-specific factors, including comorbidities and anxiety, associated with the HRQOL of caregivers of these older patients with advanced HF may guide support strategies.

Rapid enantiomeric quantification of an antiviral nucleoside agent (D,L-FMAU, 2'-fluoro-5-methyl-beta,D,L-arabinofurano-syluracil) by mass spectrometry.

A novel mass spectrometric method is applied to rapid, accurate (<1%) quantification of chiral Clevudine (L-FMAU, 2'-fluoro-5-methyl-beta,L-arabinofuranosyluracil), a potent antiviral nucleoside agent against hepatitis B virus. Transition metal bound complex ions containing the chiral drug are generated by electrospray ionization mass spectrometry and subjected to collision-induced dissociation. The ratio of the two competitive dissociation rates is related to the enantiomeric composition of the drug mixture, allowing the determination of enantiomeric contamination in the drug.

Determination of cocaine and selected metabolites in canine and human serum by reversed-phase high-performance liquid chromatography on coupled cyanopropyl and silica columns.

A high-performance liquid chromatographic procedure for the determination of cocaine and selected metabolites (benzoylecgonine, norcocaine and benzoylnorecgonine) from human and canine serum has been developed. The analytes are extracted from 0.5-ml serum samples using strong cation-exchange and octadecylsilane solid-phase extraction columns. Chromatographic separation was accomplished on coupled cyanopropyl and silica columns using acetonitrile-6.25 mM phosphate buffer, pH 2.9 (80:20 v/v) as eluent and a flow-rate of 1.1 ml/min. Low-wavelength UV detection (228 nm, cadmium lamp) allowed detection of 1 ng/ml for each analyte. The assay was linear from 0 to 200 ng/ml (r2 = 0.997-0.999, n = 15 for each analyte) and showed good precision (relative standard deviation = 0.66-13.8%, n = 6) and accuracy (98-115% relative recovery).

Comparative intraoperative concentrations of two cephalosporins with activity against anaerobic bacteria.

We determined the intraoperative concentrations of cefmetazole and cefoxitin in serum and muscle from the wound of 30 patients who were undergoing cholecystectomies. The study employed an open-label design in which all patients randomly received cefoxitin sodium (30 mg/kg) or cefmetazole sodium (15 or 30 mg/kg) intravenously with the induction of anesthesia. Total serum and wound-muscle concentrations achieved with cefmetazole 30 mg/kg were significantly greater than those achieved with a similar dose of cefoxitin. Cefmetazole in a 15 mg/kg dose was comparable with cefoxitin 30 mg/kg in achieved concentrations. The elimination half-life for cefoxitin was much shorter than that for cefmetazole (41 min v. 64-68 min, respectively) and this relates to a shorter duration of action for the former. The choice of agent for surgical prophylaxis should incorporate factors relating to drug pharmacokinetic properties as well as microbiological factors.

Computer-controlled anesthetic delivery system.

We designed and tested a computer-controlled syringe pump for the administration of volatile anesthetics into a closed breathing circuit. The system consists of a small computer, a flip-flop circuit, and an automatic syringe pump. The computer was programmed to administer liquid anesthetics according to the square root of time model of anesthetic uptake. A simple electronic flip-flop circuit connected the computer to the syringe pump. Safeguards to prevent accidental anesthetic overdosage and algorithms to provide for dosage changes based on patient response were written into the program. After testing, the system was used to administer anesthetics to ten patients undergoing surgical procedures. The anesthetic uptake deviated from the square root of time model after approximately two hours. The system provided smooth and reliable administration of volatile anesthetics during closed circuit anesthesia.

Effect of nitrous oxide solubility on vaporizer aberrance.

Concentrations of halogenated anesthetics produced by contemporary vaporizers vary from vaporizer dial settings when carrier gas is not 100% oxygen. This effect is most marked when carrier gas changes from 100% O2 to 100% nitrous oxide (N2O). Vapor concentrations of halothane and enflurane from vaporizers with 6 L/min carrier gas flows were reduced to 3% from 4% until absorption of N20 by the liquid anesthetic ceased. Presaturation of liquid anesthetics with N2O eliminated the transient decrease of vapor output. Steady-state outputs of halothane and enflurane in 100% N2O were 10% below dial settings. The significance of these changes in administration of closed-circuit anesthesia with an out-of-circuit vaporizer is discussed.