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Prophylactic Levetiracetam for the Prevention of Posttraumatic Brain Injury Seizures
No full textClass of 2013 AbstractSpecific Aims: Guidelines developed by the Brain Trauma Foundation recommend the use of prophylactic anticonvulsants, particularly phenytoin, for the prevention of early posttraumatic seizures for patients with severe traumatic brain injuries. The purpose of this study is to evaluate the effectiveness of levetiracetam, a newer anticonvulsant, for posttraumatic seizure prevention in patients with severe traumatic brain injury. Methods: This study was approved by the University of Arizona Medical Center Institutional Review Board. The project consists of a retrospective cohort analysis from January 1, 2010 to September 30, 2011. We have abstracted data from all patients with traumatic brain injuries over this time period from the University of Arizona Medical Center Trauma Registry, and have matched these patients with their records in the pharmacy database to determine who received levetiracetam versus no prophylaxis. Patients younger than 18 years of age, pregnant women, patients who were deemed to be nonsalvageable, and patients who had a seizure prior to initiation of levetiracetam were excluded from the study. The following data was collected: age, gender, ethnicity, mechanism of injury, injury severity score, ED GCS, ED SBP, ED pulse, ED RR, blood alcohol level, ICU length of stay, number of ventilator days, hospital length of stay, FIM score at discharge (totals, and by component), diagnosis, surgery and complication type, anticonvulsant given, type of beta-blocker given, maximum and minimum dose used, cumulative doses given, and whether there exists a known prior history of anticonvulsant use. All data were recorded without patient identifiers and have been kept confidential. A multivariate logistic regression analysis was used to evaluate a relationship between other data collected from the patients’ medical records and seizure occurrence. Chi Square or Fisher's Exact test will be used in the final analysis to compare the effectiveness of levetiracetam versus no prophylaxis to prevent posttraumatic brain injury seizures. Significance is defined as p<0.05 for all analyses. Main Results: The results are pending the final data analysis. Conclusion: To be determined.This item is part of the Pharmacy Student Research Projects collection, made available by the College of Pharmacy and the University Libraries at the University of Arizona. For more information about items in this collection, please contact Jennifer Martin, Librarian and Clinical Instructor, Pharmacy Practice and Science, [email protected]
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Evaluation of Timing of Vancomycin Surgical Site Infection Prophylaxis with Scheduled Antibiotic
No full textClass of 2012 AbstractSpecific Aims: The primary purpose of this study was to evaluate the time of vancomycin pre-operative surgical site infection prophylaxis administration relative to other scheduled antibiotic therapy at a tertiary care, academic medical center. The secondary purpose was to characterize the incidence of adverse events post-surgery that were associated with vancomycin therapy in patients who received both pre-operative scheduled vancomycin therapy and vancomycin for surgical site infection prophylaxis Methods: This descriptive study was a retrospective medical chart review of all patients over the age of 28 days who received vancomycin for surgical site infection prophylaxis between February 2011 and May 2011 at a tertiary care, academic medical center. This study was approved be the Institutional Review Board. The subject population included patients admitted to the hospital for at least 72 hours who received at least 48 hours of scheduled vancomycin (IV), daptomycin or linezolid therapy before index surgery and subsequently received surgical site infection prophylaxis with vancomycin. Main Results: Of the 20 subjects who meet the study inclusion criteria, 18 (90%) subjects received scheduled vancomycin doses within 48 hours prior to surgery, 5 (25%) subjects within 4 hours, and 4 (20%) subjects within 2 hours. No surgical site infections were reported. Conclusions: This was a pilot study to evaluate the timing of vancomycin surgical site infection prophylaxis doses with scheduled vancomycin, linezolid, and daptomycin. No adverse effects associated with surgical site infection prophylaxis were reported but the sample size is small and likely inadequate to detect this potential issue.This item is part of the Pharmacy Student Research Projects collection, made available by the College of Pharmacy and the University Libraries at the University of Arizona. For more information about items in this collection, please contact Jennifer Martin, Librarian and Clinical Instructor, Pharmacy Practice and Science, [email protected]
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Inpatient Management of Blood Pressure and Fluid Overload in Patients With End-Stage Renal Disease on Hemodialysis
No full textClass of 2014 AbstractSpecific Aims: The main objectives of the study are to compare the number of antihypertensive medications upon admission versus discharge, determine the fluctuation index ((SBPmax – SBPmin)/Avg)x100) between inpatient HD sessions, determine the minimum SBP during each inpatient HD session and compare pre-HD weight to post-HD weight for each inpatient HD session to determine inter-dialytic weight gain. The findings of this study are expected to have a positive impact on the management of blood pressure and fluid overload in HD patients by identifying the adverse effects associated with an increased anti-hypertensive medication burden. Methods: The Institutional Review Board approved this retrospective chart review. The electronic medical record system identified patients that received HD between January 1, 2010 and January 1, 2013. The following data was collected: the admission diagnosis and patient comorbidities; time on dialysis prior to admission and time since last HD session; the number and class of anti-hypertensive medications documented on admission, while inpatient, and upon discharge; the use of midodrine, receipt of erythropoietin stimulating agents, total time on dialysis while admitted, intra-dialytic hypotensive events, blood pressure readings pre- and post-HD, and inter-dialytic weight gain. Descriptive and demographic variables were also collected from the electronic medical record systems. The investigators will use this information to compare the number of anti-hypertensive medications upon admission versus discharge, determine the fluctuation of systolic blood pressure (SBP) between each inpatient HD session, determine the minimum SBP during each inpatient HD session and compare pre-HD weight to post-HD weight to determine inter-dialytic weight gain and total volume removed per each HD session. Descriptive statistics will be used to analyze our demographic data. Multiple linear regression analyses will be completed to evaluate independent predictors of inter-dialytic weight gain and intra-dialytic hypotension. Main Results: Pending Conclusion: PendingThis item is part of the Pharmacy Student Research Projects collection, made available by the College of Pharmacy and the University Libraries at the University of Arizona. For more information about items in this collection, please contact Jennifer Martin, Librarian and Clinical Instructor, Pharmacy Practice and Science, [email protected]
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Evaluation of Anticoagulation Parameters After Discontinuation of Argatroban in Critically Ill Patients.
No full textClass of 2015 AbstractObjectives: Argatroban is the current drug of choice for type II heparin induced thrombocytopenia. Primarily metabolized by the liver, this direct thrombin inhibitor has a volume of distribution of approximately 174 mLs per kg. While few studies suggested no differences in coagulation parameters or clinical outcomes between obese and non-obese populations receiving argatroban, a recent case report revealed elevated anticoagulation parameters for 20 days post argatroban discontinuation in a morbidly obese female. The purpose of this study is to assess anticoagulation parameters in obese and non-obese patients in an intensive care unit (ICU) setting who received argatroban treatment during their stay. Methods: This is a retrospective, observational, single-centered study. Participants of the study must be adults, at least 18 years of age. Patient must be an inpatient and have received argatroban for either suspected or confirmed heparin-induced thrombocytopenia (HIT). All patients in the study were screened for the above criteria between November 2008 and September 2013. Patients admitted to the cardiac ICU were excluded from the study. Main anticoagulation parameters post discontinuation evaluated were daily international normalized ratio (INR) and activated partial thromboplastin time (aPTT), while safety outcomes included major, minor and non-bleed events. All data were analyzed with STATA 13 with P less than 0.05 being considered as statistically significant. Results: The study included a total of 51 patients, 37 were non-obese with body mass index (BMI) less than 30 kg per m2 (73 percent), and 14 were obese with BMI greater or equal to 30 kg per m2 (27 percent). Among basic demographic data, no differences were found between age, sex, race, height and SOFA scores at baseline between the two groups, BMI less than 30 kg per m2 and BMI greater or equal to 30 kg per m2. (P equals 0.7, 0.21, 1.0, 0.41, 0.51 respectively). However, as expected, weight was the only characteristic that was different at baseline (P less than 0.01). Primary outcome of time of INR to normalization post argatroban administration (2.73 seconds plus or minus 0.27 seconds) as well as safety outcomes including major, minor, and non-bleed adverse events (P equals 0.61) were statistically non-significant between the two groups. Conclusions: In this retrospective, observational, single centered study, no differences were identified between non-obese and obese groups in terms of argatroban administration, primary anticoagulation parameters, and safety outcomes. The length of time required for coagulation parameters to normalize after discontinuation of argatroban therapy for HIT does not appear to be influenced by BMI. Large, multicenter, and random controlled trials are needed to evaluate obesity on pharmacokinetic parameters and clinical outcomes of argatroban.This item is part of the Pharmacy Student Research Projects collection, made available by the College of Pharmacy and the University Libraries at the University of Arizona. For more information about items in this collection, please contact Jennifer Martin, Librarian and Clinical Instructor, Pharmacy Practice and Science, [email protected]
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Continuous Intravenous Insulin Weight Based Dose-Related Hypoglycemia in Critically Ill Patients
No full textClass of 2014 AbstractSpecific Aims: To evaluate the association of weight-based insulin dose with hypoglycemia in critically ill patients receiving continuous intravenous insulin infuions. To determine whether higher weight-based doses of insulin were associated with a higher incidence of hypoglycemia Methods: This was a retrospective, case-control study conducted at a tertiary care, academic medical center. Adult (>18 years) patients admitted to the intensive care unit (ICU) receiving intravenous (IV) regular insulin infusions for the management of hyperglycemia between 1 January 2008 and 30 March 2013 were included. Medical records were retrospectively reviewed. Each patient with hypoglycemia was matched with a non-hypoglycemic control subject, based on age range and sex. Laboratory data, patient demographics, hypoglycemic events, insulin infusion data, SOFA scores, length of hospital and ICU stay, and patient outcomes were collected and evaluated. Main Results: Sixty-one patients experienced a hypoglycemic event and were matched with 61 non-hypoglycemic control subjects for statistical analysis. With the exception of ethnicity (p = 0.041) as a demographic predictor of hypoglycemia; age, sex, weight, height, and BMI were not significant. The starting insulin infusion rate and the total number of insulin units per day administered were not found to be associated with hypoglycemia, p=0.107 and p=0.357, respectively. Conclusion: This study failed to show significance in the total units per day of insulin and the incidence of hypoglycemia. There was no statistical significance in BMI between case and control groups, thus no clear conclusion can be made associating hypoglycemia with weight-based insulin dosing.This item is part of the Pharmacy Student Research Projects collection, made available by the College of Pharmacy and the University Libraries at the University of Arizona. For more information about items in this collection, please contact Jennifer Martin, Librarian and Clinical Instructor, Pharmacy Practice and Science, [email protected]
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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