Different methods to calculate the inhibitory quotient of boosted single protease inhibitors and their association with virological response.
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Anti-HIV Agents↗
Biomedical subjects
Nimesh Patel
Publications and source records attributed to Nimesh Patel.
Improving timely surgical antibiotic prophylaxis redosing administration using computerized record prompts.
BACKGROUND: Timely prophylactic antibiotic administration aids in preventing postoperative superficial surgical site infections. However, during lengthy surgical procedures, redosing of prophylactic antibiotics may be unintentionally omitted. We assessed the utility of a computerized reminder as part of the anesthesia charting system to increase the rate of timely intraoperative prophylactic antibiotic redosing. METHODS: A retrospective observational analysis was performed on consecutive patients undergoing non-cardiac surgical procedures at a university-affiliated hospital prior to and after the institution of a computerized reminder system. The reminder system presented the clinician with a series of on-screen dialog boxes prior to the redose time for the specific prophylactic antibiotic administered preoperatively. Antibiotic redosing was defined as appropriate if it occurred within 30 min prior to or after the due time, calculated as twice the half-life of the specific antibiotic. Patients were excluded if the case duration was less than twice the half-life of the administered prophylactic antibiotic, or if no prophylactic antibiotic was given. RESULTS: A total of 287 cases were included in the study (148 pre-intervention, 139 post-intervention). Patient age, case length, and American Society of Anesthesiologists (ASA) score stratification did not differ between the groups. Use of the reminder system resulted in an increase in the appropriate redosing of antibiotics from 20% prior to institution of the reminder to 58% after institution (p < 0.001). CONCLUSIONS: A computerized reminder system is an effective tool to assist in appropriate intraoperative redosing of prophylactic antibiotics during lengthy surgical procedures.
Adult↗
Validation of LC/MS electrospray ionisation method for the estimation of ursodiol in human plasma and its application in bioequivalence study.
A novel High Performance Liquid Chromatography-electrospray mass spectrometric method has been developed for the estimation of Ursodiol (Ursodeoxycholic acid)--a bile acid, in human plasma using Ornidazole as internal standard. The methodology involved solid phase extraction of the analyte from human plasma matrix. The chromatographic separation was achieved within seven minutes by an isocratic mobile phase containing 1.0 mM ammonium acetate and Acetonitrile (65:35, v/v), flowing through XTerra MS C18, 100 x 2.1, 3.5 microm analytical column, at a flow rate of 0.2 ml/min. Ion signals were measured in negative mode for Ursodiol and internal standard at m/z 391.3 and 278.1, respectively. A detailed validation of the method was performed as per USFDA guidelines and the standard curves were found to be linear in the range 50.0 ng/ml to 3000.0 ng/ml with the mean correlation coefficient more than 0.99. The absolute recovery was more than 54.90% for Ursodiol and 76.51% for internal standard. Ursodiol was stable for sixty-nine days at -70 degrees C and for eight hours at ambient temperature. After extraction from plasma, the reconstituted samples of Ursodiol were stable in autosampler at 10 degrees C for forty-eight hours. Upon subjecting to three freeze thaw cycles, there was no change in the recovery of the analyte. The integrity of the plasma samples remained unaffected even upon four-fold dilution with drug free human plasma. The method was simple, specific, sensitive, precise, accurate and suitable for bioequivalence and pharmacokinetic studies. It was successfully applied to the pilot bioequivalence study of Ursodiol in male human subjects.
Cholagogues and Choleretics↗
Improving anesthesiologist performance through profiling and incentives.
STUDY OBJECTIVE: To determine the influence of profiling and incentives on anesthesiologist behavior in relation to several key indicators of performance. DESIGN: Prospective collection and analysis of operational data before and after implementation of a physician profiling, reporting, and incentive program. SETTING: University hospital. MEASUREMENTS: An intervention consisting of two components was studied with the intent of stimulating a high level of performance in relation to a peer group. The first component, a monthly report of physician performance via an individualized performance report, was provided to each physician for each of 6 months. The second component consisted of a financial incentive. For each month in the study, physicians were eligible to receive a variable financial incentive of between $0 and $500 per month depending on individual performance based scoring in relation to each other. Physician performance was tracked in five areas: 1) percentage of first cases of the day in the room at or before the scheduled in-room time, 2) percentage of cases with an anesthesia prep time less than a target, 3) percentage of cases delayed due to waiting for an anesthesiology patient evaluation, 4) percentage of cases delayed during the anesthesiology controlled time, and, 5) percentage of cases delayed due to waiting for the anesthesiology attending. Results were reported to each physician on a monthly basis, by e-mail distribution, of an individualized perioperative efficiency summary report. A monthly financial incentive was awarded to the top performing physicians in the form of a credit to the physician's personal CME/expense account. Also, all physicians received a rank order list of their performance on each indicator at the end of each month. MAIN RESULTS: 31 anesthesiologists, comprising the multispecialty division, and covering all services with the exception of obstetrics, pediatrics, and cardiothoracic anesthesia were tracked for 6 months. Compared to the first month, the percent of first cases of the day in the room at or before the scheduled start time and the percent of cases with an anesthesiology prep time less than target increased significantly (19 +/- 4.6%, vs. 61 +/- 6.5%, 95% CI, p <0.001; and 57 +/- 5.3%, vs. 73 +/- 5.1%, 95% CI, p <0 .001) during the sixth month. The mean number of cases per physician with a delay during anesthesiology controlled time decreased (14.9 +/- 2.9 vs. 3.3 +/- 1, p <0.001), no change occurred in the number of cases with a delay due to waiting for an anesthesiology patient evaluation or number of cases delayed due to waiting for the anesthesiology attending in the sixth month compared with the first month. CONCLUSION: Tracking and rewarding physician performance with monthly profiling and a financial incentive given to the best in a peer group improves anesthesiologist performance in several key areas.
Anesthesiology↗
Erythropoietin protects the kidney against the injury and dysfunction caused by ischemia-reperfusion.
Erythropoietin (EPO) is upregulated by hypoxia and causes proliferation and differentiation of erythroid progenitors in the bone marrow through inhibition of apoptosis. EPO receptors are expressed in many tissues, including the kidney. Here it is shown that a single systemic administration of EPO either preischemia or just before reperfusion prevents ischemia-reperfusion injury in the rat kidney. Specifically, EPO (300 U/kg) reduced glomerular dysfunction and tubular injury (biochemical and histologic assessment) and prevented caspase-3, -8, and -9 activation in vivo and reduced apoptotic cell death. In human (HK-2) proximal tubule epithelial cells, EPO attenuated cell death in response to oxidative stress and serum starvation. EPO reduced DNA fragmentation and prevented caspase-3 activation, with upregulation of Bcl-X(L) and XIAP. The antiapoptotic effects of EPO were dependent on JAK2 signaling and the phosphorylation of Akt by phosphatidylinositol 3-kinase. These findings may have major implications in the treatment of acute renal tubular damage.
Animals↗
A chemotherapy incident reporting and improvement system.
BACKGROUND: The Vanderbilt University Medical Center (VUMC) has designed and deployed the Chemotherapy Incident Reporting and Improvement System (CIRIS), which is embedded into daily care processes. The system uses commercial information technologies, including handheld computers, to create a mobile Web-based chemotherapy incident reporting system for nurses and pharmacists. Two phases--(1) development and implementation of the CIRIS incident reporting safety registry and (2) development of the handheld-computer interface--were implemented. The final phase entails integration of the computerized order entry system into the front end of the CIRIS architecture. The voluntary incident reporting system data are stored over time for use by the multidisciplinary safety improvement team. RESULTS: Staff buy-in has been demonstrated by increased reporting rates, the high number of provider-initiated improvements made to the reporting tool during the first year of implementation, and specific chemotherapy safety interventions conceived from analysis of the reported data. CONCLUSION: The CIRIS model for pediatric chemotherapy safety improvement has been implemented in the inpatient setting but could easily be configured for a variety of other clinical applications in inpatient or outpatient settings. CIRIS has been effective, especially in the chemotherapy pharmacy, where incident reporting has increased dramatically.
Child↗