Biomedical subjects

Robert K Hallisey

Publications and source records attributed to Robert K Hallisey.

5 recordsLinked to original sources

PubMed2005

Argatroban and lepirudin requirements in a 6-year-old patient with heparin-induced thrombocytopenia.

A 6-year-old girl required argatroban at dosages up to 18 mug/kg/minute for treatment of heparin-induced thrombocytopenia (HIT) type 2; however, her activated partial thromboplastin time (aPTT) values remained subtherapeutic. Treatment was converted to lepirudin, which resulted in therapeutic aPTT values, and later to long-term warfarin therapy; no further thromboembolic incidents occurred. The reporting of cases of HIT in prepubertal patients has generally been scarce. Argatroban and lepirudin dosing and pharmacokinetics have not yet been established for young children. The argatroban dosage for this patient exceeded the upper limit of the dose range for adults. Several possible explanations for why argatroban did not illustrate typical first-order pharmacokinetics in this patient are discussed, and the pharmacokinetics and pharmacodynamics of argatroban are compared with those of lepirudin, with special consideration given to the pediatric population.

Anticoagulants↗

PubMed2005

Designing an electronic medication reconciliation system.

Unintended medication discrepancies at hospital admission and discharge potentially harm patients. Explicit medication reconciliation (MR) can prevent unintended discrepancies among care settings and is mandated by JCAHO for 2005. Enterprise-wide, we are linking pre-admission and discharge medication lists in our outpatient electronic health records (EHR) with our inpatient order entry applications (OE) - currently not interoperable - to support MR and inform the development of comprehensive MR among hospitalized patients.

Hospitalization↗

PubMed2004

Effect of renal function on the pharmacodynamics of argatroban.

BACKGROUND: Argatroban is a direct thrombin inhibitor used to treat heparin-induced thrombocytopenia (HIT). Argatroban is primarily cleared by hepatic mechanisms, with only small amounts of unchanged drug cleared by the kidneys. OBJECTIVE: To assess the effects of renal function on argatroban dose and activated partial thromboplastin time (aPTT). METHODS: Patients treated with argatroban were identified and prospectively screened. Patients with liver dysfunction were excluded from the analysis. Charts and laboratory data were reviewed daily until a therapeutic aPTT was reached or argatroban was discontinued. Data points collected included age, weight, gender, admitting diagnosis, past medical history, indication for anticoagulation, indication for argatroban, initial dose, goal aPTT, titration instructions, liver function tests, serum creatinine (S(cr)), blood urea nitrogen, and estimated creatinine clearance (Cl(cr)). RESULTS: A total of 66 patients were evaluated and 44 met criteria for inclusion. Baseline S(cr) was elevated at 1.5 mg/dL (0.9, 2.3; median 25th, 75th percentile), with an estimated Cl(cr) 40 mL/min/1.73 m(2) (26, 74). The median dose of argatroban to reach the predefined therapeutic range was 1 microg/kg/min (0.68, 2), with a corresponding aPTT of 60 seconds (54, 66). After univariate analysis, Cl(cr) significantly predicted the therapeutic dose (coefficient b +/- SE 0.019 +/- 0.004; r(2) 0.35; p < 0.001). Covariates that predicted dose were the presence of HIT (coefficient b +/- SE -0.61 +/- 0.3; p = 0.045), history of myocardial infarction (coefficient b +/- SE -0.74 +/- 0.3; p = 0.02), and an indication for anticoagulation of deep-vein thrombosis/pulmonary embolism (coefficient b +/- SE 0.69 +/- 0.3; p = 0.03). CONCLUSIONS: Estimated Cl(cr) significantly predicted the dose of argatroban needed to reach a therapeutic aPTT.

Aged↗

PubMed2003

Pegylated interferon and ribavirin-induced interstitial pneumonitis with ARDS.

A 49-year-old man with cirrhosis due to hepatitis C virus developed interstitial pneumonitis documented by surgical lung biopsy specimen evaluation after two weekly doses of pegylated interferon-alpha(2)b in combination with ribavirin. He developed ARDS and died after 26 days of hospitalization from multisystem organ failure. This case suggests that interstitial pulmonary disease can occur with pegylated interferon-alpha(2)b therapy.

Antiviral Agents↗

PubMedDate not supplied

Design and implementation of an application and associated services to support interdisciplinary medication reconciliation efforts at an integrated healthcare delivery network.

Confusion about patients' medication regimens during the hospital admission and discharge process accounts for many preventable and serious medication errors. Many organizations have begun to redesign their clinical processes to address this patient safety concern. Partners HealthCare, an integrated delivery network in Boston, Massachusetts, has answered this interdisciplinary challenge by leveraging its multiple outpatient electronic medical records (EMR) and inpatient computerized provider order entry (CPOE) systems to facilitate the process of medication reconciliation. This manuscript describes the design of a novel application and the associated services that aggregate medication data from EMR and CPOE systems so that clinicians can efficiently generate an accurate pre-admission medication list. Information collected with the use of this application subsequently supports the writing of admission and discharge orders by physicians, performance of admission assessment by nurses, and reconciliation of inpatient orders by pharmacists. Results from early pilot testing suggest that this new medication reconciliation process is well accepted by clinicians and has significant potential to prevent medication errors during transitions of care.

Clinical Pharmacy Information Systems↗