Complete blood count inflammatory markers (CBC-IMs) have been associated with cardiovascular diseases and mortality. We aimed to evaluate the relationship between preoperative CBC-IMs and 5-year survival after carotid endarterectomy (CEA). Retrospective analysis of 411 consecutive patients who underwent CEA between 2004 and 2018 was done. CBC-IM included the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte (LMR) ratio, and systemic immune-inflammation index (SII). Survival rate at 5 years was 79.8%. Age (hazard ratio (HR) = 1.05, P = .003), hemoglobin (HR = 0.78, P < .001), heart failure (HR = 2.91, P = .005), American Society of Anesthesiologists (ASA)-IV score (HR = 2.41, P = .043), and active neoplastic disease (HR = 2.61, P = .028) were independently related to survival. The discrimination of this model (C-statistic) was 0.698. Spline analysis showed a linear relationship between survival and NLR ( P < .001), PLR ( P < .001), and SII ( P < .001). After adjusting for the baseline predictive score, there was a significant relationship between survival and NLR (HR = 1.191, P = .001), PLR (HR = 1.004, P = .017), and SII (HR = 1.001, P < .001). The addition of NLR, PLR, and SII to the survival model improved the continuous net reclassification index (c-NRI) by 0.29 ( P = .028), 0.347 ( P = .008), and 0.481 ( P < .001), respectively, but not the C-statistic. CBC-IMs show a linear and independent relationship with 5-year survival after CEA and may moderately contribute to patient selection for this preventive intervention.
PIP was identified prospectively in the CMA. The total number of recommendations and acceptance rate were recorded for the post-implementation period. Results At baseline, the median proportion of residual PIPs was 69.0% (range 50.0-83.3%) with a median number of 13.1 (range 9.5-15.8) residual PIPs per day. After the CMA intervention, the median proportion and median number decreased to 11.8% (range 0-50%) and 2.2 (range 0-9.5), respectively. Clinical rules showed an immediate relative reduction of 66% (p<0.0001) in pain related residual PIPs. A significant decreasing time trend was observed during the postimplementation period. Over 1 year in the post-implementation period, the clinical pharmacists provided 1683 recommendations for 1427 individual patients during 1478 hospital admissions. The treating physicians accepted 74.3% of the recommendations. Conclusion and relevance We proved that the CMA approach improved analgesic prescribing, as the number of pain related residual PIPs was reduced in a highly significant and sustained manner. The downward trend in the post-implementation period might indicate a learning effect on physicians, resulting in a higher acceptance rate of recommendations over time. More pharmacist involvement and the use of clinical rules during hospital stay should be further promoted to optimise appropriate prescribing of analgesics.
Background Recent marketing authorizations for the first protease inhibitors for hepatitis C virus (HCV) have changed the management of chronic hepatitis C patients. However, it should be noted that the cost, number as well as the severity of adverse effects will increase. It is therefore reasonable to adopt criteria to ensure maximum efficiency and patient safety. IL-28B polymorphism is one of the factors associated with the treatment outcome and has been closely linked to interferon response. Purpose To describe the implementation of the determination of the IL-28B polymorphism, rs12979860, and the results obtained, in order to personalise the treatment in HCV mono-infected patients in a tertiary hospital. Materials and Methods We designed a standard form for HCV patients starting treatment with protease inhibitors. It includes several items that require clinical evaluation: viral load, HCV genotype, FibroScan and/or liver biopsy, response to previous treatment and polymorphism of the IL-28B genotype. Homozygous CC is the favourable genotype, predicting a good response. CT and TT genotypes are considered unfavourable. The test was conducted in the pharmacogenetics area of the pharmacy department. To calculate the response time, we considered how long it takes to get the different responses. The results were added to the hospital’s electronic medical records programme for easy reference online. Results A total of 26 genotypes was determined, of which 11 (42%) were requested by the department of infectious diseases (56% co-infected), 10 (38%) by the hepatology department and 5 (18%) by an external department. Results 15 (58%) were CT, 8 (31%) CC and 3 (11%) TT. 100% of patients had a score of FibroScan > 9.5 kPascal. The response for the tests was on average 3 to 7 days, with the limiting factor the sequencer availability. Conclusions IL28B determination has been added to the hospital’s services portfolio as a clinical assessment tool for the treatment of hepatitis C, with a response time of 3–7 days. No conflict of interest.
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