Heart failure (HF) is an end-stage condition of all heart disease and is associated with significant mortality, morbidity, and health expenses. Tolvaptan, a V2 receptor antagonist, is being used in many countries as an adjunct to the diuretic therapy of HF. Although it has been proven effective and safe, some patients do not respond well to the medication. Since there are indications that a specific population can achieve this therapy’s optimal effect, it is essential to identify responders and predictors to develop individual treatment plans. Therefore, this study provides an overview of the effect of tolvaptan and predictors of response that can be used as a strategy in optimizing the treatment of HF. The article searching process was conducted through PubMed, Google Scholar, and Scopus, including predictors, heart failure, and tolvaptan. The predictors identified in the study were urine osmolality, U-AQP2/PAVP, age, serum creatinine, BUN, BUN/Cr, UUN/BUN, UNa/UCr, BNP, AVP/PAC, CKD, HFpEF, and echocardiographic parameters. The variation in results is caused by differences in response definition, patient characteristics, and the types of variables analyzed. Implementing some of these predictors in countries with inadequate hospital facilities and health insurance coverage is complicated. Therefore, the use of response predictors, at any rate, is expected to assist health professionals in considering the risks and benefits of HF therapy.
This study aims to determine the application of credit risk management and criteria as well as efforts to minimize credit risk in Bank Nagari Simpang Haru Sub-Branch. In implementing credit risk management at Bank Nagari Simpang Haru Sub-Branch, it includes the identification, measurement, monitoring and control of credit risk. Credit risk is the risk of non-performing loans where the debtor must be under special surveillance while the credit measurement must be in accordance with the NPL, Non-perfoming loan (NPL) is very important for credit risk measurement at Bank Nagari Simpang Haru Sub-Branch, because it must be in accordance with the applicable provisions of the Bank Indonesia (BI), by using a non perfoming loan, it will be easy for the Bank to find out the criteria in analyzing credit risk where the Indonesian bank sets a maximum Npl of 5%. Credit collectability is the basis in calculating the level of NPL. Credit Risk Issues that appear at Bank Nagari Simpang Haru Sub-Branch, namely Problem Loans. In this case there are credit risk factors including internal banks, debtors and others. Thus the debtor becomes a factor that often arises and is of special concern.
Tolvaptan has been used in many countries as an adjunct to diuretic therapy for heart failure. The identification of predictors of response to tolvaptan is essential in developing individual treatment plans, and this study therefore aims to identify responders and predictors to the use of this treatment. A total of 75 acute heart failure patients with congestion receiving tolvaptan were analyzed retrospectively. Clinical parameters after tolvaptan treatment were evaluated to provide an overview of the effectiveness and safety of tolvaptan. A predictive model was created, and logistic regression analysis was performed. The criterion for diuresis response was peak fluid balance of >-1000 ml, while the criterion for sodium response was >3.5 mEq/l sodium increase. Clinical parameters of urine volume and fluid balance before and after tolvaptan did not differ significantly, but serum creatinine, eGFR, sodium, potassium, and blood pressure were significantly different. Hypernatremia occurred in one patient. Multivariate analysis of all samples showed that diabetes (OR=4.856; P=0.006) and systolic blood pressure (SBP) (OR=1.031; P=0.046) affected diuresis response. Analysis in hyponatremic patients demonstrated that sex (OR=0.159; P=0.033) and serum sodium (OR=0.83; P=0.045) affected sodium response. Administration of tolvaptan significantly changed serum creatinine, eGFR, sodium, potassium, and blood pressure. The predictors for diuresis responders were the absence of type 2 diabetes and having higher baseline SBP, while the predictors for sodium responders were being male and having lower baseline serum sodium levels.
Salah satu instalasi pelayanan kesehatan adalah rumah sakit. Pasiensebagai pengguna jasa pelayanan rumah sakit menuntut pelayananyang diberikan sesuai dengan haknya, yakni pelayanan yang bermutudan paripurna. Tujuan umum dari penelitian yang dilakukan iniadalah mengetahui bagaimana kepuasan pasien terhadap pelayananperdaftaran di Rumah Sakit Umum Citra Husada Sigli Tahun 2022.Dikarenakan jumlah pasien yang besar, maka perhitungan jumlahsampel dilakukan dengan menggunakan rumus Slovin dan diperolehsampel sebanyak 37 orang pasien. Kepuasan pasien terhadap kualitaspelayanan yang dilihat dari lima dimensi, yaitu: berdasarkan dimensikeandalan (reability) memiliki persentase 76% dikatagorikan baik,berdasarkan dimensi daya tanggap (responsiveness) memiliki persentase78% dikatagorikan baik, berdasarkan dimensi jaminan (assurance)memiliki persentase 81% dikatagorikan baik, berdasarkan dimensiempati (empathy) memiliki persentase 84% dikategorikan baik,berdasarkan dimensi bukti fisik (tangible) memiliki persentase 84% dandikatagorikan baik.
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