Intravenous (IV) push administration can provide clinical and practical advantages over longer IV infusions in multiple clinical scenarios, including in the emergency department, in fluid-restricted patients, and when supplies of diluents are limited. In these settings, conversion to IV push administration may provide a solution. This review compiles available data on IV push administration of antibiotics in adults, including preparation, stability, and administration instructions. Prescribing information, multiple tertiary drug resources, and primary literature were consulted to compile relevant data. Several antibiotics are Food and Drug Administration-approved for IV push administration, including many beta-lactams. In addition, cefepime, ceftriaxone, ertapenem, gentamicin, and tobramycin have primary literature data to support IV push administration. While amikacin, ciprofloxacin, imipenem/cilastatin, and metronidazole have limited primary literature data on IV push administration, available data do not support that route. In addition, a discussion on practical considerations, such as IV push best practices and pharmacodynamic considerations, is provided.
Background Grading of Recommendations Assessment, Development, and Evaluation (GRADE) is a systematic approach to grading strength of recommendation (SOR) and quality of evidence (QOE) for guideline recommendations. We aimed to assess the relationship between SOR and QOE in current Infectious Diseases Society of America (IDSA) guidelines. Methods In this cross-sectional analysis, we analyzed the frequency of SOR-QOE pairings, including discordance (defined as strong SOR based on expert opinion, very low, or low QOE) for GRADEd recommendations in IDSA guidelines published since 2010. Data for each recommendation were extracted on SOR, QOE, the domain of disease management (one or more of diagnosis, treatment, prevention, and other categories), and relevance to drug or non-drug treatment. Results Seventeen eligible guidelines provided 1042 unique GRADEd recommendations (n = 237, 711, 76, and 73 pertaining to diagnosis, treatment, prevention, and other domains, respectively; n = 574 and 137 pertaining to drug and non-drug treatment). Overall, the most common SOR was strong (71.8%; n = 748) and the most common QOE was low (48.6%; n = 506). Among all strong recommendations, 47.1% (n = 352) demonstrated discordance with QOE. By domain, strong recommendations were discordant in 36.6%, 51.4%, 29.3%, and 58.1% of recommendations pertaining to diagnosis, treatment, prevention, and other domains, respectively. Similarly, 50.7% and 54.0% of strong recommendations related to drug and non-drug treatment were discordant, respectively. We identified 39.6% of discordant recommendations to be consistent with good practice statements, which are recommended to be labeled as such without formal GRADEd designations of SOR or QOE. Conclusions Among all IDSA guideline recommendations with strong SOR, approximately half were discordant with QOE, and this frequency varied across strata of domains of disease management and in drug and non-drug treatment.
Analysis of major medical, nursing, and pharmacy journals found that articles from nursing and pharmacy journals were indexed with MeSH terms more slowly than articles from medical journals. Journal identity was significantly associated with time to indexing.
An analysis of three major pharmacy practice journals showed that the median time to indexing articles published in 2010 and 2011 was 114 days. While all articles from AJHP and Pharmacotherapy were indexed, 40 articles from Annals of Pharmacotherapy remained unindexed.
Background: Incorporation of drug restriction policy into electronic drug order entries (DOEs) can promote responsible medication use and resource utilization when implemented systematically. Objective: To identify drugs that require further incorporation of formulary restriction policy into their DOEs after migration to an electronic health record with computerized prescriber order entry (CPOE). Methods: After transition to CPOE, test orders for formulary restricted drugs were entered in the CPOE environment. Data were collected about rationale for drug restriction, type of formulary restriction, presence of incorporation of restriction policy into the DOE, and whether incorporation was consistent with a recommended method. Restricted drugs requiring revision of policy incorporation into their DOEs were analyzed to create a prioritized task list based on rationale for the restriction. Results: Of all restricted drugs, 63.6% (287/451) did not have restriction policy incorporated into their DOEs consistent with the recommended method and therefore required revision. Eighteen percent (81/451) of restricted drugs had no incorporation of restriction policy in their DOEs. Safety was the rationale for restriction in 21% (17/81) of these, which received highest priority for revision. When drugs were orderable but restricted, 61.9% (78/126) lacked optimal incorporation of policy in DOEs to promote adherence. When drugs were not orderable, 64% (206/322) did not provide guidance to formulary alternatives in DOEs when they should have. Conclusion: After transition to CPOE, almost two-thirds of all analyzed restricted drugs lacked optimal incorporation of formulary restriction policies in their DOEs. DOEs with restrictions related to safety reasons were among those most frequently requiring revision. Some DOEs can better promote adherence and provide guidance to prescribers through revision. Predefined, systematic implementation strategies should be used during changes in computerized drug use processes.
Study Objective: Vasodilatory shock is the most common type of shock. Catecholamine vasopressors are the cornerstone of hemodynamic therapy but carry risks. Angiotensin II (AT2) was recently approved, and other novel agents (selepressin and terlipressin) are under investigation and used outside the United States (terlipressin). We performed a systematic review to summarize the efficacy and safety of these novel vasopressors and to offer guidance on their appropriate use. Design: Systematic review of controlled trials. Methods: Numerous databases were searched using terms related to angiotensin II, selepressin, terlipressin, vasopressor, and shock. Twenty-one citations, including 16 prospective comparative trials and 5 post hoc analyses reporting effects of AT2, selepressin, and terlipressin, were reviewed for data on outcomes related to hemodynamic measures, mortality, severity and duration of illness, concomitant vasopressor utilization, and adverse effects. Findings from eligible literature are described qualitatively using Cochrane methods. Results: Fourteen controlled trials were assessed after exclusion of 2 dated trials of a distinct AT2 formulation. Trials are limited for AT2 (n = 2) and selepressin (n = 1), while terlipressin was investigated in 11 small trials. Overall, the trials have an unclear risk of bias. Most report mean arterial pressure (MAP) as primary end point, and all indicate novel vasopressors increase MAP compared to placebo and to a similar degree as with catecholamine vasopressors. Mortality findings are preliminary, as they have been limited to specific subgroups in trials of terlipressin and post hoc analyses of one trial of AT2. Trials reported safety concerns for each agent including thromboembolism with AT2 and ischemia with terlipressin/selepressin. Conclusion: In this systematic review, controlled trials of novel vasopressors in treatment of vasodilatory shock were limited and of low quality. Angiotensin II, selepressin, and terlipressin appear to significantly increase MAP, but further study is required, particularly for selepressin, to determine their safety, efficacy, and role in treatment of vasodilatory shock.
The Medical Library Association’s InSight Initiative provides an open and collaborative environment for library and industry partners to discuss vexing problems and find solutions to better serve their users. The initiative’s fifth summit, continuing work from the previous summit, focused on understanding how users discover and access information in the clinical environment. During the summit, participants were divided into working groups and encouraged to create a tangible product as a result of their discussions. At the end of the summit, participants established a framework for understanding users’ pain points, discussed possible solutions to those points, and received feedback on their work from an End User Advisory Board comprising physicians, clinical researchers, and clinical faculty in biomedicine. In addition to the pain point framework, participants are developing MLA InSight Initiative Learning content with modules to educate librarians and publishers about critical aspects of user behavior. The 2020 Insight Initiative Fall Forum will serve as a virtual home for constructive dialogue between health sciences librarians and publishers on improving discovery and access to information.
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