BackgroundThe timing of intravenous antibiotic administration and lactate measurement is associated with survival of septic shock patients. Septic shock patients were admitted to the medical intensive care unit (MICU) from 2 major sources: hospital ward and emergency department (ED). This study aimed to compare the timing of antibiotic administration and lactate measurement between hospital wards and the ED.Patients and methodsMedical data were collected from adult patients admitted to the MICU with septic shock from January 2015 to December 2016. “Time Zero” was defined as the time of diagnosis of sepsis. The associations between the times and risk-adjusted 28-day mortality were assessed.ResultsIn total, 150 septic shock patients were admitted to the MICU. The median time interval (hour [h] interquartile range [IQR]) from time zero to antibiotic administration was higher in patients from the hospital wards compared to those from the ED (4.84 [3.5–8.11] vs 2.04 [1.37–3.54], P<0.01), but the lactate level measurement time interval (h [IQR]) from time zero was not different between the hospital wards and the ED (1.6 [0.2–2.7] vs 1.6 [0.9–3.0], P=0.85). In multivariate analysis, higher risk-adjusted 28-day mortality was associated with antibiotic monotherapy (odds ratio [OR]: 19.3, 95% confidence interval [CI]: 2.4–153.1, P<0.01) and admission during the weekends (OR: 24.4, 95% CI: 2.9–199.8, P<0.01).ConclusionAntibiotic administration in septic shock patients from the hospital wards took longer, and there was also less appropriate antibiotic prescriptions seen in this group compared with those admitted from the ED. However, neither the timing of antibiotic administration nor lactate measurement was associated with mortality.
Objectives: This study aimed to assess the prevalence of under-prescription among elderly type 2 diabetic patients in the primary care unit of a university hospital in southern Thailand and identify the associated factors.Material and Methods: A 1-year retrospective medical record review was conducted in elderly type 2 diabetic patients treated continuously in the primary care unit. Under-prescription was the primary outcome assessed from criteria developed from the START criteria (2015), Thailand’s clinical practice guideline for diabetes (2014), and for hypertension (2015).Results: This study included 458 medical records that fit our inclusion criteria. The median age was 69.1 years old and more than 80% of them had a comorbidity of dyslipidemia or hypertension. The prevalence of under-prescription in elderly type 2 diabetic patients was 84.5%. The most commonly omitted medication was aspirin for primary prevention of cardiovascular disease. An increased number of medications received and having cardiovascular disease was associated with a lower risk of under-prescription.Conclusion: The prevalence of the omission of beneficial medications in elderly type 2 diabetic patients in the primary care unit of a university hospital was high, especially under-prescription of aspirin for primary prevention of cardiovascular disease.
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