Drug utilisation in medical intensive care unit: a retrospective analysis from a tertiary care teaching hospital

Background: The World Health Organisation has defined drug utilization study as “the marketing, distribution, prescription and use of drugs in a society, with special emphasis on the resulting medical, social, and economic consequences. The objective was to evaluate drug utilization pattern in medical intensive care unit (MICU) in a tertiary care teaching hospital.Methods: A retrospective observational study was conducted in MICU for adult patients admitted from October to December 2013. Data collected was analysed for demographics, indication, duration of stay, World Health Organisation (WHO) prescribing indicators including anatomical therapeutic chemical classification and defined daily dose (DDD).Results: A six hundred encounters from 63 male and 44 female patients with a mean age of 60.88±16.87 were studied. Average duration of stay was 5.61±3.88 days. The common indications for admission were dyspnoea 20 (18.69%), upper gastrointestinal bleed 16 (14.95%), cerebrovascular accident 14 (13.08%) and sepsis 13 (12.15%). Total number of drugs prescribed was 246. Total drug encounters were 7695. Average number of drugs per encounter was 12.83. Percentage of drugs prescribed by generic name was 38.21%, 44.7% and 40.65% of the drugs were prescribed from National and WHO essential medicine list respectively. Among the drugs prescribed 65.44%, 32.93% and 17.48% were oral, injectable and fixed dose combination preparations respectively. Percentage of encounters resulting in prescription of an antibiotic and an injection were 59% and 85.83% respectively. The most commonly prescribed drugs were pantoprazole (100%), human regular insulin (52.83%), piperacillin + tazobactam (45%) and ceftriaxone (38%). Their DDD/100 bed days were found to be 83.79, 12.78, 12.50, and 17.81 respectively.Conclusions: Overall the prescribing pattern seems to be rational but may be further strengthened by increasing generic drug prescription, judicious use of pantoprazole and periodic longitudinal surveillance studies

Healthier Convenience Stores

The project proposes to test the feasibility of introducing interventions into convenience stores in Scotland aimed at increasing the purchase of healthier food, as well as collecting data on the effectiveness of these interventions

Left ventricular structure and diastolic function by cardiac magnetic resonance imaging in hypertrophic cardiomyopathy

Objective: Diastolic dysfunction is common in hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HHD), but its relationships with left ventricular (LV) parameters have not been well studied. Our objective was to assess the relationship of various measures of diastolic function, and maximum left ventricular wall thickness (MLVWT) and left ventricular mass index (LVMI) in HCM, HHD and normal controls using cardiac magnetic resonance imaging (CMR). We also assessed LV parameters and diastolic function in relation to late gadolinium enhancement (LGE) and right ventricular (RV) hypertrophy in HCM. Methods: 41 patients with HCM, 21 patients with HHD and 20 controls were studied. Peak filling rate (PFR), time to peak filling (TPF), MLVWT and LVMI were measured using CMR. LGE and RV morphology were assessed in HCM patients. Results: MLVWT correlated with TPF in HCM (r = 0.38; p = 0.02), HHD (r = 0.58; p = 0.01) and controls (r = 0.54; p = 0.01); correlation between MLVWT and TPF was weaker in HCM than HHD. LVMI did not correlate with diastolic function. In HCM, LGE extent correlated with MLVWT (τ = 0.41; p = 0.002) and with TPF (τ = 0.29; p = 0.02). The HCM patients with RV hypertrophy had higher MLVWT (p < 0.001) and TPF (p = 0.03) than patients without RV hypertrophy. Conclusion: MLVWT correlates with diastolic function (TPF) in HCM, HHD and controls. LVMI did not show significant correlation with TPF. The diastolic dysfunction in HCM is not entirely explained by wall thickening. LGE and RV involvement are associated with worse LV diastolic function, suggesting that these may be markers of more severe underlying myocardial disarray and fibrosis that contribute to diastolic dysfunction

Prognostic value of cardiovascular magnetic resonance left ventricular volumetry and geometry in patients receiving an implantable cardioverter defibrillator

Abstract Background Current indications for implantable cardioverter defibrillator (ICD) implantation for sudden cardiac death prevention rely primarily on left ventricular (LV) ejection fraction (LVEF). Currently, two different contouring methods by cardiovascular magnetic resonance (CMR) are used for LVEF calculation. We evaluated the comparative prognostic value of these two methods in the ICD population, and if measures of LV geometry added predictive value. Methods In this retrospective, 2-center observational cohort study, patients underwent CMR prior to ICD implantation for primary or secondary prevention from January 2005 to December 2018. Two readers, blinded to all clinical and outcome data assessed CMR studies by: (a) including the LV trabeculae and papillary muscles (TPM) (trabeculated endocardial contours), and (b) excluding LV TPM (rounded endocardial contours) from the total LV mass for calculation of LVEF, LV volumes and mass. LV sphericity and sphere-volume indices were also calculated. The primary outcome was a composite of appropriate ICD shocks or death. Results Of the 372 consecutive eligible patients, 129 patients (34.7%) had appropriate ICD shock, and 65 (17.5%) died over a median duration follow-up of 61 months (IQR 38–103). LVEF was higher when including TPM versus excluding TPM (36% vs. 31%, p < 0.001). The rate of appropriate ICD shock or all-cause death was higher among patients with lower LVEF both including and excluding TPM (p for trend = 0.019 and 0.004, respectively). In multivariable models adjusting for age, primary prevention, ischemic heart disease and late gadolinium enhancement, both LVEF (HR per 10% including TPM 0.814 [95%CI 0.688–0.962] p = 0.016, vs. HR per 10% excluding TPM 0.780 [95%CI 0.639–0.951] p = 0.014) and LV mass index (HR per 10 g/m2 including TPM 1.099 [95%CI 1.027–1.175] p = 0.006; HR per 10 g/m2 excluding TPM 1.126 [95%CI 1.032–1.228] p = 0.008) had independent prognostic value. Higher LV end-systolic volumes and LV sphericity were significantly associated with increased mortality but showed no added prognostic value. Conclusion Both CMR post-processing methods showed similar prognostic value and can be used for LVEF assessment. LVEF and indexed LV mass are independent predictors for appropriate ICD shocks and all-cause mortality in the ICD population