Association of Infectious Disease Physician Approval of Peripherally Inserted Central Catheter With Appropriateness and Complications

Importance: Peripherally inserted central catheters (PICCs) are frequently used to deliver intravenous antimicrobial therapy. However, inappropriate PICC use may lead to patient harm. Objective: To evaluate whether infectious disease physician approval prior to PICC placement for intravenous antimicrobials is associated with more appropriate device use and fewer complications. Design, Setting, and Participants: This cohort study of 21 653 PICCs placed for a primary indication of intravenous antimicrobial therapy between January 1, 2015, and July 26, 2019, was conducted in 42 hospitals participating in a quality collaborative across Michigan among hospitalized medical patients. Main Outcomes and Measures: Appropriateness of PICCs was defined according to the Michigan Appropriateness Guide for Intravenous Catheters as a composite measure of (1) single-lumen catheter use, (2) avoiding use of PICCs for 5 days or less, and (3) avoiding use of PICCs for patients with chronic kidney disease (defined as an estimated glomerular filtration rate/min/1.73 m2). Complications related to PICCs included catheter occlusion, deep vein thrombosis, and central line-associated bloodstream infection. The association between infectious disease physician approval, device appropriateness, and catheter complications was assessed using multivariable models, adjusted for patient comorbidities and hospital clustering. Results were expressed as odds ratios with 95% CIs. Results: A total of 21 653 PICCs were placed for intravenous antimicrobials (11 960 PICCs were placed in men [55.2%]; median age, 64.5 years [interquartile range, 53.4-75.4 years]); 10 238 PICCs (47.3%) were approved by an infectious disease physician prior to placement. Compared with PICCs with no documented approval, PICCs with approval by an infectious disease physician were more likely to be appropriately used (72.7% [7446 of 10 238] appropriate with approval vs 45.4% [5180 of 11 415] appropriate without approval; odds ratio, 3.53; 95% CI, 3.29-3.79; P \u3c .001). Furthermore, approval was associated with lower odds of a PICC-related complication (6.5% [665 of 10 238] with approval vs 11.3% [1292 of 11 415] without approval; odds ratio, 0.55; 95% CI, 0.50-0.61). Conclusions and Relevance: This cohort study suggests that, when PICCs were placed for intravenous antimicrobial therapy, infectious disease physician approval of PICC insertion was associated with more appropriate device use and fewer complications. Policies aimed at ensuring infectious disease physician approval prior to PICC placement for antimicrobials may improve patient safety

Čvrste disperzije silimarina: Karakterizacija i utjecaj načina priprave na oslobađanje

The influence of preparation methodology of silymarin solid dispersions using a hydrophilic polymer on the dissolution performance of silymarin was investigated. Silymarin solid dispersions were prepared using HPMC E 15LV by kneading, spray drying and co-precipitation methods and characterized by FTIR, DSC, XRPD and SEM. Dissolution profiles were compared by statistical and model independent methods. The FTIR and DSC studies revealed weak hydrogen bond formation between the drug and polymer, while XRPD and SEM confirmed the amorphous nature of the drug in co-precipitated solid dispersion. Enhanced dissolution compared to pure drug was found in the following order: co-precipitation > spray drying > kneading methodology (p sušenje sprejom > metoda gnječenja (p < 0.05). Iz svih pripravaka oslobađanje je bilo sporije, bez obzira na metodu priprave. Pripravci dobiveni metodom koprecipitacije bili su stabilni, a oslobađanje silimarina iz njih bilo je 2,5 bolje u odnosu na čisti lijek

SIMULTANEOUS DETERMINATION OF MOXIFLOXACIN HYDROCHLORIDE AND DIFLUPREDNATE BY RATIO DERIVATIVE SPECTROPHOTOMETRY

Objective: Ratio derivative spectrophotometric method has been developed for the simultaneous determination of Moxifloxacin HCl (MH) and Difluprednate (DIFLU) in Phosphate Buffer pH 7.4. Methods: In this method, the overlapping spectra of MH and DIFLU were well resolved by making use of the first-derivative of the ratios of their direct absorption spectra. The derivative ratio absorbances of MH and DIFLU were measured at λmax 325.8 and λmax 238.0 nm, respectively for their quantification. MH and DIFLU were determined in the concentration range of 2-10 μg/ml and 4-20 μg/ml respectively. Results: The method was validated as per the ICH guideline and accuracy, precision are found to be within the acceptable limit. The limits of detection and quantitation were found to be 0.1144 and 0.3466 μg/ml, respectively for MH and 0.0311 and 0.094 μg/ml, respectively for DIFLU. Conclusion: The proposed ratio first derivative spectrophotometric method is novel, rapid, simple, sensitive, accurate, precise and does not require separation of MH and DIFLU hence successfully applied for simultaneous estimation of MH and DIFLU in marketed eye drops (liquid dosage form). Â&nbsp

RP-HPLC Estimation of Venlafaxine Hydrochloride in Tablet Dosage Forms

A simple, specific, accurate, and precise reverse phase high performance liquid chromatographic method was developed and validated for the estimation of venlafaxine hydrochloride in tablet dosage forms. A Phenomenex Gemini C-18, 5 μm column having 250 × 4.6 mm i.d. in isocratic mode, with mobile phase containing methanol: 0.05 M potassium dihydrogen orthophosphate (70:30, v/v; pH 6.2) was used. The flow rate was 1.0 ml/min and effluents were monitored at 226 nm. Carbamazepine was used as an internal standard. The retention time of venlafaxine hydrochloride and carbamazepine were 3.7 min and 5.3 min, respectively. The method was validated for specificity, linearity, accuracy, precision, limit of quantification, limit of detection, robustness and solution stability. Limit of detection and limit of quantification for estimation of venlafaxine hydrochloride were found to be 100 ng/ml and 300 ng/ml, respectively. Recoveries of venlafaxine hydrochloride in tablet formulations were found to be in the range of 99.02-101.68%. Proposed method was successfully applied for the quantitative determination of venlafaxine hydrochloride in tablet dosage forms