Alendronate use in older patients with reduced renal function: challenges and opportunities in clinical practice

2021 ◽  
Author(s):  
N. Naganathar ◽  
W. -P. Yau ◽  
Z. H. Mok ◽  
Z. Y. F. Tan ◽  
S. T. H. Chew
Keyword(s):  
Renal Function ◽  
Clinical Practice ◽  
Older Patients ◽  
Challenges And Opportunities ◽  
Reduced Renal Function

scholarly journals Adjunctive Perampanel in Older Patients With Epilepsy: A Multicenter Study of Clinical Practice

Drugs & Aging ◽  
2021 ◽  
Author(s):  
Simona Lattanzi ◽  
Claudia Cagnetti ◽  
Nicoletta Foschi ◽  
Roberta Ciuffini ◽  
Elisa Osanni ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Multicenter Study ◽  
Older Patients ◽  
Patients With Epilepsy

scholarly journals Population Pharmacokinetics and Pharmacodynamics of Levofloxacin in Acutely Hospitalized Older Patients with Various Degrees of Renal Function

2016 ◽  
Vol 61 (3) ◽  
Author(s):  
Pier Giorgio Cojutti ◽  
Virginia Ramos-Martin ◽  
Isabella Schiavon ◽  
Paolo Rossi ◽  
Massimo Baraldo ◽  
...  
Keyword(s):  
Renal Function ◽  
Clinical Outcome ◽  
Creatinine Clearance ◽  
Population Pharmacokinetics ◽  
Older Patients ◽  
Classification And Regression Tree ◽  
Therapeutic Drug ◽  
Time Curve ◽  
Content Type ◽  
Cart Analysis

ABSTRACT A retrospective study was conducted in a large sample of acutely hospitalized older patients who underwent therapeutic drug monitoring during levofloxacin treatment. The aim was to assess the population pharmacokinetics (popPK) and pharmacodynamics of levofloxacin among older patients. PopPK and Monte Carlo simulation were performed to define the permissible doses in older patients according to various degrees of renal function. Classification and regression tree (CART) analysis was used to detect the cutoff 24-hour area under the concentration-time curve (AUC24)/MIC ratio that best correlated with the clinical outcome. The probability of target attainment (PTA) of this value was calculated against different pathogens. A total of 168 patients were included, and 330 trough and 239 peak concentrations were used for the popPK analysis. Creatinine clearance (CrCL) was the only covariate that improved the model fit (levofloxacin CL = 0.399 + 0.051 × CrCLCKD-EPI [creatinine clearance estimated by means of the chronic kidney disease epidemiology]). Drug doses ranged between 500 mg every 48 h and 500 mg every 12 h in relation to different renal functions. The identified cutoff AUC24/MIC ratio (≥95.7) was the only covariate that correlated with a favorable clinical outcome in multivariate regression analysis (odds ratio [OR], 20.85; 95% confidence interval [CI], 1.56 to 186.73). PTAs were optimal (>80%) against Escherichia coli and Haemophilus influenzae, borderline against Staphylococcus aureus, and suboptimal against Pseudomonas aeruginosa. The levofloxacin doses defined in our study may be effective for the treatment of infections due to bacterial pathogens, with an MIC of ≤0.5 mg/liter in older patients with various degrees of renal function, while minimizing the toxicity risk. Conversely, the addition of another active antimicrobial should be considered whenever treating infections caused by less susceptible pathogens.

The Search for a New Marker of Renal Function in Older Patients with Chronic Kidney Disease Stages 3–4: Usefulness of Cystatin C-Based Equations

2009 ◽  
Vol 112 (3) ◽  
pp. c164-c170 ◽  
Author(s):  
Néstor Fontseré ◽  
Vicens Esteve ◽  
Ana Saurina ◽  
Mónica Pou ◽  
Nuria Barba ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Cystatin C ◽  
Older Patients ◽  
Disease Stages

scholarly journals Neurological diagnoses in the emergency room: differences between younger and older patients

2011 ◽  
Vol 69 (2a) ◽  
pp. 212-216 ◽  
Author(s):  
Marcos C. Lange ◽  
Vera L. Braatz ◽  
Carolina Tomiyoshi ◽  
Felipe M. Nóvak ◽  
Artur F. Fernandes ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Emergency Room ◽  
Older Patients ◽  
Tertiary Care Hospital ◽  
Neurological Diseases ◽  
Tertiary Care ◽  
Primary Headache ◽  
Care Hospital ◽  
National Guidelines ◽  
And Training

Neurological diseases are prevalent in the emergency room (ER). The aim of this study was to compare the neurological diagnoses between younger and older patients evaluated in the ER of a tertiary care hospital. METHOD: Patients admitted to the ER who required neurological evaluation in the first 24 hours were separated into two groups based on age, <;50 years old and >50 years old. RESULTS: Cerebrovascular disease (59.6% vs. 21.8%, p<0.01) was most frequent in the >50 years old group. Seizures (8.1% vs. 18.6%, p<0.01) and primary headache (3.7% vs. 11.4%, p<0.01) were most frequent in the <;50 years old group. CONCLUSION: The current study demonstrated that these three neurological diagnoses represented the majority of the neurological evaluations in the ER. National guidelines for ER teams that treat these prevalent disorders must be included in clinical practice and training.

scholarly journals Midwifery Practice and Education: Current Challenges and Opportunities

2014 ◽  
Vol 19 (2) ◽  
Author(s):  
Deborah Walker ◽  
Barbara Lannen ◽  
Debra Rossie
Keyword(s):  
Clinical Practice ◽  
The United States ◽  
Third Party ◽  
Prescriptive Authority ◽  
Educational Challenges ◽  
Midwifery Education ◽  
Challenges And Opportunities ◽  
Nurse Midwives ◽  
Restrictive Legislation ◽  
Third Party Reimbursement

Midwifery clinical practice and education has changed significantly since Mary Breckinridge first introduced nurse-midwives to the United States in 1925. This article discusses current challenges in midwifery clinical practice and education and proposes possible solutions. Midwifery clinical challenges include restrictive legislation and business-related barriers, including but not limited to physician supervision restrictions, prescriptive authority, out-of-hospital birth legislation, and third party reimbursement. Educational challenges highlighted include the current healthcare climate’s influence on midwifery education, the contribution of clinical sites and preceptors, and the benefits of midwifery education.

scholarly journals SUBCLINICAL HYPOTHYROIDISM;

2012 ◽  
Vol 20 (01) ◽  
pp. 023-029
Author(s):  
MOHAMMAD ASIF ◽  
ATIF ULLAH ◽  
MUHAMMAD AKRAM
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Cardiovascular Risk ◽  
Subclinical Hypothyroidism ◽  
Renal Mass ◽  
Medical Institute ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Endocrine Abnormality ◽  
Reduced Renal Function

Chronic kidney disease (CKD) is characterized by progressive destruction of renal mass with irreversible sclerosis andloss of nephrons.Various metabolic, hematological and endocrine abnormalities are known to occur in CKD. Subclinical hypothyroidismis an important endocrine abnormality associated with a greater cardiovascular risk, atherosclerosis and an important factor forprogression of renal disease in such patients. Objective: To calculate the frequency of subclinical hypothyroidism in predialysis CKDpatients. Design: Cross sectional survey. Setting: Pathology Department Post Graduate Medical Institute, Lahore. Period: 06 months(June 2011 to Dec 2011). Results: 210 patients were included in the study. Serum creatinine. TSH and FT4 were measured and therelevant data was entered in predesigned proforma. 19.5 % of CKD population had subclinical hypothyroidism with slightly increasedpreponderance in females as compared to males and also increased frequency as the stage of CKD increased. Subclinicalhypothyroidism is more common in CKD population. Conclusions: Increased frequency of subclinical hypothyroidism was found inpatients with reduced renal function not on dialysis. 19.5% of CKD population on conservative management had labortary evidence ofthyroid dysfunction.

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