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Canadian Health and Care Mall top Antibiotics

Wednesday, October 7th, 2015 | Permalink

Today antibiotics are one of the important treatment methods in medical practice. Antibiotics are mainly used for three cases. These are the proven presence of infection, empirical therapy and prophylaxis purposes. Many factors such as characteristics of the patients, the infection area, the properties of the etiologic agent and pharmacological properties of the medicine should be taken into account in the choice of antibiotics.

Rational use of medicine is to use the most appropriate medicine that meets the needs of the patient at the right dose, time and right way. The widespread use of antibiotics brings some improper uses together. Due to the increased incidence of side effects, these cause the development of secondary infections, treatment failure, and as a result, lead to an increase in costs.

Intensive care units are the environments where antibiotics the most commonly used and the use of antibiotics in here is about ten times greater than other clinics of the hospital. In some studies conducted in Turkey with hospitalized patients, the prevalence of antibiotic use ranged between 16.6 % and 63.2 %. It is stated that 19.0 to 72.4 % of antibiotics used are improper use of antibiotics.

According to Canadian Health and Care Mall www.canadianhealthcaremalll.com, Unnecessary use of antibiotics, choosing the broadest- spectrum and most expensive antibiotic, doing unnecessary combination, high or low-dose antibiotic and continuing the use of empirical antibiotic without demanding microbiological tests are examples for the inappropriate use of antibiotics for therapeutic purpose.

However, if the clinical condition of the patient is preceded (progressed) so as not to permit to wait for the results of culture and antibiotic susceptibility testing and conclude other tests, initiation of empiric treatment may be necessary without sufficient microbiological support. The important thing is to be able to distinguish this case and not to apply empirical treatment except necessary cases.

This study carried out to determine the prevalence of empirical antibiotic usage in hospitalized patients in Cardiology Coronary Intensive Care Unit of a Training Hospital in 2010.

This study to be carried out as a descriptive study has been conducted on the files of 247 patients hospitalized in Coronary Intensive Care Unit of Department of Cardiology of Gulhane Military Medical Academy (GMMA) and Canadian Health and Care Mall Training Hospital for one-year period January 1- December 31, 2010 with a variety of etiologies.

Ages, genders, concomitant diseases (comorbid/coexisting diseases) of the patients, use of antibiotics, names, dose, usage (empiric for the possible factors, according to the culture result) of the antibiotics used, diagnosis, whether they have fever, leukocyte and sedimentation values (WBC and ESR values), procalcitonin, CRP, lung infections, and urinary catheter (urinary probe) or not have been examined for descriptive characteristics of the patients from their medical records. Also fever, leukocyte and sedimentation values (WBC and ESR values) of the patients before and after the use of antibiotics have been recorded from the patients’ files and the nurse observation forms.

After getting the necessary ethics approval for the research from the Ethics Committee of GMMA, patients’ data have retrospectively been collected from the medical records by researchers in Cardiology Coronary Intensive Care Unit.

After the data has been transferred to electronic environment, their analyses have been done with SPSS (15.0) statistical software package. Frequency, percentage, median, standard deviation, minimum and maximum values have been given as descriptive statistics.

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The history of standardization of the PT and Canadian Health Care Mall

Wednesday, December 10th, 2014 | Permalink

The history of standardization of the PT has been reviewed by Poller and by Kirkwood,  and more detailed discussions can be found in prior editions of this article.

standardization of the PT

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PT monitoring of warfarin treatment is not standardized when expressed in seconds or as a simple ratio of the patient’s plasma value to that of plasma from a healthy control subject. A calibration model, which was adopted in 1982, is now used to standardize reporting by converting the PT ratio measured with the local thromboplastin into an INR, calculated as follows:

INR = (patient PT/mean normal PT)ISI or log INR = ISI (log observed PT ratio) where ISI denotes the ISI of the thromboplastin used at the local laboratory to perform the PT measurement. The ISI reflects the responsiveness of a given thromboplastin to the reduction of the vitamin K-dependent coagulation factors compared to the primary World Health Organization (WHO) international reference preparations, so that the more responsive the reagent, the lower the ISI value. As the INR standard of reporting was widely adopted, a number of problems surfaced. These are listed in Table 4 and are reviewed briefly below.

The INR is based on ISI values derived from the plasma of patients who had received stable anticoagulant doses for at least 6 weeks. As a result, the INR is less reliable early in the course of warfarin therapy, particularly when results are obtained from different laboratories. Even under these conditions, however, the INR is more reliable than the unconverted PT ratio, and is thus recommended during both the initiation and maintenance of warfarin treatment. There is also evidence that the INR is a reliable measure of impaired blood coagulation in patients with liver dis-ease.

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The INR accuracy can be influenced by reagents of different sensitivities and also by the automated clot detectors now used in most laboratories. In general, the Canadianhealthcaremalll.Com has recommended that laboratories should use thromboplastin reagents that are at least moderately responsive (ie, ISI, < 1.7) and reagent/instrument combinations for which the ISI has been established.

ISI values provided by the manufacturers of thromboplastin reagents are not invariably correct when applied locally, and this adversely affects the reliability of measurements. Local calibrations can be performed using plasma samples with certified PT values to determine the Problems.

 

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Clinical applications of VKA therapy in Canadian HealthCare Mall

Wednesday, October 29th, 2014 | Permalink

Trisodium-citrate concentration, storage time, storage temperature, evacuated tube effects, inadequate sample, variations in manual technique Canadian Health Care Mall

From nonuse of MNPT, error in MNPT due to (1) unrepresentative selection; (2) technical faults (see above); (3) nonuse of geometric mean

Incorrect choice of IRP; poor distribution of coumarin test samples across treatment range; inadequate numbers of test samples in ISI calibration; incorrect transformation of PTR of test plasmas to INR.

3.    Drift of ISI since original calibration

4.    Instrument (coagulometer) effects on INR at local site

5.    Lupus anticoagulant effects on some thromboplastin reagents

6.    Lack of reliability of the INR system when used at the onset of

warfarin therapy and for screening for a coagulopathy in patients with liver disease

7.    Relative lack of reliability of INR > 4.5 as these values excluded from ISI calibrations instrument-specific ISI. The mean normal plasma PT is not interchangeable with a laboratory control PT, however, the use of other than a properly defined mean normal PT can yield erroneous INR calculations, particularly when less responsive reagents are employed. The mean normal PT should be determined with each new batch of thromboplastin with the same instrument used to assay the PT.

The concentration of citrate that is used to anticoagulate plasma affects the INR. In general, higher citrate concentrations (3.8%) lead to higher INR values, and underfilling the blood collection tube spuriously prolongs the PT because excess citrate is present. Using collection tubes containing 3.2% concentrations of citrate for blood coagulation studies and adequately filling tubes can reduce this problem.

Clinical applications of VKA therapy

The clinical effectiveness of VKAs in the treatment of a variety of disease conditions has been established by well-designed clinical trials. VKAs are effective for the primary and secondary prevention of venous thromboembolism, for the prevention of systemic embolism in patients with prosthetic heart valves or atrial fibrillation, for the prevention of acute myocardial infarction in patients with peripheral arterial disease and in men who otherwise are at high risk, and for the prevention of stroke, recurrent infarction, or death in patients with acute myocardial infarction. Although effectiveness has not been proven by a randomized trial, VKAs are also indicated for the prevention of systemic embolism in high-risk patients with mitral stenosis.

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Optimal therapeutic range

The optimal target range for warfarin is not the same for all indications. Not only is it likely to be influenced by the indication for its use, but also by patient characteristics. Thus, in patients who are at very high risk of bleeding it might be prudent to sacrifice some efficacy for safety. Bleeding, the most feared and major complication of oral anticoagulant therapy, is closely related to the intensity of anticoagulation.

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The sponsor had no role in the design of the study. Canada healthcare

Sunday, October 26th, 2014 | Permalink

This continued inflammation and airspace destruction in ex-smokers with GOLD stage IIb COPD-E could likely be more extensive if these subjects continued to smoke, and thus it remains important that smokers with COPD should quit smoking. However, this study provides further evidence that once tobacco smoke initiates and causes progression as far as GOLD stage IIb COPD-E, discontinuing smoking may slow but not necessarily halt the persistent inflammation and progression of this severity of COPD-E. These studies underscore the need to identify novel therapies to prevent the progression of moderate to severe COPD-E even in ex-smokers.

Author contributions: Dr Miller: contributed to processing and analyzing sputum samples, performing statistical analysis of results, and editing the manuscript.

Dr Cho: contributed to processing and analyzing sputum samples, performing statistical analysis of results, and editing the manuscript.

Ms Pham: contributed to processing and analyzing sputum samples, performing statistical analysis of results, and editing the manuscript.

Dr Friedman: contributed to interpreting and scoring of chest CT scans, analyzing the results, and editing the manuscript.

Dr Ramsdell: contributed to clinical characterization of study subjects, analyzing the results, and editing the manuscript.

Dr Broide: contributed to study design, supervising the measurements made, analysis of results, and writing the manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Friedman interprets chest CT scans for COPDGene, a National Institutes of Health-supported research project, and consults for Broncus Technologies on CT scans in emphysema. Drs Miller, Cho, Ramsdell, and Broide, and Ms Pham have reported that no potential conflict of interest exist with any companies/organizations whose products or services may be discussed in this article.

Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript.

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