Evaluating the potential effect of melatonin on the post-cardiac surgery sleep disorder

Postoperative neurological injuries, including cognitive dysfunction, sleep disorder, delirium, and anxiety, are the important consequences of coronary artery bypass graft surgery [CABG]. Evidence has shown that postoperative sleep disturbance is partly due to disturbed melatonin secretion in the perioperative period. The aim of this study was to evaluate the effect of melatonin on postoperative sleep disorder in patients undergoing CABG. One hundred forty-five elective CABG patients participated in a randomized double-blind study during the preoperative period. The patients were randomized to receive either 3 mg of melatonin or 10 mg of Oxazepam one hour before sleep time. Each group received the medication from 3 days before surgery until the time of discharge. Sleep quality was evaluated using the Groningen Sleep Quality Score [GSQS], and the incidence of delirium was evaluated by nursing records. Sleep quality and anxiety scores were compared before and after surgery through the Wilcoxon signed-rank test. The analysis of covariance [ANCOVA] and independent t-test were used to compare the sleep and anxiety scores between the groups. P values

Plasma vitamin D status and its correlation with risk factors of thrombosis, P-selectin and hs-CRP level in patients with venous thromboembolism; the first study of iranian population

Low plasma level of vitamin D is linked to the increased risk of cardiovascular diseases such as hypertension, diabetes, dyslipidemia and peripheral vascular diseases. Vitamin D deficiency is a worldwide problem that involves Iranian population. To the best of our knowledge, this was the first investigation on venous thromboembolism [VTE] subjects that assessed the correlation of vitamin D level with plasma P-selectin, hs-CRP, and risk factors of thrombosis. In this prospective study, patients with diagnosis of acute deep vein thrombosis and or pulmonary eboembolism were enrolled. All patients' clinical data, demographics and risk factors of thrombosis were evaluated. Plasma level of P-selectin and hs-CRP were measured by ELISA method. Radio immune assay method was used to determine plasma level of 25-hydroxy vitamin D. In this study, 60 subjects were included. The mean +/- SD plasma 25-hydroxy vitamin D level [25[OH] D] of participants was 21.4 +/- 14.6 ng/mL. The vitamin D deficiency was reported in 60% of patients. No significant relation was found between the plasma 25[OH]D level and P-selectin and hs-CRP. In multiple regression analysis, there was a significant relationship between the level of 25[OH]D and the patients' age [beta = 0.452; p = 0.001], diabetes [beta = 0.280; p = 0.036] and positive family history of cardiovascular diseases [beta = 0.373; p = 0.003]. Vitamin D deficiency is a frequent problem in Iranian VTE patients. Moreover, Plasma level of vitamin D is not associated with increase level of P-selectin and hs-CRP in VTE patients

Detection and management of medication errors in internal wards of a teaching hospital by clinical pharmacists

Any suboptimum treatment in the management of patients can lead to medication errors [MEs] that may increase morbidity and mortality in hospitalized individuals. By establishing well-designed patient care activities within the managed care setting, clinical pharmacists can cooperate with other health care professionals to provide quality care and maximize safety. The aim of this study was to evaluate the frequency and prevention of MEs by clinical pharmacists. This was a cross-sectional interventional study conducted in internal wards of a teaching hospital during a two-month period. During this period, patient records, and physician orders were reviewed by clinical pharmacists. Any prescription error identified was documented. Incorrect drug selection, dose, dosage form, frequency, or route of administration all were considered as medication errors. Then, the clinical pharmacist discuss about findings with the clinical fellows to change faulty orders. The frequency and types of MEs in different wards that were detected and prevented by clinical pharmacists was documented. During the study period, in 132 patients, 262 errors were detected [1.98 per each]. Wrong frequency 71 [27%], forget to order 37 [14.1%], wrong selection 33 [12.5%], drug interactions 26 [9.9%], forget to discontinue 25 [9.5%] and inappropriate dose adjustment in renal impairment 25 [9.5%] were the most types of errors. Cardiovascular medications were the class with the highest detected errors [31.6%] followed by gastrointestinal agents [15.6%]. Medication errors are common problems in medical wards that their frequency can be restricted by the intervention of clinical pharmacists

potential role of clinical pharmacy services in patients with cardiovascular diseases

Clinical pharmacy is deemed an integral component of a health care system. The presence of clinical pharmacists in medical rounds could assist physicians in optimizing patients' pharmacotherapy. Moreover, clinical pharmacists may reduce adverse effects and medication errors insofar as they contribute significantly to the detection and management of drug-related problems, not least in patients with cardiovascular diseases, who have the highest rank in the frequency of medication errors. Clinical pharmacists can also collaborate with physicians in the management of cardiovascular risk factors as well as anticoagulation therapy based on patients' specific situations. In summary, the practice of clinical pharmacy is considered a crucial part of a health care team to improve the level of patients' care by increasing the quality of therapy with the least expense for a health care system

Evaluation of the pattern of human albumin utilization at a university affiliated hospital

Albumin is a protein colloidal solution that possesses great value in the clinic, particularly for the resuscitation of critically ill patients. It has accounted for a high percentage of the cost in our center. This study evaluates the appropriateness of albumin usage at Masih Daneshvari Hospital, Tehran, Iran. This study evaluated 69 patient charts. Data included patient demographics, ward of admission, primary reasons for prescribing albumin, and details of albumin use. Possible correlations between the appropriateness of albumin usage, the number of albumin vials, and mortality rate were analyzed. Albumin was prescribed appropriately in 63.8% of patients. Cardiac surgery accounted for 37.3% of all indications. The most prevalent inappropriate indication of used albumin was for mild hypoalbuminemia and nutritional support. There was a significant correlation between the number of used albumin vials and mortality rate. In conclusion, the albumin use in Masih Daneshvari Hospital was not completely in accordance with the accredited references. Albumin is an expensive medication prescribed unnecessarily for many patients. Using the clinical pharmacist's prepared guideline could minimize the situations where its administration is not needed

drug utilization evaluation study of amphotericin B in neutropenic patients in a teaching hospital in Iran

Drug Utilization Evaluation [DUE] studies facilitate assessing the appropriateness and rational use of medications.The goal of the present study was to evaluate Amphotericin B usage in neutropenic patients. A prospective DUE study was performed in Hematology-Oncology and Stem Cell Transplantation wards at Taleghani hospital for one-year. National comprehensive cancer network, clinical practice guidelines in oncology, American Hospital Formulary Service and other relevant medical practice and up-to dated articles were used to evaluate whether Amphotericin B is properly used according to the guidelines. All data collected by a pharmacist in daily review using information of physician and nursing records as well as laboratory findings. During the one-year study, 35 patients receiving amphotericin B were evaluated. 29 patients [82.9%] received amphotericin B due to neutropenia and fever and 6 patients had confirmed fungal infections. All of the injectable solutions of amphotericin B were appropriately prepared for intravenous infusion. In addition, for all patients, ordering [indication] of the study drug was in accordance with the guidelines. Twenty-five [71.4%] patients received an appropriate dose according to the guidelines. Duration of treatment was properly selected in 21 [60%] patients. Twenty-two [62.8%] patients developed hypokalemia as the most frequent adverse drug event. Although, preparation and indication of amphotericin B was in compliance with the current guidelines, dosage and duration of treatment were considered to be incoherent with the designed protocol used in this study. We conclude more attention should be paid to dosage and duration of treatment with amphotericin B in order to optimize its administration