ABSTRACT
Introduction: Automatic drug dispensers are now widely used in critical care.1-2 They can provide information about dispensed drugs. Good practice in sedation restricts the use of sedatives and titrates doses to defined responses.3-4 Objectives: To extract drug dispenser issuing records for sedatives and link these to patient records to evaluate sedative use. Method(s): in October 2019, we introduced two Omnicell XT automated dispensing cabinets (Omnicell inc. CA, USA) into a 42 bedded general/neurological unit. ICNARC (Intensive care national audit and research centre) and CCMDS (Critical care minimum data set) data was collected using the Ward Watcher program. Dispenser issuing records for alfentanil, propofol and midazolam were obtained as Excel files for 13 months from January 2020. Output time stamps were converted to dates and times. Outputs were linked to outputs of the ICNARC and CCMDS records for the patients that the drugs were issued to. All the outputs had patients identified by their unique hospital numbers. These were used in Excel "power queries" to produce a spread sheet with a single row per patient. Multiple admissions used the first diagnosis, the final outcome and the total length of stay. The total dose of sedatives was calculated from ampoule dose and number. The duration of treatment was calculated from the first and last issues of the drug. ICNARC codes were used to identify the primary system in the admission diagnostic code and those patients admitted for COVID-19. Variables were compared using Chi Squared, Mann-Whitney U and Kruskal Wallis Tests. The significance of associations was established using Spearman's Rho. Linear regression was used to define relationships more clearly. Result(s): Table one summarises the patient characteristics with respect to all admissions during the study period and for patients who had had the studied drugs issued to them. Midazolam was used in fewer patients, they were more likely to be male, heavier (p>0001) and to die than patients receiving Propofol or Alfentanil (p>0.001). With respect to diagnostic groups, all the sedatives, particularly Midazolam (p<0.001), were more likely to be used in patients with COVID-19. The relationship between the dose of sedative drugs and patient age and weight was explored using the dose per advanced respiratory day. All three drugs had a significant but weak negative relationship with age, lower doses being given to older people (Propofol r2 = 0.02, p=0.01. Alfentanil r2 = 0.04, p=0.00. Midazolam r2 = 0.07, p=0.00.). There was also a weak but significant relationship between increasing dose of Propofol with patient weight (r2 = 0.02, p=0.01), but there was no relation between weight and doses of the other drugs. Conclusion(s): Information from automatic drug dispensers can be interpreted and combined with other datasets to produce clinically relevant information. The limited weak relationships between drug dose and age and weight suggests that sedative drugs could have been better titrated to response.
ABSTRACT
Introduction: Telogen effluvium (TE) is characterized by diffuse hair shedding 2-3 months after a stressor, and factors such as hypoxia, inflammation (interleukin 6), medications and need for mechanical ventilation may play a role in the development and severity of TE caused by COVID-19. Aims: Evaluate the benefit of the hair care routine using products containing active ingredients to reduce the microinflammation of the scalp and increase the resistance of the hair strand to treat subjects with TE caused by COVID-19. Case presentation: After 60 days of the hospitalization due to COVID-19 infection, a 58-year-old woman showed a typical diagnostic of TE associated to post–COVID-19 infection, presenting positive results to traction test, trichoscopy, and trichogram. During 30 days, she used: 1) Product A: shampoo containing Aminexil, niacinamide, pyridoxine and panthenol;2) Product B: conditionate containing SP94 (glucose + linoleic acid);and 3) Product C: treatment ampoules containing creatine, panthenol, and ceramide R. The products A plus B were used once time for daily and the product C was used 3 times a week. Results: After the treatment, the subject presented an improvement of 100% of the hair loss, with negative results to traction test, trichoscopy, and trichogram analysis. The subject reported a high satisfaction with the treatment (ratio 10/10). Discussion: The hair care routine using the products A, B, and C could improve the TE caused by COVID-19, maybe by reduction inflammatory process in the scalp. Clinical studies in the high scale must be conducted to proof this hypothesis.
ABSTRACT
Objectives: COVID-19 has demanded innovation in critical care and shone a light on ready-to-administer formulations for intravenous administration. This analysis quantifies the human resource released when moving away from traditional mixing of drug concentrate at the bedside. Methods: A model was constructed to simulate noradrenaline delivery for people experiencing critical hypotension requiring vasopressor support in the intensive care setting. It simulated resource consumption over 24 hours taking account of noradrenaline dose and flow rate, product size, ampoule pooling for dilution, preparation volume, sterility changes, pumping methods, and drug wastage. The duration, location and skill requirement of human-resourced tasks were also included and costed. Outcomes were applied to a hypothetical English population over one year (2019). Results: Based on 4,123 critical care beds giving 231,011 days of vasopressor support annually, and a move from syringe-based double pumping to volumetric pumping in 80% of units (20% estimated to deliver volumetrically already), a comprehensive switch to the ready-to-administer formulation released 33,927 days (167.1 WTEs) of nursing time from non-patient facing activity. A resource equivalent to £11.0m at 50/50 band 5/6. There were fewer episodes of preparation needed, no ampoule cracking or pooling for dilution, and no injection into infusion bags and changing with ensuing sterility risk. The cost of moving to the ready-to-administer product was £2.2m in acquisition (Sinora®). When monetised throughout, there was a net saving of £8.7m. Conclusions: The human resource of the NHS is its highest value component as made evident by the COVID-19 pandemic. This modelling supports the recommendations of the Lord Carter review, the Royal Pharmaceutical Society, and the NHS Specialist Pharmacy Service in their encouragement of ready-to-administer formulations in this context of care. Resource-effective approaches will help skilled healthcare professionals divert their time from therapy preparation to patient-facing care.