ABSTRACT
BACKGROUND: Digoxin is a frequently prescribed drug in the elderly population. Estimated glomerular filtration rate is widely used to adjust dosages. The HUGE value is a tool for differentiating the presence or absence of chronic kidney disease in elderly patients. We aimed to investigate the usefulness of the HUGE value to predict the initial dose of digoxin in patients aged older than 70 years. METHODS: We reviewed retrospectively the medical records of patients aged older than 70 years with serum digoxin concentrations (SDCs) monitored over a 6-month period (63 patients). A linear regression relating the patient's SDC, maintenance dose of digoxin and the HUGE value was estimated to generate a dosage equation. This equation was validated retrospectively (33 patients) and prospectively (35 patients) in comparison with two existing methods based on creatinine clearance. RESULTS: An equation (HUGE_DIG) was generated to calculate the initial digoxin dose to reach a specific target SDC. Thus, to achieve a SDC of 0.8 ng/mL: Digoxin (mg/day) = 0.091 - 0.006 x HUGE. After retrospective validation, the calculated digoxin doses with this equation were administered in the prospective phase and we did not observe statistical differences between measured and desired SDCs. Moreover, the predictive performance of our equation was better than that obtained with the compared methods. CONCLUSIONS: We offer a new validated digoxin dosing equation for elderly patients. Our results support the need to perform digoxin dosing in elderly people, bearing in mind the changes in renal physiology secondary to ageing and not merely the estimated glomerular filtration rate.
Subject(s)
Aging , Digoxin/administration & dosage , Aged , Aged, 80 and over , Algorithms , Dose-Response Relationship, Drug , Female , Humans , Kidney Function Tests , Male , Retrospective StudiesSubject(s)
Nutritional Support/standards , Dietetics/education , Enteral Nutrition/adverse effects , Enteral Nutrition/methods , Enteral Nutrition/standards , Evidence-Based Medicine , Feeding Behavior , Food Preservation/standards , Food Service, Hospital/standards , Food, Formulated/adverse effects , Food, Formulated/standards , Food-Drug Interactions , Humans , Malnutrition/diagnosis , Malnutrition/prevention & control , Malnutrition/therapy , Mass Screening/methods , Mass Screening/standards , Medical Records/standards , Nutrition Assessment , Parenteral Nutrition/adverse effects , Parenteral Nutrition/methods , Parenteral Nutrition/standards , Parenteral Nutrition Solutions/administration & dosage , Parenteral Nutrition Solutions/chemistry , Parenteral Nutrition Solutions/standards , Patient Care Planning , Quality Assurance, Health Care , Risk Factors , Spain , Surveys and QuestionnairesABSTRACT
Most of the patients who are candidate to liver transplant have varying degrees of hyponutrition. That is why they may be subsidiary to receive nutritional therapy so as to improve their nutritional status and the transplant outcomes. However, preoperative support is difficult to perform in many cases due to multiple factors among which the patients clinical situation, the diagnostic requirements, the therapeutic regimens, and extra-hospital care of the "stable" candidates may be listed. In the post-surgical phase, the patients must receive nutritional support in the same way other patients submitted to major surgery do. Early enteral nutrition is the most appropriate method in most of the cases, for which intraoperative placement of a transpyloric access to the digestive tract is recommended, usually through a naso-jejunal tube. Enteral nutrition should be maintained until nutritional requirements may appropriately be covered by oral feeding. Immunosuppressive therapy importantly contributes to the development of such problems after transplantation through its secondary metabolic-nutritional effects. The patients require nutritional follow-up not only to assess the evolution of their nutritional status but also to detect, prevent, and treat late-onset impairments such as obesity, hyperlipidemia, or osteoporosis, which commonly occur in these patients.
Subject(s)
Liver Transplantation , Nutritional Support , Enteral Nutrition , Follow-Up Studies , Humans , Immunosuppressive Agents/adverse effects , Nutritional Requirements , Nutritional Status , Postoperative Care , Postoperative Complications/diagnosis , Postoperative Complications/prevention & control , Time Factors , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Aminoglycosides/administration & dosage , Reproducibility of ResultsABSTRACT
OBJECTIVE: Taking into account the high prevalence of behavioral problems in the pediatric outpatient clinic, a need for a useful and easy to administer tool for the evaluation of this problem arises. The psychometric characteristics of the Spanish version of the Eyberg Behavioral Child Inventory (EBCI), [in Spanish Inventario de Eyberg para el Comportamiento de Niño (IECN)], a 36-item questionnaire were established. PATIENTS AND METHODS: The ECBI inventory/questionnaire was translated into Spanish. The basis of the ECBI is the evaluation of the child's behavior through the parents' answers to the questionnaire. Healthy children between 2 and 12 years of age were included and were taken from pediatric outpatient clinics from urban and suburban areas of Barcelona and from our hospital's own ambulatory clinic. RESULTS: The final sample included 518 subjects. The mean score on the intensity scale was 96.8 and on the problem scale 3.9. Internal consistency (Cronbach's alpha) was 0.73 and the test-retest had an r of 0.89 (p < 0.001) for the intensity scale and r = 0.93 (p < 0.001) for the problem scale. Interrater reliability for the intensity scale was r = 0.58 (p < 0.001) and r = 0.32 (p < 0.001) for the problem scale. Concurrent validity between both scales was r = 0.343 (p < 0.001). CONCLUSIONS: The IECN is a useful and easy tool to apply in the pediatrician's office as a method for early detection of behavior problems.
