ABSTRACT
Background Albumin is a protein colloidal solution with limited availability and high cost. It should be used in such approved indications as paracentesis, extensive burn, spontaneous bacterial peritonitis, and nephrotic syndrome. Objectives The aim of this study was to evaluate and compare the appropriateness of albumin usage before and after an evidence-based guideline. Setting Four wards of Imam Reza Hospital, Mashhad, Iran. Method An interventional pre-post design study was performed on 2 groups of patients; in gGroup 1 as a preparation phase group in 6 months from February 2015 to July 2015 and Group 2 as an interventional group from September 2015 to February 2016. A guideline for proper indications of albumin, designed and finalized based on the physicians' comments, was implemented in Group 2. Main outcome measure The pattern of albumin consumption. Results Fifty patients were evaluated in each group. The implementation of the guideline resulted in reduction of improper albumin use from 62 to 57.5%, which was not statistically significant; however., it reduced inappropriate dose and duration of albumin therapy (55.5-16.7%), the number of consumed albumin vial, and the average cost for each patient (317.78 ± 3.15-149.81 ± 1.91 USD) significantly, as well. Conclusion This study illustrated that in this hospital in most cases, albumin was used inappropriately and at an alarming rate. This improved after the introduction of an evidence-based guideline. Moreover, guideline implementation resulted in significant cost reduction.
Subject(s)
Albumins/standards , Drug Utilization Review/standards , Evidence-Based Medicine/standards , Hospitals, Teaching/standards , Practice Guidelines as Topic/standards , Adolescent , Adult , Aged , Albumins/therapeutic use , Burns/drug therapy , Burns/epidemiology , Drug Utilization Review/methods , Evidence-Based Medicine/methods , Female , Hospitals, Teaching/methods , Humans , Iran/epidemiology , Male , Middle Aged , Shock/drug therapy , Shock/epidemiology , Young AdultABSTRACT
OBJECTIVE: Regarding the anticonvulsant effects of Satureja hortensis (S . hortensis) in Avicenna's book: canon of medicine; the present study was undertaken to evaluate the anti- eplileptic effects of S . hortensis aqueous and ethanolic aerial part extracts. Furthermore, the mechanisms of their anticonvulsant activities were also evaluated. MATERIALS AND METHODS: Seizure was induced by Pentylentetrazol (PTZ) and MES (maximal electroshock) models. Mice were randomly divided into 8 groups; negative control (normal saline, 10ml/Kg), positive control (diazepam, 2 mg/kg), S. hortensis aqueous and ethanolic extracts (200, 400 and 600 mg/kg). In PTZ test, latency to the first minimal clonic seizure (MCS), latency to the first generalized tonic-clonic seizures (GTCS), the total duration of seizures and protection against mortality were evaluated. In MES test, the stretching length of extremities and protection against mortality were recorded. RESULTS: Aqueous and ethanolic extracts (400 and 600 mg/kg) significantly increased MCS and GTCS latencies in PTZ model. Three doses of the extracts decreased the total duration of seizure. These extracts did not show any protective effects on seizure induced by MES model. In PTZ model, flumazenil, an antagonist of benzodiazepine (BZD) site in the GABAA-BZD receptor complex and 7- nitroindazole (7- NI), a selective nNOS (neuronal nitric oxide synthase) inhibitor, reduced the prolongation of seizure latency. CONCLUSION: S. hortensis showed anticonvulsant activity in PTZ model and this effect may be mediated, at least partly, through interacting with nitric oxide and GABAA-BZD receptor complex.
