Discontinuation of anticoagulant care during admission to a psychiatric hospital.

PURPOSE: Continuation of coumarin therapy is important to prevent thromboembolic events. Continuation of medication, unrelated to the reason for hospital admission, may be at risk due to the patient's psychiatric status and the involvement of several physicians in patient care. METHODS: We performed a retrospective follow-up study of users of orally administered anticoagulants who were admitted to a psychiatric hospital. Information on patient characteristics, anticoagulant use, and International Normalized Ratio (INR) measurements was collected. Discontinuation of anticoagulant care was defined as no anticoagulant dispensing during the first 7 days of hospitalization and/or no INR measurement during hospitalization. Relative risks (RR) of discontinuation, overall and stratified by patient characteristics, was estimated using Cox regression analysis. RESULTS: Of 111 patients, 24.3 % had their anticoagulant care discontinued. For 17.1 %, no anticoagulant was dispensed during the first week, and 13.5 % had no INR measurement during hospitalization. CONCLUSIONS: Admission to a psychiatric hospital leads to discontinuation of anticoagulant care in 24.3 % of patients, with highest risk of discontinuation in patients admitted to nonpsychogeriatric wards. More research is needed to evaluate the clinical impact of this finding.

[Optimalization of antibiotic policy in the Netherlands. VII. SWAB-guidelines for antimicrobial therapy in adults patients with infectious endocarditis]. / Optimaliseren van het antibioticabeleid in Nederland. VII. SWAB-richtlijnen voor antimicrobiële therapie bij volwassen patiënten met infectieuze endocarditis.

The Working Party on Antibiotic Policy (Dutch acronym: SWAB) has developed guidelines for in-hospital antimicrobial therapy of adult patients with infective endocarditis. The choice and the duration of antimicrobial therapy are determined by the infecting micro-organism, the sensitivity of this micro-organism to antimicrobial therapy, the location of the endocarditis (left- or right-sided) and the presence of intracardial prosthetic material. While waiting for the culture results, the antibiotic treatment of an infected native valve is benzylpenicillin (in cases which begin subacutely or have a long history) or flucloxacillin (cases which begin acutely, are fulminant or in i.v. drug users), and gentamicin. If a prosthetic valve is infected then treatment of choice is vancomycin and gentamicin. Further antibiotic treatment depends on the causative micro-organism. Streptococci, enterococci and staphylococci are the most frequently occurring of these.

Optimisation of the antibiotic guidelines in The Netherlands. VII. SWAB guidelines for antimicrobial therapy in adult patients with infectious endocarditis.

The Working Party on Antibiotic Policy (Dutch acronym is SWAB) is a Dutch organisation that develops guidelines for in-hospital antimicrobial therapy of bacterial infectious diseases. This present guideline describes the antimicrobial treatment for adult patients with infective endocarditis. The choice and duration of antimicrobial therapy is determined by the infecting micro-organism, sensitivity of this micro-organism for antimicrobial therapy, location of the endocarditis, left-sided or right-sided, and presence of intracardial prosthetic material. In this guideline, the empirical therapy for endocarditis is discussed as well as the therapy for the most frequent causative organisms: streptococci, enterococci, staphylococci and HACEK micro-organisms.

[Meperidine (pethidine) outdated as analgesic in acute pancreatitis]. / Pethidine achterhaald als pijnstiller bij acute pancreatitis.

The most important symptom in acute pancreatitis is pain. This pain often is so severe that treatment is started with opioid analgesics. In daily practice meperidine is often the analgesic of first choice because it is supposed to cause less spasm of the M. sphincter ampullae hepatopancreaticae (sphincter of Oddi). Drawbacks of the use of meperidine compared with other opiods are myoclonias, tremors and convulsions due to accumulation of the metabolite norpethidine, and hypotension, tachycardia and erythema due to release of more histamine from mast cells. From literature study it appeared that all opioids have a spasmogenic effect on the sphincter of Oddi, that there are no good arguments to assume that this effect is less when meperidine is used, and that there is no good evidence that this spasmogenic effect of opioid analgesics influences the course of acute pancreatitis in an unfavourable way. Since the profile of effects and side effects of meperidine is unfavourable, we prefer the use of opioids with a larger therapeutic width.

Exploding the albumin myth.

In this article arguments are given to stop the current practise of infusing albumin in patients in shock and low levels of serum albumin. Correcting the albumin levels is not correlated with better survival or change in morbidity. Fluid therapy including the use of synthetic plasma expanders is the accepted therapy for patients in sceptic shock.

Comparative bioavailability of rectal and oral formulations of chloroquine.

The relative bioavailability of chloroquinone in Witepsol H15 suppositories can vary between 10 and 53% of the bioavailability of a tablet formulation in adults. Therefore, it is therapeutically not sound to replace chloroquine tablets by a rectal formulation with the same dose.