RESUMEN
OBJECTIVE: To determine the pharmacokinetics (PK) of metoclopramide administered via intravenous continuous rate infusion (IV CRI) and subcutaneous (SC) bolus and evaluate for gastrointestinal motility and adverse side effects. STUDY DESIGN: Experimental study; randomized, crossover design. ANIMALS: Six healthy adult horses. METHODS: Each horse received metoclopramide via IV CRI (0.04 mg/kg/h for 24 h) and SC bolus (0.08 mg/kg once), with ≥1 week washout period between. Plasma was analyzed by UPLC-MS/MS. Compartmental modeling was used to determine PK parameters for each treatment; nonparametric superposition was used to simulate multiple SC bolus regimens. Gastrointestinal motility and evidence of adverse effects were monitored. RESULTS: Tmax (h) for SC bolus was 0.583 ± 0.204 versus 17.3 ± 6.41 for IV CRI, while Cmax (ng/mL) was 27.7 ± 6.38 versus 43.6 ± 9.97, respectively. AUC (h × ng/mL) was calculated as 902 ± 189 for 24 h IV CRI versus 244 ± 37.4 simulated for 0.08 mg/kg SC bolus every 8 h. Simulations revealed similar exposure between groups with administration of 0.96 mg/kg/day SC bolus, divided into three, four, or six doses. SC bolus bioavailability was estimated as 110 ± 11.5%. No clear trends in motility alteration were identified. No adverse effects were noted. CONCLUSION: Repeated SC boluses of metoclopramide at 0.08 mg/kg would result in lower total drug exposure and Tmax than IV CRI administration but would be highly bioavailable. CLINICAL SIGNIFICANCE: Higher and/or more frequent SC bolus doses are needed to achieve a similar AUC to IV CRI. No adverse effects were noted; however, evaluation of alternative dosing strategies is warranted.
Asunto(s)
Antieméticos , Estudios Cruzados , Metoclopramida , Metoclopramida/farmacocinética , Metoclopramida/administración & dosificación , Animales , Caballos/sangre , Masculino , Infusiones Intravenosas/veterinaria , Femenino , Inyecciones Subcutáneas/veterinaria , Antieméticos/farmacocinética , Antieméticos/administración & dosificación , Antieméticos/sangre , Área Bajo la Curva , Motilidad Gastrointestinal/efectos de los fármacosAsunto(s)
Terapia Asistida por Animales/normas , Actitud del Personal de Salud , Atención a la Salud/normas , Personal de Salud/psicología , Seguridad del Paciente/normas , Guías de Práctica Clínica como Asunto , Adulto , Animales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados UnidosAsunto(s)
Cuidados Críticos/organización & administración , Cuidados Críticos/psicología , Personal de Enfermería en Hospital/organización & administración , Personal de Enfermería en Hospital/psicología , Recursos Humanos/organización & administración , Lugar de Trabajo/organización & administración , Lugar de Trabajo/psicología , Adulto , Factores de Edad , Conducta Cooperativa , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Today's nursing programs are struggling to accommodate the changing needs of the health care environment and need to make changes in how students are taught. Using constructivism theory, whereby learning is an active process in which learners construct new ideas or concepts based upon their current or past knowledge, leaders in nursing education can make a paradigm shift toward concept-based curricula. This article presents a summary and analysis of constructivism and an innovative application of its active-learning principles to curriculum development, specifically for the education of nursing students.
Asunto(s)
Educación en Enfermería , Teoría de Enfermería , Aprendizaje Basado en Problemas , Ciencia Cognitiva , Curriculum , Humanos , Modelos Psicológicos , Estados UnidosRESUMEN
This study sought to determine the effect of an advanced-practice-nurse (APN)-led telephone intervention on hospital readmissions, quality of life, and self-care behaviors (SCBs) of patients with heart failure (HF). Twenty participants were randomly assigned to either an experimental group that received the APN-led telephone intervention (ALTI) or a control group that received usual care in this pretest-posttest experimental study. The results of this study support the idea that an ALTI positively impacts outcomes of patient with HF, particularly by improving SCBs and decreasing hospital readmissions. An ALTI warrants consideration to improve outcomes of patients with HF.