RESUMEN
Osteoporotic hip fractures can be life changing and can increase mortality. Treatment of osteoporosis following hip fracture is often delayed. We began offering osteoporosis medication during hospitalization for hip fracture, dramatically increasing the number of patients meeting standard of care. INTRODUCTION: Osteoporotic hip fracture is a debilitating condition with major morbidity and mortality implications. Osteoporosis medication given within 90 days of hip fracture improves mortality and reduces risk of future fractures. The aim of this project was to improve rates of timely osteoporosis treatment following fragility hip fracture. METHODS: This was a two-step intervention utilizing the Plan-Do-Study-Act cycle, beginning with resident-focused education in cycle 1. In cycle 2, we offered osteoporosis medication to inpatients for hip fracture with help from a new electronic order set. RESULTS: Prior to this intervention, 32% of patients received osteoporosis medication within 90 days of fragility hip fracture; this improved to 81% after intervention. CONCLUSIONS: Resident education and an electronic order set dramatically improved the percentage of patients meeting standard of care with osteoporosis pharmacotherapy following fragility fracture.
Asunto(s)
Conservadores de la Densidad Ósea/administración & dosificación , Fracturas de Cadera/prevención & control , Osteoporosis/tratamiento farmacológico , Fracturas Osteoporóticas/prevención & control , Mejoramiento de la Calidad/organización & administración , Prevención Secundaria/normas , Accidentes por Caídas , Anciano , Conservadores de la Densidad Ósea/uso terapéutico , Denosumab/administración & dosificación , Denosumab/uso terapéutico , Esquema de Medicación , Fracturas de Cadera/etiología , Hospitalización , Humanos , Osteoporosis/complicaciones , Estudios Retrospectivos , Nivel de Atención , Texas , Ácido Zoledrónico/administración & dosificación , Ácido Zoledrónico/uso terapéuticoRESUMEN
Systemic candidiasis affects 1.6 to 4.5% of very low birth weight (8 microg/ml.
Asunto(s)
Antifúngicos/farmacología , Candida/efectos de los fármacos , Candida/aislamiento & purificación , Candidiasis/diagnóstico , Fluconazol/farmacología , Candida/clasificación , Candida albicans/clasificación , Candida albicans/efectos de los fármacos , Candida albicans/aislamiento & purificación , Candidiasis/tratamiento farmacológico , Candidiasis/microbiología , Errores Diagnósticos , Farmacorresistencia Microbiana , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Sepsis/diagnóstico , Sepsis/tratamiento farmacológico , Sepsis/microbiología , Especificidad de la EspecieRESUMEN
OBJECTIVE: To identify areas of consensus and controversy in the management of neonatal candidiasis. METHODS: A questionnaire was distributed to US-based members of the Pediatric Infectious Diseases Society and a sampling of US neonatologists. RESULTS: Three hundred eighty evaluable questionnaires were returned (42% of those mailed). Ninety-five percent of respondents have cared for an infant with systemic candidiasis in the past 2 years. Fluconazole and liposomal amphotericin are used to some extent by 90 and 69% of respondents, respectively. A single blood culture positive for Candida led to a recommendation for immediate treatment by 99%; amphotericin B was the preferred therapy for candidemia (88%). More than 80% of respondents would request cerebrospinal fluid, urine and repeat blood cultures and ophthalmologic examination in the evaluation of candidemia. If a cerebrospinal fluid culture is positive, 25% would use amphotericin B alone whereas 62% would add flucytosine. For candiduria Society members chose fluconazole therapy more often than did neonatologists, 23% vs. 3.4% (P<0.001). There was no consensus concerning duration of therapy, use of an amphotericin B test dose or management of a central catheter in place during candidemia. CONCLUSIONS: Systemic candidiasis in neonates is a frequently encountered clinical problem. There is agreement that prompt therapy with amphotericin B is required if a blood culture is positive for Candida and that such infants require additional evaluations. Other antifungals (fluconazole, liposomal amphotericin B) are used to some extent in this population. Many issues in management have no clear consensus and warrant further research.
Asunto(s)
Antifúngicos/uso terapéutico , Candidiasis/tratamiento farmacológico , Anfotericina B/uso terapéutico , Candidiasis/diagnóstico , Toma de Decisiones , Fungemia/diagnóstico , Fungemia/tratamiento farmacológico , Humanos , Recién Nacido , Encuestas y CuestionariosRESUMEN
Previous work has demonstrated that adult newt cardiac myocytes possess a proliferative ability in response to an experimentally induced injury, in vivo. This study describes an in vitro model in which the proliferative events of the adult cardiac myocyte may be studied. Ventricles were minced and then enzymatically dissociated in a Ca++- and MG++-free salt solution containing 0.5% trypsin and 625 U/ml of CLS II collagenase for 8 to 10 hours at 25 degrees C. Enzyme digests were preplated and then cultured on bovine corneal endothelial-derived basement membrane "carpets" in either serum-free or serum-supplemented modified Leibovitz's medium for up to 30 days. Light and transmission electron microscopic characterization demonstrated that a majority of the myocytes underwent an initial period of disorganization characterized by a "rounding up" of the cell and a loss of myofibrillar organization. Once the myocytes had attached to the culture substratum they began to spread out, underwent a reassembly of their contractile elements, resumed spontaneous contractions, and demonstrated ultrastructural evidence of protein synthesis. Mitosis was observed in several myocytes 8 to 15 days following isolation. In 15-day serum-supplemented and serum-free cultures, 6.5% +/- 0.9% and 8.1% +/- 1.4% of the myocytes were binucleated, respectively. These results demonstrate that adult newt ventricular myocytes can be successfully placed into primary culture and are capable of undergoing mitosis. This work may be considered as a foundation for future investigations which will focus on the mechanisms which control cardiac myocyte proliferation.
Asunto(s)
Técnicas Citológicas , Miocardio/citología , Salamandridae/anatomía & histología , Animales , Sangre , Células Cultivadas , Medios de Cultivo , Ventrículos Cardíacos , Microscopía Electrónica , Mitosis , Miocardio/ultraestructura , Factores de TiempoRESUMEN
Cell division in the adult cardiac myocyte has been examined in a number of different species in vivo and in vitro. The newt cardiac myocyte responds to trauma in vivo with proliferation. It has recently been successfully placed into cell culture. The purpose of the present study was to analyze the process of DNA synthesis in these cultures. The myocytes were cultured in modified Leibovitz L-15 medium on a bovine corneal endothelial cell membrane carpet and were incubated with tritiated thymidine (1 microCi/ml) for 24 hr prior to fixation at 10, 15, 20 and 30 days. Labeling indices were determined to be 10.5 +/- 2.5, 16.5 +/- 2.8, 10.5 +/- 2.2, and 2.9 +/- 0.6, respectively. When myocytes were exposed to 1 microCi/ml tritiated thymidine continuously from the fifth to the thirtieth day in culture, the labeling index was 34.5 +/- 6.8. Comparison of DNA synthesis in the in vivo and in vitro systems indicated comparable patterns, although there was an earlier onset of activity in culture. Between 8 and 15 days in culture, myocyte mitoses were regularly observed. Myocytes in metaphase contained well-organized myofibrillae, suggesting that mitosis may occur with highly differentiated morphology in vitro. It appears that this system will be useful in the definition of mechanisms involved in both initiating and stopping proliferative events in the cardiac myocyte.
Asunto(s)
ADN/biosíntesis , Miocardio/metabolismo , Animales , Células Cultivadas , Mitosis , Miocardio/citología , SalamandridaeRESUMEN
This report describes a technique which permits a high yield of viable adult cardiac myocytes from the adult newt using enzymatic separation techniques at low temperature and high enzyme concentrations. Observations by light microscopy showed the isolated myocytes to have a distinctively slender morphology which consisted of a variable number of arm-like appendages radiating from the center of cells which were predominantly mononucleated. Atrial myocytes were typically observed to have two to three arm-like appendages while ventricular myocytes typically had three to six appendages. The majority of myocytes displayed normal fine structure when examined by transmission electron microscopy. Computerized image analysis revealed that atrial cells were significantly greater in cell length (192.9 +/- 53.4 microns) and in nuclear length (25 +/- 5.3 microns) and perimeter (59.2 +/- 10.7 microns) than were ventricular cells (162.8 +/- 39 microns, 23.6 +/- 5.1 microns and 57.4 +/- 11.1 microns, respectively), while cell widths and areas were greater in ventricular cells (16.5 +/- 4.7 microns and 1839.8 +/- 585.0 microns, respectively) than in atrial cells (13.2 +/- 3.1 microns and 1520.3 +/- 527.6 microns, respectively). Comparison of these data with previous descriptions of isolated amphibian and mammalian cardiac myocytes emphasizes species-related differences.