Stress-induced gastrointestinal ulcers are common among patients admitted to the intensive care unit(ICU).These ulcers impose significant morbidity and mortality,therefore,stress ulcer prophylaxis(SUP) is a common cli...Stress-induced gastrointestinal ulcers are common among patients admitted to the intensive care unit(ICU).These ulcers impose significant morbidity and mortality,therefore,stress ulcer prophylaxis(SUP) is a common clinical practice among healthcare providers dealing with these critically-ill patients.Several strategies for SUP have been suggested over the past four decades,with acid suppressive therapies being the most commonly used in the ICU.Whether SUP is effective and safe,or not,remains a topic of controversy.The data is still conflicting,and provision of a simple answer is not feasible at the present time.Recently,a large phase IV,multicenter,randomized clinical trial(SUP-ICU),negated the benefits(and harms) of proton pump inhibitors as SUP.This article reviews some of these controversies.展开更多
AIM:To assess the appropriateness of the indication and route of administration of proton-pump-inhibitors (PPIs) and their associated cost impact. METHODS:Data collection was performed prospec-tively during a 6-mo per...AIM:To assess the appropriateness of the indication and route of administration of proton-pump-inhibitors (PPIs) and their associated cost impact. METHODS:Data collection was performed prospec-tively during a 6-mo period on 340 patients who re-ceived omeprazole intravenously during their hospital stay in non-intensive care floors. Updated guidelines were used to assess the appropriateness of the indication and route of administration. RESULTS:Complete data collection was available for 286 patients which were used to assess intravenous (IV) PPIs utilization. Around 88% of patients were receiving PPIs for claimed stress ulcer prophylaxis (SUP) indication; of which,only 17% met the guideline criteria for SUP indication,14% met the criteria for non-steroidal-anti-inflammatory drugs-induced ulcer prophylaxis,while the remaining 69% were identifi ed as having an unjustified indication for PPI use. Theinitiation of IV PPIs was appropriate in 55% of pa-tients. Half of these patients were candidates for switching to the oral dosage form during their hos-pitalization,while only 36.7% of these patients were actually switched. The inappropriate initiation of PPIs via the IV route was more likely to take place on the medical floor than the surgical floor (53% vs 36%,P = 0.003). The cost analysis associated with the appro-priateness of the indication for PPI use as well as the route of administration of PPI revealed a possible saving of up to $17 732.5 and $14 571,respectively. CONCLUSION:This study highlights the over-utili-zation of IV PPIs in non-intensive care unit patients. Restriction of IV PPI use for justified indications and route of administration is recommended.展开更多
AIM:To evaluate the current practice of stress ulcer prophylaxis (SUP) in Lebanese Health care centers.METHODS:A multi-center prospective chart review study was conducted over 8 mo.A questionnaire was distributed to p...AIM:To evaluate the current practice of stress ulcer prophylaxis (SUP) in Lebanese Health care centers.METHODS:A multi-center prospective chart review study was conducted over 8 mo.A questionnaire was distributed to pharmacy students who collected data on demographics,SUP medications,dose,route,duration and associated risk factors.The appropriateness of SUP use was determined as per American Society of Health-System Pharmacists guidelines.Institutional review board approval was obtained from each hospital center.RESULTS:A total of 1004 patients were included.67% of the patients who received prophylaxis did not have an indication for SUP.The majority (71.6%) of the patients who were administered parenteral drugs can tolerate oral medications.Overall,the regimen of acid-suppressant drugs was suboptimal in 87.6% of the sample.This misuse was mainly observed in non-teaching hospitals.CONCLUSION:This study highlighted the need,in Lebanese hospitals,to establish clinical practice guidelines for the use of SUP;mainly in non-critical care settings.展开更多
目的对质子泵抑制剂和H_2受体阻滞剂预防应激性溃疡的有效性和安全性系统评价进行再评价。方法计算机检索Cochrane图书馆、Pub Med、Embase、Web of Sciene、中国知网(CNKI)、中国科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBM...目的对质子泵抑制剂和H_2受体阻滞剂预防应激性溃疡的有效性和安全性系统评价进行再评价。方法计算机检索Cochrane图书馆、Pub Med、Embase、Web of Sciene、中国知网(CNKI)、中国科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBM)和万方医学数据库,检索时限均从建库至2016年5月。根据纳入排除标准,筛选符合纳入排除标准的系统评价和Meta分析,使用AMSTAR量表评价所纳入系统评价的方法学质量,Grade系统评价结局指标的证据质量,提取原始研究用Rev Man 5.3软件进行Meta分析。结果共纳入7个系统评价/Meta分析,方法学质量评分>7分者仅占41.86%;对21个单个结局指标分别进行质量评价,14个(67.77%)的证据质量均为低或极低。对36个研究(3 820例)数据进行再分析,PPI在预防应激性溃疡出血、临床大出血和显性出血方面优于H_2RA(P<0.001),但是在肺炎发生率、死亡率和ICU住院天数方面,PPI和H_2RA比较差异无统计学意义(P>0.05)。结论 PPI预防ICU的危重患者的应激性溃疡出血优于H_2RA,但原始研究质量不高,仍需后续更多的高质量、结局指标设计全面的前瞻性研究。展开更多
文摘Stress-induced gastrointestinal ulcers are common among patients admitted to the intensive care unit(ICU).These ulcers impose significant morbidity and mortality,therefore,stress ulcer prophylaxis(SUP) is a common clinical practice among healthcare providers dealing with these critically-ill patients.Several strategies for SUP have been suggested over the past four decades,with acid suppressive therapies being the most commonly used in the ICU.Whether SUP is effective and safe,or not,remains a topic of controversy.The data is still conflicting,and provision of a simple answer is not feasible at the present time.Recently,a large phase IV,multicenter,randomized clinical trial(SUP-ICU),negated the benefits(and harms) of proton pump inhibitors as SUP.This article reviews some of these controversies.
文摘AIM:To assess the appropriateness of the indication and route of administration of proton-pump-inhibitors (PPIs) and their associated cost impact. METHODS:Data collection was performed prospec-tively during a 6-mo period on 340 patients who re-ceived omeprazole intravenously during their hospital stay in non-intensive care floors. Updated guidelines were used to assess the appropriateness of the indication and route of administration. RESULTS:Complete data collection was available for 286 patients which were used to assess intravenous (IV) PPIs utilization. Around 88% of patients were receiving PPIs for claimed stress ulcer prophylaxis (SUP) indication; of which,only 17% met the guideline criteria for SUP indication,14% met the criteria for non-steroidal-anti-inflammatory drugs-induced ulcer prophylaxis,while the remaining 69% were identifi ed as having an unjustified indication for PPI use. Theinitiation of IV PPIs was appropriate in 55% of pa-tients. Half of these patients were candidates for switching to the oral dosage form during their hos-pitalization,while only 36.7% of these patients were actually switched. The inappropriate initiation of PPIs via the IV route was more likely to take place on the medical floor than the surgical floor (53% vs 36%,P = 0.003). The cost analysis associated with the appro-priateness of the indication for PPI use as well as the route of administration of PPI revealed a possible saving of up to $17 732.5 and $14 571,respectively. CONCLUSION:This study highlights the over-utili-zation of IV PPIs in non-intensive care unit patients. Restriction of IV PPI use for justified indications and route of administration is recommended.
文摘AIM:To evaluate the current practice of stress ulcer prophylaxis (SUP) in Lebanese Health care centers.METHODS:A multi-center prospective chart review study was conducted over 8 mo.A questionnaire was distributed to pharmacy students who collected data on demographics,SUP medications,dose,route,duration and associated risk factors.The appropriateness of SUP use was determined as per American Society of Health-System Pharmacists guidelines.Institutional review board approval was obtained from each hospital center.RESULTS:A total of 1004 patients were included.67% of the patients who received prophylaxis did not have an indication for SUP.The majority (71.6%) of the patients who were administered parenteral drugs can tolerate oral medications.Overall,the regimen of acid-suppressant drugs was suboptimal in 87.6% of the sample.This misuse was mainly observed in non-teaching hospitals.CONCLUSION:This study highlighted the need,in Lebanese hospitals,to establish clinical practice guidelines for the use of SUP;mainly in non-critical care settings.
文摘目的对质子泵抑制剂和H_2受体阻滞剂预防应激性溃疡的有效性和安全性系统评价进行再评价。方法计算机检索Cochrane图书馆、Pub Med、Embase、Web of Sciene、中国知网(CNKI)、中国科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBM)和万方医学数据库,检索时限均从建库至2016年5月。根据纳入排除标准,筛选符合纳入排除标准的系统评价和Meta分析,使用AMSTAR量表评价所纳入系统评价的方法学质量,Grade系统评价结局指标的证据质量,提取原始研究用Rev Man 5.3软件进行Meta分析。结果共纳入7个系统评价/Meta分析,方法学质量评分>7分者仅占41.86%;对21个单个结局指标分别进行质量评价,14个(67.77%)的证据质量均为低或极低。对36个研究(3 820例)数据进行再分析,PPI在预防应激性溃疡出血、临床大出血和显性出血方面优于H_2RA(P<0.001),但是在肺炎发生率、死亡率和ICU住院天数方面,PPI和H_2RA比较差异无统计学意义(P>0.05)。结论 PPI预防ICU的危重患者的应激性溃疡出血优于H_2RA,但原始研究质量不高,仍需后续更多的高质量、结局指标设计全面的前瞻性研究。
