Wos İndeksli Yayınlar Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/11727/4807
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Item Clinical pharmacist assessment of drug-related problems among intensive care unit patients in a Turkish university hospital(2022) Albayrak, Aslinur; Basgut, Bilgen; Bikmaz, Gulbin Aygencel; Karahalil, Bensu; 35033079Background Critically ill patients treated in the intensive care units (ICUs) often suffer from side effects and drug-related problems (DRPs) that can be life-threatening. A way to prevent DRPs and improve drug safety and efficacy is to include clinical pharmacists in the clinical team. This study aims to evaluate the classification of drug-related problems and the implementation of clinical pharmacy services by a clinical pharmacist in the ICU of a university hospital in Turkey. Methods This study was carried out prospectively between December 2020 and July 2021 in Gazi University Medical Faculty Hospital Internal Diseases ICU. All patients hospitalized in the intensive care unit for more than 24 h were included in the study. During the study, the clinical pharmacist's interventions and other clinical services for patients were recorded. DRPs were classed according to the Pharmaceutical Care Network Europe V.8.02. Results A total of 151 patients were included during the study period corresponding to 2264 patient-days. Patients with DRPs had a longer hospital stay and a higher mortality rate (p < 0.05). 108 patients had at least one DRP and the total number of DRPs was 206. There was an average of 1.36 DRPs per patient, 71.5% of patients experienced DRP and 89.22 DRPs per 1000 patient-days. A total of 35 ADEs were observed in 32 patients. ADE incidence was per 1000 patient-days 15.45. ADEs were caused by nephrotoxicity (48.57%), electrolyte disorders (17.14%), drug-induced thrombocytopenia (17.14%), liver enzyme increase (8.57%) and other causes (8.57%). Drug selection (40.29%) and dose selection (54.36%) constituted most of the causes of DRPs. Dose change was the highest percentage of planned interventions with a rate of 56.79%. Intervention was accepted at a rate of 90.8% and it was fully implemented. Conclusion In this study, the importance of the clinical pharmacist in the determination and analysis of DRPs was emphasized. Clinical pharmacy services like the one described should be implemented widely to increase patient safety.Item COVID-19 healthcare cost and length of hospital stay in Turkey: retrospective analysis from the first peak of the pandemic(2021) Oksuz, Ergun; Malhan, Simten; Gonen, Mustafa Sait; Kutlubay, Zekayi; Keskindemirci, Yilmaz; Tabak, Fehmi; 0000-0002-5723-5965; 34623528; K-8238-2012Background During the COVID-19 pandemic, health care systems are under extreme pressure. This study analyzed health care resource use (HCRU) and costs in patients admitted to the hospital for COVID-19 and aimed to estimate the one-year direct medical cost of the disease in Turkey. Methods This retrospective cohort study was conducted between March and July 2020 in a tertiary hospital (n = 1056) in Istanbul. Patient demographics, clinical and treatment characteristics at admission, comorbidities, disease severity, and costs from a payer perspective were evaluated using the microcosting method. The results include LOS, hospital costs, and univariate and generalized linear models to investigate influencing factors. The data were extrapolated to provide a country-level estimate. Results The mean length of stay was 9.1 days (SD 6.9). The mean length of stay was 8.0 days (4.7) for patients hospitalized in wards versus 14.8 days (SD 12.0) for patients hospitalized in the ICU. In univariate analysis, several factors, including O-2 therapy (+ 3.7 days), high CRP > 41.8 mg/L (+ 3.8 days), and elevated ferritin (+ 3.5), were found to be associated with a longer LOS (p < 0.05). The direct annual medical cost of COVID-19 was estimated at PPP$ 2.1 billion. The COVID-19 pandemic resulted in a direct medical burden that corresponds to 2.0% of the government health expenditures and 0.8 per thousand of Turkey's gross domestic product (GDP). Conclusions Estimating the impact of this pandemic in terms of HCRU and costs to the health care system can help design strategies to manage the pandemic.Item Immediate Tracheal Extubation After Pediatric Liver Transplantation(2021) Sahinturk, Helin; Ozdemirkan, Aycan; Yilmaz, Olcay; Zeyneloglu, Pinar; Torgay, Adnan; Pirat, Arash; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0003-0159-4771; 30346263; AAJ-8097-2021; AAJ-1419-2021Objectives: We examined whether immediate tracheal extubation among pediatric liver transplant recipients was safe and feasible. Materials and Methods: We retrospectively analyzed medical records of pediatric liver transplant recipients at Baskent University Hospital from January 2012 to December 2017. We grouped children who were extubated in the operating room versus those extubated in the intensive care unit. Results: In our study group of 81 pediatric patients, median age was 4 years (range, 4 mo to 16 y) and 44 (54%) were male. Immediate tracheal extubation in the operating room was performed in 39 patients (48%). Children who remained intubated (n = 42) had more frequent massive hemorrhage (14% vs 0%; P = .015), received larger amounts of packed red blood cells (19.3 vs 10.2 mL/kg; P < .001), and had higher serum lactate levels (9.0 vs 6.9 mmol/L; P = .001) intraoperatively. All children with open abdomens postoperatively remained intubated (n = 7). Patients extubated in the operating room received less vasopressors (1 [3%] vs 12 [29%]; P = .002) and antibiotics (11 [28%] vs 22 [52%]; P = 0.041) and developed infections less frequently postoperatively (3.0 [8%] vs 15.0 [36%]; P = .003). Children extubated in the operating room had shorter mean stay in the intensive care unit (2.0 vs 4.5 days; P < .001). Hospital mortality was higher in children who remained intubated (12% vs 0%; P = .026). Conclusions: Immediate tracheal extubation was well tolerated in almost half of our patients and did not compromise their outcomes. Patients who remained intubated had longer intensive care unit stays and higher hospital mortalities. Therefore, we recommend immediate tracheal extubation in the operating room after pediatric liver transplant among those children without intraoperative requirements for massive blood transfusion, high-dose vasopressors, high serum lactate levels, and open abdomen.