Included patients received a median of 2760 (IQR 1110-6415) mg of intravenous (IV) amiodarone during their ICU stay. Receipt of more than or equal to 2700 mg of amiodarone was identified as an independent factor associated with longer ICU LOS (hazard ratio [HR] 1.30; 95% confidence interval [CI], 1.10-2.28). In a sensitivity analysis of hospital survivors (n = 105), receipt of more than or equal to 2700 mg of amiodarone remained independently associated with longer ICU LOS (HR 1.64; 95% CI, 1.05-2.58). Conclusions Exposure to more than or equal to 2700 mg of amiodarone in the setting of NOAF and septic shock is positively correlated with longer ICU LOS. Identifying opportunities to limit amiodarone exposure and address/resolve potential precipitating causes of NOAF in this clinical scenario may reduce the morbidity associated with septic shock.Background Proton pump inhibitors (PPIs) are the most potent antacids used in clinical practice with greater safety and efficacy. Limited data are available on the usage of PPIs in Indian health-care settings. Our aim was to understand the usage pattern and potential drug interactions with concurrently administered medications employing a single-day cross-sectional study design. Methods A prospective observational cross-sectional study conducted on a single day, at two tertiary care teaching hospitals in South India. Inpatients of above 18 years of age were included. Case profiles were reviewed and data were collected in predesigned forms and analyzed. Drug interactions were identified using Micromedex and Medscape drug-interaction databases. Results A total of 797 case profiles screened from both the centers; 714 were prescribed with PPIs. In intensive care units (ICUs), the use of PPIs was highest with 95% of cases getting these drugs. A PPI was seen in about 93% of patients, who had more than or equal to 4 drugs in their prescriptions. Pantoprazole was the mostly prescribed PPI in around 90% of the cases. Around 33% of the PPIs usage was through IV (intravenous) route, and 75% of that use was seen in wards. Around 134 drug interactions were identified, of which 10 were of major severity. Conclusions Around 90% of inpatients were prescribed with PPIs. Pantoprazole is the most commonly prescribed PPI (90%). The IV administration was seen more in wards than ICUs, and 10 major drug interactions were observed in this single-day study. Careful monitoring is needed to avoid serious drug interactions involving PPIs, and training programs should sensitize the clinicians on the evidence-based use of PPIs.Background In a hospitalized setting, malnutrition is known to increase patient’s mortality and lower the quality of life; therefore, it is essential to detect such cases and intervene at the earliest possible. The goal of this study is to estimate the rate of malnutrition in hospitalized Lebanese patients, explore its association with different factors, and create a simple tool to detect patients at high risk of malnutrition. Methods One hundred and fifty Lebanese hospitalized patients, suffering at least from one chronic disease, were randomly chosen from Centre Hospitalier Universitaire Notre Dame de Secours (CHU-NDS) hospital. The Mini Nutritional Assessment (MNA) score was used to assess nutritional status. Results A total of 34.7% of patients in our sample were at risk of malnutrition and 9.3% were malnourished. A higher risk of malnutrition was found in patients with a low body mass index, who were physically inactive or admitted to the hospital more than once in the past 6 months. The nutritional status was not associated with certain chronic diseases more than others. We designed a simple decision tree model based only on 3 questions to detect patients at high risk of malnutrition/malnourished. This tool has a sensitivity of 62% and a specificity of 77%. Conclusion The prevalence found in our study was comparable with previous data. selleck inhibitor However, factors associated with poor nutritional status were somewhat different. Further studies are needed to validate our screening tool and to examine the effect of specific diseases on malnutrition on a larger scale.Background/purpose The electronic clinical decision support system (CDSS) is mainly used to assist health care providers in their decision-making process. CDSS includes the dose range checking (DRC) tool. This study aims to evaluate the clinical validity of the DRC tool and compare it to the institutional Formulary and Drug Therapy Guide powered by Lexi-Comp. Methods This retrospective study analyzed DRC alerts in the inpatient setting. Alerts were assessed for their clinical validity when compared to recommendations of the institution’s formulary. Relevant data regarding patient demographics and characteristics were collected. A sample size of 3000 DRC alerts was needed to give a margin of error of 1% (using normal approximation to binomial distribution gives 30.26/3000 = 1%). Results In our cohort, 1659 (55%) of the DRC alerts were generated for adult patients. A total of 1557 (52%) of all medication-related DRC alerts recommended renal dose adjustments, while 708 (24%) needed hepatic dose adjustments. Majority of alerts, 2844 (95%), were clinically invalid. A total of 2892 (96%) alerts were overridden by prescribers. In 997 (33%) cases, there was an overdose relative to the recommended dose, and in 1572 (52%) there was underdosing. Residents were more likely to accept the DRC alerts compared with other health provider categories (P less then .001). Conclusion Using DRC as a clinical decision support tool with minimal integration yielded serious clinically invalid recommendations. This could increase medication-prescribing errors and lead to alert fatigue in electronic health care systems.Background Antimicrobial stewardship programs commonly utilize infectious diseases pharmacists to guide appropriate utilization of broad-spectrum antimicrobials. Strategies should be developed to increase staff pharmacist’s participation in decreasing broad-spectrum antibiotic use. Objective The purpose of this study was to determine the effectiveness of a pharmacy-driven 72-hour antimicrobial stewardship initiative. Methods A pharmacy-driven 72-hour antibiotic review policy was implemented at a community hospital. Targeted antibiotics included ertapenem, meropenem, and daptomycin. The hospital’s infectious diseases pharmacist provided policy education to staff pharmacists. All pharmacists provided prospective audit and feedback to physicians. Preimplementation and postimplementation data were collected through a retrospective chart review to analyze the impact of the initiative. Results There were a total of 570 targeted antibiotic orders for review, of which 155 antibiotic orders met criteria for inclusion; 97 in the preimplementation group and 58 in the postimplementation group.