Monthly Archives: March 2016

Notes from Merck conference on Antimicrobial Stewardship 2013

Standard

Metropolitan Hotel: Vancouver

CARA: http://www.can-r.com/

http://www.vchri.ca/tags/dr-anthony-chow
http://id.med.ubc.ca/person/anthony-chow/

No Boundaries for Disease or Education

http://www.albertahealthservices.ca/hp/if-hp-antimicrobial-assessment-stewardship-resources-provincial.pdf

http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Antimicrobial%20Stewardship.pdf
http://www.hqontario.ca/Portals/0/Documents/eds/rapid-reviews/pneumonia-timing-antiobiotic-administration-131120-en.pdf
RIGHT:
Drug, dose, timing and duration
50% of use inappropriate
ID specialist + Director of Pharmacy: leverage on something that has gone bad and create a business case

Chloramphenicol PO: higher availability
T > MIC 50% of time, predictive of antibacterial effect

Early ART decreases inflammation
CMV, EBV and HCV co-infections
monocytes inflammation emerging as a new contributor for CV
The Berlin Patient: New York Times

BCPSQSC
80% of strokes can be decreased by lifestyle changes/management

Inspire action to address challenges and leverage opportunities for accelerating improvement in quality of care

Dr. Rolando Barrios: http://www.positivelivingbc.org/person/dr-rolando-barrios

Home

John Kotter: Why do change efforts fail?

The 8-Step Process for Leading Change

Leveraging client voice for improvement

BPMH: collect, clarify and reconcile

Feb 16 2015: Interesting poster read: The Use of Self-Administered Medicinal Cannabis For Cystic Fibrosis Symptom Management: Patient Reported Experiences by Kathleen MN Lee, Pat MacDiarmid, Stephen Shalansky, Pearce Wilcox
http://www.hqontario.ca/Portals/0/Documents/eds/rapid-reviews/pneumonia-timing-antiobiotic-administration-131120-en.pdf

insertion, removal or presence of a catheter in selected sites can place an anticoagulated pt at some risk for local bleeding, complications leading to neurologic injury and paraplegia by causing a spinal hematoma. Removal of catheter must occur when the pt has minimal amount of anticoagulant in their blood.
You can give anticoagulant 4 hrs after removal or 20 hrs after dose

Causes of mesenteric vein thrombosis: appendicitis, cancer, diverticulitis, liver disease with cirrhosis, pancreatitis

Angiodysplasia (swollen, fragile blood vessels in the colon that occasionally result in blood loss from the GI tract mostly related to aging and degeneration of the blood vessels.

Normal pressure hydrocephalys (NPH): Clinical symptom complex characterized by abnormal gait, urinary incontinence, dementia. Potentially reversible cause of dementia
Hydrocephalus: Disturbance of formation, flow or absorption of CSF (cerebrospinal fluid) that leads to an increase in volume occupied by this fluid in the CNS.

“In hereditary hemorrhagic telangiectasia, some arterial vessels flow directly into veins rather than into the capillaries. These abnormalities are called arteriovenous malformations. When they occur in vessels near the surface of the skin, where they are visible as red markings, they are known as telangiectases (the singular is telangiectasia).
Without the normal buffer of the capillaries, the blood moves from the arteries at high pressure into the thinner walled, less elastic veins. The extra pressure tends to strain and enlarge these blood vessels, and may result in compression or irritation of adjacent tissues and frequent episodes of severe bleeding (hemorrhage). Nosebleeds are very common in people with hereditary hemorrhagic telangiectasia, and more serious problems may arise from hemorrhages in the brain, liver, lungs, or other organs.”

May 21, 2016

Darifenacin
Antimuscarinic agent (M3 selective) Dose 7.5 to 15 mg PO daily
Peak serum levels are attained 7 hours post dose
Half life 13-19 hours