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Zavala S, Pape KO, Walroth TA, Reger M, Hoyte B, Thomas W, Adams B, Hill DM. Vitamin D Deficiency Is Associated With Increased Length of Stay After Acute Burn Injury: A Multicenter Analysis. J Burn Care Res 2024; 45:728-732. [PMID: 38141248 DOI: 10.1093/jbcr/irad201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Indexed: 12/25/2023]
Abstract
In burn patients, vitamin D deficiency has been associated with increased incidence of sepsis and infectious complications. The objective of this study was to assess the impact of vitamin D deficiency in adult burn patients on hospital length of stay (LOS). This was a multicenter retrospective study of adult patients at 7 burn centers admitted over a 3.5-year period, who had a 25-hydroxyvitamin D concentration drawn within the first 7 days of injury. Of 1147 patients screened, 412 were included. Fifty-seven percent were vitamin D deficient. Patients with vitamin D deficiency had longer LOS (18.0 vs 12.0 days, P < .001), acute kidney injury (AKI) requiring renal replacement therapy (7.3 vs 1.7%, P = .009), more days requiring vasopressors (mean 1.24 vs 0.58 days, P = .008), and fewer ventilator-free days of the first 28 days (mean 22.9 vs 25.1, P < .001). Univariable analysis identified burn center, AKI, TBSA, inhalation injury, admission concentration, days until concentration drawn, days until initiating supplementation, and dose as significantly associated with LOS. After controlling for center, TBSA, age, and inhalation injury, vitamin D deficiency was associated with longer LOS. In conclusion, patients with thermal injuries and vitamin D deficiency on admission have increased LOS and worsened clinical outcomes when compared with patients with nondeficient vitamin D concentrations.
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Affiliation(s)
- Sarah Zavala
- Department of Pharmacy, Jesse Brown VA Medical Center, Chicago, IL 60612, USA
| | - Kate O Pape
- Department of Pharmacy, University of Iowa Health Care, Iowa City, IA 52245, USA
| | - Todd A Walroth
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN 46202, USA
| | - Melissa Reger
- Department of Pharmacy, Community Regional Medical Center, Fresno, CA 93721, USA
| | - Brittany Hoyte
- Department of Pharmacy, Corewell Health, Grand Rapids, MI 49503, USA
| | - Wendy Thomas
- Department of Pharmacy, Corewell Health, Grand Rapids, MI 49503, USA
| | - Beatrice Adams
- Department of Pharmacy, Tampa General Hospital, Tampa, FL 33606, USA
| | - David M Hill
- Department of Pharmacy, Regional One Health, Memphis, TN 38103, USA
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Garner KM, Zavala S, Pape KO, Walroth T, Reger M, Thomas W, Hoyte B, Adams B, Hill DM. A multicenter study analyzing the association of vitamin D deficiency and replacement with infectious outcomes in patients with burn injuries. Burns 2021; 48:1319-1324. [PMID: 34903417 DOI: 10.1016/j.burns.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/02/2022]
Abstract
Vitamin D (25OHD) deficiency is associated with poor outcomes in intensive care populations. The primary objective of this 7-center study was to determine if 25OHD deficiency is associated with infectious outcomes in adult burn patients. Generalized linear mixed modeling was used to control for center effect, percent total body surface area burn (% TBSA), age, and presence of inhalation injury. A total of 1147 patients were initially included (admitted January 2016 through August 2019). After exclusions, 234 (56.8%) in the deficient (25OHD < 20 ng/mL) and 178 in the non-deficient group (25OHD ≥ 20 ng/mL) remained, surpassing a priori power requirements. The non-deficient group had their concentration drawn earlier (p < 0.001), were more likely to be male (p = 0.006), Caucasian (p < 0.001), have lower body mass index (p = 0.009), lower % TBSA (p = 0.002), and taking a 25OHD supplement prior to admission (p < 0.001). Deficient patients were more likely to have an infectious outcome (52.1% vs 36.0%, p = 0.002), acute kidney injury with renal replacement therapy (p = 0.009), less ventilator free days in the first 28 days (p < 0.001), and vasopressors (p = 0.01). After controlling for center, % TBSA, age, and inhalation injury the best model also included presence of deficiency (OR 2.425 [CI 1.206-4.876]), days until 25OHD supplement initiation (OR 1.139 [CI 1.035-1.252]), and choice of cholecalciferol over ergocalciferol (OR 2.112 [CI 1.151-3.877]). To the authors' knowledge, this is the first multicenter study to evaluate the relationship between 25OHD and infectious complications in burn patients.
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Affiliation(s)
- Katelyn M Garner
- Clinical Pharmacist, Department of Pharmacy, Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA
| | - Sarah Zavala
- Clinical Pharmacist, Department of Pharmacy, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Kate O Pape
- Clinical Pharmacist, Department of Pharmacy, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Todd Walroth
- Clinical Pharmacist, Department of Pharmacy Services, Eskenazi Health, 640 Eskenazi Avenue, Indianapolis, IN 46202, USA
| | - Melissa Reger
- Clinical Pharmacist, Pharmacy Department, Community Regional Medical Center, 2823 Fresno Street, Fresno, CA 93721, USA
| | - Wendy Thomas
- Clinical Pharmacist, Pharmacy Department, Spectrum Health, 100 Michigan Street Northeast, Grand Rapids, MI 49503, USA
| | - Brittany Hoyte
- Clinical Pharmacist, Pharmacy Department, Spectrum Health, 100 Michigan Street Northeast, Grand Rapids, MI 49503, USA
| | - Beatrice Adams
- Clinical Pharmacist, Pharmacy Department, Tampa General Hospital, 1 Tampa Circle, Tampa, FL 33606, USA
| | - David M Hill
- Clinical Pharmacist, Department of Pharmacy, Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA.
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Peppard WJ, Peppard SR, Feih JT, Kim AK, Obenberger SJ, Mulvey AF, Teng BQ, Brazauskas R, Pape KO, Gibson GA, Dzierba AL, Dobesh PP. Prospective Observational Evaluation of Predatory Journals in Critical Care Pharmacy Practice: Defining Characteristics Associated With Receiving Unsolicited Invitations to Publish. J Pharm Pract 2021; 36:494-500. [PMID: 34645297 DOI: 10.1177/08971900211036091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Open-access publishing promotes accessibility to scholarly research at no cost to the reader. The emergence of predatory publishers, which exploit the author-pay model by charging substantial publication fees for publication in journals with questionable publishing processes, is on the rise. Authors are solicited through aggressive marketing tactics, though who is targeted is not well described. The purpose of this study was to identify characteristics associated with critical care pharmacists that make them targets of unsolicited invitations to publish. A prospective, observational study of critical care pharmacists was performed. Participants archived emails received by their professional email that were unsolicited invitations to submit their original work for publication in a journal (unsolicited journals). Variables were evaluated to determine which were associated with unsolicited invitations; these were compared to legitimate journals, defined as all PubMed-indexed journals in which the participants were previously published. Twenty-three pharmacist participants were included, all of whom were residency and/or fellowship trained and practicing in an academic medical center. Participants had a median of 7 years of experience since their post-graduate training, 6 years since their last change in professional email address, and 2 years since their first PubMed-indexed publication. From these participants, 136 unsolicited and 59 legitimate journals were included. The average number of invitations increased 1.04 (95% CI, 1.02-1.05) times for every additional PubMed-indexed publication (P < .001). Most unsolicited journals were considered predatory. Legitimate and unsolicited journals differed significantly. The number of previous PubMed-indexed publications strongly correlates with the likelihood of critical care pharmacists receiving unsolicited publication invitations, often from predatory journal.
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Affiliation(s)
- William J Peppard
- 5506Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sarah R Peppard
- 5506Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joel T Feih
- 5506Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andy K Kim
- 5506Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Ashley F Mulvey
- 5506Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bi Qing Teng
- 5506Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ruta Brazauskas
- 5506Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kate O Pape
- 5506Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Amy L Dzierba
- 5506Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paul P Dobesh
- 5506Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
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Heard J, Shamrock A, Galet C, Pape KO, Laroia S, Wibbenmeyer L. Thrombolytic Use in Management of Frostbite Injuries: Eight Year Retrospective Review at a Single Institution. J Burn Care Res 2021; 41:722-726. [PMID: 32030427 DOI: 10.1093/jbcr/iraa028] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Frostbite injuries are uncommon, understudied, and lack standardized treatment protocols. Although thrombolytics are commonly used, their efficacy remains controversial. Herein, we report the results of a retrospective review of frostbite treatment practices at a single institution. The impact of thrombolytics on outcomes was evaluated. Medical records of frostbite patients admitted between January 2010 and April 2018 were reviewed. Demographics, injury details, treatment, and outcomes were collected. Descriptive statistics were obtained. A case-control analysis comparing patients who received tissue plasminogen activator (tPA) with those who did not was performed. A total of 102 patients were included. The mean age was 43 ± 17.7; 82.4% were male. About 13% of patients were presented with first-degree, 54% with second-degree, 29% with third-degree, and 5% with fourth-degree frostbite. Toes (69%), fingers (53%), and feet (43%) were most commonly affected. Thirteen patients had angiograms. Twelve patients received tPA: three systemic tPA and nine catheter-directed tPA. Overall, 32 patients (31%) required surgery and 27 (26.5%) patients required amputation with an average of 6.5 digits amputated. Digit salvage rate based on angiography was 84.7%. Length of stay (P = .046), number of operations (P = .037), and need for surgery (P = .030) were significantly lower for patients who received thrombolytics. Two patients had bleeding complications but did not require intervention or interruption of therapy. Despite its small sample size, our study suggests benefits from thrombolytic therapy. Prospective, well designed, and multi-institutional studies are warranted to establish evidence-based treatment guidelines for the management of frostbite injuries.
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Affiliation(s)
| | | | | | - Kate O Pape
- Department of Pharmaceutical Care.,College of Pharmacy
| | - Sandeep Laroia
- Department of Radiology, The University of Iowa, Iowa City, Iowa
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Cox CL, McIntire AM, Bolton KJ, Foster DR, Fritschle AC, Harris SA, Pape KO, Whitten JA, Harman BC, Sood R, Walroth TA. A Multicenter Evaluation of Outcomes Following the Use of Nebulized Heparin for Inhalation Injury (HIHI2 Study). J Burn Care Res 2020; 41:1004-1008. [PMID: 32594168 DOI: 10.1093/jbcr/iraa101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Inhalation injury causes significant morbidity and mortality secondary to compromise of the respiratory system as well as systemic effects limiting perfusion and oxygenation. Nebulized heparin reduces fibrin cast formation and duration of mechanical ventilation in patients with inhalation injury. To date, no study has compared both dosing strategies of 5000 and 10,000 units to a matched control group. This multicenter, retrospective, case-control study included adult patients with bronchoscopy-confirmed inhalation injury. Each control patient, matched according to age and percent of total body surface area, was matched to a patient who received 5000 units and a patient who received 10,000 units of nebulized heparin. The primary endpoint of the study was duration of mechanical ventilation. Secondary endpoints included 28-day mortality, ventilator-free days in the first 28 days, difference in lung injury scores, length of hospitalization, incidence of ventilator-associated pneumonia, and rate of major bleeding. Thirty-five matched patient trios met inclusion criteria. Groups were well-matched for age (P = .975) and total body surface area (P = .855). Patients who received nebulized heparin, either 5000 or 10,000 units, had 8 to 11 less days on the ventilator compared to controls (P = .001). Mortality ranged from 3 to 14% overall and was not statistically significant between groups. No major bleeding events related to nebulized heparin were reported. Mechanical ventilation days were significantly decreased in patients who received 5000 or 10,000 units of nebulized heparin. Nebulized heparin, either 5000 units or 10,000 units, is a safe and effective treatment for inhalation injury.
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Affiliation(s)
- Courtney L Cox
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN
| | | | - Kimberly J Bolton
- Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - David R Foster
- College of Pharmacy, Purdue University, West Lafayette, IN
| | | | | | - Kate O Pape
- Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | - Brett C Harman
- Richard M. Fairbanks Burn Center, Eskenazi Health, Indianapolis, IN
| | - Rajiv Sood
- Richard M. Fairbanks Burn Center, Eskenazi Health, Indianapolis, IN
| | - Todd A Walroth
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN
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Hill DM, Pape KO, Zavala S, Boyd AN, Gayed RM, Reger M, Adams B, Voycik M, Carter KE, Quan A, Jones KM, Walroth TA. A Review of the Most Impactful Published Pharmacotherapy-Pertinent Literature of 2017 and 2018 for Clinicians Caring for Patients with Burn or Inhalation Injuries. J Burn Care Res 2020; 41:167-175. [PMID: 31400762 DOI: 10.1093/jbcr/irz138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Staying current and evaluating literature related to pharmacotherapy in burn or inhalation injury can be difficult as burn care teams are multidisciplinary and pertinent content can be spread across a plethora of journals. The goal of this review is to critically evaluate recently published pharmacotherapy-pertinent literature, assist practitioners staying current, and better identify potential future research targets. Twelve board-certified clinical pharmacists with experience caring for patients with burn and inhalation injuries reviewed and graded scientific literature published in 2017 and 2018. An MeSH-based search revealed 1158 articles related to burns, which were published during the 2-year period. One-hundred fifty one were determined to be potentially related to pharmacotherapy. After exclusions, only 82 (7%) remained for scoring, and the top 10 comprehensively presented. More than half of the reviewed manuscripts were assessed as lacking a significant impact on pharmacotherapy. There is a need for higher impact literature to support pharmacotherapy-pertinent treatment of such complex patients.
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Affiliation(s)
- David M Hill
- Department of Pharmacy, Firefighters' Burn Center, Regional One Health, Memphis, Tennessee.,Department of Clinical Pharmacy & Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kate O Pape
- Department of Pharmaceutical Care, Burn Treatment Center, University of Iowa Hospitals and Clinics, Maywood, Illinois
| | - Sarah Zavala
- Department of Pharmacy, Loyola University Medical Center, Maywood, Illinois
| | - Allison N Boyd
- Department of Pharmacy, Rhode Island Hospital Burn Center, Rhode Island Hospital, Providence
| | - Rita M Gayed
- Department of Pharmacy and Clinical Nutrition, Grady Burn Center, Grady Health System, Atlanta, Georgia
| | - Melissa Reger
- Department of Pharmacy, Leon S. Peters Burn Center, Community Regional Medical Center, Fresno, California
| | | | - Meaghan Voycik
- Department of Pharmacy, UPMC Mercy Burn Center, UPMC Mercy Hospital, Pittsburgh, Pennsylvania
| | - Kristen E Carter
- Department of Pharmacy, Burns Special Care Unit, UC Health University of Cincinnati Medical Center, Ohio
| | - Asia Quan
- Department of Pharmacy, The Arizona Burn Center at Maricopa Integrated Health System, Phoenix
| | - Kendrea M Jones
- Department of Pharmacy, Burn Center, Arkansas Children's Hospital, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock
| | - Todd A Walroth
- Department of Pharmacy, Richard M. Fairbanks Burn Center, Eskenazi Health, Indianapolis, Indiana
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