Many patients cannot swallow safely or have medical conditions that require the use of enteral feeding tubes for prolonged periods of time. For such patients, medication administration can present challenges. Alternative methods of drug administration may be considered, such as transdermal, rectal, or injectable routes. However, there are limitations in availability, convenience, cost, and patient acceptance with alternative routes. Liquid preparations of medications are frequently unavailable or at times inappropriate. Therefore, the use of oral solid dosage forms delivered through an enteral feeding tube is often used for multiple reasons. 1 Several aspects must be considered before administering medications through an enteral access device. Dosage form, ability to crush, feeding tube size, placement site, and compatibility with enteral nutrition are just a few of many relevant considerations. For a more extensive discussion of medication administration through enteral feeding tubes, interested readers are directed to more comprehensive reviews. 1-3 646384P MTXXX10.

Background: Published literature has described the temporal relationship of dexmedetomidine with elevated temperatures, but there is limited data to quantify the incidence of fever in ICU patients receiving dexmedetomidine. Objective: The primary objective of this study was to estimate the incidence of temperature greater than or equal to 38.5°C in ICU patients receiving dexmedetomidine. Methods: This was a retrospective cohort study of ICU patients who received dexmedetomidine with a propensity-matched subgroup analysis comparing dexmedetomidine fever patients to non-fever patients. Patients 18 years of age and older admitted between November 2017 and August 2018 who received continuous dexmedetomidine for 6 or more hours were eligible for inclusion. Included patients with a temperature of great than or equal to 38.5°C while receiving dexmedetomidine were established as having dexmedetomidine-related fever. Results: Of 882 eligible ICU patients, 404 dexmedetomidine patients were included in the study. Sixty-one patients (15.1%) met the definition for the primary endpoint. Forty-two patients who received dexmedetomidine but experienced no fever were matched for multivariate analysis. The fever group received a higher mean maximum infusion rate (0.98 µg/kg/h ± 0.43 vs. 0.68 µg/kg/h ± 0.42, P < 0.001) and a longer median duration of dexmedetomidine (43.0 hours [range 7-711] vs. 24.3 hours [6-148], P = 0.001) compared to the non-fever group. Conclusion: Fever greater than 38.5°C was observed in 15.1% of ICU patients while receiving dexmedetomidine. Prospective studies are warranted to validate these findings.

<p>Lifestyle diseases represent a large burden on developed societies and account for much morbidity worldwide. Research has shown that eating a diet rich in fruit and vegetables helps to ameliorate and prevent some of these diseases. Antioxidants found in fruits and vegetables may provide a substantial benefit in reducing disease incidence. This study examines the antioxidant properties of resveratrol, piceatannol, and pterostilbene, and the ability of Burkitt’s Lymphoma (Raji) cells to uptake these three antioxidants. It also studies the effect of the antioxidants in protecting against DNA damage, and their role in DNA repair following oxygen radical exposure in Raji cells. The Oxygen Radical Absorbance Capacity (ORAC) assay was used to measure overall antioxidant contribution as well as the ability of Raji cells to uptake antioxidant following exposure to 2,2’-Azobis(2-methyl-propionamide) dihydrochloride (AAPH). The single cell gel electrophoresis (Comet) assay was used to assess DNA damage and DNA repair rates of cells. Results showed that Raji cells, following oxygen radical exposure, significantly uptake pterostilbene (p &lt; 0.0001), but not piceatannol or resveratrol. Piceatannol provided protection against hydrogen peroxide induced DNA damage, but pterostilbene and resveratrol increased DNA damage following hydrogen peroxide treatment. None of the compounds showed any effect on DNA repair. Overall, this study indicates there is merit for further research into the bioactive roles, including antioxidant capacity, of all three compounds. Such research may provide evidence for the more widespread use of these and other food based compounds for preventing lifestyle diseases.</p>

Purpose: To determine why an inpatient has had one of the following occurrences in the electronic health record due to an adverse drug event (ADE): international normalized ratio (INR) > 6, plasma blood glucose ≤ 50 mg/dL, or naloxone administration use. Utilizing the Institute for Healthcare Improvement (IHI) Global Trigger Tool, the information gathered will be used to determine how to prevent these events from occurring in the future. Summary: The positive predictive value (PPV) for elevated INR was 35% (confidence interval [CI] 21–53%), hypoglycemia was 70.4% (CI 62–78%), and 53% for naloxone administration (CI 45–60%). Drug interactions were the most common factor that may have contributed to an elevated INR, with a mean INR of 7.9. Basal insulin monotherapy, recent diet changes, decreases in renal function, and discontinuation/tapering of corticosteroids were all observed to be contributing factors to hypoglycemia events. The mean trigger glucose level was 42.98 mg/dL. Dose range order sets, high morphine milligram equivalents (MME), and decreased renal function may have contributed to naloxone administration. Polypharmacy was attributed to some of these adverse events, with the average inpatient MME of 100.5 mg. Conclusion: The use of trigger tool methodology was useful for identifying ADEs related to hypoglycemia with insulin, moderately useful for naloxone administration, and least successful for elevated INR with warfarin. The ADEs that were identified revealed a wide variety of contributing factors that can be used as areas of interest when creating new policies and procedures to reduce ADEs in the future.