Concomitant administration of intravenous drugs in the ICU: evaluation of physico-chemical compatibilities

Background and objective: Patients in the ICU often get many intravenous (iv) drugs at the same time. Even with three-lumen central venous catheters, the administration of more than one drug in the same iv line (IVL) is frequently necessary. The objective of this study was to observe how nurses managed to administer these many medications and to evaluate the proportion of two-drugs associations (TDA) that are compatible or not, based on known compatibility data. Design: Observational prospective study over 4 consecutive months. All patients receiving simultaneously more than one drugs in the same IVL (Y-site injection or mixed in the same container) were included. For each patient, all iv drugs were recorded, as well as concentration, infusion solution, location on the IVL system, time, rate and duration of administration. For each association of two or more drugs, compatibility of each drug was checked with each other. Compatibilities between these pairs of drugs were assessed using published data (mainly Trissel LA. Handbook on Injectable Drugs and Trissel's Tables of Physical Compatibility) and visual tests performed in our quality control laboratory. Setting: 34 beds university hospital adult ICU. Main outcome measures: Percentage of compatibilities and incompatibilities between drugs administered in the same IVL. Results: We observed 1,913 associations of drugs administered together in the same IVL, 783 implying only two drugs. The average number of drugs per IVL was 3.1 ± 0.8 (range: 2-9). 83.2% of the drugs were given by continuous infusion, 14.3% by intermittent infusion and 2.5% in bolus. The associations observed allowed to form 8,421 pairs of drugs (71.7% drug-drug and 28.3% drug-solute). According to literature data, 80.2% of the association were considered as compatible and 4.4% incompatible. 15.4% were not interpretable because of different conditions between local practices and those described in the literature (drug concentration, solute, etc.) or because of a lack of data. After laboratory tests performed on the most used drugs (furosemide, KH2PO4, morphine HCl, etc.), the proportion of compatible TDA raised to 85.7%, the incompatible stayed at 4.6% and only 9.7% remain unknown or not interpretable. Conclusions: Nurses managed the administration of iv medications quite well, as only less than 5% of observed TDA were considered as incompatible. But the 10% of TDA with unavailable compatibility data should have been avoided too, since the consequences of their concomitant administration cannot be predictable. For practical reasons, drugs were analysed only by pairs, which constitutes the main limit of this work. The average number of drugs in the same association being three, laboratory tests are currently performed to evaluate some of the most observed three-drugs associations.

Kerr measurements on single-domain SrRuO3 thin films

We report on the magneto-optical measurements of an epitaxial SrRuO3 film grown on SrTiO3 (0 0 1), which previously was determined to be single domain orientated by x-ray diffraction and Raman spectroscopy techniques. Our experiments reveal a large Kerr rotation, which reaches a maximum value of about 0.5° at low temperature. By measuring magnetic hysteresis loops at different temperatures, we determined the temperature dependence of the Kerr rotation in the polar configuration. Values of the anisotropic magnetoresistance ~ 20% have been measured. These values are remarkably higher than those of other metallic oxides such as manganites. This striking difference can be attributed to the strong spin-orbit interaction of the Ru 4d ion in the SrRuO3 compound.

Intravitreal ranibizumab for age-related macular degeneration - optical coherence tomography guided retreatment intervals and their intra- and inter-individual variability

PURPOSE:To determine whether the need for retreatment after an initial loading phase of 3 monthly intravitreal injections of ranibizumab shows an intra-individual regular rhythm and to what degree it varies between different patients.SETTING:Prospective mono-centre cohort study.METHODS:Prospective study with 42 patients with exudative age-related macular degeneration (AMD), treatment na?ve, giving informed consent. Loading dose of 3 monthly doses of ranibizumab (0,5mg), followed by a 12 months pro re nata (PRN) regimen according to early exudative signs on spectral domain optical coherence tomography (HD-OCT Cirrus Zeiss?, cube 512x126). The follow-up visits were intensified (week 4, 5, 6, 7, 8, 10, 12, 14, 16, 20, 24, etc after each injection) in order to detect exudative recurrences early, and injection followed within 3 days in cases of subretinal fluid, or intraretinal cysts, or central thickness increase of >50?m. Intervals were calculated between injections and the following recurrence was calculated for the 12 month follow-up with PRN treatment. Variability was expressed as standard deviation (SD). RESULTS Visual acuity (VA) improved from a mean ETDRS letter score of 61.6 (SD 10.8) at baseline to 68.0 (SD 10.2, +6.4 letters) at month 3 and increased further to 74.7 (SD 9.0, +13.1 letters from baseline) at month 12. The 15 patients who have completed the study by October 2010 showed maintenance of the VA improvement. Retinal thickness of the central foveal subfield improved from a mean value of 366?m(baseline) to 253?m(month 3), well maintained thereafter. Mean number of injections was 8.8 (SD 3.5) per 12 months of follow-up (after 3 loading doses), ranging from 0 to 12, with mean individual treatment-recurrence intervals ranging from 28 to >365 days (mean 58 days). Intraindividual variability of treatment-recurrence intervals, measured as SD of the individual intervals, was 7.1days as a mean value(range 1.7 ? 22.6 days) for the 33 patients with more than 1 injection during follow-up. SD was higher for longer intervals of an individual patient. It ranged within 20% of the mean intra-individual interval for 30 patients(91%) and within 15% for 21 patients(64%). The first interval was within 1 week of the mean intra-individual interval in 64% of patients and within 2 weeks in 89% of patients.CONCLUSIONS:The majority of AMD patients showed a relatively stable rhythm for PRN injections of intravitreal ranibizumab after initial loading phase, associated with excellent functional and anatomical results. The initial interval between last loading dose and first recurrence may have a predictive value for further need of treatment, therefore potentially facilitating follow-up and patient care.

Least limiting water range in assessing compaction in a Brazilian Cerrado latosol growing sugarcane

In the south-central region of Brazil, there is a trend toward reducing the sugarcane inter-harvest period and increasing traffic of heavy harvesting machinery on soil with high water content, which may intensify the compaction process. In this study, we assessed the structural changes of a distroferric Red Latosol (Oxisol) by monitoring soil water content as a function of the Least Limiting Water Range (LLWR) and quantified its effects on the crop yield and industrial quality of the first ratoon crop of sugarcane cultivars with different maturation cycles. Three cultivars (RB 83-5054, RB 84-5210 and RB 86-7515) were subjected to four levels of soil compaction brought about by a differing number of passes of a farm tractor (T0 = soil not trafficked, T2 = 2 passes, T10 = 10 passes, and T20 = 20 passes of the tractor in the same place) in a 3 × 4 factorial arrangement with three replications. The deleterious effects on the soil structure from the farm machinery traffic were limited to the surface layer (0-10 cm) of the inter-row area of the ratoon crop. The LLWR dropped to nearly zero after 20 tractor passes between the cane rows. We detected differences among the cultivars studied; cultivar RB 86-7515 stood out for its industrial processing quality, regardless of the level of soil compaction. Monitoring of soil moisture in the crop showed exposure to water stress conditions, although soil compaction did not affect the production variables of the sugarcane cultivars. We thus conclude that the absence of traffic on the plant row maintained suitable soil conditions for plant development and may have offset the harmful effects of soil compaction shown by the high values for bulk density between the rows of the sugarcane cultivars.