Erstad, B., Patanwala, A. E., Abarca, J., Huckleberry, Y., & Erstad, B. L. (2006). Pharmacologic management of constipation in the critically ill patient. Pharmacotherapy, 26(7).
To compare the effectiveness of common laxatives in producing a bowel movement in patients admitted to a medical intensive care unit (MICU).
Erstad, A. J., Erstad, B. L., & Nix, D. E. (2006). Accuracy and reproducibility of small-volume injections from various-sized syringes. American Journal of Health-System Pharmacy, 63(8), 748-750.
Erstad, B. L. (2015). Designing Drug Regimens for Special Intensive Care Unit Populations. World J Crit Care, 4, 139-151.
Patanwala, A. E., Erstad, B. L., & Nix, D. E. (2007). Cost-effectiveness of linezolid and vancomycin in the treatment of surgical site infections. Current Medical Research and Opinion, 23(1), 185-193.
PMID: 17257479;Abstract:
Objective: This decision-analytic study was intended to determine the expected cost-effectiveness of linezolid compared to vancomycin for treating surgical site infections (SSIs) caused by methicillin-resistant Staphyloccocus aureus (MRSA) from the perspective of a tertiary-care academic medical center. Research Design and Methods: This study is a cost-effectiveness analysis based on a modeling approach for the treatment of MRSA SSIs. Three clinical scenarios were considered in the decision analysis: (1) treatment with intravenous (IV) vancomycin during hospitalization and after discharge with home-care follow-up; (2) treatment with IV vancomycin during hospitalization, followed by oral linezolid after discharge; (3) treatment with oral linezolid during hospitalization and after discharge. Cost data was obtained from internal and external sources. Cure rate probabilities for MRSA SSIs were obtained from records at the medical center and from results of a randomized, multicenter trial. Healthcare costs for each scenario were obtained from the medical center, healthcare buying groups, and national databases. The robustness of the baseline cost-effectiveness determination was evaluated using sensitivity analyses over a broad range of costs and probabilities. Results: Treatment with oral linezolid during hospitalization and after discharge (scenario 3) was associated with lower costs ($8923, $11 479, and $12 481, respectively) and greater effectiveness (0.867, 0.787, and 0.707, respectively) compared to the IV vancomycin/oral linezolid switch (scenario 2) and IV vancomycin (scenario 1), so it dominated the latter options in the base-case, incremental cost-effectiveness analysis ($10 292, $14 486, and $17653 per MRSA SSI cure, respectively). Furthermore, the sensitivity analysis demonstrated that the IV vancomycin/oral linezolid (scenario 2) option would be the expected cost-effective choice only if the length of hospitalization for this scenario was less than 6 days or if the probability of cure with oral linezolid (scenario 3) was less than or equal to 0.72; otherwise, the oral linezolid option was dominant. A major limitation of this study is the utilization of probability estimates from both institutional and published research sources. Additionally, the success rates for linezolid were obtained from one relatively small randomized, open-label trial. Conclusions: Using decision-analytic modeling, treatment with oral linezolid during hospitalization and after discharge is expected to be the most cost-effective approach for treating SSIs caused by MRSA. © 2007 Librapharm Limited. All rights reserved: reproduction in whole or part not permitted.
Erstad, B. L. (1992). Serum albumin concentrations: Who needs them?. Annals of Pharmacotherapy, 26(9), 1134-1138.
PMID: 1421681;Abstract:
OBJECTIVE: To examine the multiple factors that influence serum albumin concentrations and to discuss settings in which the monitoring of such concentrations provides clinically useful information. DATA SOURCES: Original investigations, review articles, books, and abstracts published in English. STUDY SELECTION: Studies pertaining to factors affecting serum albumin concentration were chosen based on general applicability. Recommendations related to the appropriate monitoring of albumin concentrations were based on studies performed in the clinical setting with direct applicability to patient care. DATA EXTRACTION: Data on factors affecting serum albumin concentration were extracted from studies that resulted in similar conclusions regardless of assay technique. Appropriate indications for albumin monitoring were derived from studies demonstrating direct clinical relevance. DATA SYNTHESIS: A number of factors may influence serum albumin concentration and ultimately affect interpretation of the concentration. Serum albumin concentrations generally are useful in the institutional setting shortly after admission or preoperatively to determine patient prognosis. Albumin concentrations have limited merit for predicting the free fractions of various hormones, electrolytes, and drugs. When used as an indicator of nutritional support, albumin concentrations are most helpful when measured over longer periods in relatively stable patients. CONCLUSIONS: Serum albumin determinations should be limited to those situations in which the concentrations are likely to provide clinically useful information. Such situations are limited.
