Publications by authors named "Ryan Hanula"
Rationale & Objective: Patients treated with dialysis are commonly prescribed multiple medications (polypharmacy), including some potentially inappropriate medications (PIMs). PIMs are associated with an increased risk of medication harm (eg, falls, fractures, hospitalization). Deprescribing is a solution that proposes to stop, reduce, or switch medications to a safer alternative.
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- Standalone nucleic acid amplification tests (NAATs) for Clostridioides difficile infections often don't differentiate between colonization and actual disease, but a 2-stage algorithm combining NAATs with toxin immunoassays (Toxin) could improve diagnostic specificity.
- A systematic review of 26 studies including 12,737 patients found no significant difference in 30-day mortality between NAAT+/Toxin+ and NAAT+/Toxin- patients, but a higher recurrence rate for the former group.
- Treating patients who tested NAAT+/Toxin- lowered all-cause mortality but did not affect recurrence rates, suggesting that some of these patients might still benefit from treatment despite the limitations of observational studies.
Importance: Despite widespread use, summary evidence from prior meta-analyses has contradictory conclusions regarding whether oseltamivir decreases the risk of hospitalization when given to outpatients. Several large investigator-initiated randomized clinical trials have not yet been meta-analyzed.
Objective: To assess the efficacy and safety of oseltamivir in preventing hospitalization among influenza-infected adult and adolescent outpatients.
Background: CT head is commonly performed in the setting of delirium and altered mental status (AMS), with variable yield. We aimed to evaluate the yield of CT head in hospitalized patients with delirium and/or AMS across a variety of clinical settings and identify factors associated with abnormal imaging.
Methods: We included studies in adult hospitalized patients, admitted to the emergency department (ED) and inpatient medical unit (grouped together) or the intensive care unit (ICU).
Article Synopsis
- Studies are increasingly comparing short and long durations of antibiotic treatment, with randomized controlled trials (RCTs) being the preferred method despite their logistical challenges.
- This review compares the strengths and weaknesses of observational studies and RCTs using uncomplicated Gram-negative bacteraemia as a case example, analyzing treatment duration outcomes based on mortality and relapse rates.
- The findings suggest that observational studies indicated a higher probability (91%) of longer treatment being better for 30-day mortality compared to RCTs (42%), although none of the observational studies fully addressed potential biases.
Background: Toxoplasmic encephalitis (TE) is an opportunistic infection of people with human immunodeficiency virus (HIV) or other causes of immunosuppression. Guideline-recommended treatments for TE are pyrimethamine and sulfadiazine (P-S) or pyrimethamine and clindamycin (P-C); however, a substantial price increase has limited access to pyrimethamine. Consequently, some centers have transitioned to trimethoprim-sulfamethoxazole (TMP-SMX), an inexpensive alternative treatment.
View Article and Find Full Text PDFThis quality improvement study uses data from the MedSafer trial to evaluate drug-drug interactions between nirmatrelvir-ritonavir and maintenance medications to identify use of potentially inappropriate medications in older adults with polypharmacy.
View Article and Find Full Text PDFImportance: Widely available and affordable options for the outpatient management of COVID-19 are needed, particularly for therapies that prevent hospitalization.
Objective: To perform a meta-analysis of the available randomized clinical trial evidence for fluvoxamine in the outpatient management of COVID-19.
Data Sources: World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.