Appropriateness of antiepileptic drug level monitoring

Article Abstract:

The monitoring of patients' antiepileptic drug levels by hospitals does not appear to be reliable enough to justify the expense. Drug levels are often monitored to find out if a patient's symptoms are due to a drug reaction or overdose, but many hospitals have started monitoring antiepileptic drug levels in all patients who receive the drugs. Researchers evaluated antiepileptic drug level determinations in 330 patients for four antiepileptic drugs: phenytoin, carbamazepine, phenobarbital, and valproic acid. Of 855 antiepileptic drug level determinations, 624 were rated inappropriate, but only four had levels exceeding 20% higher than normal upper limits. None of the patients showed signs of drug toxicity. Only 27% of the drug level determinations were considered appropriate, and of these, only half were correctly sampled. Measures should be devised to improve antiepileptic drug level monitoring and sampling. Decreasing the level of unnecessary drug level determinations would result in cost savings.

Management, Measurement, Anticonvulsants, Drug metabolism

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Home uterine activity monitoring for preterm labor: policy statement

Article Abstract:

The US Preventive Task Force can neither recommend nor advise against home uterine activity monitoring (HUAM) for the prevention of preterm births. HUAM is used to screen women with high-risk pregnancies for preterm labor. Neither the sensitivity nor the accuracy of HUAM is certain. HUAM has similar results in the hospital, but physicians vary significantly in their interpretation of these results. Six research studies examined the effectiveness of HUAM in women at risk for preterm delivery. Three studies found that that HUAM did not reduce the incidence of preterm delivery or low birth weight. The other three studies found that HUAM reduced the incidence of preterm birth and low birth weight. Women who had HUAM received more nursing care than those who did not. No adverse affects have occurred among women who have had HUAM.

Care and treatment, Diagnosis, Pregnant women, Premature labor, Uterus, Uterine contractions, Pregnancy, Complications of, Pregnancy complications

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