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Grifka J, Götz J, Fenk-Mayer A, Benditz A. [Injection treatment for cervical and lumbar syndromes: principles, indications and general performance]. Orthopadie (Heidelb) 2023; 52:1017-1024. [PMID: 38015212 DOI: 10.1007/s00132-023-04449-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 11/29/2023]
Abstract
An intensive conservative treatment that exhausts all treatment options should fundamentally be carried out before every surgical intervention in the region of the spinal column. The therapeutic measures are determined by the extent of the cervical or lumbar syndrome. As a rule, in cases of local complaints symptomatic measures with physiotherapy or digital healthcare applications are indicated. In cases of referred cervical and lumbar syndromes targeted injections can be employed. Before targeted injection treatment a detailed orthopedic clarification with respect to the intensity of local, radicular or pseudoradicular complaints must be carried out. When carrying out minimally invasive injection treatment specific prerequisites with respect to spatial, personnel and technical conditions must be fulfilled. The indications and contraindications must be strictly controlled.
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Affiliation(s)
- J Grifka
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach GmbH, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - J Götz
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach GmbH, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - A Fenk-Mayer
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach GmbH, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - A Benditz
- Klinikum Fichtelgebirge Marktredwitz, Schillerhain 1-8, 95615, Marktredwitz, Deutschland
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Martínez-Aguilar L, Sanz-Valero J, Martínez-Martínez F, Faus MJ. Suitability of indexing terms in the MEDLINE bibliographic database on drug-related problems. Res Social Adm Pharm 2023; 19:1440-1445. [PMID: 37481351 DOI: 10.1016/j.sapharm.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/26/2023] [Accepted: 07/12/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND For years, there has been controversy about the meaning of medication-related problems (MRPs). This has led several authors to attempt to redefine and classify this term with the aim of using it correctly in the healthcare setting. So far without achieving the desired objective, resulting in erroneous results in the sources of information and thus in malpractice in the sector. OBJECTIVE To describe and analyze the appropriateness of the existing indexing of scientific publications in the MEDLINE bibliographical database with respect to drug-related problems (DRPs) and to determine whether the descriptors used fulfilled the function of suitably representing this concept. METHODS A descriptive study was conducted, using the following search terms: Medication Errors; Drug Interactions; Drug Overdose; Drug-Related Side Effects and Adverse Reactions; Contraindications, Drug. The sample size was calculated by estimating population parameters in an infinite population (expected value = 0.05; precision of interval = 0.05; level of confidence = 0.95) and the selection method was simple random sampling without replacement, taking the total number of bibliographical references in the database as the basis. The agreement of the indexing with DRPs was evaluated with the coefficient of determination (R2), and the Cohen kappa coefficient was used for the association between the definition of the descriptors and the objective of the article. RESULTS The 1930 records analyzed showed a total of 2888 different major topics. These major topics were present, with at least one of the five descriptors studied, in 482 (25.0%; 95% CI 23.0-27.0) documentary files, with statistically significant differences between the two phases analyzed (χ2 = 183.8; degrees of freedom (df) = 1; p < 0.001): 1st phase, 295 (13.3%; 95% CI 13.7-16.9) and 2nd phase, 187 (9.7%; 95% CI 8.4-11.0). Overall scientific output with the five descriptors showed a coefficient of determination (R2) of 0.9 (p < 0.001) and the relationship between the objective of the study and the definitions of the five descriptors was 0.9 (p < 0.001). CONCLUSIONS There was a very good direct exponential trend of the overall scientific output retrieved with the terms associated with DRPs, although the progression of the five descriptors separately did not show a growth model conforming to expectations. There was a moderate agreement between the objective of the study and the definition of each of the five descriptors used and a low relationship between the objective of the study and the concept of DRPs used for this investigation. It is essential to have a descriptor that unifies the terminological diffusion that has existed up till now, since process (causes) and effects (outcomes) have been mixed together under the various definitions and classifications of DRPs found in the studies.
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Affiliation(s)
- Laura Martínez-Aguilar
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, University of Granada, Granada, Spain
| | - Javier Sanz-Valero
- Carlos III Health Institute, National School of Occupational Medicine, Madrid, Spain.
| | - Fernando Martínez-Martínez
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, University of Granada, Granada, Spain
| | - María J Faus
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, University of Granada, Granada, Spain
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Dutta AK, Jain A, Jearth V, Mahajan R, Panigrahi MK, Sharma V, Goenka MK, Kochhar R, Makharia G, Reddy DN, Kirubakaran R, Ahuja V, Berry N, Bhat N, Dutta U, Ghoshal UC, Jain A, Jalihal U, Jayanthi V, Kumar A, Nijhawan S, Poddar U, Ramesh GN, Singh SP, Zargar S, Bhatia S. Guidelines on optimizing the use of proton pump inhibitors: PPI stewardship. Indian J Gastroenterol 2023; 42:601-628. [PMID: 37698821 DOI: 10.1007/s12664-023-01428-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/10/2023] [Indexed: 09/13/2023]
Abstract
Proton pump inhibitors (PPIs) have been available for over three decades and are among the most commonly prescribed medications. They are effective in treating a variety of gastric acid-related disorders. They are freely available and based on current evidence, use of PPIs for inappropriate indications and duration appears to be common. Over the years, concerns have been raised on the safety of PPIs as they have been associated with several adverse effects. Hence, there is a need for PPI stewardship to promote the use of PPIs for appropriate indication and duration. With this objective, the Indian Society of Gastroenterology has formulated guidelines on the rational use of PPIs. The guidelines were developed using a modified Delphi process. This paper presents these guidelines in detail, including the statements, review of literature, level of evidence and recommendations. This would help the clinicians in optimizing the use of PPIs in their practice and promote PPI stewardship.
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Affiliation(s)
- Amit Kumar Dutta
- Department of Gastroenterology, Christian Medical College and Hospital, Vellore, 632 004, India.
| | | | - Vaneet Jearth
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Ramit Mahajan
- Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | | | - Vishal Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | | | | | - Govind Makharia
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | | | - Richard Kirubakaran
- Center of Biostatistics and Evidence Based Medicine, Vellore, 632 004, India
| | - Vineet Ahuja
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Neha Berry
- BLK Institute of Digestive and Liver Disease, New Delhi, 201 012, India
| | - Naresh Bhat
- Aster CMI Hospital, Bengaluru, 560 092, India
| | - Usha Dutta
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Uday Chand Ghoshal
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Ajay Jain
- Choithram Hospital and Research Center, Indore, 452 014, India
| | | | - V Jayanthi
- Sri Ramachandra Medical College, Chennai, 600 116, India
| | - Ajay Kumar
- Institute of Digestive and Liver Diseases, BLK - Max Superspeciality Hospital, New Delhi, 201 012, India
| | | | - Ujjal Poddar
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | | | - Shivram P Singh
- Kalinga Gastroenterology Foundation, Cuttack, 753 001, India
| | - Showkat Zargar
- Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Kashmir, 190 011, India
| | - Shobna Bhatia
- Sir H N Reliance Foundation Hospital, Mumbai, 400 004, India
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Bregman D, Nicholson L. Indications for replantation and factors that predict success. Eur J Orthop Surg Traumatol 2023:10.1007/s00590-023-03671-2. [PMID: 37596464 DOI: 10.1007/s00590-023-03671-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/02/2023] [Indexed: 08/20/2023]
Abstract
Since the advent of replantation techniques, there has been uneven progress in terms of success-even considering whether success is defined as continued perfusion of the digit or long term functional outcomes. Early enthusiasm and success have not been maintained despite increasing familiarity with microsurgical techniques and greater understanding of how to optimize outcomes for the individual components of replantation such as tendon repair, nerve repair, and osteosynthesis. Practitioners participating in the care of patients undergoing replantation should be familiar with the history and current understanding of both the indications and contraindications for the procedure, post-operative rehabilitation, and factors contributing to functional outcomes. A review of the literature from the first publications on the topic demonstrates evolution in practice and understanding of which patients should be indicated for replantation. Indications can be considered in three broad categories: injury factors, patient factors, and care context factors. These factors intersect with one another and can inform the surgeon pre-operatively regarding the most likely outcome for a given patient. This insight is critical to discuss pre-operatively with the patient in order to make a shared decision about how to manage their injury.
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Affiliation(s)
- Dana Bregman
- Department of Orthopedics, University of Southern California, Los Angeles, California, USA.
| | - Luke Nicholson
- Department of Orthopedics, University of Southern California, Los Angeles, California, USA
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Schoenen J, Van Dycke A, Versijpt J, Paemeleire K. Ten open questions in migraine prophylaxis with monoclonal antibodies blocking the calcitonin-gene related peptide pathway: a narrative review. J Headache Pain 2023; 24:99. [PMID: 37528353 PMCID: PMC10391994 DOI: 10.1186/s10194-023-01637-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/21/2023] [Indexed: 08/03/2023] Open
Abstract
The monoclonal antibodies (mAbs) blocking the calcitonin-gene related peptide (CGRP) pathway, collectively called here "anti-CGRP/rec mAbs", have dramatically improved preventive migraine treatment. Although their efficacy and tolerability were proven in a number of randomized controlled trials (RCTs) and, maybe even more convincingly, in real world settings, a number of open questions remain. In this narrative review, we will analyze published data allowing insight in some of the uncertainties related to the use of anti-CGRP/rec mAbs in clinical practice: their differential efficacy in migraine subtypes, outcome predictors, switching between molecules, use in children and adolescents, long-term treatment adherence and persistence, effect persistence after discontinuation, combined treatment with botulinum toxin or gepants, added-value and cost effectiveness, effectiveness in other headache types, and potential contraindications based on known physiological effects of CGRP. While recent studies have already provided hints for some of these questions, many of them will not find reliable and definitive answers before larger studies, registries or dedicated RCTs are available.
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Affiliation(s)
- Jean Schoenen
- Headache Research Unit, Department of Neurology‑Citadelle Hospital, University of Liège, Boulevard du 12 ème de Ligne 1, Liège, 4000, Belgium.
| | - Annelies Van Dycke
- Department of Neurology, General Hospital Sint-Jan Bruges, Ruddershove 10, Bruges, 8000, Belgium
| | - Jan Versijpt
- Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, Brussels, 1090, Belgium
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, 9000, Belgium
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Lee J, Hwang SC, Park ST. Pituitary Apoplexy After Leuprolide Therapy in a Breast Cancer Patient: A Case Report. Brain Tumor Res Treat 2023; 11:153-157. [PMID: 37151158 PMCID: PMC10172007 DOI: 10.14791/btrt.2023.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Pituitary apoplexy (PA) is a clinical syndrome resulting from sudden hemorrhage and/or infarction of the pituitary gland. Recent reports documented the development of PA secondary to treatment with gonadotropin-releasing hormone (GnRH) agonists for prostate cancer. A 52-year-old woman visited our emergency room with a severe headache, occurred 1 day prior. She underwent breast-conserving surgery for breast cancer 1 month prior. She was currently undergoing radiation and hormone therapy, consisting of leuprorelin. Brain contrast-enhanced MRI revealed a pituitary adenoma with internal hemorrhage in the sellar and suprasellar areas. Pachymeningeal enhancement was observed along the retroclival and bilateral frontal areas. The patient was diagnosed with PA and aseptic meningitis. The patient underwent total excision via transsphenoidal surgery 8 days after admission. The patient was pathologically diagnosed with a pituitary adenoma with necrosis. On immunochemical staining, the tumor was positive for follicle-stimulating hormone. The follow-up MRI revealed no evidence of residual tumor or an improved pachymeningeal enhancement. She is currently undergoing follow-up at the neurosurgery and endocrinology outpatient departments with no noted complications. In breast cancer patients receiving GnRH agonist therapy, PA may be rare complication.
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Affiliation(s)
- Jungbin Lee
- Department of Radiology, Soonchunghyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sun-Chul Hwang
- Department of Neurosurgery, Soonchunghyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sung-Tae Park
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
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Miao G, Chen Z, Cao H, Wu W, Chu X, Liu H, Zhang L, Zhu H, Cai H, Lu X, Shi J, Liu Y, Feng T. From Immunogen to COVID-19 vaccines: Prospects for the post-pandemic era. Biomed Pharmacother 2023; 158:114208. [PMID: 36800265 PMCID: PMC9805901 DOI: 10.1016/j.biopha.2022.114208] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/30/2022] [Accepted: 12/30/2022] [Indexed: 01/03/2023] Open
Abstract
The COVID-19 pandemic has affected millions of people and posed an unprecedented burden on healthcare systems and economies worldwide since the outbreak of the COVID-19. A considerable number of nations have investigated COVID-19 and proposed a series of prevention and treatment strategies thus far. The pandemic prevention strategies implemented in China have suggested that the spread of COVID-19 can be effectively reduced by restricting large-scale gathering, developing community-scale nucleic acid testing, and conducting epidemiological investigations, whereas sporadic cases have always been identified in numerous places. Currently, there is still no decisive therapy for COVID-19 or related complications. The development of COVID-19 vaccines has raised the hope for mitigating this pandemic based on the intercross immunity induced by COVID-19. Thus far, several types of COVID-19 vaccines have been developed and released to into financial markets. From the perspective of vaccine use in globe, COVID-19 vaccines are beneficial to mitigate the pandemic, whereas the relative adverse events have been reported progressively. This is a review about the development, challenges and prospects of COVID-19 vaccines, and it can provide more insights into all aspects of the vaccines.
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Affiliation(s)
- Ganggang Miao
- Department of General Surgery, The People’s Hospital of Danyang, Affiliated Danyang Hospital of Nantong University, Danyang, China,Department of General Surgery, The Affiliated Nanjing Hospital of Nanjing Medical University, Nanjing, China
| | - Zhiqiang Chen
- Department of Nuclear Medicine, The First Affiliated Hospital of Suzhou University, Suzhou, China
| | - Hengsong Cao
- Department of General Surgery, The Affiliated Nanjing Hospital of Nanjing Medical University, Nanjing, China
| | - Wenhao Wu
- Department of Clinical Medicine, Nanjing Medical University The First School of Clinical Medicine, Nanjing, China
| | - Xi Chu
- Department of Radiology, Nanjing Medical University The Fourth School of Clinical Medicine, Nanjing, China
| | - Hanyuan Liu
- Department of General Surgery, The Affiliated Nanjing Hospital of Nanjing Medical University, Nanjing, China
| | - Leyao Zhang
- Department of Clinical Medicine, Nanjing Medical University The First School of Clinical Medicine, Nanjing, China
| | - Hongfei Zhu
- Department of Clinical Medicine, Nanjing Medical University The First School of Clinical Medicine, Nanjing, China
| | - Hongzhou Cai
- Department of Urology, Jiangsu Cancer Hospital &The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research, Nanjing, China.
| | - Xiaolan Lu
- Department of Clinical laboratory, Canglang Hospital of Suzhou, Suzhou, China.
| | - Junfeng Shi
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Molecular and Celluar Biochemistry, Markey Cancer Center, University of Kentucky, Lexington, KY, USA.
| | - Yuan Liu
- Department of Infectious Disease,The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Tingting Feng
- Jiangsu Key Laboratory of Infection and Immunity, Institute of Biology and Medical Sciences, Soochow University, Suzhou, China.
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Ortega-Usobiaga J, Rocha-de-Lossada C, Llovet-Rausell A, Llovet-Osuna F. Update on contraindications in laser corneal refractive surgery. Arch Soc Esp Oftalmol (Engl Ed) 2023; 98:105-111. [PMID: 36114139 DOI: 10.1016/j.oftale.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/15/2022] [Indexed: 02/07/2023]
Abstract
More than 25 years of experience with refractive surgery techniques (since the FDA [Food and Drug Administration] of the United States approved the use of the excimer laser in the remodeling of the cornea in 1995), added to the technological advances in ophthalmology (femtosecond laser, topography-guided ablation, anterior segment imaging systems) and increased understanding of refractive errors, higher order aberrations, and corneal biomechanics make corneal laser refractive surgery a safe method and effective for the correction of these defects. However, to date, there are still certain circumstances that represent a contraindication for its application, in addition to others that could be associated with complications, and that must be carefully analyzed. This review analyzes the current contraindications for laser corneal refractive surgery listed in the Preferred Practice Protocols (PPPs) of the American Academy of Ophthalmology and the Spanish Ophthalmology Society. These protocols are based on the best scientific evidence currently available and allow clear recommendations to be drawn, improving the safety profile of these techniques. Contraindications can be differentiated into relative or absolute; among the latter are: age less than 18 years, the absence of refractive stability and the existence of certain ocular pathologies (including certain corneal dystrophies, keratoconus, poorly controlled dry eye) or systemic pathologies (active autoimmune processes or poorly controlled diabetes mellitus). Other circumstances such as the use of certain drugs (amiodarone, isotretinoin), extreme values of mean central keratometry and pachymetry, history of previous uveitis or glaucoma, pregnancy and lactation, are considered relative contraindications according to the PPPs. However, there are studies that demonstrate the safety of refractive surgery in some of these cases.
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Affiliation(s)
- J Ortega-Usobiaga
- Departamento de Catarata y Cirugía Refractiva, Clínica Baviera (Aier Eye Hospital Group), Bilbao, Vizcaya, Spain.
| | - C Rocha-de-Lossada
- Departamento de Oftalmología, Hospital Virgen de las Nieves, Granada, Spain; Departamento de Oftalmología (Qvision), Hospital Vithas, Almería, Spain; Departamento de Cirugía, Universidad de Sevilla, Sevilla, Spain
| | - A Llovet-Rausell
- Departamento de Catarata y Cirugía Refractiva, Clínica Baviera (Aier Eye Hospital Group), Valencia, Spain; Servicio de Oftalmología, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | - F Llovet-Osuna
- Departamento de Catarata y Cirugía Refractiva, Clínica Baviera (Aier Eye Hospital Group), Valencia, Spain; Facultad de Medicina, Ciencias de la Salud, Universidad Cardenal Herrera - CEU, Valencia, Spain
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Abstract
The following substances are approved for the treatment of glucocorticoid-induced osteoporosis: the oral bisphosphonates alendronate and risedronate, the intravenous bisphosphonate zoledronate, the RANKL antibody denosumab as antiresorptive substances and teriparatide as osteoanabolic substance. In comparison to placebo a reduction of vertebral fractures is proven for all mentioned substances. Thereby, teriparatide is more effective than alendronate and risedronate with respect to the reduction of vertebral fractures. The severity of osteoporosis, especially the presence of osteoporotic fractures, the approach of treatment (preventive or curative) and contraindications are factors that are important for the differentiated application of the mentioned substances. Furthermore, it must be noted that the effect of osteoanabolic treatment must be stabilized by a subsequent antiresorptive treatment and that after termination of antiresorptive treatment with denosumab a temporary bisphosphonate treatment is required to prevent a rebound phenomenon.
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Affiliation(s)
- Peter Oelzner
- Funktionsbereich Rheumatologie und Osteologie, Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Deutschland.
| | - T Eidner
- Funktionsbereich Rheumatologie und Osteologie, Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Deutschland
| | - A Pfeil
- Funktionsbereich Rheumatologie und Osteologie, Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Deutschland
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Ayalew MB, Spark MJ, Quirk F, Dieberg G. Potentially inappropriate prescribing for adults living with diabetes mellitus: a scoping review. Int J Clin Pharm 2022; 44:860-872. [PMID: 35776376 PMCID: PMC9393152 DOI: 10.1007/s11096-022-01414-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND People living with diabetes often experience multiple morbidity and polypharmacy, increasing their risk of potentially inappropriate prescribing. Inappropriate prescribing is associated with poorer health outcomes. AIM The aim of this scoping review was to explore and map studies conducted on potentially inappropriate prescribing among adults living with diabetes and to identify gaps regarding identification and assessment of potentially inappropriate prescribing in this group. METHOD Studies that reported any type of potentially inappropriate prescribing were included. Studies conducted on people aged < 18 years or with a diagnosis of gestational diabetes or prediabetes were excluded. No restrictions to language, study design, publication status, geographic area, or clinical setting were applied in selecting the studies. Articles were systematically searched from 11 databases. RESULTS Of the 190 included studies, the majority (63.7%) were conducted in high-income countries. None of the studies used an explicit tool specifically designed to identify potentially inappropriate prescribing among people with diabetes. The most frequently studied potentially inappropriate prescribing in high-income countries was contraindication while in low- and middle-income countries prescribing omission was the most common. Software and websites were mostly used for identifying drug-drug interactions. The specific events and conditions that were considered as inappropriate were inconsistent across studies. CONCLUSION Contraindications, prescribing omissions and dosing problems were the most commonly studied types of potentially inappropriate prescribing. Prescribers should carefully consider the individual prescribing recommendations of medications. Future studies focusing on the development of explicit tools to identify potentially inappropriate prescribing for adults living with diabetes are needed.
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Affiliation(s)
- Mohammed Biset Ayalew
- Pharmacy, School of Rural Medicine, University of New England, Armidale, NSW 2351 Australia ,Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - M. Joy Spark
- Pharmacy, School of Rural Medicine, University of New England, Armidale, NSW 2351 Australia
| | - Frances Quirk
- School of Rural Medicine, University of New England, Armidale, NSW 2351 Australia
| | - Gudrun Dieberg
- Biomedical Science, School of Science and Technology, University of New England, Armidale, NSW 2351, Australia.
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Takeshima T, Ueda K, Komori M, Zagar AJ, Kim Y, Jaffe DH, Matsumori Y, Hirata K. Potential Unmet Needs in Acute Treatment of Migraine in Japan: Results of the OVERCOME (Japan) Study. Adv Ther 2022; 39:5176-5190. [PMID: 36089637 PMCID: PMC9525323 DOI: 10.1007/s12325-022-02289-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/29/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Using data from the ObserVational survey of the Epidemiology, tReatment, and Care Of MigrainE study in Japan (OVERCOME [Japan]), we describe the current status of the acute treatment of migraine in Japan. METHODS OVERCOME (Japan) was a cross-sectional, observational, population-based web survey of people with migraine in Japan (met modified International Classification of Headache Disorders criteria or had a physician diagnosis of migraine) conducted between July and September 2020. Respondents reported current acute medication use and effectiveness (assessed using the Migraine Treatment Optimization Questionnaire [mTOQ-4]). Cardiovascular history and risk factors of the respondents were also recorded. Potential unmet acute treatment needs were defined as insufficient effect of current acute treatments (mTOQ-4 score ≤ 5), a history of oral triptan use (and not currently taking any triptan), potential contraindications to triptans due to cardiovascular comorbidities, and/or cardiovascular risk factors. RESULTS In total, 17,071 people with migraine in Japan completed the survey; 14,869 (87.1%) of these were currently using acute treatments. Poor effectiveness of current acute treatment was reported by 7170 respondents (42.0%), 900 respondents (5.3%) were former triptan users, 1759 (10.3%) had contraindications to triptans, and 9026 (52.9%) reported at least one cardiovascular risk factor. Overall, 12,649 (74.1%) of OVERCOME (Japan) respondents were categorized into one or more of these groups and were considered to have potential unmet acute treatment needs. CONCLUSION Almost three-quarters of people with migraine in Japan may have potential unmet needs for acute treatment of migraine. There are substantial opportunities for improving care for people with migraine in Japan, including prescription of novel acute medications.
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Affiliation(s)
| | - Kaname Ueda
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., 5-1-28, Isogamidori, Chuo-ku, Kobe, 651-0086, Japan
| | - Mika Komori
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., 5-1-28, Isogamidori, Chuo-ku, Kobe, 651-0086, Japan.
| | | | - Yongin Kim
- Eli Lilly and Company, Indianapolis, IN, USA
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Meyer-Schwickerath C, Köppel M, Kühl R, Rivera JB, Tsiouris A, Huber G, Wiskemann J. Health care professionals' understanding of contraindications for physical activity advice in the setting of stem cell transplantation. Support Care Cancer 2022; 30:9151-9161. [PMID: 36031656 PMCID: PMC9420674 DOI: 10.1007/s00520-022-07336-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/18/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Most patients receiving a hematopoietic stem cell transplantation (HSCT) are able to tolerate and benefit from physical activity (PA). Therefore, it is important that health care professionals (HCPs) advise patients to perform PA before, during, and after transplantation. By understanding which medical conditions and safety issues are associated with the (non-) promotion of PA, concrete actions and interventions can be planned and implemented. METHODS Physicians (N = 51), nurses (N = 52), and physical therapists (N = 26) participated in a nationwide cross-sectional online survey. HCPs' understanding of 15 medical conditions as contraindications for PA was assessed. Significant group differences were determined using chi-square analysis. RESULTS Acute infection was the only condition which was considered as contraindication by all HCPs (62.7%). Cachexia (78%), having a stoma (91%), or port (96.2%), psychological problems (88.4%), and leukopenia (83.3%) were not considered as contraindications. Six conditions were rated inconsistently between the groups, whereas physicians had the least concerns regarding PA. Physicians with an additional training in PA perceived a platelet count of ≤ 50,000/μl significantly less often as contraindication (p < 0.05). CONCLUSION The large number of potentially-answers especially in nursing staff and physical therapists might reflect caution or uncertainty. There is a clear need for a good multidisciplinary cooperation between all HCPs in order to support patients to confidently engage in PA. Furthermore, education possibilities and evidence-based courses to build knowledge regarding safety concerns should be the standard practice in the setting of HSCT. The investigative nature of the paper indicates that certain trends should be interrogated in a causal-longitudinal design.
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Affiliation(s)
- Corinna Meyer-Schwickerath
- Institute of Sports and Sports Sciences, University of Heidelberg, Heidelberg, Germany ,Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Maximilian Köppel
- Institute of Sports and Sports Sciences, University of Heidelberg, Heidelberg, Germany ,Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Rea Kühl
- Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Janina Bujan Rivera
- Institute of Sports and Sports Sciences, University of Heidelberg, Heidelberg, Germany ,Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Angeliki Tsiouris
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Gerhard Huber
- Institute of Sports and Sports Sciences, University of Heidelberg, Heidelberg, Germany
| | - Joachim Wiskemann
- Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
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Xu L, Chen L, Zhang W. Neoadjuvant treatment strategies for hepatocellular carcinoma. World J Gastrointest Surg 2021; 13:1550-1566. [PMID: 35070063 PMCID: PMC8727178 DOI: 10.4240/wjgs.v13.i12.1550] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/27/2021] [Accepted: 12/03/2021] [Indexed: 02/06/2023] Open
Abstract
The incidence of hepatocellular carcinoma (HCC) remains high globally. Surgical treatment is the best treatment for improving the prognosis of patients with HCC. Neoadjuvant therapy plays a key role in preventing tumor progression and even downstaging HCC. The liver transplantation rate and resectability rate have increased for neoadjuvant therapy. Neoadjuvant therapy is effective in different stages of HCC. In this review, we summarized the definition, methods, effects, indications and contraindications of neoadjuvant therapy in HCC, which have significance for guiding treatment.
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Affiliation(s)
- Lei Xu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Lin Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Wei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Gendolla A, Rauer N, Kraemer S, Schwerdtner I, Straube A. Epidemiology, Demographics, Triptan Contraindications, and Prescription Patterns of Patients with Migraine: A German Claims Database Study. Neurol Ther 2021; 11:167-183. [PMID: 34837636 PMCID: PMC8857336 DOI: 10.1007/s40120-021-00304-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/17/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Migraine is a neurological disease with a considerable economic and societal burden that negatively impacts quality of life and productivity. Triptans are potent serotonin receptor agonists widely used to treat migraine attacks. Little is known about German patients with migraine diagnosed with triptan contraindications or those who discontinue triptans. Methods This retrospective observational study identifies adults with migraine from a German sickness fund database (2010–2018). Migraine prevalence was calculated for the database population and extrapolated to the German Statutory Health Insurance (SHI) population. Medication use, proportion and demographics of patients with triptan contraindications, prevalence of triptan discontinuation and use of triptans by patients with contraindications were analysed. Results In total 120,170 patients with migraine were identified in the database population, of whom 77.7% were female; migraine prevalence was 2.0% (male) and 7.3% (female), leading to an extrapolated 2,923,979 patients with migraine in the entire German SHI population (2019); of these, 14.5% had ≥ 1 triptan contraindication. The most frequent contraindication was a history of stroke/transient ischaemic attack. However, an extrapolated 25.9% of patients who had a triptan contraindication received a triptan prescription following diagnosis. We calculated that 975,698 patients in the entire German SHI population had ever received a triptan, of whom 596,364 did not receive a triptan prescription in the follow-up year. Of these 596,364 individuals, 96.6% continued to receive a migraine diagnosis after their last triptan prescription. These ‘triptan discontinuers’ were predominantly female (82.6%). Most patients utilized only one specific triptan, with a large majority of ongoing triptan users who had used this specific triptan receiving > 4 prescriptions. Conclusion We confirm the existence of German patients with migraine and unmet therapeutic needs. These are patients diagnosed with triptan contraindications or patients who have discontinued triptan use despite continued migraine attacks. More research is needed to ascertain reasons for triptan discontinuation and the risk of triptan use by patients with contraindications.
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Affiliation(s)
| | | | | | | | - Andreas Straube
- Department of Neurology, Klinikum Grosshadern,University Hospital, Ludwig-Maximilian-University, 81377, Munich, Germany.
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15
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MacCallum CA, Lo LA, Boivin M. "Is medical cannabis safe for my patients?" A practical review of cannabis safety considerations. Eur J Intern Med 2021; 89:10-18. [PMID: 34083092 DOI: 10.1016/j.ejim.2021.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/23/2021] [Accepted: 05/01/2021] [Indexed: 02/07/2023]
Abstract
Medical cannabis use is increasing worldwide. Clinicians are commonly asked by patients to provide guidance on its safety and efficacy. Although there has been an increase in research on the role of medical cannabis for a number of different conditions, we found that there was a paucity of clear safety guidance on its use. We aim to address this issue by answering two pertinent clinician safety questions: 1 Can medical cannabis be safely used in this patient? 2. What strategies can be used to ensure that any harms from medical cannabis are mitigated? To address these questions, we reviewed available evidence and provided expert clinical opinion to summarize the fundamental components for evaluating medical cannabis safety and strategies to reduce risk from its use. Our review resulted in a safety-focused framework for medical cannabis initiation and utilization. We provide clear recommendations for patients being considered for cannabis (e.g. precautions, contraindications and drug interactions). Risk mitigation strategies such as appropriate chemovar (strain) selection, routes of administration, and dosing are reviewed. As with any other pharmacotherapy, we review the key components of monitoring and address potential issues that may arise while using medical cannabis. We propose a structured assessment and monitoring strategy that can be used by clinicians recommending cannabis (CRC) to guide patients through each step of their cannabis journey. This framework can be used to ensure that medical cannabis utilization is associated with the lowest possible risk to the patient.
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Affiliation(s)
- Caroline A MacCallum
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Faculty of Medicine, Division of Palliative Care, UBC, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, UBC, Vancouver, BC, Canada.
| | - Lindsay A Lo
- Department of Psychology, Queen's University, Kingston, ON, Canada
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16
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Esposito L, Allaix ME, Galosi B, Cinti L, Arezzo A, Ammirati CA, Morino M. Should be a locally advanced colon cancer still considered a contraindication to laparoscopic resection? Surg Endosc 2021. [PMID: 34129086 DOI: 10.1007/s00464-021-08600-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/06/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The role of elective laparoscopic resection (LR) for the treatment of locally advanced colon cancer (LACC) is unclear. Most studies have retrospectively investigated the outcomes of LR for pT4 cancers, while clinical T4 (cT4) cancers are excluded in the large randomized controlled trials comparing LR and open resection (OR). The aim of this study was to investigate the outcomes in patients undergoing elective LR for LACC. METHODS A prospective single-institution database including consecutive patients undergoing elective LR for clinical LACC (high-risk T3 or T4 N0-2) between March 1996 and March 2017 was retrospectively reviewed. A multivariate analysis was performed to identify predictors of conversion to OR and risk factors for adverse oncologic outcomes. RESULTS A total of 300 patients undergoing LR for LACC were included. A multi-visceral resection was needed in 17 (5.7%) patients. A total of 63 (21%) LRs were converted to OR, mainly due to suspected adjacent organ invasion (82.5%) or obesity (9.5%). Overall postoperative Clavien-Dindo 3-4 complication rate was 4.7%, with no significant differences between completed and converted LRs. Final pathology showed 18 (6%) pT2, 215 (71.7%) pT3, 54 (18%) pT4a, and 13 (4.3%) pT4b cancers. A R0 resection was achieved in 98.3% of patients. On multivariate analysis, tumor size ≥ 7 cm and tumor site (splenic flexure) were the independent risk factors for conversion to OR. A pT4 colon cancer and LNR of 0.25 or greater, but not conversion to OR, were independently associated with both poorer OS and DFS. CONCLUSION(S) Clinical LACC should not be considered a contraindication to LR itself. Bulky tumors ≥ 7 cm and splenic flexure cancers are at higher risk of conversion to OR; however, there is no increased postoperative morbidity or adverse oncologic outcomes in converted patients.
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Rodriguez MI, Kaufman M, Manibusan B, Anderson L, McConnell KJ. Medical contraindications to combined hormonal contraceptive use among women using methods prescribed by a pharmacist. Contraception 2021; 104:547-552. [PMID: 34116068 DOI: 10.1016/j.contraception.2021.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether pharmacist prescription of combined hormonal contraception is associated with inappropriate prescription to women with medical contraindications. STUDY DESIGN We conducted a retrosopective cohort study of all short-acting, hormonal contraceptive users (pill, patch, ring, injectable) in Oregon's All Payer All Claims database from January 1, 2016 to December 31, 2018. Our primary outcome was the proportion of women receiving a combined hormonal method who had a Medical Eligibility Category (MEC) 3 or 4 condition. We identified potential contraindications using International Classification of Disease codes. We conducted descriptive analyses of contraindication prevalence and prescription error rate by prescriber type. We used a multivariable logistic regression model to test the association between pharmacist prescriber and population characteristics. RESULTS Our study sample consisted of 439,240 contraceptive users, of which 3782 (0.86%) received their prescriptions from a pharmacist. Women aged 25 to 29 were more likely than women over age 35 to receive contraception from a pharmacist (adjusted odds ratio (aOR) 2.74, 95% confidence interval [CI] 2.44-3.08). Pharmacist prescriptions were slightly less likely in rural areas (aOR 0.78, 95% CI 0.69-0.89) and among women on Medicaid, relative to those with commercial insurance (aOR 0.21, 95% CI 0.19-0.24). Among women given contraception in a clinical setting, 4.25% had evidence of an MEC 3 or 4 contraindication, compared to 0.9% for women seen by a pharmacist. Rates of prescribing a combined method to women with a potential contraindication were not meaningfully different by prescriber type (2.16% for clinicians vs 0.74% for pharmacists). CONCLUSION Rates of contraceptive prescribing with a contraindication were relatively low and did not differ between clinicians and pharmacists. IMPLICATIONS Pharmacists can safely screen for medical contraindications to combined hormonal contraception.
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Affiliation(s)
- Maria I Rodriguez
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, United States; Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, United States.
| | - Menolly Kaufman
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, United States
| | - Brynna Manibusan
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, United States
| | - Lorinda Anderson
- College of Pharmacy, Oregon State University, Corvallis, OR, United States
| | - K John McConnell
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, United States
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18
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Gabor JJ, Kreidenweiss A, Weber S, Salama M, Sulyok M, Sulyok Z, Koehne E, Esen M, Kreuels B, Shamsrizi P, Biecker E, Mordmüller B, Berg CP, Fusco S, Köhler C, Kubicka S, Leitlein J, Addo M, Ramharter M, Schwab M, Bissinger AL, Velavan TP, Krishna S, Kremsner PG. A call to caution when hydroxychloroquine is given to elderly patients with COVID-19. Int J Infect Dis 2021; 106:265-268. [PMID: 33848675 PMCID: PMC8035801 DOI: 10.1016/j.ijid.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Use of hydroxychloroquine in patients with coronavirus disease 2019 (COVID-19) was widespread and uncontrolled until recently. Patients vulnerable to severe COVID-19 are at risk of hydroxychloroquine interactions with co-morbidities and co-medications contributing to detrimental, including fatal, adverse treatment effects. Methods A retrospective survey was undertaken of health conditions and co-medications of patients with COVID-19 who were pre-screened for enrolment in a randomized, double-blind, placebo-controlled hydroxychloroquine multi-centre trial. Results The survey involved 305 patients [median age 71 (interquartile range 59–81) years]. The majority of patients (n = 279, 92%) considered for inclusion in the clinical trial were not eligible, mainly due to safety concerns caused by health conditions or co-medications. The most common were QT-prolonging drugs (n = 188, 62%) and haematologic/haemato-oncologic diseases (n = 39, 13%) which prohibited the administration of hydroxychloroquine. In addition, 165 (54%) patients had health conditions and 167 (55%) patients were on co-medications that did not prohibit the use of hydroxychloroquine but had a risk of adverse interactions with hydroxychloroquine. The most common were diabetes (n = 86, 28%), renal insufficiency (n = 69, 23%) and heart failure (n = 58, 19%). Conclusion The majority of hospitalized patients with COVID-19 had health conditions or took co-medications precluding safe treatment with hydroxychloroquine. Therefore, hydroxychloroquine should be administered with extreme caution in elderly patients with COVID-19, and only in clinical trials.
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Affiliation(s)
- Julian J Gabor
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; Zollernalb Hospital Balingen, Balingen, Germany.
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; German Centre for Infection Research, Tübingen / Hamburg, Germany
| | - Stefan Weber
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany
| | | | - Mihaly Sulyok
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; Zollernalb Hospital Balingen, Balingen, Germany; Department of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Zita Sulyok
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; Neonatology, University Hospital Tübingen, Tübingen, Germany
| | - Erik Koehne
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; Zollernalb Hospital Balingen, Balingen, Germany
| | - Meral Esen
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; German Centre for Infection Research, Tübingen / Hamburg, Germany
| | - Benno Kreuels
- Department of Tropical Medicine Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Parichehr Shamsrizi
- Department of Tropical Medicine Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Benjamin Mordmüller
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Christoph P Berg
- Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Stefano Fusco
- Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Carsten Köhler
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; German Centre for Infection Research, Tübingen / Hamburg, Germany
| | | | | | - Marylyn Addo
- Department of Tropical Medicine Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; German Centre for Infection Research, Tübingen / Hamburg, Germany
| | - Michael Ramharter
- Centre de Recherches Médicale de Lambaréné, Lambaréné, Gabon; Department of Tropical Medicine Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; German Centre for Infection Research, Tübingen / Hamburg, Germany
| | - Matthias Schwab
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany; Departments of Clinical Pharmacology, and Pharmacy and Biochemistry, University Tübingen, Tübingen, Germany
| | - Alfred Lennart Bissinger
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany
| | - Thirumalaisamy P Velavan
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; Vietnamese-German Centre for Medical Research, Hanoi, Viet Nam
| | | | - Peter G Kremsner
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; Centre de Recherches Médicale de Lambaréné, Lambaréné, Gabon; German Centre for Infection Research, Tübingen / Hamburg, Germany
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Abstract
Video capsule endoscopy is indicated in a broad range of clinical settings, most commonly in evaluating suspected small bowel bleeding. It is also useful in diagnosing Crohn's disease and monitoring patients with known Crohn's. Video capsule endoscopy has a role in evaluating patients with refractory celiac disease symptoms and in surveying patients with polyposis syndromes. The only absolute contraindication to video capsule endoscopy is luminal gastrointestinal tract obstruction. Despite manufacturer statement, video capsule endoscopy can be used safely in patients with implantable cardiac devices including pacemakers, defibrillators, and ventricular assist devices.
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Affiliation(s)
- Jacquelyn G Bolwell
- Duke University Medical Center, 1151 Duke South, Yellow Zone, Box 3534, Durham, NC 27710, USA
| | - Daniel Wild
- Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA.
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Prinz J, Mehta JS, Walter P, Fuest M. [Simple limbal epithelial transplantation (SLET) : A simple technique for the treatment of unilateral complete limbal stem cell deficiency. Video article]. Ophthalmologe 2021; 118:404-412. [PMID: 33683425 DOI: 10.1007/s00347-021-01346-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of simple limbal epithelial transplantation (SLET) is the regeneration of the corneal surface in unilateral complete limbal stem cell deficiency (LSCD). INDICATIONS SLET is indicated for unilateral complete LSCD. CONTRAINDICATIONS Contraindications include bilateral LSCD, severe corneal thinning, pronounced keratoconjunctivitis sicca, chronic inflammatory condition of the ocular surface, malposition of the eyelids and pronounced adhesions of the conjunctiva with trichiasis. SURGICAL TECHNIQUE A 1‑h biopsy is obtained from the superior limbus of the healthy donor eye. A 360° peritomy is performed on the LSCD eye and pannus tissue covering the cornea is removed. An amniotic membrane (AM) is glued to the corneal surface with fibrin. The donor tissue is then divided into 8-10 small pieces, which are placed on the AM sparing the visual axis and fixed by fibrin glue. A contact lens is placed on the eye. A surgical video, which is available online, shows the surgical technique in detail. FOLLOW-UP Examinations are necessary within the first postoperative week and 1 month after SLET, then every 3 months within the first postoperative year. Antibiotic eye drops should be applied 5 times daily until complete epithelialization. Topical steroids should be applied 6 times daily in the early postoperative period and can be tapered thereafter. Artificial tears can improve epithelial healing. Ideally, all eye drops should be preservative-free. The contact lens can be removed after 7-10 days. The AM dissolves within a few weeks. An epithelialization of the corneal surface can be observed by the second postoperative week. EVIDENCE A recent systematic review reported a stable epithelialized corneal surface in 78% of SLET cases after 1.5 years. An improvement of visual acuity of at least two lines was found in 69% of SLET cases.
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Affiliation(s)
- Julia Prinz
- Klinik für Augenheilkunde, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapur, Singapur
- Singapore Eye Research Institute, Singapur, Singapur
| | - Peter Walter
- Klinik für Augenheilkunde, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Matthias Fuest
- Klinik für Augenheilkunde, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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Postler A, Lützner C, Lange T, Schmitt J, Lützner J, Günther KP. [Decision for total hip arthroplasty-the surgeons' view]. Orthopade 2021; 50:278-86. [PMID: 33666675 DOI: 10.1007/s00132-021-04078-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The decision for total hip arthroplasty (THA) is based on pain, loss of function, radiological changes and failed conservative therapy. These criteria are rarely based on systematic research and have not been integrated in generally accepted treatment guidelines. Aim of our study was, therefore, to analyse which decision criteria German orthopaedic and trauma surgeons use in order to recommend THA for patients with hip osteoarthritis. MATERIALS AND METHODS From 10/2019 to 07/2020 we conducted a nation-wide survey among 218 orthopaedic and trauma surgeons about their criteria for and against THA surgery, as well as their treatment objectives. RESULTS 147 fully completed questionnaires were analysed. Pain (99%), limitation of movement (99%), as well as impairment of walking distance (97%), and the subjective burden (97%) were the most frequent criteria. 97% and 96% of surgeons consider prescription of analgesics and physical therapy, as well as a lack of their effectiveness, as criteria for THA. 87% see radiological changes grade Kellgren & Lawrence III as threshold. A recommendation against surgery is triggered by obesity (BMI ≥ 40 kg/m2) in 48% and by the presence of an active infection in 96%. CONCLUSIONS Current surgeons' practice criteria of recommendations for THA in Germany seem to reflect widely nationally and internationally discussed recommendations. Particular attention is given to patient factors like pain, loss of function and subjective burden, as well as previous conservative treatment and contraindications, like poorly controlled diabetes or an active infection, whereas morbid obesity is not seen as contraindication by all surgeons.
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Barison A, Baritussio A, Cipriani A, De Lazzari M, Aquaro GD, Guaricci AI, Pica S, Pontone G, Todiere G, Indolfi C, Dellegrottaglie S. Cardiovascular magnetic resonance: What clinicians should know about safety and contraindications. Int J Cardiol 2021; 331:322-328. [PMID: 33571560 DOI: 10.1016/j.ijcard.2021.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/19/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
Cardiovascular magnetic resonance (MR) is a multiparametric, non-ionizing, non-invasive imaging technique, which represents the imaging gold standard to study cardiac anatomy, function and tissue characterization. Faced with a wide range of clinical application, in this review we aim to provide a comprehensive guide for clinicians about MR safety, contraindications and image quality. Starting from the physical interactions of the static magnetic fields, gradients and radiofrequencies with the human body, we will describe the most common metal and electronic devices which are allowed (MR-safe), allowed under limited conditions (MR-conditional) or contraindicated (MR-unsafe). Moreover, some conditions potentially affecting image quality and patient comfort will be mentioned, including arrhythmias, claustrophobia, and poor breath-hold capacity. Finally, we will discuss the pharmacodynamics and pharmacokinetics of current gadolinium-based contrast agents, their contraindications and their potential acute and chronic adverse effects, as well as the safety issue concerning the use of vasodilating/inotropic agents in stress cardiac MR.
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Affiliation(s)
| | - Anna Baritussio
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Italy
| | - Alberto Cipriani
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Italy
| | - Manuel De Lazzari
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Italy
| | | | - Andrea Igoren Guaricci
- University Cardiology Unit, Cardiothoracic Department, Policlinic University Hospital, Bari, Italy
| | - Silvia Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Milan, Italy
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Ciro Indolfi
- Division of Cardiology, Magna Graecia University, Catanzaro, Italy; Center for Cardiovascular Research, Magna Graecia University, Catanzaro, Italy; Mediterranea Cardiocentro, Naples, Italy
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Houvèssou GM, Farías-Antúnez S, da Silveira MF. Combined hormonal contraceptives use among women with contraindications according to the WHO criteria: A systematic review. Sex Reprod Healthc 2021; 27:100587. [PMID: 33545506 DOI: 10.1016/j.srhc.2020.100587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/06/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Combined hormonal contraceptives (CHC), containing estrogen, remain the most popular choice of contraceptive among women. While the method offers many benefits, the use of CHC involves potential health risks. The aim of this study was to analyze the available evidence on the prevalence of CHC use among women with contraindications to their use according to the WHO recommendations (2015). METHODS Pubmed, Lilacs, and Web of Sciences databases were searched. Selection was based on articles that described the use of combined hormonal contraceptives according to the characteristics that are listed as contraindications in WHO medical eligibility criteria for contraceptive use. RESULTS A total of 4363 articles were identified and 18 articles were selected for the review. The most prevalent contraindications against use of CHC were systemic arterial hypertension, migraine, and smoking (in women aged 35 years or older). Prevalence rates of contraindications against use of CHC ranged from 5.9% to 41.9%. CONCLUSIONS A high proportion of women still use CHC when contraindicated to do so according to the WHO criteria. Health policies should focus on highlighting the importance of a detailed health evaluation on CHC candidates, to reduce the proportion of inappropriate prescriptions.
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Leroy-Melamed M, Katz A, Shew ML. Menstrual Dysfunction and Treatment Among Adolescents With Congenital Heart Disease. J Pediatr Adolesc Gynecol 2020; 33:686-690. [PMID: 32827759 PMCID: PMC9134926 DOI: 10.1016/j.jpag.2020.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE This study describes menstrual dysfunction and treatment among adolescent and young adult (AYA) females with congenital heart disease (CHD). DESIGN Data collected from a 1-time survey completed by AYA females (and mothers if AYA unable). SETTING Participants were recruited from pediatric cardiology clinics. PARTICIPANTS Female AYA with CHD, aged 14-21 years (N = 114). INTERVENTIONS None. MAIN OUTCOME MEASURES The questionnaire assessed sexual and reproductive health (SRH) concerns, behaviors, and management. Outcome measures were self-reported menstrual complaints, use of over-the-counter (OTC) pain relief medications for dysmenorrhea, reported visits with a clinician for a menstrual problem, and reported use of hormones for menstrual problems or birth control. RESULTS Mean age was 17.0 years (SD = 2.2). The majority of participants (83%) reported 1 or more menstrual complaints (67.5% cramping, 42.1% irregular menses, 46.5% heavy periods), and 88% reported any history of taking OTC medications for pain relief. Increased menstrual complaints were not associated with level of cardiac complexity, reported transplantation, or reported use of hormonal contraception. However, 32% of participants reported use of hormonal contraception for menstrual dysfunction. Combined oral contraceptive pills (COCs) were the most common; 2 of these women carried contraindications to estrogen. CONCLUSIONS A large majority of AYA females with CHD reported menstrual dysfunction. Use of OTC medication for menstrual pain and inappropriate use of estrogen creates concerns that menstrual disorders may be unaddressed or addressed inappropriately. Thus, gynecological needs of adolescents with CHD may need to be specifically targeted by providers who feel comfortable with this population and their complex needs.
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Affiliation(s)
| | - Amy Katz
- Indiana University School of Medicine, Indianapolis, IN
| | - Marcia L Shew
- Indiana University School of Medicine, Indianapolis, IN
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Alsulami R, Alzahrani S, AlQahtani B, Khayyat H, Alghamdi S. Reasons for not performing surface ablation refractive surgery in Saudi population. Saudi J Ophthalmol 2020; 34:35-39. [PMID: 33542985 PMCID: PMC7849858 DOI: 10.4103/1319-4534.301294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 01/31/2020] [Accepted: 02/25/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE: The primary goal of this study is to analyze the reasons why refractive surgery was not performed for candidates who requested the procedure among single eye-clinic visitors in Saudi Arabia. Secondarily, we aimed to determine the corneal parameters that are characteristic of Saudi population and to figure out the relationship between the magnitude of central corneal thickness and the degree of myopia. METHODS: A retrospective data was collected for all patients who presented to a single-surgeon eye clinic at King Abdul Aziz Medical City-National Guard, Saudi Arabia, seeking refractive surgery between January 2010 and December 2015. RESULTS: Unstable refraction (21.78%) followed by amblyopia with unrealistic expectations (18.75%) and high myopia (15.62%) were the most common reasons not to proceed with refractive surgery in the included sample. The mean central corneal thickness for all patients included in this study was (538 μm ± 32.6). We found no significant relationship between central corneal thickness and the degree of myopia OD [rs(178) = −0.017, P = 0.823] and OS [rs(182) = 0.016, P = 0.831] for right and left eyes, respectively. CONCLUSION: Unstable refraction followed by amblyopia with unrealistic expectations and high myopia were the leading causes not to perform refractive surgery in this study. No significant relationship can be figured out between central corneal thickness and the degree of myopia.
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Affiliation(s)
- Raed Alsulami
- Ministry of National Guard Health Affairs, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia
| | | | - Bader AlQahtani
- Ministry of National Guard Health Affairs, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia
| | - Hassan Khayyat
- Ministry of National Guard Health Affairs, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia
| | - Saeed Alghamdi
- Ministry of National Guard Health Affairs, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia
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Burn and Trauma Branch of Chinese Geriatrics Society. [National expert consensus on application of enriched platelet products in wound repair (2020 version)]. Zhonghua Shao Shang Za Zhi 2020; 36:993-1002. [PMID: 33238681 DOI: 10.3760/cma.j.cn501120-20200507-00256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Wound biotherapy, represented by platelet concentrate derivatives, has attracted much attention. However, there are some different viewpoints due to the disunity of quality control of preparation, the ways of use, and so on. The members of the consensus writing group reviewed a large number of literatures, screened out high-quality evidence references, combined with the repeated discussion of experts in the field of wound repair to form a guiding consensus of experts, so as to guide medical personnel using enriched platelet treatment scientifically and standardly in wound repair.
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Forgerini M, Schiavo G, Lucchetta RC, Mastroianni PC. Drug interactions for elderly people with mental and behavioral disorders: a systematic scoping review. Arch Gerontol Geriatr 2021; 93:104283. [PMID: 33227533 DOI: 10.1016/j.archger.2020.104283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/08/2020] [Accepted: 10/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To identify drug interactions of potentially inappropriate medications and mental and behavioral disorders, according to explicit potentially inappropriate medications criteria-based tools. METHODOLOGY A systematic scoping review was conducted in February 2020. Study characteristics, potentially inappropriate medications, drug interactions, rationale, and therapeutic management proposed were extracted. The commercialization and potentially inappropriate medications standard as essential in Brazil and in the world were identified. Therapeutic management was proposed for the most cited potentially inappropriate medications. RESULTS 36 tools including 151 drug interactions, in addition to 132 potentially inappropriate medications with concerns related to six mental and behavioral disorders were identified. Cognitive impairment and dementia were the most frequently disorders reported and antipsychotics, anticholinergics, and benzodiazepines were the pharmacological classes more involved in the drug interactions. Despite the tools recommended risperidone and quetiapine when the use of antipsychotics were inevitable; levodopa + carbidopa for Parkinson's disease; and short and intermediate half-life benzodiazepines; the quality of the evidence needs to be assessed. In this review, sleep hygiene; deprescription; medication review; and clinical monitoring of adverse drug reactions are strongly recommended. In addition, to consider agomelatine, bupropion, moclobemide and melatonin as potential safer options for benzodiazepines. CONCLUSION Knowing the clinical conditions or risk morbidities associated with the use of potentially inappropriate medications and management of these medications for safer therapeutic equivalents or non-pharmacotherapeutic alternatives are relevant for patient safety.
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Martínez-Pías E, García-Azorín D, Minguez-Olaondo A, Trigo J, Sierra Á, Ruiz M, Guerrero ÁL. Triptanophobia in migraine: A case-control study on the causes and consequences of the nonuse of triptans in chronic migraine patients. Expert Rev Neurother 2020; 21:123-130. [PMID: 33111580 DOI: 10.1080/14737175.2021.1842733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Triptanophobia is the excessive and inadequately justified concern about potential risks of triptans. We evaluated causes and consequences of nonuse of triptans in chronic migraine (CM) Methods: Case-control study. We included CM patients firstly referred to aheadache unit. Patients were cases or controls depending on whether they were triptan naïve, or not. We analyzed if nonuse of triptans was justified by formal contraindications or adverse events. We assessed if triptan naïve patients had higher frequency of vascular risk factors (VRF), contraceptive drugs or older age. Results: We included 941 patients, 247 (26.2%) triptan users. Triptans had been discontinued due to tolerability in 116 patients (12.3%), being 578 patients (61.4%) triptan naïve. Formal contraindications were found in 23 patients (2.4%). Frequency of VRF, contraceptive drugs or age did not differ between the groups (p > 0.1). Triptan users consumed symptomatic medications fewer days/month (13.9 vs 17.1, p < 0.001), were under prophylactic treatment more frequently (79.4% vs 34.8%, p < 0.001) and had medication overuse headache less frequently (55.1% vs. 63.0%, p = 0.03). Conclusion: Triptans were not used by three-quartersof CM patients. Nonuse of triptans was not justified by tolerability, frequency of contraindications, or frequency of VRF. Expert opinion: In the present study, we evaluated causes and consequences of the nonuse of triptans in CM sufferers. We analyzed frequency of triptan use in CM patients. We compared, between triptan users and triptan naïve patients, the presence of contraindications, frequency of vascular risk factors, and differences in management prior to the referral to a headache unit.
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Affiliation(s)
- Enrique Martínez-Pías
- Headache Unit, Neurology Department, Hospital Clínico Universitario De Valladolid , Valladolid, Spain
| | - David García-Azorín
- Headache Unit, Neurology Department, Hospital Clínico Universitario De Valladolid , Valladolid, Spain
| | - Ane Minguez-Olaondo
- Neurology Department, Hospital Universitario De Donostia , San Sebastian, Spain
| | - Javier Trigo
- Headache Unit, Neurology Department, Hospital Clínico Universitario De Valladolid , Valladolid, Spain
| | - Álvaro Sierra
- Headache Unit, Neurology Department, Hospital Clínico Universitario De Valladolid , Valladolid, Spain
| | - Marina Ruiz
- Neurology Department, Hospital Universitario De Torrevieja , Alicante. Spain
| | - Ángel L Guerrero
- Headache Unit, Neurology Department, Hospital Clínico Universitario De Valladolid , Valladolid, Spain.,Headache and neuropathic pain research group, Institute for Biomedical Research of Salamanca (IBSAL) , Salamanca, Spain.,Department of Medicine, University of Valladolid , Valladolid, Spain
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[National expert consensus on application of phototherapy in acute and chronic wounds (2020 version)]. Zhonghua Shao Shang Za Zhi 2020; 36:887-894. [PMID: 33105939 DOI: 10.3760/cma.j.cn501120-20200507-00257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In general, different kinds of light play different roles in the treatment of wound, but the different kinds of light with similar wavelengths have some similar or the same therapeutic function. The importance of phototherapy has been gradually discovered and phototherapyhas become an important means of clinical wound treatment. At present, red light is the most widely used light in wound treatment for the outstanding effects in accelerating wound healing, alleviating pain, controlling effusion volume. Through reviewing a large number of literature and screening out high-quality evidence articles, combined with the repeated discussion of experts in the field of wound repair, the expert consensus on phototherapy in acute and chronic wounds is formulated with guiding significance, which can provide scientific and standardized application guidance for light treatment in wound repair.
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Rovere G, Meduri A, Savino G, Flammia FC, Lo Piccolo F, Carafa MRP, Larici AR, Natale L, Merlino B, Marano R. Practical instructions for using drugs in CT and MR cardiac imaging. Radiol Med 2020; 126:356-364. [PMID: 32833196 DOI: 10.1007/s11547-020-01261-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022]
Abstract
The progressive increase in numbers of noninvasive cardiac imaging examinations broadens the spectrum of knowledge radiologists are expected to acquire in the management of drugs during CT coronary angiography (CTCA) and cardiac MR (CMR) to improve image quality for optimal visualization and assessment of the coronary arteries and adequate MR functional analysis. Aim of this review is to provide an overview on different class of drugs (nitrate, beta-blockers, ivabradine, anxiolytic, adenosine, dobutamine, atropine, dipyridamole and regadenoson) that can be used in CTCA and CMR, illustrating their main indications, contraindications, efficacy, mechanism of action, metabolism, safety, side effects or complications, and providing advices in their use.
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Affiliation(s)
- Giuseppe Rovere
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Agostino Meduri
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Giancarlo Savino
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Francesco Ciriaco Flammia
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Francesca Lo Piccolo
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Maria Rachele Pia Carafa
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Anna Rita Larici
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Luigi Natale
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Biagio Merlino
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Riccardo Marano
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy.
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Bhalla A, Attaran R. Mechanical Circulatory Support to Treat Pulmonary Embolism: Venoarterial Extracorporeal Membrane Oxygenation and Right Ventricular Assist Devices. Tex Heart Inst J 2020; 47:202-206. [PMID: 32997787 DOI: 10.14503/thij-19-7025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Mechanical circulatory support may help patients with massive pulmonary embolism who are not candidates for systemic thrombolysis, pulmonary embolectomy, or catheter-directed therapy, or in whom these established interventions have failed. Little published literature covers this topic, which led us to compare outcomes of patients whose massive pulmonary embolism was managed with the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) or a right ventricular assist device (RVAD). We searched the medical literature from January 1990 through September 2018 for reports of adults hospitalized for massive or high-risk pulmonary embolism complicated by hemodynamic instability, and who underwent VA-ECMO therapy or RVAD placement. Primary outcomes included weaning from mechanical circulatory support and discharge from the hospital. We found 16 reports that included 181 patients (164 VA-ECMO and 17 RVAD). All RVAD recipients were successfully weaned from support, as were 122 (74%) of the VA-ECMO patients. Sixteen (94%) of the RVAD patients were discharged from the hospital, as were 120 (73%) of the VA-ECMO patients. Of note, the 8 RVAD patients who had an Impella RP System were all weaned and discharged. For patients with massive pulmonary embolism who are not candidates for conventional interventions or whose conditions are refractory, mechanical circulatory support in the form of RVAD placement or ECMO may be considered. Larger comparative studies are needed.
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Affiliation(s)
- Aneil Bhalla
- Section of Cardiovascular Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut 06519
| | - Robert Attaran
- Section of Cardiovascular Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut 06519
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Abstract
Pharmacotherapy is a central component in the context of an overall therapeutic concept in the treatment of adults with attention deficit hyperactivity disorder (ADHD). In this concept psychosocial interventions with psychoeducation or specific psychotherapy measures also play an important role. In adults three compounds are currently approved for the pharmacological treatment of ADHD in Germany. The long-acting stimulants retarded methylphenidate preparations and lisdexamfetamine can be prescribed. Alternatively, the adrenergic uptake inhibitor atomoxetine can be used. In several meta-analyses good effectiveness and tolerance of these drugs on ADHD psychopathology has been shown. They also improve ADHD-related disorders of emotional regulation capability and disorganization in everyday life. Importantly, an improvement in everyday functionality and quality of life under medication could also be shown in several studies. In this review the evidence for pharmacotherapy of ADHD and its implementation into treatment of adult patients is presented.
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Affiliation(s)
- W Retz
- Neurozentrum, Forschungsgruppe ADHS, Universitätsklinikum des Saarlandes, Gebäude 90/III, 66421, Homburg/Saar, Deutschland.
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Mainz, Mainz, Deutschland.
| | - P Retz-Junginger
- Neurozentrum, Forschungsgruppe ADHS, Universitätsklinikum des Saarlandes, Gebäude 90/III, 66421, Homburg/Saar, Deutschland
| | - S Davydenko
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - M Rösler
- Neurozentrum, Forschungsgruppe ADHS, Universitätsklinikum des Saarlandes, Gebäude 90/III, 66421, Homburg/Saar, Deutschland
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Lewandrowski KU, Dowling Á, de Carvalho PST, Calderaro AL, Dos Santos TS, de Lima E Silva MS, León JFR, Yeung A. Indication and Contraindication of Endoscopic Transforaminal Lumbar Decompression. World Neurosurg 2020; 145:631-642. [PMID: 32201296 DOI: 10.1016/j.wneu.2020.03.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The indications and contraindications to the endoscopic transforaminal approach for lumbar spinal stenosis are not well defined. METHODS We performed a Kaplan-Meier durability survival analysis of patients with the following types of spinal stenosis: type I, central canal; type II, lateral recess; type III, foraminal; and type IV, extraforaminal. The 304 patients comprised 140 men and 164 women, with an average age of 51.68 ± 15.78 years. The average follow-up was 45.3 years (range, 18-90 years). The primary clinical outcome measures were the Oswestry Disability Index, visual analog scale, and the modified Macnab criteria. RESULTS Of 304 study patients, 70 had type I (23.0%) stenosis, 42 type II (13.7%), 151 type III (49.7%), and 41 type IV (13.5%). Excellent outcomes were obtained in 114 patients (37.5%), good in 152 (50.0%), fair in 33 (10.9%), and poor in 5 (1.6%). Kaplan-Meier durability analysis of the clinical treatment benefit with the endoscopic transforaminal decompression surgery showed statistically significance differences (P < 0.0001) on log-rank (Mantel-Cox) χ2 testing between the estimated median (50% percentile) survival times of type I (28 months), type II (53 months), type III (32 months), and type IV (66 months). CONCLUSIONS We recommend stratifying patients based on the underlying compressive disease and the skill level of the endoscopic spine surgeon to decide preoperatively whether more difficult central or complex foraminal stenotic lesions should be considered for alternative endoscopic approaches.
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Affiliation(s)
- Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Tucson, Arizona, USA and Visiting Professor, Department Neurosurgery, UNIRIO, Rio de Janeiro, Brazil.
| | - Álvaro Dowling
- Orthopaedic Spine Surgeon, Director of Endoscopic Spine Clinic, Santiago, Chile and Visiting Professor, Department of Orthopaedic Surgery, USP, Ribeirão Preto, Brazil
| | | | - André Luiz Calderaro
- Centro Ortopedico Valqueire, Departamento de Full Endoscopia da Coluna Vertebral, Rio de Janeiro, Brazil
| | | | | | - Jorge Felipe Ramírez León
- Fundación Universitaria Sanitas, Bogotá, D.C., Colombia; Research Team, Centro de Columna, Bogotá, Colombia; Centro de Cirugía de Mínima Invasión, CECIMIN-Clínica Reina Sofía, Bogotá, Colombia
| | - Anthony Yeung
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico; Associate, Desert Institute for Spine Care, Phoenix, Arizona, USA
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May N, Niehaus-Gebele C, Reichenberger F, Behr J, Gesierich W. Screening for Bronchoscopic Lung Volume Reduction: Reasons for Not Receiving Interventional Treatment. Lung 2020; 198:221-8. [PMID: 31832749 DOI: 10.1007/s00408-019-00303-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Evidence for bronchoscopic lung volume reduction (BLVR) is based on phase 2 studies and small randomized controlled trials with in- and exclusion criteria defining a therapeutic window and contraindications. Little is known about the applicability in routine clinical practice. AIM Which percentage of patients with severe emphysema referred to a specialized treatment center for BLVR is ultimately suitable for interventional bronchoscopic treatment? What is the relevance of the different contraindications? METHODS Retrospective evaluation of emphysema patients referred to Asklepios Fachkliniken Munich-Gauting for BLVR between January 2014 and June 2015. RESULTS 138 patients were referred for evaluation of BLVR. 38 patients (27.5%) underwent BLVR procedures (valves n = 18; coils n = 18; thermal vapor ablation n = 2). 100 patients (72.5%) were deemed not eligible for BLVR based on the following contraindications: 34% emphysema morphology and emphysema-related findings (severe homogeneous emphysema, extensive pleuropulmonary adhesions, postinflammatory scaring with natural volume reduction, giant bullae), 16% active smoking; 9% pulmonary function not within indication range; 8% unexpected CT findings (nodules, cancer, interstitial disease); 8% chronic ventilatory failure; 8% patient refused BLVR; 5% relevant comorbidity; 5% frequent exacerbations, 3% preserved quality of life, 4% other. CONCLUSION BLVR is a therapeutic option for highly selected patients. In our cohort, one in four could be treated. These data highlight the limitations of BLVR under real-life conditions.
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Pitsios C, Tsoumani M, Bilò MB, Sturm GJ, Rodríguez del Río P, Gawlik R, Ruëff F, Paraskevopoulos G, Valovirta E, Pfaar O, Calderón MA, Demoly P. Contraindications to immunotherapy: a global approach. Clin Transl Allergy 2019; 9:45. [PMID: 31528333 PMCID: PMC6737684 DOI: 10.1186/s13601-019-0285-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 09/04/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Recommendations on contraindications to allergen immunotherapy (AIT) have been independently developed by National and International Societies/Academies. AIT contraindications are mainly based on case reports, case-series, or experts' opinion, while evidence-based information is limited. The aim of the present review was to describe existing guidelines on contraindications to AIT and to highlight differences between them. MAIN BODY An extended review of the literature regarding contraindications to AIT for respiratory allergy and venom hypersensitivity was performed. Furthermore, Societies and Academies registered in the World Allergy Organization and EAACI databases, were asked for additional information. Only AIT guidelines published under official auspicies were included. A large heterogeneity among the various recommendations on contraindications was registered. Common contraindications to most of the guidelines were: lack of adherence, pregnancy before the start of AIT, the use of beta-blockers, certain age groups, uncontrolled asthma, autoimmune diseases and malignancies. CONCLUSION As new data arise, revisions might soon be needed allowing AIT in the cases of patients treated with ACE inhibitors and beta-blockers, in elderly patients and in patients with concomitant autoimmune diseases and neoplasias in remission. The decision to prescribe AIT is always tailor-made, balancing risk vs benefit. Creating globally accepted guidelines would help Allergologists in their decision making.
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Affiliation(s)
- C. Pitsios
- Medical School, University of Cyprus, P.O. Box 20537, 1678 Nicosia, Cyprus
| | - M. Tsoumani
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - M. B. Bilò
- Dept. of Internal Medicine, Allergy Unit, University Hospital, Ancona, Italy
| | - G. J. Sturm
- Dept. of Dermatology and Venereology, Medical University of Graz, Graz, Austria
- Allergy Outpatient Clinic Reumannplatz, Vienna, Austria
| | | | - R. Gawlik
- Dept. of Internal Medicine, Allergy and Clin. Immunology, Silesian University of Medicine, Katowice, Poland
| | - F. Ruëff
- Dermatology and Allergology Clinic and Policlinic, Ludwig-Maximilians University, Munich, Germany
| | - G. Paraskevopoulos
- Allergy Outpatient Clinic, 401 General Military Hospital of Athens, Athens, Greece
| | - E. Valovirta
- Terveystalo Turku, Allergy Clinic, University of Turku, Turku, Finland
| | - O. Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Manneim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - M. A. Calderón
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute and Royal Brompton Hospital NSH, London, UK
| | - P. Demoly
- Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
- UMR-S 1136, IPLESP, Equipe EPAR, Sorbonne Université, 75013 Paris, France
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Walz L, Jönsson AK, Ahlner J, Östgren CJ, Druid H. Metformin - Postmortem fatal and non-fatal reference concentrations in femoral blood and risk factors associated with fatal intoxications. Forensic Sci Int 2019; 303:109935. [PMID: 31491622 DOI: 10.1016/j.forsciint.2019.109935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/05/2019] [Accepted: 08/21/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND & OBJECTIVES To improve the interpretation of fatal intoxications by establishing fatal and non-fatal reference concentrations of metformin in postmortem femoral blood and to further evaluate risk factors associated with fatal metformin intoxication. METHODS All forensic autopsies in Sweden where metformin was detected in femoral blood 2011-2016 were identified in the National Board of Forensic Medicine databases (NFMD). The cases were classified as single substance intoxications, A (n = 22), multiple substance intoxications, B (N = 7) and postmortem controls, C (N = 13). The control group consisted of cases where metformin was detected, but the cause of death excluded the incapacitation by metformin or other substances. Strict inclusion criteria were used, and all postmortem cases were assessed by two independent reviewers. All other cases where the inclusion criteria of groups A-C where not met formed group O (N = 78). The forensic findings logged in the NFMD where linked to national registers whereby information on comorbidities, dispensed drugs and clinical data could be obtained. RESULTS The mean age was 66 ± 10 years in the total study population and did not differ between the groups. The proportion of men was 64% in group A, 71% in B, 77% in C and 74% in group O. The median values of metformin in group A (48.5 μg/g; range 13.0-210 μg/g) and B (21.0 μg/g; range 4.40-95.0 μg/g) were significantly (p < 0.001 and p = 0.015 respectively) higher than those of the control group C (2.30 μg/g ; range 0.70-21.0 μg/g). The median concentration of metformin in group A and B was also significantly higher than in group O (4.60 μg/g; range 0.64-54.0 μg/g) (p < 0.001 and p = 0.040 respectively). The results suggest that intoxication with metformin as a cause of death should be considered when the postmortem femoral blood level exceeds about 10 μg/g, although higher levels may be seen in postmortem in cases without incapacitation. The metformin intoxication was confirmed to be intentional in 23% (n = 5) of the single intoxications. Underlying factors identified as important for the remaining fatal metformin intoxications included living alone, any contraindication for the use of metformin, known alcohol abuse and a history of stroke or cardiovascular disease. CONCLUSIONS The reported post mortem femoral blood concentrations of metformin can hopefully contribute to a better interpretation of results in suspected poisonings and obscure cases. Living in a single household, history of cardiovascular disease and contraindications, predominantly alcohol abuse, were associated with fatal metformin intoxication.
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Abstract
CLINICAL ISSUE Intravenous (i.v.) thrombolysis and mechanical thrombectomy are two essential pillars of acute stroke treatment in patients with vascular occlusion in the anterior circulation. The issue about using so-called bridging thrombolysis in acute stroke patients is increasingly under discussion. RESULTS After application of i.v. thrombolysis treatment, stroke patients who were primarily transported to a neurovascular center and underwent timely endovascular treatment, showed a lower preinterventional recanalization rate, a lower 90-day mortality but no significant difference in the clinical outcome after 3 months compared with stroke patients with mechanical thrombectomy alone. Higher rates of intracranial hemorrhage could be detected in the bridging thrombolysis group of patients. CONCLUSION The i.v. thrombolysis treatment is still an essential treatment concept in acute stroke management. Further studies should be carried out with respect to the application in mothership stroke patients undergoing early endovascular treatment.
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Tezval M, Spering C. [Intravenous regional anesthesia]. Oper Orthop Traumatol 2019; 32:13-17. [PMID: 31468076 DOI: 10.1007/s00064-019-00627-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/02/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Intravenous regional anesthesia. INDICATIONS Short duration hand operations. CONTRAINDICATIONS Open wounds, lengthy operations, local infections, polyneuropathy, Raynaud syndrome, allergy to local anesthetics. TECHNIQUE Insertion of an intravenous cannula, attachment of a double lumen cuff, Esmarch's tourniquet, injection of the local anesthetic, stepwise pumping up the tourniquet, surgery, stepwise removal of the tourniquet. POSTOPERATIVE MANAGEMENT Postoperative monitoring of the patient after the end of anesthesia. RESULTS Over a time period of 2 years (January 2017-December 2018) 90 operations of the hand were carried out with the patient under intravenous regional anesthesia (IVRA). The average age of the patients was 61 years. After surgery the patients were questioned according to the criteria of the quality of recovery‑9 score according to Myles in the German version of Eberhard et al. (2002). The tourniquet could be removed on average 29 min after surgery. No intraoperative or postoperative complications occurred. Therefore, the IVRA represents a reliable and simple form of anesthesia especially for surgery of the hand.
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Affiliation(s)
- Mohammad Tezval
- Klinik für Unfallchirurgie, Sporttraumatologie und Handchirurgie, Dorstener Str. 151, 45657, Recklinghausen, Deutschland.
| | - Christopher Spering
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
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Abstract
Due to high prescription rates as well as the frequent use as over the counter drugs, it is of interest to consider non-opioid analgesics when evaluating the quality and appropriateness of a given overall medication. This article sums up the basic pharmacology and main adverse effects of these analgesics. Non-opioids can be further classified according to their additional mechanisms of action besides analgesia. High-dose acetylsalicylic acid, traditional nonsteroidal anti-inflammatory drugs, and coxibs exhibit antipyretic and anti-inflammatory properties. Acetaminophen and metamizole (dipyrone) are analgesics and antipyretic agents, while metamizole exhibits also spasmolytic effects. Capsaicin and intrathecal ziconotide are pure analgesics.
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Balke L, Panholzer B, Haneya A, Bewig B. [ECMO treatment in acute lung failure : Who profits?]. Med Klin Intensivmed Notfmed 2019; 115:682-689. [PMID: 31363799 DOI: 10.1007/s00063-019-0597-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/18/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Abstract
In intensive care medicine, rapid technical developments that are often beneficial to patients are taking place. On the other hand, there are also voices that generally criticize an increasing "interventionalism". This area of tension includes other important questions regarding usefulness, quality, ethical compliance, scientific evidence, structural capacities and economy. The treatment of acute respiratory distress syndrome (ARDS) using extracorporeal membrane oxygenation (ECMO) is an example of these considerations. Although ECMO has rarely been prospectively evaluated according to scientific criteria, it is still used with an increasing tendency, not least since the documented register survival rates in ECMO patients with severe ARDS are 60%. However, the implementation of this therapy means an immense effort. The necessary centralization and certification for ECMO treatment is currently under intensive discussion. Closely related to this are considerations about which criteria represent good quality in patient care. In order to be able to guarantee high quality, a precise indication is the first step. And here indications and contraindications still need to be defined. It has not yet been sufficiently clarified which prognosis factors need to be taken into account. This article summarizes what is known about ECMO prognosis and indication criteria. In conclusion, parameters are identified that should be developed scientifically in the future.
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Affiliation(s)
- L Balke
- Klinik für Innere Medizin 1, Universitätsklinikum Schleswig Holstein, Campus Kiel, Rosalind-Franklin-Straße 12, 24105, Kiel, Deutschland. .,Interdisziplinäres ARDS-ECMO-Zentrum, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland.
| | - B Panholzer
- Interdisziplinäres ARDS-ECMO-Zentrum, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland.,Klinik für Herz- und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - A Haneya
- Interdisziplinäres ARDS-ECMO-Zentrum, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland.,Klinik für Herz- und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - B Bewig
- Klinik für Innere Medizin 1, Universitätsklinikum Schleswig Holstein, Campus Kiel, Rosalind-Franklin-Straße 12, 24105, Kiel, Deutschland.,Interdisziplinäres ARDS-ECMO-Zentrum, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
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Abstract
Arthroscopic reduction of tibial plateau fractures have been gaining in popularity. Advantages include accurate diagnosis and treatment of joint pathology, minimally invasive soft tissue dissection, quicker recovery of joint motion, and anatomic reduction of joint surface. Success depends on accurate fracture selection. With arthroscopic-assisted reduction of tibial plateau fractures, patient set-up is similar to standard knee arthroscopy, but the C-arm is used to aid with fracture reduction and fixation. Outcomes are comparable or even improved when compared with standard procedures, and morbidity with arthroscopic reduction can often be lower with decreased rates of infection, wound complications, and thromboembolism.
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Affiliation(s)
- Rebecca Chase
- Philadelphia College of Osteopathic Medicine, 4190 City Avenue, Suite 320, Philadelphia, PA 19131, USA
| | - Kudret Usmani
- Cooper University Hospital, Three Cooper Plaza, Suite 408, Camden, NJ 08103, USA.
| | - Alisina Shahi
- Cooper University Hospital, Three Cooper Plaza, Suite 408, Camden, NJ 08103, USA
| | - Kenneth Graf
- Cooper University Hospital, Three Cooper Plaza, Suite 408, Camden, NJ 08103, USA
| | - Rakesh Mashru
- Cooper University Hospital, Three Cooper Plaza, Suite 408, Camden, NJ 08103, USA
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Abstract
BACKGROUND Carbon dioxide (CO2) is a very good and validated alternative to iodine-containing contrast media in diagnostic and interventional angiography. Nevertheless, its routinely use is still limited to specialized centers. OBJECTIVE The presentation of the current role and limitations of CO2 in diagnostic and interventional angiography (venous and arterial). MATERIAL AND METHODS A comprehensive review of the literature regarding CO2 angiography (physical features, indications, contraindications, applications) was carried out. RESULTS The results show that CO2 can be used as a reliable alternative for diagnostic angiography and to support interventions in many arterial and venous vascular territories. An exception is the intra-arterial use of CO2 above the diaphragm due to the risk of severe myocardial and cerebral complications, which represents the most important contraindication. Moreover, due to its very low viscosity, CO2 is more effective than iodine-containing contrast media in detecting bleeding arising from small vessels. CONCLUSION The CO2 angiography is a safe and effective technique and can be used as valid alternative. In several clinical cases it even offers some advantages compared to iodine-containing contrast media.
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Affiliation(s)
- F Pedersoli
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - P Bruners
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - C K Kuhl
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - T Schmitz-Rode
- Institut für Angewandte Medizintechnik, RWTH Aachen, Pauwelsstraße 20, 52074, Aachen, Deutschland
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Lindh-Åstrand L, Hoffmann M, Fredrikson M, Hammar M, Spetz Holm AC. Use of hormone therapy (HT) among Swedish women with contraindications - A pharmacoepidemiological cohort study. Maturitas 2019; 123:55-60. [PMID: 31027678 DOI: 10.1016/j.maturitas.2019.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/15/2019] [Accepted: 02/22/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To assess how women in Sweden with breast cancer (BC), endometrial cancer (EC), and/or pulmonary embolism (PE) were dispensed menopausal hormone therapy (HT). STUDY DESIGN A retrospective study of Swedish women aged 40 years or more on 31 December 2005 (n = 2,863,643), followed through to December 2011. The study analysed three mandatory national healthcare registries: the Swedish Prescribed Drug Register, the National Inpatient Register and the Cancer Register. New users were defined as having a first dispensation after at least a 9-month break, and thus were possible to identify from April 2006. New users with at least one of the diagnoses BC, EC or PE before the first dispensation were classified as having a relative or absolute contraindication for HT. MAIN OUTCOME MEASURES The relative risks of having HT dispensed after being diagnosed with BC, EC and/or PE. RESULTS In total, 171,714 women had at least one of the diagnoses BC, EC or PE. The relative risk of having hormone therapy dispensed (current and new users) after being diagnosed with any of the diagnoses was significantly lower (PE, IRR 0.11, 95% CI 0.10-0.12;/ BC, IRR 0.12, 95% CI 0.11-0.13; EC, IRR 0.43, CI 0.40-0.46) than for women without these diagnoses. CONCLUSIONS One in about 250 women started treatment with HT after being diagnosed with BC, PE or EC. Swedish prescribers seem to be well aware of the recommendations for HT use in women with contraindications. A few women, however, are prescribed HT despite having BC, EC or PE, possibly after careful evaluation of the risks and benefits and giving informed consent. Women with a history of PE were prescribed transdermal HT to a larger extent than women in general, in line with results from observational studies.
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Zhang J. [National experts consensus on application of silver-containing dressings in wound therapy (2018 version)]. Zhonghua Shao Shang Za Zhi 2018; 34:761-765. [PMID: 30481914 DOI: 10.3760/cma.j.issn.1009-2587.2018.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
New silver-containing dressings developed in recent years have brought new and powerful means for the prevention and treatment of wound infection, which promote development and progress of wound therapy. There are many kinds of silver-containing dressings, however, misunderstanding and even misapplication exist in how to choose and use these dressings. Based on literature evidence, we propose this national expert consensus on clinical application of silver-containing dressings, particularly in terms of kinds and mechanisms, indications, contraindications, rational selections in different wounds, and cautions in the clinical application of silver-containing dressings. This consensus would be helpful for medical and nursing personnel to use silver-containing dressings in wound repair field in clinic correctly and professionally.
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Zhang JP. [National experts consensus on application of silver-containing dressings in wound therapy (2018 version)]. Zhonghua Shao Shang Za Zhi 2018; 34:E002. [PMID: 30440144 DOI: 10.3760/cma.j.issn.1009-2587.2018.11.e002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
New silver-containing dressings developed in recent years have brought new and powerful means for the prevention and treatment of wound infection, which promote development and progress of wound therapy. There are many kinds of silver-containing dressings, however, misunderstanding and even misapplication exist in how to choose and use these dressings. Based on literature evidence, we propose this national expert consensus on clinical application of silver-containing dressings, particularly in terms of kinds and mechanisms, indications, contraindications, rational selections in different wounds, and cautions in the clinical application of silver-containing dressings. This consensus would be helpful for medical and nursing personnels to use silver-containing dressings in wound repair field in clinic correctly and professionally.
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Affiliation(s)
| | - J P Zhang
- 400038 Chongqing, State Key Laboratory of Trauma, Burns and Combined Injury, Department of Plastic Surgery, the First Affiliated Hospital of Army Medical University (the Third Military Medical University)
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Rosenberg Danziger C, Anis E, Gordon ES, Grotto I, Danon YL. Reintroducing OPV in Israel on the journey to global polio eradication - Estimation at a low rate of contraindicated population. Vaccine 2018; 36:3717-3720. [PMID: 29776752 DOI: 10.1016/j.vaccine.2018.05.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The 2013 reemergence of wild poliovirus in Israel led to the reinstatement of a routine OPV vaccination. Fearing VAPP in immunocompromised, the MOH regulated contraindications for vaccination candidates and household contacts. In this study we estimate the size of the contraindicated population to OPV vaccination. METHOD We studied vaccination candidates aged 2-9 and 14-23 months and probable household contacts. Using the rate of contraindications extracted for each study group from a medical records database, a statistical model was built to estimate the probability of contraindications in candidates. RESULTS 3.9% of the 2-9-month-old study group and 4% of the 14-23-month-old group had contraindications by either self or household contacts. CONCLUSION A statistical model can provide an estimation of the contraindicated population and can be used in the future when devising vaccination campaigns. In contrast to concerns raised by the MOH, our findings show a smaller than anticipated contraindicated population.
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Affiliation(s)
| | - Emilia Anis
- Public Health Services, Ministry of Health, Jerusalem 9101002, Israel; Braun School of Public Health, Hebrew University Hadassah Medical School, Jerusalem 9112102, Israel
| | | | - Itamar Grotto
- Public Health Services, Ministry of Health, Jerusalem 9101002, Israel; Epidemiology Department, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Yehuda L Danon
- Ariel University, Ariel 4070000, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
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Yuan CM, Nee R, Little DJ, Narayan R, Childs JM, Prince LK, Raghavan R, Oliver JD. Survey of Kidney Biopsy Clinical Practice and Training in the United States. Clin J Am Soc Nephrol 2018; 13:718-725. [PMID: 29669819 PMCID: PMC5968891 DOI: 10.2215/cjn.13471217] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/13/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Practicing clinical nephrologists are performing fewer diagnostic kidney biopsies. Requiring biopsy procedural competence for graduating nephrology fellows is controversial. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS An anonymous, on-line survey of all Walter Reed training program graduates (n=82; 1985-2017) and all United States nephrology program directors (n=149; August to October of 2017), regarding kidney biopsy practice and training, was undertaken. RESULTS Walter Reed graduates' response and completion rates were 71% and 98%, respectively. The majority felt adequately trained in native kidney biopsy (83%), transplant biopsy (82%), and tissue interpretation (78%), with no difference for ≤10 versus >10 practice years. Thirty-five percent continued to perform biopsies (13% did ≥10 native biopsies/year); 93% referred at least some biopsies. The most common barriers to performing biopsy were logistics (81%) and time (74%). Program director response and completion rates were 60% and 77%. Seventy-two percent cited ≥1 barrier to fellow competence. The most common barriers were logistics (45%), time (45%), and likelihood that biopsy would not be performed postgraduation (41%). Fifty-one percent indicated that fellows should not be required to demonstrate minimal procedural competence in biopsy, although 97% agreed that fellows should demonstrate competence in knowing/managing indications, contraindications, and complications. Program directors citing ≥1 barrier or whose fellows did <50 native biopsies/year in total were more likely to think that procedural competence should not be required versus those citing no barriers (P=0.02), or whose fellows performed ≥50 biopsies (P<0.01). CONCLUSIONS Almost two-thirds of graduate respondents from a single military training program no longer perform biopsy, and 51% of responding nephrology program directors indicated that biopsy procedural competence should not be required. These findings should inform discussion of kidney biopsy curriculum requirements.
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Affiliation(s)
| | | | | | - Rajeev Narayan
- San Antonio Kidney Disease Center, San Antonio, Texas; and
| | - John M. Childs
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | - Rajeev Raghavan
- Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas
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Abstract
This article is an in-depth analysis of proximal interphalangeal joint arthrodesis indications and surgical techniques. There are a wide variety of indications for proximal interphalangeal joint arthrodesis with relatively few contraindications. Moreover, although there is a limited surgical approach, there is a wide breadth of modalities in which to obtain the arthrodesis, of which several are listed here. Proximal interphalangeal joint arthrodesis has been shown to have excellent outcomes and a high success rate.
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Affiliation(s)
- James Jung
- Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion 3, 2nd Floor, Orange, CA 92868, USA
| | | | - Ranjan Gupta
- Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion 3, 2nd Floor, Orange, CA 92868, USA.
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DiGiorgi D, Cerf JL, Bowerman DS. Outcomes indicators and a risk classification system for spinal manipulation under anesthesia: a narrative review and proposal. Chiropr Man Therap 2018. [PMID: 29541445 PMCID: PMC5842582 DOI: 10.1186/s12998-018-0177-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Over a period of decades chiropractors have utilized spinal manipulation under anesthesia (SMUA) to treat chronic back and neck pain. As an advanced form of manual therapy, SMUA is reserved for the patient whose condition has proven refractory to office-based manipulation and other modes of conservative care. Historically, the protocols and guidelines put forth by chiropractic MUA proponents have served as the clinical compass for directing MUA practice. With many authors and MUA advocates having focused primarily on anticipated benefit, the published literature contains no resource dedicated to treatment precautions and contraindications. Also absent from current relevant literature is acknowledgement or guidance on the preliminary evidence that may predict poor clinical outcomes with SMUA. This review considers risk and unfavorable outcomes indicators in therapeutic decision making for spinal manipulation under anesthesia. A new risk classification system is proposed that identifies patient safety and quality of care interests for a procedure that remains without higher-level research evidence. A scale which categorizes risk and outcome potential for SMUA is offered for the chiropractic clinician, which aims to elevate the standard of care and improve patient selection through the incorporation of specific indices from existing medical literature.
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Affiliation(s)
| | - John L Cerf
- Clinical and Consultant Practice- Jersey City, NJ, USA
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50
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Alshammari TM, Devadasu VR, Rathnam RP. Comparison of the safety information on drug labels in three developed countries: The USA, UK and Canada. Saudi Pharm J 2017; 25:1103-1107. [PMID: 30166896 PMCID: PMC6111122 DOI: 10.1016/j.jsps.2017.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/09/2017] [Indexed: 12/04/2022] Open
Abstract
The safety information on drug labels of a company marketing the same drugs in different countries is sometimes different. The aim of the present study is to understand the differences in the volume and content of safety information on the drug labels from the same manufacturers in three developed countries: the United States of America (USA), the United Kingdom (UK) and Canada. This study involved the calculation of the proportion of total safety information (PSI) and of contraindications (PCI) in comparison to all information on the label and the percentage of boxed warnings (PBW) among the 100 labels studied from each country. The PSI on the labels of different countries is different with USA labels bearing lesser value PSI and UK labels bearing higher value PSI. The qualitative information provided on these drug labels from each country in 'contraindications' sections, 'boxed/serious warnings' and 'overdosage' sections presented differences in the information provided on most of the labels. We have found distinct differences between the safety information available on drug labels in terms of volume and content. We conclude that the safety information for the same products should be standardised across all countries.
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Affiliation(s)
- Thamir M. Alshammari
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
- Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Venkat Ratnam Devadasu
- Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Rajendra Prasad Rathnam
- Department of Pharmaceutical Chemistry, College of Pharmacy, University of Hail, Hail, Saudi Arabia
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