Background
Although hand-assisted laparoscopic surgery (HALS) offers patients smaller surgical incisions, they still experience pain. Currently, there is no consensus on the optimal analgesic package ...for patients undergoing HALS. The aim of this prospective, randomized, double-blinded, placebo-controlled clinical trial was to evaluate the effect of transversus abdominis plane (TAP) block on postoperative pain control (pain score and analgesic use) and other outcomes in colon cancer patients undergoing hand-assisted laparoscopic left hemicolectomy.
Methods
Sixty-four patients with colon cancer scheduled for an elective colon resection were enrolled in this study. Patients were randomized into two groups to receive either TAP block using 20 mL of 0.375% ropivacaine (TAP block group: 32 patients) or 20 mL of 0.9% normal saline infusion (placebo group: 32 patients). Anaesthetic and surgical techniques were standardized. Twenty-four-hour postoperative analgesia was maintained by continuous infusion of 0.1–0.9 µg/kg/h fentanyl and intravenous injection of ketorolac. The primary outcome of the study was postoperative pain control (pain score and analgesic use). Pain was assessed using numeric rating scale at 2, 4, 8, 12, and 24 h after surgery at rest and during movement. Secondary outcomes included the time to resumption of intestinal function and the length of hospital stay. The data of the two groups were compared using Mann–Whitney
U
test. All statistical tests were two-tailed at a significance level of 0.05.
Results
The patients’ mean age was 60.50 ± 6.77 years, and 68.75% of patients were males. The mean body mass index was 26.23 ± 4.83 kg/m
2
. The TAP block group had lower pain scores after surgery at 2, 4, and 12 h at rest (
p
< 0.05), at 2 and 4 h during movement (
p
< 0.01) and used less fentanyl and ketorolac than the placebo group (
p
< 0.01). The mean time to resumption of intestinal function was shorter in the TAP block group than that in the placebo group (
p
< 0.0001). The mean length of hospital stay was by 2.7 days shorter in the TAP block group than in the placebo group (
p
= 0.001).
Conclusions
The ultrasound-guided TAP block given during hand-assisted laparoscopic colon surgery as part of a multimodal analgesic regimen is a feasible and effective technique for postoperative analgesia in colon cancer patients and significantly reduces both pain experienced by patients and short-term postoperative analgesic use and promotes early ambulation. Future studies are needed to determine the efficacy and costs/benefits of the ultrasound-guided TAP block in HALS.
Background
Perioperative intravenous (IV) infusion of lidocaine has been shown to decrease post-operative pain, shorten time to return of bowel function, and reduce the length of hospital stay. This ...randomized, prospective, double-blinded, placebo-controlled clinical trial evaluated the impact of IV lidocaine on the quality of post-operative analgesia and other outcomes after hand-assisted laparoscopic colon surgery.
Methods
Sixty four patients with colon cancer scheduled for elective colon resection were involved in this study. Patients were randomized to receive either lidocaine infusion lidocaine group (LG) or normal 0.9 % saline infusion placebo group (PG) for a period of 24 h. Anaesthetic and surgical techniques were standardized. Twenty-four-hour post-operative analgesia in the recovery area was maintained by continuous infusion of 0.1 μg/kg/h fentanyl. The primary outcome of the study was post-operative pain control. Pain was assessed using visual analogue scale (VAS) scores at 2, 4, 8, 12, and 24 h after surgery. Patients with a VAS score >3 were treated with ketorolac 30 mg as needed. Secondary outcomes included time to resumption of bowel function and length of hospital stay. Data in the two groups were compared using the two-tailed Student’s
t
test. All statistical tests were two-tailed at a significance level of 0.05.
Results
Demographic characteristics and clinical features of both groups were similar. Intensity of pain at rest in LG compared with PG was significantly lower during the first 24 h post-operatively. LG patients reported significantly less pain during movements at 2-, 12-, and 24-h post-surgery than PG patients. The study showed that ketorolac consumption was significantly higher in PG: mean ketorolac consumption in LG was 43.77 ± 13.86 mg and in PG 51.67 ± 13.16 mg (
p
= 0.047). Compared with placebo, lidocaine infusion produced a 32 % reduction in time to the first drink (Cohen’s
d
= 3.85), 16 % reduction in time to the first full diet (Cohen’s
d
= 3.35), and 18 % reduction in time to the first bowel movement (Cohen’s
d
= 2.30). Patients who received lidocaine stayed in hospital 1.2 days less than patients who received placebo (
p
< 0.01, Cohen’s
d
= 0.72). There were no significant differences in surgery-related complications between the two groups.
Conclusions
Perioperative continuous IV lidocaine infusion has a beneficial effect as regards post-operative pain, restoration of bowel function, and length of hospital stay in patients who have undergone hand-assisted laparoscopic colon surgery.
Interesų konfliktų kyla beveik visomis gyvenimo situacijomis, kai vienas asmuo veikia kito asmens interesais. Šiame straipsnyje nagrinėjamas teorinis interesų konflikto sąvokos modelis, apibūdinamos ...interesų konfliktų rūšys, taip pat pateikiami galimi interesų konflikto sprendimo būdai: prevencinės ir interesų konfliktų valdymo priemonės. Visas tyrimas atliekamas remiantis atstovavimo teorija.
Almost all of the situations where one person acts according to another‘s interests give rise to conflicts of interest. In this paper author analyses the theoretical model of conflict of interests, describes various types of conflicts of interests and presents possible solutions: preventive and managing measures. All the research is carried out in the context of agency theory.
Interesų konfliktų kyla beveik visomis gyvenimo situacijomis, kai vienas asmuo veikia kito asmens interesais. Šiame straipsnyje nagrinėjamas teorinis interesų konflikto sąvokos modelis, apibūdinamos ...interesų konfliktų rūšys, taip pat pateikiami galimi interesų konflikto sprendimo būdai: prevencinės ir interesų konfliktų valdymo priemonės. Visas tyrimas atliekamas remiantis atstovavimo teorija. Almost all of the situations where one person acts according to another‘s interests give rise to conflicts of interest. In this paper author analyses the theoretical model of conflict of interests, describes various types of conflicts of interests and presents possible solutions: preventive and managing measures. All the research is carried out in the context of agency theory.
Extracts of 12 medicinal and aromatic plants were investigated for their radical scavenging activity using DPPH and ABTS assays: Salvia sclarea, Salvia glutinosa, Salvia pratensis, Lavandula ...angustifolia, Calendula officinalis, Matricaria recutita, Echinacea purpurea, Rhaponticum carthamoides, Juglans regia, Melilotus officinalis, Geranium macrorrhizum and Potentilla fruticosa. Salvia officinalis was used as a reference plant with well documented antioxidant activity. G. macrorrhizum and P. fruticosa extracts possessed very high radical scavenging activity (RSA) in both assays, higher than that of S. officinalis extract. High RSA was also characteristic to other Salvia species and Rhaponticum carthamoides. The content of total phenolic compounds, flavonoids and flavonols was measured in plant extracts. A correlation between radical scavenging capacities of extracts with total phenolic compound content was observed. (C) 2003 Elsevier Ltd. All rights reserved.
Macitentan is beneficial for long-term treatment of pulmonary arterial hypertension. The microvasculopathy of chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension ...are similar.
The phase 2, double-blind, randomised, placebo-controlled MERIT-1 trial assessed macitentan in 80 patients with CTEPH adjudicated as inoperable. Patients identified as WHO functional class II-IV with a pulmonary vascular resistance (PVR) of at least 400 dyn·s/cm
and a walk distance of 150-450 m in 6 min were randomly assigned (1:1), via an interactive voice/web response system, to receive oral macitentan (10 mg once a day) or placebo. Treatment with phosphodiesterase type-5 inhibitors and oral or inhaled prostanoids was permitted for WHO functional class III/IV patients. The primary endpoint was resting PVR at week 16, expressed as percentage of PVR measured at baseline. Analyses were done in all patients who were randomly assigned to treatment; safety analyses were done in all patients who received at least one dose of the study drug. This study is registered with ClinicalTrials.gov, number NCT02021292.
Between April 3, 2014, and March 17, 2016, we screened 186 patients for eligibility at 48 hospitals across 20 countries. Of these, 80 patients in 36 hospitals were randomly assigned to treatment (40 patients to macitentan, 40 patients to placebo). At week 16, geometric mean PVR decreased to 73·0% of baseline in the macitentan group and to 87·2% in the placebo group (geometric means ratio 0·84, 95% CI 0·70-0·99, p=0·041). The most common adverse events in the macitentan group were peripheral oedema (9 23% of 40 patients) and decreased haemoglobin (6 15%).
In MERIT-1, macitentan significantly improved PVR in patients with inoperable CTEPH and was well tolerated.
Actelion Pharmaceuticals Ltd.
The dearth of child and adolescent mental health services (CAMHS) is a global problem. Integrating CAMHS in primary care has been offered as a solution. We sampled integrated care perspectives from ...colleagues around the world. Our findings include various models of integrated care namely: the stepped care model in Australia; shared care in the United Kingdom (UK) and Spain; school-based collaborative care in Qatar, Singapore and the state of Texas in the US; collaborative care in Canada, Brazil, US, and Uruguay; coordinated care in the US; and, developing collaborative care models in low-resource settings, like Kenya and Micronesia. These findings provide insights into training initiatives necessary to build CAMHS workforce capacity using integrated care models, each with the ultimate goal of improving access to care. Despite variations and progress in implementing integrated care models internationally, common challenges exist: funding within complex healthcare systems, limited training mechanisms, and geopolitical/policy issues. Supportive healthcare policy, robust training initiatives, ongoing quality improvement and measurement of outcomes across programs would provide data-driven support for the expansion of integrated care and ensure its sustainability.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Macitentan is beneficial for long-term treatment of pulmonary arterial hypertension. The microvasculopathy of chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension ...are similar.
The phase 2, double-blind, randomised, placebo-controlled MERIT-1 trial assessed macitentan in 80 patients with CTEPH adjudicated as inoperable. Patients identified as WHO functional class II-IV with a pulmonary vascular resistance (PVR) of at least 400 dyn·s/cm
and a walk distance of 150-450 m in 6 min were randomly assigned (1:1), via an interactive voice/web response system, to receive oral macitentan (10 mg once a day) or placebo. Treatment with phosphodiesterase type-5 inhibitors and oral or inhaled prostanoids was permitted for WHO functional class III/IV patients. The primary endpoint was resting PVR at week 16, expressed as percentage of PVR measured at baseline. Analyses were done in all patients who were randomly assigned to treatment; safety analyses were done in all patients who received at least one dose of the study drug. This study is registered with ClinicalTrials.gov, number NCT02021292.
Between April 3, 2014, and March 17, 2016, we screened 186 patients for eligibility at 48 hospitals across 20 countries. Of these, 80 patients in 36 hospitals were randomly assigned to treatment (40 patients to macitentan, 40 patients to placebo). At week 16, geometric mean PVR decreased to 71·5% of baseline in the macitentan group and to 87·6% in the placebo group (geometric means ratio 0·81, 95% CI 0·70-0·95, p=0·0098). The most common adverse events in the macitentan group were peripheral oedema (9 23% of 40 patients) and decreased haemoglobin (6 15%).
In MERIT-1, macitentan significantly improved PVR in patients with inoperable CTEPH and was well tolerated.
Actelion Pharmaceuticals Ltd.
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