Background Routine imaging of patients with spine-related complaints referred for surgical assessment may represent an inefficient use of technological resources. Our objective was to explore ...Canadian spine surgeons’ requirements with respect to imaging studies accompanying spine-related referrals. Methods We administered an 8-item survey to all 100 actively practising surgeon members of the Canadian Spine Society that inquired about demographic variables and imaging requirements for patients referred with spine-related complaints. Results Fifty-five spine surgeons completed our survey, for a response rate of 55%. Most respondents (43; 78%) required imaging studies to accompany all spine-related referrals. The type of imaging required was highly variable, with respondents endorsing 7 different combinations. Half (47%) required magnetic resonance imaging and 38% required plain radiographs either alone or in combination with other forms of imaging. Half of the respondents refused to see 20% or more of all patients referred for spine-related complaints. Conclusion Most Canadian spine surgeons require imaging studies to accompany spine-related referrals; however, the type and combination of studies is highly variable, and many patients who are referred are never seen (for a consultation). Standardization and optimization of imaging practices for patients with spine-related complaints referred for surgical assessment may be an important area for cost savings.
Abstract Purpose Although anticoagulant thromboprophylaxis reduces the incidence of venous thromboembolism in critically ill patients, it may increase the risk of devastating bleeding complications ...in neurosurgical patients. For this population, anticoagulant thromboprophylaxis remains controversial and randomized controlled studies are sparse. Our goal was to establish sufficient clinical equipoise to facilitate future research in this area. Materials and Methods We conducted a survey of Canadian neurosurgeons and neurointensivists to better understand current practice. We developed a novel self-administered questionnaire on anticoagulant thromboprophylaxis for different neurosurgical subgroups using illustrative clinical scenarios. The instrument was evaluated for clinical sensibility by 20 nurses, neurosurgeons, and intensivists and then mailed to Canadian neurosurgeons (Canadian Neurosurgery Society) and intensivists (Canadian Critical Care Society). Results The response rate after 3 mailings was 50% for neurosurgeons (66/132) and 49% for intensivists (94/193). Most respondents reported use of anticoagulant thromboprophylaxis for neurosurgical patients, although the timing varied considerably. Use of anticoagulant thromboprophylaxis (ever) ranged from 60% for traumatic intracranial hemorrhage after decompressive craniotomy to 90% for traumatic spinal injury. The responses were comparable between specialties. Conclusions Most Canadian physicians reported using anticoagulant thromboprophylaxis after neurosurgery, although practice patterns differed as to when and for whom. Future research should quantify the benefits and risks in relation to the time of initiation in different neurosurgical subgroups. Our results suggest there is equipoise regarding the use of anticoagulation thromboprophylaxis in neurosurgical patients. Therefore randomized controlled trials are justifiable and needed to guide clinicians.
Summary An 83-year-old Caucasian female was referred for dobutamine stress echocardiography. At peak dobutamine stress, no chest pain was elicited, and there were no ischemic electrocardiographic ...changes or inducible wall motion abnormalities. During recovery, however, the patient experienced chest burning, and ST-elevations were seen on recovery electrocardiography. Moreover, distal inferior and apical akinesis developed during recovery echocardiography. The patient was referred for coronary angiography, revealing apical akinesis and no obstructive stenoses. A follow-up echocardiogram 2 weeks later showed recovery of the “ballooned” segments. To our knowledge, this report is the third case of Takotsubo cardiomyopathy occurring during the recovery phase of dobutamine stress echocardiography.
Abstract Background Allergic rhinitis affects 10 to 40% of the population. It reduces quality of life, school and work performance, and is a frequent reason for office visits in general practice. ...Medical costs are large but avoidable costs associated with lost work productivity are even larger than those incurred by asthma. New evidence has accumulated since the last revision of the Allergic Rhinitis and its Impact on Asthma – ARIA guidelines in 2010 prompting its update. Objective To provide a targeted update of the ARIA guidelines. Methods The ARIA guideline panel identified new clinical questions and selected questions requiring an update. We performed systematic reviews of health effects and the evidence about patient values and preferences, and resource requirements (up to June 2016). We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence-to-decision frameworks to develop recommendations. Results The 2016 revision of the ARIA guidelines provides updated and new recommendations about the pharmacological treatment of allergic rhinitis. It specifically addresses the relative merits of using oral H1-antihistamines, intranasal H1-antihistamines, intranasal corticosteroids, and leukotriene receptor antagonists either alone or their combination. The ARIA guideline panel provides specific recommendations for the choice of treatment, the rationale for the choice, and discusses specific considerations that clinicians and patients may want to review in order to choose the management most appropriate for an individual patient. Conclusions Appropriate treatment of allergic rhinitis may improve patients’ quality of life, school and work productivity. ARIA recommendations support patients, their caregivers, and health care providers in choosing the optimal treatment.
Background: Preclinical data indicate that docetaxel, platinum salts, and the combination of both drugs are highly synergistic with the anti-HER2 antibody trastuzumab. The University of California at ...Los Angeles-Oncology Research Network (UCLA-ORN) and the Breast Cancer International Research Group (BCIRG) have conducted two phase II studies to evaluate docetaxel and trastuzumab in combination with either cisplatin or carboplatin for the treatment of women with advanced breast cancer that overexpresses HER2. Methods: Each study enrolled 62 patients with HER2-overexpressing tumors. Patients received a median of six cycles of docetaxel at 75 mg/m2 of body surface area and cisplatin (BCIRG 101 study) at 75 mg/m2 or carboplatin (UCLA-ORN study) at AUC = 6 mg/mL · min given on day 1 and then every 21 days. Trastuzumab was given on day 1, cycle 1 (4 mg/kg) and then continued weekly at 2 mg/kg for 1 year or until disease progression. Tumor measurements were obtained at baseline, after three cycles of chemotherapy, and then every 3 months. HER2 gene amplification was determined by fluorescence in situ hybridization. Results: Patient characteristics were comparable between trials with the exception that 15% of the patients in the UCLA-ORN study had received previous adjuvant taxane therapy. Both regimens were well tolerated, with manageable toxicities. Hematologic toxicities were more frequent in patients in the UCLA-ORN study than in patients in the BCIRG 101 study, whereas the reverse pattern was observed for non-hematologic toxicities. One patient in each study developed reversible congestive heart failure. Responses were observed in 49 of 62 patients in the BCIRG 101 study (overall response rate = 79%, 95% confidence interval CI = 66% to 89%) and in 34 of 59 evaluable patients in the UCLA-ORN study (overall response rate = 58%, 95% CI = 44% to 70%). Median times to progression were 9.9 months (95% CI = 8.3 to 13.1 months) and 12.7 months (95% CI = 8.6 to 15.5 months) for patients in the BCIRG 101 and UCLA-ORN studies, respectively. Overall response rates were higher and median time to progression was longer in the subset of patients whose tumors harbored HER2 gene amplification. Conclusion: Combinations of docetaxel, a platinum salt, and trastuzumab are feasible and active in patients with advanced breast cancers that overexpress HER2. The BCIRG is conducting ongoing randomized studies of the three-drug combination in both the metastatic and adjuvant settings.
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