To describe the use of non-steroidal anti-inflammatory drugs (NSAID), opioids, and physiotherapy (PT) among persons with newly diagnosed knee or hip osteoarthritis (OA) with and without NSAID ...contraindications or precautions.
We used population-based register data to identify adults aged ≥35 as of January 1, 2014, residing in Skåne region (Sweden) between 2004 and 2013, without a previous knee or hip OA diagnosis. Among this cohort, we identified people with incident knee or hip OA diagnosis between 2014 and 2018 and the presence of contraindications to or precautions for oral NSAIDs at the time of OA diagnosis. We estimated the risk of 1) regular oral NSAID use, 2) regular opioid use, and 3) PT during the first year after diagnosis among those with vs. without contraindications or precautions using confounder-adjusted logistic regression with standardization.
We identified 35,173 persons with newly diagnosed OA, of whom 3257 and 8351 had ≥1 contraindication to oral NSAIDs and ≥1 precaution, respectively. Overall, 27% of individuals used oral NSAIDs (with or without opioids or PT), 10% used opioids, and 57% attended PT. Among patients with contraindications, 21% used oral NSAIDs compared to 31% without (absolute adjusted difference −0.06 (95% CIs: −0.08, −0.05)), 53% vs 59% used PT (adjusted difference −0.03 (−0.05, −0.01)), while 14% vs. 8% had prescribed dispensed opioids (adjusted difference 0.02 (0.01, 0.03)). Similar results were observed for those with precautions.
We highlight the need for safer treatment options. People with OA and contraindications/precautions to NSAIDs have a higher risk of opioid use, slightly lower risk of PT use, and continue to be prescribed NSAIDs.
This document presents a professional view of evidence-based recommendations around the issues of antiplatelet and anticoagulation management in cardiac surgery. It was prepared by the Audit and ...Guidelines Committee of the European Association for Cardio-Thoracic Surgery (EACTS). We review the following topics: evidence for aspirin, clopidogrel and warfarin cessation prior to cardiac surgery; perioperative interventions to reduce bleeding including the use of aprotinin and tranexamic acid; the use of thromboelastography to guide blood product usage; protamine reversal of heparin; the use of factor VIIa to control severe bleeding; anticoagulation after mechanical, tissue valve replacement and mitral valve repair; the use of antiplatelets and clopidogrel after cardiac surgery to improve graft patency and reduce thromboembolic complications and thromboprophylaxis in the postoperative period. This guideline is subject to continuous informal review, and when new evidence becomes available. The formal review date will be at 5 years from publication (September 2013).
The athletic trainer's (AT) emergency management skill set requires competency in the delivery of basic lifesaving medications. Some lifesaving medications have been a part of athletic training ...practice for decades, but that list has grown as ATs' practice setting has expanded - increasing the types of em ergent conditions that the AT may have to treat. The 2020 CAATE curricular standards require athletic training students be trained to administer the following: supplemental oxygen, nitroglycerine, low dose aspirin, bronchodilators, epinephrine using automated injection device, glucagon, and naloxone. Clinically, the conditions treated by these medications can be categorized as follows: cardiac, respiratory, hypoglycemia, or anaphylaxis. All ATs should know the indications, contraindications, administration methods, and the details of patient monitoring for each medication. Generally, these medications are safe, have clear indications for use, and few contraindications. While ATs are trained to administer these medications, they must consider state laws and local policies.
While pharmacists may know that a particular drug is inactive in a given pH environment, they often do not know the pH of common foods. For dietitians the situation is reverse. With contributions ...from pharmacy, dietetics, and medicine, this book serves as a guide to the interdisciplinary prevention or correction of negative food-drug interactions. While other books simply list potential food-drug interactions, this book gives specific recommendations based on frequency and severity of reactions. It provides special dietary modifications necessary for prevention of adverse side effects. It also identifies new foods, supplements, and ethnic dishes that may contribute significantly to food-drug interactions.
We previously reported that the Charlson Comorbidity Index (CCI) was useful for predicting outcomes in patients undergoing allogeneic hematopoietic cell transplantation (HCT). However, the sample ...size of patients with scores of 1 or more, captured by the CCI, did not exceed 35%. Further, some comorbidities were rarely found among patients who underwent HCT. Therefore, the current study was designed to (1) better define previously identified comorbidities using pretransplant laboratory data, (2) investigate additional HCT-related comorbidities, and (3) establish comorbidity scores that were suited for HCT. Data were collected from 1055 patients, and then randomly divided into training and validation sets. Weights were assigned to individual comorbidities according to their prognostic significance in Cox proportional hazard models. The new index was then validated. The new index proved to be more sensitive than the CCI since it captured 62% of patients with scores more than 0 compared with 12%, respectively. Further, the new index showed better survival prediction than the CCI (likelihood ratio of 23.7 versus 7.1 and c statistics of 0.661 versus 0.561, respectively, P < .001). In conclusion, the new simple index provided valid and reliable scoring of pretransplant comorbidities that predicted nonrelapse mortality and survival. This index will be useful for clinical trials and patient counseling before HCT. (Blood. 2005;106: 2912-2919)
Patient C died 3 days later after being managed in the intensive care unit of the issued hospital as the defendant. Patient's successors, A and B, claimed that the defendant physician overdosed ...propofol, which was contraindicated during the administration of pediatric artificial respiration, resulting in C's death due to the Propofol Infusion Syndrome. Tokyo District Court held that the plaintiff's medical records showed that he was cautious and tended to refuse using anesthetics, but the defendant didn't pay attention to this and only explained the danger of pneumothorax without mentioning the danger of prolonged use of anesthetics, which was a violation of the duty of disclosure. The defendant didn't consider adjusting the dosage or changing the medication one day after intubation, so it couldn't be said that there was a reasonable purpose for using the contraindicated medication. Therefore, the defendant physician was negligent and had a causal relationship with C's death.
Introduction: Colon capsule endoscopy (CCE) is a new technology with two approved indications; to provide visualization of the colon after an incomplete colonoscopy and second, to detect pathology in ...patients with evidence of lower gastrointestinal bleeding. Training physicians to properly implement this technology is critical. Our hypothesis is that participants in a live, in-person training for Pillcam Colon achieve increased levels of comfort with the indications, contraindications and reading after course completion. Methods: We conducted a prospective study comparing surveys administered prior to and after an educational training session on PC. The educational session was an eight hour course designed to teach providers how to read the PC studies effectively. The data was pooled from two separate educational sessions in 2018 taught by two different educators. Survey questions covered many topics with inquiries focusing on comfort level with indications, contraindications and reading PC studies. These were rated using a 5-point Likert scale pre- and post-course. Other questions assessed the quality of the course materials, content, comfort with online training and plans for implementation into one's practice. At the end of the course, participants took a graded exam assessing their skill level reading PC. Statistical analysis was performed in SPSS 25.0. Results: 29 physicians participated in the training. The average age of participants was 52.3±13.1 years with an average of 20.1 ± 14.1 years in practice prior to the course. When comparing pre- with postcourse evaluations, there were significant increases in comfort levels with understanding indications (median: 1.0 pre- vs. 4.0 post-course, p< 0.001), contraindications (median: 4.0 pre- vs. 5.0 post-course, p<0.001) and reading (median: 4.0 pre- to 5.0 post-course, p<0.001) PC studies. The mean score of comfort level reading PC prior to the training was 1.5 vs. 4.2 after course completion, a marked improvement in comfort level. At the end of training, 95.4% of trainees who completed the assessment correctly identified all pathology. Conclusion: An in-person, live training course for PC is an effective method for clinicians to become proficient with PC. More live-courses might be beneficial for greater understanding and usage of PC, to implement this technology into our clinical arsenal of tools designed to help patients with incomplete colonoscopic exams and lower gastrointestinal bleeding of undetermined etiology.
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