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.
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)
To determine whether pharmacist prescription of combined hormonal contraception is associated with inappropriate prescription to women with medical contraindications.
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.
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).
Rates of contraceptive prescribing with a contraindication were relatively low and did not differ between clinicians and pharmacists.
Pharmacists can safely screen for medical contraindications to combined hormonal contraception.
Triptans are the drugs of choice in moderate to severe migraine attacks. It is estimated that they are ineffective in one-third of patients. Moreover, triptans are contraindicated in patients with ...cardiovascular diseases. Therefore, there is a need for novel antimigraine treatments devoid of vasoconstrictor activity. The aim of this review paper is to report current data on 5HT1F agonist – lasmiditan. Its efficacy was confirmed in randomized controlled trails – SAMURAI, SPARTAN and GLADIATOR. The percentages of patients free of migraine pain and migraine bothersome symptoms were higher in the group treated with lasmiditan compared to placebo. Generally, lasmiditan has a favourable safety profile. Dizziness was the most frequently reported adverse event. No toxic effects on the liver or negative effects on hemodynamic or laboratory parameters were reported. The discontinuation rate due to adverse events in patients treated with lasmiditan was low. According to the available data, lasmiditan is safe, efficacious and well tolerated in treating migraine attacks. Lasmiditan does not exhibit vasoconstrictive proprieties and may be used in patients with cardiovascular diseases, in whom triptans are contraindicated. The results of studies on effectiveness and tolerability of lasmiditan are promising and it is hoped that in the future it will expand abortive therapeutic options for migraine. In October 2019, lasmiditan was approved by the US Food and Drug Administration for the treatment of migraine attacks in adult patients. Currently this drug in not available in Poland.
Background: The re-emergence of tourniquet use for injured military members has been accompanied by robust data showing its improvement in mortality and morbidity. Translation of this military ...practice to civilian settings has not been accompanied by equivalent data but rather is based on recommendations from military populations. We used expert military physicians to create practice recommendations for civilian first responder tourniquet use outside the tactical setting, by those who have trained to use tourniquets in combat environments. Methods: Eighteen military physicians agreed to participate in a Delphi questionnaire. Both emergency medicine physicians and surgeons engaged in the iterative process to arrive at consensus about ideas and themes initially identified by the group. Results: Our participants were able to achieve consensus on 13 of 18 (72%) indications and 5 of 8 (63%) contraindications for prehospital use of tourniquets by first responders. Anatomic injury patterns that closely mirror combat blast injuries, such as limb amputation or uncontrolled bleeding, were identified as an indication for prehospital tourniquet placement. Participants identified physiologic derangements, such as hemodynamic instability, as additional indications. In our study historic indications of battlefield tourniquet indication, such as open fracture, blast injury or penetrating injury, did not meet consensus as an indication for civilian tourniquet application. Agreed-upon contraindications to civilian tourniquet use included treatment of snake bites and the ability to control bleeding with direct pressure. There was agreement among the group that an anticipated transport time greater than 2 hours should not be a contraindication to civilian prehospital tourniquet use. Conclusion: Military members who wear ballistic protective apparel in combat environments while sustaining rifle and blast injuries have substantially different injury patterns than civilian emergency medical services patients in nontactical environments, upon which existing guidelines have been built. A panel of experts, with extensive experience treating both combat and civilian trauma, recommend the use of tourniquet application in the civilian environment for specific indications. Content licence: This is an Open Access supplement distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/ licenses/by-nc-nd/4.0/
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