Clinical therapeutics
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Clinical therapeutics · Sep 1994
Comparative Study Clinical TrialPoint-of-care versus central laboratory testing: an economic analysis in an academic medical center.
A cost-effectiveness study was conducted to determine time and labor costs for point-of-care (POC) versus central laboratory testing. A prospective, observational time and motion study was carried out at a teaching hospital located in Philadelphia, Pennsylvania. The cohort consisted of 210 patients presenting to the emergency department who were triaged at the urgent or emergent level during a 4-week period. ⋯ The cost per test for POC analysis ranged from $14.37 to $16.67, depending on the POC test volume (estimated volume based on 20% to 50% of emergency department patients that had either Chem-7 or CBC test done applied over the useful life of the POC testing equipment) and the personnel (nurse or emergency department technician) who performed the test. With an increasing volume of POC tests performed per unit time, costs for POC testing would be reduced substantially. POC test costs are volume dependent under current reimbursement mechanisms for emergency department patient care services, for example, fee-for-service payment.(ABSTRACT TRUNCATED AT 400 WORDS)
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Clinical therapeutics · Sep 1994
Clinical TrialThe inotropic and hemodynamic effects of intravenous milrinone when reflex adrenergic stimulation is suppressed by beta-adrenergic blockade.
Milrinone is an inotropic and vasodilator agent proven to be effective in the treatment of heart failure. This study evaluated whether milrinone produces inotropic and hemodynamic effects independent of reflex adrenergic stimulation. Eleven stable heart failure patients (New York Heart Association class II to III) undergoing cardiac catheterization received intravenous (i.v.) milrinone (50 micrograms/kg for 10 minutes followed by 0.5 micrograms/kg/min for 50 minutes) during beta-adrenergic blockade. ⋯ Mean percentage increase in cardiac index from baseline was statistically significant at 20 and 30 minutes, and mean absolute decline from baseline for pulmonary capillary wedge pressure was statistically significant at 20 and 40 minutes (P < 0.05). The inotropic and hemodynamic effects of i.v. milrinone were thus preserved during beta-adrenergic blockade. This finding is consistent with a mechanism of action of i.v. milrinone--myocardial phosphodiesterase inhibition--that is independent of reflex adrenergic stimulation.
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Clinical therapeutics · May 1994
Randomized Controlled Trial Comparative Study Clinical TrialA single-dose, double-blind comparison of naproxen sodium, acetaminophen, and placebo in postoperative dental pain.
The analgesic efficacy and duration of action of naproxen sodium 440 mg (n = 92), acetaminophen 1000 mg (n = 89), and placebo (n = 45) were compared in a single-dose, randomized, double-blind, 12-hour study of patients with at least moderate pain secondary to extraction of three or four third molars. Time to remedication, a measure of duration of analgesic effect, was significantly longer (P < 0.001) with naproxen sodium (median, 9.9 hours) than with either acetaminophen (median, 3.1 hours) or placebo (median, 2.0 hours). ⋯ The overall percentages of patients reporting adverse events, and the types of events reported, were comparable with the three treatments. Thus naproxen sodium demonstrated superior efficacy and similar tolerability to acetaminophen in this postoperative dental pain model.
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Clinical therapeutics · May 1994
Randomized Controlled Trial Comparative Study Clinical TrialComparison of single-dose ibuprofen lysine, acetylsalicylic acid, and placebo for moderate-to-severe postoperative dental pain.
In a single-dose, double-blind, parallel-group, single-site study, ibuprofen lysine 200 mg (IBL 200) was compared with acetylsalicylic acid 500 mg (ASA 500) and placebo in 183 patients with moderate-to-severe postoperative dental pain. The relative onset of analgesic response, duration and degree of analgesia, and safety were assessed over a 6-hour postdose period. ⋯ IBL 200 also had a significantly faster onset of action, greater peak and overall analgesic effect, and longer duration of analgesia than ASA 500. All treatments were generally well tolerated.
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Clinical therapeutics · Nov 1993
Treatment of disseminated intravascular coagulation with gabexate mesilate.
Gabexate mesilate (FOY) was used to treat 215 patients with disseminated intravascular coagulation (DIC) and 146 patients with a predisposition to DIC (pre-DIC). Sixty percent of DIC patients and 48% of pre-DIC patients exhibited pretreatment organ failure, which resolved after FOY treatment in 16% of DIC patients and 17% of pre-DIC patients. Seventy percent of DIC patients and 49% of pre-DIC patients had a pretreatment bleeding tendency that was ameliorated by FOY treatment in 32% of DIC patients and 30% of pre-DIC patients. ⋯ DIC scores were significantly lowered in both leukemic and nonleukemic patients from the third day of treatment with FOY. Among leukemic DIC patients, 59% showed complete remission (CR), 21% partial remission (PR), and 7% exacerbation of their condition; 46% of the nonleukemic DIC patients demonstrated CR, 17% PR, and 17% exacerbation. Of the leukemic pre-DIC patients, 59% showed improvement and 7% exacerbation, whereas 55% of the nonleukemic pre-DIC patients showed improvement and 27% exacerbation.