Clinical therapeutics
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Clinical therapeutics · Jan 2016
Randomized Controlled Trial Comparative StudyDexmedetomidine-fentanyl Compared With Midazolam-fentanyl for Conscious Sedation in Patients Undergoing Lumbar Disc Surgery.
Patients undergoing awake lumbar disc surgery need adequate sedation and analgesia. This study investigated whether use of a dexmedetomidine-fentanyl (DF) regimen could be superior to midazolam-fentanyl (MF) for these patients. ⋯ Although awake lumbar disc surgery can be performed successfully under sedation with either MF or DF combination, the latter may be a better alternative because of less consumption of opioid analgesics. ChiCTR.org identifier: ChiCTR-TRC-13003645.
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Clinical therapeutics · Jan 2016
Randomized Controlled TrialMagnesium Sulfate Plus Lidocaine Reduces Propofol Injection Pain: A Double-blind, Randomized Study.
Propofol injection can cause distressing pain, and no method can inhibit it completely. Neither lidocaine nor magnesium sulfate (MgSO4) was sufficient to prevent pain from the injection of propofol. This prospective, double-blind, placebo-controlled study was designed to investigate the efficacy of the MgSO4 plus lidocaine on suppressing propofol injection pain. ⋯ Administration of 300 mg MgSO4 plus 40 mg lidocaine reduces propofol injection pain very well. No complications were observed in the treatment groups.
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Clinical therapeutics · Jan 2016
Multicenter Study Comparative StudyComparative Effectiveness of Vancomycin Versus Daptomycin for MRSA Bacteremia With Vancomycin MIC >1 mg/L: A Multicenter Evaluation.
Clinical studies comparing vancomycin with alternative therapy for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia are limited. The objective of this study was to compare outcomes of early daptomycin versus vancomycin treatment for MRSA bacteremia with high vancomycin MICs in a geographically diverse multicenter evaluation. ⋯ Results from this multicenter study provide, for the first time, a geographically diverse evaluation of daptomycin versus vancomycin for patients with vancomycin-susceptible MRSA bacteremia with vancomycin MIC values >1 µg/mL. Although the overall composite failure rates did not differ between the vancomycin and daptomycin groups when intensively matched according to risks for failure, the rates of acute kidney injury were significantly lower in the daptomycin group. These findings suggest that daptomycin is a useful therapy for clinicians treating patients who have MRSA bacteremia. Prospective, randomized trials should be conducted to better assess the potential significance of elevated vancomycin MIC.
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Clinical therapeutics · Jan 2016
Comparative StudyEconomic Impact of Oritavancin for the Treatment of Acute Bacterial Skin and Skin Structure Infections in the Emergency Department or Observation Setting: Cost Savings Associated with Avoidable Hospitalizations.
Data indicate that acute bacterial skin and skin structure infection (ABSSSI) patients without major comorbidities can be managed effectively in the outpatient setting. Because most patients with ABSSSIs present to the emergency department, it is essential that clinicians identify candidates for outpatient treatment given the substantially higher costs associated with inpatient care. We examined the potential cost avoidance associated with shifting care from inpatient treatment with vancomycin to outpatient treatment with oritavancin for ABSSSI patients without major complications or comorbidities. ⋯ This cost-minimization model indicates that use of oritavancin in the emergency department or observation setting is associated with substantial cost savings compared with inpatient treatment with vancomycin.
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Clinical therapeutics · Dec 2015
Case ReportsMissed Opportunities for Intervention in a Patient With Prolonged Postoperative Delirium.
Postoperative delirium is a common and costly state of brain dysfunction that complicates postsurgical management in some patients. The purpose of this report was to describe a case of prolonged postoperative delirium and to review the appropriate identification and management of this condition. ⋯ In this high-risk patient, a proactive approach to the prevention and treatment of delirium may have avoided or mitigated the prolonged delirium and, potentially, long-term cognitive deficits.