Clinical therapeutics
-
Clinical therapeutics · Apr 2020
Review Meta AnalysisEffect of 5-μg Dose of Dexmedetomidine in Combination With Intrathecal Bupivacaine on Spinal Anesthesia: A Systematic Review and Meta-analysis.
Intrathecal dexmedetomidine (DEX) has been used to improve the quality and duration of spinal anesthesia. The aim of this meta-analysis is to evaluate whether intrathecal DEX could prolong the duration of sensory and motor block during spinal anesthesia. ⋯ Intrathecal DEX can prolong the duration of sensory block, the duration of motor block, and the time to first analgesic request associated with spinal anesthesia.
-
Clinical therapeutics · Apr 2020
Meta AnalysisRisk Factors for the Relapse of Graves' Disease Treated With Antithyroid Drugs: A Systematic Review and Meta-analysis.
Antithyroid drugs (ATDs) are the first-line treatment for Graves' disease (GD). A common problem with ATD treatment is the high relapse rate after drug withdrawal. The goal of this study was to analyze the influencing factors for the relapse of GD patients treated with ATD by using a systematic review and meta-analysis, provide some predictive indexes for the susceptibility of GD recurrence, and then further explore some useful methods to decrease the GD relapse rate after ATD treatment. ⋯ This analysis revealed that certain risk factors were associated with GD relapses such as younger age, larger goiter size or thyroid volume, and the higher free triiodothyronine or free thyroxine level in the diagnosing phase of GD. For patients with these clinical characteristics, early definitive treatment with radioactive iodine or surgery should be offered to those who are unlikely to achieve remission with ATDs only. In addition, more prospective cohort studies with different ATD regimens would help to determine the optimum ATD treatment for patients with GD. PROSPERO identifier: CRD 42019146825.
-
Clinical therapeutics · Apr 2020
The Enhancing Quality of Prescribing Practices for Older Veterans Discharged From the Emergency Department (EQUIPPED) Potentially Inappropriate Medication Dashboard: A Suitable Alternative to the In-person Academic Detailing and Standardized Feedback Reports of Traditional EQUIPPED?
The Enhancing Quality of Prescribing Practices for Older Veterans Discharged From the Emergency Department (EQUIPPED) program is a quality improvement initiative that combines education, clinical decision support (ie, geriatric pharmacy order sets), and in-person academic detailing coupled with audit and feedback in an effort to improve appropriate prescribing to older veterans discharged from the emergency department. Although the EQUIPPED program is effective at reducing the prescribing of potentially inappropriate medications, the reliance on in-person academic detailing may be a limitation for broader dissemination. The EQUIPPED dashboard is a passive yet continuous audit and feedback mechanism developed to potentially replace the in-person academic detailing of the traditional EQUIPPED program. We describe the development process of the EQUIPPED dashboard and the key audit and feedback components found within. ⋯ To our knowledge, the EQUIPPED dashboard is the first information display of its kind with built-in audit and feedback that has been developed for VA emergency department practitioners as the primary end users. Further investigation is warranted to determine whether the EQUIPPED dashboard is a suitable alternative to in-person academic detailing. The EQUIPPED dashboard will be leveraged in a formal implementation trial that will entail the randomization of multiple VA sites to either (1) traditional EQUIPPED with in-person academic detailing coupled with audit and feedback or (2) EQUIPPED with passive audit and feedback delivered through the EQUIPPED dashboard without in-person prescribing outreach.
-
Clinical therapeutics · Apr 2020
Valproic Acid for the Management of Agitation and Delirium in the Intensive Care Setting: A Retrospective Analysis.
Valproic acid has been proposed as an alternative agent for treatment of agitation and delirium in the intensive care unit (ICU). Clinical data to support the use of valproic acid for this indication are limited. The objective of this analysis was to assess the efficacy and safety associated with the use of valproic acid for the management of agitation and delirium in the ICU. ⋯ Valproic acid may be an alternative option to assist in the management of agitation and delirium in the ICU. Additional prospective data are needed to validate the use of this agent for the treatment of agitation and delirium in critically ill patients.
-
Clinical therapeutics · Mar 2020
Meta AnalysisThe Hepatorenal Toxicity and Tumor Response of Chemotherapy With or Without Aidi Injection in Advanced Lung Cancer: A Meta-Analysis of 80 Randomized Controlled Trials.
Chemotherapy-induced hepatorenal toxicity often decreases tolerance for further therapies and results in poor quality of life and prognosis for patients with lung cancer. In this meta-analysis, all related studies were systematically re-evaluated to determine whether Aidi injection relieves hepatorenal toxicity and improves tumor response, and to determine its threshold and the optimal treatment regimen for obtaining the desired responses. ⋯ The moderate evidence indicates that Aidi injection with chemotherapy may improve tumor response and result in a low incidence of hepatorenal toxicity in patients with lung cancer. Aidi injection may relieve hepatorenal toxicity and exhibit an important protective effect against chemotherapy-induced hepatorenal toxicity. Based on the subgroup analysis results, Aidi injection seems to lower the threshold for chemotherapy. Treatment with 50 mL per time, 10 to 14 days per cycle, and 2 to 3 cycles may be the optimal usage for attaining a decrease in hepatorenal toxicity.