The American journal of medicine
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Antimicrobial agents are among the most frequently prescribed medications during hospitalization. However, approximately 30% to 50% or more of inpatient antimicrobial use is unnecessary or suboptimal. ⋯ Further, we discuss supporting data to dispel each of these myths. This analysis will provide hospitalists and other clinicians with a foundation for rational decision-making about antimicrobial use and support antimicrobial stewardship efforts at both the patient and institutional levels.
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Clinical trials have shown a beneficial effect from biological disease-modifying antirheumatic drugs (bDMARDs) on hand or axial bone loss in patients with rheumatoid arthritis; however, it is unclear if this translates to a reduced fracture risk. We investigated the effect of bDMARDs on osteoporotic fracture risk compared to no biological treatment in rheumatoid arthritis. ⋯ We found no independent beneficial effect from using bDMARDs on reducing the risk of osteoporotic fractures in patients with rheumatoid arthritis.
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Vertebral compression fractures are the most common complication of osteoporosis, with 700,000 cases reported every year in the United States. Vertebral compression fractures typically present with abrupt-onset low back pain with or without a history of trauma, although more than two-thirds are detected incidentally. ⋯ Magnetic resonance imaging is also the modality of choice to determine if the fracture is acute vs chronic in nature. Patients can be managed with a combination of nonsurgical modalities including medications, bracing, and physical therapy, although when indicated, kyphoplasty or vertebroplasty may be considered to provide symptom relief.
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Multicenter Study
Association of medication-assisted-therapy with new onset of cardiac arrhythmia in patients diagnosed with opioid use disorders.
No data exist on comparative risk of cardiac arrhythmias among 3 Medication-Assisted Therapy (MAT) medications in patients with opioid use disorder. Understanding MAT medications with the least risk of arrhythmia can guide clinical decision-making. ⋯ MAT users had higher risk of cardiac arrhythmia than non-users. Naltrexone is associated with the highest risk of arrhythmia, suggesting caution with naltrexone use, especially in opioid use disorder patients with pre-existing heart conditions.
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Determining if a medication is effective should be easy: Either the condition is or is not improved. However, the truth is often more complex than that, including in the antiarrhythmic drug (AAD) management of atrial fibrillation. In clinical trials, AAD efficacy is usually determined by the time to first atrial fibrillation recurrence. ⋯ In clinical practice AADs, for atrial fibrillation, are prescribed to reduce symptoms/improve quality of life, which usually correlate with reduced atrial fibrillation frequency, duration, and beneficial hemodynamic effects in certain patient subgroups. Time to first recurrence is not a reliable predictor of clinical efficacy endpoints in practice. This article presents a review for the practitioner of AAD efficacy endpoints in clinical trials versus those in clinical practice and why such differences are present.