Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2014
Review Comparative StudyCost-efficiency of knowledge creation: randomized controlled trials vs. observational studies.
This article reviews traditional and current perspectives on randomized, controlled trials (RCTs) and observational studies relative to the economic implications for public healthcare stakeholders. ⋯ Considering the strengths and limitations of each study type, clinical researchers should explore the contextual worthiness of either design in promulgating knowledge. They should focus on quality of conduct and reporting that may allow for the liberation of limited public and private clinical research funding.
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Curr Opin Anaesthesiol · Apr 2014
ReviewThe changing anesthesia economic landscape: emergence of large multispecialty practices and Accountable Care Organizations.
In this review, we evaluate the current US employment models for healthcare in general and anesthesiologists in particular and the emergence of large, multispecialty physician groups and the forces behind this change to the current anesthesia practice model. We will also examine the present payment method for anesthesiologists and determine how Accountable Care Organizations will affect the future payment models. ⋯ This is the most critical time in the specialty of anesthesiology from an economic viewpoint, and significant threats and opportunities will arise for anesthesiologists in how they are reimbursed, and how they demonstrate the delivery of quality care to patients.
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In the perioperative period, acute heart failure can result from a variety of conditions, and treatment may vary considerably depending on its mechanism. This review aims to provide conceptual framework by selectively presenting recent knowledge and advances in acute heart failure therapies including drugs (inotropes, diuretics) and devices (mechanical assistance, biventricular pacing, ultrafiltration). ⋯ Poor data exist in the perioperative setting concerning acute heart failure therapies. Large trials are needed to support the use of levosimendan, mechanical assistance, utrafiltration and biventricular pacing in the perioperative setting. The prognostic role of natriuretic peptides was confirmed in the perioperative period.
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Evidence is emerging that delirium is associated with both short-term and long-term morbidity and mortality. This review highlights the epidemiology, outcomes, prevention and treatment strategies associated with delirium after cardiac surgery. ⋯ Clinicians in the ICU must recognize the impact of delirium in predicting long-term outcomes for patients. Further research is needed in determining interventions that will be effective in preventing and treating delirium in cardiac surgical setting.
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Bleeding in trauma carries a high mortality and is increased in case of coagulopathy. Our understanding of hemostasis and coagulopathy has improved, leading to a change in the protocols for hemostatic monitoring. This review describes the current state of evidence supporting the use of viscoelastic hemostatic assays to guide trauma resuscitation. ⋯ We are moving toward avoiding coagulopathy by individualized, goal-directed transfusion therapy, using viscoelastic hemostatic assays to guide ongoing resuscitation of actively bleeding patients in a goal-directed manner.