Inflammation research : official journal of the European Histamine Research Society ... [et al.]
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Clinical Trial
Influence of histamine release on postoperative vomiting (POV) following gynaecological laparoscopic surgery.
The mechanisms leading to the high incidence of postoperative vomiting (POV) after gynaecological laparoscopic surgery are still unknown. The effectiveness of POV-prophylaxis using H1 + H2-receptor antagonists has been demonstrated, suggesting a role for histamine in the pathogenesis of POV. However, histamine levels were not measured in these studies. The aim of this study was to investigate the incidence of plasma histamine release and its association with POV after gynaecological laparoscopic surgery. ⋯ A high incidence of plasma histamine release was demonstrated in most but not all patients with POV. The probability of POV with histamine release (0.5) was higher than without histamine release (0.3), thus histamine release was shown to be one of the contributory determinants for POV in this clinical study. Thus, patients at risk for POV may benefit from a H1 + H2-receptor antagonists prophylaxis alone or in combination with other antiemetic strategies.
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Randomized Controlled Trial Clinical Trial
Premedication with H1 and H2 blocking agents reduces the incidence of postoperative nausea and vomiting.
Patients undergoing anaesthesia and surgery frequently complain about postoperative nausea and vomiting (PONV). Whether pretreatment with H1 and H2 blocking agents reduces the incidence of PONV remains controversial. To answer this question, we performed a randomised, prospective, placebo-controlled clinical study to evaluate the efficacy of a premedication with H1 and H2 receptor antagonists. ⋯ Premedication with H1 and H2 blocking agents significantly reduces the incidence of postoperative nausea and vomiting.
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The nature of score-based predictions is probabilistic, and their accuracy depends on the reliability and validity of the applied system. As an example, the present study investigates the accuracy of the RIP-algorithm (RIP = Riyadh Intensive Care Program) based on daily APACHE II scores, and compares it with published results of that algorithm from other investigators. ⋯ Sequential assessment of scores in intensive care could identify high risk patients, but with some degree of uncertainty. Therefore, the scores should only be used by those familiar with their limitations and risks.
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Case Reports
A problem solving and decision making toolbox for approaching clinical problems and decisions.
In this paper, we begin by presenting three real patients and then review all the practical conceptual tools that have been suggested for systematically analyzing clinical problems. Each of these conceptual tools (e.g. ⋯ A heuristic for guiding the clinician in using the tools is proposed. The heuristic is then used to analyze management of the three patients presented at the outset.
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The aims of this paper are to identify the issues and forces that were the impetus for two recent developments in academic medicine, evidence-based medicine (EBM) and medical decision making (MDM); to make explicit their underlying similarities and differences; and to relate them to the fates of these innovations. Both developments respond to concerns about practice variation; the rapid growth of medical technology, leading to a proliferation of diagnostic and treatment options; the patient empowerment movement; and psychological research that raised questions about the quality of human judgment and decision making. ⋯ Major differences include: emphasis on knowledge or judgment as the fundamental problem; the status of formal models and utility assessment; and the spirit and tone of the innovation. These differences have led to broader acceptance of EBM within academic medicine, while decision analysis, the fundamental tool of MDM, has been less welcomed in clinical circles and has found its place in guideline development, cost-effectiveness analysis, and health policy.