Therapeutics and clinical risk management
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Ther Clin Risk Manag · Jan 2018
Effect of denosumab on bone mineral density in Japanese women with osteopenia treated with aromatase inhibitors for breast cancer: subgroup analyses of a Phase II study.
The aim of the study was to conduct subgroup analyses of therapeutic effects of 12-month denosumab therapy on the percentage change in bone mineral density (BMD) from baseline in the lumber spine and femoral neck. ⋯ Twice-yearly treatment with denosumab was associated with increased BMD among Japanese women receiving adjuvant AI therapy, regardless of the baseline characteristics or skeletal site.
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Ther Clin Risk Manag · Jan 2018
Pulse pressure variation and pleth variability index as predictors of fluid responsiveness in patients undergoing spinal surgery in the prone position.
This study investigated the ability of pulse pressure variation (PPV) and pleth variability index (PVI) to predict fluid responsiveness of patients undergoing spinal surgery in the prone position. ⋯ Both PPV and PVI were able to predict fluid responsiveness; their predictive abilities were maintained in the prone position.
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Ther Clin Risk Manag · Jan 2018
ReviewA meta-analysis and systematic review evaluating the use of erythropoietin in total hip and knee arthroplasty.
The debate is still ongoing on the effectiveness and safety of erythropoietin (EPO) treatment in orthopedic surgeries. Specifically, previous studies have not compared the dynamic change of hemoglobin (Hb) levels between different transfusion methods. Besides, complications or side effects of this alternative have not been quantitatively analyzed. We conducted a meta-analysis and systemic review to evaluate the efficacy of EPO on Hb levels observed during the whole perioperative period as well as the volume of allogeneic blood transfusion (ABT), the risk of venous thromboembolism, and application frequency of ABT in hip and knee surgery. ⋯ Preoperative administration of EPO was shown to generally increase Hb levels during the whole perioperative period; however, the extent of the positive effects varies with time points. Additionally, EPO minimizes the need for transfusion significantly in patients undergoing hip or knee surgery without increasing the chance of developing thrombotic complications. Therefore, EPO offers an alternative blood management strategy in total hip arthroplasty and total knee arthroplasty.
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Ther Clin Risk Manag · Jan 2018
The use of the C-MAC videolaryngoscope for awake intubation in patients with a predicted extremely difficult airway: case series.
The C-MAC videolaryngoscope was evaluated for intubation in patients with predicted extremely difficult airway. The presented cases are patients with neoplasm tumors in larynx. In all cases, awake intubation using C-MAC videolaryngoscope was performed in patients breathing spontaneously, under local anaesthesia, with oxygen administered via nasal catheter. ⋯ Based on my experience, I assume that C-MAC videolaryngoscope is a very useful tool for anaesthesiologists and can be applied not only for unexpected difficult intubation but also for predicted difficult airway. Moreover, it could be used as an additional diagnosis tool before larynx surgery. The view obtained with the C-MAC videlaryngoscope corresponds with larynx examination performed before surgery, and could potentially reveal more details.
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Ther Clin Risk Manag · Jan 2018
A restrictive dose of crystalloids in patients during laparoscopic cholecystectomy is safe and cost-effective: prospective, two-arm parallel, randomized controlled trial.
There are no evidence-based guidelines for volume replacement during surgical procedures such as laparoscopic cholecystectomy. However, the administration of a restrictive volume of crystalloids could be more cost-effective and safe. This trial aimed to determine the effectiveness and safety of a restrictive regimen of crystalloids in patients during laparoscopic cholecystectomy by analyzing its cost-effectiveness and 1-year morbidity rate. ⋯ Restrictive fluid therapy during laparoscopic cholecystectomy is justified, safe, and more cost-effective than other options.