Hospital practice (1995)
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Hospital practice (1995) · Feb 2012
ReviewAn update in options for the treatment of pain: a review of new opioid formulations.
In the past 2 decades, there has been a significant increase in the use of opioids for the management of chronic nonmalignant pain. This increase in usage has led to concerns of misuse and abuse of opioids. ⋯ In addition, alternative delivery systems have been developed to provide physicians with more options to provide adequate pain management for those with chronic pain. This article reviews new opioid options for the treatment of pain management and requirements of the Risk Evaluation and Mitigation Strategies program.
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In the postoperative pain setting, the use of opioid analgesics remains essential in achieving effective analgesia and in avoiding the deleterious sequelae of uncontrolled pain that can worsen patient outcomes. However, postoperative pain remains undertreated in many patients. Choosing the most appropriate use of opioids in the postoperative setting, especially for patients undergoing ongoing opioid treatment for chronic pain, can pose daunting challenges for many clinicians. In this article, we examine the pitfalls that may be encountered when implementing postoperative pain management strategies with opioid analgesics, especially in patients receiving chronic opioid therapy prior to admission, and the critical steps for appropriate and effective analgesia in this setting.
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Hospital practice (1995) · Feb 2012
Evaluation of costs associated with tolvaptan-mediated hospital length of stay reduction among US patients with the syndrome of inappropriate antidiuretic hormone secretion, based on SALT-1 and SALT-2 trials.
Two randomized clinical trials, the Study of Ascending Levels of Tolvaptan in Hyponatremia 1 and 2 (SALT-1 and SALT-2), showed that tolvaptan was an efficacious and safe therapy for the treatment of hyponatremic patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). ⋯ Based on the SALT-1 and SALT-2 trials, tolvaptan usage is associated with a shorter hospital LOS than placebo among patients with the SIADH. Including the drug cost for 4 days of inpatient tolvaptan therapy, tolvaptan is associated with an estimated mean hospital cost reduction of $694 per admission in the United States.
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Hospital practice (1995) · Feb 2012
Comparative StudyCost analysis of varenicline versus bupropion, nicotine replacement therapy, and unaided cessation in Nicaragua.
In Nicaragua, 30% of current morbidities are associated with tobacco smoking. Tobacco control policy measures have been initiated in this Central American country; however, the population does not have a complete understanding of the long-term consequences of tobacco use. The aim of this study was to compare the direct medical costs of smoking cessation therapies with varenicline, bupropion, nicotine replacement therapy, and unaided cessation in Nicaragua over 5 time horizons: 2, 5, 10, and 20 years, and lifetime. ⋯ The use of a smoking cessation therapy with varenicline would generate long-term savings to Nicaragua's health care institutions of > US$11 million in the lifetime time horizon.
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Hospital practice (1995) · Feb 2012
ReviewPrevention and management of central line-associated bloodstream infections in hospital practice.
In this article aimed at hospitalists, we examine the literature on preventive measures for central line-associated bloodstream infections (CLABSIs) and optimal management once a CLABSI has been established. We focus on a number of core preventive measures and the contemporary approach of bundling these measures for maximal impact in reducing infection rates. We then discuss empiric and pathogen-specific antibiotic therapy, including the role of newer antimicrobial agents, as well as the management of an infected central venous catheter.