- The use of direct oral anticoagulants for extended duration thromboprophylaxis in medically ill patients: a systematic review and meta-analysis. [Journal Article]
- JTJ Thromb Thrombolysis 2019 Jun 20
- The extended use of thromboprophylaxis with direct oral anticoagulants (DOACs) for more than 30 days has been evaluated as an alternative for the standard duration thromboprophylaxis (7-10 days) with…
The extended use of thromboprophylaxis with direct oral anticoagulants (DOACs) for more than 30 days has been evaluated as an alternative for the standard duration thromboprophylaxis (7-10 days) with low molecular weight heparin in medically ill patients to reduce the risk of venous thromboembolism (VTE) after hospital discharge. EMBASE and MEDLINE were searched for studies evaluating extended duration thromboprophylaxis with DOACs versus standard thromboprophylaxis with enoxaparin in medically ill patients through October 2018. Search was limited to randomized-controlled trials. Symptomatic VTE, VTE-related death, and death from any cause, and major and clinically relevant non-major bleeding were used to assess the efficacy and safety, respectively. The Mantel-Haenszel random-effects model risk ratio (RR) and corresponding 95% CIs were calculated using the metan routine in Stata (version 14.2) to estimate the pooled treatment effects. Heterogeneity was assessed by the I2 statistics. Four studies met the inclusion criteria. DOACs were superior to enoxaparin in preventing symptomatic VTE (RR = 0.59, 95% CI 0.44-0.79). There were no significant differences in thromboprophylactic efficacy between extended and standard thromboprophylaxis as to VTE-related death (RR = 0.81, 95% CI 0.60-1.10) and death from any cause (RR = 0.98, 95% CI 0.87-1.09). Compared to the standard duration, extended thromboprophylaxis was associated with approximately two-fold greater risk of major (RR = 1.95, 95% CI 1.25-3.04), and clinically relevant non-major (RR = 1.81, 95% CI 1.29-2.53) bleeding. The superior efficacy was diminished by the unfortunate safety profile. Therefore, we continue to support both the American Society of Hematology (ASH) and the American College of Chest Physicians (ACCP) guidelines recommendation against the extended use of thromboprophylaxis beyond the hospital stay.
- Cardiopulmonary Testing Prior to Lung Resection: What are Thoracic Surgeons Doing? [Journal Article]
- ATAnn Thorac Surg 2019 Jun 07
- CONCLUSIONS: Among thoracic surgeons, there is variation in preoperative cardiopulmonary assessment practices, with differences by practice type and years in practice, and marked discordance with the ACCP guidelines. Further study of guideline adherence linked to postoperative morbidity and mortality is warranted to determine whether adherence impacts outcomes.
- Aetna's Compassionate Care Program: Sustained Value for Our Members with Advanced Illness. [Journal Article]
- JPJ Palliat Med 2019 Jun 10
- CONCLUSIONS: Advanced illness case management programs such as ACCP can improve access to hospice and improve patient outcomes while reducing unnecessary admissions in the last 90 days of life.
- Chronic Cough After Acute Viral Bronchiolitis: Suggestions from the ACCP. [Journal Article]
- AFAm Fam Physician 2019 May 15; 99(10):654-655
- Risk factors and outcomes of urosepsis in patients with calculous pyonephrosis receiving surgical intervention: a single-center retrospective study. [Journal Article]
- BABMC Anesthesiol 2019 May 01; 19(1):61
- CONCLUSIONS: Hypotension during surgery and urgent surgery were risk factors of intra- and postoperative urosepsis for calculous pyonephrosis patients, which may lead to a prolonged ICU stay, postoperative hospital stay and higher mortality.
- [Preconditioning of the lungs and circulation before visceral and thoracic surgical interventions]. [Review]
- CChirurg 2019; 90(7):529-536
- CONCLUSIONS: In addition to preoperative diagnostics to assess the perioperative risk, effective preconditioning of patients is also necessary. For this an interdisciplinary approach including anesthesia, pneumology, psychotherapy and physiotherapy is necessary. In addition to the conservative medicinal optimization, prehabilitation concepts are gaining in importance and will certainly become established in routine clinical practice. From the surgical perspective, minimally invasive approaches and parenchyma-sparing resections also serve to reduce risks.
- Routine monitoring for heparin-induced thrombocytopenia following lower limb arthroplasty: Is it necessary? A prospective study in a UK district general hospital. [Journal Article]
- OTOrthop Traumatol Surg Res 2019; 105(3):497-501
- CONCLUSIONS: The incidence of HIT in the elective arthroplasty population is low. Therefore, routine postoperative monitoring of platelets is not necessary in this population of patients.
- [Novel hepatokine in rheumatoid arthritis laboratory diagnostics.] [Journal Article]
- KLKlin Lab Diagn 2018; 63(12):756-760
- Fetuin-A (α2-Heremans-Schmid glycoprotein, AHSG) is a glycoprotein mainly secreted by hepar in adults. It was shown, that AHSG is a positive as well as a negative acute-phase protein with pro- and an…
Fetuin-A (α2-Heremans-Schmid glycoprotein, AHSG) is a glycoprotein mainly secreted by hepar in adults. It was shown, that AHSG is a positive as well as a negative acute-phase protein with pro- and anti-inflammatory effects. We studied serum levels of an AHSG in patients with rheumatoid arthritis (RA) and healthy controls in order to determine its role in the diagnostics of this disease. We measured serum levels of AHSG in 110 patients with RA and 30 healthy controls. To determine RA phenotype we measured rheumatoid factor and anticitrullinated protein antibodies. All patients were examined by the rheumatologist to identify clinical features of RA. Serum CRP and ESR were measured to assess inflammation. Mean level of AHSG in group with RA was 765,67±120,66 (Hereinafter M±σ), which was significantly lower than of healthy controls (812,76,2±76,2 μg/ml; p=0,0437). Insignificant difference of mean levels of AHSG was observed between men and women with RA (p=0,424). The reference ranges for AHSG measured from the healty controls were 653,55-972,19 ug/ml (M±2σ). We studied mean levels of AHSG according to the clinical and immunological manifestations of RA. AHSG levels were significantly lower within patients positive on ACCP, with moderate or high disease activity, with 2nd, 3rd and 4th x-ray stages and functional classes, with erosivity, extra-articular manifestations and complications. The moderate negative correlation was observed between AHSG level and CRP (r=-0,3146; p<0,001), ESR (r=-0,344; p<0,001) and DAS28 (r=-0,4334; p<0,001). In summary, AHSG mean levels were significantly different in patients with RA. It can be used to improve the diagnostics of RA activity, severity, extra-articular manifestations and complications.
- International Consensus Guidelines for the Optimal Use of the Polymyxins: Endorsed by the American College of Clinical Pharmacy (ACCP), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti-infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP). [Journal Article]
- PPharmacotherapy 2019; 39(1):10-39
- The polymyxin antibiotics colistin (polymyxin E) and polymyxin B became available in the 1950s and thus did not undergo contemporary drug development procedures. Their clinical use has recently resur…
The polymyxin antibiotics colistin (polymyxin E) and polymyxin B became available in the 1950s and thus did not undergo contemporary drug development procedures. Their clinical use has recently resurged, assuming an important role as salvage therapy for otherwise untreatable gram-negative infections. Since their reintroduction into the clinic, significant confusion remains due to the existence of several different conventions used to describe doses of the polymyxins, differences in their formulations, outdated product information, and uncertainties about susceptibility testing that has led to lack of clarity on how to optimally utilize and dose colistin and polymyxin B. We report consensus therapeutic guidelines for agent selection and dosing of the polymyxin antibiotics for optimal use in adult patients, as endorsed by the American College of Clinical Pharmacy (ACCP), Infectious Diseases Society of America (IDSA), International Society of Anti-Infective Pharmacology (ISAP), Society for Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP). The European Society for Clinical Microbiology and Infectious Diseases (ESCMID) endorses this document as a consensus statement. The overall conclusions in the document are endorsed by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). We established a diverse international expert panel to make therapeutic recommendations regarding the pharmacokinetic and pharmacodynamic properties of the drugs and pharmacokinetic targets, polymyxin agent selection, dosing, dosage adjustment and monitoring of colistin and polymyxin B, use of polymyxin-based combination therapy, intrathecal therapy, inhalation therapy, toxicity, and prevention of renal failure. The treatment guidelines provide the first ever consensus recommendations for colistin and polymyxin B therapy that are intended to guide optimal clinical use.
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- Association of polymorphisms of HLA-DRB1 and TNF-308 G/A with radiographic joint damage in patients with early rheumatoid arthritis with high inflammatory activity, treated according to the principle of "Treat to target" (REMARKA study). [Journal Article]
- TATer Arkh 2018 May 11; 90(5):38-43
- CONCLUSIONS: Our data suggest that HLA-DRB1 (SE+) gene and TNFα (-308G>A) polymorphisms are associated with the progression of radiographic joint destruction in early, active RA patients managed according to "Treat to target" stratagy.