Patient Outcomes Following Ketamine Administration for Acute Agitation with a Decreased Dosing Protocol in the Prehospital Setting

2021 ◽  
pp. 1-7
Author(s):  
Cassidy Cunningham ◽  
Karen Gross ◽  
John P. Broach ◽  
Laurel O’Connor
Keyword(s):  
Length Of Stay ◽  
Adverse Events ◽  
Standard Dose ◽  
Prehospital Care ◽  
Admission Rate ◽  
Prehospital Setting ◽  
Intubation Rate ◽  
Post Intervention ◽  
Dose Cohort ◽  
Significant Difference

Abstract Background: Agitated behaviors are frequently encountered in the prehospital setting and require emergent treatment to prevent harm to patients and prehospital personnel. Chemical sedation with ketamine works faster than traditional pharmacologic agents, though it has a higher incidence of adverse events, including intubation. Outcomes following varying initial doses of prehospital intramuscular (IM) ketamine use have been incompletely described. Objective: To determine whether using a lower dose IM ketamine protocol for agitation is associated with more favorable outcomes. Methods: This study was a pre-/post-intervention retrospective chart review of prehospital care reports (PCRs). Adult patients who received chemical sedation in the form of IM ketamine for agitated behaviors were included. Patients were divided into two cohorts based on the standard IM ketamine dose of 4mg/kg and the lower IM dose of 3mg/kg with the option for an additional 1mg/kg if required. Primary outcomes included intubation and hospital admission. Secondary outcomes included emergency department (ED) length of stay, additional chemical or physical restraints, assaults on prehospital or ED employees, and documented adverse events. Results: The standard dose cohort consisted of 211 patients. The lower dose cohort consisted of 81 patients, 17 of whom received supplemental ketamine administration. Demographics did not significantly differ between the cohorts (mean age 35.14 versus 35.65 years; P = .484; and 67.8% versus 65.4% male; P = .89). Lower dose subjects were administered a lower ketamine dose (mean 3.24mg/kg) compared to the standard dose cohort (mean 3.51mg/kg). There was no statistically significant difference between the cohorts in intubation rate (14.2% versus 18.5%; P = .455), ED length of stay (14.31 versus 14.88 hours; P = .118), need for additional restraint and sedation (P = .787), or admission rate (26.1% versus 25.9%; P = .677). In the lower dose cohort, 41.2% (7/17) of patients who received supplemental ketamine doses were intubated, a higher rate than the patients in this cohort who did not receive supplemental ketamine (8/64, 12.5%; P <.01). Conclusion: Access to effective, fast-acting chemical sedation is paramount for prehospital providers. No significant outcomes differences existed when a lower dose IM ketamine protocol was implemented for prehospital chemical sedation. Patients who received a second dose of ketamine had a significant increase in intubation rate. A lower dose protocol may be considered for an agitation protocol to limit the amount of medication administered to a population of high-risk patients.

scholarly journals 1476. Impact of an Educational Campaign on Rates of Sputum Culture Acquisition as an Opportunity for Antibiotic De-escalation

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S739-S739
Author(s):  
Jessica Snawerdt ◽  
Derek N Bremmer ◽  
Dustin R Carr ◽  
Thomas L Walsh ◽  
Tamara Trienski ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Community Acquired Pneumonia ◽  
Sputum Culture ◽  
Post Intervention ◽  
Significant Difference ◽  
Educational Campaign ◽  
The Difference ◽  
Hospital Acquired ◽  
Culture Acquisition

Abstract Background The 2019 community-acquired pneumonia (CAP) guidelines recommend obtaining a sputum culture in patients who are empirically treated for methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa to assist clinicians in optimizing antimicrobial therapy. A previous study at our institution found respiratory cultures were rarely obtained in patients with CAP. As a result of these findings, an educational campaign was implemented to promote the use of an induced sputum protocol. Methods This was a multicenter, retrospective cohort study that included patients who were ≥18 years of age, had a diagnosis of CAP, and received ≥48 hours of anti-pseudomonal antibiotics. Patients were excluded if mechanically ventilated within 48 hours of admission or diagnosed with hospital-acquired or ventilator-associated pneumonia. Patients were grouped into pre- and post-intervention time periods. The intervention involved education on obtaining respiratory cultures including technique on induced sputums and updates to CAP order sets. The primary outcome was the rate of sputum culture acquisition. Secondary outcomes included duration of anti-pseudomonal and anti-MRSA therapy, in-hospital mortality, and length of stay. Results A total of 143 patients met inclusion criteria, 72 in the pre-implementation group and 71 in the post-implementation group. Baseline characteristics were similar between the two groups. More patients in the post-implementation group had a sputum culture obtained but the difference was not statistically significant (38.9% vs 53.5%; p=0.08). Anti-pseudomonal therapy was continued for an average of 5.6 days pre-implementation and 5.2 days post-implementation (p=0.499). There was also not a significant difference in anti-MRSA duration between the two groups (3.4 days vs 3.2 days; p=0.606). In-hospital mortality and length of stay were similar between the two groups. Conclusion An educational campaign focusing on the acquisition of induced sputums led to an increase in rates of sputum cultures collected. However, this did not correlate with a decrease in duration of anti-MRSA or anti-pseudomonal therapy. Further interventions should be made to optimize de-escalation of broad spectrum antibiotics based on sputum culture results. Disclosures All Authors: No reported disclosures

scholarly journals Risk of Adverse Outcomes in Females Taking Oral Creatine Monohydrate: A Systematic Review and Meta-Analysis

Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1780
Author(s):  
Deborah L. de Guingand ◽  
Kirsten R. Palmer ◽  
Rodney J. Snow ◽  
Miranda L. Davies-Tuck ◽  
Stacey J. Ellery
Keyword(s):  
Weight Gain ◽  
Adverse Events ◽  
Meta Analysis ◽  
Creatine Supplementation ◽  
Hepatic Function ◽  
Creatine Monohydrate ◽  
Adverse Outcomes ◽  
Post Intervention ◽  
Serious Adverse Events ◽  
Significant Difference

Creatine Monohydrate (CrM) is a dietary supplement routinely used as an ergogenic aid for sport and training, and as a potential therapeutic aid to augment different disease processes. Despite its increased use in recent years, studies reporting potential adverse outcomes of CrM have been mostly derived from male or mixed sex populations. A systematic search was conducted, which included female participants on CrM, where adverse outcomes were reported, with meta-analysis performed where appropriate. Six hundred and fifty-six studies were identified where creatine supplementation was the primary intervention; fifty-eight were female only studies (9%). Twenty-nine studies monitored for adverse outcomes, with 951 participants. There were no deaths or serious adverse outcomes reported. There were no significant differences in total adverse events, (risk ratio (RR) 1.24 (95% CI 0.51, 2.98)), gastrointestinal events, (RR 1.09 (95% CI 0.53, 2.24)), or weight gain, (mean difference (MD) 1.24 kg pre-intervention, (95% CI −0.34, 2.82)) to 1.37 kg post-intervention (95% CI −0.50, 3.23)), in CrM supplemented females, when stratified by dosing regimen and subject to meta-analysis. No statistically significant difference was reported in measures of renal or hepatic function. In conclusion, mortality and serious adverse events are not associated with CrM supplementation in females. Nor does the use of creatine supplementation increase the risk of total adverse outcomes, weight gain or renal and hepatic complications in females. However, all future studies of creatine supplementation in females should consider surveillance and comprehensive reporting of adverse outcomes to better inform participants and health professionals involved in future trials.

OP5 Rapid analgesia for prehospital hip disruption (RAPID): findings from a randomised feasibility study

2019 ◽  
Vol 36 (1) ◽  
pp. e2.3-e3
Author(s):  
Jenna Bulger ◽  
Alan Brown ◽  
Bridie Evans ◽  
Greg Fegan ◽  
Simon Ford ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Pain Relief ◽  
Length Of Stay ◽  
Feasibility Study ◽  
Prehospital Care ◽  
Statistical Significance ◽  
Length Of Hospital Stay ◽  
Primary Outcome Measure ◽  
Adequate Pain Relief ◽  
Significant Difference

BackgroundAdequate pain relief in prehospital care is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilise and whose long term outcomes may be adversely affected by administration of opiate analgesics. Fascia Iliaca Compartment Block (FICB) is routinely undertaken by clinicians in the emergency department for patients with hip fracture, but has not been fully evaluated for use by paramedics in prehospital care.We aimed to test whether FICB for hip fracture pain relief carried out by paramedics in prehospital care was feasible, safe and acceptable, and whether trial Methods were viable, so that we could decide whether to proceed to a fully-powered RCT to evaluate clinical and cost effectiveness.MethodsNineteen paramedics were trained to administer FICB. They randomly allocated eligible patients to FICB or usual care using audited scratchcards. Patients were followed up to assess availability of key outcomes including quality of life, length of hospital stay, pain scores, and adverse events. Findings were analysed against pre-specified feasibility criteria to determine whether it was appropriate to progress to a fully-powered trial.ResultsSeventy-one patients were randomised by paramedics between 28/6/16 and 31/7/17; 57 of these patients consented to follow up. The only outcome which reached a statistically significant difference between groups was the proportion of participants who received morphine (38% difference between groups 95% CI −61.88 to −15.79). There was a difference of approximately nine days in the length of stay between trial arms (mean difference 9.12 (95% CI −20.51 to 2.27).ConclusionsRAPID met its pre-specified progression criteria; a funding application for a fully-powered RCT will therefore be submitted. We will consider the use of length of stay as the primary outcome measure, as feasibility study findings indicated that there was a difference between groups without reaching statistical significance.

scholarly journals Comparison of OPD-Referral and Self-Referral Patients In The Emergency Department

2021 ◽  
Author(s):  
Yu-Rung Chou ◽  
Mi-Chia Ma ◽  
Ching-Chi Lee ◽  
Chih-Chia Hsieh ◽  
Chih-Hao Lin
Keyword(s):  
Emergency Department ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Pediatric Patients ◽  
Admission Rate ◽  
Tertiary Teaching ◽  
Significant Difference ◽  
Tertiary Teaching Hospital ◽  
Referral Status ◽  
Hospital Cardiac Arrest

Abstract Background: To compare outpatient department (OPD) referral patients and self-referral patients in the emergency department (ED) in terms of hospitalization, mortality, and length of stay.Methods: We collected ED patients of a tertiary teaching hospital over a 3-month period. We excluded pediatric patients and patients with certain inconsistent characteristics, such as trauma and out-of-hospital cardiac arrest, or referral from other facilities. After propensity score matching, we compared the hospitalization, mortality, and length of stay in the ED of the OPD-referral patents and self-referral patients. We categorized the patients as “emergency” or “urgency” according to their triage information and then analyzed the effects of different severity levels.Results: The OPD-referral ED patients, compared with the self-referral patients, had a higher admission rate (49.8% vs. 28.9%, p < 0.001; odds ratio [OR] = 2.44, 95% confidence intervals [CIs]: 1.91 - 3.12). Among the emergency patients, there was no significant difference regarding the admission rate (62.6% vs. 55.8%, p = 0.257) or the mortality rate (4.6% vs. 8%, p = 0.253). Among the urgent patients, the admission rate was significantly different between the OPD-referral and self-referral groups (46% vs. 20.2%, p < 0.001; OR = 3.36, 95% CIs: 2.48 - 4.55). The urgent patients who were referred from OPD tended to have a higher mortality rate (2.1% vs. 0.5%, p = 0.064). Regarding the length of ED stay, only the discharge and urgent subgroups differed according to OPD- and self-referral status (p < 0.001), with a median of 5.8 hours versus 2.3 hours.Conclusions: The OPD-referral ED patients have a higher admission rate and a longer length of stay than self-referral patients in urgent triage. The OPD-referral ED patients might have more severe and complex conditions. We should be more alert to OPD-referred patients even when they initially appear not severely ill.

scholarly journals Operative and nonoperative adverse events in the management of traumatic fractures of the thoracolumbar spine: a systematic review

2014 ◽  
Vol 37 (1) ◽  
pp. E8 ◽  
Author(s):  
George M. Ghobrial ◽  
Christopher M. Maulucci ◽  
Mitchell Maltenfort ◽  
Richard T. Dalyai ◽  
Alexander R. Vaccaro ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Length Of Stay ◽  
Adverse Events ◽  
Nonoperative Management ◽  
Thoracolumbar Spine ◽  
Complication Rates ◽  
Medline Search ◽  
Significant Difference ◽  
The Mean ◽  
Nonoperative Group

Object Thoracolumbar spine injuries are commonly encountered in patients with trauma, accounting for almost 90% of all spinal fractures. Thoracolumbar burst fractures comprise a high percentage of these traumatic fractures (45%), and approximately half of the patients with this injury pattern are neurologically intact. However, a debate over complication rates associated with operative versus nonoperative management of various thoracolumbar fracture morphologies is ongoing, particularly concerning those patients presenting without a neurological deficit. Methods A MEDLINE search for pertinent literature published between 1966 and December 2013 was conducted by 2 authors (G.G. and R.D.), who used 2 broad search terms to maximize the initial pool of manuscripts for screening. These terms were “operative lumbar spine adverse events” and “nonoperative lumbar spine adverse events.” Results In an advanced MEDLINE search of the term “operative lumbar spine adverse events” on January 8, 2014, 1459 results were obtained. In a search of “nonoperative lumbar spine adverse events,” 150 results were obtained. After a review of all abstracts for relevance to traumatic thoracolumbar spinal injuries, 62 abstracts were reviewed for the “operative” group and 21 abstracts were reviewed for the “nonoperative” group. A total of 14 manuscripts that met inclusion criteria for the operative group and 5 manuscripts that met criteria for the nonoperative group were included. There were a total of 919 and 436 patients in the operative and nonoperative treatment groups, respectively. There were no statistically significant differences between the groups with respect to age, sex, and length of stay. The mean ages were 43.17 years in the operative and 34.68 years in the nonoperative groups. The majority of patients in both groups were Frankel Grade E (342 and 319 in operative and nonoperative groups, respectively). Among the studies that reported the data, the mean length of stay was 14 days in the operative group and 20.75 in the nonoperative group. The incidence of all complications in the operative and nonoperative groups was 300 (32.6%) and 21 (4.8%), respectively (p = 0.1065). There was no significant difference between the 2 groups with respect to the incidence of pulmonary, thromboembolic, cardiac, and gastrointestinal complications. However, the incidence of infections (pneumonia, urinary tract infection, wound infection, and sepsis) was significantly higher in the operative group (p = 0.000875). The incidence of instrumentation failure and need for revision surgery was 4.35% (40 of 919), a significant morbidity, and an event unique to the operative category (p = 0.00396). Conclusions Due to the limited number of high-quality studies, conclusions related to complication rates of operative and nonoperative management of thoracolumbar traumatic injuries cannot be definitively made. Further prospective, randomized studies of operative versus nonoperative management of thoracolumbar and lumbar spine trauma, with standardized definitions of complications and matched patient cohorts, will aid in properly defining the risk-benefit ratio of surgery for thoracolumbar spine fractures.

scholarly journals C.01 Intrathecal morphine following lumbar fusion: a randomized, placebo-controlled trial

2016 ◽  
Vol 43 (S2) ◽  
pp. S11-S11
Author(s):  
D Yavin ◽  
P Dhaliwal ◽  
T Whittaker ◽  
GS Hawboldt ◽  
GA Jewett ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Length Of Stay ◽  
Adverse Events ◽  
Respiratory Depression ◽  
Repeated Measures ◽  
Intrathecal Morphine ◽  
Lumbar Fusion ◽  
Controlled Trial ◽  
Lumbar Spine Surgery ◽  
Significant Difference

Background: Despite the ease of intraoperative injection, intrathecal morphine (ITM) is rarely provided in lumbar spine surgery. We therefore sought to demonstrate the safety and efficacy of ITM following lumbar fusion. Methods: In this double-blind trial, 150 patients undergoing elective instrumented lumbar fusion were randomly assigned to receive a single injection of ITM (0.2 mg) or placebo (saline) prior to wound closure. Primary outcomes were postoperative pain on the visual-analog scale during the inital 24 hours after surgery and respiratory depression. Secondary outcomes included related adverse events, opioid requirements, and length of stay. Outcome curves were estimated in an intention-to-treat, repeated-measures analysis. Results: Age, disability, operative times, and pre-operative pain were similar in both groups. ITM was associated with less pain both at rest (p<0.002) and with movement (p<0.02) during the initial 24 hours following surgery. ITM did not increase the cumulative incidence of respiratory depression (hazard ratio 0.86, p=0.66). While ITM reduced postoperative opioid requirements (p<0.03), there was no significant difference in length of stay (p=0.67). Adverse events did not significantly differ between groups. The early benefits of ITM on postoperative pain were no longer apparent after 48 hours. Conclusions: A single ITM injection safety reduces postoperative pain following lumbar fusion. (ClinicalTrials.gov NCT01053039)

scholarly journals 1491. Standard- vs. High-dose Trimethoprim-Sulfamethoxazole for Stenotrophomonas maltophilia pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S747-S747
Author(s):  
Brenton C Hall ◽  
Jessica Ortwine ◽  
Wenjing Wei ◽  
Norman Mang ◽  
Bonnie C Prokesch ◽  
...  
Keyword(s):  
Adverse Events ◽  
Stenotrophomonas Maltophilia ◽  
Adverse Drug Events ◽  
Clinical Success ◽  
Standard Dose ◽  
Hospital Length Of Stay ◽  
High Dose ◽  
In Vitro Susceptibility ◽  
Significant Difference ◽  
Secondary Outcomes

Abstract Background Stenotrophomonas maltophilia is a multidrug-resistant pathogen known to cause pneumonia with associated mortality rates up to 44%.1,2 Trimethoprim-sulfamethoxazole (TMP-SMX) is the drug of choice based on available clinical evidence and excellent in-vitro susceptibility rates.3 High-dose TMP-SMX strategies recommend between 15-20mg/kg/day of the TMP component, however this has been associated with increased adverse drug events (ADE).4,5 The optimal dosing strategy remains unclear and it is unknown whether lower doses of TMP-SMX would achieve similar outcomes. Methods Patients with positive respiratory cultures for S. maltophilia who received at least 72 hours of TMP-SMX therapy for hospital-acquired or ventilator-associated pneumonia from January 2010 to March 2020 were included. Doses were categorized as standard-dose (SD) TMP-SMX (&lt; 15 mg/kg/day TMP) or high-dose (HD) TMP-SMX (≥ 15 mg/kg/day TMP) after adjusting for renal function. The primary outcome was clinical success, defined as the composite of resolution of signs/symptoms of pneumonia, in-hospital survival, and no escalation of care. Secondary outcomes included hospital length of stay (LOS), 30-day mortality, 30-day readmission, and ADE. Results Of the 44 patients meeting inclusion criteria for the study, 27 received SD and 17 received HD TMP-SMX therapy. Patients received 12 mg/kg/day (IQR 11-14) and 16 mg/kg/day (IQR 16-19) in the SD and HD groups, respectively. There was no difference in clinical success between the SD and HD group (41% vs 59%, p=0.24). Secondary outcomes were similar between both groups except for 30-day hospital readmission; the SD group had significantly lower readmission rates (6% vs 69%, p &lt; 0.01). Rates of adverse events were not statistically different between the two groups. Conclusion This study provides evidence that SD TMP-SMX may achieve similar clinical efficacy to HD TMP-SMX. We found no significant difference in clinical success, LOS, 30-day mortality, or adverse events between groups. Although HD TMP-SMX is the current recommendation for S. maltophilia infections, concerns about tolerability and adverse effects suggest that further clinical and pharmacodynamic research is needed. Disclosures All Authors: No reported disclosures

High-dose rifamycins in the treatment of TB: a systematic review and meta-analysis

Thorax ◽  
2022 ◽  
pp. thoraxjnl-2020-216497
Author(s):  
Omri A Arbiv ◽  
JeongMin M Kim ◽  
Marie Yan ◽  
Kamila Romanowski ◽  
Jonathon R Campbell ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Systematic Reviews ◽  
Standard Dose ◽  
Meta Analysis ◽  
High Dose ◽  
Tb Treatment ◽  
Cochrane Database ◽  
Significant Difference ◽  
Culture Conversion

BackgroundThere is growing interest in using high-dose rifamycin (HDR) regimens in TB treatment, but the safety and efficacy of HDR regimens remain uncertain. We performed a systematic review and meta-analysis comparing HDR to standard-dose rifamycin (SDR) regimens.MethodsWe searched MEDLINE, Embase, CENTRAL, Cochrane Database of Systematic Reviews and clinicaltrials.gov for prospective studies comparing daily therapy with HDRs to SDRs. Rifamycins included rifampicin, rifapentine and rifabutin. Our primary outcome was the rate of severe adverse events (SAEs), with secondary outcomes of death, all adverse events, SAE by organ and efficacy outcomes of 2-month culture conversion and relapse. This study was prospectively registered in the International Prospective Register of Systematic Reviews (CRD42020142519).ResultsWe identified 9057 articles and included 13 studies with 6168 participants contributing 7930 person-years (PY) of follow-up (HDR: 3535 participants, 4387 PY; SDR: 2633 participants, 3543 PY). We found no significant difference in the pooled incidence rate ratio (IRR) of SAE between HDR and SDR (IRR 1.00, 95% CI 0.82 to 1.23, I2=41%). There was no significant difference when analysis was limited to SAE possibly, probably or likely medication-related (IRR 1.07, 95% CI 0.82 to 1.41, I2=0%); studies with low risk of bias (IRR 0.98, 95% CI 0.79 to 1.20, I2=44%); or studies using rifampicin (IRR 1.00, 95% CI 0. 0.75–1.32, I2=38%). No significant differences were noted in pooled outcomes of death, 2-month culture conversion and relapse.ConclusionsHDRs were not associated with a significant difference in SAEs, 2-month culture conversion or death. Further studies are required to identify specific groups who may benefit from HDR.

Extrakorporális és intrakorporális anasztomózis rövid távú eredményeinek összehasonlítása malignus daganat miatt végzett laparoszkópos jobb oldali hemikolektómia esetén

2020 ◽  
Vol 73 (4) ◽  
pp. 148-152
Author(s):  
Kornél Vajda ◽  
László Sikorszki
Keyword(s):  
Length Of Stay ◽  
Gold Standard ◽  
Average Length ◽  
Colon Surgery ◽  
Right Hemicolectomy ◽  
Malignant Tumours ◽  
Short Term ◽  
Significant Difference ◽  
Laparoscopic Assisted ◽  
Laparoscopic Hemicolectomy

Összefoglaló. Bevezetés: A laparoszkópia térhódítása a jobb oldali colon műtéteknél is nyilvánvaló. Ma legtöbb helyen a laparoszkóposan asszisztált jobb oldali hemikolektómia extrakorporális anasztomózissal a gold standard. A morbiditás randomizált vizsgálatok alapján még 30% körüli. A technikai fejlődés lehetővé tette az intrakorporális anasztomózist. Célkitűzés: Retrospektív módon elemezni rosszindulatú jobb oldali vastagbéldaganat miatt végzett laparoszkópos hemikolektómiák rövid távú eredményeit a két módszer összehasonlításával. Eredmények: 2018. 01. 01. – 2019. 12. 31. között 184 jobb oldali hemikolektómiát végeztünk, ezek közül 122 történt malignus betegség miatt. 51 esetben nyitott és 71 esetben laparoszkópos műtét történt. 37 férfi (átlagéletkor: 70,59 év) és 34 nő (átlagéletkor: 72,14 év) volt. 50 esetben extrakorporális (EA) és 21 esetben pedig intrakorporális anasztomózist (IA) végeztünk. Az EA csoportban 18, míg az IA csoportban 3 szövődmény alakult ki 30 napon belül (p = 0,067). Az EA csoportból 3, az IA csoportból 1 beteget veszítettünk el 30 napon belül (p = 0,66). Az átlagos ápolási idő az EA csoportban 9,48 (5–32) nap, míg az IA csoportban 6,52 (4–19) nap volt (p = 0,001) a szövődményes esetekkel együtt. A szövődményes esetek nélkül az EA csoportban 6,35 (5–10) nap, az IA csoportban pedig 5,55 (4–8) napnak bizonyult (p = 0,09). A műtéti idő pedig az EA csoportban 147 (90–240) perc, az IA csoportban pedig 146,47 (90–265) perc volt (p = 0,11). Konklúzió: Az irodalommal összhangban azt találtuk, hogy IA esetén kevesebb a szövődmény, ezzel is összefüggésben rövidebb az átlagos ápolási idő, és a műtéti időt tekintve nincs szignifikáns különbség. Ezeket figyelembe véve az intrakorporális anasztomózis javasolható jobb oldali laparoszkópos hemikolektómia esetén. Summary. Introduction: Laparoscopy became evident for right-sided colon surgery too. Today the laparoscopic-assisted right-hemicolectomy is the gold standard with extracorporeal anastomosis. Morbidity according to randomized trials is still approximately 30%. The development of the surgical technique resulted in the creation of intracorporeal anastomosis. Our aim was to compare the short-term results of the two methods. Aim: To analyse the short-term results of right-sided hemicolectomy that were performed due to malignant tumours with the comparison of the two methods. Results: A cohort of 184 right-sided hemicolectomy were performed from 01.01.2018 to 31.12.2019 from which 122 were operated on because of a malignant disease. 51 open and 71 laparoscopic operations were performed. The average age of 37 men and 34 women were 70.59 and 72.14 years, respectively. 50 patients underwent extracorporeal (EA) anastomosis and 21 intracorporeal (IA) anastomosis. Within 30 days the number of complications were 18 in the EA group and 3 in the IA group (p = 0.067). 3 from the EA group and 1 from IA group died within 30 days (p = 0.66). The average length of stay were 9.48 days in the EA group and 6.52 days in the IA group together with the complicated cases (p = 0.001) while 6.35 days and 5.55 days without the complicated cases (p = 0.09). The average duration of operation was 147 minutes in the EA and 146.47 minutes in the IA group (p = 0.11). Conclusion: We found concordance with the literature that there are fewer complications in case of IA which might be related to shorter length of stay. There is no significant difference between the surgical times. Bearing these facts in mind, IA might be suggested for right- sided laparoscopic hemicolectomy.

Efficacy and Safety of Non-Steroidal Anti-Androgens in Patients with Metastatic Prostate Cancer: Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 15 (1) ◽  
pp. 34-47 ◽  
Author(s):  
Muhammed Rashid ◽  
Madhan Ramesh ◽  
K. Shamshavali ◽  
Amit Dang ◽  
Himanshu Patel ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Adverse Events ◽  
Randomized Controlled Trials ◽  
Quality Assessment ◽  
Cochrane Library ◽  
Control Group ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Randomized Controlled ◽  
Significant Difference

Background: Prostate cancer (PCa) is the sixth primary cause of cancer death. However, conflicts are present about the efficacy and safety of Non-steroidal anti-androgens (NSAA) for its treatment. The aim of this study was to assess the efficacy and safety of NSAAs versus any comparator for the treatment of advanced or metastatic PCa (mPCa). Methodology: MEDLINE and the Cochrane Library were searched. References of included studies and clinicaltrials.gov were also searched for relevant studies. Only English language studies after 1990 were considered for review. Randomized controlled trials (RCTs) examining the efficacy and safety of NSAAs as compared with any other comparator including surgery or chemotherapy in mPCa patients were included. The outcomes include efficacy, safety and the tolerability of the treatment. The Cochrane Risk of Bias Assessment Tool was used for quality assessment. Two authors were independently involved in the selection, extraction and quality assessment of included studies and disagreements were resolved by discussion or by consulting a third reviewer. Results: Fifty-eight out of 1307 non-duplicate RCTs with 29154 patients were considered for the review. NSAA showed significantly better progression-free survival [PFS] (Hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.46-0.78; P=0.0001), time to distant metastasis or death [TTD] (HR, 0.80; 95% CI 0.73-0.91; p<0.0001), objective response (Odds ratio [OR], 1.64; 95% CI 1.06-2.54; P=0.03) and clinical benefits (OR, 1.33; 95% CI 1.08-1.63; P=0.006) as compared to the control group. There was no significant difference observed between the groups in terms of overall survival (HR, 0.95; 95%CI, 0.87-1.03; P=0.18) and time to progression (HR, 0.93; 95% CI 0.77-1.11; P=0.43). Treatment-related adverse events were more with the NSAA group, but the discontinuation due to lack of efficacy reason was 43% significantly lesser than the control group in patients with mPCa. Rest of the outcomes were appeared to be non-significant. Conclusion: Treatment with NSAA was appeared to be better efficacious with respect to PFS, TTD, and response rate with considerable adverse events when compared to the control group in patients with metastatic PCa.

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