scholarly journals Updates on the Clinical Evidenced Herb-Warfarin Interactions

2014 ◽  
Vol 2014 ◽  
pp. 1-18 ◽  
Author(s):  
Beikang Ge ◽  
Zhen Zhang ◽  
Zhong Zuo
Keyword(s):  
Red Clover ◽  
Clinical Findings ◽  
Warfarin Interaction ◽  
Therapeutic Window ◽  
General Mechanism ◽  
Clinical Effects ◽  
Multicenter Studies ◽  
Level Ii ◽  
Level I

Increasing and inadvertent use of herbs makes herb-drug interactions a focus of research. Concomitant use of warfarin, a highly efficacious oral anticoagulant, and herbs causes major safety concerns due to the narrow therapeutic window of warfarin. This paper presents an update overview of clinical findings regarding herb-warfarin interaction, highlighting clinical outcomes, severity of documented interactions, and quality of clinical evidence. Among thirty-eight herbs, Cannabis, Chamomile, Cranberry, Garlic, Ginkgo, Grapefruit, Lycium, Red clover, and St. John’s wort were evaluated to have major severity interaction with warfarin. Herbs were also classified on account of the likelihood of their supporting evidences for interaction. Four herbs were considered ashighly probableto interact with warfarin (level I), three were estimated asprobable(level II), and ten and twenty-one werepossible(level III) anddoubtful(level IV), respectively. The general mechanism of herb-warfarin interaction almost remains unknown, yet several pharmacokinetic and pharmacodynamic factors were estimated to influence the effectiveness of warfarin. Based on limited literature and information reported, we identified corresponding mechanisms of interactions for a small amount of “interacting herbs.” In summary, herb-warfarin interaction, especially the clinical effects of herbs on warfarin therapy should be further investigated through multicenter studies with larger sample sizes.

scholarly journals Paving the Path to Value: The Role of Registry Studies in Interventional Radiology

2018 ◽  
Vol 02 (02) ◽  
pp. 128-132
Author(s):  
Melinda Wang ◽  
Maureen Kohi
Keyword(s):  
Interventional Radiology ◽  
Evidence Based ◽  
Randomized Controlled ◽  
Level Ii ◽  
Complementary Role ◽  
Inadequate Sample Size ◽  
Level I ◽  
Based Medicine

AbstractThe growth rate of interventional radiology (IR) procedures and practitioners has exceeded the pace of evidence development to support evidence-based practice. In the innovative and highly adaptive field of IR, there exists a tremendous need for interventional radiologists to practice evidence-based medicine as a way to maintain and improve quality of health care. Randomized controlled trials (RCTs) are considered to be the gold standard of research, providing level I evidence, but in procedural subspecialties, they remain difficult to design and implement due to challenges in randomization, blinding, and inadequate sample size. To build the foundation of evidence in IR, registry studies can play a complementary role to RCTs. Clinical data registries may offer a more practical approach to gathering outcomes data, important in this era with the advent of the Medicare Access and CHIP Reauthorization Act (MACRA), in comparison with RCTs. Properly designed registries can store an abundance of data with which high-quality observational studies can be performed. Although considered level II evidence, these registry studies will allow the evaluation of both performance and value of IR procedures, particularly in circumstances in which an RCT would not be feasible. This manuscript aims to serve as a guide for developing and participating in IR registry studies.

scholarly journals System Failure: An Analysis of 2000 Incident Reports

1993 ◽  
Vol 21 (5) ◽  
pp. 684-695 ◽  
Author(s):  
W. B. Runciman ◽  
R. K. Webb ◽  
R. Lee ◽  
R. Holland
Keyword(s):  
Complex Systems ◽  
Human Factors ◽  
Human Error ◽  
Local Level ◽  
System Failure ◽  
International Agencies ◽  
Level Ii ◽  
Level I ◽  
Four Levels

Although 70–80% of problems have some component of human error, its overall contribution to many problems may be small; studies of complex systems have revealed that up to 85% are primarily due to deficiencies in the lay-out and processes of the system. The anaesthetist has to operate in a complex system; many problems originate from deficiencies in this system. Information of relevance to system failure was extracted from the first 2000 incidents reported to the Australian Incident Monitoring Study (AIMS). A system-based deficiency directly contributed to one-quarter of problems (four-fifths if human factors are included), some aspect of the system minimized the adverse outcome in over half of all cases (four-fifths if human factors are included), and in two-thirds (three-quarters if human factors are included) a system-based strategy would have been helpful; the system was implicated in 90% of all incidents (97% if human factors are included). Regardless of whether or not all human error should be regarded as part of the “system”, attempts to modify its incidence and nature have to emanate from the system. AIMS reporting pathways and the organizations involved in developing and implementing strategies to improve the system operate at four levels. Level I involves the use of AIMS reports by hospitals and group practices for audit at a local level. Level II involves AIMS participants sending forms to the AIMS central office; collated information is then sent back to contributors by newsletter. Level III involves interaction between AIMS and the major professional bodies and level IV interaction between AIMS, these bodies and a variety of national and international agencies. Over 100 topics were identified from the AIMS data for consideration at one or more of these levels. AIMS has the potential not only to play a vital practical role in the continued enhancement of the quality of anaesthetic practice, but also to provide a valuable resource for research at the increasingly important interface between human behaviour and complex systems.

scholarly journals DISC REPLACEMENT IN LUMBAR SPINE

2018 ◽  
Vol 17 (1) ◽  
pp. 59-62
Author(s):  
EDUARDO SOARES DE SOUZA ◽  
RENÉ KUSABARA ◽  
FABIO MASTROMAURO DE OLIVEIRA ◽  
YOSHINOBU NAGASSE ◽  
CLÓVIS YAMAZATO ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Total Disc Replacement ◽  
The Elderly ◽  
Disc Replacement ◽  
Disc Disease ◽  
Level Of Evidence ◽  
Level Ii ◽  
Level I ◽  
Total Disk Replacement

ABSTRACT With the increase in the elderly population worldwide, the prevalence of degenerative diseases tends to grow, especially degenerative disc disease (DDD) in the lumbar spine. It is important to seek excellence treatments to ensure a better quality of life for patients. In this sense, the total disc replacement and the use of prostheses in the lumbar spine have been pointed out as alternative and promising treatments when compared to the standard treatment. The aim of this study is to show the results of total replacement of the intervertebral disc, through a review of the literature. The electronic search was performed in the PubMed databases, with the keywords “Total Disk Replacement”, “Low Back Pain”, and “Arthroplasty” in articles published as of 2012. We selected 16 articles. Level of Evidence: II. Type of study: Systematic reviewb of Level II studies or Level I studies with inconsistent results.

scholarly journals An Overview of Trauma Center Levels and Disparities in Rural Trauma Care

2020 ◽  
Vol 10 ◽  
Author(s):  
Udit Dave ◽  
Brandon Gosine ◽  
Ashwin Palaniappan
Keyword(s):  
United States ◽  
Trauma Care ◽  
Rural Areas ◽  
The United States ◽  
Trauma Centers ◽  
Traumatic Injuries ◽  
Level Ii ◽  
Level I ◽  
Injured Patients

Trauma centers in the United States focus on providing care to patients who have suffered injuries and may require critical care. These trauma centers are classified into five different levels: Level I to Level V. Level V trauma centers are the least comprehensive, providing minimal 24-hour care and resuscitation, and Level I trauma centers are the most comprehensive, accepting the most severely injured patients and always delivering care through the use of an attending surgeon. However, there is a major inequity in access to trauma centers across the United States, especially amongst rural residents. Level III to Level V trauma centers tend to be dominantly situated in rural and underserved areas. Furthermore, trauma centers tend to be widely dispersed with respect to rural areas. Therefore, these areas tend to have a greater mortality rate in relation to traumatic injuries. Improvements in access to high-tier traumatic care must occur in order to reduce mortality due to traumatic injuries in underserved rural areas. Possible improvements to rural trauma care include bolstering the quality of care in Level III trauma centers, increasing Level II center efficiency through the involvement of orthopedic traumatologists, placing medical helicopter bases in more strategic locations that enable transport teams to reach other trauma centers faster, building more Level I and Level II trauma centers, and converting Level III centers into either Level I or Level II centers. 

CLINICAL FEATURES, INDICATIONS AND RESULT OF TRACHEOTOMY

2017 ◽  
pp. 50-55
Author(s):  
Duc Luu Ngo ◽  
Tu The Nguyen ◽  
Manh Hung Ho ◽  
Thanh Thai Le
Keyword(s):  
Clinical Features ◽  
University Hospital ◽  
Female Ratio ◽  
Tube Obstruction ◽  
Level Ii ◽  
Study Results ◽  
Male Female Ratio ◽  
Hospital Patients ◽  
Level I

Background: This study aims to survey some clinical features, indications and results of tracheotomy at Hue Central Hospital and Hue University Hospital. Patients and method: Studying on 77 patients who underwent tracheotomy at all of departments and designed as an prospective, descriptive and interventional study. Results: Male-female ratio was 4/1. Mean age was 49 years. Career: farmer 44.2%, worker 27.2%, officials 14.3%, student 7.8%, other jobs 6.5%. Respiratory condition before tracheotomy: underwent intubation 62.3%, didn’t undergo intubation 37.7%. Period of stay of endotracheal tube: 1-5 days 29.2%, 6-14 days 52.1%, >14 days 18.7%. Levels of dyspnea before tracheotomy: level I 41.4%, level II 48.3%, level III 0%, 10.3% of cases didn’t have dyspnea. Twenty cases (26%) were performed as an emergency while fifty seven (74%) as elective produces. Classic indications (37.7%) and modern indications (62.3%). On the bases of the site, we divided tracheostomy into three groups: high (0%), mid (25.3%) and low (74.7%). During follow-up, 44 complications occurred in 29 patients (37.7%). Tracheobronchitis 14.3%, tube obstruction 13%, subcutaneous empysema 10.4%, hemorrhage 5%, diffcult decannulation 5.2%, tube displacement 3.9%, canule watery past 2.6%, wound infection 1.3%. The final result after tracheotomy 3 months: there are 33 patients (42.9%) were successfully decannulated. In the 33 patients who were successfully decannulated: the duration of tracheotomy ranged from 1 day to 90 days, beautiful scar (51.5%), medium scar (36.4%), bad scar (12.1%). Conclusions: In tracheotomy male were more than female, adult were more than children. The main indication was morden indication. Tracheobronchitis and tube obstruction were more common than other complications. Key words: Tracheotomy

Obesity management through Ayurveda - A Case Study

2017 ◽  
Vol 2 (4) ◽  
Author(s):  
Dheeraj Kumar Tyagi ◽  
Shivakumar .
Keyword(s):  
Clinical Findings ◽  
Dietary Habit ◽  
Unhealthy Lifestyle ◽  
Lifestyle Management ◽  
Before And After ◽  
Effect Of Treatment ◽  
And Control

Lifestyle disorders are one of the biggest threats for the population living unhealthy lifestyle. Sthoulya (Obesity) is one such disorder which creates lot of physical as well as mental disorder to the sufferer. Due to changing lifestyle, comforts and dietary habit lots of individuals changed their life totally. Obesity is a growing disease in developed and developing countries. Prevalence is drastically hike in past few years. Ayurveda, the science of life with which we can manage and control lots of lifestyle disorders. Focusing on dietary and lifestyle management along with treatment, we can overcome the hazards of obesity which is growing in a uncontrolled manner. The available data is based on the clinical findings only. Aim and objective: To assess the effect of “Guru Cha Atarpanam Chikitsa” in the management of Sthoulya. Setting: Swastharakshana evam Yoga, OPD and IPD, SDMCAH, Hassan. Method: Udwarthana, Parisheka, Shamana Aushadhis, Ahara, and Vihara was followed within the treatment duration and effect of treatment was assessed before and after treatment, advised for follow up. Results: The treatment adopted is effective in the management of Sthoulya and to improve the quality of life.

scholarly journals Carbon Dioxide Laser Vulvovaginal Rejuvenation: A Systematic Review

Cosmetics ◽  
2021 ◽  
Vol 8 (3) ◽  
pp. 56
Author(s):  
Tassahil Messas ◽  
Achraf Messas ◽  
George Kroumpouzos
Keyword(s):  
Carbon Dioxide ◽  
Systematic Review ◽  
Laser Therapy ◽  
Carbon Dioxide Laser ◽  
Invasive Treatment ◽  
Erbium:Yag Laser ◽  
Non Invasive ◽  
Level I ◽  
Carbon Dioxide Co2

Genitourinary syndrome of menopause (GSM) causes significant symptomatic aggravation that affects the quality of life (QoL). Vulvovaginal atrophy (VVA), the hallmark of GSM, is managed with topical non-hormonal therapy, including moisturizers and lubricants, and topical estrogen application. Patients not responding/being unsatisfied with previous local estrogen therapies are candidates for a noninvasive modality. Carbon dioxide (CO2) laser therapy, especially the fractionated type (FrCO2), has drawn considerable attention over the past two decades as a non-invasive treatment for GSM. This systematic review describes the accumulated evidence from 40 FrCO2 laser studies (3466 participants) in GSM/VVA. MEDLINE, Scopus and Cochrane databases were searched through April 2021. We analyze the effects of FrCO2 laser therapy on symptoms, sexual function, and QoL of patients with GSM/VVA. As shown in this review, FrCO2 laser therapy for GSM shows good efficacy and safety. This modality has the potential to advance female sexual wellness. Patient satisfaction was high in the studies included in this systematic review. However, there is a lack of level I evidence, and more randomized sham-controlled trials are required. Furthermore, several clinical questions, such as the number of sessions required that determine cost-effectiveness, should be addressed. Also, whether FrCO2 laser therapy may exert a synergistic effect with systemic and/or local hormonal/non-hormonal treatments, energy-based devices, and other modalities to treat GMS requires further investigation. Lastly, studies are required to compare FrCO2 laser therapy with other energy-based devices such as erbium:YAG laser and radiofrequency.

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