Febrile Nonhemolytic Transfusion Reactions

2004 ◽  
Vol 128 (9) ◽  
pp. 991-995
Author(s):  
Christian N. Ezidiegwu ◽  
Karla J. Lauenstein ◽  
Lazaro G. Rosales ◽  
Karen C. Kelly ◽  
John Bernard Henry
Keyword(s):  
Clinical Effect ◽  
Blood Product ◽  
Published Data ◽  
Clinical Implications ◽  
Drug Induced ◽  
Comparative Cost ◽  
Routine Administration ◽  
The Cost ◽  
Transfusion Reactions ◽  
Antipyretic Medication

Abstract Context.—Febrile nonhemolytic transfusion reactions (FNHTRs) cause unwelcome interruptions during the course of blood product transfusions and necessitate measures to verify the nature of the reaction and to exclude certain dangerous reactions, such as hemolytic and septic phenomena. Objective.—To examine transfusion medicine data to determine the clinical implications of the routine administration of antipyretic medication to adult patients before transfusion for the prevention of FNHTRs. Design.—A retrospective review was conducted of FNHTR data during 5 years (1998–2002), and a determination was made of the cost of a transfusion complicated by an FNHTR. In addition, a comparative cost analysis was performed using our data and published data on the incidence of FNHTRs. The clinical implications of medication with respect to possible drug-induced adverse effects were assessed, as well as the potential interference with diagnosing other forms of transfusion reactions and the mitigation of the clinical effect of an FNHTR. Results.—For nearly 120 000 U of transfused blood components, approximately 80% of which were preceded by antipyretic medication during the study period, the overall incidence of FNHTR was found to be 0.09%. Furthermore, there was no evidence of antipyretic-associated complications, nor any evidence that antipyretics prevented the recognition of other more dangerous complications of transfusions. Conclusion.—Our findings indicate that this practice provides significant advantages to the recipient of a transfusion, but does not appear to yield significant cost benefits for the health care provider.

Speed, stride frequency and energy cost per stride: how do they change with body size and gait?

1988 ◽  
Vol 138 (1) ◽  
pp. 301-318 ◽  
Author(s):  
N. C. Heglund ◽  
C. R. Taylor
Keyword(s):  
Body Size ◽  
Body Mass ◽  
Energy Cost ◽  
Reaction Force ◽  
Stride Frequency ◽  
Energetic Cost ◽  
Published Data ◽  
Frequency Change ◽  
Cost Of Locomotion ◽  
The Cost

In this study we investigate how speed and stride frequency change with body size. We use this information to define ‘equivalent speeds’ for animals of different size and to explore the factors underlying the six-fold difference in mass-specific energy cost of locomotion between mouse- and horse-sized animals at these speeds. Speeds and stride frequencies within a trot and a gallop were measured on a treadmill in 16 species of wild and domestic quadrupeds, ranging in body size from 30 g mice to 200 kg horses. We found that the minimum, preferred and maximum sustained speeds within a trot and a gallop all change in the same rather dramatic manner with body size, differing by nine-fold between mice and horses (i.e. all three speeds scale with about the 0.2 power of body mass). Although the absolute speeds differ greatly, the maximum sustainable speed was about 2.6-fold greater than the minimum within a trot, and 2.1-fold greater within a gallop. The frequencies used to sustain the equivalent speeds (with the exception of the minimum trotting speed) scale with about the same factor, the −0.15 power of body mass. Combining this speed and frequency data with previously published data on the energetic cost of locomotion, we find that the mass-specific energetic cost of locomotion is almost directly proportional to the stride frequency used to sustain a constant speed at all the equivalent speeds within a trot and a gallop, except for the minimum trotting speed (where it changes by a factor of two over the size range of animals studied). Thus the energy cost per kilogram per stride at five of the six equivalent speeds is about the same for all animals, independent of body size, but increases with speed: 5.0 J kg-1 stride-1 at the preferred trotting speed; 5.3 J kg-1 stride-1 at the trot-gallop transition speed; 7.5 J kg-1 stride-1 at the preferred galloping speed; and 9.4 J kg-1 stride-1 at the maximum sustained galloping speed. The cost of locomotion is determined primarily by the cost of activating muscles and of generating a unit of force for a unit of time. Our data show that both these costs increase directly with the stride frequency used at equivalent speeds by different-sized animals. The increase in cost per stride with muscles (necessitating higher muscle forces for the same ground reaction force) as stride length increases both in the trot and in the gallop.

scholarly journals Awareness of the cost of psychotropic medication among doctors: a service evaluation

2010 ◽  
Vol 34 (9) ◽  
pp. 364-366 ◽  
Author(s):  
Dhananjay Kumar Singh ◽  
Shakil Khawaja ◽  
Ishaq Pala ◽  
Jaleel Khaja ◽  
Ray Krishnanu ◽  
...  
Keyword(s):  
Cost Effective ◽  
Service Evaluation ◽  
Financial Resources ◽  
Clinical Implications ◽  
North East ◽  
The North ◽  
Old Age Psychiatry ◽  
Level Of Knowledge ◽  
The Cost ◽  
Structured Questionnaire

Aims and methodCost-effective prescribing is an increasingly important aspect of our practice. A service evaluation was carried out to assess the level of awareness and knowledge of different aspects of cost-effective prescribing among doctors working in the North East London Foundation Trust. A semi-structured questionnaire was used to benchmark knowledge against six standards.ResultsThe survey was completed by 71% of doctors working in adult or old age psychiatry. A total of 2% of doctors stated that they should always take into consideration the price of the drug when prescribing and only 5% of doctors claimed to know the price of medications they prescribe most frequently.Clinical implicationsStrategies to improve the poor level of knowledge and awareness in this area of clinical practice would be of benefit in making the best use of limited financial resources without any detriment to patient care.

scholarly journals Genetic characterization of N-acetyltransferase 2 variants in acquired multidrug-resistant tuberculosis in Indonesia

2021 ◽  
Author(s):  
Rika Yuliwulandari ◽  
Kinasih Prayuni ◽  
Intan Razari ◽  
Retno W Susilowati ◽  
Yenni Zulhamidah ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
Resistance Rate ◽  
Published Data ◽  
Drug Induced ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Appropriate Treatment ◽  
Acetylator Status ◽  
Mdr Tb

Background: Owing to the high resistance rate of tuberculosis (TB) to isoniazid, which is metabolized by N-acetyltransferase 2 (NAT2), we investigated the associations between NAT2 variants and multidrug-resistant (MDR)-TB. Materials & methods: The acetylator status based on NAT2 haplotypes of 128 patients with MDR-TB in Indonesia were compared with our published data from patients with anti-TB drug-induced liver injury (AT-DILI), TB and the general population. Results: NAT2*4 was more frequent in the MDR-TB group than in the AT-DILI group, TB controls and general controls. NAT2*4/*4 was significantly more frequent in patients with MDR-TB than in those with AT-DILI. NAT2*5B/7B, *6A/6A and *7B/*7B were detected at lower frequencies in patients with AT-DILI. Rapid acetylators were significantly more frequent in patients with MDR-TB than in those with AT-DILI. Conclusion: These results provide an initial data for optimizing TB treatment in the Indonesian population, and suggest that NAT2 genotyping may help to select appropriate treatment by predicting TB-treatment effect.

The Cost-Effectiveness of an RCT to Establish Whether 5 or 10 Years of Bisphosphonate Treatment Is the Better Duration for Women With a Prior Fracture

2009 ◽  
Vol 29 (6) ◽  
pp. 678-689 ◽  
Author(s):  
Matt D. Stevenson ◽  
Jeremy E. Oakley ◽  
Myfawny Lloyd Jones ◽  
Alan Brennan ◽  
Juliet E. Compston ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Fracture Prevention ◽  
Published Data ◽  
Bisphosphonate Treatment ◽  
Net Benefit ◽  
England And Wales ◽  
Term Efficacy ◽  
The Cost

Purpose. Five years of bisphosphonate treatment have proven efficacy in reducing fractures. Concerns exist that long-term bisphosphonate treatment may actually result in an increased number of fractures. This study evaluates, in the context of England and Wales, whether it is cost-effective to conduct a randomized controlled trial (RCT) and what sample size may be optimal to estimate the efficacy of bisphosphonates in fracture prevention beyond 5 years. Method. An osteoporosis model was constructed to evaluate the cost-effectiveness of extending bisphosphonate treatment from 5 years to 10 years. Two scenarios were run. The 1st uses long-term efficacy data from published literature, and the 2nd uses distributions elicited from clinical experts. Results of a proposed RCT were simulated. The expected value of sample information technique was applied to calculate the expected net benefit of sampling from conducting such an RCT at varying levels of participants per arm and to compare this with proposed trial costs. Results. Without further information, the better duration of bisphosphonate treatment was estimated to be 5 years using the published data but 10 years using the elicited expert opinions, although in both cases uncertainty was substantial. The net benefit of sampling was consistently high when between 2000 and 5000 participants per arm were recruited. Conclusions. An RCT to evaluate the long-term efficacy of bisphosphonates in fracture prevention appears to be cost-effective for informing decision making in England and Wales.

The department of health’s comparative cost circulars

1971 ◽  
Vol 9 (1) ◽  
pp. 3-4
Keyword(s):  
Cost Effectiveness ◽  
Pharmacological Action ◽  
Comparative Cost ◽  
Department Of Health ◽  
The Cost

It is difficult to assess the cost effectiveness of drugs used in treatment. It is easy to compare them on the basis of cost alone and this is what the Department of Health achieves in its comparative cost circulars. A note on each circular states that ‘. . . . . . . it is only meant to illustrate the comparative costs of the quantity shown and is not suggested that all products have the same pharmacological action. The cost of the treatment will, of course, depend on the dosage used. . .’ Each circular is intended simply to make doctors aware of the cost of a number of products. This aim is undoubtedly worthwhile, but its single-minded pursuit has led to some unfortunate misunderstandings.

Acquired haemolytic anaemia

2020 ◽  
pp. 5479-5489
Author(s):  
Amy Powers ◽  
Leslie Silberstein
Keyword(s):  
Cell Membrane ◽  
Haemolytic Anaemia ◽  
Membrane Damage ◽  
Autoimmune Haemolytic Anaemia ◽  
Red Cell ◽  
Drug Induced ◽  
Red Cell Membrane ◽  
Cell Membrane Damage ◽  
Drug Dependent ◽  
Transfusion Reactions

Premature destruction of red cells occurs through two primary mechanisms: (1) decreased erythrocyte deformability that leads to red cell sequestration and extravascular haemolysis in the spleen and other components of the reticuloendothelial system—may be caused by membrane defects, metabolic abnormalities, exogenous oxidizing agents, or pathological antibodies; and (2) red cell membrane damage and intravascular haemolysis—may be caused by exposure to pathological antibodies, activated complement, mechanical forces, chemicals, and infectious agents. Congenital haemolytic anaemias—congenital disorders resulting in a haemolytic anaemia include (1) disorders of the red cell membrane such as hereditary spherocytosis and hereditary elliptocytosis; (2) disorders of red cell enzymes such as glucose-6-phosphate dehydrogenase deficiency and pyruvate kinase deficiency; and (3) disorders of globin structure. Acquired immune haemolytic anaemias—immune haemolysis may occur when IgG, IgM, or IgA antibodies and/or complement bind to the erythrocyte surface. Autoimmune haemolytic anaemias—these are best classified according to the temperature at which the antibody optimally binds to the erythrocyte: warm autoimmune haemolytic anaemia, cold agglutinin-mediated autoimmune haemolytic anaemia, paroxysmal cold haemoglobinuria, and mixed type autoimmune haemolytic anaemia. Drug-induced haemolytic anaemia—haemolysis can be caused by drugs that induce a positive DAT. Drug-induced antibodies may be drug dependent or drug independent depending on whether the presence of the drug is required for their detection. Alloimmune haemolytic anaemias—these include acute haemolytic transfusion reactions and other conditions such as delayed haemolytic transfusion reactions, passenger lymphocyte haemolysis, and haemolytic disease of the newborn. Acquired nonimmune haemolytic anaemias and microangiopathic haemolytic anaemia are also discussed in this chapter.

Evolution: Medicine’s most basic science

2020 ◽  
pp. 39-42
Author(s):  
Randolph M. Nesse ◽  
Richard Dawkins
Keyword(s):  
Population Genetics ◽  
Natural Selection ◽  
Basic Science ◽  
Evolutionary Biology ◽  
Phylogenetic Trees ◽  
The Body ◽  
Clinical Implications ◽  
Trade Offs ◽  
The Cost

The role of evolutionary biology as a basic science for medicine is expanding rapidly. Some evolutionary methods are already widely applied in medicine, such as population genetics and methods for analysing phylogenetic trees. Newer applications come from seeking evolutionary as well as proximate explanations for disease. Traditional medical research is restricted to proximate studies of the body’s mechanism, but separate evolutionary explanations are needed for why natural selection has left many aspects of the body vulnerable to disease. There are six main possibilities: mismatch, infection, constraints, trade-offs, reproduction at the cost of health, and adaptive defences. Like other basic sciences, evolutionary biology has limited direct clinical implications, but it provides essential research methods, encourages asking new questions that foster a deeper understanding of disease, and provides a framework that organizes the facts of medicine.

Dose-escalation and pharmacodynamic study of topotecan in combination with cyclophosphamide in patients with refractory cancer.

1997 ◽  
Vol 15 (1) ◽  
pp. 148-157 ◽  
Author(s):  
J R Murren ◽  
S Anderson ◽  
J Fedele ◽  
G Pizzorno ◽  
D Belliveau ◽  
...  
Keyword(s):  
Dna Fragmentation ◽  
Mononuclear Cells ◽  
Day Treatment ◽  
Alkylating Agents ◽  
Plasma Concentrations ◽  
Fixed Dose ◽  
Sign Test ◽  
Published Data ◽  
Drug Induced ◽  
Peripheral Blood Mononuclear

PURPOSE Based on preclinical data that demonstrated synergy between alkylating agents and topoisomerase (topo) I poisons, we determined the maximum-tolerated dose (MTD) of topotecan, using a 5 day bolus schedule, that could be given in combination with a single, fixed dose of cyclophosphamide. Pharmacodynamics of this combination were explored by analyzing biochemical effects of treatment in peripheral-blood mononuclear cells (PBMCs). PATIENTS AND METHODS Patients with refractory cancer were treated with cyclophosphamide 600 mg/m2 on day 1, followed by topotecan given as a 30-minute infusion for 5 consecutive days. Cycles were repeated every 3 weeks. Once the MTD was defined, granulocyte colony-stimulating factor (G-CSF) was added to the regimen in an attempt to escalate further the dose of topotecan. Plasma concentrations of topotecan were determined during the first treatment cycle by high-performance liquid chromatography. PBMCs were sampled at baseline and throughout the 5-day treatment period for analysis of topo I protein concentrations and to determine drug-induced DNA fragmentation. RESULTS Twenty-six patients were treated with topotecan at doses that ranged from 0.5 mg/m2/d to 1.2 mg/ m2/d for a total of 74 cycles. Reversible neutropenia was dose-limiting, with mild to moderate suppression of the other blood-cell elements commonly occurring. Transfusions of RBCs and platelets were required in 24% and 7% of treatment cycles, respectively. The most prominent nonhematologic toxicities were fatigue and weight loss. Compared with previously published data in which topotecan was administered alone, cyclophosphamide did not appear to alter the pharmacokinetics of topotecan. Significant increases in topo I concentration were identified in PBMCs following the administration of cyclophosphamide on day 1 and there was a significant decrease in topo 1 during the 5-day course of treatment (P < .01, sign test). DNA fragmentation as a result of drug treatment was identified in 11 of 15 (73%) cycles analyzed. CONCLUSION For previously treated patients, the recommended dose of topotecan in this schedule is 0.75 mg/m2/d without growth factor support and 1.0 mg/ m2/d if it is administered with G-CSF. Biochemical changes in cells induced by exposure to camptothecins can be measured in vivo and these effects may have important implication in the design of combination therapies and the optimal scheduling of this class of agents.

scholarly journals Use of cognitive–behavioural therapy skills among trained psychiatrists

2006 ◽  
Vol 30 (2) ◽  
pp. 58-60 ◽  
Author(s):  
Graeme Whitfield ◽  
Moira Connolly ◽  
Alan Davidson ◽  
Chris Williams
Keyword(s):  
Professional Development ◽  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
Postal Survey ◽  
Clinical Implications ◽  
Therapeutic Activity ◽  
Protected Time ◽  
Training And Supervision ◽  
Cognitive Behavioural ◽  
The Cost

Aims and MethodPrevious studies have suggested that despite the cost of attendance at postgraduate cognitive–behavioural therapy (CBT) courses, psychiatrists are unable to engage in CBT after qualification. A postal survey of psychiatrists with postgraduate CBT training currently practising in Scotland was performed to assess the levels of training and supervision that they provide, therapeutic CBT activity, and supervision and continued professional development that they receive.ResultsOf the 58 psychiatrists, 51 replied to the survey (88%). Less than half of the respondents supervised other staff. Although 43 (84%) engaged in some therapeutic CBT activity, only 25 (49%) received supervision for their own practice. The main reasons given for not engaging in CBT therapeutic activity were that there was inadequate ‘protected time’ and that CBT had not been included in ‘job plans'.Clinical ImplicationsPsychiatrists can help to disseminate CBT skills. To do this, they require personal supervision, and time for the development and maintenance of therapeutic skills as well as for the training and supervision of others. This survey builds on the results of others and indicates that these requirements are currently being inadequately met.

scholarly journals Cost-effectiveness of single-dose zoledronic acid for nursing home residents with osteoporosis in the USA

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e022585 ◽  
Author(s):  
Kouta Ito
Keyword(s):  
Nursing Home ◽  
Single Dose ◽  
Cost Effectiveness ◽  
Zoledronic Acid ◽  
Usual Care ◽  
Nursing Home Residents ◽  
Cost Effective ◽  
Routine Administration ◽  
The Usa ◽  
The Cost

ObjectiveTo evaluate the cost-effectiveness of routine administration of single-dose zoledronic acid for nursing home residents with osteoporosis in the USA.DesignMarkov cohort simulation model based on published literature from a healthcare sector perspective over a lifetime horizon.SettingNursing homes.ParticipantsA hypothetical cohort of nursing home residents aged 85 years with osteoporosis.InterventionsTwo strategies were compared: (1) a single intravenous dose of zoledronic acid 5 mg and (2) usual care (supplementation of calcium and vitamin D only).Primary and secondary outcome measuresIncremental cost-effectiveness ratio (ICER), as measured by cost per quality-adjusted life year (QALY) gained.ResultsCompared with usual care, zoledronic acid had an ICER of $207 400 per QALY gained and was not cost-effective at a conventional willingness-to-pay threshold of $100 000 per QALY gained. The results were robust to a reasonable range of assumptions about incidence, mortality, quality-of-life effects and the cost of hip fracture and the cost of zoledronic acid. Zoledronic acid had a potential to become cost-effective if a fracture risk reduction with zoledronic acid was higher than 23% or if 6-month mortality in nursing home residents was lower than 16%. Probabilistic sensitivity analysis showed that the zoledronic acid would be cost-effective in 14%, 27% and 44% of simulations at willingness-to-pay thresholds of $50 000, $100 000 or $200 000 per QALY gained, respectively.ConclusionsRoutine administration of single-dose zoledronic acid in nursing home residents with osteoporosis is not a cost-effective use of resources in the USA but could be justifiable in those with a favourable life expectancy.

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