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Clinical Burden and Health Care Resource Utilization Associated With Managing Sickle Cell Disease With Recurrent Vaso-occlusive Crises in England. 英国镰状细胞病复发性血管闭塞性危象的临床治疗负担和医疗资源使用情况。
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2024-11-06 DOI: 10.1016/j.clinthera.2024.09.023
Chuka Udeze, Nelly F Ly, Fiona C Ingleby, Sophia D Fleming, Sarah C Conner, Jo Howard, Nanxin Li, Farrukh Shah
{"title":"Clinical Burden and Health Care Resource Utilization Associated With Managing Sickle Cell Disease With Recurrent Vaso-occlusive Crises in England.","authors":"Chuka Udeze, Nelly F Ly, Fiona C Ingleby, Sophia D Fleming, Sarah C Conner, Jo Howard, Nanxin Li, Farrukh Shah","doi":"10.1016/j.clinthera.2024.09.023","DOIUrl":"https://doi.org/10.1016/j.clinthera.2024.09.023","url":null,"abstract":"<p><strong>Purpose: </strong>Sickle cell disease (SCD) is an inherited red blood cell disease caused by a mutation in the gene encoding the β-subunit of adult hemoglobin that leads to hemolysis, anemia, vaso-occlusive crises (VOCs), morbidity, and mortality. This study provides a real-world assessment of the clinical burden and health care resource utilization (HCRU) associated with SCD with recurrent VOCs in England.</p><p><strong>Methods: </strong>This retrospective study linked primary care records from the Clinical Practice Research Datalink database with secondary care records from the Hospital Episode Statistics database to identify patients with SCD with recurrent VOCs between July 1, 2008, and June 30, 2018. A VOC was defined as SCD with crisis, acute chest syndrome, or priapism. Eligible patients had SCD, ≥2 VOCs/year in any 2 consecutive years after a diagnosis of SCD, and ≥1 year of follow-up data from the index date. Patients were exact matched with 5 controls from the general population in the databases. Demographics were assessed at index. Mortality, clinical complications, and HCRU were summarized during follow-up.</p><p><strong>Findings: </strong>After applying eligibility criteria, 1117 patients with SCD with recurrent VOCs and 5585 controls were included in the study. Mean age at index was 25 years in both groups. The proportion of deaths (3.67% vs 0.68%; P < 0.001) and mortality rate (0.78 deaths per 100 person-years vs 0.16 deaths per 100 person-years) were substantially higher in patients with SCD with recurrent VOCs versus matched controls. Mean (standard deviation [SD]) age of death in patients with SCD with recurrent VOCs who died during the follow-up period was 40.17 (14.09) years. The mean (SD) rate of VOCs for patients with SCD with recurrent VOCs was 5.84 (12.50) per patient per year (PPPY) during follow-up. Compared with matched controls, patients with SCD with recurrent VOCs had substantially higher mean [SD] rates PPPY of inpatient hospitalizations (7.59 [14.50] vs 0.32 [2.71]), prescriptions (31.06 [60.62] vs 7.58 [27.77]), and outpatient visits (9.60 [10.69] vs 1.78 [4.18]). Older patients and those with increased numbers of VOCs had increased mortality, frequency of clinical complications, and HCRU.</p><p><strong>Implications: </strong>Despite currently available care, patients with SCD with recurrent VOCs in England have increased mortality, substantial clinical complications, and significant HCRU driven by VOCs and hospitalizations. Elevated mortality and clinical complications in patients with SCD with recurrent VOCs highlight the need for novel therapies in this space.</p>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Silver Linings: Side Effects and Secondary Findings of Newly Emerging Therapies. 银线:新兴疗法的副作用和次要发现。
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2024-11-05 DOI: 10.1016/j.clinthera.2024.10.002
Jill L Maron
{"title":"Silver Linings: Side Effects and Secondary Findings of Newly Emerging Therapies.","authors":"Jill L Maron","doi":"10.1016/j.clinthera.2024.10.002","DOIUrl":"https://doi.org/10.1016/j.clinthera.2024.10.002","url":null,"abstract":"","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Systematic Review of Sex-specific High Sensitivity Cardiac Troponin I and T Thresholds. 性别特异性高敏心肌肌钙蛋白 I 和 T 阈值的系统性回顾。
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2024-11-05 DOI: 10.1016/j.clinthera.2024.09.025
Mengchen Cao, Ava E Pierce, Marquita S Norman, Bhaskar Thakur, Kiersten Diercks, Cooper Hale, Yacine Issioui, Deborah B Diercks
{"title":"Systematic Review of Sex-specific High Sensitivity Cardiac Troponin I and T Thresholds.","authors":"Mengchen Cao, Ava E Pierce, Marquita S Norman, Bhaskar Thakur, Kiersten Diercks, Cooper Hale, Yacine Issioui, Deborah B Diercks","doi":"10.1016/j.clinthera.2024.09.025","DOIUrl":"https://doi.org/10.1016/j.clinthera.2024.09.025","url":null,"abstract":"<p><strong>Purpose: </strong>High-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) have been demonstrated to have lower sex-specific 99th percentiles in healthy females. However, these sex-specific thresholds are not widely adopted in clinical practice which could lead to underdiagnosis of acute myocardial infarction in females. We conducted a systematic review to explore sex-specific 99th percentiles for hs-cTnI and hs-cTnT from healthy reference populations.</p><p><strong>Methods: </strong>The principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to complete this systematic review. We used PubMed and OVID EMBASE to search for original studies published between November 2017 and November 2021 that included reference populations used to establish the 99th percentiles of hs-cTnI and hs-cTnT with the following inclusion criteria: adults; English language; samples taken as part of a healthy, reference population; studies using high-sensitivity troponin assay; and sample size > 300. Studies were excluded if the reference population sample size was < 300, if a conventional troponin assay was used, or if they did not include independently derived, sex-specific 99th percentiles. Data was extracted from the studies through Covidence to perform a qualitative data synthesis. Female-specific, male-specific, and overall 99th percentiles for hs-cTn were compared.</p><p><strong>Findings: </strong>We reviewed 131 articles of which 19 met inclusion criteria. These 19 studies derived sex-specific 99th percentiles for 11 different hs-cTnI assays and 9 different hs-cTnT assays. More than 90% (13 of 14 studies) of hs-cTnI assays found lower female 99th percentiles compared to male and to overall 99th percentiles. One study included nine different hs-cTnI assays, of which only one assay resulted in a higher female 99th percentile compared to male and to overall 99th percentiles. Eight of nine hs-cTnT studies (88.9%) found lower female 99th percentiles compared to male and to overall 99th percentiles.</p><p><strong>Implications: </strong>The data shows significantly lower 99th percentiles in females compared to 99th percentiles in males and overall. Incorporating these sex-specific 99th percentile cut-offs into clinical practice could lead to increased diagnosis and potentially better outcomes for females presenting with acute myocardial infarction.</p>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical Burden and Healthcare Resource Utilization Associated With Managing Transfusion-dependent β-Thalassemia in England. 英格兰输血依赖型 β 地中海贫血症的临床负担和医疗资源使用情况。
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2024-11-01 DOI: 10.1016/j.clinthera.2024.09.024
Chuka Udeze, Nelly F Ly, Fiona C Ingleby, Sophia D Fleming, Sarah C Conner, Jo Howard, Nanxin Li, Farrukh Shah
{"title":"Clinical Burden and Healthcare Resource Utilization Associated With Managing Transfusion-dependent β-Thalassemia in England.","authors":"Chuka Udeze, Nelly F Ly, Fiona C Ingleby, Sophia D Fleming, Sarah C Conner, Jo Howard, Nanxin Li, Farrukh Shah","doi":"10.1016/j.clinthera.2024.09.024","DOIUrl":"https://doi.org/10.1016/j.clinthera.2024.09.024","url":null,"abstract":"<p><strong>Purpose: </strong>Patients with transfusion-dependent β-thalassemia (TDT) have reduced levels of β-globin, leading to ineffective erythropoiesis and iron overload. Patients with TDT depend on regular red blood cell transfusions (RBCTs) and iron chelation therapy for survival and management of disease- and treatment-related clinical complications. This study describes the clinical and economic burden in patients with TDT in England.</p><p><strong>Methods: </strong>This longitudinal, retrospective study linked the Clinical Practice Research Datalink (CPRD) database with secondary care data from the Hospital Episode Statistics database to identify patients with a diagnosis of β-thalassemia between July 1, 2008, and June 30, 2018. Included patients had a diagnosis of β-thalassemia prior to the index date, ≥8 RBCTs per year for ≥2 consecutive years, and ≥1 year of follow-up data available from the index date. Each eligible patient was exact matched with up to 5 controls in the CPRD. Proportions of deaths and rates of mortality, acute and chronic complications, and healthcare resource utilization (HCRU) were calculated during the follow-up period.</p><p><strong>Findings: </strong>Of 11,359 identified patients with β-thalassemia, 237 patients with TDT met the eligibility criteria and were matched with 1184 controls. The mean age at the index date was approximately 25 years in the patient and control groups. The proportion of deaths (7.17% vs 1.18%; P < 0.05) and mortality rate (1.19 deaths per 100 person-years vs 0.20 deaths per 100 person-years) were higher among patients with TDT compared to controls. Endocrine complications and bone disorders were the most prevalent complications among patients with TDT (58.23%) and included osteoporosis (29.11%), diabetes mellitus (28.27%), and hypopituitarism (28.27%). Patients with TDT had a mean of 13.62 RBCTs per patient per year (PPPY). HCRU was substantially higher among patients with TDT, wherein patients with TDT had higher rates of prescriptions recorded in primary care (24.09 vs 8.61 PPPY), outpatient visits (16.69 vs 1.31 PPPY), and inpatient hospitalizations (17.41 vs 0.24 PPPY) than controls. Inpatient hospitalizations were primarily <1 day, with 16.62 events PPPY lasting <1 day and 0.79 events PPPY lasting ≥1 day. Patients with TDT aged ≥18 years had increased rates of mortality, clinical complications, and HCRU than those aged <18 years.</p><p><strong>Implications: </strong>Patients with TDT in England have higher mortality than matched controls, substantial disease-related clinical complications, and substantial HCRU. High mortality and clinical complications highlight the need for additional innovative therapies for TDT.</p>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of Intravenous Lidocaine on Postoperative Cognitive Dysfunction in Patients Undergoing General Anesthesia Surgery: A Systematic Review of a Randomized Controlled Trial. 静脉注射利多卡因对全身麻醉手术患者术后认知功能障碍的影响:随机对照试验的系统回顾
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2024-10-30 DOI: 10.1016/j.clinthera.2024.09.027
Xian-Xue Wang, Jing Dai, Hui-Wei Deng, Qi Wang, Yun Liu, Hua-Jing Guo
{"title":"Effect of Intravenous Lidocaine on Postoperative Cognitive Dysfunction in Patients Undergoing General Anesthesia Surgery: A Systematic Review of a Randomized Controlled Trial.","authors":"Xian-Xue Wang, Jing Dai, Hui-Wei Deng, Qi Wang, Yun Liu, Hua-Jing Guo","doi":"10.1016/j.clinthera.2024.09.027","DOIUrl":"https://doi.org/10.1016/j.clinthera.2024.09.027","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Postoperative cognitive dysfunction (POCD) is a common neurologic complication that occurs after surgery, which prolongs the hospital stay of patients to a certain extent, increases the occurrence of complications, and even leads to the patient's death. Intravenous lidocaine can reduce perioperative inflammatory response in patients undergoing surgery, but its effect on postoperative cognitive function has not been systematically evaluated. Notably, prior findings regarding the impact of intravenous lidocaine on postoperative cognitive function have been variable. Therefore, on this basis, this study explored the effects of intravenous lidocaine on postoperative cognitive function of patients undergoing general anesthesia through a systematic review and meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Pubmed, Cochrane Library, Embase, Medline, Wanfang Medical Database, China Biomedical Literature Database, and China Academic Journals Full-Text Database were searched from inception to February 2024 for relevant studies that investigated effect of intravenous lidocaine on POCD in patients undergoing general anesthesia surgery. Key data obtained from the referenced literature included the prevalence of POCD, scores from the Mini-Mental State Examination (MMSE), and perioperative serum concentrations of neuron-specific enolase (NSE) and central nervous specific protein (S-100β) protein, serving as biomarkers for central nervous system specificity. Meta-analysis of data was performed using RevMan5.3 software. The software Trial Sequential Analysis (version 0.9) (TSA) was used to analyze high-quality literature focusing on POCD outcome indicators to explore the reliability of the results of meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Twenty-five studies were included for quality evaluation and data analysis. The studies compared the effect of intravenous lidocaine on the incidence of POCD in patients undergoing surgery at different time points. Subgroup analysis was used to investigate the incidence of POCD at different time points. The results showed that intravenous lidocaine significantly reduced the incidence of POCD at 1, 3, 7, 9 days and 1 year after surgery compared with the control group (on the first day postoperatively: odds ratio (OR) = 0.48, 95% CI: 0.32-0.69, P &lt; 0.001; postoperative day 3: OR = 0.42, 95% CI: 0.25-0.72, P = 0.002; postoperative day 7: OR = 0.34, 95% CI: 0.21-0.55, P &lt; 0.001; postoperative day 9: OR = 0.32, 95% CI: 0.17-0.61, P &lt; 0.001; 1 year postoperatively: OR = 0.39, 95% CI: 0.28-0.54, P &lt; 0.001). The incidence of POCD in patients undergoing general anesthesia at postoperative day 1 with lidocaine was analyzed sequentially. The results showed that with the increase of the included sample size, the Z-curve still did not exceed the TSA boundary and did not reach the required information size. Fourteen studies compared MMSE scores before, 1, 2, 3, and 7 days after surgery between the 2 groups","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Extraglycemic Effects of SGLT2/GLP-1: A Topic Update. SGLT2/GLP-1 的血糖外效应:最新话题。
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2024-10-28 DOI: 10.1016/j.clinthera.2024.10.005
Uazman Alam
{"title":"Extraglycemic Effects of SGLT2/GLP-1: A Topic Update.","authors":"Uazman Alam","doi":"10.1016/j.clinthera.2024.10.005","DOIUrl":"https://doi.org/10.1016/j.clinthera.2024.10.005","url":null,"abstract":"","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Correlation of Triethylamine N-oxide (TMAO), LPS, and TNF-Alpha Levels With Clinical Features of the Disease in Patients With and Without Septic Shock Infected With COVID-19 Virus. 感染 COVID-19 病毒的脓毒性休克患者体内三乙胺 N-氧化物 (TMAO)、LPS 和 TNF-Alpha 水平与疾病临床特征的相关性。
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2024-10-26 DOI: 10.1016/j.clinthera.2024.09.021
Kübra Polat, Mehtap Gömleksiz, Kübra Oral, Nevzat Gözel, Gaweł Sołowski, Tugҫe Kaymaz, Mehmet Ferit Gürsu
{"title":"Correlation of Triethylamine N-oxide (TMAO), LPS, and TNF-Alpha Levels With Clinical Features of the Disease in Patients With and Without Septic Shock Infected With COVID-19 Virus.","authors":"Kübra Polat, Mehtap Gömleksiz, Kübra Oral, Nevzat Gözel, Gaweł Sołowski, Tugҫe Kaymaz, Mehmet Ferit Gürsu","doi":"10.1016/j.clinthera.2024.09.021","DOIUrl":"https://doi.org/10.1016/j.clinthera.2024.09.021","url":null,"abstract":"<p><strong>Background: </strong>Inflammation is a response of the immune system to protect the body against various diseases or injuries. Serum trimethylamine N-oxide (TMAO) levels may vary depending on age, gender, habits, comorbidities, and microbiota.</p><p><strong>Aims: </strong>In this study, we investigated whether TMAO levels have diagnostic significance and their potential as a marker in the early diagnosis of the disease. Another aim of the research was to identify changes in TMAO levels as a reflection of the deterioration in the microflora, and IL-6, IL-10, IL-1β, TNF-alpha, and LPS levels in patient groups. Then, we recognized relationships between these parameters in patients infected with COVID-19 without septic shock and with COVID-19 who were without transmission of COVID-19 in septic shock.</p><p><strong>Study design: </strong>A total of 160 patients were investigated, including 40 patients infected with COVID-19 without septic contact, 40 patients with COVID-19 positive septic shock, 40 patients with COVID-19 negative septic shock, and 40 healthy individuals as the control group.</p><p><strong>Results: </strong>TNF-α and IL-1β levels were significantly lower (P < 0.001) and IL-6 and IL-10 levels were significantly higher (P < 0.001) in patient groups than in control groups. IL-1β showed a significant decrease, especially in the groups infected with COVID-19. Although IL-6, increased even more in the groups infected with COVID-19.</p><p><strong>Conclusions: </strong>LPS level was remarkably high in the sepsis group infected with COVID-19 compared to the other groups. TMAO level was significantly higher (P < 0.001) in the sepsis group. Therefore, TMAO is a potential biomarker in sepsis and septic shock.</p>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effectiveness of Remimazolam on Preventing Adverse Reactions Caused by Carboprost Tromethamine During Cesarean Section. 雷马唑仑对预防剖宫产术中由卡前列素氨基丁三醇引起的不良反应的效果
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2024-10-25 DOI: 10.1016/j.clinthera.2024.09.020
Jianjun Fan, Zhiguo Zhang, Jie Wang, Dianwei Han, Yongbo Zhen, Jinpei Fan, Shuai Wang, Fei Wang
{"title":"Effectiveness of Remimazolam on Preventing Adverse Reactions Caused by Carboprost Tromethamine During Cesarean Section.","authors":"Jianjun Fan, Zhiguo Zhang, Jie Wang, Dianwei Han, Yongbo Zhen, Jinpei Fan, Shuai Wang, Fei Wang","doi":"10.1016/j.clinthera.2024.09.020","DOIUrl":"https://doi.org/10.1016/j.clinthera.2024.09.020","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effectiveness of remimazolam in preventing adverse reactions triggered by carboprost tromethamine during cesarean section procedures.</p><p><strong>Methods: </strong>A total of 200 parturients scheduled for cesarean sections at risk of postpartum hemorrhage in our hospital from October 2022 to July 2023 were included. The participants were assigned via random number table method to either a study group or a control group, resulting in 100 cases in each. All parturients received combined spinal and epidural anesthesia (CSEA) during cesarean section, followed by administration of carboprost tromethamine (250 µg) for preventing postpartum hemorrhage after childbirth. CSEA was performed with 1.8 to 2 mL of 0.5% bupivacaine and 7 to 10 mL of 2% lidocaine. The study group was given remimazolam via intravenous infusion at a rate of 0.3 mg/kg/h commencing at 1 minute prior to CSEA and concluding with a final dosage adjustment 20 minutes preceding the end of surgery, while the control group was given the same volume of saline within this time frame. Primary outcome measures were adverse reactions and sedative effects of the parturients.</p><p><strong>Findings: </strong>Nausea and vomiting were the only adverse reactions that exhibited significant differences between groups. The study group reported significantly fewer cases (32 cases) of nausea and vomiting when compared to the 48 cases observed in the control group. Moreover, the use of remimazolam appeared to alleviate the severity of nausea and vomiting, as evidenced by the significantly lower incidence of Grade III event and the higher risk of Grade I event in comparison with the control group (P < 0.05). The Apgar scores of newborns at birth and 5 minutes after birth were compared, and no statistically significant difference was found (P > 0.05). Parturients receiving remimazolam exhibited better effective sedation outcomes and were more satisfied with the treatment when compared with controls (P < 0.05). There were no significant differences in postpartum bleeding volume at 2 and 12 hours postpartum, as well as in the duration of postpartum bleeding between the two groups (P > 0.05).</p><p><strong>Implications: </strong>Intravenous administration of remimazolam effectively prevents adverse reactions induced by carboprost tromethamine during cesarean section performed under CSEA, thereby improving sedative effects.</p>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Systemic Estrogen Therapy and Thrombosis: A Call for Individualized Clinical Decision Making in the Acute Care Setting. 系统性雌激素疗法与血栓形成:呼吁在急症护理中进行个性化临床决策》(A Call for Individualized Clinical Decision Making in the Acute Care Setting)。
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2024-10-22 DOI: 10.1016/j.clinthera.2024.09.026
Valentina Restrepo, Kelsey Martin, Layla Van Doren
{"title":"Systemic Estrogen Therapy and Thrombosis: A Call for Individualized Clinical Decision Making in the Acute Care Setting.","authors":"Valentina Restrepo, Kelsey Martin, Layla Van Doren","doi":"10.1016/j.clinthera.2024.09.026","DOIUrl":"https://doi.org/10.1016/j.clinthera.2024.09.026","url":null,"abstract":"<p><p>Systemic estrogen therapies (SETs) are integral to health care, playing critical roles in reproductive rights, managing heavy menstrual bleeding (HMB), alleviating menopausal symptoms, and supporting gender-affirming hormone therapy (GAHT) for transwomen. However, SETs are associated with an increased risk of venous thromboembolism (VTE), posing a challenge in the acute care setting. Here, we explore the nuanced management of SETs in patients who present with a hormone-related VTE in the acute care setting. The prevailing practice of discontinuing SETs in this setting may lead to significant adverse effects, including exacerbation of HMB, unintended pregnancy, menopausal symptoms, and psychological distress from interrupted GAHT or hormone replacement therapy. The discontinuation of SETs can severely affect patients' health, quality of life, and adherence to anticoagulation therapy in the case of HMB, increasing the risk of VTE recurrence. We challenge the practice of broadly discontinuing SETs in the acute care setting, advocating for a patient-centered approach that considers the underlying reasons for SET use, potential adverse effects of abrupt cessation, and individual patient needs. We underscore the importance of shared decision making and individualized care, particularly for historically marginalized groups in health care, cis women, transwomen, and individuals with HMB, to ensure safe, equitable, and affirming health care. A tailored approach to managing SETs in the acute care setting will enhance health care delivery and reduce health inequities. Lastly, we highlight the need for further research, particularly regarding GAHT-related VTE for transwomen.</p>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cobenfy Xanomeline and Trospium Chloride. Cobenfy Xanomeline 和 Trospium Chloride。
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2024-10-22 DOI: 10.1016/j.clinthera.2024.10.001
Paul Beninger
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