Hospital practice (1995)
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Hospital practice (1995) · Feb 2012
ReviewAn update in options for the treatment of pain: a review of new opioid formulations.
In the past 2 decades, there has been a significant increase in the use of opioids for the management of chronic nonmalignant pain. This increase in usage has led to concerns of misuse and abuse of opioids. ⋯ In addition, alternative delivery systems have been developed to provide physicians with more options to provide adequate pain management for those with chronic pain. This article reviews new opioid options for the treatment of pain management and requirements of the Risk Evaluation and Mitigation Strategies program.
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Clostridium difficile has become an increasingly important nosocomial pathogen and is one of the most common causes of hospital-acquired diarrhea. The incidence of C difficile infection (CDI) is increasing worldwide. ⋯ The increasing incidence of CDI has a major impact on increasing health care costs. This article will summarize the epidemiology, pathogenesis, clinical manifestations, laboratory diagnosis, and treatment options for CDI, as well as infection-control measures for the prevention of CDI.
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Hospital practice (1995) · Feb 2012
Outpatient antibiotic prescribing in a low-risk veteran population with acute respiratory symptoms.
Acute respiratory tract infections are usually caused by viruses and are self-limited in healthy adults. Providers frequently provide antibiotic prescriptions for sinusitis, bronchitis, pharyngitis, and nonspecific upper respiratory tract infections, despite no evidence of improved clinical outcomes. We sought to determine: 1) primary care providers' antibiotic prescribing practices for acute respiratory tract infections in low-risk outpatient veterans and 2) short-term health outcome differences between those receiving and not receiving an antibiotic prescription. ⋯ Many low-risk veterans received antibiotics for acute respiratory tract infections despite guidelines indicating that symptomatic treatment is sufficient for most patients. Novel interventions are required to reduce unnecessary and potentially harmful antibiotic use for low-risk outpatients with acute respiratory complaints.
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Hospital practice (1995) · Feb 2012
Comparative StudyCost analysis of varenicline versus bupropion, nicotine replacement therapy, and unaided cessation in Nicaragua.
In Nicaragua, 30% of current morbidities are associated with tobacco smoking. Tobacco control policy measures have been initiated in this Central American country; however, the population does not have a complete understanding of the long-term consequences of tobacco use. The aim of this study was to compare the direct medical costs of smoking cessation therapies with varenicline, bupropion, nicotine replacement therapy, and unaided cessation in Nicaragua over 5 time horizons: 2, 5, 10, and 20 years, and lifetime. ⋯ The use of a smoking cessation therapy with varenicline would generate long-term savings to Nicaragua's health care institutions of > US$11 million in the lifetime time horizon.
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Hospital practice (1995) · Feb 2012
Evaluating therapeutic benefit in postsurgical analgesia requires global assessment: an example from liposome bupivacaine in hemorrhoidectomy.
Interpreting analgesic efficacy based solely on measures of pain intensity can be misleading. Here, we use data from an adult hemorrhoidectomy study to demonstrate the importance of evaluating pain intensity scores with other outcome measures in interpreting analgesic study results. ⋯ Liposome bupivacaine produced superior analgesia when compared with placebo at early postoperative time points, but appropriate use of rescue medication diminished this effect after 12 hours. However, based on our assessment of multiple outcome measures used in the study, it appears that the therapeutic benefit associated with the tested analgesic lasted throughout the 72-hour study period.