Standard Medical Therapy (standard + medical_therapy)

Distribution by Scientific Domains


Selected Abstracts


Does the Early Administration of Beta-blockers Improve the In-hospital Mortality Rate of Patients Admitted with Acute Coronary Syndrome?

ACADEMIC EMERGENCY MEDICINE, Issue 1 2010
Ethan Brandler MD
Abstract Objectives:, Beta-blockade is currently recommended in the early management of patients with acute coronary syndromes (ACS). This was a systematic review of the medical literature to determine if early beta-blockade improves the outcome of patients with ACS. Methods:, The authors searched the PubMed and EMBASE databases for randomized controlled trials from 1965 through May 2009 using a search strategy derived from the following PICO formulation of our clinical question: Patients included adults (18+ years) with an acute or suspected myocardial infarction (MI) within 24 hours of onset of chest pain. Intervention included intravenous or oral beta-blockers administered within 8 hours of presentation. The comparator included standard medical therapy with or without placebo versus early beta-blocker administration. The outcome was the risk of in-hospital death in the intervention groups versus the comparator groups. The methodologic quality of the studies was assessed. Qualitative methods were used to summarize the study results. In-hospital mortality rates were compared using a forest plot of relative risk (RR; 95% confidence interval [CI]) between beta-blockers and controls. Statistical analysis was done with Review Manager V5.0. Results:, Eighteen articles (total N = 72,249) met the inclusion/exclusion criteria. For in-hospital mortality, RR = 0.95 (95% CI, 0.90,1.01). In the largest of these studies (n = 45,852), a significantly higher rate (p < 0.0001) of cardiogenic shock was observed in the beta-blocker (5.0%) versus control group (3.9%). Conclusions:, This systematic review failed to demonstrate a convincing in-hospital mortality benefit for using beta-blockers early in the course of patients with an acute or suspected MI. ACADEMIC EMERGENCY MEDICINE 2010; 17:1,10 © 2010 by the Society for Academic Emergency Medicine [source]


Albumin dialysis in cirrhosis with superimposed acute liver injury: possible impact of albumin dialysis on hospitalization costs

LIVER INTERNATIONAL, Issue 2003
T. Hassanein
Abstract Albumin dialysis using the Molecular Adsorbents Recirculating System (MARS) has been found to be beneficial in the treatment of cirrhotic patients with acute decompensation to improve survival as well as reduce associated complications. The present study attempts to analyze the costs involved, and compare it to the benefit as a result of the MARS therapy, thus evaluating its cost-effectiveness. Using the results of a study by Kim et al. (Hepatology 2001) describing the effects of complications on the cost of hospitalization in alcoholic liver disease patients, the expenditure incurred in a group of 11 patients treated with standard medical therapy (five survivors) and a group of 12 patients treated with MARS in addition (11 survivors) (Heemann et al., Hepatology 2002) were analyzed. MARS resulted in a reduction of in-hospital deaths, as well as liver disease-related complications. Both these factors led to a substantial reduction of costs in the MARS group, which was enough to counterbalance the extra costs associated with extra-corporeal therapy. In the control group, the total hospitalization cost per survivor were calculated to be at $35 904. In the MARS group, the overall expenditure per survivor including standard medical therapy plus additional MARS liver support therapy were $32 036 , a saving of nearly $4000 compared to the control group. Therefore, it appears that the benefits of MARS therapy are enough to justify the cost of treatment and safe hospital costs, at least in the described population. However, further studies are needed to confirm these results. [source]


Artificial and bioartificial support systems for liver failure: a Cochrane Hepato-Biliary Group Protocol

LIVER INTERNATIONAL, Issue 5 2002
Jianping Liu
Abstract: Aims/Background: Liver support systems may bridge patients to liver transplantation or recovery from liver failure. This review is to evaluate the beneficial and harmful effects of artificial and bioartificial support systems for acute and acute-on-chronic liver failure. Data Sources: Randomized trials on any support system versus standard medical therapy will be included irrespective of publication status or language. Non-randomized studies are included in explorative analyses. Trials will be identified through bibliographies, correspondence with original investigators, and electronic searches (Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Controlled Trials Register, MEDLINE, EMBASE, and The Chinese Biomedical Database). Methods of the review: The extracted data will include characteristics of trials, patients, interventions, and all outcome measures. Methodological quality will be assessed by the randomization, follow up, and blinding. The RevMan and STATA will be used for statistical analyses. Sources of heterogeneity and methodological quality in the assessment of the primary outcome will be explored by sensitivity analyses and meta-regression. [source]


Use of herbal remedies by diabetic Hispanic women in The southwestern United States

PHYTOTHERAPY RESEARCH, Issue 4 2006
Lane Johnson
Abstract Objective: The primary purpose of this study was to examine the use and documentation of herbal remedies used by Hispanic women with Type II diabetes enrolled in two Community Health Centers in the Southwest USA. A secondary purpose was to review the literature on identified herbs to assess their likely effects on diabetes. Design: Open-ended structured interviews were conducted on a convenience sample (n = 23) of participants. Medical and medication charts were reviewed for the interviewed participants, and for a random sample of enrolled Hispanic diabetic patients (n = 81) who were not interviewed. Setting: Two Community Health Centers in the Southwest USA. Participants: Enrolled patient, Hispanic females with Type II diabetes. Intervention: Subjects were interviewed about their use of herbal therapies and supplements. Information collected from medical and pharmaceutical charts included documented use of herbal remedies; standard therapies prescribed and diabetes control (hemoglobin A1C values). For those herbal remedies reported, literature reviews were conducted to determine if there was supporting evidence of harm or efficacy for the stated condition. Main Outcome Measures: Reports of herbal use, and types of remedies used. Results: Among the interviewed participants, 21 of 23 (91%) reported using one or more herbal remedies. Among a random sample of patient medical charts, seven (6.7%) contained documentation of diabetes-specific herbs, and 16 (15.4%) had documented general herb use. A total of 77 different herbal remedies were identified, most of which were contained as part of commercial preparations, and appeared to supplement, rather than replace standard medical therapy for diabetes. Conclusion: Use of herbal therapies is not uncommon among diabetic patients. Many of the herbs reported have potential efficacy in treating diabetes or may result in adverse effects or interactions. In practical use, however, the herbs reported in this study are unlikely to have a significant effect on clinical outcomes in diabetes, either positively or negatively. Copyright © 2006 John Wiley & Sons, Ltd. [source]


Sudden cardiac death complicating alcohol septal ablation: A case report and review of literature,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 7 2009
Patrick Antoun MD
Abstract Over the years, alcohol septal ablation has become an effective and well-accepted modality in the treatment of patients with hypertrophic obstructive cardiomyopathy refractory to standard medical therapy. Malignant tachyarrythmias infrequently complicates the procedure and are usually self-terminating. We describe a case of alcohol septal ablation complicated by sudden cardiac death occurring immediately following the procedure requiring prolonged resuscitative efforts with eventual complete recovery. We also discuss the pathophysiologic significance of this event in the setting of this cardiomyopathy and its relevance as a complication of the procedure. © 2009 Wiley-Liss, Inc. [source]