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Phase III study suggests apixaban could more than halve stroke risk versus aspirin

prady — Tue, 07 Sep 2010 12:33:41 CDT

Source: PharmaTimes
Area: News
PharmaTimes reports on the results of a phase III study presented at the European Society of Cardiology (ESC) 2010 conference, which suggests that the oral Factor Xa inhibitor apixaban can more than halve the risk of stroke or systemic embolism compared with aspirin in patients with atrial fibrillation (AF) who unable to take warfarin. The trial (AVERROES trial) was conducted in 36 countries and recruited 5,600 AF patients regarded as intolerant of, or unsuitable for, therapy with a vitamin K antagonist such as warfarin. Patients were randomised to either apixaban 5mg twice daily or aspirin 81-324mg once daily. The primary outcome measure (stroke or systemic embolism) occurred in 1.6% of patients in the apixaban group and 3.6% of patients in the aspirin group, giving a relative risk reduction of 54% (p<0.001) for apixaban. The annual rate of stroke, a component of the primary outcome measure), was 1.5% for apixaban and 3.3% for aspirin, a relative risk reduction of 52% ...

Confirming the drugs administered during anaesthesia: a feasibility study in the pilot National Health Service sites, UK

prady — Tue, 07 Sep 2010 12:17:30 CDT

Source: British Journal of Anaesthesia
Area: Evidence > Medicines Management > References
Background: To help prevent drug errors, it is recommended that drugs should be confirmed/checked with a second person before administration. We aimed to assess the feasibility of introducing second-person or electronic bar-code confirmation of drugs, administered during anaesthesia, in the National Health Service (NHS) settings in the UK.
Methods: Seven NHS sites took part in a pilot study over a 3-month period. Five used a second-person and two used bar-code electronic confirmation of drugs given during anaesthesia. A total of 36 consultant anaesthetists and 3 trainees, 15 operating department practitioners (ODPs) and 7 anaesthetic nurses participated. A group of anaesthetists, ODPs and nurse practitioners (n = 11) from different NHS sites independently observed both methodologies. In addition, each site was visited and observed by one of the study investigators. At the end of the study period, four focus groups (two with ...

Effect of epidural analgesia in patients with traumatic rib fractures: a systematic review and meta-analysis of randomized controlled trials

prady — Tue, 07 Sep 2010 12:17:30 CDT

Source: DARE
Area: Evidence > Disease Focused Reviews
CRD Summary: This generally well-conducted review concluded that there was no benefit of epidural analgesia on mortality or length of intensive care unit stay and hospital stay, but there may be a reduced duration of mechanical ventilation with thoracic epidural analgesia with local anaesthetics. The conclusion appears likely to be reliable, but is based on small studies of variable quality.
[Included studies used bupivacaine, fentanyl, lidocaine, meperidine, mepivacaine and morphine for epidurals and controls.]
CRD Commentary: The review question was clear and supported by specific inclusion criteria. The authors searched three relevant databases and other relevant sources. The absence of restrictions on the search reduced the chances of language or publication bias being introduced into the review. The authors reported using methods designed to reduce reviewer bias and error in the selection of studies for the review and in the extraction of data, but not in the assessment ...

Drug errors: consequences, mechanisms, and avoidance

prady — Tue, 07 Sep 2010 12:17:30 CDT

Source: British Journal of Anaesthesia
Area: Evidence > Medicines Management > References
Medication errors are common throughout healthcare and result in significant human and financial cost. Prospective studies suggest that the error rate in anaesthesia is around one error in every 133 anaesthetics. There are several categories of medication error ranging from slips and lapses to fixation errors and deliberate violations. Violations may be more likely in organisations with a tendency to blame front-line workers, a tendency to deny the existence of latent conditions, and a blinkered pursuit of productivity indicators. In these organisations, borderline-tolerated conditions of use may occur which blur the distinction between safe and unsafe practice. Latent conditions will also make the error at the 'sharp end' more likely to result in actual patient harm. Several complementary strategies are proposed which may result in fewer medication errors. At the organisational level, developing a safety culture and promoting robust error ...

Updated national IV monograph for remifentanil hydrochloride (Ultiva®)

prady — Tue, 07 Sep 2010 12:17:30 CDT

Source: Medusa
Area: News
An updated IV monograph for remifentanil hydrochloride (Ultiva®)is now available from the NHS injectable medicines guide website (Medusa) at the link below (registration required for access).

Litigation related to regional anaesthesia: an analysis of claims against the NHS in England 1995-2007

prady — Tue, 07 Sep 2010 12:17:30 CDT

Source: Anaesthesia
Area: Evidence > Medicines Management > References
The authors analysed 366 claims related to regional anaesthesia and analgesia from the 841 anaesthesia-related claims handled by the National Health Service Litigation Authority between 1995 and 2007. The majority of claims (281/366, 77%) were closed at the time of analysis. The total cost of closed claims was GBP 12,724,017 (34% of the cost of the anaesthesia dataset) with a median (IQR (range)) of GBP 4772 (GBP 0-28,907 (GBP 0-2,070,092)). Approximately half of the claims (186/366; 51%) were related to obstetric anaesthesia and analgesia and of the non-obstetric claims, the majority (148/180; 82%) were related to neuraxial block. The total cost for obstetric closed claims was GBP 5,433,920 (median (IQR (range)) GBP 5678 (GBP 0-27,690 (GBP 0-1,597,565)) while that for non-obstetric closed claims was GBP 7,290,097 (GBP 3337 (GBP 0-31,405 (GBP 0-2,070,062)). Non-obstetric claims were more likely to relate to severe outcomes than obstetric ones. ...

Cosmetic foot surgery can have serious downsides