Nonobstetric Surgery during Pregnancy: An Overview for Anesthesia Providers

2018 ◽  
Author(s):  
Rebecca L Hamilton ◽  
Elizabeth Young Han ◽  
Dan M Drzymalski
Keyword(s):  
Obstetric Anesthesia ◽  
Anesthesia Provider ◽  
Anesthetic Technique ◽  
Clinical Practices ◽  
Scientific Methods ◽  
Randomized Controlled Studies ◽  
Anesthesia Providers ◽  
Improved Outcomes ◽  
The Us ◽  
Key Words Anesthesia

A pregnant patient’s surgery can be challenging for the anesthesia provider—the needs of the parturient and fetus must be addressed while balancing the physiologic and pharmacologic changes that occur during pregnancy. Improved outcomes have led to an increase in the frequency of surgeries in parturients, with approximately 50,000 procedures performed annually in the US. Due to a lack of randomized controlled studies, determining the optimal anesthetic technique for nonobstetric surgery during pregnancy is predicated on understanding the physiologic changes of pregnancy. The anesthesia provider must become familiar with specific changes and challenges in each parturient to formulate a safe anesthetic plan. Here, we review physiologic and pharmacologic conditions observed in common surgical cases that may occur during pregnancy. Our goal is to inform safe clinical practices determined by the latest scientific methods for nonobstetric surgery during pregnancy.    This review contains 5 figures, 3 tables and 45 references. Key Words: anesthesia, nonobstetric surgery, obstetric anesthesia, pregnancy, surgery, physiology, pharmacology, gynecology

Nonobstetric Surgery during Pregnancy: An Overview for Anesthesia Providers

2018 ◽  
Author(s):  
Rebecca L Hamilton ◽  
Elizabeth Young Han ◽  
Dan M Drzymalski
Keyword(s):  
Obstetric Anesthesia ◽  
Anesthesia Provider ◽  
Anesthetic Technique ◽  
Clinical Practices ◽  
Scientific Methods ◽  
Randomized Controlled Studies ◽  
Anesthesia Providers ◽  
Improved Outcomes ◽  
The Us ◽  
Key Words Anesthesia

A pregnant patient’s surgery can be challenging for the anesthesia provider—the needs of the parturient and fetus must be addressed while balancing the physiologic and pharmacologic changes that occur during pregnancy. Improved outcomes have led to an increase in the frequency of surgeries in parturients, with approximately 50,000 procedures performed annually in the US. Due to a lack of randomized controlled studies, determining the optimal anesthetic technique for nonobstetric surgery during pregnancy is predicated on understanding the physiologic changes of pregnancy. The anesthesia provider must become familiar with specific changes and challenges in each parturient to formulate a safe anesthetic plan. Here, we review physiologic and pharmacologic conditions observed in common surgical cases that may occur during pregnancy. Our goal is to inform safe clinical practices determined by the latest scientific methods for nonobstetric surgery during pregnancy.    This review contains 5 figures, 3 tables and 45 references. Key Words: anesthesia, nonobstetric surgery, obstetric anesthesia, pregnancy, surgery, physiology, pharmacology, gynecology

Anesthesia for Cesarean Delivery

2019 ◽  
Author(s):  
Emily E. Naoum ◽  
Rebecca D. Minehart
Keyword(s):  
Cesarean Delivery ◽  
Deep Understanding ◽  
Obstetric Anesthesia ◽  
Anesthetic Technique ◽  
Vaginal Birth After Cesarean ◽  
Anesthesia Providers ◽  
Gastric Contents ◽  
Potential Risks ◽  
Hypotensive Syndrome ◽  
Preparation Techniques

Cesarean delivery is a cornerstone of obstetric anesthesia and it is imperative for providers to have a deep understanding of the indications, preparation, techniques, and potential complications of both the procedure and the anesthesia. It is necessary to obtain a focused but thorough history and physical and to develop an appropriate individual by considering a multitude of factors including co-morbid maternal and fetal conditions, timing of delivery, technical needs of the surgeon, potential adverse events, and systems based decision making. Anesthesia providers need to determine the safest method to provide anesthesia for the mother with an aim to minimize risk to the fetus. Once the decision of which anesthetic technique will be utilized is made, the provider must have the knowledge of how to best execute the plan and remain vigilant by maintaining a back-up plan in the case of complications. Obstetric anesthesia for cesarean delivery carries a set of unique challenges and potential risks in addition to the standard risks associated with general and neuraxial anesthesia. This review contains 5 figures, 6 tables, and 86 references. Keywords: Maternal Physiology, Maternal-Fetal Considerations, Systemic Medications, Cesarean Delivery, Difficult Airway, Aspiration Prophylaxis, Supine Hypotensive Syndrome, Aspiration of Gastric Contents, Vaginal Birth After Cesarean Section (VBAC)

Improved Outcomes Amongst High Risk Lung Transplant Patients at High Volume Centers: A Case for Regionalization in the US

2015 ◽  
Vol 34 (4) ◽  
pp. S243
Author(s):  
J.C. Grimm ◽  
J. Magruder ◽  
A. Kilic ◽  
V. Valero ◽  
S.P. Dungan ◽  
...  
Keyword(s):  
High Risk ◽  
Lung Transplant ◽  
High Volume ◽  
Transplant Patients ◽  
Improved Outcomes ◽  
The Us

Utilization and patient characteristics for the trastuzumab originator, biosimilars, and other HER2 inhibitors in the United States.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 308-308
Author(s):  
Young Hee Nam ◽  
Aaron Mendelsohn ◽  
James Marshall ◽  
Nancy Lin ◽  
Jeffrey Brown ◽  
...  
Keyword(s):  
Endocrine Therapy ◽  
Metastatic Breast ◽  
Patient Characteristics ◽  
The United States ◽  
Baseline Period ◽  
Research Network ◽  
Health Plans ◽  
Clinical Practices ◽  
Full Data ◽  
The Us

308 Background: Biosimilars for trastuzumab, a HER2 inhibitor (HER2I), have been available for use in the US since in 2019, yet information on their utilization and patient characteristics is limited. We assessed utilization and patient characteristics for the trastuzumab originator, biosimilars, and other HER2Is in the US. Methods: We analyzed healthcare claims for 10/1/2016-up to 2/29/2020 (end date varied across health plans) from the Biologics and Biosimilars Collective Intelligence Consortium’s Distributed Research Network ( > 95 million persons) using the FDA’s Sentinel distributed analysis tools. We conducted descriptive analyses on the number of incident users and patients’ characteristics for each HER2I. Adults continuously enrolled in their health plan with medical and drug coverage ≥365 days (baseline period) prior to their incident HER2I use were eligible for analysis. Results: Of the incident users (incident to any HER2Is), we identified 6,631 originator trastuzumab users, 122 trastuzumab-anns, 116 ado-trastuzumab emtansine, 54 neratinib, and 54 lapatinib users. Trastuzumab-dkst and trastuzumab/hyaluronidase-oysk had < 11 users each. Mean age was the highest for trastuzumab/hyaluronidase-oysk (73.7 years; SD, 18.6) and similar between the trastuzumab originator and biosimilars (52.5-59.0). The number of incident users/100,000 person-years decreased for the trastuzumab originator from 13.5 in 2016 to 9.4 in 2020 and increased for trastuzumab-anns from 0.4 in 2019 to 4.9 in 2020. Of the baseline clinical characteristics examined, Charlson/Elixhauser comorbidity score was the highest for lapatinib (2.0), lowest for trastuzumab-dkst and neratinib (0.5), and similar between the trastuzumab originator (1.1) and trastuzumab-anns (1.3). The proportion of patients who received any chemotherapy during the baseline period was 38.9% for lapatinib, 18.5% for the trastuzumab originator, and 14.8% for trastuzumab-anns. The proportion of endocrine therapy users was the highest for neratinib (63.0%) and similar between the trastuzumab originator (11.1%) and trastuzumab-anns (10.7%). Among incident users with metastatic breast cancer, endocrine therapy receivers during the baseline period accounted for 19.3% for the trastuzumab originator and 69.6% for lapatinib. Conclusions: Though full data were not available for 2019-2020 for all health plans, these preliminary findings suggest that utilization of biosimilar trastuzumab-anns increased whereas the trastuzumab originator use decreased over time and that there is a variation in patient characteristics between HER2Is and by metastatic status while the characteristics were generally similar between the trastuzumab originator and trastuzumab-anns. We plan to conduct ongoing assessment of HER2I utilization as more data become available to help inform clinical practices and health policies.

scholarly journals The Prevention of Hemorrhagic Stroke

2008 ◽  
Vol 14 (4) ◽  
pp. 365-373
Author(s):  
J. Raymond ◽  
JP Mohr ◽  
Keyword(s):  
Good Practice ◽  
Preventive Treatment ◽  
Clinical Work ◽  
Point Of View ◽  
Dominant Factor ◽  
Clinical Practices ◽  
Trial Methodology ◽  
Scientific Methods ◽  
Unruptured Aneurysms ◽  
The Face

There is currently no evidence that preventive treatment of unruptured aneurysms or AVMs is beneficial and randomized trials have been proposed to address this clinical uncertainty. Participation in a trial may necessitate a shift of point of view compared to a certain habitual clinical mentality. A review of the ethical and rational principles governing the design and realization of a trial may help integrate clinical research into expert clinical practices. The treatment of unruptured aneurysms and AVMs remains controversial, and data from observational studies cannot provide a normative basis for clinical decisions. Prevention targets healthy individuals and hence has an obligation of results. There is no opposition between the search for objective facts using scientific methods and the ethics of medical practice since a good practice cannot forbid physicians the means to define what could be beneficial to patients. Perhaps the most difficult task is to recognize the uncertainty that is crucial to allow resorting to trial methodology. The reasoning that is used in research and analysis differs from the casuistic methods typical of clinical work, but clinical judgement remains the dominant factor that decides both who enters the trial and to whom the results of the trial will apply. Randomization is still perceived as a difficult and strange method to integrate into normal practice, but in the face of uncertainty it assures the best chances for the best outcome to each participant. Some tension exists between scientific methods and normal practice, but they need to coexist if we are to progress at the same time we care for patients.

scholarly journals Post QALY: Scientific Approaches to Real World Formulary Decision Making

2020 ◽  
Vol 11 (2) ◽  
pp. 19
Author(s):  
Paul Langley ◽  
Stephen McKenna
Keyword(s):  
Decision Making ◽  
Medical Devices ◽  
Evidence Base ◽  
Pharmaceutical Products ◽  
Normal Science ◽  
Value Assessment ◽  
Scientific Methods ◽  
Article Type ◽  
The Us ◽  
The Uk

The purpose of this anniversary supplement for Innovations in Pharmacy is to consider and / or propose modern, scientific methods for determining the evidence base for the fair pricing and accessibility of pharmaceutical products and medical devices. At present, such decisions are based on the construction of imaginary value assessment models that fail to meet the standards of normal science. Such a business model has been adopted by the Institute for Clinical and Economic Review (ICER) in the US, NICE in the UK and in a number of other countries.   Article Type: Call for Papers

scholarly journals WAS J. BENTHAM THE FIRST LEGAL UTILITARIAN?

2020 ◽  
Vol 24 (2) ◽  
pp. 438-471
Author(s):  
Igor V. Kolosov ◽  
Konstantin E. Sigalov
Keyword(s):  
Legal Policy ◽  
Scientific Methods ◽  
Legal Thought ◽  
The Us ◽  
Analysis And Synthesis ◽  
Scientific Papers ◽  
History Of ◽  
Distinct Features ◽  
Statutory Regulation ◽  
Theoretical Component

Legal utilitarianism is attractive for practice because this field of legal thought and philosophy of law sets out a particular direction of legal policy and statutory regulation (focus on the utility principle in decision-making) that can, under certain reservations, be used to improve people's lives. Most scholars conclude that the first utilitarian was J. Bentham. However, scientific studies prevalently do not involve the analysis of earlier legal doctrines in relation to the use of utility principle. Thus, the relevance and scientific novelty of analysis of the origin of legal utilitarianism is associated with the need to develop a theoretical component of this doctrine that is of current interest for the legal policy and to enlarge the underdeveloped - in our opinion - theoretical framework of legal utilitarianism genesis. The purpose is to identify the first theory in the history of legal thought, which can be classified as legal utilitarianism, and, if such theory is the J. Bentham's utilitarianism, to determine the reasons why earlier theories based on the utility principle cannot be classified as legal utilitarianism. The theoretical basis of the article is materials such as original sources by various thinkers whose works are based on the utility principle and scientific papers of European and the US researchers. For the purpose of the article, the following methodological tools were used: metaphysical (dialectic method), general (analysis and synthesis, deduction and induction, analogy, comparison) and specific (historical and legal-historical) scientific methods. The main outcome of the research is identification of distinct features of pre-Bentham legal thought based on the utility principle and identification of pre-requisites and basis (provisions which had formed the basis) for J. Bentham's utilitarianism, as well as the answer to the question: Was J. Bentham the first legal utilitarian?.

scholarly journals Ultrasound-Guided Percutaneous Needle Electrolysis in Dancers with Chronic Soleus Injury: A Randomized Clinical Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
B. De-la-Cruz-Torres ◽  
I. Barrera-García-Martín ◽  
F. Valera-Garrido ◽  
F. Minaya-Muñoz ◽  
C. Romero-Morales
Keyword(s):  
Eccentric Exercise ◽  
Soleus Muscle ◽  
Sports Injuries ◽  
Exercise Program ◽  
Exercise Group ◽  
Muscle Injuries ◽  
Therapeutic Tool ◽  
Clinically Important Difference ◽  
Improved Outcomes ◽  
The Us

Damage to intramuscular tendons is very common in sports injuries, specifically in soleus muscle injuries. This study sought to compare the effects of applying ultrasound- (US-) guided percutaneous needle electrolysis (PNE) in combination with an eccentric exercise program on pain and functionality in dancers with chronic soleus injury, located in the central tendon. Thirty dancers with injured central tendon of the soleus muscle were randomly allocated to a PNE group (n = 10), an eccentric exercise group (n = 10), or a combined group (n = 10). Pain, ankle dorsiflexion range of motion (DROM), endurance, the heel raise test, the DFOS questionnaire, and the minimal clinically important difference (MCID) were analyzed at baseline and after treatment (four weeks). Over half (52%) of the dancers had a chronic soleus muscle injury. Variables for pain, DROM, the heel rise test, ADL, technique, DFOS total, and DFOS-subjective variables showed significant differences (P<0.05) in pretreatment and posttreatment in all groups, whereas no significant differences were observed between intervention groups. However, the combined group showed a higher percentage of changes compared to the other groups, and these dancers had greater perceived changes (MCID = 4.70 ± 1.42). The conclusion of the study was that dancers with chronic soleus injury, located in the central tendon, treated with a combination of US-guided PNE and an eccentric exercise program displayed improved outcomes compared to the application of PNE therapy or eccentric exercise alone. The US-guided PNE, combined with an eccentric exercise program, is a useful therapeutic tool for the treatment of chronic soleus injury, located in the central tendon. The trial is registered with NCT04042012.

scholarly journals Rapid Diagnostics for Blood Cultures: Supporting Decisions for Antimicrobial Therapy and Value-Based Care

2019 ◽  
Vol 3 (4) ◽  
pp. 686-697 ◽  
Author(s):  
Donna M Wolk ◽  
J Kristie Johnson
Keyword(s):  
Critical Care ◽  
Antibiotic Therapy ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Rapid Diagnostics ◽  
Clinical Practices ◽  
Critical Care Units ◽  
The Us ◽  
Causes Of Mortality ◽  
Value Based Care

Abstract Bacteremia and sepsis are critically important syndromes with high mortality, morbidity, and associated costs. Bloodstream infections and sepsis are among the top causes of mortality in the US, with &gt;600 deaths each day. Most septic patients can be found in emergency medicine departments or critical care units, settings in which rapid administration of targeted antibiotic therapy can reduce mortality. Unfortunately, routine blood cultures are not rapid enough to aid in the decision of therapeutic intervention at the onset of bacteremia. As a result, empiric, broad-spectrum treatment is common—a costly approach that may fail to target the correct microbe effectively, may inadvertently harm patients via antimicrobial toxicity, and may contribute to the evolution of drug-resistant microbes. To overcome these challenges, laboratorians must understand the complexity of diagnosing and treating septic patients, focus on creating algorithms that rapidly support decisions for targeted antibiotic therapy, and synergize with existing emergency department and critical care clinical practices put forth in the Surviving Sepsis Guidelines.

scholarly journals OPTIMAL STAFFING MODELS TO CARE FOR FRAIL ELDERLY ADULTS IN PRIMARY CARE AND GERIATRIC PRACTICES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S66-S66
Author(s):  
David I Auerbach ◽  
Carie Michael ◽  
Douglas Levy ◽  
Peter Maramaldi ◽  
Robert Dittus ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Frail Elderly ◽  
Elderly Population ◽  
Care Home ◽  
Care Practice ◽  
Clinical Practices ◽  
Frail Elders ◽  
The Us ◽  
Health Care Home

Abstract As the US population ages, primary care is expected to be the health care “home” for older adults, and several initiatives are aimed at helping to transform primary care practice to care for this population. Wide variation in staffing has been observed. Meyers et al proposed ideal models of primary care staffing for a general population and for a frail elderly population (2018). We developed the 2018 Survey of Primary Care and Geriatric Clinicians to measure optimal team configuration in clinical practices caring for older adults. A majority employed NPs, MDs and PAs, with [r = -.53] between % of clinician labor of NPs and physicians). High-NP practices are more likely located in states with full scope of practice, perform well for frail elders and are less expensive. Meyers' models, with fewer physicians, more SW and CHWs, more RNs, perform better for frail elders, and are less expensive.

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