Κυριακή, 28 Ιανουαρίου 2018

Cost-effectiveness of intravenous acetaminophen and ketorolac in adolescents undergoing idiopathic scoliosis surgery

Summary

Background

Enhanced recovery after surgery protocols increasingly use multimodal analgesia after major surgeries with intravenous acetaminophen and ketorolac, despite no documented cost-effectiveness of these strategies.

Aims

The goal of this prospective cohort study was to model cost-effectiveness of adding acetaminophen or acetaminophen + ketorolac to opioids for postoperative outcomes in children having scoliosis surgery.

Methods

Of 106 postsurgical children, 36 received only opioids, 26 received intravenous acetaminophen, and 44 received acetaminophen + ketorolac as analgesia adjuncts. Costs were calculated in 2015 US $. Decision analytic model was constructed with Decision Maker® software. Base-case and sensitivity analyses were performed with effectiveness defined as avoidance of opioid adverse effects.

Results

The groups were comparable demographically. Compared with opioids-only strategy, subjects in the intravenous acetaminophen + ketorolac strategy consumed less opioids (P = .002; difference in mean morphine consumption on postoperative days 1 and 2 was −0.44 mg/kg (95% CI −0.72 to −0.16); tolerated meals earlier (P < .001; RR 0.250 (0.112-0.556)) and had less constipation (P < .001; RR 0.226 (0.094-0.546)). Base-case analysis showed that of the 3 strategies, use of opioids alone is both most costly and least effective, opioids + intravenous acetaminophen is intermediate in both cost and effectiveness; and opioids + intravenous acetaminophen and ketorolac is the least expensive and most effective strategy. The addition of intravenous acetaminophen with or without ketorolac to an opioid-only strategy saves $510-$947 per patient undergoing spine surgery and decreases opioid side effects.

Conclusion

Intravenous acetaminophen with or without ketorolac reduced opioid consumption, opioid-related adverse effects, length of stay, and thereby cost of care following idiopathic scoliosis in adolescents compared with opioids-alone postoperative analgesia strategy.



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Prosthetic energy return during walking increases after 3 weeks of adaptation to a new device

There are many studies that have investigated biomechanical differences among prosthetic feet, but not changes due to adaptation over time. There is a need for objective measures to quantify the process of ada...

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When CPR Doesn't Work

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<p style="margin-bottom: 1.2em;">CPR is an attempt to make up for circulation in the heart that is not happening normally. CPR does not stop the dying process; it simply slows down biological cell death. The hope is that this procedure can buy time for EMS to arrive to try other methods of restoring proper circulation of oxygenated blood throughout the body to buy even more time so that the underlying reason why the person went into cardiac arrest in the first place can be explored. If CPR doesn't work, remember, you gave that person that best chance of survival.</p> <p style="font-size: 1.2em; font-weight: bold; margin-bottom: 1.2em;">Visit ProCPR for comprehensive <a href="http://www.procpr.org/training">CPR and first aid training</a>.</p>

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How to Administer Narcan for Opioid Overdose

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<p style="margin-bottom: 1.2em;">Opiates and opioids are central nervous system depressants and their use can lead to overdose. Overdose commonly occurs when the patient takes more than prescribed, when the opioids are combined with other drugs, or when the person has a condition that makes them more sensitive to overdose.</p> <p style="margin-bottom: 1.2em;">There are several kinds of opiates and opioids whose effects can be reversed with proper administration of Naloxone Intramuscular or Intranasal, also known as Narcan.</p> <p style="font-size: 1.2em; font-weight: bold; margin-bottom: 1.2em;">Visit ProCPR for comprehensive <a href="http://www.procpr.org/training">CPR and first aid training</a>.</p>

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How to Administer Narcan for Opioid Overdose

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Opiates and opioids are central nervous system depressants and their use can lead to opiate or opioid overdose. Overdose commonly occurs when the patient takes more than prescribed, when the opioids are combined with other drugs, or when the person has a condition that makes them more sensitive to overdose. There are several kinds of opiates and opioids whose effects can be reversed with proper administration of Naloxone Intramuscular or Intranasal, also known as Narcan.

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The Effect of Support and Training for Family Members on Access to Outpatient Services for Veterans with Posttraumatic Stress Disorder (PTSD)

Abstract

The VA Program of Comprehensive Assistance for Family Caregivers (PCAFC) provides landmark support for family caregivers of post-9/11 veterans. This study examines PCAFC support for veterans with and without PTSD and assesses whether program effect differs by PTSD status using a pre-post, non-equivalent, propensity score weighted comparison group design (n = 24,280). Veterans with and without PTSD in PCAFC accessed more mental health, primary, and specialty care services than weighted comparisons. PCAFC participation had stronger effects on access to primary care for veterans with PTSD than for veterans without PTSD. For veterans with PTSD, PCAFC support might enhance health service use.



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