Podcasts about conclusions clinical

Crystalloids versus colloids for resuscitation is an age old debate! In this episode I present the following paper before going on to talk about the use of colloids in hypoproteinaemia. Click Here For Your FREE Copy of a Transcript of This Episode For online presentations and notes on Hypovolaemia and Shock and Parenteral Fluid Therapy visit my online training portal. Cazzolli D, Prittie J. The crystalloid-colloid debate: Consequences of resuscitation fluid selection in veterinary critical care. J Vet Emerg Crit Care 2015. Early View online 22 January. ABSTRACT Objective: To provide a comprehensive review of the current literature in human and veterinary medicine evaluating the impact of resuscitation fluid choice on patient outcome and adverse effects. Data Sources: Prospective and retrospective studies, experimental models, and review articles in both human and veterinary medicine retrieved via PubMed. Human Data Synthesis: A series of recent, large, randomized controlled trials in critically ill human patients comparing crystalloid versus colloid driven fluid resuscitation algorithms have demonstrated no outcome benefit with the use of natural or synthetic colloids. Synthetic colloidal solutions are associated with an increased incidence of adverse effects including acute kidney injury, need for renal replacement therapy, and coagulopathies. Further, colloidal solutions demonstrate a larger volume of distribution in the setting of critical illness than hypothesized. These findings have created controversy regarding colloid fluid resuscitation in critically ill patients and challenge current resuscitation strategies. A thorough review of the most influential human data is provided. Veterinary Data Synthesis: No veterinary clinical outcome data pertaining to fluid resuscitation choice currently exist. Veterinary data from experimental and small clinical trials evaluating the coagulopathic effects of hydroxyethyl starch solutions are described. Data pertaining to the use of natural colloids and albumin products in clinical veterinary patients are reviewed. In addition, data pertaining to the comparative intravascular volume expansion effectiveness of different fluid types in canine patients are reviewed. Conclusions: Clinical data from critically ill human patients have failed to demonstrate an outcome advantage associated with colloidal fluid resuscitation and indicate that hydroxyethyl starch solutions may be associated with significant adverse effects, including acute kidney injury, need for renal replacement therapy, coagulopathies, and pathologic tissue uptake. The ability to apply these findings to veterinary patients is unknown; however, similar pathophysiology may apply, and critical re-evaluation of resuscitation strategies is justified.

Background: Flupirtine is an analgesic with muscle-relaxing properties that activates Kv7 potassium channels. Kv7 channels are expressed along myelinated and unmyelinated peripheral axons where their activation is expected to reduce axonal excitability and potentially contribute to flupirtine's clinical profile. Trial design: To investigate the electrical excitability of peripheral myelinated axons following orally administered flupirtine, in-vitro experiments on isolated peripheral nerve segments were combined with a randomised, double-blind, placebo-controlled, phase I clinical trial (RCT). Methods: Threshold tracking was used to assess the electrical excitability of myelinated axons in isolated segments of human sural nerve in vitro and motoneurones to abductor pollicis brevis (APB) in situ in healthy subjects. In addition, the effect of flupirtine on ectopic action potential generation in myelinated axons was examined using ischemia of the lower arm. Results: Flupirtine (3-30 mu M) shortened the relative refractory period and increased post-conditioned superexcitability in human myelinated axons in vitro. Similarly, in healthy subjects the relative refractory period of motoneurones to APB was reduced 2 hours after oral flupirtine but not following placebo. Whether this effect was due to a direct action of flupirtine on peripheral axons or temperature could not be resolved. Flupirtine (200 mg p.o.) also reduced ectopic axonal activity induced by 10 minutes of lower arm ischemia. In particular, high frequency (ca. 200 Hz) components of EMG were reduced in the post-ischemic period. Finally, visual analogue scale ratings of sensations perceived during the post-ischemic period were reduced following flupirtine (200 mg p.o.). Conclusions: Clinical doses of flupirtine reduce the excitability of peripheral myelinated axons.

Background: Study aim was to collect intermediate-term data of the Mosaic bioprosthesis in aortic position after implanting the first device worldwide in February 1994 in our hospital. Methods: The Mosaic bioprosthesis is a stented porcine aortic valve, which combines glutaraldehyde fixation with zero pressure and root pressure techniques and antimineralization treatment with amino oleic acid for improved hemodynamics and tissue durability. Included in a multicenter study, 100 patients (49 females) underwent aortic valve replacement with the Mosaic bioprosthesis between February 1994 and May 1999. Mean age at implant was 73.4 ± 7.3 years. Concomitant procedures were performed in 40.0%. Patients were followed-up within 30 days postoperative, after six months and at annual intervals. Mean follow-up was 3.8 years (range 0.1-7.1 years); total follow-up was 383.1 patient-years (pt-yr) and was 100% complete. Results: Early mortality (within 30 days) was 3.0%; late mortality was 4.6%/pt-yr, including a valve-related mortality of 0.6%/pt-yr. Freedom from event rates at seven years were 96.8% ± 1.8% for thromboembolic events, 97.2% ± 2.0% for thrombosed bioprosthesis, 96.6% ± 2.6% for structural valve deterioration, 98.2% ± 1.8% for nonstructural dysfunction, 95.9% ± 2.0% for antithromboembolic hemorrhage, 98.9% ± 1.1% for endocarditis and 93.9 % ± 3.2% for reoperation and explant. Mean systolic pressure gradient was 15.3 ± 6.7mmHg (21mm), 14.5 ± 5.7mmHg (23mm), 12.7 ± 4.1mmHg (25mm) and 13.0 ± 4.8mmHg (27mm) after one year; effective orifice area was 1.4 ± 0.4cm2 (21mm), 1.7 ± 0.4cm2 (23mm), 1.8 ± 0.4cm2 (25mm) and 2.6 ± 0.4cm2 (27mm); effective orifice area index was 0.8 ± 0.3cm2/m2 (21mm), 0.9 ± 0.2cm2/m2 (23mm), 0.9 ± 0.2cm2/m2 (25mm) and 1.3 ± 0.1cm2/m2 (27mm). Left ventricular mass index decreased significantly from 159.7 ± 56.8g/m2 to 137.3 ± 40.8g/m2 for all sizes after one year. Conclusions: Clinical and hemodynamic performance of the Mosaic bioprosthesis was highly satisfactory during the first seven years after clinical introduction.

Purpose: The goal of this treatment trial was to investigate the efficacy of an inpatient group therapy program specifically designed for patients suffering from Obsessive Compulsive Disorder (OCD, ICD 10, F 42). Methods: In the experimental group (EG; n = 14) the specific group therapy was carried out in addition to individual cognitive-behavioral therapy, the control group (KG; n = 16) received non-specific group therapy in mixed patient-groups in addition to individual therapy. 7 patients (EG = 3, KG = 4) received also Selective Serotonin re-uptake inhibitors (SSRIs). Y-BOCS, BDI, and STAI-X1 were performed pre- and post-treatment. Furthermore therapists' ratings and self ratings were taken. Results: At post-treatment both groups showed significant improvement of the symptomatology. For the EG the Y-BOCS mean was reduced from 23.64 to 11.35, for the KG from 23.81 to 12.81. The group comparison showed no significant differences (alpha = 0.05) in clinical measurements, therapists' and self ratings. However, there were significantly more responders (improvement >50%, Y-BOCS) in the EG and treatment duration was shorter by 15 days. Conclusions: Clinical outcome in the EG was not superior. However, the specific group therapy for OCD contributes to an economic and effective treatment.