Factors influencing postoperative morbidity and mortality in patients treated with bleomycin.

Patients treated with bleomycin are at risk of developing the acute adult respiratory distress syndrome post-operatively. In a prospective study of 12 patients who had received bleomycin preoperatively and were undergoing removal of retroperitoneal lymph nodes or pulmonary metastases several preventive factors were established. These were the use of low concentrations of inspired oxygen during operation and in the immediate postoperative period, careful monitoring of fluid replacement, and restriction of crystalloids in favour of colloids.     

Perinatal mortality and one-year infant morbidity.

Perinatal mortality in Southampton and South-west Hampshire Health District fell from 20.8 per 1000 total births in 1970 to 11.3 per 1000 in 1976. This was atributable mainly to a fall in the stillbirth rate, but also to a recent fall in the neonatal death rate in the first week. All infants born in 1975 who had any problems in the perinatal period were followed up for one year. Of the 12 children identified at one year as having a major handicap, eight suffered from problems of prenatal origin, two from problems associated with preterm delivery, and two from other conditions acquired during the perinatal period. As two-thirds of the major handicaps arose from congenital abnormalities, preterm delivery and low birth weight were not the main causes of major handicap.     

Continuing mortality and morbidity from smallpox vaccination.

Three cases of cross-infection after smallpox vaccination are described, in two of which the outcome was fatal. Probably all occurred because simple precautions were not observed at the time of vaccination--for example, exclusion of contraindications and warnings about risks. If those countries still requiring evidence of vaccination for entry were to abolish this rule, however, the risk of cross-infection could be eliminated. Vaccinating a person with contraindications is justified only when exposure to smallpox has occurred.     

稳定期慢性阻塞性肺疾病医药共管专家共识

研究适合中国当前药物治疗门诊发展的基本策略,为三级医院开展药物治疗门诊提供参考。

应用SWOT分析法分析在医保支付方式改革背景下福建医科大学附属协和医院药物治疗门诊开展慢性气道疾病管理具有的优势、劣势以及所面临的机会与威胁。

笔者所在医院药物治疗门诊开展慢性气道疾病管理具有如下优势：药物治疗门诊基础扎实;医生对药学服务需求以及认可度不断增加;有独立诊室,工作日全天开诊。存在以下劣势：患者对药师的认可度及知晓率不高,对收费需要有接受过程;部分医生不知晓药物治疗门诊的存在及服务范畴;药师临床知识储备与临床实践有差距。外部环境所提供的机会：国家政策驱动发展;部分省市地方医疗保障局支持;临床以及患者对药学服务的需求不断增加;提升患者医疗服务满意度。面临如下威胁：制度及体系不完善;处方权限制;人力成本高。

药物治疗门诊药师要充分利用优势和机会,克服劣势和威胁,全面提高药物治疗门诊的服务质量。

     

Long-term morbidity and mortality trials with amlodipine

Prospective controlled clinical trials with cardiovascular events and mortality as end points are needed to provide clinicians with a fully informed choice of optimal hypertensive therapy. Seven trials (six of them still ongoing) have provided insight into the effects of the third-generation calcium antagonist, amlodipine, on mortality and end-organ damage in patients with hypertension or other forms of cardiovascular disease. The completed PRAISE study has addressed the safety of amlodipine in patients with advanced heart failure (CHF). The trial showed that amlodipine does not increase mortality or morbidity in CHF patients and significantly reduces the risk for these end points in patients whose CHF has a nonischemic etiology. The PRAISE-2 study is now under way to further evaluate the benefits of amlodipine in nonischemic CHF patients. The ALLHAT trial compares the effects of standard diuretic treatment with three alternative treatments (amlodipine, lisinopril, and doxazosin) on the incidence of fatal coronary artery disease (CAD) and nonfatal myocardial infarction (MI) in 40,000 hypertensive patients. The ASCOT trial compares the effects of amlodipine +/- perindopril with atenolol +/- bendrofluazide on fatal CAD and nonfatal MI in 18,000 high-risk patients. The PREVENT trial tests a similar hypothesis, looking at the effects of amlodipine on arterial atherosclerotic lesions, and the AASK trial is evaluating the effects of amlodipine on renal disease. The PRAISE trial has provided valuable information on the safety and efficacy of amlodipine in preventing death and disability in patients with CHF. The six ongoing trials will provide important additional information on the effect of amlodipine in patients with heart disease of other etiologies.     

Cardiovascular morbidity and mortality in peripheral arterial disease

The term peripheral arterial disease (PAD) is often used to describe atherosclerosis involving the arteries supplying the lower extremities. Potentially modifiable factors that predispose to the development and progression of both symptomatic and asymptomatic PAD include smoking, diabetes mellitus, hyperlipidemia, and hypertension. Since the same risk factors for PAD predispose to the development of systemic atherosclerosis, identification of PAD increases the likelihood of coexistent coronary heart and cerebrovascular disease. Even after adjustment for risk factors, PAD appears to increase the risk for ischemic manifestations involving these other vascular territories with about a 2-fold increase in myocardial infarction and perhaps stroke. The most dramatic consequence of PAD is impaired survival with a 2- to 3-fold increased risk of 5- to 10-year mortality. While the adverse cardiovascular and cerebrovascular complications are highest for persons with more severe PAD, there is still a significant risk in persons with mild and even asymptomatic disease. The focus in the management of PAD should be on early diagnosis and efforts to reduce the risk of adverse events including risk factor modification and antiplatelet therapy.     

Adult hypertension: reducing cardiovascular morbidity and mortality

(1) Since our last review of treatments for arterial hypertension in 1999 (Prescrire International no.41), many new data have been published and new antihypertensive drugs have appeared on the market. (2) The working definition of hypertension is unchanged, namely blood pressure of at least 160/95 mm Hg in the general population, and at least 140/80 mm Hg in patients with diabetes and a history of stroke; these figures must be found on several occasions using a standardised method, with the patient at rest. (3) The goals of antihypertensive therapy are to reduce mortality and cardiovascular events, and not simply to drive blood pressure below a fixed (and often controversial) threshold. (4) Some drug and non drug interventions have a positive risk-benefit balance in the long term. (5) When antihypertensive drug therapy is needed, trials based on clinical endpoints show that it is best to start treatment with a single drug. (6) New data support the use of certain thiazide diuretics (chlortalidone, or hydrochlorothiazide if chlortalidone is not available) as first line treatment for most hypertensive patients, including non diabetic adults, diabetic adults, elderly subjects (over 65 years), and stroke patients. Some betablockers and angiotensin-converting-enzyme inhibitors (ACE inhibitor) are second-line alternatives. (7) Assessment of other antihypertensive drugs has also progressed since 1999, including indapamide (thiazide-like diuretic), amlodipine, diltiazem and verapamil (calcium channel blockers), lisinopril (ACE inhibitor), and losartan and valsartan (angiotensin II antagonists). However, these drugs are not as thoroughly evaluated as thiazide diuretics, betablockers and some ACE inhibitors.     

Telmisartan for the reduction of cardiovascular morbidity and mortality

Cardiovascular disease (CVD) poses a significant healthcare and economic burden on societies and individuals. Angiotensin II is a key component of the renin-angiotensin system that plays a central role in atherosclerotic mechanisms that contribute to CVD. Renin-angiotensin system blockers are widely used to reduce cardiovascular (CV) risk owing to their potential both to lower blood pressure, a CV risk factor, and to attenuate the atherosclerotic disease process directly. Telmisartan has a number of pharmacological properties that distinguish it from other angiotensin II receptor blockers (ARBs) - the longest plasma half-life, highest lipophilicity and strongest receptor binding affinity in class. The ONTARGET(?) trial showed that telmisartan is as effective as ramipril in reducing CV morbidity (including myocardial infarction and stroke) and mortality in a broad range of patients at increased CV risk. Evidence from other ARBs remains largely restricted to patients with heart failure, diabetic nephropathy or specific subsets of hypertensive patients. Telmisartan is, therefore, the only ARB with a broad indication for CV risk reduction in patients with atherothrombotic disease or diabetes with end-organ damage.     

Gastric acid, gastrin and pancreatic polypeptide responses to modified sham feeding in duodenal ulcer patients before and after highly selective or truncal vagotomy

Gastric acid secretion, as well as gastrin and pancreatic peptide release into the bloodstream before and after TV or HSV were observed in 28 patients following modified sham feeding (MSF) and pentagastrin tests. Prior to surgery the majority of patients showed stimulation of gastric acid secretion and hormone release into the bloodstream as the result of the employed tests. The MSF-induced acid output (SAO) and pentagastrin-induced acid output (PAOpg) values were mainly observed immediately following the stimulus. In the majority of patients MSF triggered an increase in blood gastrin and PP concentrations. Nevertheless, the peak concentration values for the two hormones occurred at different time intervals following the stimulus. For gastrin the peak values appeared later than SAO, whereas for PP they occurred either in the course of or immediately after MSF. Irrespectively of, the type of surgical procedure used and the completeness of vagotomy, the values of BAO, PAO, SAO and PAOpg were significantly lower following the procedure. Blood hormone concentration, however, showed greater variations. The test stimulated gastrin release showed the peak values were greater after, than prior to, the surgery, whereas PP release was markedly inhibited. No correlation was found between gastric acid secretion, blood serum gastrin and PP levels.     

Benzodiazepine drugs in Australia: associated mortality and morbidity

The use of benzodiazepine drugs in Australia results not only in widespread therapeutic benefits but also in harmful outcomes at both an individual and societal level. Accurate measurement of the level of harm has been precluded by a lack of robust data relating to the use of these drugs and to the resulting adverse consequences. This paper examines existing mortality and morbidity data, comments upon the available data sources and recommends areas where research is needed in order to clarify the relationship between the use of benzodiazepines and associated adverse effects.