20 Mar 11
Posted in Healthcare management at 12:47 by Laci
By L Quam, R Smith
BMJ 2005; 330 : 530
The NHS and US insurance based health systems seem worlds apart. Despite the differences, each has much to learn from examples of good practice in the other
Learning within clinical medicine often spreads rapidly across the globe. Once an innovation—for example, thrombolysis for patients with heart attacks—is accepted, it is likely to be picked up rapidly in most countries. This is because cardiologists travel to world meetings, know each other well, read the same international journals, and are encouraged to innovate by global pharmaceutical companies. In stark contrast, innovations in how care is organised and delivered have rarely spread. We examine why countries have not been good at learning from each other and some of the areas where learning between the United Kingdom and United States could be beneficial.
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05 Mar 11
Posted in Fluid management at 17:42 by Laci
By A Groeneveld, R Navickis, M Wilkes
Ann Surg 2011;253:470-483
To provide an updated systematic review on the comparative safety of colloids based on recent clinical studies.
Background: Recent investigations, including large-scale randomized trials and meta-analyses, have sought to determine the effects of colloids on mortality and morbidity. Hypothesized differences in safety profile between hydroxyethyl starch (HES) solutions have also been evaluated in randomized trials.
Methods
Clinical studies reported since 2002 with safety data for acutely ill patients receiving HES, gelatin, dextran, or albumin were sought by computer searches and other methods. Safety endpoints included mortality, morbidity, bleeding and impaired coagulation, and acute kidney injury (AKI). Data extracted from the included study reports were qualitatively summarized.
Results
Sixty-nine clinical studies were included. Of those, 42 were randomized controlled trials (RCTs) with 10,382 total patients. New safety data, since 2002, predominantly concerned albumin or HES. A large RCT of intensive care unit patients showed that albumin does not adversely affect survival. Acute kidney injury and a dose-dependent increase in mortality were observed in a large RCT of patients with severe sepsis or septic shock receiving HES. Impaired coagulation and clinical bleeding were frequently reported after HES infusion, especially in cardiac surgery. In head-to-head randomized comparisons of different HES solutions, observed effects on coagulation and renal function were similar. Gelatin showed less impairment of coagulation than HES. Very few safety data related to dextran were identified.
Conclusions
Albumin displayed a more favorable safety profile than HES. Available evidence does not support the existence of consistent safety differences between HES solutions.
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