The purpose of this study was to compare the cost of percutaneous coronary intervention(PCI) using bivalirudin with provisional platelet glycoprotein(GP) Ⅱb/Ⅲa inhibition with that of heparin +routine GP Ⅱb/Ⅲa inh...The purpose of this study was to compare the cost of percutaneous coronary intervention(PCI) using bivalirudin with provisional platelet glycoprotein(GP) Ⅱb/Ⅲa inhibition with that of heparin +routine GP Ⅱb/Ⅲa inhibition. Although GP Ⅱb/Ⅲa inhibition has been shown to reduce ischemic complications in a broad range of patients undergoingPCI, many patients currently do not receive such therapy because of concerns about bleeding complications or cost. Recently, bivalirudin with provisional GP Ⅱb/Ⅲa inhibition has been validated as an alternative to heparin+routine GP Ⅱb/Ⅲa inhibition for patients undergoing PCI. However, the cost-effectiveness of this novel strategy is unknown. In the Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events (REPLACE)-2 trial, 4,651 U.S. patients undergoing non-emergent PCI were randomized to receive bivalirudin with provisional GP Ⅱb/Ⅲa(n=2,319) versus heparin +routine GP Ⅱb/Ⅲa (n=2,332). Resource utilization data were collected prospectively through 30-day follow-up on all U.S.patients. Medical care costs were estimated using standard methods including bottom-upaccounting(for procedural costs), the Medicare fee schedule(for physician services), hospital billing data(for 2,821 of 4,862 admissions), and regression-based approaches for the remaining hospitalizations. Among the bivalirudin group, 7.7%required provisionalGP ⅡIb/Ⅲa. Thirty-day ischemic outcomes including death or myocardial infarction were similar for the bivalirudin and GP Ⅱb/Ⅲa groups, but bivalirudin resulted in lower rates of major bleeding (2.8%vs. 4.5%,p=0.002) and minor bleeding (15.1%vs. 28.1%, p < 0.001). Compared with routine GP Ⅱb/Ⅲa, in-hospital and 30-day costs were reduced by $405(95%confidence interval$37 to $773) and $374(95%CI $61 to $688) per patient with bivalirudin (p< 0.001 for both). Regression modeling demonstrated that, in addition to the costs of the anticoagulants themselves, hospital savings were due primarily to reductions in major bleeding(cost savings=$107/patient), minor bleeding($52/patient), and thrombocytopenia($47/patient). Compared with heparin+routine GP Ⅱb/Ⅲa inhibition, bivalirudin+provisional GP Ⅱb/Ⅲa inhibition resulted in similar acute ischemic events and cost savings of $375 to $400/patient depending on the analytic perspective.展开更多
OBJECTIVE:The purpose of this study was to determine whether acupuncture is effective in reducing pain and swelling around the knee and improving range of motion(ROM) during the post-acute phase of rehabilitation afte...OBJECTIVE:The purpose of this study was to determine whether acupuncture is effective in reducing pain and swelling around the knee and improving range of motion(ROM) during the post-acute phase of rehabilitation after total knee arthroplasty(TKA).METHODS:Following TKA,80 knees in 80 patients were randomly assigned to either an acupuncture treatment group(Group A) or a control group(Group C).In Group A,the complementary treatment of acupuncture was performed three times/week from postoperative day 7 until postoperative day 21.Outcome measures were:i) pain as assessed by a visual analog scale;ii) reduction of swelling around the knee as indicated by its circumference at the center of the patella;and iii) ROM of the affected knee.RESULTS:Group A patients had significantly reduced pain and swelling around the knees and earlier recovery of ROM than did those in Group C.CONCLUSION:Acupuncture provides effective treatment during the post-acute phase of rehabilitation after TKA with respect to pain relief,reduction of swelling around the knee,and early recovery of ROM.展开更多
The number of structural heart disease interventions has greatly increased in the past decade.Moreover,interest in the sex-specific outcomes of various cardiovascular conditions and procedures has increased.In this re...The number of structural heart disease interventions has greatly increased in the past decade.Moreover,interest in the sex-specific outcomes of various cardiovascular conditions and procedures has increased.In this review,we discuss the sex differences in the clinical profiles and outcomes of patients undergoing the most commonly performed structural procedures:transcatheter aortic valve replacement,transcatheter edge to edge repair of the mitral and tricuspid valve,transcatheter pulmonary valve replacement,patent foramen ovale closure and left atrial appendage occlusion.We shed light on potential reasons for these differences and emphasize the importance of increasing the representation of women in randomized clinical trials,to understand these differences and support the application of these cutting-edge technologies.展开更多
文摘The purpose of this study was to compare the cost of percutaneous coronary intervention(PCI) using bivalirudin with provisional platelet glycoprotein(GP) Ⅱb/Ⅲa inhibition with that of heparin +routine GP Ⅱb/Ⅲa inhibition. Although GP Ⅱb/Ⅲa inhibition has been shown to reduce ischemic complications in a broad range of patients undergoingPCI, many patients currently do not receive such therapy because of concerns about bleeding complications or cost. Recently, bivalirudin with provisional GP Ⅱb/Ⅲa inhibition has been validated as an alternative to heparin+routine GP Ⅱb/Ⅲa inhibition for patients undergoing PCI. However, the cost-effectiveness of this novel strategy is unknown. In the Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events (REPLACE)-2 trial, 4,651 U.S. patients undergoing non-emergent PCI were randomized to receive bivalirudin with provisional GP Ⅱb/Ⅲa(n=2,319) versus heparin +routine GP Ⅱb/Ⅲa (n=2,332). Resource utilization data were collected prospectively through 30-day follow-up on all U.S.patients. Medical care costs were estimated using standard methods including bottom-upaccounting(for procedural costs), the Medicare fee schedule(for physician services), hospital billing data(for 2,821 of 4,862 admissions), and regression-based approaches for the remaining hospitalizations. Among the bivalirudin group, 7.7%required provisionalGP ⅡIb/Ⅲa. Thirty-day ischemic outcomes including death or myocardial infarction were similar for the bivalirudin and GP Ⅱb/Ⅲa groups, but bivalirudin resulted in lower rates of major bleeding (2.8%vs. 4.5%,p=0.002) and minor bleeding (15.1%vs. 28.1%, p < 0.001). Compared with routine GP Ⅱb/Ⅲa, in-hospital and 30-day costs were reduced by $405(95%confidence interval$37 to $773) and $374(95%CI $61 to $688) per patient with bivalirudin (p< 0.001 for both). Regression modeling demonstrated that, in addition to the costs of the anticoagulants themselves, hospital savings were due primarily to reductions in major bleeding(cost savings=$107/patient), minor bleeding($52/patient), and thrombocytopenia($47/patient). Compared with heparin+routine GP Ⅱb/Ⅲa inhibition, bivalirudin+provisional GP Ⅱb/Ⅲa inhibition resulted in similar acute ischemic events and cost savings of $375 to $400/patient depending on the analytic perspective.
文摘OBJECTIVE:The purpose of this study was to determine whether acupuncture is effective in reducing pain and swelling around the knee and improving range of motion(ROM) during the post-acute phase of rehabilitation after total knee arthroplasty(TKA).METHODS:Following TKA,80 knees in 80 patients were randomly assigned to either an acupuncture treatment group(Group A) or a control group(Group C).In Group A,the complementary treatment of acupuncture was performed three times/week from postoperative day 7 until postoperative day 21.Outcome measures were:i) pain as assessed by a visual analog scale;ii) reduction of swelling around the knee as indicated by its circumference at the center of the patella;and iii) ROM of the affected knee.RESULTS:Group A patients had significantly reduced pain and swelling around the knees and earlier recovery of ROM than did those in Group C.CONCLUSION:Acupuncture provides effective treatment during the post-acute phase of rehabilitation after TKA with respect to pain relief,reduction of swelling around the knee,and early recovery of ROM.
文摘The number of structural heart disease interventions has greatly increased in the past decade.Moreover,interest in the sex-specific outcomes of various cardiovascular conditions and procedures has increased.In this review,we discuss the sex differences in the clinical profiles and outcomes of patients undergoing the most commonly performed structural procedures:transcatheter aortic valve replacement,transcatheter edge to edge repair of the mitral and tricuspid valve,transcatheter pulmonary valve replacement,patent foramen ovale closure and left atrial appendage occlusion.We shed light on potential reasons for these differences and emphasize the importance of increasing the representation of women in randomized clinical trials,to understand these differences and support the application of these cutting-edge technologies.
