Monday, April 14, 2014

FDA: Use Sicker Patients in Clinical Trials

By  David Pittman , Washington Correspondent, MedPage Today


WASHINGTON -- The FDA is taking steps to include more patients with multiple chronic conditions in clinical trials of new drugs, believing such patients are too frequently excluded from new drug studies.
Pharmaceutical companies routinely exclude the sickest patients from studies, fearing complications they may suffer from the drug candidates, but, as a result, the studies don't provide a glimpse of the treatment's "real world" effect.
To counter this, the FDA recently issued a memo to its new drug reviewers asking them to work with drug manufacturers to include a broader population in trials more regularly.
"The whole point of this is that if there really are differences in response -- either favorable or unfavorable -- among subsets of the population, what clinicians need is to know about it, so they can either watch for them or use a different drug," Bob Temple, MD, deputy director for clinical science at the FDA's Center for Drug Evaluation and Research, told reporters Friday. "This adds to the information available."
The internal memo, which effectively changes FDA policy, will force those conducting trials to focus more on their inclusion criteria and avoid unnecessary exclusions.

Sunday, April 13, 2014

Adhesion Incidence and Severity Vary by Surgical Procedure

By Jeannette Wick |
 MExperts estimate approximately 93% of patients who have undergone laparoscopic surgery develop abnormal fibroid bands that bind organ surfaces to the abdominal wall after a second surgery. Many adhesions are asymptomatic, but in some patients, they can cause pain, small bowel obstruction and other postoperative issues, as well as increase cost and complicate surgical suite workload. As surgeons underestimate the rate of adhesion development given that up to 93% of consent forms don’t address them, the March 2014 issue of Surgery Today contained a systematic review estimating the formation rate, distribution, and severity of postoperative adhesions in abdominal surgery patient.
Full article  http://www.hcplive.com/publications/surgical-rounds/2014/March-2014/Adhesion-Incidence-and-Severity-Vary-by-Surgical-Procedure

Friday, April 11, 2014

Benefits and harms of adhesion barriers for abdominal surgery: a systematic review and meta-analysis

Richard P G ten Broek MD a Corresponding AuthorEmail Address, Martijn W J Stommel MD a, Chema Strik MD a, Prof Cornelis J H M van Laarhoven MD a,Fred
erik Keus MD b, Prof Harry van Goor FRCS a

Summary

Background

Formation of adhesions after peritoneal surgery results in high morbidity. Barriers to prevent adhesion are seldom applied, despite their ability to reduce the severity of adhesion formation. We evaluated the benefits and harms of four adhesion barriers that have been approved for clinical use.

Methods

In this systematic review and meta-analysis, we searched PubMed, CENTRAL, and Embase for randomised clinical trials assessing use of oxidised regenerated cellulose, hyaluronate carboxymethylcellulose, icodextrin, or polyethylene glycol in abdominal surgery. Two researchers independently identified reports and extracted data. We compared use of a barrier with no barrier for nine predefined outcomes, graded for clinical relevance. The primary outcome was reoperation for adhesive small bowel obstruction. We assessed systematic error, random error, and design error with the error matrix approach. This study is registered with PROSPERO, number CRD42012003321.

Findings

Our search returned 1840 results, from which 28 trials (5191 patients) were included in our meta-analysis. The risks of systematic and random errors were low. No trials reported data for the effect of oxidised regenerated cellulose or polyethylene glycol on reoperations for adhesive small bowel obstruction. Oxidised regenerated cellulose reduced the incidence of adhesions (relative risk [RR] 0·51, 95% CI 0·31—0·86). Some evidence suggests that hyaluronate carboxymethylcellulose reduces the incidence of reoperations for adhesive small bowel obstruction (RR 0·49, 95% CI 0·28—0·88). For icodextrin, reoperation for adhesive small bowel obstruction did not differ significantly between groups (RR 0·33, 95% CI 0·03—3·11). No barriers were associated with an increase in serious adverse events.

Interpretation

Oxidised regenerated cellulose and hyaluronate carboxymethylcellulose can safely reduce clinically relevant consequences of adhesions.

Funding

None.

Factors in Adhesions Reformation

Boston Doc's first to use Google glasses

BOSTON (CBS) — Doctors at Beth Israel Deaconess Medical Center are the first in the country to be using Google Glass technology to save valuable seconds.
Google introduced the Glass technology in 2013 and only a limited number of people have been able to try it. Beth Israel Deaconess is the first hospital in the world to use the high-tech classes for direct patient care.
Dr. Steven Horng is an emergency room physician who spearheaded a program to bring the technology to the ER.
What they do is project an image of the patient’s screens so information about the patient is obtained right away. Information like the patient’s name, their past medical history, even X-rays can all come up with Google Glass and could be life-saving, especially if a patient can’t communicate or doesn’t know their allergies and medications.