ABSTRACT
The optimal on-demand treatment of joint bleeds in haemophilia patients with inhibitors is a source of debate, with studies reporting various efficacy levels for different drugs and dosage regimens. To analyse, in a unified Bayesian meta-regression model, the published efficacy of recombinant activated factor VII (rFVIIa) and/or activated prothrombin complex concentrate (aPCC) as on-demand treatments for joint bleeds in haemophilia patients with inhibitors. A systematic search was carried out to identify studies reporting on dosage and efficacy of rFVIIa and aPCC in the treatment of joint bleeds in the target patient population. Data were abstracted and included in the model and adjusted for potential sources of heterogeneity. Pooled efficacy levels for typical rFVIIa and aPCC regimens were estimated. Seventeen studies, collectively reporting on >2000 joint bleeds, were included. Medication type combined with dosage was the only significant explanatory parameter. The model predicts that a typical regimen of 90 microg kg(-1) rFVII repeated every 3 h if needed results in cumulative joint bleed resolution of 66%, 88% and 95% after 12, 24 and 36 h, respectively. In comparison, a typical regimen of 75 IU kg(-1) aPCC repeated every 12 h if needed results in cumulative joint bleed resolution of 39%, 62% and 76%, respectively. These differences were statistically significant and were also robust in sensitivity analyses. This analysis suggests that a typical rFVIIa regimen will resolve joint bleeds more effectively than a typical aPCC regimen after 12, 24 and 36 h.
Subject(s)
Blood Coagulation Factor Inhibitors/therapeutic use , Blood Coagulation Factors/therapeutic use , Factor VIIa/therapeutic use , Hemophilia A/drug therapy , Hemophilia B/drug therapy , Hemorrhage/prevention & control , Bayes Theorem , Blood Coagulation Factor Inhibitors/adverse effects , Blood Coagulation Factors/adverse effects , Factor VIIa/adverse effects , Hemophilia A/complications , Hemophilia B/complications , Hemorrhage/drug therapy , Humans , Models, TheoreticalSubject(s)
Bird Diseases/epidemiology , Culicidae/virology , Insect Vectors/virology , West Nile Fever/veterinary , West Nile virus/isolation & purification , Animals , Bird Diseases/transmission , Birds , Climate , Female , Humans , Male , Risk Assessment , Sentinel Surveillance/veterinary , United Kingdom/epidemiology , West Nile Fever/epidemiology , West Nile Fever/transmission , ZoonosesSubject(s)
Analgesia , Anesthesia , Community Health Nursing , Labor, Obstetric , Midwifery , Cohort Studies , Female , Humans , Nurse-Patient Relations , Pregnancy , Retrospective StudiesABSTRACT
A retrospective cohort study based on obstetric records was performed, to compare the use of analgesia/anaesthesia during labour by consultants and general practitioners. The episiotomy rates for the two groups were also compared. 111 general practitioner patients were identified and these were matched with 111 consultant patients. No difference was found between the two groups for duration of stages I or II. The rates for episiotomy, 1 degree or 2 degrees tear or intact perineum were the same in each group. Women delivered under consultant supervision used more entonox than women delivered under general practitioner care, but this was counterbalanced by an increased use of pethidine in the latter group. No difference was found between the two groups with regard to the use of epidurals. There was an increased use of local anaesthetic by general practitioners. This was due to general practitioners preferring to use local anaesthetic for suturing after an epidural had worn off, whereas hospital doctors preferred to top-up the epidural to provide anaesthesia for suturing. This study supports the view that women delivered under the care of their own general practitioner in a hospital obstetric unit fare no worse than similar women delivered under consultant supervision. The former group have the advantage of continuity of care from their general practitioner.
