case reports and signal detection studies showed that enoxaparin was suspected of liver injury after arthroplasty. The objective of this study was to compare enoxaparin and rivaroxaban in their safety (liver injury and bleeding) and efficacy (DVT, PE, and mortality) by performing a meta-analysis of randomized controlled trials that focused in patients after total knee or hip arthroplasty. Methods: A comprehensive search was performed using PubMed, Embase, and Cochrane to retrieve studies that compared enoxaparin and rivaroxaban after arthroplasty. Relative risk (RR) and 95% confidence intervals using Mantel-haenszel approach were reported. Beta-Binomial model was applied to perform sensitivity analysis. The primary endpoints are liver injury and bleeding and the secondary endpoints are incidences of DVT, PE, and mortality. Results: Ten studies were included in the meta-analysis. Compared to rivaroxaban, enoxaparin had a higher risk of liver injury [RR= 1.77; 95% CI: 1.29,2.44]. Use of enoxaparin resulted in a nearly two-fold risk for DVT compared to rivaroxaban and was statistically significant. The pooled estimate for proximal DVT, distal DVT and any DVT were [RR=3.04; 95% CI: 1.34,6.88], [RR=1.72; 95% CI: 1.29,2.29], [RR=2.09; 95% CI :1.48,2.97] respectively. However, there was no statistically significant difference in the rate of symptomatic and asymptomatic DVT, PE, mortality, and bleeding between the two drugs. Conclusions: Enoxaparin was associated with a higher risk for liver injury and rivaroxaban was associated with lower rates of distal DVT, proximal DVT, and any DVT. However, no difference was observed in the risk of bleeding, PE, and mortality. Overall, enoxaparin is less effective and more risky compared to rivaroxaban for people undergoing total knee or hip arthroplasty.
two diagnostic tests resulted in fewer unnecessary revision TJA procedures per patient versus the Serum CRP test alone (TKA -0.056 two-stage revisions, 0.024 misdiagnosed one-stage revisions; THA -0.034 two-stage revisions, 0.011 misdiagnosed one-stage revisions). Conclusions: This novel Alpha Defensin detection test provides an accurate and rapid result to aid in PJI diagnosis and reduces the economic and clinical burden associated with unnecessary revision TJA procedures due to misdiagnosed PJI. This diagnostic test may offer demonstrable economic value to patients, healthcare providers and payers.
A485distribution automation systems. We used descriptive analysis to present trends in the utilization of automation in medication distribution systems in the US hospitals using the information derived from the ASHP surveys. Descriptive analysis was also used to describe the trends in the quantity and quality of the economic studies published in journal articles. We also assessed the correlation between the number of studies published in the economic literature about medication distribution automation technologies and the percentage of the hospitals reporting the use of each technology. Results: At the end of 1990, the majority of hospitals used unit dose dispensing with the assistance of computerized systems. In the 2000s, hospitals started to use decentralized distribution technologies and robotics for supporting medication dispensing activities. The implementation of new pharmacy technologies in the hospital was not preceded by the publication of peer-reviewed journal articles confirming the benefits and associated costs of the technologies. ConClusions: US hospitals have experienced important changes in their drug distribution systems that have affected the dispensing of drugs. There is a need for better evidence of the costs and benefits of new technologies used in hospital drug distribution systems that could be used to inform decisions about the implementation of those technologies.
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