Effectiveness of new oral anticoagulants (NOAC) in patients with cancer is not clearly defined. There remain concerns of doubtful benefit and chances of potential harm with newer agents. In this meta-analysis, we evaluated the efficacy and safety of NOAC in patients with cancer. PubMed, Cochrane Library, EMBASE, Web of Science, and CINAHL databases were searched from January 01, 2001 through February 28, 2013. Randomized controlled trials reporting efficacy and safety data of NOACs (rivaroxaban, dabigatran, and apixaban) with control (low-molecular-weight heparin/vitamin K antagonists/placebo) for patients with cancer were included. Primary efficacy outcome was venous thromboembolism (VTE) or VTE-related death, and primary safety outcome was clinically relevant bleeding. We used random-effects models. Six trials randomized 19,832 patients, and 1197 patients had cancer. Risk of VTE or VTE-related death was not significantly different with NOAC versus control [odds ratio (OR), 0.80; 95% confidence interval (CI), 0.39-1.65] in patients with cancer. Separate analysis for individual effects showed similar results for rivaroxaban (OR, 1.08; 95% CI, 0.60-1.94) and dabigatran (OR, 0.91; 95% CI, 0.21-3.91). Clinically relevant bleeding was not higher with NOAC compared with control (OR, 1.49; 95% CI, 0.82-2.71); individual effect of rivaroxaban showed similar results. No statistically significant difference of efficacy and safety with NOAC was found between patients with and without cancer. Rivaroxaban might be equally effective and safe as vitamin K antagonist in patients with cancer. Dabigatran is as effective as comparator; however, safety profile of dabigatran is unknown. Randomized trials of new anticoagulants specific to the cancer population are necessary, and NOAC also need to be evaluated against low-molecular-weight heparin.

ObjectiveAs a proactive diagnosis of diabetes mellitus (DM) may prevent the onset of severe complications, we used an oral glucose tolerance test (OGTT) to check for impaired glucose tolerance (IGT) and DM in patients with long-standing HIV infection and long durations of exposure to antiretroviral drugs with normal fasting plasma glucose (FPG) levels. MethodsThis was a cross-sectional, single-centre study. The homeostatic model assessment for insulin resistance (HOMA-IR) and 2-h post-load glucose levels were used to evaluate patients with known HIV-1 infection since before 1988 and no previous diagnosis of DM for whom data on hepatitis C virus (HCV) and hepatitis B virus (HBV) infection were available. ResultsEighty-four Caucasian patients [67 (80%) male; median age 45.7 years; range 43.8-49.1 years] were able to be evaluated; 65 (77%) were coinfected with HCV, and seven (8%) were coinfected with HBV. Median (interquartile range [IQR]) exposure to antiretrovirals was 12.8 (10.4-16.5) years. Fifteen patients (18%) had a previous AIDS-defining event, 64 (76%) had HIV RNAo50 copies/mL, and the median (IQR) CD4 count was 502 (327-628) cells/mL. The median [IQR] FPG was 81 mg/dL (4.5 mmol/ L) [75-87 mg/dL (4.2-4.8 mmol/L)], and the median (IQR) HOMA-IR was 2.82 (1.89-4.02). After OGTT, nine patients (11%) were diagnosed as having IGT (6) or DM (3). A first multivariable analysis showed that CD4 cell count (P 5 0.038) and HOMA-IR (P 5 0.035) were associated with IGT or DM, but a second model including only the variables with a P-value of o0.2 in the univariable analysis (CD4 cell count, HBV coinfection, and HOMA-IR) found that only HOMA-IR independently predicted IGT or DM. ConclusionsIn patients with long-standing HIV infection and normal FPG levels, an OGTT can reveal IGT or DM.Keywords: antiretroviral therapy, diabetes, HIV, insulin resistance, oral glucose tolerance test IntroductionDiabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycaemia resulting from defects in insulin secretion, insulin activity or both. The cause of type 1 diabetes is an absolute insulin deficiency, whereas that of type 2 diabetes is a combination of resistance to insulin activity and an inadequate compensatory insulin secretion response [1]. Hyperglycaemia, insulin resistance and DM have been associated with treatment with protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs) and nonnucleoside reverse transcriptase inhibitors (NNRTIs) in HIV-infected patients [2][3][4][5][6][7][8][9][10]. DOI: 10.1111DOI: 10. /j.1468DOI: 10. -1293DOI: 10. .2010 (2011), 12, 109-117 109 Antiretroviral drugs, such as some PIs [11,12] and some NRTIs [13,14], and uncontrolled HIV replication [15] both increase the risk of myocardial infarction. This leads to a higher risk of coronary artery disease in HIV-infected patients than in the age-matched general population [16,17], and more than double the risk of myocardial infarction in HIV-infected patients with DM [18]..x r 2010 British HIV Association HI...

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Introduction: The overuse of hospital resources is a pervasive issue. Out of the $3.5 trillion, the United States spent on health care in 2017, 30 % was considered excess cost in complications and ancillary orders. Even with established guidelines and revisions over the past few years, overzealous use of telemetry is rampant. Methods: The study included observation and admitted patients in September and October of 2018 and 2019. Patients in 2018 constituted baseline cohort (BC) and patients in 2019 were intervention cohort (IC). Both observation and inpatient admissions were analyzed separately. In August 2019, a series of presentations regarding AHA telemetry guidelines and group training for the use of telemetry monitor and software was undertaken. A template was used to document telemetry which consisted of reason for telemetry and day of telemetry in daily progress notes. Daily report of telemetry was shared on secured messaging group for residents. A comparison was made between the cohorts. Results: 516 patients were included in the study, 335 observation patients and 181 admitted patients. The number of patients on telemetry in combined IC (2019 patients) reduced by 31 % (34.32 % in observation group & 24.86 % in admission group). Taking an average of $ 272 per patient on telemetry (based on hospital billing data), the burden of cost reduced by $ 43,520 in the two months of 2019. “To rule out ACS” and “monitor for arrythmias” were the most common reason for telemetry use in observation and admitted inpatients in both cohorts. There was an increase of 14.59 % patients exceeding 48 hours on telemetry in inpatient admissions of IC. Telemetry triggers in notes (reasoning and justification) increased from 4.04 % to 37.08 %. All changes in IC occurred without any adverse outcome. The comparison is shown in Figure 1. Conclusions: Strict adherence to AHA guidelines improves the quality of care and is an effective means to reduce cost for hospitals without significant adverse events.