Differential impact of two risk communications on antipsychotic prescribing to people with dementia in Scotland: segmented regression time series analysis 2001-2011

The two risk communications were associated with reductions in antipsychotic use, in ways which were compatible with marked differences in their content and dissemination. Further research is needed to ensure that the content and dissemination of regulatory risk communications is optimal, and to track their impact on intended and unintended outcomes. Although rates are falling, antipsychotic prescribing in dementia in Scotland remains unacceptably hig

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Etiology of Mental Retardness

The causes of mental retardation can be various: internal and external factors, hereditary disorders, infectious diseases during pregnancy, birth injuries, metabolic disorders, disorders of genetic metabolism in cells, injuries and others

EXPERIENCE OF TREATMENT WITH ABATACEPT IN PATIENTS WITH JUVENILE RHEUMATOID ARTHRITIS

The article presents a case report of a patient with juvenile rheumatoid arthritis refractory to the treatment with metothrexate. Combined therapy with metothrexate and leflunomide induced development of unfavorable effects resulted in cancellation of leflunomide. Successful administration of biological agent inhibitor of T-lymphocytes co-stimulation abatacept is described. Treatment with abatacept resulted in remission of a disease; it increased patient and her family’s quality of life

EXPERIENCE OF TREATMENT WITH ABATACEPT IN PATIENTS WITH JUVENILE RHEUMATOID ARTHRITIS

The article presents a case report of a patient with juvenile rheumatoid arthritis refractory to the treatment with metothrexate. Combined therapy with metothrexate and leflunomide induced development of unfavorable effects resulted in cancellation of leflunomide. Successful administration of biological agent inhibitor of T-lymphocytes co-stimulation abatacept is described. Treatment with abatacept resulted in remission of a disease; it increased patient and her family’s quality of life.<br /

METHOTREXATE — «GOLD STANDARD» OF JUVENILE RHEUMATOID ARTHRITIS TREATMENT

The article presents the literature review of recent publications on efficacy and safety of methotrexate in treatment of juvenile rheumatoid arthritis. Administration of methotrexate 15 mg/m2 of body surface weekly results in significant decrease of inflammatory activity of rheumatoid process and in several cases in induction of clinical and laboratory remission of the disease. Maximal effect can be achieved via subcutaneous or intramuscular injection