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What effect does total knee replacement have on quality of life and what are the differences in lifetime economic outcomes if use of total knee replacement depends on level of symptoms?

This study from the US investigates the relationship between the quality of life improvement after total knee replacement and the cost effectiveness of this procedure.

The conclusions reached were that the current practice of total knee replacement had small health effects at the group level and was found to be economically unattractive. If surgery were restricted to more severely affected patients, total knee replacement could be considered cost effective.

BMJ 2017; 356:j1131

Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults

Delirium is a common and serious postoperative complication. Subanaesthetic ketamine is often administered intraoperatively for postoperative analgesia, and some evidence suggests that ketamine prevents delirium.

This international trial was designed to elucidate this issue: 672 patients older than 60 years who were to have major cardiac or non-cardiac surgery were included. After anaesthetic induction and before surgical incision, one-third were given placebo (normal saline), another third were given low-dose ketamine and the other third high-dose ketamine.

The researchers report that a single subanaesthetic dose of ketamine did not decrease delirium in older adults after major surgery, and might cause harm by inducing negative experiences. The latter included postoperative hallucinations and nightmares.

Lancet 2017; 390:267–75

Follow-up of prostatectomy versus observation for early prostate cancer

This research group has previously reported that there were no significant differences in mortality between men who underwent surgery for localised prostate cancer and those who were treated with observation only. Uncertainty persists regarding non-fatal health outcomes and long-term mortality.

The study began in 1994 and involved 731 men with localised prostate cancer who were randomised to be treated by radical prostatectomy or observation.

After 19.5 years of follow-up (median 12.7 years), the researchers concluded that surgery was not associated with significantly lower all-cause or prostate cancer mortality than observation. Surgery was associated with a higher frequency of adverse events than observation but a lower frequency of treatment for disease progression, mostly for asymptomatic, local or biochemical progression.

N Engl J Med 2017; 377:132–42

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Contact diana@nzma.org.nz
for the PDF of this article

View Article PDF

What effect does total knee replacement have on quality of life and what are the differences in lifetime economic outcomes if use of total knee replacement depends on level of symptoms?

This study from the US investigates the relationship between the quality of life improvement after total knee replacement and the cost effectiveness of this procedure.

The conclusions reached were that the current practice of total knee replacement had small health effects at the group level and was found to be economically unattractive. If surgery were restricted to more severely affected patients, total knee replacement could be considered cost effective.

BMJ 2017; 356:j1131

Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults

Delirium is a common and serious postoperative complication. Subanaesthetic ketamine is often administered intraoperatively for postoperative analgesia, and some evidence suggests that ketamine prevents delirium.

This international trial was designed to elucidate this issue: 672 patients older than 60 years who were to have major cardiac or non-cardiac surgery were included. After anaesthetic induction and before surgical incision, one-third were given placebo (normal saline), another third were given low-dose ketamine and the other third high-dose ketamine.

The researchers report that a single subanaesthetic dose of ketamine did not decrease delirium in older adults after major surgery, and might cause harm by inducing negative experiences. The latter included postoperative hallucinations and nightmares.

Lancet 2017; 390:267–75

Follow-up of prostatectomy versus observation for early prostate cancer

This research group has previously reported that there were no significant differences in mortality between men who underwent surgery for localised prostate cancer and those who were treated with observation only. Uncertainty persists regarding non-fatal health outcomes and long-term mortality.

The study began in 1994 and involved 731 men with localised prostate cancer who were randomised to be treated by radical prostatectomy or observation.

After 19.5 years of follow-up (median 12.7 years), the researchers concluded that surgery was not associated with significantly lower all-cause or prostate cancer mortality than observation. Surgery was associated with a higher frequency of adverse events than observation but a lower frequency of treatment for disease progression, mostly for asymptomatic, local or biochemical progression.

N Engl J Med 2017; 377:132–42

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Contact diana@nzma.org.nz
for the PDF of this article

View Article PDF

What effect does total knee replacement have on quality of life and what are the differences in lifetime economic outcomes if use of total knee replacement depends on level of symptoms?

This study from the US investigates the relationship between the quality of life improvement after total knee replacement and the cost effectiveness of this procedure.

The conclusions reached were that the current practice of total knee replacement had small health effects at the group level and was found to be economically unattractive. If surgery were restricted to more severely affected patients, total knee replacement could be considered cost effective.

BMJ 2017; 356:j1131

Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults

Delirium is a common and serious postoperative complication. Subanaesthetic ketamine is often administered intraoperatively for postoperative analgesia, and some evidence suggests that ketamine prevents delirium.

This international trial was designed to elucidate this issue: 672 patients older than 60 years who were to have major cardiac or non-cardiac surgery were included. After anaesthetic induction and before surgical incision, one-third were given placebo (normal saline), another third were given low-dose ketamine and the other third high-dose ketamine.

The researchers report that a single subanaesthetic dose of ketamine did not decrease delirium in older adults after major surgery, and might cause harm by inducing negative experiences. The latter included postoperative hallucinations and nightmares.

Lancet 2017; 390:267–75

Follow-up of prostatectomy versus observation for early prostate cancer

This research group has previously reported that there were no significant differences in mortality between men who underwent surgery for localised prostate cancer and those who were treated with observation only. Uncertainty persists regarding non-fatal health outcomes and long-term mortality.

The study began in 1994 and involved 731 men with localised prostate cancer who were randomised to be treated by radical prostatectomy or observation.

After 19.5 years of follow-up (median 12.7 years), the researchers concluded that surgery was not associated with significantly lower all-cause or prostate cancer mortality than observation. Surgery was associated with a higher frequency of adverse events than observation but a lower frequency of treatment for disease progression, mostly for asymptomatic, local or biochemical progression.

N Engl J Med 2017; 377:132–42

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Contact diana@nzma.org.nz
for the PDF of this article

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