Intravenous iron administration before cardiac surgery reduces red blood cell transfusion in patients without anaemia
Friedman T et al. British Journal of Anaesthesia (December 2023)
Bottom line: This double-blind, randomised, placebo-controlled trial included 200 patients without anaemia who underwent on-pump cardiac surgery. Patients were administered either a single dose of 1000 mg ferric carboxymaltose intravenously 1-3 days before surgery (n = 102) or placebo (n = 98). The primary outcome was the number of red cell units transfused during the first four postoperative days, and the secondary outcome measures were blood haemoglobin concentrations at 4 days and 6 weeks after surgery. Results showed that the ferric carboxymaltose group had a significantly lower mean number of red cell units transfused than the placebo group (0.3 vs 1.6; P=0.007) and higher mean haemoglobin concentrations on postoperative day 4 and 6 weeks after surgery (P=0.03 and P=0.012, respectively). The study concluded that treatment with ferric carboxymaltose significantly reduced the need for red cell transfusions and increased the postoperative haemoglobin concentration.
LINK TO ARTICLE (Friedman et al.)
Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity (SURMOUNT-4)
Aronne L et al. JAMA (December 2023)
Bottom Line: This is a phase 3, randomized withdrawal clinical trial with a 36-week open-label lead-in period followed by a 52-week double-blind, placebo-controlled period to assess the effect of continued treatment with tirzepatide on maintenance of initial weight reduction. The study included 670 participants with obesity or overweight and a weight-related complication, excluding diabetes. Participants were initially treated with once-weekly subcutaneous tirzepatide at a maximum tolerated dose (10 or 15 mg) for 36 weeks, then randomized to continue treatment (n = 335) or switch to placebo (n = 335) for 52 weeks. The primary outcome was the mean percent change in weight from week 36 to week 88, with a significant difference of -19.4% between the tirzepatide and placebo groups ([95% CI, −21.2% to −17.7%]; P < .001). The secondary end points included the proportion of participants at week 88 who maintained at least 80% of the weight loss during the lead-in period. 89.5% of participants receiving tirzepatide at 88 weeks maintained at least 80% of weight loss during the lead-in period compared to 16.6% receiving placebo (P < .001). The most common adverse events were mild to moderate gastrointestinal events. The study concluded that continued treatment with tirzepatide maintained and augmented initial weight reduction in participants with obesity or overweight.
LINK TO ARTICLE (Aronne et al.)
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Effect of chair placement on physicians’ behavior and patients’ satisfaction: randomized deception trial
Iyer R et al. BMJ (December 2023)
Bottom Line: This single center, double blind, randomized controlled deception trial was conducted at a county hospital in Texas, USA. The study included 51 hospitalist physicians and 125 patient encounters. Each patient encounter was randomized to either chair placement (≤3 feet [0.9 m] of patient’s bedside and facing the bed) or control (chair inside a cabinet in the patient’s room). The primary outcome was the binary decision of the physician to sit or not sit during a patient encounter. Results showed that chair placement significantly increased the likelihood of physicians sitting during a patient encounter compared to usual chair location 38 of the 60 physicians in the chair placement group sat during the patient encounter compared with five of the 65 physicians in the control group (odds ratio 20.7, 95% confidence interval 7.2 to 59.4; P<0.001). The intervention also resulted in higher patient satisfaction scores and improved communication. No safety concerns were associated with chair placement. This study highlights the effectiveness of a simple, no cost, low tech intervention in improving physician behavior and patient satisfaction.
