Clinical incidents reduction

EUingson K, et al Sustained reduction in the clinical incidence of methicillin-resistant Staphylococcus aureus colonization or infection associated with a multifaceted infection control intervention. Infect Control Hosp Epidemiol 2011 32 1-8. 

As a result of these findings, a scheduled standard pelvic exploration is now an obligatory procedure in clinical trials with new SERMs. It is important to note that this adverse effect has not been associated with tamoxifen or toremifene therapy (Maenpaa et al. 1997 Fisher et al. 1998), and in the case of raloxifene, a post hoc metaanalysis of 6926 nonhysterectomized postmenopausal women participating in clinical trials for 3 years or more showed a significant 50% reduction in the incidence of surgery for repairing pelvic floor relaxation, reported as an adverse event, compared with placebo (Goldstein et al. 2001). 

Selective COX-2 inhibitors have also been shown to prevent early and late forms of colorectal neoplasia in rat models. Reddy et al. showed that administration of celecoxib inhibited aberrant colonic crypt foci (ACF) induction and multiplicity by about 40-49% in an azoxymethane-induced ACF rat model (81). Later the same investigators also showed that dietary administration of celecoxib can inhibit both the incidence and multiplicity of colon tumors by about 93 % and 97 %, respectively in the same rat model (82). Other researchers reported similar results with the Min mouse model (52). There is little data on human clinical trials with selective COX-2 inhibitors for colorectal tumor prevention. Recently Steinbach et al. conducted a double-blind, placebo-controlled study with 77 patients with FAP, and reported that treatment with celecoxib, a selective COX-2 inhibitor, for 6 mo led to a significant reduction (28%) in the number of colorectal polyps in these patients (50). Collectively, COX-2 nonspecific or specific NSAIDs appear to have chemopreventive activity against colorectal cancer development. Selective... 

Lipid Research Clinics Program. 1984. The lipid research clinics coronary primary prevention trial results. I. Reduction in incidence of coronary heart disease. JAMA 251, 351-364. 

No respiratory effects were associated with exposure to 2,3,7,8-TCDD-contaminated herbicides in a group of Vietnam Air Force veterans involved in Operation Ranch Hand examined more than 10 years after the war (Wolfe et al. 1985). In the 1987 follow-up (USAF 1991), no association was found between the initial or current serum level of 2,3,7,8-TCDD and incidences of asthma, bronchitis, pleurisy, pneumonia, or tuberculosis abnormal spirometric measurements were often associated with CDD blood levels, but according to the authors (USAF 1991), the differences in the mean level between high- and low-exposure subjects were not clinically important. The authors suggested that these findings may have been related to the association between 2,3,7,8-TCDD and body fat because obesity is known to cause a reduction in vital capacity. 

Hence in pooled analysis of the randomized clinical trial experience in PCI, including I 1,638 patients (bivalirudin, 5861 heparin, 5777), bivalirudin was associated with a reduction in the incidence of death, Ml, revascularization, and major bleeding (7.8% vs. 10.8%, P< 0.001) at 48 hours (32). Despite a very low event rate, a benefit in terms of mortality was observed (0.01% vs. 0.02%, P = 0.049), whereas reductions for major bleeding were substantial (2.7% vs. 5.8%, P < 0.001). Furthermore, given the lower overall costs of this agent and savings associated with reduced bleeding, the use of bivalirudin remains economically attractive (33). 

---