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Results for “Randomized Response Technic”

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At least 91 records · Page 5Linked to original sources

PubMed2002

[Surgical morbidity for bronchial cancers after neoadjuvant treatment].

Two randomized trials, in 1994, have demonstrated the benefit of neoadjuvant chemotherapy, in term of median survival, for stage III lung cancer. Further studies have evaluated the potential benefit of chemotherapy or chemotherapy-radiotherapy association, either for patients suitable for surgery, or for non resectables tumors. However, these treatments treatments may increase the morbidity of surgery. Such an increase has not been demonstrated, except in one study, after chemotherapy alone before surgery. When radiation therapy is associated with pre-operative chemotherapy, the risk of complications seems to be dose dependent: low for doses below 50 Gy, important for doses over 55 Gy. These datas justify pre-operative lung function measurements and modifications of the surgical technic, especially for the lymphadenectomy extension. Despite this potential increase of morbidity, the benefit of neoadjuvant treatment is real.

Antineoplastic Agents↗

PubMed1989

Satisfaction of mothers by nursing care provided to their sick children in ambulatory health care centers.

The aim of the study was to measure satisfaction of mothers attending health units with their ambulatory children. A random sample of 150 mothers was included in the study from 3 ambulatory care units in Ismailia. The indirect method of measuring satisfaction was used through identification of mothers pre-visit expectations and measuring the post visit fulfillment by technical quality of nursing care. The percentage of expectation fulfillment reflected the degree of satisfaction. The mother's responses were validated by observers opinion to the same service provided. The results of the study revealed that respondent scores indicated a weak satisfaction with most of nursing care services such as taking temperature, weighing the child and carrying physicians orders. The results also revealed that aspects related to nurse's advice and guidance to mothers regarding child's condition, elicited high level of unsatisfaction.

Ambulatory Care↗

PubMed2000

A randomized controlled study of reviewer bias against an unconventional therapy.

A study was designed to test the hypothesis that experts who review papers for publication are prejudiced against an unconventional form of therapy. Two versions were produced (A and B) of a 'short report' that related to treatments of obesity, identical except for the nature of the intervention. Version A related to an orthodox treatment, version B to an unconventional treatment. 398 reviewers were randomized to receive one or the other version for peer review. The primary outcomes were the reviewers' rating of 'importance' on a scale of 1-5 and their verdict regarding rejection or acceptance of the paper. Reviewers were unaware that they were taking part in a study. The overall response rate was 41.7%, and 141 assessment forms were suitable for statistical evaluation. After dichotomization of the rating scale, a significant difference in favour of the orthodox version with an odds ratio of 3.01 (95% confidence interval, 1.03 to 8.25), was found. This observation mirrored that of the visual analogue scale for which the respective medians and interquartile ranges were 67% (51% to 78.5%) for version A and 57% (29.7% to 72.6%) for version B. Reviewers showed a wide range of responses to both versions of the paper, with a significant bias in favour of the orthodox version. Authors of technically good unconventional papers may therefore be at a disadvantage in the peer review process. Yet the effect is probably too small to preclude publication of their work in peer-reviewed orthodox journals.

Bias↗

PubMedDate not supplied

Failure of hysteroscopic insemination of the fallopian tube in synchronized cycles.

The study consisted of a randomized, controlled trial of synchronized hysteroscopic insemination of the fallopian tube (SHIFT), in which selected infertile couples underwent hormonal delay of menstruation, ovulation induction, and insemination of a selected motile sperm population into the tubal isthmus above the utero-tubal junction. Of 40 couples recruited, only 2 became pregnant, both during a nonsynchronized control cycle. No conceptions were reported in either the 72 SHIFT or 73 non-SHIFT synchronized cycles. Hysteroscopic insemination was found to be a relatively easy procedure with a low rate of technical failure. There was low morbidity with no major clinical complications. However, 57% of tracked synchronized cycles showed a failed response to the follicular stimulation protocol; and 91% showed failure of follicular rupture greater than or equal to 52 hours after hCG induction. These failures of the ovulation synchronization/induction regimen were probably due to the use of medroxyprogesterone acetate for cycle synchronization, and should not preclude further evaluation of the technique of hysteroscopic insemination.

Clinical Trials as Topic↗

PubMed2003

Management of hypertrophic cardiomyopathy in children.

Hypertrophic cardiomyopathy (HCM) is an inherited cardiac disease characterized by unexplained left ventricular hypertrophy, typically involving the interventricular septum. Hypertrophy may be present in infants, but commonly develops during childhood and adolescence. Management of children with HCM aims to provide symptomatic relief and prevention of sudden death, which is the primary cause of death. Unfortunately, no randomized comparative trials to date have assessed different treatment options in HCM. Medical treatment with negative inotropic agents (beta-adrenoceptor antagonists [beta-blockers], verapamil) is the first therapeutic choice in all symptomatic patients. Beta-blockers also appear to have prognostic merit in children. Surgical myectomy is effective in reducing symptoms in children with left ventricular (LV) obstruction who are unresponsive to medical treatment, although a repeat operation may be needed in a substantial proportion of patients due to relapse of LV obstruction. The recently introduced percutaneous septal ablation can also be regarded as a feasible alternative in this cohort. Technical limitations of both invasive therapeutic options should be carefully considered, preferably in experienced centers. Results of recent randomized trials indicate that dual chamber pacing, once considered a therapeutic option for patients with HCM, should only be used as treatment for conduction abnormalities. Regular clinical risk stratification for sudden death is of vital importance for the prevention of sudden death in young patients. Familial history of sudden death at a young age, LV hypertrophy >3 cm, unexplained syncope, nonsustained ventricular tachycardia in Holter monitoring, and abnormal blood pressure response during exercise are currently considered clinical risk factors for sudden death. Each factor has a low positive predictive accuracy, but patients having two or more of these risk factors are deemed as high risk. Secondary prevention of sudden death in patients successfully resuscitated from cardiac arrest and/or sustained ventricular tachycardia warrants treatment with an implantable cardioverter defibrillator (ICD). Primary prevention of sudden death in patients considered to be at high risk should aim at the management of obvious arrhythmogenic mechanisms (paroxysmal atrial fibrillation, sustained monomorphic ventricular tachycardia, conduction system disease, accessory pathway, myocardial ischemia), and the prevention and/or management of ventricular tachyarrhythmias with amiodarone and/or ICD implantation, respectively. The choice of treatment in children is greatly influenced by technical aspects, such as adverse effects of amiodarone, and ICD implantation difficulties or complications. Amiodarone could also be used as a bridge in children at high risk, until they reach adulthood, possibly achieving a lower risk status, or until their physical growth permits ICD implantation as long-term therapy.

Adrenergic beta-Antagonists↗

PubMed1997

Effects of family structure information on nurses' impression formation and verbal responses.

The purpose of this study was to investigate the effects of family structure information on how nurses (a) interpreted information, (b) gathered data, and (c) responded to a patient. Nurses were randomly assigned to see one of eight videotaped interviews portraying: married mother, married with no children, divorced mother, divorced with no children, unmarried mother, unmarried with no children, remarried with spouse's children (stepmother), and remarried with no children. The results indicate that the technical aspects of nursing may be affected only in a relatively minor way, but the affective dimensions of nursing care may be more detrimentally influenced by knowing about a patient's family structure.

Adult↗

PubMed2001

[Sensor-induced rate adaptation: sensor systems and tuning. Manual versus automatic tuning].

BACKGROUND: Rate adaptive stimulation represents an established therapeutic option in the management of cardiac rhythm disturbance. To realize a physiologic heart rate in patients with chronotopic incompetence several different sensor systems were developed. Due to the requirements of a physiologic pacemaker with all algorithms and therapeutic functions complex pacemaker systems were created. The realization of an automatic rate optimization was given by self adjusting algorithm or new sensor systems (closed loop systems). Comparing data respecting automatic vs manual sensor adjustment are not present. The automatic sensor adjustment was examined only in small patient groups. CONCLUSION: This studies indicated that most patients could be adjusted by the automatic function. Nevertheless, out of technical reasons a small group of patients could not be adjusted. The verification of the correct individual rate response in all patients treated with rate response pacemakers belongs to the physicians obligation.

Adult↗

PubMed1997

Patient satisfaction with pharmaceutical services at independent and chain pharmacies.

Patients' satisfaction with pharmaceutical services at independent community pharmacies and chain community pharmacies was studied. An interviewer administered the Pharmacy Encounter Survey (PES) face-to-face to 260 consecutive people immediately after their visits to randomly selected chain pharmacies (n = 10) or independent pharmacies (n = 16) in Philadelphia County, Pennsylvania. The 15-item PES gathers demographic data and asks respondents to rate their satisfaction with the time it took for prescriptions to be filled, the technical skills and courtesy of pharmacy personnel, the convenience of the pharmacy's location, and other aspects of the experience. An aggregate of responses across the two pharmacy types showed an excellent or very good rating given by most respondents for all items. Respondents were most satisfied with pharmacy location and least satisfied with time spent waiting for prescriptions to be filled. However, for each item rated, and for the overall visit, respondents rated independent pharmacies better than chain pharmacies. The PES was a practical, easy-to-administer tool for measuring satisfaction, an increasingly important dimension of quality in managed care organizations. People interviewed with the PES at independent and chain community pharmacies in Philadelphia County rated the pharmacies highly, with higher ratings being given to the independent pharmacies.

Community Pharmacy Services↗

PubMed1986

Consumer acceptance of prepaid and fee-for-service medical care: results from a randomized controlled trial.

Do consumers find the care provided by health maintenance organizations (HMOs) and that provided in the fee-for-service (FFS) system equally acceptable? To address this question, we randomly assigned 1,537 people ages 17 to 61 either to FFS insurance plans that allowed choice of physicians or to a well-established HMO. We also studied 486 people who had already selected the HMO (control group). Those who had chosen the HMO were as satisfied overall with medical care providers and services as their FFS counterparts. The typical person assigned to the HMO, however, was significantly less satisfied overall relative to FFS participants. Attitudes toward specific features of care favored both FFS and HMO, depending on the feature rated. Four differences (length of appointment waits, parking arrangements, availability of hospitals, and continuity of care) favored FFS; two (length of office waits, costs of care) favored the HMO. HMO versus FFS differences in ratings of access to care and availability of resources mirror differences in the organizational features of these two systems that are generally considered responsible for the significantly lower medical expenditures at HMOs. Regardless of their origin, less favorable attitudes toward interpersonal and technical quality of care in the HMO have marked consequences: dissatisfaction and disenrollment.

Adolescent↗

PubMed2000

The effects of uncontrolled hyperglycemia on thrombosis and formation of neointima after coronary stent placement in a novel diabetic porcine model of restenosis.

BACKGROUND: Results of recent clinical studies suggest that patients with diabetes mellitus have a higher than normal rate of restenosis after percutaneous transluminal coronary angioplasty or coronary stenting. The mechanism for this exaggerated neointimal response is not known. OBJECTIVES: To determine the technical feasibility of a model of in-stent restenosis in swine with streptozotocin-induced hyperglycemia and to compare the late arterial responses to injury induced by placement of oversized coronary stents in diabetic and nondiabetic animals. METHODS: Eighteen 25-40 kg castrated male or intact female Yucatan miniature swine aged 6 months were obtained from a commercial supplier. Twelve of the miniature swine were randomly selected for intravenous treatment with 125 mg/kg streptozotocin to induce a hyperglycemic state. Twelve weeks after treatment, all animals underwent placement of oversized balloon-expandable stainless steel stents in the coronary arteries. After 28 days, histomorphometric analysis of the stented coronary arteries to determine the neointimal responses for the diabetic and nondiabetic animals was completed. RESULTS: Sudden death due to stent thrombosis occurred for five of 11 (45%) of the diabetic animals and none of the age-matched nondiabetic control animals (P=0.05). For histology after 28 days, the neointimal response was correlated to the extent of arterial injury for the diabetic (r=0.79, P < 0.0001) and nondiabetic (r=0.86, P < 0.0001) animals. The surviving diabetic animals had areas of neointimal (1.67 +/- 0.74 mm2) and percentages of in-stent stenosis (28 +/- 14) similar to those of the nondiabetic swine (1.36 +/- 0.40 mm2, P=0.26; 22 +/- 6, P=0.17). Multiple regression analysis also demonstrated that arterial injury (P < 0.0001) alone, not hyperglycemia (P=0.237), was independently correlated to formation of neointima. CONCLUSIONS: Uncontrolled hyperglycemia results in greater than normal thrombosis after coronary-stent placement in swine with streptozotocin-induced diabetes. These data suggest that greater than normal early formation of thrombus rather than proliferation of smooth muscle cells contributes to restenosis after coronary stenting in patients with diabetes mellitus.

Angioplasty, Balloon, Coronary↗

PubMed2004

Update on sirolimus drug-eluting stents.

Percutaneous transluminal coronary angioplasty (PTCA) has become the main method of coronary revascularization. However, despite technical advancement, restenosis with incidence rate of 30 to 50% remains a major limitation to the long-term success of PTCA. The introduction of stents has significantly improved capability of interventional cardiology in treatment and prevention of restenosis. Recent experimental studies in animals, clinical studies in humans and multi-center randomized clinical trials with Sirolimus-eluting stents, have demonstrated a significant reduction in vasculoproliferative response with no intimal tissue growth. Moreover, no significant adverse clinical events have been reported at long-term follow-up and first studies that explored the potential of this technology for the treatment of in-stent restenosis demonstrated safety and efficacy. Although the first clinical experiences with drug-eluting stents have produced stunning results, there are a number of theoretical limitations to these devices, including: 1) limitations of drug loading capacity and 2) ability to control drug elution that could result in unfavorable pharmacokinetics. There are also questions about the durability of the polymer coatings (deformation under mechanical stress, gaps between metal and arterial wall, etc). The thickness of some coatings makes them unsuitable for very small vessels. Finally most biodegradable coatings are prone to chronic inflammation. Since only a polymer-coated bare metal stent remains following the drug's release, the potential for long term polymer biocompatibility problems remains a concern. The potential for some drugs to produce radiation-like effects such as "black holes", malapposed and naked struts and wall thinning are potentially the dark side of this technology and may contribute to late thrombosis, aneurysms or delayed restenosis. Long term clinical follow-up is necessary to assess the long term safety of this technology. There is a legitimate question as to whether drug-eluting stents will produce similar results across all patient subsets encountered in "real-life" interventional practice (e.g. long lesions, small diameter vessels, vein grafts, chronic total occlusions, bifurcated and ostial lesions). Cost-benefit issues also need to be addressed, especially because multivessel stenting and multistent usage is likely to increase.

Angioplasty, Balloon, Coronary↗

PubMed2001

The midlatency auditory evoked potentials predict responsiveness to verbal commands in patients emerging from anesthesia with xenon, isoflurane, and sevoflurane but not with nitrous oxide.

BACKGROUND: It has recently been demonstrated that the approximately 40-Hz spectral power of the midlatency auditory evoked potential (MLAEP) correlates well with wakefulness during desflurane or propofol anesthesia. The aim of this study was to characterize how other inhalational anesthetics affects the MLAEP as the patients regain responsiveness to simple verbal command during emergence from anesthesia. METHODS: Sixty patients were randomly assigned to receive xenon, isoflurane, sevoflurane, or nitrous oxide (N2O) supplemented with epidural anesthesia. During emergence, the concentration of an anesthetic was decreased in 0.1-minimum alveolar concentration (MAC) decrements from 0.8 MAC or from 70% in the case of N2O, and each new concentration was maintained for 15 min. Every 5 min during each equilibration period, the MLAEP was recorded and the patients were asked to open their eyes and squeeze and release the investigator's hand. This process was repeated until the first response to either of these commands was observed. RESULTS: Thirteen patients were excluded because of technical reasons. The preanesthetic MLAEP showed a periodic waveform, where the Na-Pa-Nb complex was the most prominent component contributing to the high energy around 29-39 Hz in the power spectrum. Emergence from xenon, isoflurane, and sevoflurane anesthesia produced similar changes in the MLAEP. The spectral power for the frequency 29 Hz or greater was severely suppressed at 0.8 MAC but significantly recovered between the concentration only 0.1 MAC higher that permitting the first response to command and that associated with the first response. In contrast, N2O hardly affected the MLAEPs, even at the concentrations producing unresponsiveness. Two patients did not lose responsiveness even at the highest concentration tested (70%). CONCLUSIONS: The MLAEP is closely associated with responsiveness to verbal command during emergence from anesthesia with xenon, isoflurane, and sevoflurane but not with N2O.

Adult↗

PubMed2000

Direct and correlated responses to selection for milk yield: results and conclusions of regional project NC-2, "improvement of dairy cattle through breeding, with emphasis on selection". NC-2 Technical Committee.

Measurement of direct and correlated responses to single-trait selection for milk yield was the major objective of regional project NC-2. The NC-2 Technical Committee included representatives from Alaska, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Nebraska, South Dakota, Wisconsin, and the USDA. All representatives, except Illinois, Kansas and Nebraska, maintained a selection line formed by using AI sires selected for high estimated transmitting abilities for milk and a second line that served as some type of a control. Stations varied in criteria for selection of bulls for control lines. Farms were managed similarly, including feeding and management of selection and control lines as one herd, random mating within line, and restricted culling policies. Selection for milk yield effectively increased milk production. All selection lines increased milk and net income per lactation more than control lines. Realized gains matched or exceeded gains expected from estimates of breeding values. Yields of milk components increased, but component percentages decreased appreciably for selection lines. Reproduction of nulliparous animals was not affected, but days open for lactating selection cows increased in some of the individual projects. Selected cows tended to have larger health costs, specifically for mammary treatment. Udder and conformation traits did not deteriorate for selection lines, although control lines with selection of sires on genetic evaluations for type received higher type scores. There should be few reservations about undesirable responses correlated with selection for milk yield.

Animal Feed↗

PubMed1998

Crossover studies are a better format for comparing equivalent treatments than parallel-group studies.

BACKGROUND: In controlled clinical trials the new treatment may be a slight modification of the standard or be equivalent to it with the addition of a new component. In this situation there is a positive correlation between the response to the new and the standard treatment. OBJECTIVE: The influence of the correlation between the treatment responses on the statistical sensitivity of testing was studied. Randomized trials of equivalent treatments in psychiatry and hypertension research were studied for their design in relation to their level of correlation. RESULTS: With equivalent treatments and, thus, a positive correlation a paired analysis provides better power than an unpaired one. CONCLUSIONS: Crossover studies are a better format than parallel-group studies for comparing equivalent treatments. The scientific community is technically largely unaware of the mechanisms by which correlation levels influence or lack to influence the statistical power of controlled clinical trials.

Adrenergic alpha-Antagonists↗

PubMed2002

The safety, plasma pharmacokinetics, and antiviral activity of subcutaneous enfuvirtide (T-20), a peptide inhibitor of gp41-mediated virus fusion, in HIV-infected adults.

Enfuvirtide (T-20) is a novel antiretroviral agent that blocks HIV-1 cell fusion. A 28-day randomized dose-comparison study was conducted to determine the safety, pharmacokinetics, and antiviral activity of enfuvirtide in 78 HIV-infected adults, most with extensive treatment experience. Patients received enfuvirtide, added to a failing regimen, either by continuous subcutaneous infusion (CSI: 12.5, 25, 50 or 100 mg/day) or by subcutaneous (SC) injection (50 or 100 mg twice daily). Dose-related decreases in viral load were observed, with a maximum mean reduction from baseline of 1.6 log(10) copies/ml (p< 0.001) seen in the 100 mg bid SC group. Most responses diminished by 28 days. Plasma pharmacokinetics and antiviral responses were more consistent for SC injection than for CSI because of technical difficulties experienced with CSI. Injection site reactions were common but generally mild. These results indicate that enfuvirtide is a promising new therapeutic agent for HIV-infected patients, including those with prior antiretroviral treatment.

Acquired Immunodeficiency Syndrome↗

PubMed1982

A randomized trial of cytoreductive surgery followed by chemotherapy versus chemotherapy alone in bulky stage testicular cancer with poor prognostic features.

Thirty-nine patients with Stage III nonseminomatous testicular cancer were treated in a prospective randomized trial comparing cytoreductive surgery followed by a cis-platinum containing combination chemotherapy regimen versus chemotherapy alone. All patients had one or more of the following poor prognostic signs: palpable retroperitoneal disease, liver involvement, invasion or obstruction of the inferior vena cava, or lung metastases larger than 2 cm in diameter. Cytoreductive surgery was technically feasible in this group of patients as assessed radiographically (70-90% reduction in tumor mass) and by the decline in serum levels of alpha-fetoprotein and human chorionic gonadotropin in 75% of the patients following surgery. However, there was no statistically significant improvement in overall response rate (75% versus 84%), complete response rate (50 versus 37%) or in survival between the patients treated with surgery prior to chemotherapy or with chemotherapy as the initial treatment. It is unlikely (P less than 0.028) that any true beneficial effect of surgery was missed due to the relatively small number of patients in each treatment arm. The authors of this study conclude that cytoreductive surgery prior to chemotherapy in patients with poor prognosis Stage III testicular carcinoma is not routinely indicated. Since the overall complete response rate to chemotherapy in these 39 patients with bulky Stage III disease was only 43%, alternate approaches, other than cytoreductive surgery, are necessary to improve the prognosis for this group of patients.

Antineoplastic Agents↗

PubMed2003

Nutritional evaluation of egg byproducts in diets for early-weaned pigs.

A total of 272 Cotswold pigs (17 +/- 1 d) were utilized in three experiments to evaluate the nutritive value of spray-dried egg proteins for early-weaned pigs. In all experiments, pigs were stratified by sex and initial BW and then assigned randomly to experimental diets. In Exp. 1, four corn-soybean meal-based diets containing 7% of either spray-dried porcine plasma (SDPP), spray-dried technical albumen (SDTA), SDTA stored at 70 degrees C for 3 d (SDTA-ht), or spray-dried whole egg (SDWE) were assigned to five pens each with four pigs for a 3-wk study period. Average daily gain, ADFI, and gain:feed ratio (G:F) were determined. At the end of wk 3, five pigs per treatment were killed to determine ileal AA and energy digestibilities, as well as Enterobacteriaceae counts. Compared with the SDPP diet, ADG and G:F were lower (P < 0.05) for SDTA-, SDTA-ht- and SDWE-containing diets. Apparent ileal digestibilities of cystine, histidine, isoleucine, methionine, and threonine in the SDPP diet were lower (P < 0.05) than in diets containing spray-dried egg products. Ileal digestible energy content did not differ (P > 0.05) in all diets (3.1 to 3.2 Mcal/kg). Enterobacteriaceae counts were lower in the SDTA-ht diet than in either the SDTA or SDWE diets (P < 0.05). In Exp. 2, the effect of substituting SDPP with varying levels of SDTA was investigated. Diets were randomly assigned to five pens (except for the 100% SDTA diet, which had four pens), each with four pigs. Average daily gain, ADFI, and G:F decreased linearly as the level of SDTA was increased in the diet (P < 0.05). Replacing SDPP with SDTA at 25 or 50% had no effect on pig performance (P > 0.10). In Exp. 3, phase I diets containing 0, 25, or 50% SDTA in place of SDPP (7% of the diet) were each assigned at random to eight pens each with four pigs for a 14-d period, after which all pigs were switched to a common phase II diet lacking both SDPP and SDTA for another 14 d. Average daily feed intake and ADG did not differ among all diets in phase I and II and overall (d 0 to 28). Pigs fed the diet containing 50% SDTA in phase I had lower (P < 0.05) G:F than those fed the SDPP diet. The results indicate that technical albumen can replace 25 to 50% of SDPP in early-weaned pig diets without compromising performance, and further suggest that heat-treated SDTA may affect intestinal microbial population in pigs.

Amino Acids↗

PubMed2003

A needle-free jet-injection system with lidocaine for peripheral intravenous cannula insertion: a randomized controlled trial with cost-effectiveness analysis.

UNLABELLED: Insertion of a peripheral IV cannula is a common, although painful, procedure. We tested the analgesic efficacy, adverse effects, and cost-effectiveness of a needle-free intradermal drug delivery system (Jet) with lidocaine for the insertion of an IV cannula (18-gauge; dorsum of hand). Four-hundred patients were randomly allocated to one of four groups: (a) no treatment, (b) Jet (J-Tip), National Medical Products Inc, CA; $3.0 per device) with 0.5 mL of saline, (3) Jet with 0.5 mL of lidocaine 1%, and (4) Jet with 0.5 mL of lidocaine 2%. Pain was evaluated using a numerical verbal scale (NVS 0-10). A NVS < or =3 was considered as acceptable in this context. Incremental cost-effectiveness ratios were calculated. Without treatment, 42.4% of patients had a NVS < or = 3, 39.3% with saline, 60.7% with 1% lidocaine (relative risk [RR] compared with no treatment, 0.70; 95% confidence interval [CI], 0.53-0.93), and 86.7% with 2% lidocaine (RR, 0.49; 95% CI, 0.38-0.62). Nineteen and one-half percent of patients had a NVS >3 because of Jet treatment, 13.5% had local hyperemia, and 16.9% had minor local bleeding. Of all Jet treatments, 10.5% were technical failures, and there were 17.6% cannula insertion failures (10.1% without treatment [RR, 1.74; 95% CI, 0.92-3.32]). Compared with no treatment, costs to generate one additional patient with a NVS < or =3 were $23 with lidocaine 1% and $10 with lidocaine 2%. On insertion of an IV cannula on the back of the hand, 58% of patients report at least moderate pain. Lidocaine-Jet is analgesic; there is dose-responsiveness. However, Jet treatment is not painless, and costs incurred to achieve one success compared with doing nothing are not negligible. IMPLICATIONS: Insertion of an IV cannula is painful. Four-hundred patients were randomly allocated to test the analgesic efficacy, adverse effects, and cost-effectiveness of the needle-free intradermal drug delivery system (J-Tip); Jet). Jet with lidocaine is effective, but its application is not painless. Costs to achieve one patient with no more than moderate pain (numerical verbal scale < or =3 of 10) on insertion of an IV cannula are $10.

Adolescent↗