scholarly journals Comparison of Various Glucocorticoid Replacement Regimens Used in Chronic Adrenal Insufficiency: A Systematic Review

2020 ◽  
Vol 26 (2) ◽  
pp. 50-68
Author(s):  
Nduku Kiko ◽  
Atul Kalhan
Keyword(s):  
Systematic Review ◽  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Clinical Outcomes ◽  
Modified Release ◽  
Prednisolone Therapy ◽  
Glucocorticoid Replacement Therapy ◽  
Cv Disease ◽  
The Impact

<b><i>Objective:</i></b> Patients with adrenal insufficiency require life-long glucocorticoid replacement therapy. Hydrocortisone (15–30 mg/day) and prednisolone (3–7.5 mg/day) are the preferred agents used although there is a lack of consensus among endocrinologists regarding the impact of different steroid regimens on quality of life, bone metabolism, cardiometabolic outcomes, adrenal crisis and infections. We carried out a retrospective systematic review of the literature to compare the efficacy and side effects of various glucocorticoid replacement regimens in patients with chronic adrenal insufficiency. <b><i>Methods:</i></b> We searched PubMed, Cochrane Reviews and Google Scholar databases up to March 14, 2019, for studies evaluating various clinical outcomes with glucocorticoid replacement therapy. The abstracts and full studies were appraised and data extracted from the eligible studies. The quality of evidence was evaluated and risk of bias carried out. <b><i>Results:</i></b> A total of 47 studies including 9 randomised controlled trials (RCTs) and 38 observational studies were evaluated in this systematic review. Prednisolone therapy was observed to be safe as well as efficacious as hydrocortisone although a higher dose was associated with an increased risk of cardiovascular (CV) disease. A lower hydrocortisone dose (15–20 mg/day) was associated with a reduction of blood pressure and improved clinical outcomes although this observation was based on a solitary RCT. Modified release hydrocortisone was observed to reduce the risk of CV disease based upon results from 2 of the RCTs. However, there was no conclusive evidence of benefit of modified release hydrocortisone and continuous subcutaneous hydrocortisone infusion in improving subjective health status. <b><i>Conclusion:</i></b> Prednisolone therapy remains a safe and efficacious alternative to hydrocortisone although there are concerns of dyslipidaemia and CV disease with higher doses. There is limited level I evidence suggestive of a positive effect of modified release hydrocortisone on CV and metabolic outcomes, particularly weight reduction.

Adrenal insufficiency: review of clinical outcomes with current glucocorticoid replacement therapy

2016 ◽  
Author(s):  
Gudmundur Johannsson ◽  
Alberto Falorni ◽  
Stanko Skrtic ◽  
Hans Lennernas ◽  
Marcus Quinkler ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Clinical Outcomes ◽  
Glucocorticoid Replacement Therapy

Adrenal insufficiency: review of clinical outcomes with current glucocorticoid replacement therapy

2014 ◽  
Vol 82 (1) ◽  
pp. 2-11 ◽  
Author(s):  
Gudmundur Johannsson ◽  
Alberto Falorni ◽  
Stanko Skrtic ◽  
Hans Lennernäs ◽  
Marcus Quinkler ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Clinical Outcomes ◽  
Glucocorticoid Replacement Therapy

scholarly journals The impact of asynchronous e-visits on clinical outcomes and healthcare delivery: A systematic review (Preprint)

2021 ◽  
Author(s):  
Oliver T. Nguyen ◽  
Amir Alishahi Tabriz ◽  
Jinhai Huo ◽  
Karim Hanna ◽  
Christopher M. Shea ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Of Care ◽  
Clinical Outcomes ◽  
Healthcare Costs ◽  
Healthcare Delivery ◽  
Healthcare Quality ◽  
Antibiotic Prescribing ◽  
Infection Management ◽  
The Impact

BACKGROUND E-visits involve asynchronous communication between providers and patients through a secure web-based platform, such as a patient portal, to elicit symptoms and determine a diagnosis and treatment plan. E-visits are now reimbursable through Medicare due to the COVID-19 pandemic. The state of the evidence regarding e-visits, such as the impact on clinical outcomes and healthcare delivery, is unclear. OBJECTIVE To address this gap, this systematic review examines how e-visits have impacted clinical outcomes and healthcare quality, access, utilization, and costs. METHODS MEDLINE, Embase, and Web of Science were searched from January 2000 through October 2020 for peer-reviewed studies that assessed e-visits’ impact on clinical and healthcare delivery outcomes. RESULTS Out of 1,858 papers, 19 studies met the inclusion criteria. E-visit usage was associated with improved or comparable clinical outcomes, especially for chronic disease management (e.g., diabetes care, blood pressure management). The impact on quality of care varied across conditions. Quality of care was equivalent or better for chronic conditions but variable quality was observed in infection management (e.g., appropriate antibiotic prescribing). Similarly, the impact on healthcare utilization varied across conditions (e.g., lower utilization for dermatology) but mixed impact in primary care. Healthcare costs were lower for e-visits for a wide-range of conditions (e.g., dermatology and acute visits). No studies examined the impact of e-visits on healthcare access. Available studies are observational in nature and it is difficult to draw firm conclusions about effectiveness or impact on care delivery. CONCLUSIONS Overall, the evidence suggests e-visits may provide comparable clinical outcomes to in-person care and reduce healthcare costs for certain healthcare conditions. At the same time, there is mixed evidence on healthcare quality, especially regarding infection management (e.g., sinusitis, urinary tract infections, conjunctivitis). Further studies are needed to test implementation strategies that might improve delivery (e.g., clinical decision support for antibiotic prescribing) and to assess which conditions are amenable to e-visits and which conditions require in-person or face-to-face care (e.g., virtual visit). CLINICALTRIAL not applicable

scholarly journals Inequalities in general practice remote consultations: A systematic review

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0040
Author(s):  
Ruth Parker ◽  
Emma Figures ◽  
Charlotte Paddison ◽  
James Matheson ◽  
David Blane ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
General Practice ◽  
Quality Of Care ◽  
Clinical Outcomes ◽  
The Elderly ◽  
Face To Face ◽  
The Impact ◽  
Remote Consultations

BackgroundCOVID-19 has led to rapid and widespread use of remote consultations in general practice, but the health inequalities impact remains unknown.AimTo explore the impact of remote consultations in general practice compared to face-to-face consultations on utilisation and clinical outcomes across socio-economic and disadvantaged groups.Design & settingSystematic reviewMethodWe undertook an electronic search of MEDLINE, EMBASE and Web of Science from inception to June 2020. We included studies which compared remote consultations to face-to-face consultations in primary care and reported outcomes by PROGRESS Plus criteria. Risk of bias was assessed using ROBINS-I. Data was synthesised narratively.ResultsBased on 13 studies, exploring telephone and internet-based consultations, we found that telephone consultations were used by younger working age people, the very old and non-immigrants, with internet-based consultations more likely to be used by younger people. Women consistently used more remote forms of consulting than men. Socio-economic and ethnicity findings were mixed, with weak evidence that patients from more affluent areas were more likely to use internet-based communication. Remote consultations appeared to help patients with opioid dependence remain engaged with primary care. No studies reported on the impact on quality of care or clinical outcomes.ConclusionRemote consultations in general practice are likely to be used more by younger working people, non-immigrants, the elderly and women, with internet-based consultations more by younger, affluent and educated groups. Wide-spread use of remote consultations should be treated with caution until the inequalities impact on clinical outcomes and quality of care is known.

scholarly journals The Effect of Higher Level Computerized Clinical Decision Support Systems on Oncology Care: A Systematic Review

Cancers ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 1032 ◽  
Author(s):  
Sosse E. Klarenbeek ◽  
Harm H.A. Weekenstroo ◽  
J.P. Michiel Sedelaar ◽  
Jurgen J. Fütterer ◽  
Mathias Prokop ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Quality Of Care ◽  
Decision Support ◽  
Clinical Outcomes ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Process Outcomes ◽  
The Impact

Background: To deal with complexity in cancer care, computerized clinical decision support systems (CDSSs) are developed to support quality of care and improve decision-making. We performed a systematic review to explore the value of CDSSs using automated clinical guidelines, Artificial Intelligence, datamining or statistical methods (higher level CDSSs) on the quality of care in oncology. Materials and Methods: The search strategy combined synonyms for ‘CDSS’ and ‘cancer.’ Pubmed, Embase, The Cochrane Library, Institute of Electrical and Electronics Engineers, Association of Computing Machinery digital library and Web of Science were systematically searched from January 2000 to December 2019. Included studies evaluated the impact of higher level CDSSs on process outcomes, guideline adherence and clinical outcomes. Results: 11,397 studies were selected for screening, after which 61 full-text articles were assessed for eligibility. Finally, nine studies were included in the final analysis with a total population size of 7985 patients. Types of cancer included breast cancer (63.1%), lung cancer (27.8%), prostate cancer (4.1%), colorectal cancer (3.1%) and other cancer types (1.9%). The included studies demonstrated significant improvements of higher level CDSSs on process outcomes and guideline adherence across diverse settings in oncology. No significant differences were reported for clinical outcomes. Conclusion: Higher level CDSSs seem to improve process outcomes and guidelines adherence but not clinical outcomes. It should be noticed that the included studies primarily focused on breast and lung cancer. To further explore the impact of higher level CDSSs on quality of care, high-quality research is required.

scholarly journals Would Cortisol Measurements Be a Better Gauge of Hydrocortisone Replacement Therapy? Congenital Adrenal Hyperplasia as an Exemplar

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Peter C Hindmarsh ◽  
John W Honour
Keyword(s):  
Quality Of Life ◽  
Congenital Adrenal Hyperplasia ◽  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Plasma Cortisol ◽  
Poor Quality ◽  
Adrenal Hyperplasia ◽  
Mortality And Morbidity ◽  
Glucocorticoid Replacement Therapy

There is an increase in mortality and morbidity as well as poor quality of life in patients with congenital adrenal hyperplasia (CAH) and other causes of adrenal insufficiency. Glucocorticoid replacement therapy should aim to replace the missing cortisol as close as possible to the normal circadian rhythm using hydrocortisone. Dosing should be based on the individual’s absorption and clearance of the drug. Adequacy of dosing should be checked using 24-hour profiles of plasma cortisol with samples drawn preferably every hour or at least every 2 hours. Measurement of cortisol should be the preferred method of assessing replacement therapy as it is over- and undertreatment with hydrocortisone, both of which can occur over a 24-hour period, which leads to the problems observed in patients with CAH and adrenal insufficiency.

scholarly journals Novel insights into glucocorticoid replacement therapy for pediatric and adult adrenal insufficiency

2019 ◽  
Vol 10 ◽  
pp. 204201881882129 ◽  
Author(s):  
Alina Oprea ◽  
Nicolas C. G. Bonnet ◽  
Olivier Pollé ◽  
Philippe A. Lysy
Keyword(s):  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Adrenocorticotropic Hormone ◽  
Current Knowledge ◽  
Hormone Synthesis ◽  
Adrenal Steroidogenesis ◽  
Glucocorticoid Replacement Therapy ◽  
Adrenocortical Hormone ◽  
Novel Strategy

Adrenal insufficiency is defined as impaired adrenocortical hormone synthesis. According to its source, the deficit is classified as primary (adrenal steroidogenesis impairment), secondary (pituitary adrenocorticotropic hormone deficit) or tertiary (hypothalamic corticotropin-releasing hormone deficit). The management of adrenal insufficiency resides primarily in physiological replacement of glucocorticoid secretion. Standard glucocorticoid therapy is shrouded in several controversies. Along the difficulties arising from the inability to accurately replicate the pulsatile circadian cortisol rhythm, come the uncertainties of dose adjustment and treatment monitoring (absence of reliable biomarkers). Furthermore, side effects of inadequate replacement significantly hinder the quality of life of patients. Therefore, transition to circadian hydrocortisone therapy gains prominence. Recent therapeutic advancements consist of oral hydrocortisone modified-release compounds (immediate, delayed and sustained absorption formulations) or continuous subcutaneous hydrocortisone infusion. In addition to illustrating the current knowledge on conventional glucocorticoid regimens, this review outlines the latest research outcomes. We also describe the management of pediatric patients and suggest a novel strategy for glucocorticoid replacement therapy in adults.

scholarly journals Mechanisms and impact of public reporting on physicians and hospitals’ performance: A systematic review (2000–2020)

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247297
Author(s):  
Khic-Houy Prang ◽  
Roxanne Maritz ◽  
Hana Sabanovic ◽  
David Dunt ◽  
Margaret Kelaher
Keyword(s):  
Systematic Review ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Clinical Outcomes ◽  
Consumer Choice ◽  
Structural Characteristics ◽  
Level Of Evidence ◽  
Positive Effects ◽  
The Impact

Background Public performance reporting (PPR) of physician and hospital data aims to improve health outcomes by promoting quality improvement and informing consumer choice. However, previous studies have demonstrated inconsistent effects of PPR, potentially due to the various PPR characteristics examined. The aim of this study was to undertake a systematic review of the impact and mechanisms (selection and change), by which PPR exerts its influence. Methods Studies published between 2000 and 2020 were retrieved from five databases and eight reviews. Data extraction, quality assessment and synthesis were conducted. Studies were categorised into: user and provider responses to PPR and impact of PPR on quality of care. Results Forty-five studies were identified: 24 on user and provider responses to PPR, 14 on impact of PPR on quality of care, and seven on both. Most of the studies reported positive effects of PPR on the selection of providers by patients, purchasers and providers, quality improvement activities in primary care clinics and hospitals, clinical outcomes and patient experiences. Conclusions The findings provide moderate level of evidence to support the role of PPR in stimulating quality improvement activities, informing consumer choice and improving clinical outcomes. There was some evidence to demonstrate a relationship between PPR and patient experience. The effects of PPR varied across clinical areas which may be related to the type of indicators, level of data reported and the mode of dissemination. It is important to ensure that the design and implementation of PPR considered the perspectives of different users and the health system in which PPR operates in. There is a need to account for factors such as the structural characteristics and culture of the hospitals that could influence the uptake of PPR.

Sign in / Sign up

Export Citation Format

Share Document