Low Blood Flow Continuous Veno-Venous Haemodialysis Compared with Higher Blood Flow Continuous Veno-Venous Haemodiafiltration: Effect on Alarm Rates, Filter Life, and Azotaemic Control

2021 ◽  
pp. 1-8
Author(s):  
Benjamin Sansom ◽  
Shyamala Sriram ◽  
Jeffrey Presneill ◽  
Rinaldo Bellomo
Keyword(s):  
Blood Flow ◽  
Median Filter ◽  
Random Effect ◽  
Effect Estimate ◽  
Control Effect ◽  
Tertiary Referral Hospital ◽  
Femoral Access ◽  
Filter Life ◽  
Bedside Clinician ◽  
Reduced Risk

<b><i>Title:</i></b> Low blood flow continuous veno-venous haemodialysis (CVVHD) compared with higher blood flow continuous veno-venous haemodiafiltration (CVVHDF): effect on alarm rates, filter life, and azotaemic control. <b><i>Introduction:</i></b> Continuous renal replacement therapy (CRRT) can be delivered via convective, diffusive, or mixed approaches. Higher blood flows have been advocated for convective clearance efficiency and promotion of filter life. It is unclear whether a lower blood flow predominantly diffusive approach may benefit filter life and alarm rates. <b><i>Materials and Methods:</i></b> Sequential cohort study of 284 patients undergoing 874 CRRT circuits from January 2015 to August 2018 in a single university-associated tertiary referral hospital in Australia. Patients underwent a protocol of either CVVHDF at blood flow 200–250 mL/min or CVVHD at blood flow 100–130 mL/min. Machine and patient data were analysed. Outcomes of azotaemic control, filter life, and warning alarm rates were log transformed and analysed with mixed linear modelling with patient as a random effect. <b><i>Results:</i></b> Both groups had similar azotaemic control (effect estimate on log creatinine CVVHD vs. CVVHDF 1.04 [0.87–1.25], <i>p</i> = 0.68) and median filter life (CVVHDF 16.8 [8.4–90.5] h and CVVHD 16.4 [9.4–82.3] h, <i>p</i> = 0.97). However, circuit pressures were less extreme with a narrower distribution during CVVHD. Multivariate analysis showed CVVHD had a reduced risk of warning alarms (incidence risk ratio [IRR] 0.51 [0.38–0.70]) and femoral access placement also had a reduced risk of alarms (IRR 0.55 [0.41–0.73]). <b><i>Conclusion:</i></b> Low blood flow CVVHD and femoral vascular access reduce alarms while maintaining azotaemic control and circuit patency thus minimizing bedside clinician workload.

scholarly journals The Effect on Treatment Adherence of Administering Drugs as Fixed-Dose Combinations versus as Separate Pills: Systematic Review and Meta-Analysis

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Katy A. van Galen ◽  
Jeannine F. Nellen ◽  
Pythia T. Nieuwkerk
Keyword(s):  
Treatment Adherence ◽  
Medical Condition ◽  
Statistical Significance ◽  
Random Effect ◽  
Random Effect Model ◽  
Fixed Dose ◽  
Favourable Effect ◽  
Effect Estimate ◽  
Medical Conditions ◽  
Optimal Adherence

Administering drugs as fixed-dose combinations (FDCs) versus the same active drugs administered as separate pills is assumed to enhance treatment adherence. We synthesized evidence from randomized controlled trials (RCTs) about the effect of FDCs versus separate pills on adherence. We searched PubMed for RCTs comparing a FDC with the same active drugs administered as separate pills, including a quantitative estimate of treatment adherence, without restriction to medical condition. The odds ratio (OR) of optimal adherence with FDCs versus separate pills was used as common effect size and aggregated into a pooled effect estimate using a random effect model with inverse variance weights. Out of 1258 articles screened, only six studies fulfilled inclusion criteria. Across medical conditions, administering drugs as FDC significantly increased the likelihood of optimal adherence (OR 1.33 (95% CI, 1.03–1.71)). Within subgroups of specific medical conditions, the favourable effect of FDCs on adherence was of borderline statistical significance for HIV infection only (OR 1.46 (95% CI, 1.00–2.13)). We observed a remarkable paucity of RCTs comparing the effect on adherence of administering drugs as FDC versus as separate pills. Administering drugs as FDC improved medication adherence. However, this conclusion is based on a limited number of RCTs only.

scholarly journals The impact of leptomeningeal collaterals in acute ischemic stroke

2020 ◽  
Author(s):  
Nida Fatima ◽  
Maher Saqqur ◽  
Ashfaq Shuaib
Keyword(s):  
Blood Flow ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Mesh Terms ◽  
Favorable Clinical Outcome ◽  
The Impact

Abstract Objectives: Leptomeningeal collaterals provide an alternate pathway to maintain cerebral blood flow in stroke to prevent ischemia, but their role in predicting outcome is still unclear. So, our study aims at assessing the significance of collateral blood flow (CBF) in acute stroke. Methods: Electronic databases were searched under different MeSH terms from Jan 2000 to Feb 2019. Studies were included if there was available data on good and poor CBF in acute ischemic stroke (AIS). The clinical outcomes included were modified rankin scale (mRS), recanalization, mortality, and symptomatic intracranial hemorrhage (sICH) at 90 days. Data was analyzed using random-effect model.Results: A total of 47 studies with 8,194 patients were included. Pooled meta-analysis revealed that there exist 2-fold higher likelihood of favorable clinical outcome (mRS≤2) at 90 days with good CBF compared with poor CBF (RR: 2.27; 95%CI: 1.94-2.65; p<0.00001) irrespective of the thrombolytic therapy [RR with IVT: 2.90; 95%CI: 2.14-3.94; p<0.00001, and RR with IAT/EVT: 1.99; 95% CI: 1.55-2.55; p<0.00001]. Moreover, there exists 1-fold higher probability of successful recanalization with good CBF (RR: 1.31; 95% CI: 1.15-1.49; p<0.00001). However, there was 54% and 64% lower risk of sICH and mortality respectively in patients with good CBF in AIS (p<0.00001).Conclusions: The relative risk of favorable clinical outcome is more in patients with good pretreatment CBF. This could be explained due to better chances of recanalization, combined with lesser risk of intracerebral hemorrhage in good CBF status.

scholarly journals Clinical efficacy, safety and tolerability of aliskiren monotherapy: a protocol for an umbrella review

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e033448
Author(s):  
Qiyuan Zhao ◽  
Jiantong Shen ◽  
Jingya Lu ◽  
Fan Li ◽  
Qi Jiang ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Selection Process ◽  
Random Effect ◽  
Cochrane Library ◽  
Effect Estimate ◽  
Umbrella Review ◽  
Quality Of Reporting ◽  
Ethical Approval ◽  
Randomised Controlled ◽  
Meta Analyses

IntroductionAliskiren is a newly developed medicine. As one of the effective renin–angiotensin–aldosterone system inhibitors, its role in lowering blood pressure has been recognised. However, its safety and tolerability still remain controversial. The aim of the paper is to systematically summarise the published studies about the clinical efficacy and side effects of aliskiren monotherapy.Methods and analysisA comprehensive review of PubMed, Embase and Cochrane Library databases published from inception until June 2019 will be conducted. The selected articles are meta-analyses that integrated the randomised controlled studies, which evaluated efficacy, safety and tolerability of aliskiren monotherapy. Two people will select eligible articles and extract data independently. Any disputes will be resolved by discussion or the arbitration of a third person. The quality of reporting evidence will be assessed using the AMSTAR 2 tool. Study selection process will be presented using a flowchart. We will re-analyse each outcome with the random effect methods if necessary. If possible, we will also calculate 95% prediction intervals for each random effect estimate, by using Egger’s test to evaluate if the reporting bias existed.Ethics and disseminationEthical approval is not required for the study, as we only collected data from available published materials. This umbrella review will be also submitted to a peer-reviewed journal for publication after completion.PROSPERO registration numberCRD42019142141.

Ambient heat and hospitalisation for COPD in Brazil: a nationwide case-crossover study

Thorax ◽  
2019 ◽  
Vol 74 (11) ◽  
pp. 1031-1036 ◽  
Author(s):  
Qi Zhao ◽  
Shanshan Li ◽  
Micheline de Sousa Zanotti Staglior Coelho ◽  
Paulo Hilário Nascimento Saldiva ◽  
Rongbin Xu ◽  
...  
Keyword(s):  
Random Effect ◽  
National Level ◽  
Heat Exposure ◽  
Weather Conditions ◽  
Evidence Base ◽  
Effect Estimate ◽  
Case Crossover ◽  
Hot Season ◽  
Meta Analyses ◽  
The Impact

BackgroundHeat exposure has been related to increased morbidity and mortality for several health outcomes. There is little evidence whether this is also true for COPD. This study quantified the relationship between ambient heat and hospitalisation for COPD in the Brazilian population.MethodsData on hospitalisations for COPD and weather conditions were collected from 1642 cities during the 2000–2015 hot seasons. A time-stratified, case-crossover design was used for city-specific analyses, which were then pooled at the regional and national levels using random-effect meta-analyses. Stratified analyses were performed by sex, age group and early/late hot season. Annual change in the association was examined using a random-effect meta-regression model.ResultsThe OR of hospitalisation was 1.05 (95% CI 1.04 to 1.06) for every 5℃ increase in daily mean temperature at the national level, with the effect estimate stronger in the late hot season compared with the early hot season. The effect was similar in women and in men but was greatest for those aged ≥75 years. The association was stronger in the central west and southeast regions and minimal in the northeast. Assuming a causal relationship, 7.2% of admissions were attributable to heat exposure. There was no significant temporal decline in the impact of ambient heat over the 16-year study period.ConclusionIn Brazil, exposure to ambient heat was positively associated with hospitalisation for COPD, particularly during the late hot season. These data add to the growing evidence base implicating global warming as being an important contributor to the future healthcare burden.

Is metformin use associated with a reduced risk of oesophageal cancer? A systematic review and meta-analysis

2021 ◽  
pp. postgradmedj-2021-140432
Author(s):  
Yue Chen ◽  
Xingyu Cheng ◽  
Chenyu Sun ◽  
Na Hyun Kim ◽  
Sujatha Kailas ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Oesophageal Cancer ◽  
Search Strategy ◽  
Meta Analysis ◽  
Random Effect ◽  
Registration Number ◽  
Comprehensive Search ◽  
Meta Regression ◽  
Comprehensive Search Strategy ◽  
Reduced Risk

ObjectivesStudies on the association between metformin use and the risk of oesophageal cancer (OC) have generated controversial findings. This updated meta-analysis was conducted to reassess the effects of metformin on OC.MethodsA comprehensive search strategy was conducted to select relevant studies from origination to February 2021. Heterogeneity was evaluated through the Q test and I2 statistics. HRs and 95% CIs were pooled through either random-effect or fixed-effect models. Meta-regression, subgroup analyses, sensitivity analysis and publication bias diagnosis were also performed.ResultsSeven studies with 5 426 343 subjects were included. Metformin use was associated with reduced risk of OC (HR=0.69, 95% CI 0.54 to 0.87, p<0.001). Sensitivity analysis suggested that the results were relatively stable.ConclusionMetformin is associated with a reduced risk of OC. More well-designed studies are still needed to further elaborate on these associations.PROSPERO registration numberCRD42021237127.

Abstract 16146: Topical Nitroglycerine Reduces Radial Access Site Failure and Femoral Crossover - Topical Nitroglycerine to Prevent Radial Artery Spasm (TNTRASP) Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Prabhakaran P Gopalakrishnan ◽  
Manova David ◽  
Pradeep Manoharan ◽  
Sharan Rufus Ponniah ◽  
Brendan Duffy
Keyword(s):  
Radiation Dose ◽  
Radial Artery ◽  
Drug Application ◽  
Sectional Area ◽  
Access Site ◽  
Cross Sectional ◽  
Femoral Access ◽  
Topical Lidocaine ◽  
Increased Risk ◽  
Reduced Risk

Background: Radial to femoral access crossover has been reported as high as 7.6%. Access site failure, radial spasm and tortuosity are potential reasons. Methods: Patients undergoing radial catheterization were randomly assigned to 30 mg of topical nitroglycerine (NTG, n =48) or placebo ( n =52) at least one hour before access. Both groups received 40 mg of topical lidocaine. Radial artery dimensions were measured before drug application and immediately before access. RASP score (Forearm discomfort + Difficult catheter manipulation + Additional intraarterial NTG + Sheath removal difficulty) >0 indicates radial spasm. Results: Radial artery cross sectional area (CSA) increased significantly in NTG group (30% vs. -3%, p <0.001). Radial artery was smaller than the sheath at time of access in fewer patients in NTG group (10% vs. 27%, p <0.05). Fewer patients had spasm in NTG group (17% vs. 29%, p =0.14). Average RASP score was lower in NTG group (0.2 vs. 0.6, p =0.10). No crossover to femoral access in NTG group compared to 4 crossovers in control ( p <0.05). Femoral crossover was 10 times more likely if radial diameter < 2 mm ( p <0.05). Risk of radial spasm was higher with multiple arterial sticks ( p <0.01); arterial tortuosity ( p <0.05); intraarterial heparin ( p <0.01), use of multiple wires ( p <0.001); use of multiple catheters ( p <0.01) and nonhydrophillic catheter use ( p =0.001). Preprocedural valium reduced risk of radial spasm. Radial spasm was associated with 5 fold risk of hematoma ( p =0.01) and higher radiation dose ( p <0.001). Discussion: Pre-dilation with topical NTG reduced access site failure and risk of femoral crossover. Radial spasm incidence was lower in NTG but not statistically significant. Radial spasm was influenced by several factors like choice of wires and catheters. Radial spasm increased risk of hematoma as well as radiation exposure. Conclusion: Topical nitroglycerine to predilate radial artery reduces risk of femoral crossover and may reduce radial spasm.

scholarly journals Statin Use and the Risk of Hepatocellular Carcinoma: A Meta-Analysis of Observational Studies

Cancers ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 671 ◽  
Author(s):  
Md. Mohaimenul Islam ◽  
Tahmina Nasrin Poly ◽  
Bruno Andreas Walther ◽  
Hsuan-Chia Yang ◽  
Yu-Chuan (Jack) Li
Keyword(s):  
Hepatocellular Carcinoma ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Experimental Studies ◽  
Inhibitory Effect ◽  
Patients With Diabetes ◽  
The Impact ◽  
Reduced Risk ◽  
Statin Use

Background and Aims: Statins are the first-line medication to treating hypercholesterolemia. Several studies have investigated the impact of statins on the risk of hepatocellular carcinoma (HCC). However, the extent to which statins may prevent HCC remains uncertain. Therefore, we performed a meta-analysis of relevant studies to quantify the magnitude of the association between statins use and the risk of HCC. Methods: A systematic literature search of PubMed, EMBASE, Google Scholar, Web of Science, and Scopus was performed for studies published between January 1, 1990, and September 1, 2019, with no restriction of language. Two reviewers independently evaluated the literature and included observational and experimental studies that reported the association between statin use and HCC risk. The random-effect model was used to calculate the overall risk ratio (RR) with a 95% confidence interval (CI), and the heterogeneity among the studies was assessed using the Q statistic and I2 statistic. The Newcastle Ottawa Scale (NOS) was also used to evaluate the quality of the included studies. Results: A total of 24 studies with 59,073 HCC patients was identified. Statin use was associated with a reduced risk of HCC development (RR: 0.54, 95% CI: 0.47–0.61, I2 = 84.39%) compared with nonusers. Moreover, the rate of HCC reduction was also significant among patients with diabetes (RR: 0.44, 95% CI: 0.28–0.70), liver cirrhosis (RR: 0.36, 95% CI: 0.30–0.42), and antiviral therapy (RR: 0.21, 95% CI: 0.08–0.59) compared with nonusers. Conclusion: This study serves as additional evidence supporting the beneficial inhibitory effect of statins on HCC incidence. The subgroup analyses of this study also highlight that statins are significantly associated with a reduced risk of HCC and may help to direct future prevention efforts. Additional large clinical studies are needed to determine whether statins are associated with a lower risk of HCC.

Influence of RFC1 c.80A>G Polymorphism on Methotrexate-Mediated Toxicity and Therapeutic Efficacy in Rheumatoid Arthritis: A Meta-analysis

2021 ◽  
pp. 106002802110020
Author(s):  
Shaik Mohammad Naushad ◽  
Salman A. Alrokayan ◽  
Fahad N. Almajhdi ◽  
Tajamul Hussain
Keyword(s):  
Rheumatoid Arthritis ◽  
Therapeutic Efficacy ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Random Effect ◽  
Reduced Folate Carrier ◽  
Gene Variant ◽  
Efficacy And Safety ◽  
Random Effect Models ◽  
Reduced Risk

Background: Methotrexate (MTX) is an antirheumatic drug, transported by reduced folate carrier-1 (RFC1). The most common RFC1 gene variant, c.80 A>G (rs1051266) is ambiguously linked to adverse effects of MTX therapy in some rheumatoid arthritis (RA) patients. Objective: The purpose of meta-analysis was to summarize all major published studies on c.80 A>G SNP to clarify this ambiguity in MTX therapy. Methods: A total of 18 studies representing 3592 RA patients comprising 699 men and 2893 women were included. Both fixed and random effect models were applied to study the data. Results: The RFC1 80A-allele showed null association with MTX-mediated toxicity in both fixed (odds ratio [OR] = 0.91; 95% CI = 0.80-1.03) and random effects (OR = 0.89; 95% CI: 0.71-1.11) models. Because heterogeneity was observed in this association ( P = 0.0006), data were segregated based on use of folate therapy. In 7 studies (n = 1191) where folate was used along with MTX, RFC1 AA patients showed reduced risk for MTX-mediated toxicity (OR = 0.67; 95% CI: 0.50-0.89; P = 0.0006). The RFC1 80A-allele was found to increase the efficacy of MTX therapy by 1.53-fold (95% CI: 1.24-1.88), whereas the 80AA-genotype increased the efficacy by 1.85-fold (95% CI: 1.41-2.42). No publication bias was observed in these associations. Conclusion and Relevance: RFC1 c.80 A>G is an important pharmacogenetic determinant of MTX therapy in RA. The RFC1 80A-allele robustly increased therapeutic efficacy and safety when folate was used along with MTX. Findings are relevant to decision-making in the clinical use of MTX as a treatment for RA patients harboring the RFC1 gene variant.

scholarly journals PENGARUH KONSUMSI SERAT DENGAN PENGURANGAN RISIKO KANKER KOLON DI NEGARA BARAT: STUDI META ANALISIS

2018 ◽  
Vol 12 (2) ◽  
pp. 97
Author(s):  
Masrul Masrul
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Random Effect ◽  
Western Countries ◽  
Colorectal Cancer Patients ◽  
Published Research ◽  
Random Effect Models ◽  
Reduced Risk

The association between dietary fibre and colorectal cancer risk is controversial. This systematic review and meta-analysis was performed to determine fibre consumption reduced risk of colorectal cancer patients in western countries.The authors conducted a meta-analysis of published research articles on fibre consumption reduced risk of colorectal cancer patients in western countries published between January 2000 and January 2018 in the online article databases of PubMed, ProQuest and EBSCO. Pooled relative risk (PRR) were calculated with fixed and random-effect models. Data were processed using Stata version 14.2 (Stata Corporation). This study reviewed 405 articles. There are 7 studies conducted a systematic review and continued with Meta-analysis. The results showed fibre consumption reduced risk of colorectal cancer patients in western countries (RR = 0.83 [95% CI 0.75-0.93]). This analysis confirmed fibre consumption reduced risk of colorectal cancer patients in western countries.

scholarly journals Impact of rate control in hospitalized patients with atrial fibrillation and sepsis: a systematic review and meta-analysis

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
GF Romiti ◽  
M Proietti
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Sensitivity Analysis ◽  
Hospital Mortality ◽  
Rate Control ◽  
Meta Analysis ◽  
Random Effect ◽  
Fixed Effect ◽  
Channel Blockers ◽  
Reduced Risk

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial Fibrillation (AF) is a common complication in patients with sepsis, and imposes a worse prognosis and challenging clinical management. Administration of antiarrhythmics is often needed, to achieve rate or rhythm control, especially in the occurrence of AF with rapid ventricular response; however, it is unclear whether different classes of antiarrhythmics are associated with better outcomes in patients with sepsis and AF. Methods We performed a systematic review and meta-analysis according to PRISMA Guidelines. Pubmed and EMBASE databases were systematically searched for studies reporting outcomes in patients with sepsis and AF, according to the use of Beta-blockers (BBs), calcium-channel blockers (CCBs), digoxin and amiodarone. Random-effect models were used to provide pooled estimates; fixed-effect models were also performed as a sensitivity analysis. Results Among 4,166 studies, 2 articles were included from the literature search, and an additional 1 from the author’s knowledge, yielding a total of 40,593 patients with sepsis and AF included. According to the data available from the included studies, the meta-analysis was performed only for in-hospital mortality. BBs were associated with a reduced risk of in-hospital mortality compared to amiodarone (OR 0.52, 95% CI: 0.46-0.58; I2 = 0%, Figure 1, Panel C), while no significant differences were observed for BBs. vs. CCBs (Figure 1, Panel A) and for BBs vs. digoxin (Figure 1, Panel B). In the pre-specified sensitivity analysis using a fixed-effect model, BBs resulted associated with a lower risk of in-hospital mortality compared with both CCBs and digoxin). Conclusion In patients with AF during sepsis, BBs were associated with reduced risk of in-hospital mortality, compared to amiodarone; inconclusive results emerged for the comparisons between BBs and CCBs or digoxin, although with a benefit of BBs observed in the fixed-effect models. Further studies are needed to provide definitive data and to guide physicians in the choice of the best rate control strategy in this clinical setting. Abstract Figure.

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