Abstract 4450: Does the Evidence Support Guideline Recommendations for Clopidogrel Pretreatment?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Shervin Eshaghian ◽  
Stanley Chou ◽  
Jayanta Das ◽  
George A Diamond ◽  
Prediman K Shah ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Time Course ◽  
Meta Analysis ◽  
Bleeding Risk ◽  
Evidence Base ◽  
Current Evidence ◽  
Optimal Timing ◽  
Significant Heterogeneity ◽  
Current Evidence Base ◽  
The Impact

Although few concrete data exist about the optimal timing and dose of clopidogrel pretreatment, the ACC/AHA & ESC guidelines endorse pretreatment with 300 – 600 mg of clopidogrel at least 2– 6 hours before PCI as Class IA (ACS) and Class IC (elective PCI) recommendation. To evaluate the current evidence base in support for clopidogrel pretreat-ment. Five trials examining the impact of clopidogrel pretreatment in stable and unstable CAD were evaluated: PCI-CURE, PCI-CLARITY, CREDO, PRAGUE-8, ARMYDA-5. Because of substantial clinical heterogeneity in trial design and population, concomitant therapies (glycoprotein 2b/3a inhibitors, thrombolysis, etc), loading dose, pretreatment duration and analysis plan between PCI-CURE, PCI-CLARITY and the rest, a formal meta-analysis was confined only to CREDO, PRAGUE-8, ARMYDA-5. The key data are summarized in the Table . Clopidogrel pretreatment was associated with significant reduction in ischemic outcomes without a significant increase in major bleeding in two out of the 5 trials (PCI-CURE and PCI-CLARITY). Both these trials utilized nonrandomized subgroup comparisons with pretreatment duration longer than that typically encountered in clinical practice (<48h). A meta-analysis of the 3 trials demonstrated a nonsignificant 23% odds reduction in efficacy (P=0.1) and a nonsignificant 29% odds increase in major bleeding (P=0.24). No significant heterogeneity was observed for pooled efficacy (P=0.79) or bleeding (P=0.77) outcomes. Pretreatment hypothesis is currently not validated in rigorous prospective assessments, thereby calling into question the Class I recommendation (benefit >>>risk) endorsed by the guidelines. Clearly, further clinical data regarding dose, time course of pretreatment and associated benefit are warranted to provide unequivocal support. Until then, it is prudent to rule out surgical CAD before pretreatment to avoid bleeding risk. Trials Assessing Clopidogrel Pretreatment

scholarly journals Polyphenols and Cognition In Humans: An Overview of Current Evidence from Recent Systematic Reviews and Meta-Analyses

2020 ◽  
pp. 1-15
Author(s):  
Daniel Joseph Lamport ◽  
Claire Michelle Williams
Keyword(s):  
Systematic Reviews ◽  
Evidence Base ◽  
Epidemiological Studies ◽  
Cognitive Outcome ◽  
Current Evidence ◽  
Duration Of Treatment ◽  
Current Evidence Base ◽  
Cognitive Benefits ◽  
Meta Analyses ◽  
The Impact

There is increasing interest in the impact of dietary influences on the brain throughout the lifespan, ranging from improving cognitive development in children through to attenuating ageing related cognitive decline and reducing risk of neurodegenerative diseases. Polyphenols, phytochemicals naturally present in a host of fruits, vegetables, tea, cocoa and other foods, have received particular attention in this regard, and there is now a substantial body of evidence from experimental and epidemiological studies examining whether their consumption is associated with cognitive benefits. The purpose of this overview is to synthesise and evaluate the best available evidence from two sources, namely meta-analyses and systematic reviews, in order to give an accurate reflection of the current evidence base for an association between polyphenols and cognitive benefits. Four meta-analyses and thirteen systematic reviews published between 2017–2020 were included, and were categorised according to whether they reviewed specific polyphenol-rich foods and classes or all polyphenols. A requirement for inclusion was assessment of a behavioural cognitive outcome in humans. A clear and consistent theme emerged that whilst there is support for an association between polyphenol consumption and cognitive benefits, this conclusion is tentative, and by no means definitive. Considerable methodological heterogeneity was repeatedly highlighted as problematic such that the current evidence base does not support reliable conclusions relating to efficacy of specific doses, duration of treatment, or sensitivity in specific populations or certain cognitive domains. The complexity of multiple interactions between a range of direct and indirect mechanisms of action is discussed. Further research is required to strengthen the reliability of the evidence base.

scholarly journals Investigation of antihypertensive class, dementia, and cognitive decline

Neurology ◽  
2019 ◽  
Vol 94 (3) ◽  
pp. e267-e281 ◽  
Author(s):  
Ruth Peters ◽  
Sevil Yasar ◽  
Craig S. Anderson ◽  
Shea Andrews ◽  
Riitta Antikainen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cognitive Decline ◽  
Meta Analysis ◽  
Evidence Base ◽  
Reliable Change Index ◽  
Current Evidence ◽  
Index Method ◽  
Current Evidence Base ◽  
Registration Number ◽  
Prospective Longitudinal

ObjectiveHigh blood pressure is one of the main modifiable risk factors for dementia. However, there is conflicting evidence regarding the best antihypertensive class for optimizing cognition. Our objective was to determine whether any particular antihypertensive class was associated with a reduced risk of cognitive decline or dementia using comprehensive meta-analysis including reanalysis of original participant data.MethodsTo identify suitable studies, MEDLINE, Embase, and PsycINFO and preexisting study consortia were searched from inception to December 2017. Authors of prospective longitudinal human studies or trials of antihypertensives were contacted for data sharing and collaboration. Outcome measures were incident dementia or incident cognitive decline (classified using the reliable change index method). Data were separated into mid and late-life (>65 years) and each antihypertensive class was compared to no treatment and to treatment with other antihypertensives. Meta-analysis was used to synthesize data.ResultsOver 50,000 participants from 27 studies were included. Among those aged >65 years, with the exception of diuretics, we found no relationship by class with incident cognitive decline or dementia. Diuretic use was suggestive of benefit in some analyses but results were not consistent across follow-up time, comparator group, and outcome. Limited data precluded meaningful analyses in those ≤65 years of age.ConclusionOur findings, drawn from the current evidence base, support clinical freedom in the selection of antihypertensive regimens to achieve blood pressure goals.Clinical trials registrationThe review was registered with the international prospective register of systematic reviews (PROSPERO), registration number CRD42016045454.

scholarly journals The Effectiveness of Mindfulness- and Acceptance-Based Interventions for Informal Caregivers of People With Dementia: A Meta-Analysis

2018 ◽  
Vol 59 (4) ◽  
pp. e363-e379 ◽  
Author(s):  
Rebecca N Collins ◽  
Naoko Kishita
Keyword(s):  
Stress Reduction ◽  
Meta Analysis ◽  
Informal Caregivers ◽  
Cost Effective ◽  
The United States ◽  
Evidence Base ◽  
Significant Heterogeneity ◽  
Moderator Variables ◽  
People With Dementia ◽  
The Impact

Abstract Background and Objectives The application of mindfulness- and acceptance-based interventions (MABIs) for informal caregivers of people with dementia (PwD) is relatively novel, and the current state of the evidence base is unclear. This meta-analysis examined the effectiveness of MABIs on reducing symptoms of depression and burden in informal caregivers of PwD. The quality of included studies was evaluated and moderator variables explored. Research Design and Methods A literature search of six electronic databases (PsycARTICLES, PsycINFO, MEDLINE Complete, SCOPUS, Web of Science, and ProQuest) was conducted from the first available date to 20 December 2016. Inclusion criteria involved studies that quantitatively investigated the impact of MABIs on depression and/or burden in informal caregivers of PwD. Results Twelve studies, providing data on 321 caregivers, were included. Most used mindfulness-based stress reduction and were conducted in the United States. The average attrition among participants was 15.83%. The pre–post effect of MABIs was large for depression and moderate for burden. These effects were largely maintained at follow-up. Significant heterogeneity of effect sizes was observed, with no significant moderators identified. Study quality varied from very poor to moderately good. Discussion and Implications The low attrition and moderate to large effects suggest that MABIs are acceptable and beneficial for informal caregivers of PwD. The lack of significant moderators could advocate services using more cost-effective forms of MABIs. Further higher-quality research is needed to improve the robustness of the evidence base and enable a meta-analysis to thoroughly examine and quantify moderator variables.

scholarly journals Effectiveness of universal programmes for the prevention of suicidal ideation, behaviour and mental ill health in medical students: a systematic review and meta-analysis

2019 ◽  
Vol 22 (2) ◽  
pp. 84-90 ◽  
Author(s):  
Katrina Witt ◽  
Alexandra Boland ◽  
Michelle Lamblin ◽  
Patrick D McGorry ◽  
Benjamin Veness ◽  
...  
Keyword(s):  
Systematic Review ◽  
Medical Students ◽  
Suicidal Ideation ◽  
Meta Analysis ◽  
Evidence Base ◽  
Current Evidence ◽  
Study Selection ◽  
Medical Education And Training ◽  
Current Evidence Base ◽  
Anxiety Depression

QuestionA growing body of work suggests that medical students may be particularly at risk of mental ill health, suicidal ideation and behaviour, resulting in recent calls to develop interventions to prevent these outcomes. However, few reviews have synthesised the current evidence base regarding the effectiveness of these interventions and provided guidance to improve future intervention efforts.Study selection and analysisThe authors conducted a systematic review to identify studies of any design reporting the effectiveness of any universal intervention to address these outcomes in medical students. Embase, MEDLINE and PsycINFO databases were searched from their respective start dates until 1 December 2017.FindingsData from 39 studies were included. Most investigated the effectiveness of relatively brief interventions designed to reduce stress; most commonly using mindfulness-based or guided meditation approaches. Only one implemented an intervention specifically designed to address suicidal ideation; none investigated the effectiveness of an intervention specifically designed to address suicidal behaviour. Five investigated the effects of curriculum-level changes. Overall, there was limited evidence of an effect for these programmes at both the postintervention and longest follow-up assessment on depression, anxiety and stress.ConclusionsRelatively brief, individually focused, mindfulness-based interventions may be effective in reducing levels of anxiety, depression and stress in medical students in the short term. Effects on suicidal ideation and behaviour, however, remain to be determined. There has been a significant lack of attention on organisational-level stressors associated with medical education and training.

scholarly journals A review of vitamin D status and CVD

2013 ◽  
Vol 73 (1) ◽  
pp. 65-72 ◽  
Author(s):  
Kevin D. Cashman
Keyword(s):  
Vitamin D ◽  
Meta Analysis ◽  
Analysis Data ◽  
Evidence Base ◽  
Causal Link ◽  
Current Evidence ◽  
Vitamin D Status ◽  
Cvd Risk ◽  
Increased Risk ◽  
Current Evidence Base

Beyond the well-accepted effects on the skeleton, low vitamin D status has been linked to increased risk of several non-skeletal disease, including CVD. If low serum 25-hydroxyvitamin D (25(OH)D) concentration is causally linked to risk of CVD then this is important not only because low vitamin D status is quite common particularly in winter in countries above 40°N, but also of key relevance is the fact that such low vitamin D status can be improved by food-based strategies. The overarching aim of the present paper is to review the current evidence-base to support a link between low vitamin D status and CVD risk. The review initially briefly overviews how mechanistically vitamin D may play a role in CVD and then reviews the current available evidence-base to support a link between low vitamin D status and CVD risk, with particular emphasis on data from the randomised control trials, cohort studies and recent meta-analysis data as well as to the conclusions of a number of authoritative agencies/bodies. Finally, the review summarises current serum 25(OH)D concentrations within a select number of adult populations in the context of different definitions of vitamin D status proposed recently, and then briefly highlights food-based strategies for increasing vitamin D intake and status. In conclusion, at present the data for a causal link between low vitamin D status and CVD are mixed and ambiguous; however, should causality be affirmed by ongoing and future studies, there are food-based strategies for enhanced vitamin D status in the population which could ultimately lower risk of CVD.

scholarly journals The Welsh Government Flying Start Data Linking Project

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Laura Herbert ◽  
Tony Whiffen ◽  
Sarah Lowe ◽  
Craiger Solomons
Keyword(s):  
Health Education ◽  
School Attendance ◽  
Evidence Base ◽  
Early Years ◽  
Current Evidence ◽  
Special Educational Needs ◽  
Parenting Support ◽  
Individual Level ◽  
Current Evidence Base ◽  
The Impact

Background with rationale Flying Start is the Welsh Government’s (WG) flagship Early Years programme for families with children aged less than 4 years of age. Running since 2006, the four entitlements are: Enhanced Health Visiting Free part-time childcare for 2-3 year olds Parenting support Speech, language, and communication support Previous Flying Start evaluations have focused on area-based analysis to explore outcomes of Flying Start eligible children. The current project is the first to obtain individual level Flying Start data to look at outcomes around health, education and social care and to explore these outcomes in relation to levels of engagement with different entitlements of Flying Start. Main Aim The aim of the project is to link individual-level Flying Start intervention data with health, education and other data to investigate the potential impact of Flying Start. Methods/Approach Individual level data for Flying Start children is currently being obtained from six pilot Local Authorities in Wales using the Secure Anonymised Information Linkage (SAIL) databank. The Flying Start data will be linked to other data within the SAIL databank in order to investigate the impact of the Flying Start programme on a number of different outcomes including hospitalisations, Accident & Emergency (A&E) attendances, Primary Care interactions, educational attainment, school attendance and Special Educational Needs (SEN). Results The project will report on the emerging findings from the analysis of pilot data. It is anticipated that Flying Start dosage effects will also be investigated and reported on. Conclusion The findings will feed into the current evidence base for Flying Start and help to inform future policy-making. If successful, this model of evaluation is likely to be adopted by related WG programmes.

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