Norepinephrine and Vasopressin Compared With Norepinephrine and Epinephrine in Adults With Septic Shock

2019 ◽  
Vol 53 (9) ◽  
pp. 877-885 ◽  
Author(s):  
Bryan E. Menich ◽  
Todd A. Miano ◽  
Gourang P. Patel ◽  
Drayton A. Hammond
Keyword(s):  
Septic Shock ◽  
Propensity Score ◽  
Propensity Scores ◽  
Variance Estimation ◽  
Mortality Rates ◽  
Matched Cohort ◽  
Free Survival ◽  
Entire Cohort ◽  
Robust Variance ◽  
Robust Variance Estimation

Background: The optimal adjuvant vasopressor to norepinephrine in septic shock remains controversial. Objective: To compare durations of shock-free survival between adjuvant vasopressin and epinephrine. Methods: A retrospective, single-center, matched cohort study of adults with septic shock refractory to norepinephrine was conducted. Patients receiving norepinephrine not at target mean arterial pressure (MAP; 65 mm Hg) were initiated on vasopressin or epinephrine to raise MAP to target. Vasopressin-exposed patients were matched to epinephrine-exposed patients using propensity scores. Mortality outcomes were examined using multivariable Poisson regression with robust variance estimation. Results: Of 166 patients, 96 (entire cohort) were included in the propensity score–matched cohort. Shock-free survival durations in the first 7 days were similar between epinephrine- and vasopressin-exposed patients in the matched cohort (median = 13.2 hours, interquartile range [IQR] = 0-121.0, vs median = 41.3 hours, IQR = 0-125.9; P = 0.51). Seven- and 28-day mortality rates were similar in the matched cohort (7-day: 47.9% vs 39.6%, P = 0.35; 28-day: 56.3% vs 58.3%, P = 0.84). Mortality rates were similar between epinephrine- and vasopressin-exposed patients in propensity score–matched regression models with and without adjustments at 7 (relative risk [RR] = 1.28, 95% CI = 0.92-1.79; RR = 1.21, 95% CI = 0.81-1.81) and 28 days (RR = 1.04, 95% CI = 0.81-1.34; RR = 0.96, 95% CI = 0.69-1.34). Conclusion and Relevance: Shock-free survival durations were similar in matched epinephrine- and vasopressin-exposed groups. Adjuvant epinephrine or vasopressin alongside norepinephrine to raise MAP to target requires further investigation.

Listening Ears or Reading Eyes: A Meta-Analysis of Reading and Listening Comprehension Comparisons

2021 ◽  
pp. 003465432110608
Author(s):  
Virginia Clinton-Lisell
Keyword(s):  
Listening Comprehension ◽  
Variance Estimation ◽  
Meta Analysis ◽  
Age Groups ◽  
Robust Variance ◽  
Reading Condition ◽  
P 16 ◽  
Robust Variance Estimation ◽  
Literal Comprehension

In this study, a meta-analysis of reading and listening comprehension comparisons across age groups was conducted. Based on robust variance estimation (46 studies; N = 4,687), the overall difference between reading and listening comprehension was not reliably different (g = 0.07, p = .23). Reading was beneficial over listening when the reading condition was self-paced (g = 0.13, p = .049) rather than experimenter-paced (g = −0.32, p = .16). Reading also had a benefit when inferential and general comprehension rather than literal comprehension was assessed (g = 0.36, p = .02; g = .15, p = .05; g = −0.01, p = .93, respectively). There was some indication that reading and listening were more similar in languages with transparent orthographies than opaque orthographies (g = 0.001, p = .99; g = 0.10, p = .19, respectively). The findings may be used to inform theories of comprehension about modality influences in that both lower-level skill and affordances vary comparisons of reading and listening comprehension. Moreover, the findings may guide choices of modality; however, both audio and written options are needed for accessible instruction.

Effect of the Timing of Frozen Embryo Transfer on Pregnancy Outcomes in High Ovarian Response Patients Undergoing Freeze-All Strategy

2020 ◽  
Author(s):  
Na Zuo ◽  
Yingzhuo Gao ◽  
Ningning Zhang ◽  
Da Li ◽  
Xiuxia Wang
Keyword(s):  
Propensity Score ◽  
Embryo Transfer ◽  
Subgroup Analysis ◽  
Pregnancy Outcomes ◽  
Ovarian Response ◽  
Frozen Embryo Transfer ◽  
Matched Cohort ◽  
Entire Cohort ◽  
Long Acting ◽  
Long Protocol

Abstract Background: Frozen embryo transfer (FET) can greatly improve the pregnancy outcomes for high ovarian response (HOR) population. However, it is not known whether the impaired endometrial receptivity derived from controlled ovarian hyperstimulation (COH) can be fully recovered in the first menstrual cycle after oocyte retrieval, and whether the timing of FET is a risk factor on pregnancy outcomes in HOR population undergoing freeze-all strategy.Methods: A retrospective cohort study to compare the pregnancy outcomes of the immediate and delayed FET groups in HOR population undergoing freeze-all strategy. Propensity score matching was used to make the potential risk factors of the immediate and delayed FET groups comparable. Multivariable regression analysis was used to study the effect of the timing of FET on pregnancy outcomes in the entire cohort and propensity score-matched cohort, even in different COH protocol cohorts as subgroup analysis.Results: We showed that the immediate FET group were no worse than delayed FET group in the entire cohort [clinical pregnancy rate (CPR), adjusted odd ratio (OR), 0.942, 95% confidence interval (CI), 0.784-1.133; spontaneous abortion rate (SAR), adjusted OR, 1.118, 95% Cl (0.771-1.623); live birth rate (LBR), adjusted OR, 1.060, 95% Cl (0.886-1.267)]. The same results were obtained by χ2 test in the propensity score-matched cohort (CPR, 60.5% versus 63.5%; SAR, 11.6% versus 12.3%; LBR, 48% versus 49.3%) (P > 0.05). Subgroup analysis indicated that pregnancy outcomes of immediate FET were non-inferior to delayed FET in short-acting gonadotropin-releasing hormone agonist (GnRH-a) long protocol (P > 0.05). The SAR of the immediate FET group were lower than that of the delayed FET group in GnRH antagonist protocol (adjusted OR, 0.646, 95% CI, 0.432-0.966) and long-acting GnRH-a long protocol (adjusted OR, 0.375, 95% CI, 0.142-0.990) (P < 0.05), no differences were observed in CPR and LBR (P > 0.05).Conclusions: These findings indicate that immediate FET might not affect pregnancy outcomes in HOR patients undergoing freeze-all strategy. Delaying FET could increase the SAR in GnRH-ant and long-acting GnRH-a long protocols.

scholarly journals Meta-Analysis with Robust Variance Estimation: Expanding the Range of Working Models

2020 ◽  
Author(s):  
James E Pustejovsky ◽  
Elizabeth Tipton
Keyword(s):  
Variance Estimation ◽  
Meta Analysis ◽  
Estimation Methods ◽  
Single Type ◽  
Dependence Structure ◽  
Dependent Effect ◽  
Working Models ◽  
Robust Variance ◽  
Robust Variance Estimation ◽  
Meta Regression

In prevention science and related fields, large meta-analyses are common, and these analyses often involve dependent effect size estimates. Robust variance estimation (RVE) methods provide a way to include all dependent effect sizes in a single meta-regression model, even when the nature of the dependence is unknown. RVE uses a working model of the dependence structure, but the two currently available working models are limited to each describing a single type of dependence. Drawing on flexible tools from multivariate meta-analysis, this paper describes an expanded range of working models, along with accompanying estimation methods, which offer benefits in terms of better capturing the types of data structures that occur in practice and improving the efficiency of meta-regression estimates. We describe how the methods can be implemented using existing software (the ‘metafor’ and ‘clubSandwich’ packages for R) and illustrate the approach in a meta-analysis of randomized trials examining the effects of brief alcohol interventions for adolescents and young adults.

P5002The impact of diabetes mellitus on global longitudinal strain of patients with acute heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Kwak ◽  
I.-C Hwang ◽  
J.-J Park ◽  
J.-H Park ◽  
G.-Y Cho ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Propensity Score ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
P Value ◽  
Matched Cohort ◽  
Entire Cohort ◽  
The Impact

Abstract Introduction Diabetes mellitus (DM) aggravates the clinical features and the prognosis of heart failure (HF) patients. However, the impact of DM on the ventricular systolic function of HF patients is not well delineated. Purpose The present study aimed to investigate the impact of DM on HF, regarding the systolic function presented by the global longitudinal strain (GLS). Methods In 4312 patients with acute HF, left ventricle (LV) and right ventricle (RV) GLS were acquired by speckle-tracking echocardiography. HF patients with DM were compared to those without DM from the entire cohort (n=4312), as well as the propensity-score matched cohort (n=3034). Results Our cohort consisted of 1750 DM patients (40.6%). Both LV-GLS and LVEF were significantly lower within the patients with DM (10.1±4.8% vs. 11.3±5.1%, p<0.001 for LV-GLS; 39.1±15.5% vs. 41.7±15.6%, p<0.001 for LVEF) in the entire cohort. In the propensity-score matched cohort, LV-GLS was significantly reduced in the patients with DM compared to those without DM (10.2±4.9% vs. 10.9±5.0%, p<0.001), even with the matched LVEF (Table 1). Decreased LV-GLS in the DM patients was consistently identified in both subgroups of preserved EF and reduced EF (Table 1). Although RV-GLS was slightly lower in the patients with DM from the matched cohort, it was not significant in neither the preserved EF nor the reduced EF subgroup. When comparing the adverse outcome in the propensity-score matched cohort, the survival of patients with DM was significantly lower (Figure 1-A, 1-B), except for the preserved EF group (Figure 1-C). Comparison between heart failure patients with and without diabetes in the matched cohort Matched cohort p-value HFrEF (matched) p-value HFpEF (matched) p-value No-DM (n=1517) DM (n=1517) No-DM (n=823) DM (n=801) No-DM (n=652) DM (n=669) Age, years 71±14 71±11 0.962 69±14 70±11 0.305 75±11 74±10 0.061 Ischemic heart disease, n (%) 545 (35) 575 (37) 0.275 375 (36) 402 (39) 0.238 150 (34) 147 (34) 0.945 GFR, mL/min/1.73m2 56±27 55±27 0.282 58±28 56±27 0.253 54±27 54±26 1.000 HbA1C, % 5.7±0.4 7.3±1.4 <0.001 5.7±0.4 7.3±1.4 <0.001 5.7±0.4 7.2±1.4 <0.001 LV ejection fraction, % 39±15 39±15 0.871 31±9 31±10 0.99 59±5 59±6 0.279 LV-GLS, % 10.9±5.0 10.2±4.9 <0.001 9.1±3.8 8.3±3.6 <0.001 15.5±4.5 14.9±4.5 0.036 RV-GLS, % 13.1±6.5 12.7±6.2 0.045 12.1±6.2 11.8±5.9 0.188 15.6±6.5 15.0±6.4 0.157 Figure 1. Outcome by DM status Conclusions DM is associated with the impaired LV systolic function presented by GLS in HF patients, even with the adjustment of LVEF. The result indicates that GLS is a more sensitive marker of systolic function than LVEF, in terms of the DM status among the HF patients.

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