scholarly journals The Impact of Chromothripsis on the Clinical Outcomes of Acute Myeloid Leukemia (AML): A Meta-Analysis

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 34-34
Author(s):  
Philip A Haddad ◽  
Dalia Hammoud ◽  
Kevin M. Gallagher
Keyword(s):  
Clinical Outcomes ◽  
English Language ◽  
Conflicts Of Interest ◽  
Meta Analysis ◽  
Response Rates ◽  
Kaplan Meier ◽  
Online Databases ◽  
Inverse Variance ◽  
Aggressive Clinical Course ◽  
The Impact

Introduction: Chromothripsis is a single genomic catastrophic event that can involve one or several chromosomes resulting in chromosomal fragmentation. Genomic instability leading to loss of chromosomes and complex karyotype is known to be associated with resistance to chemotherapy and poor prognosis in AML. While chromothripsis is associated with aggressive clinical course in various cancers, its impact on AML clinical outcomes has not been consistently conclusive. The purpose of this meta-analysis is to evaluate the pooled effect of chromothripsis on the response rates and overall survival of patients with AML. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of AML diagnosis, English language, and studies reporting OS with hazard ratios (HR) or Kaplan-Meier curves that compared AML outcomes with and without chromothripsis. A meta-analysis using an inverse variance method with a random-effects model was conducted. Results: Two comparative studies with a total of 444 patients were included in this meta-analysis. In the presence of chromothripsis OS was adversely impacted (HR 1.78, 95%CI: 1.05-3.01, p=0.03) with a heterogeneity estimate, I2=40%. Moreover, response rates were significantly lower in AML cases with chromothripsis versus those without (19% vs. 62%, p<0.05). Conclusions: This meta-analysis confirms the adverse impact of chromothripsis on response rates and OS of patients with AML. Disclosures No relevant conflicts of interest to declare.

scholarly journals RADT-37. THE IMPACT OF POSTOPERATIVE RADIATION THERAPY (PORT) AND EXTENT OF SURGERY ON CLINICAL OUTCOMES OF ATYPICAL MENINGIOMA (AM): A META-ANALYSIS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii189-ii189
Author(s):  
Philip Haddad ◽  
Furqan Akhtar ◽  
Kevin Gallagher
Keyword(s):  
Clinical Outcomes ◽  
Comparative Studies ◽  
English Language ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Subtotal Resection ◽  
Recurrence Rates ◽  
Postoperative Radiation Therapy ◽  
Extent Of Surgery ◽  
The Impact

Abstract BACKGROUND Although meningiomas are among the most prevalent types of brain tumors, AMs account for around 4% of all meningiomas. AMs tend to be more aggressive with relatively higher rates of recurrence and mortality. Gross total resection (GTR) has been the standard of care when possible. However, GTR itself is not always enough to prevent the recurrence of AMs. The role of PORT remains controversial in AM as the comparative studies to support its use have provided conflicting RESULTS: The purpose of this meta-analysis is to evaluate the impact of PORT on clinical outcomes according to the extent of resection in AMs. METHODS A review of the medical literature was conducted using online databases. Inclusion criteria consisted of AM diagnosis, English language, Simpson graded resections, and comparative studies reporting recurrence rates (RcR), Progression-Free Survival (PFS), and Overall Survival (OS) with hazard ratios (HR) or Kaplan-Meier curves. A meta-analysis was conducted using an inverse variance method with a random-effects model. RESULTS Twenty-two comparative studies with a total of 5,129 patients were included and analyzed. When GTR was attained, PORT was associated with improved RcR (HR =0.72, 95%CI:0.59-0.86) and PFS (HR=0.77, 95%CI:0.65-0.90), but not OS (HR=0.93, 95%CI:0.83-1.04). When subtotal resection (STR) was attained, PORT was associated with improved PFS (HR=0.35, 95%CI:0.26-0.48) as well as OS (HR=0.70, 95%CI:0.54-0.89). The extent of surgery also impacted AM outcomes as GTR demonstrated superior PFS (HR=0.45, 95%CI:0.31-0.65) and OS (HR=0.30, 95%CI:0.13-0.72). CONCLUSIONS This is the first meta-analysis to show that PORT is associated with PFS benefit in AMs with GTR and STR. Moreover, PORT significantly improved OS of AMs that underwent STR but had no impact on OS when GTR was achieved. In the absence of randomized clinical trials, this meta-analysis represents the most compelling data supporting the use of PORT in this patient population.

Postoperative radiation therapy (PORT) impact on clinical outcomes of resected atypical meningioma: A meta-analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2570-2570
Author(s):  
Kevin M. Gallagher ◽  
furqan akhtar ◽  
Philip A. Haddad
Keyword(s):  
Clinical Outcomes ◽  
Comparative Studies ◽  
English Language ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Subtotal Resection ◽  
Recurrence Rates ◽  
Postoperative Radiation Therapy ◽  
The Impact

2570 Background: Although meningiomas are among the most prevalent types of brain tumors, atypical meningiomas (AM) account for around 4% of all meningiomas. AMs tend to be more aggressive with relatively higher rates of recurrence and mortality. Gross total resection (GTR) has been the standard of care when possible. However, GTR itself is not always enough to prevent recurrence of AMs. The role of PORT remains controversial in AM as the comparative studies to support its use have provided conflicting results. The purpose of this meta-analysis is to evaluate the impact of PORT on clinical outcomes in resected AMs. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of (i) AM diagnosis, (ii) English language, (iii) Simpson graded resections, and (iv) comparative studies reporting recurrence rates (RcR), Progression Free Survival (PFS), and Overall Survival (OS) with hazard ratios (HR) or Kaplan-Meier curves. A meta-analysis was conducted using an inverse variance method with random-effects model. Results: Twenty-two comparative studies with a total of 5,129 patients were included and analyzed. When GTR was attained, PORT was associated with improved RcR (HR = 0.72, 95%CI:0.59-0.86) and PFS (HR = 0.77, 95%CI:0.65-0.90), but not OS (HR = 0.93, 95%CI:0.83-1.04). When subtotal resection (STR) was attained, PORT was associated with improved PFS (HR = 0.35, 95%CI:0.26-0.48) as well as OS (HR = 0.70, 95%CI:0.54-0.89). Conclusions: This is the first meta-analysis to show that PORT is associated with PFS benefit in AMs with GTR and STR. Moreover, PORT significantly improved OS of AMs that underwent STR but had no impact on OS when GTR was achieved. In the absence of randomized clinical trials, this meta-analysis represents the most compelling data supporting the use of PORT in this patient population.

scholarly journals Enteral immunonutrition versus enteral nutrition for patients undergoing oesophagectomy: a systematic review and meta-analysis

2020 ◽  
Vol 30 (6) ◽  
pp. 854-862 ◽  
Author(s):  
Xiao-Kun Li ◽  
Hai Zhou ◽  
Yang Xu ◽  
Zhuang-Zhuang Cong ◽  
Wen-Jie Wu ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Clinical Outcomes ◽  
English Language ◽  
Early Stage ◽  
Meta Analysis ◽  
Mean Difference ◽  
Cochrane Library ◽  
P Value ◽  
Standard Mean Difference ◽  
The Impact

Abstract OBJECTIVES According to retrospective studies, oesophageal carcinoma is the second deadliest gastrointestinal cancer after gastric cancer. Enteral immunonutrition (EIN) has been increasingly used to enhance host immunity and relieve the inflammatory response of patients undergoing oesophagectomy; however, conclusions across studies remain unclear. We aimed to evaluate the effect of EIN on the clinical and immunological outcomes of patients undergoing oesophagectomy. METHODS Four electronic databases (MEDLINE, Embase, Web of Science and Cochrane Library) were used to search articles in peer-reviewed, English-language journals. The mean difference, relative risk or standard mean difference with 95% confidence interval were calculated. Heterogeneity was assessed by the Cochran’s Q test and I2 statistic combined with the corresponding P-value. The analysis was carried out with RevMan 5.3. RESULTS Six articles were finally included, with a total of 320 patients with oesophageal cancer. The meta-analysis results showed that EIN did not improve clinical outcomes (such as infectious complications, pneumonia, surgical site infection, anastomotic leak and postoperative hospital stay) or immune indices [referring to C-reactive protein, interleukin (IL)-6, IL-8, tumour necrosis factor-α]. Descriptive analysis suggested that EIN also increased the serum concentrations of IgG and the percentage of the B-cell fraction. Thus, its impact on IL-8 and IL-6 remains inconsistent. CONCLUSIONS The early-stage impact of EIN on immunological status in patients undergoing oesophagectomy is still unclear. According to the results of this meta-analysis, whether EIN could improve the clinical outcomes or biological status after oesophagectomy compared to standard enteral nutrition is uncertain. Since the impact of EIN is unclear, current guidelines that strongly advise the use of EIN should be changed, as the utility of EIN is very uncertain. More appropriately powered clinical studies are warranted to confirm its effectiveness.

Vulnerability of medical students and professionals to extreme work stress: A select review of the literature

2018 ◽  
Vol 14 (2) ◽  
pp. 181-187
Author(s):  
Maciej Walkiewicz ◽  
Małgorzata Tartas
Keyword(s):  
Medical Students ◽  
Work Stress ◽  
English Language ◽  
Psychological Intervention ◽  
Medical Professionals ◽  
Extreme Stress ◽  
Online Databases ◽  
Medical Career ◽  
Medical University ◽  
The Impact

The goal of the paper is to describe the extent to which medical students and professionals are vulnerable to extreme stress. A select review of existing literature on this area has been undertaken, using the English-language online databases EBSCO, Medline and PubMed. The search has identified 36 citations relating to 6324 medical students and 28,285 medical staff (physicians, residents, nurses). The review indicates that merely beginning medical studies is a risk factor for stress, and that medical professionals, who are vulnerable to extreme work stress, say that they do not receive enough support from their co-workers. They are also often notably impulsive, introverted, neurotic and perfectionist, with low emotional intelligence and agreeableness, as well as low and external locus of control. Additionally, from longitudinal studies we have been able to identify psychological factors underpinning admission to a medical university that may be useful for predicting future stress in medical career. The results of this study may be taken into account when organizing psychological intervention programs targeted at educating future medical professionals. It seems that early identification of people at risk could reduce the impact of stress related to medical career and enhance the somatic and mental health of medical professionals.

scholarly journals Effect of prior cancer on survival outcomes for patients with advanced prostate cancer

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yechen Wu ◽  
Xi Chen ◽  
Duocheng Qian ◽  
Wei Wang ◽  
Yiping Zhang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Outcomes ◽  
Cancer Diagnosis ◽  
Advanced Prostate Cancer ◽  
Lymphocytic Leukemia ◽  
Cancer History ◽  
Non Hodgkin Lymphoma ◽  
Kaplan Meier ◽  
History Of ◽  
The Impact

Abstract Background A history of prior cancer commonly results in exclusion from cancer clinical trials. However, whether a prior cancer history has an adversely impact on clinical outcomes for patients with advanced prostate cancer (APC) remains largely unknown. We therefore aimed to investigate the impact of prior cancer history on these patients. Methods We identified patients with advanced prostate cancer diagnosed from 2004 to 2010 in the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was used to balance baseline characteristics. Kaplan–Meier method and the Cox proportional hazard model were utilized for survival analysis. Results A total of 19,772 eligible APC patients were included, of whom 887 (4.5 %) had a history of prior cancer. Urinary bladder (19 %), colon and cecum (16 %), melanoma of the skin (9 %) malignancies, and non-hodgkin lymphoma (9 %) were the most common types of prior cancer. Patients with a history of prior cancer had slightly inferior overall survival (OS) (AHR = 1.13; 95 % CI [1.02–1.26]; P = 0.017) as compared with that of patients without a prior cancer diagnosis. Subgroup analysis further indicated that a history of prior cancer didn’t adversely impact patients’ clinical outcomes, except in patients with a prior cancer diagnosed within 2 years, at advanced stage, or originating from specific sites, including bladder, colon and cecum, or lung and bronchus, or prior chronic lymphocytic leukemia. Conclusions A large proportion of APC patients with a prior cancer history had non-inferior survival to that of patients without a prior cancer diagnosis. These patients may be candidates for relevant cancer trials.

scholarly journals Associations of Sedentary Time with Heart Rate and Heart Rate Variability in Adults: A Systematic Review and Meta-Analysis of Observational Studies

2021 ◽  
Vol 18 (16) ◽  
pp. 8508
Author(s):  
Abdullah Bandar Alansare ◽  
Lauren C. Bates ◽  
Lee Stoner ◽  
Christopher E. Kline ◽  
Elizabeth Nagle ◽  
...  
Keyword(s):  
Systematic Review ◽  
Heart Rate ◽  
English Language ◽  
Sedentary Time ◽  
Meta Analysis ◽  
Qualitative Synthesis ◽  
Cross Sectional ◽  
Inverse Variance ◽  
Observational Design ◽  
Substantial Heterogeneity

Purpose: To evaluate if sedentary time (ST) is associated with heart rate (HR) and variability (HRV) in adults. Methods: We systematically searched PubMed and Google Scholar through June 2020. Inclusion criteria were observational design, humans, adults, English language, ST as the exposure, resting HR/HRV as the outcome, and (meta-analysis only) availability of the quantitative association with variability. After qualitative synthesis, meta-analysis used inverse variance heterogeneity models to estimate pooled associations. Results: Thirteen and eight articles met the criteria for the systematic review and meta-analysis, respectively. All studies were cross-sectional and few used gold standard ST or HRV assessment methodology. The qualitative synthesis suggested no associations between ST and HR/HRV. The meta-analysis found a significant association between ST and HR (β = 0.24 bpm per hour ST; CI: 0.10, 0.37) that was stronger in males (β = 0.36 bpm per hour ST; CI: 0.19, 0.53). Pooled associations between ST and HRV indices were non-significant (p > 0.05). Substantial heterogeneity was detected. Conclusions: The limited available evidence suggests an unfavorable but not clinically meaningful association between ST and HR, but no association with HRV. Future longitudinal studies assessing ST with thigh-based monitoring and HRV with electrocardiogram are needed.

scholarly journals Impact of remdesivir on 28 day mortality in hospitalized patients with COVID-19: February 2021 Meta-analysis

2021 ◽  
Author(s):  
Robert Robinson ◽  
Vidhya Prakash ◽  
Raad Al Tamimi ◽  
Nour Albast ◽  
Basma Al-Bast ◽  
...  
Keyword(s):  
Usual Care ◽  
English Language ◽  
Meta Analysis ◽  
Severity Of Illness ◽  
Hospitalized Patients ◽  
Randomized Controlled ◽  
Analysis Process ◽  
All Cause Mortality ◽  
The Impact

AbstractBackgroundThe COVID-19 pandemic has stimulated worldwide investigation into a myriad of potential therapeutic agents, including antivirals such as remdesivir. The first RCT reporting results on the impact of remdesivir on COVID-19 in a peer reviewed journal was the ACTT-1 trial published in November, 2020. The ACTT-1 trial showed more rapid clinical improvement and a reduced risk of 28-day mortality in patients who received remdesivir.This study is a meta-analysis of peer reviewed RCTs aims to estimate the association of remdesivir therapy compared to the usual care or placebo on all-cause mortality in hospitalized patients with COVID-19. Software based tools to accelerate the analysis process.MethodsMeta-analysis of peer reviewed RCTs comparing remdesivir to usual care or placebo. The protocol for this meta-analysis was registered and published in the PROSPERO database (CRD42021229985) on February 5, 2021.ResultsFour English language RCTs were identified, including data from 7,333 hospitalized patients worldwide using remdesivir in COVID-19 positive patients.Meta-analysis of all identified RCTs showed no difference in survival in patients who received remdesivir therapy compared to usual care or placebo. The random effects meta-analysis has a summary odd ratio is 0.89 (95% CI 0.65-1.21, p = 0.30). Considerable variability in the severity of illness is noted with the rates of IMV at the time of randomization ranging from 0% to 27%.ConclusionsThis meta-analysis of randomized controlled trials published in peer-reviewed literature by February 1, 2021 did not show reduced mortality in hospitalized patients with COVID-19 who received remdesivir. Further research is needed to clarify the role of remdesivir therapy in the management of COVID-19.

scholarly journals Intangible assets in the process of internationalization

2020 ◽  
Vol 56 (1) ◽  
pp. 63-78
Author(s):  
Łukasz Bryl
Keyword(s):  
English Language ◽  
Intangible Assets ◽  
Meta Analysis ◽  
Strong Relationship ◽  
Valuable Insight ◽  
Internationalization Process ◽  
Journal Articles ◽  
Employee Education ◽  
Current State ◽  
Online Databases

AbstractThe aim of this article is to determine the current state of impact of various forms of intangible assets on the internationalization process. For the purpose of the paper meta-analysis was adopted as a method of the study. English-language peer-reviewed journal articles were analyzed only with the help of: EBSCOhost, ScienceDirect, Emerald, JSTOR, ProQuest and Wiley Online databases. The search was aimed at newest papers (after 2012), however some older articles (with regard to their value) were included in the analysis as well. Based on the conducted analysis, there was observed a significant and positive link between the level of employee education and internationalization probability and extent. The effect of the wages on internationalization is stage dependent. Under certain assumptions there is a positive and strong relationship between R&D intensity and internationalization. Advertising spending do not foster the process of internationalization. The practical contribution of this research is twofold. First, it provides valuable insight for practitioners which intangible assets and how foster various modes of the internationalization process. Second, it describes upon which conditions the interrelation between firm intangible assets and internationalization is significant and positive.

scholarly journals What Is the Impact of Ambulatory Vital Sign Monitoring on Deterioration Detection and Related Clinical Outcomes in Hospitalised Patients: a Systematic Review and Meta-analysis.

2021 ◽  
Author(s):  
Carlos Morgado Areia ◽  
Christopher Biggs ◽  
Mauro Santos ◽  
Neal Thurley ◽  
Stephen Gerry ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Standard Care ◽  
Meta Analysis ◽  
Ambulatory Monitoring ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Monitoring Systems ◽  
Hospitalised Patients ◽  
The Impact

Abstract Background: Timely recognition of the deteriorating inpatient remains challenging. Ambulatory monitoring systems (AMS) may augment current monitoring practices. However, there are many challenges to implementation in the hospital environment, and evidence describing the clinical impact of AMS on deterioration detection and patient outcome remains unclear. Objective: To assess the impact of vital signs monitoring on detection of deterioration and related clinical outcomes in hospitalised patients using ambulatory monitoring systems, in comparison with standard care.Methods: A systematic search was conducted in August 2020 using MEDLINE, Embase, CINAHL, Cochrane Database of Systematic Reviews, CENTRAL and Health Technology Assessment databases, as well as grey literature. Studies comparing the use of AMS against standard care for deterioration detection and related clinical outcomes in hospitalised patients were included. Deterioration related outcomes (primary) included unplanned intensive care admissions, rapid response team or cardiac arrest activation, total and major complications rate. Other clinical outcomes (secondary) included in-hospital mortality and hospital length of stay. Exploratory outcomes included alerting system parameters and clinical trial registry information. Results: Of 8706 citations, 10 studies with different designs met the inclusion criteria, of which 7 were included in the meta-analyses. Overall study quality was moderate. The meta-analysis indicated that the AMS, when compared with standard care, was associated with a reduction in intensive care transfers (risk ratio, RR, 0.87; 95% confidence interval, CI, 0.66 to 1.15), rapid response or cardiac arrest team activation (RR, 0.84; 95% CI 0.69 to 1.01), total (RR, 0.77; 95% CI 0.44 to 1.32) and major (RR, 0.55; 95% CI 0.24 to 1.30) complications prevalence. There was also association with reduced mortality (RR, 0.48; 95% CI 0.18 to 1.29) and hospital length of stay (mean difference, MD, -0.09; 95% CI -0.43 to 0.44). However, none were statistically significant.Conclusion: This systematic review indicates that implementation of AMS may have a positive impact on early deterioration detection and associated clinical outcomes, but differing design/quality of available studies and diversity of outcomes measures limits a definite conclusion. Our narrative findings suggested that alarms should be adjusted to minimise false alerts and promote rapid clinical action in response to deterioration.PROSPERO Registration number: CRD42020188633

scholarly journals Chinese Herbal Medicine (“3 Medicines and 3 Formulations”) for COVID-19: Rapid Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Xiao-Yang Hu ◽  
Yangzihan Wang ◽  
Junqiao Chen ◽  
Trisha Greenhalgh ◽  
Jon Wardle
Keyword(s):  
Systematic Review ◽  
Herbal Medicine ◽  
Disease Severity ◽  
Chinese Herbal Medicine ◽  
English Language ◽  
Meta Analysis ◽  
Chinese Herbal ◽  
Clinical Trial Registries ◽  
Inverse Variance ◽  
Secondary Outcomes

Abstract Background: To evaluate the evidence behind claims that Chinese Herbal Medicine, specifically “three medicines and three formulations” (3M3F, comprising Jinhua Qinggan, Lianhua Qingwen, Xuebijing, Qingfei Paidu, Huashi Baidu and Xuanfei Baidu), is an effective treatment for COVID-19. Methods: We searched PubMed, MEDLINE and CNKI databases, preprint servers, clinical trial registries and supplementary sources for Chinese- or English-language randomised trials or non-randomised studies with comparator groups, which tested the constituents of 3M3F in the treatment of COVID-19 up to September 2020. Primary outcome was change in disease severity. Secondary outcomes included various symptoms. Meta-analysis (using generic inverse variance random effects model) was performed when there were two or more studies reporting on the same symptom. Results: Of 607 articles identified, thirteen primary studies (six RCTs and seven retrospective non-randomised comparative studies) with 1467 participants met our final inclusion criteria. Studies were small and had significant methodological limitations, most notably potential bias in assessment of outcomes. No study convincingly demonstrated a statistically significant impact on change in disease severity. Eight studies reported sufficiently similar secondary outcomes to be included in a meta-analysis. Some statistically significant impacts on symptoms, chest CT manifestations, laboratory variables and length of stay were demonstrated, but such findings were sparse and many remain unreplicated.Conclusions: These findings neither support nor refute the claim that 3M3F alters the severity of COVID-19 or alleviates symptoms. More rigorous studies are required to properly ascertain the potential role of Chinese Herbal Medicine in COVID-19.Systematic review registration: This review was registered on PROSPERO (CRD42020187502) prior to data collection and analysis.

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