scholarly journals Abordagem aos Doentes com Intolerância às Estatinas: Revisão Baseada na Evidência

2020 ◽  
Vol 33 (1) ◽  
pp. 49 ◽  
Author(s):  
Joana Tendais Almeida ◽  
Ana Luísa Esteves ◽  
Filipa Martins ◽  
Isabel Palma
Keyword(s):  
Systematic Reviews ◽  
Patient Adherence ◽  
Management Strategies ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Level Of Evidence ◽  
Mortality And Morbidity ◽  
Number Of Patients ◽  
Pubmed Database ◽  
Meta Analyses

Introduction: Statins are among the most effective drugs in lowering cholesterol levels and, consequently, in reducing cardiovascular mortality and morbidity. Although generally well tolerated, they have adverse effects that may reduce patient adherence to therapy. The objective of this evidence-based review is to summarize the evidence on the effectiveness of alternative management strategies in patients with intolerance to statins.Material and Methods: A literature search including clinical practice guidelines, systematic reviews and meta-analyses was conducted, in January 2017, in major international databases, and considered articles published in the last 10 years. The search was complemented with research papers published over the past three years and found in the PubMed database. The level of evidence and strength of recommendation were determined using the scale Strength of Recommendation Taxonomy - SORT.Results: We included eight guidelines, six systematic reviews and one research paper.Discussion: The strategies proposed by the different studies vary according to the severity of symptoms of intolerance including maintenance of the statin therapy (dose reduction, addition of a statin of equal or lower intensity or alternate days’ uptake) and lipid-lowering therapy with other drugs (ezetimibe monotherapy or association with statin tolerated dose). Supplementation with coenzyme Q10 or vitamin D, in order to improve adherence to treatment with statins, is not recommended.Conclusion: This review highlights some alternatives to address patients’ intolerance to statins; however, these are mostly based on recommendations with low to moderate evidence. Therefore, further research with randomized studies involving greater number of patients is required, in order to obtain a more robust recommendation.

Lipid-lowering therapy and patient adherence in the MULTI GAP 2013 trial

2014 ◽  
Vol 155 (17) ◽  
pp. 669-675
Author(s):  
Gábor Simonyi
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Ldl Cholesterol ◽  
Patient Adherence ◽  
Lipid Lowering ◽  
Insurance Fund ◽  
Lipid Lowering Therapy ◽  
Health Insurance Fund ◽  
National Health Insurance Fund

Introduction: Dyslipidemia is a well-known cardiovascular risk factor. To achieve lipid targets patient adherence is a particularly important issue. Aim: To assess adherence and persistence to statin therapy in patients with atherosclerotic disease who participated in the MULTI Goal Attainment Problem 2013 (MULTI GAP 2013) study. Patient adherence was assessed using estimation by the physicians in charge and analysis of pick up rate of prescribed statins in 319 patients based on data of National Health Insurance Fund Administration of Hungary. Method: In the MULTI GAP 2013 study, data from standard and structured questionnaires of 1519 patients were processed. Serum lipid values of patients treated by different healthcare professionals (general practitioners, cardiologists, diabetologists, neurologists, and internists), treatment adherence of patients assessed by doctors and treatment adherence based on data of National Health Insurance Fund Administration of Hungary were analysed. Satisfaction of doctors with results of statin therapy and the relationship between the level of adherence and serum lipid values were also evaluated. Results: Considering the last seven years of survey data, the use of more effective statins became more prevalent with an about 70% increase of prescriptions of atorvastatin and rosuvastatin from 49% to 83%. Patients with LDL-cholesterol level below 2.5 mmol/l had 8 prescriptions per year. In contrast, patients who had LDL-cholesterol levels above 2.5 mmol/l had only 5.3–6.3 prescriptions per year. Patients who picked up their statins 10–12 or 7–9 times per year had significantly lower LDL-cholesterol level than those who had no or 1–3 pick up. The 100% persistence assessed by doctors was significantly lower (74%) based on data from the National Health Insurance Fund Administration of Hungary. About half of the patients were considered to display 100% adherence to lipid-lowering therapy by their doctors, while data from the National Health Insurance Fund Administration of Hungary showed only 36%. In patients with better adherence (90–100%) LDL-cholesterol levels below 2.5 mmol/l were more frequent (59.5%) compared to those with worse adherence. Satisfaction of doctors with lipid targets achieved was 69–80% in patients with total cholesterol between 4.5 and 6 mmol/l, and satisfaction with higher cholesterol values was also high (53–54%). Conclusions: The results show that doctors may overestimate patient adherence to lipid-lowering treatment. Based on data from the National Health Insurance Fund Administration of Hungary, satisfaction of doctors with high lipid level appears to be high. There is a need to optimize not only patient adherence, but adherence of doctors to lipid guidelines too.

scholarly journals Stroke and food groups: an overview of systematic reviews and meta-analyses

2017 ◽  
Vol 21 (4) ◽  
pp. 766-776 ◽  
Author(s):  
Cuiyu Deng ◽  
Qi Lu ◽  
Bingyan Gong ◽  
Liya Li ◽  
Lianxia Chang ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Prospective Studies ◽  
Stroke Risk ◽  
Cochrane Library ◽  
Processed Meat ◽  
Stroke Outcome ◽  
Food Groups ◽  
Level Of Evidence ◽  
High Consumption ◽  
Meta Analyses

AbstractObjectiveNumerous systematic reviews of prospective studies on the association of stroke risk with the consumption of various food groups have been published. A review of the evidence across the existing systematic reviews and meta-analyses of prospective studies was conducted to provide an overview of the range and validity of the reported associations of food groups with stroke risk.DesignThe PubMed, EMBASE and Cochrane Library databases were searched for articles published up to September 2015 to identify systematic reviews of prospective studies.ResultsA total of eighteen studies published from 2008 to 2015 were eligible for analysis. Overall, thirteen specific foods were studied for an association with stroke outcome, including nuts, legumes, fruits and vegetables, refined grains, whole grains, dairy products, eggs, chocolate, red and/or processed meat, fish, tea, sugar-sweetened beverages and coffee. Whereas a high consumption of nuts, fruits, vegetables, dairy foods, fish and tea, and moderate consumption of coffee and chocolate demonstrated a protective effect, a high consumption of red and/or processed meat was associated with increased stroke risk. Refined grain, sugar-sweetened beverage, legume, egg and whole grain intake showed no effect on stroke outcome.ConclusionsThe current overview provided a high level of evidence to support the beneficial effect of specific foods on stroke outcome. Clinicians and policy makers could inform clinical practice and policy based on this overview.

scholarly journals (Protocol) Preferred Reporting Items for Resistance Exercise Studies (PRIRES): An Umbrella Review of Systematic Reviews, Guidelines, and Position Stands for Item Extraction

2021 ◽  
Author(s):  
Ting-Yu Lin ◽  
Ting-Yu Chueh ◽  
Tsung-Min Hung
Keyword(s):  
Resistance Exercise ◽  
Systematic Reviews ◽  
Reporting Quality ◽  
Science Research ◽  
Plain Language ◽  
Letters To The Editor ◽  
Level Of Evidence ◽  
Sports Science ◽  
Animal Research Ethics ◽  
Meta Analyses

Abstract BackgroundThe issues of replication and scientific transparency have been raised in exercise and sports science research. A potential means to address the replication crisis and enhance research reliability is to improve reporting quality and transparency. This study aims to formulate a reporting checklist as a supplement to the existing reporting guidelines, specifically for resistance exercise studies.MethodsSystematic reviews/meta-analyses, guidelines, and position stands related to resistance exercise since inception will be searched in PubMed and Scopus. Only studies published in English will be included. Two authors will independently screen titles/abstracts and then full-text articles against the inclusion criteria. Basic data will be extracted by the same two authors independently. The same two authors will independently extract items from systematic reviews, guidelines, and position stands that could potentially influence training efficiency, physiological/psychological functions, other health-related variables, or replication. Summaries of the findings and items extracted from the included systematic reviews/meta-analyses and included position stands or guidelines will be presented as tables. Using items adapted from the existing checklist Consensus on Exercise Reporting Template (CERT), a preferred reporting checklist for resistance exercise studies will be formulated. The protocol for this study was developed according to the reporting checklist for umbrella reviews published by Onishi and Furukawa in 2016.DiscussionThe proposed study is expected to build a reporting checklist with a high level of evidence, which can improve the reporting quality of future resistance exercise studies.Ethics and disseminationApproval from a human/animal research ethics committee is not required. The findings of the proposed study will be disseminated through conference presentations, our lab’s website in plain language, and, if possible, letters to the editor in peer-reviewed journals related to sport and exercise science.RegistrationThis study is registered with the EQUATOR Network under the title “Preferred Reporting Items for Resistance Exercise Studies (PRIRES).” PROSPERO registration number: CRD42021235259.

scholarly journals Mapping the Evidence of Prevention and Intervention Studies for Suicidal and Self-Harming Behaviors in Young People

Crisis ◽  
2013 ◽  
Vol 34 (4) ◽  
pp. 223-232 ◽  
Author(s):  
Stefanie De Silva ◽  
Alexandra Parker ◽  
Rosemary Purcell ◽  
Patrick Callahan ◽  
Ping Liu ◽  
...  
Keyword(s):  
Young People ◽  
Systematic Reviews ◽  
Best Practice ◽  
Intervention Studies ◽  
Skills Training ◽  
Mapping Method ◽  
Mortality And Morbidity ◽  
Evidence Mapping ◽  
Life Years ◽  
Meta Analyses

Background: Suicide and self-harm (SSH) in young people is a major cause of disability-adjusted life years. Effective interventions are of critical importance to reducing the mortality and morbidity associated with SSH. Aims: To investigate the extent and nature of research on interventions to prevent and treat SSH in young people using evidence mapping. Method: A systematic search for SSH intervention studies was conducted (participant mean age between 6–25 years). The studies were restricted to high-quality evidence in the form of systematic reviews, meta-analyses, and controlled trials. Results: Thirty-eight controlled studies and six systematic reviews met the study inclusion criteria. The majority (n = 32) involved psychological interventions. Few studies (n = 9) involved treating young people with recognized mental disorders or substance abuse (n = 1) which also addressed SSH. Conclusion: The map was restricted to RCTs, CCTs, systematic reviews, and meta-analyses, and thus might have neglected important information from other study designs. The effectiveness of interventions within the trials was not evaluated. The evidence base for SSH interventions in young people is not well established, which hampers best-practice efforts in this area. Promising interventions that need further research include school-based prevention programs with a skills training component, individual CBT interventions, interpersonal psychotherapy, and attachment-based family therapy. Gaps in the research exist in evaluations of interventions for SSH in young people with identifiable psychopathology, particularly substance use disorder, and research that classifies participants on the basis of their suicidal intent.

scholarly journals Lower is better: ezetimibe and PCSK9 inhibition join the mainstream of lipid‑lowering therapy

2016 ◽  
Vol 7 (1) ◽  
pp. 17-25
Author(s):  
Cezary Wójcik
Keyword(s):  
Statin Therapy ◽  
Heart Association ◽  
Lipid Lowering ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lipid Lowering Therapy ◽  
Pcsk9 Inhibitors ◽  
Level Of Evidence ◽  
Cholesterol Guidelines ◽  
Pcsk9 Inhibition ◽  
Current Guidelines

The focus of 2013 cholesterol guidelines to prevent atherosclerotic cardiovascular disease (ASCVD) released by American College of Cardiology (ACC) and American Heart Association (AHA) is the administration of high intensity statin therapy to specific four groups of patients, which were found to benefit the most from such therapy. They no longer promote achieving specific LDL-C goals with a combination therapy involving statins and other drugs, as advocated by the former ATP-III guidelines as well as current guidelines of European Atherosclerosis Society, International Atherosclerosis Society or National Lipid Association. Such approach has been dictated by the strict reliance on randomized controlled trials as the only acceptable level of evidence. However, since publication of the 2013 ACC/AHA guidelines, cardiovascular benefits of ezetimibe added to statin therapy have been established. Moreover, the advent of PCSK9 inhibitors, providing a powerful supplement and/or alternative to statin therapy, further complicates the therapeutic horizon in dyslipdiemias. It is very likely that a new set of ACC/AHA guidelines will be published in 2016, with a return of specific LDL-C and Non-HDL-C goals of therapy as well as integration of drugs other than statins. As the treatment of dyslipidemias becomes more complex, the need for the subspecialty of clinical lipidology to be officially recognized becomes more evident.

Methodological Aspects of Meta-Analyses Assessing the Effect of Blood Pressure–Lowering Treatment on Clinical Outcomes

Hypertension ◽  
2021 ◽  
Author(s):  
Mattias Brunström ◽  
Costas Thomopoulos ◽  
Bo Carlberg ◽  
Reinhold Kreutz ◽  
Giuseppe Mancia
Keyword(s):  
Blood Pressure ◽  
Clinical Outcomes ◽  
Systematic Reviews ◽  
Research Question ◽  
Blood Pressure Reduction ◽  
Blood Pressure Level ◽  
Blood Pressure Lowering ◽  
Level Of Evidence ◽  
Pressure Lowering ◽  
Meta Analyses

Systematic reviews and meta-analyses are often considered the highest level of evidence, with high impact on clinical practice guidelines. The methodological literature on systematic reviews and meta-analyses is extensive and covers most aspects relevant to the design and interpretation of meta-analysis findings in general. Analyzing the effect of blood pressure–lowering on clinical outcomes poses several challenges over and above what is covered in the general literature, including how to combine placebo-controlled trials, target-trials, and comparative studies depending on the research question, how to handle the potential interaction between baseline blood pressure level, common comorbidities, and the estimated treatment effect, and how to consider different magnitudes of blood pressure reduction across trials. This review aims to address the most important methodological considerations, to guide the general reader of systematic reviews and meta-analyses within our field, and to help inform the design of future studies. Furthermore, we highlight issues where published meta-analyses have applied different analytical strategies and discuss pros and cons with different strategies.

scholarly journals Invasive techniques in physical therapy: A literature review

2019 ◽  
Vol 02 (02) ◽  
pp. 125-125
Author(s):  
Baraja-Vegas L. ◽  
Troyano Ruiz M. ◽  
Martí Rubio E. ◽  
Galvéz García J.
Keyword(s):  
Physical Therapy ◽  
Systematic Reviews ◽  
Randomized Clinical Trials ◽  
Scientific Evidence ◽  
Skin Barrier ◽  
Level Of Evidence ◽  
Journal Citation Reports ◽  
Impact Index ◽  
Meta Analyses ◽  
Invasive Techniques

Abstract Background Invasive techniques in physical therapy is a term used to refer to a group of techniques in which the physical agent used for the treatment of different pathologies crosses the skin barrier. The aim of this study was to examine the scientific evidence on the invasive techniques that are most used in physical therapy, by reviewing the literature available on this subject. Material and Methods A literature search was performed on the EBSCOhost, PubMed, Web of Science (WOS), PEDro and TRIP databases. The selected studies were: randomized clinical trials (RCTs), systematic reviews of RCTs and meta-analyses of RCTs. Studies had to be published between 2008 and 2018, conducted on men and women over the age of 18 and in English or Spanish. Results In total, 64 studies were retrieved, which were read and scrutinized to confirm whether they were relevant for the present study. Finally, after the various screening processes, a sample of 21 articles was obtained. The level of evidence was analyzed as well as the level of recommendation according to the Oxford scale, together with an impact index according to the Journal Citation Reports (JCR). Seventeen of the studies were meta-analyses and systematic reviews of RCTs, and one systematic review of cohort studies was included. Conclusion After the analysis of the selected articles and the conclusions, invasive techniques in physical therapy are confirmed to be relatively safe and effective for different pathologies, especially when performed in depth and when the local twitch response (LTR) is sought.

The clinical outcome of the Metha short hip stem: a systematic scoping review

2020 ◽  
pp. 112070002090371 ◽  
Author(s):  
Michael-Alexander Malahias ◽  
Purnachandra Tejaswi ◽  
Dimitrios Chytas ◽  
Vikram Kadu ◽  
Dimitrios Karanikas ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Systematic Reviews ◽  
Scoping Review ◽  
Hip Resurfacing ◽  
Long Term Results ◽  
Middle Aged ◽  
Cochrane Database ◽  
Pubmed Database ◽  
Meta Analyses ◽  
Age Range

Introduction: Short femoral stems were designed to bridge the gap between conventional straight design stems and hip resurfacing prostheses in total hip arthroplasty (THA). A number of clinical trials have been recently conducted to assess the clinical and safety profile of the cementless, colarless, tapered Metha short hip stem in young or active middle-aged individuals. Methods: A systematic scoping review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. 4 reviewers independently conducted the search using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms “short” AND “hip” AND “stem”. Results: From the initial 773 studies we finally chose 12 studies after applying our inclusion-exclusion criteria. The number of operated hips that were included in these studies was 5048 (mean BMI range: 22.7–35.2, mean age range: 44.4–60.4 years, mean follow-up range: 2–9 years). The mean modified Coleman methodology score was 52.3/100, while it ranged from 31/100 to 63/100. All mean clinical outcome scores that were used in the studies illustrated significant postoperative improvement when compared with the respective initial values. The revision rate of the Metha stem for component-related reasons was 2.5%, while the rate of major complications not requiring revision of the Metha stem was 2.8%. Conclusions: The Metha stem performs well in young or active middle-aged THA patients. Further studies are required for the assessment of the long-term results.

scholarly journals The Involvement of Hypothalamus–Pituitary–Adrenal (HPA) Axis in Suicide Risk

2020 ◽  
Vol 10 (9) ◽  
pp. 653 ◽  
Author(s):  
Isabella Berardelli ◽  
Gianluca Serafini ◽  
Natalia Cortese ◽  
Federica Fiaschè ◽  
Rory C O’Connor ◽  
...  
Keyword(s):  
Hpa Axis ◽  
Systematic Reviews ◽  
Suicidal Behavior ◽  
Suicide Risk ◽  
Case Reports ◽  
Number Of Patients ◽  
Hpa Axis Dysregulation ◽  
New Treatment ◽  
Meta Analyses ◽  
Hpa Axis Activity

Stress and Hypothalamic–Pituitary–Adrenal (HPA) axis dysregulation play a major role in various pathophysiological processes associated with both mood disorders and suicidal behavior. We conducted a systematic review with the primary aim of clarifying the nature and extent of HPA axis activity and suicidal behavior. The second aim of this review was to investigate whether potential biomarkers related to HPA axis abnormalities act as individual susceptibility factors for suicide. The PRISMA statement for reporting systematic reviews was used. Only articles published in English peer-reviewed journals were considered for possible inclusion; we excluded case reports, meta-analyses, and systematic reviews, and studies that did not clearly report statistical analysis, diagnostic criteria, or the number of patients included. Overall, 36 articles on HPA axis and suicide risk met inclusion criteria and were reviewed. Studies that investigated tests detecting biomarkers and the role of early life stressors in suicide risk were also included. We found that HPA axis activity is involved in suicide risk, regardless of the presence or absence of psychiatric conditions. The HPA axis abnormalities, mainly characterized by hyperactivity of the HPA axis, may exert an important modulatory influence on suicide risk. Impaired stress response mechanisms contribute to suicide risk. Targeting HPA axis dysregulation might represent a fruitful strategy for identifying new treatment targets and improving suicide risk prediction.

scholarly journals Impact of heterogeneity and effect size on the estimation of the optimal information size: analysis of recently published meta-analyses

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e015888 ◽  
Author(s):  
Josep M Garcia-Alamino ◽  
Clare Bankhead ◽  
Carl Heneghan ◽  
Nicola Pidduck ◽  
Rafael Perera
Keyword(s):  
Systematic Reviews ◽  
Effect Size ◽  
Sequential Analysis ◽  
Trial Sequential Analysis ◽  
Size Analysis ◽  
Cochrane Reviews ◽  
Number Of Patients ◽  
Optimal Information ◽  
Meta Analyses ◽  
The Impact

ObjectiveTo estimate the proportion of systematic reviews that meet the optimal information size (OIS) and assess the impact heterogeneity and effect size have on the OIS estimate by type of outcome (eg, mortality, semiobjective or subjective).MethodsWe carried out searches of Medline and Cochrane to retrieve meta-analyses published in systematic reviews from 2010 to 2012. We estimated the OIS usingTrial Sequential Analysissoftware (TSA V.0.9) and based on several heterogeneity and effect size scenarios, stratifying by type of outcome (mortality/semiobjective/subjective) and by Cochrane/non-Cochrane reviews.ResultsWe included 137 meta-analyses out of 218 (63%) potential systematic reviews (one meta-analysis from each systematic review). Of these reviews, 83 (61%) were Cochrane and 54 (39%) non-Cochrane. The Cochrane reviews included a mean of 6.5 (SD 6.1) studies and the non-Cochrane included a mean of 13.2 (SD 10.2) studies. The mean number of patients was 2619.1 (SD 6245.8 or median 586.0) for the Cochrane and 19 888.5 (SD 32 925.7 or median 6566.5) patients for the non-Cochrane reviews. The percentage of systematic reviews that achieved the OIS for all-cause mortality outcome were 0% Cochrane and 25% for non-Cochrane reviews; for semiobjective outcome 17% for Cochrane and 46% for non-Cochrane reviews and for subjective outcome 45% for Cochrane and 72% for non-Cochrane reviews.ConclusionsThe number of systematic reviews that meet an optimal information size is low and varies depending on the type of outcome and the type of publication. Less than half of primary outcomes synthesised in systematic reviews achieve the OIS, and therefore the conclusions are subject to substantial uncertainty.

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