Efficacy and safety of Impella 5.0 in cardiogenic shock: an updated systematic review

2021 ◽  
Author(s):  
Eleonora Bossi ◽  
Claudia Marini ◽  
Giovanni Gaetti ◽  
Luca Diamanti ◽  
Davide Alessio ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiogenic Shock ◽  
Large Scale ◽  
A Priori ◽  
Survival Rates ◽  
Vascular Complications ◽  
Safety And Efficacy ◽  
Bridge To Decision ◽  
Comparative Safety ◽  
The Impact

Aim: The impact on safety and efficacy outcomes of Impella 5.0 in cardiogenic shock (CS) has not been systematically assessed. Materials & methods: We conducted a systematic review of the literature (PROSPERO protocol: CRD42020164680) to critically appraise available evidence on Impella 5.0 comparative safety, efficacy and effectiveness. Results: Of 244 retrieved citations, 17 original articles met the a priori defined inclusion criteria. All included studies had a retrospective study design and, overall, reported on, respectively, 52 and 67 different safety and efficacy/effectiveness outcomes. Thirty-day survival rates ranged from 40 to 94%, myocardial recovery from 18 to 93%. Conclusion: Impella 5.0 provides a full cardiac support, it is associated with a lower rate of vascular complications, it represents a valuable bridge-to-decision and allows for resolution of intercurrent clinical conditions. As available data suggest Impella 5.0 good performance in CS of various etiologies, more solid evidence will come from much-needed large-scale all-comer registries and prospective multicenter randomized trials.

scholarly journals Measuring and assessing the impact of using volunteers in UK libraries: issues and methods

2014 ◽  
Vol 15 (3) ◽  
pp. 112-121 ◽  
Author(s):  
Judith Broady-Preston
Keyword(s):  
Systematic Review ◽  
Large Scale ◽  
Third Sector ◽  
Professional Staff ◽  
Research Centre ◽  
Content Type ◽  
Qualitative Approaches ◽  
Starting Point ◽  
Third Sector Organisations ◽  
The Impact

Purpose – The purpose of this paper is to examine a range of issues and methods in relation to measuring the impact of volunteer labour on the design and delivery of all types of library services. With the increasing use of volunteers to deliver library and information services in all sectors, managers need to assess their effectiveness and evaluate the impact of their use in relation to operational service design and delivery, and on the development of the profession and professional practice as a whole. Presented here is an initial scoping study, outlining a range of issues, methods and challenges for more detailed future investigation. Design/methodology/approach – A number of methodological challenges and perspectives are identifiable. Contemporary libraries exhibit increasing similarities with Third Sector organisations, namely a complex stakeholder community, and increasing use of volunteers to supplement or replace services delivered by professional staff. Therefore, a starting point for the research is a systematic review and analysis of the methodologies developed by the Third Sector Research Centre, and those studies in the ESRC contemporary Developing Impact Evaluation strand. As a rich picture is required, both quantitative and qualitative approaches are necessary, with the overall study adopting a mixed methods approach. Findings – This paper reports the findings of the preliminary documentary analysis, literature review and scoping aspects of a large-scale study. Originality/value – Research undertaken to date (June 2014) has failed to identify any published systematic review and examination of these issues.

scholarly journals Proteomics and metabolomics in cow fertility: a systematic review

Reproduction ◽  
2020 ◽  
Vol 160 (5) ◽  
pp. 639-658
Author(s):  
Nicolas Aranciaga ◽  
James D Morton ◽  
Debra K Berg ◽  
Jessica L Gathercole
Keyword(s):  
Oxidative Stress ◽  
Systematic Review ◽  
Large Scale ◽  
Reproductive Tract ◽  
Early Embryo ◽  
Female Reproductive Tract ◽  
Full Potential ◽  
Technical Standards ◽  
The Impact

Cow subfertility is a multi-factorial problem in many countries which is only starting to be unravelled. Molecular biology can provide a substantial source of insight into its causes and potential solutions, particularly through large scale, untargeted omics approaches. In this systematic review, we set out to compile, assess and integrate the latest proteomic and metabolomic research on cow reproduction, specifically that on the female reproductive tract and early embryo. We herein report a general improvement in technical standards throughout the temporal span examined; however, significant methodological limitations are also identified. We propose easily actionable avenues for ameliorating these shortcomings and enhancing the reach of this field. Text mining and pathway analysis corroborate the relevance of proteins and metabolites related to the triad oxidative stress-inflammation-disease on reproductive function. We envisage a breakthrough in cattle reproductive molecular research within the next few years as in vivo sample techniques are improved, omics analysis equipment becomes more affordable and widespread, and software tools for single- and multi-omics data processing are further developed. Additional investigation of the impact of local oxidative stress and inflammation on fertility, both at the local and systemic levels, is key towards realising the full potential of this field.

Intra-aortic balloon pump versus percutaneous Impella© in emergency revascularisation for myocardial infarction and cardiogenic shock: systematic review

Perfusion ◽  
2021 ◽  
pp. 026765912110370
Author(s):  
Kristina Frain ◽  
Paul Rees
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
Cardiogenic Shock ◽  
Survival Rates ◽  
Circulatory Support ◽  
Future Research ◽  
Eligibility Criteria ◽  
Intra Aortic Balloon Pump ◽  
Mesh Terms ◽  
Randomised Controlled

Objectives: Mortality rates in patients with acute myocardial infarction and cardiogenic shock (AMI-CS) remain persistently high despite advances over the past decade in percutaneous mechanical circulatory support. This systematic review aims to analyse the existing literature to compare mortality outcomes in patients mechanically supported by intra-aortic balloon pump or percutaneous Impella 2.5/CP© for AMI-CS undergoing emergency revascularisation. Methods: The following MeSH terms were applied to the databases Ovid Medline, Ovid Embase, Cochrane and Web of Science: ‘Intra-aortic balloon pump’, ‘Impella’, ‘Cardiogenic shock’, ‘Myocardial Infarction’ and ‘Mortality’. This yielded 2643 studies. Using predefined inclusion and exclusion criteria, the studies were initially screened by title and abstract before full text analysis. Results: Fourteen studies met eligibility criteria: two randomised controlled trials (RCTs) and 12 observational studies. Data from a total of 21,006 patients were included across the studies. Notably, one study claimed reduced mortality with IABP versus control, and one study concluded that Impella© improved survival rates over the IABP. The average 30-day all-cause mortality in patients supported by IABP was 38.1%, 54.3% in Impella© groups and 39.4% in control groups. Conclusion: AMI-CS presents an important cohort of patients in whom conducting RCTs is difficult. As a result, the literature is limited. Analysis of the available literature suggests that there is insufficient evidence to support superior survival in those supported by IABP or Impella© when compared to control despite suggestions that the Impella© offers superior haemodynamic support. Limitations of the studies have been discussed to outline suggestions for future research.

scholarly journals Surgery versus stereotactic radiotherapy for treatment of pulmonary metastases. A systematic review of literature

2020 ◽  
Vol 6 (5) ◽  
pp. FSO471
Author(s):  
Francesco Londero ◽  
William Grossi ◽  
Angelo Morelli ◽  
Orlando Parise ◽  
Gianluca Masullo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stereotactic Radiotherapy ◽  
Pulmonary Metastases ◽  
A Priori ◽  
Survival Rates ◽  
Pulmonary Metastasectomy ◽  
Review Of Literature ◽  
Term Survival ◽  
Mortality And Morbidity

It is not clear as to which is the best treatment among surgery and stereotactic radiotherapy (SBRT) for lung oligometastases. A systematic review of literature with a priori selection criteria was conducted on articles on the treatment of pulmonary metastases with surgery or SBRT. Only original articles with a population of patients of more than 50 were selected. After final selection, 61 articles on surgical treatment and 18 on SBRT were included. No difference was encountered in short-term survival between pulmonary metastasectomy and SBRT. In the long-term surgery seems to guarantee better survival rates. Mortality and morbidity after treatment are 0–4.7% and 0–23% for surgery, and 0–2% and 4–31% for SBRT. Surgical metastasectomy remains the treatment of choice for pulmonary oligometastases.

scholarly journals TP9.2.18Are delays to diagnosis and treatment associated with reduced survival in oesophageal cancer?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Matteo Magnoli ◽  
Ellen Murgitroyd ◽  
Peter J Lamb ◽  
Richard JE Skipworth
Keyword(s):  
Systematic Review ◽  
Clinical Outcome ◽  
Oesophageal Cancer ◽  
Survival Rates ◽  
Tnm Stage ◽  
Diagnosis And Treatment ◽  
Cochrane Library ◽  
Optimal Timing ◽  
Randomised Controlled ◽  
The Impact

Abstract Aims Oesophageal cancer has low survival rates due to diagnosis commonly occurring in advanced stages. We performed a systematic review of delays to diagnosis and treatment in oesophageal cancer, and the impact of delay on clinical outcome. Methods A systematic review of Pubmed, Embase and Cochrane Library was carried out using the following search terms: (esophageal cancer) AND ((time) OR (diagnosis)) AND ((delay) OR (wait)). 821 results in English were retrieved and independently reviewed by two researchers. Studies were included if they were randomised controlled trials (RCT), meta-analyses or observational studies, and assessed delay in relation to at least one clinical outcome or TNM stage at diagnosis. Results 15277 patients across 12 studies were included. 10/12 studies were retrospective, and there were no RCT. Heterogeneity existed amongst the studies in defining delay and outcomes (morbidity = 1/12, mortality = 2/12, disease-free = 2/12 or overall survival = 5/12, TNM stage = 6/12). No studies demonstrated that reduced delay improved clinical outcome. Longer patient delay correlated with presence of malnutrition in one study but did not result in reduced survival. Conclusions Systematic review of published literature did not demonstrate a relationship between diagnosis/treatment delay and patient outcome in oesophageal cancer. Multi-centre prospective studies/RCTs are required to identify the impact of delay and the optimal timing of treatment.

Comparative Safety and Efficacy of Therapeutic Options in Resectable and Advanced/Metastatic Pancreatic Cancer: A Systematic Review and Indirect Comparison

2021 ◽  
pp. 1-9
Author(s):  
Aditi Kharat ◽  
Madeline Brendle ◽  
Anindit Chhibber ◽  
Nathorn Chaiyakunapruk ◽  
Joseph Biskupiak
Keyword(s):  
Systematic Review ◽  
Pancreatic Cancer ◽  
Indirect Comparison ◽  
Disease Free Survival ◽  
Progression Free Survival ◽  
Free Survival ◽  
Safety And Efficacy ◽  
Comparative Safety ◽  
Grade 3 ◽  
Indirect Comparisons

<b><i>Objectives:</i></b> FOLFIRINOX, gemcitabine/nab-paclitaxel (gem-nab/P), and gemcitabine-capecitabine (gem-cap) demonstrated superiority over gemcitabine monotherapy for pancreatic cancer (PC). It is still unclear which chemotherapy regimen is the most optimal. This study aimed to conduct a systematic review (SR) and indirect comparison to compare safety and efficacy of FOLFIRINOX versus gem-nab/P and gem-cap in PC. <b><i>Methods:</i></b> An SR was conducted in several databases from inception to November 2020. RCTs investigating resectable or advanced PC were included. Primary outcomes including overall survival (OS), disease-free survival (DFS)/progression-free survival (PFS)/relapse-free survival (RFS), and grade 3/4 adverse events (AEs) were pooled using a random effects model. Indirect comparisons were done to compare FOLFIRINOX versus gem-cap and gem-nab/P. Heterogeneity was evaluated using Cochran’s Q test and <i>I</i><sup>2</sup> statistics. <b><i>Results:</i></b> Nine studies were identified involving 6,564 patients. Indirect comparisons showed FOLFIRINOX had significantly better OS (resectable: HR 0.78 [0.61–0.99]; advanced: HR 0.71 [0.60–0.85]) and RFS/DFS/PFS (resectable: HR 0.67 [0.55–0.82]; advanced: HR 0.65 [0.57–0.74]) compared to gem-cap as well as OS (resectable: HR 0.78 [0.61–1.00]; advanced: HR 0.73 [0.54–0.98]) and DFS/PFS (resectable: HR 0.66 [0.53–0.82]; advanced: HR 0.64 [0.49–0.83]) compared to gem-nab/P. FOLFIRINOX increased grade 3/4 AE risk compared to gem-cap and gem-nab/P. <b><i>Conclusions:</i></b> FOLFIRINOX is associated with significant survival benefits compared to gem-nab/P and gem-cap. However, it is important to consider the increased grade 3/4 AE risk associated with FOLFIRINOX.

scholarly journals Technology-based Health Solutions for Cancer Caregivers to Better Shoulder the Impact of COVID-19: A Systematic Review Protocol

2020 ◽  
Author(s):  
Zhaohui Su ◽  
Dean McDonnell ◽  
Bin Liang ◽  
Jennifer Kue ◽  
Xiaoshan Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Digital Health ◽  
A Priori ◽  
Healthcare Services ◽  
Daily Basis ◽  
Eligibility Criteria ◽  
Healthcare Needs ◽  
Cancer Caregivers ◽  
Meta Analyses ◽  
The Impact

Abstract Background Cancer patients are particularly vulnerable to COVID-19, partially owing to their compromised immune systems and curbed or cut cancer healthcare services caused by the pandemic. As a result, cancer caregivers may have to shoulder triple crises: the COVID-19 pandemic, pronounced healthcare needs from the patient, and elevated need for care from within. While technology-based health interventions have the potential to address unique challenges cancer caregivers face amid COVID-19, limited insights are available. Thus, to bridge this gap, we aim to identify technology-based interventions designed for cancer caregivers and report the characteristics and effects of these interventions concerning the distinctive challenges cancer caregivers face amid COVID-19. Additionally, this paper will present practical insights into the diverse intervention approaches that can assist in the delivery of digital health solutions for cancer caregivers amid and beyond COVID-19.Methods A systematic review of the literature will be conducted in PubMed, PsycINFO, CINAHL, and Scopus in September, 2020. Articles that center on technology-based interventions for cancer caregivers will be included in the review. The search strategy was developed in consultation with an academic librarian who is experienced in systematic review studies. Titles, abstracts, and full-text articles will be screened against eligibility criteria developed a priori. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process.Results NA—This is a protocol study.Conclusions COVID-19 has uprooted cancer care as we know it. Due to barriers introduced by the COVID-19 pandemic, such as medical resources rationing, cancer caregivers often have to step up to address patients' healthcare needs and wants. This, in turn, will exert substantial stress on informal caregivers, above and beyond COVID-19-related burdens the general public shoulders on a daily basis. Findings of this study can shed light on evidence-based and practical solutions cancer caregivers can utilize to mitigate the unique challenges they face amid COVID-19. Furthermore, results of this study will also offer valuable insights for researchers who aim to develop interventions for cancer caregivers in the context of COVID-19. In addition, we also expect to be able to identify areas for improvement that need to be addressed in order for health experts to more adequately help cancer caregivers weather the storm of global health crises like COVID-19 and beyond.Study Protocol Registration: PROSPERO CRD42020196301

scholarly journals Evaluating a Geriatric Educational Program: Exploring Opportunities for Increasing Impact and Scale

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 758-758
Author(s):  
Shera Hosseini ◽  
Michelle Howard ◽  
Allison Ward
Keyword(s):  
Large Scale ◽  
Healthcare Professionals ◽  
Program Effectiveness ◽  
Qualitative Interviews ◽  
A Priori ◽  
The United States ◽  
Dissemination And Implementation ◽  
Geriatric Population ◽  
Learning Competencies ◽  
The Impact

Abstract The geriatric population is rapidly growing, and this growth is beyond the pace of increase in the number of healthcare professionals who are qualified to care for and tend to the various needs of this significant subgroup of the population. The current university curricula have not been sufficient in terms of quantity as well as their ability to address the ageism inherent in the perspectives of students from across the educational spectrum. In recognition of the absence of standardized geriatric guidelines, medical associations across Canada and the United States have established geriatric learning competencies for medical programs. Nevertheless, there are exiting gaps regarding the development and evaluation of geriatric-focused didactic programs that adequately train and build competency among the students interested in pursuing careers with geriatric-specific elements. A university-wide program was developed to enhance aging education and build competency through sparking interest, providing better education related to aging, and building better relationships between future healthcare professionals and older adults. To evaluate the impact of this program, a logical framework was developed a-priori and revised through constant iterations and following discussion with the program’s multidisciplinary stakeholder group. Quantitative measures are being augmented with in-depth qualitative interviews to explore elements influencing students’ experiences with the program and the effect on their interests in and attitudes towards geriatrics. The results will inform our conclusions regarding program effectiveness in enhancing interest in geriatric-focused education among the students and trainees and assist with recommending future directions regarding impact and large-scale dissemination and implementation.

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