Scalable Bio Marker Combinations for Early Stroke Diagnosis: A Systematic Review

Background: Acute stroke treatment is a time-critical process in which every minute counts. Laboratory biomarkers are needed to aid clinical decisions in the diagnosis. Although imaging is critical for this process, these biomarkers may provide additional information to distinguish actual stroke from its mimics and monitor patient condition and the effect of potential neuroprotective strategies. For such biomarkers to be effectively scalable to public health in any economic setting, these must be cost-effective and non-invasive. We hypothesized that blood-based combinations (panels) of proteins might be the key to this approach and explored this possibility through a systematic review.Methods: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines for systematic review. Initially, the broader search for biomarkers for early stroke diagnosis yielded 704 hits, and five were added manually. We then narrowed the search to combinations (panels) of the protein markers obtained from the blood.Results: Twelve articles dealing with blood-based panels of protein biomarkers for stroke were included in the systematic review. We observed that NR2 peptide (antibody against the NR2 fragment) and glial fibrillary acidic protein (GFAP) are brain-specific markers related to stroke. Von Willebrand factor (vWF), matrix metalloproteinase 9 (MMP-9), and S100β have been widely used as biomarkers, whereas others such as the ischemia-modified albumin (IMA) index, antithrombin III (AT-III), and fibrinogen have not been evaluated in combination. We herein propose the following new combination of biomarkers for future validation: panel 1 (NR2 + GFAP + MMP-9 + vWF + S100β), panel 2 (NR2 + GFAP + MMP-9 + vWF + IMA index), and panel 3 (NR2 + GFAP + AT-III + fibrinogen).Conclusions: More research is needed to validate, identify, and introduce these panels of biomarkers into medical practice for stroke recurrence and diagnosis in a scalable manner. The evidence indicates that the most promising approach is to combine different blood-based proteins to provide diagnostic precision for health interventions. Through our systematic review, we suggest three novel biomarker panels based on the results in the literature and an interpretation based on stroke pathophysiology.

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Incremental Net Monetary Benefit of Bariatric Surgery: Systematic Review and Meta-Analysis of Cost-Effectiveness Evidences

Obesity Surgery ◽

10.1007/s11695-021-05415-9 ◽

2021 ◽

Author(s):

Prapaporn Noparatayaporn ◽

Montarat Thavorncharoensap ◽

Usa Chaikledkaew ◽

Bhavani Shankara Bagepally ◽

Ammarin Thakkinstian

Keyword(s):

Systematic Review ◽

Bariatric Surgery ◽

Cost Effectiveness ◽

Evaluation Studies ◽

Meta Analysis ◽

Cost Effective ◽

Diabetes Group ◽

Lifetime Horizon ◽

Middle Income ◽

Full Economic Evaluation

AbstractThis systematic review aimed to comprehensively synthesize cost-effectiveness evidences of bariatric surgery by pooling incremental net monetary benefits (INB). Twenty-eight full economic evaluation studies comparing bariatric surgery with usual care were identified from five databases. In high-income countries (HICs), bariatric surgery was cost-effective among mixed obesity group (i.e., obesity with/without diabetes) over a 10-year time horizon (pooled INB = $53,063.69; 95% CI $42,647.96, $63,479.43) and lifetime horizon (pooled INB = $101,897.96; 95% CI $79,390.93, $124,404.99). All studies conducted among obese with diabetes reported that bariatric surgery was cost-effective. Also, the pooled INB for obesity with diabetes group over lifetime horizon in HICs was $80,826.28 (95% CI $32,500.75, $129,151.81). Nevertheless, no evidence is available in low- and middle-income countries. Graphical abstract

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Supporting Informal Caregivers of People With Dementia in Cost-Effective Ways: A Systematic Review and Meta-Analysis

Value in Health ◽

10.1016/j.jval.2021.05.011 ◽

2021 ◽

Author(s):

Zhaohua Huo ◽

Joyce Y.C. Chan ◽

Jiaer Lin ◽

Baker K.K. Bat ◽

Tak Kit Chan ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Informal Caregivers ◽

Cost Effective ◽

People With Dementia

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Prognostic value of metabolic syndrome for risk of stroke recurrence and mortality: A comprehensive systematic review with meta-analysis

10.37766/inplasy2020.4.0183 ◽

2020 ◽

Author(s):

Fangfang Zhang ◽

Lili Liu ◽

Tian Li ◽

Zubing Mei

Keyword(s):

Systematic Review ◽

Metabolic Syndrome ◽

Prognostic Value ◽

Meta Analysis ◽

Stroke Recurrence

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Overuse and underuse of cardiovascular diagnostic and therapeutic procedures for community-dwelling adults: a protocol for a systematic review

HRB Open Research ◽

10.12688/hrbopenres.13330.1 ◽

2021 ◽

Vol 4 ◽

pp. 99

Author(s):

Dominic Quinn ◽

David Byrne ◽

Tom Fahey ◽

Rose Anne Kenny ◽

Christine McGarrigle ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Artery Bypass ◽

Cost Effective ◽

Risk Of Bias ◽

Community Dwelling ◽

Cochrane Library ◽

Healthcare Intervention ◽

Cross Sectional ◽

International Guidelines

Background: Potentially inappropriate care can result from overuse or underuse of treatments, tests, or procedures. Overuse is defined as the use of health services with no clear benefit to the recipient or where harms outweigh benefits and/or costs of care. Underuse is defined as failure to deliver an effective and cost-effective healthcare intervention. Cardiovascular procedures such as coronary artery bypass grafting, carotid endarterectomy, coronary angiography, and coronary angioplasty (with/without stenting) are potentially both underused and overused. This systematic review aims to identify rates of potential overuse and underuse of these cardiovascular procedures and explore any associated patient or healthcare system factors. Methods: A systematic review and meta-analysis will be conducted in accordance with the PRISMA guidelines. A systematic search of MEDLINE (via Ovid), Embase, Cumulative Index to Nursing and Allied Health Literature and the Cochrane library will be conducted using a predefined search strategy. Eligible studies for inclusion will examine rates of overuse and underuse of cardiovascular procedures, measured against national/international guidelines, for adults aged ≥18 years. Primary observational studies including cross-sectional and cohort studies will be included. Titles, abstracts, and full texts will be screened for inclusion by two reviewers. Data will be extracted using a standardised form. Risk of bias for all included studies will be assessed using a modified version of the Hoy risk of bias tool. Where adequate data exists, and if statistically appropriate, meta-analyses will be conducted. If statistical pooling of the data is not possible, the findings will be narratively summarised focusing on the review’s objectives. Conclusion: This systematic review will examine overuse and underuse of cardiovascular procedures for adults. The results will help inform policy makers, researchers, patients, and clinicians in the appropriate use of these procedures, in line with international guidelines. Registration: This protocol has been submitted for registration on PROSPERO (CRD42021239041).

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Abstract 1122‐000227: Stenting Versus Medical Treatment for Chronic Internal Carotid Artery Occlusions: A Systematic Review and Meta‐analysis

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000227 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Cynthia Zevallos Mau ◽

Cynthia B Zevallos ◽

Milagros Galecio‐Castillo ◽

Sameer Ansari ◽

Julie Weng ◽

...

Keyword(s):

Systematic Review ◽

Carotid Artery ◽

Medical Therapy ◽

Complex Disease ◽

Internal Carotid ◽

Meta Analysis ◽

Carotid Occlusion ◽

Stroke Recurrence ◽

Safe Procedure ◽

Long Term Outcome

Introduction : Chronic internal carotid occlusion is responsible for 10–15% ischemic strokes or transit ischemic attacks (TIA). Subsequent ipsilateral ischemic stroke rate is 5.9% per year. However, this risk can increase up to 23% in two years in a subgroup of patients with poor collaterals regardless of medical therapy with antiplatelet or anticoagulant agents. Prevention of subsequent stroke in patients with carotid artery occlusion remains a difficult challenge. Carotid artery stenting (CAS) has recently been considered in its management. However, there is ambiguity on its safety. We aim to evaluate the safety and feasibility of CAS and compared it with medical management. Methods : We performed a systematic review and meta‐analysis to compare long‐term outcome (stroke recurrence) of current carotid occlusion treatments (CAS vs medical therapy). Two independent reviewers performed the screening, data extraction, and quality assessment. A random effects model was used for analysis. Results : A total of 5720 studies were screened. Of these, 11 studies were included in our systematic review and meta‐analysis of proportions. The CAS group has lower proportions of recurrent strokes (5% vs 30%,) after 30 days than medical therapy alone. Additionally, the proportion of periprocedural intracranial hemorrhage was 4.4% (95% CI 2.5 to 6.8) in the CAS group. Conclusions : CAS of the chronically occluded cervical ICA seems to be a safe procedure with lower rates of recurrent stroke in clinical follow up. Future randomized studies are warranted to guide the optimal management of this complex disease.

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16668 Pulsed dye laser is more cost-effective than topical brimonidine and topical oxymetazoline for the treatment of erythematotelangiectatic rosacea: A systematic review of the literature and meta-analysis

Journal of the American Academy of Dermatology ◽

10.1016/j.jaad.2020.06.361 ◽

2020 ◽

Vol 83 (6) ◽

pp. AB68

Author(s):

Kimberly Shao ◽

Reid A. Waldman ◽

Maritza Perez

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Cost Effective ◽

Dye Laser ◽

Pulsed Dye Laser ◽

Review Of The Literature

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Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis

BMJ ◽

10.1136/bmj.l4185 ◽

2019 ◽

pp. l4185 ◽

Cited By ~ 62

Author(s):

Maria Panagioti ◽

Kanza Khan ◽

Richard N Keers ◽

Aseel Abuzour ◽

Denham Phipps ◽

...

Keyword(s):

Systematic Review ◽

Confidence Interval ◽

Medical Care ◽

Data Extraction ◽

Meta Analysis ◽

Cost Effective ◽

Mitigation Strategies ◽

Patient Harm ◽

Pooled Prevalence ◽

Preventable Harm

Abstract Objective To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally. Design Systematic review and meta-analysis. Data sources Medline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched. Review methods Observational studies reporting preventable patient harm in medical care. The core outcomes were the prevalence, severity, and types of preventable patient harm reported as percentages and their 95% confidence intervals. Data extraction and critical appraisal were undertaken by two reviewers working independently. Random effects meta-analysis was employed followed by univariable and multivariable meta regression. Heterogeneity was quantified by using the I 2 statistic, and publication bias was evaluated. Results Of the 7313 records identified, 70 studies involving 337 025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death. Incidents related to drugs (25%, 95% confidence interval 16% to 34%) and other treatments (24%, 21% to 30%) accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties (intensive care or surgery; regression coefficient b=0.07, 95% confidence interval 0.04 to 0.10). Conclusions Around one in 20 patients are exposed to preventable harm in medical care. Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm (preventable and non-preventable). Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective.

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A systematic review and meta-analysis of clinical and cost-effective outcomes of transcatheter aortic valve implantation versus surgical aortic valve replacement

Heart Lung and Circulation ◽

10.1016/j.hlc.2015.06.346 ◽

2015 ◽

Vol 24 ◽

pp. S258 ◽

Cited By ~ 1

Author(s):

C. Cao ◽

S. Virk ◽

K. Liou ◽

F. Pathan ◽

C. Wilcox ◽

...

Keyword(s):

Systematic Review ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Meta Analysis ◽

Cost Effective ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

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Glucagon-like peptide 1 agonists for treatment of patients with type 2 diabetes who fail metformin monotherapy: systematic review and meta-analysis of economic evaluation studies

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-001020 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001020 ◽

Cited By ~ 1

Author(s):

Bhavani Shankara Bagepally ◽

Usa Chaikledkaew ◽

Yogesh Krishnarao Gurav ◽

Thunyarat Anothaisintawee ◽

Sitaporn Youngkong ◽

...

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Fixed Effects ◽

Evaluation Studies ◽

Meta Analysis ◽

Cost Effective ◽

Metformin Monotherapy ◽

Glucagon Like Peptide ◽

Glucagon Like Peptide 1

ObjectivesTo conduct a systematic review and meta-analysis and to pool the incremental net benefits (INBs) of glucagon-like peptide 1 (GLP1) compared with other therapies in type 2 diabetes mellitus (T2DM) after metformin monotherapy failure.Research design and methodsThe study design is a systematic review and meta-analysis. We searched MEDLINE (via PubMed), Scopus and Tufts Registry for eligible cost–utility studies up to June 2018, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We conducted a systematic review and pooled the INBs of GLP1s compared with other therapies in T2DM after metformin monotherapy failure. Various monetary units were converted to purchasing power parity, adjusted to 2017 US$. The INBs were calculated and then pooled across studies, stratified by level of country income; a random-effects model was used if heterogeneity was present, and a fixed-effects model if it was absent. Heterogeneity was assessed using Q test and I2 statistic.ResultsA total of 56 studies were eligible, mainly from high-income countries (HICs). The pooled INBs of GLP1s compared with dipeptidyl peptidase-4 inhibitor (DPP4i) (n=10), sulfonylureas (n=6), thiazolidinedione (TZD) (n=3), and insulin (n=23) from HICs were US$4012.21 (95% CI US$−571.43 to US$8595.84, I2=0%), US$3857.34 (95% CI US$−7293.93 to US$15 008.61, I2=45.9%), US$37 577.74 (95% CI US$−649.02 to US$75 804.50, I2=92.4%) and US$14 062.42 (95% CI US$8168.69 to US$19 956.15, I2=86.4%), respectively. GLP1s were statistically significantly cost-effective compared with insulins, but not compared with DPP4i, sulfonylureas, and TZDs. Among GLP1s, liraglutide was more cost-effective compared with lixisenatide, but not compared with exenatide, with corresponding pooled INBs of US$4555.09 (95% CI US$3992.60 to US$5117.59, I2=0) and US$728.46 (95% CI US$−1436.14 to US$2893.07, I2=0), respectively.ConclusionGLP1 agonists are a cost-effective choice compared with insulins, but not compared with DPP4i, sulfonylureas and TZDs.PROSPERO registration numberCRD42018105193.

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