scholarly journals Meta-analysis of pharmacist-led and pharmacist-physician intervention on blood pressure control

2021 ◽  
Vol 15 (3) ◽  
Author(s):  
Merve Memisoglu ◽  
Yusuf Çelik
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Impact Analysis ◽  
Patient Adherence ◽  
Meta Analysis ◽  
Pressure Control ◽  
Cochrane Library ◽  
Holistic View ◽  
Meta Analyses ◽  
The Impact

Effective intervention is a significant component in the improvement of blood pressure control and patient adherence. Blood pressure control includes different self-monitoring techniques, mobile health monitoring, or healthcare professionals’ interventions. This study aims to compare, analyze, and interpret the effectiveness of pharmacist-physician collaboration and pharmacist- led interventions. Meta-analysis was performed using MEDLINE via PubMed, EMBASE, EBSCO, Web of Science, Scopus, and the Cochrane Library databases between 2008-2018. Of the 51 relevant systematic reviews identified, 15 were of sufficient quality and included in the data synthesis. The breakdown of the 15 included 7 (n=2026) pharmacist and 8 pharmacist-physician interventions (n=2361). The impact of pharmacist-physician collaboration and pharmacist-led interventions on Systolic Blood Pressure was –8.22 (–11.01; –5.42) (P<0.01) and –7.68 (–9.30; –6.06) (P=0.35), respectively. On the other hand, similar correlation for Diastolic Blood Pressure for the impact of pharmacist-physician collaboration and pharmacist-led interventions was –3.55 (–4.54; –2.55) (P=0.49) and –2.58 (–3.76; –1.39) (P=0.24), respectively. These results suggest that both interventions are effective for blood pressure control. However, when two meta-analyses were compared, it was found that pharmacist-physician collaboration was more effective than pharmacist-led interventions. This finding highlights the importance of multidisciplinary approaches during blood pressure control procedures. When a holistic view is considered; especially cost-effectiveness, future studies must be diversified to encompass a broader context and impact analysis.

scholarly journals How to conduct meta-analysis: a basic tutorial

2017 ◽  
Author(s):  
Arindam Basu
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Blood Pressure Control ◽  
Meta Analysis ◽  
Pressure Control ◽  
Restricted Diet ◽  
Summary Estimate ◽  
Meta Analyses ◽  
Key Steps ◽  
Published Paper

Meta analysis refers to a process of integration of the results of many studies to arrive at evidence syn- thesis. Meta analysis is similar to systematic review; however, in addition to narrative summary that is conducted in systematic review, in meta analysis, the analysts also numerically pool the results of the studies and arrive at a summary estimate. In this paper, we discuss the key steps of conducting a meta analysis. We will discuss the steps of a simple meta-analysis with a demonstration of the key steps based on a published paper on meta-analysis and systematic review of the effectiveness of salt restricted diet on blood pressure control. This paper is a basic introduction to the process of meta-analysis. In subsequent papers in this series, we will show how you can conduct meta-analysis of diagnostic and screening studies, network meta analyses, and those of diagnostic and screening studies.

scholarly journals How to conduct meta-analysis: a basic tutorial

2017 ◽  
Author(s):  
Arindam Basu
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Blood Pressure Control ◽  
Meta Analysis ◽  
Pressure Control ◽  
Restricted Diet ◽  
Summary Estimate ◽  
Meta Analyses ◽  
Key Steps ◽  
Published Paper

Meta analysis refers to a process of integration of the results of many studies to arrive at evidence syn- thesis. Meta analysis is similar to systematic review; however, in addition to narrative summary that is conducted in systematic review, in meta analysis, the analysts also numerically pool the results of the studies and arrive at a summary estimate. In this paper, we discuss the key steps of conducting a meta analysis. We will discuss the steps of a simple meta-analysis with a demonstration of the key steps based on a published paper on meta-analysis and systematic review of the effectiveness of salt restricted diet on blood pressure control. This paper is a basic introduction to the process of meta-analysis. In subsequent papers in this series, we will show how you can conduct meta-analysis of diagnostic and screening studies, network meta analyses, and those of diagnostic and screening studies.

scholarly journals Evening anti-hypertensive dosing improves blood pressure control and reduce cardiovascular events in hypertensive: a meta-analysis of 40 trials in 44,167 patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.P Sunjaya ◽  
A.F Sunjaya
Keyword(s):  
Blood Pressure ◽  
Randomized Controlled Trials ◽  
Diastolic Blood Pressure ◽  
Blood Pressure Control ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Pressure Control ◽  
Controlled Trials ◽  
Night Time ◽  
Randomized Controlled

Abstract Introduction Nocturnal blood pressure (BP) and early morning BP surge have consistently been found to be a better prognostic marker of cardiovascular outcome than daytime BP. Most anti-hypertensive show greater blood pressure-lowering effect in the first 12 hours compared to the next 12 hours. Several prospective studies have shown better BP regulation and improved cardiovascular risk when anti-hypertensive are ingested at bedtime versus at awakening. Purpose In patients with hypertension does evening dosing of anti-hypertensive compared to morning dosing led to better reduction in pressure, blood pressure control and reduced cardiovascular morbidity. Methods A meta-analysis was performed based on randomized controlled trials obtained from Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Medline and Medline ahead of print published between 2000 and 2020. Main outcome measures include mean 24 hour systolic and diastolic blood pressure, cardiovascular events as well as prevalence of blood pressure in control. Data synthesis and analysis was done using RevMan 5.3 using a random effects model. Results A total of 40 randomized controlled trials, representing 44,167 patients were included in this meta-analysis. Most studies evaluate the administration of mixed anti-hypertensive with ≥1 medication ingested at bedtime, calcium channel blockers (CCBs) or angiotensin receptor blockers (ARBs) with sample sizes ranging from 30 to 19,084 patients. Evening administration of anti-hypertensive was found to significantly lower 24-hour systolic blood pressure (Mean difference = −1.05, 95% CI: −2.01 to −0.10, p=0.03) and 24-hour diastolic blood pressure (Mean difference = −1.09, 95% CI: −1.68 to −0.50, p=0.0003). Prevalence of controlled blood pressure was found to significantly increase with evening dosing (RR=1.15, 95% CI: 1.03 to 1.28, p=0.01). Significant reduction in cardiovascular events were found in the evening dosing group (RR=0.48, 95% CI: 0.03 to 0.68, p=&lt;0.00001). Discussion Reduction in night-time blood pressure especially among non-dippers as reported in previous studies and higher prevalence of controlled blood pressure may explain the greater than 50% reduction in cardiovascular events in the evening dosing group. This marked benefit from a simple and inexpensive strategy certainly has great potential to benefit patients in practice. Even so, few studies have reported the prevalence of blood pressure in control (9 studies) and cardiovascular events (6 studies). Few has also studied this in geriatric populations where night-time hypotension and hypoperfusion may bring the most impact. Conclusion For patients with hypertension, evening dosing significantly improves blood pressure control and reduces the risk for cardiovascular events. Careful selection of anti-hypertensive administration time in patients is recommended given the possible benefits. Anti Hypertensive Dosing Forest Plot Funding Acknowledgement Type of funding source: None

scholarly journals The Optimal Time of Applying Enteral Immunonutrition in Esophageal Cancer Patients Receiving Esophagectomy: A Network Meta-Analysis of Randomized Clinical Trials

2021 ◽  
Author(s):  
Xu Tian ◽  
Yan-Fei Jin ◽  
Zhao-Li Zhang ◽  
Hui Chen ◽  
Wei-Qing Chen ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Infectious Complications ◽  
Cochrane Library ◽  
Optimal Time ◽  
Registration Number ◽  
Meta Analyses ◽  
The Impact

Abstract Background: Enteral immunonutrition (EIN) has been extensively applied in cancer patients, however its role in esophageal cancer (EC) patients receiving esophagectomy remains unclear. We performed this network meta-analysis to investigate the impact of EIN on patients undergoing surgery for EC and further determine the optimal time of applying EIN.Methods: We searched PubMed, EMBASE, Cochrane library, and China National Knowledgement Infrastructure (CNKI) to identify eligible studies. Categorical data was expressed as the odds ratio with 95% confidence interval (CI), and continuous data was expressed as mean difference (MD) with 95% CI. Pair-wise and network meta-analysis was performed to evaluate the impact of EIN on clinical outcomes using RevMan 5.3 and ADDIS V.1.16.8 softwares. The surface under the cumulative ranking curve (SUCRA) was calculated to rank all nutritional regimes.Results: Total 14 studies involving 1071 patients were included. Pair-wise meta-analysis indicated no difference between EIN regardless of the application time and standard EN (SEN), however subgroup analyses found that postoperative EIN was associated with decreased incidence of total infectious complications (OR=0.47; 95%CI=0.26 to 0.84; p=0.01) and pneumonia (OR=0.47; 95%CI=0.25 to 0.90; p=0.02) and shortened LOH (MD=-1.01; 95%CI=-1.44 to -0.57; p<0.001) compared to SEN, which were all supported by network meta-analyses. Ranking probability analysis further indicated that postoperative EIN has the highest probability of being the optimal option in terms of these three outcomes.Conclusions: Postoperative EIN should be preferentially utilized in EC patients undergoing esophagectomy because it has optimal potential of decreasing the risk of total infectious complications and pneumonia and shortening LOH.OSF registration number: 10.17605/OSF.IO/KJ9UY.

Abstract 242: Evaluating the Impact and Barriers to a Collaborative Physician-pharmacist Care Model to Control Hypertension in a Low-income Population

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Kerrilynn C Hennessey ◽  
Carolyn Hickman ◽  
Brianne Krawczyk ◽  
Michelle Opare ◽  
Leslie Churchwell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Side Effects ◽  
Blood Pressure Control ◽  
Low Income ◽  
Health Workers ◽  
Pressure Control ◽  
Low Income Population ◽  
Early Results ◽  
Patient Reported ◽  
The Impact

Objectives: Physician-pharmacist collaborative practice models have emerged as an effective model for managing hypertension (HTN). We implemented this model in a low-income, hospital-based cardiology clinic and sought to identify programmatic features necessary to control HTN in this vulnerable population. Methods: Patients with persistently elevated blood pressure (>130/80) were referred by their primary cardiologist. Patients were excluded if they were pregnant, had acute kidney injury, or acute cardiovascular complaints including anginal chest pain, decompensated heart failure, or unstable arrhythmia. The initial pharmacist appointment occurred within 2 weeks of referral, with the goal of bi-weekly visits for 6 weeks or until blood pressure was controlled. Patients were prescribed home blood pressure cuffs and given specific instructions for home-based monitoring. Telehealth visits were made available to interested patients. During each encounter, pharmacists assessed response and side effects to medication, adherence, lifestyle behaviors, stressors, and social barriers to blood pressure control. Clinical management and barriers to HTN control were reviewed at standing weekly staff meetings that included cardiologists and pharmacists. Early results: Among 35 people referred, 22 patients attended at least one pharmacist visit. A total of 139 reminder or follow-up calls were made for these 22 patients. Among the first 35 referrals (mean age 58; 57% male; 65% African American or Latinx), 26% have documented substance use disorders, 34% have a mental health comorbidity, 20% were not taking their medications as prescribed on intake, and 17% had side effects from 2 or more prior antihypertensive medications. Medications adjustments were made in 21/43 patient visits (49% of visits). In 8/43 visits more than 1 medication change was made. The most common patient reported barriers to care include transportation (20%) and language barriers (11%). Discussion and Future Direction: Managing HTN in a low-income population requires attention to the social and contextual factors impacting blood pressure control. We plan to: 1) support the uptake of telehealth to address issues of transportation and access; 2) pilot blue-tooth connected blood pressure cuffs to facilitate home monitoring and management; and 3) partner with community health workers to assess best practices for capturing and addressing social determinants of health in the clinical setting.

scholarly journals Impact of Patient Beliefs on Blood Pressure Control in the General Population: Findings from the Population-Based STAAB Cohort Study

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Theresa Tiffe ◽  
Caroline Morbach ◽  
Viktoria Rücker ◽  
Götz Gelbrich ◽  
Martin Wagner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
General Population ◽  
Blood Pressure Control ◽  
Antihypertensive Medication ◽  
Pressure Control ◽  
Population Based ◽  
Blood Pressure Target ◽  
Successful Implementation ◽  
Inverse Association ◽  
The Impact

Background. Effective antihypertensive treatment depends on patient compliance regarding prescribed medications. We assessed the impact of beliefs related towards antihypertensive medication on blood pressure control in a population-based sample treated for hypertension. Methods. We used data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) study investigating 5000 inhabitants aged 30 to 79 years from the general population of Würzburg, Germany. The Beliefs about Medicines Questionnaire German Version (BMQ-D) was provided in a subsample without established cardiovascular diseases (CVD) treated for hypertension. We evaluated the association between inadequately controlled hypertension (systolic RR >140/90 mmHg; >140/85 mmHg in diabetics) and reported concerns about and necessity of antihypertensive medication. Results. Data from 293 participants (49.5% women, median age 64 years [quartiles 56.0; 69.0]) entered the analysis. Despite medication, half of the participants (49.8%) were above the recommended blood pressure target. Stratified for sex, inadequately controlled hypertension was less frequent in women reporting higher levels of concerns (OR 0.36; 95%CI 0.17-0.74), whereas no such association was apparent in men. We found no association for specific-necessity in any model. Conclusion. Beliefs regarding the necessity of prescribed medication did not affect hypertension control. An inverse association between concerns about medication and inappropriately controlled hypertension was found for women only. Our findings highlight that medication-related beliefs constitute a serious barrier of successful implementation of treatment guidelines and underline the role of educational interventions taking into account sex-related differences.

scholarly journals A Meta-Analysis of the Impact of Resveratrol Supplementation on Markers of Renal Function and Blood Pressure in Type 2 Diabetic Patients on Hypoglycemic Therapy

Molecules ◽  
2020 ◽  
Vol 25 (23) ◽  
pp. 5645
Author(s):  
Tawanda M. Nyambuya ◽  
Bongani B. Nkambule ◽  
Sithandiwe E. Mazibuko-Mbeje ◽  
Vuyolwethu Mxinwa ◽  
Kabelo Mokgalaboni ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Total Protein Content ◽  
Diabetic Patients ◽  
Hypoglycemic Therapy ◽  
The Impact

Evidence on the beneficial effects of resveratrol supplementation on cardiovascular disease-related profiles in patients with type 2 diabetes (T2D) is conflicting, while its impact on renal function and blood pressure measurements remains to be established in these patients. The current meta-analysis included randomized controlled trials (RCTs) reporting on the impact of resveratrol supplementation on markers of renal function and blood pressure in patients with T2D on hypoglycemic medication. Electronic databases such as MEDLINE, Cochrane Library, Scopus, and EMBASE were searched for eligible studies from inception up to June 2020. The random and fixed effects model was used in the meta-analysis. A total of five RCTs met the inclusion criteria and involved 388 participants with T2D. Notably, most of the participants were on metformin therapy, or metformin in combination with other hypoglycemic drugs such as insulin and glibenclamide. Pooled estimates showed that resveratrol supplementation in patients with T2D lowered the levels of fasting glucose (SMD: −0.06 [95% CI: −0.24, 0.12]; I2 = 4%, p = 0.39) and insulin (SMD: −0.08 [95% CI: −0.50, 0.34], I2 = 73%, p = 0.002) when compared to those on placebo. In addition, supplementation significantly lowered systolic blood pressure (SMD: −5.77 [95% CI: −8.61, −2.93], I2 = 66%, p = 0.02) in these patients. Although resveratrol supplementation did not affect creatinine or urea levels, it reduced the total protein content (SMD: −0.19 [95% CI: −0.36, −0.02]; I2 = 91%, p = 0.001). In all, resveratrol supplementation in hypoglycemic therapy improves glucose control and lowers blood pressure; however, additional evidence is necessary to confirm its effect on renal function in patients with T2D.

scholarly journals Management of haemorrhoids: protocol of an umbrella review of systematic reviews and meta-analyses

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e035287
Author(s):  
Min Chen ◽  
Tai-Chun Tang ◽  
Tao-Hong He ◽  
Yong-Jun Du ◽  
Di Qin ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Current Evidence ◽  
Cochrane Library ◽  
Final Report ◽  
Umbrella Review ◽  
Effect Model ◽  
Meta Analyses ◽  
The Impact

IntroductionThe prevalence of haemorrhoidal diseases was high in general population, and many treatments are proposed for the management of haemorrhoids. The treatments include conservative and surgical interventions; the credibility and strength of current evidence of their effectiveness are not comprehensively evaluated. We aim to evaluate the credibility of systematic reviews and meta-analyses that assess the effectiveness of the treatments for haemorrhoidal diseases through an umbrella review.Methods and analysisWe will search Ovid Medline, Embase, Cochrane library and Web of Science from inception to March 2020 without any language restriction. We will include meta-analyses that examine the effectiveness of treatments in the management of haemorrhoids. Two reviewers will independently screen the titles and abstracts of retrieved articles, and they will extract data from the included meta-analyses. For each meta-analysis, we will estimate the effect size of a treatment through the random-effect model and the fixed-effect model, and we will evaluate between-study heterogeneity (Cochrane’s Q and I2statistics) and small-study effect (Egger’s test); we will also estimate the evidence of excess significance bias. Evidence of each treatment will be graded according to prespecified criteria. Methodological quality of each meta-analysis will be evaluated by using Assessment of Multiple Systematic Reviews 2. The corrected cover area method will be used to assess the impact of overlap in reviews on the findings of the umbrella review.Ethics and disseminationWe will present the results of the umbrella review at conferences and publish the final report in a peer-reviewed journal. The umbrella review does not require ethical approval.PROSPERO registration numberCRD42019140702.

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