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BMC Geriatrics Jul 2023Frailty is a clinical syndrome of accelerated aging associated with adverse outcomes. Frailty is prevalent among patients with chronic kidney disease but is infrequently... (Review)
Review
BACKGROUND
Frailty is a clinical syndrome of accelerated aging associated with adverse outcomes. Frailty is prevalent among patients with chronic kidney disease but is infrequently assessed in clinical settings, due to lack of consensus regarding frailty definitions and diagnostic tools. This study aimed to review the practice of frailty assessment in nephrology populations and evaluate the context and timing of frailty assessment.
METHODS
The search included published reports of frailty assessment in patients with chronic kidney disease, undergoing dialysis or in receipt of a kidney transplant, published between January 2000 and November 2021. Medline, CINAHL, Embase, PsychINFO, PubMed and Cochrane Library databases were examined. A total of 164 articles were included for review.
RESULTS
We found that studies were most frequently set within developed nations. Overall, 161 studies were frailty assessments conducted as part of an observational study design, and 3 within an interventional study. Studies favoured assessment of participants with chronic kidney disease (CKD) and transplant candidates. A total of 40 different frailty metrics were used. The most frequently utilised tool was the Fried frailty phenotype. Frailty prevalence varied across populations and research settings from 2.8% among participants with CKD to 82% among patients undergoing haemodialysis. Studies of frailty in conservatively managed populations were infrequent (N = 4). We verified that frailty predicts higher rates of adverse patient outcomes. There is sufficient literature to justify future meta-analyses.
CONCLUSIONS
There is increasing recognition of frailty in nephrology populations and the value of assessment in informing prognostication and decision-making during transitions in care. The Fried frailty phenotype is the most frequently utilised assessment, reflecting the feasibility of incorporating objective measures of frailty and vulnerability into nephrology clinical assessment. Further research examining frailty in low and middle income countries as well as first nations people is required. Future work should focus on interventional strategies exploring frailty rehabilitation.
Topics: Humans; Frailty; Nephrology; Aging; Consensus; Databases, Factual; Observational Studies as Topic
PubMed: 37479978
DOI: 10.1186/s12877-023-04101-y -
Nephrology (Carlton, Vic.) Oct 2020In evidence-based medicine, clinical research questions may be addressed by different study designs. This article describes when randomized controlled trials (RCT) are... (Review)
Review
In evidence-based medicine, clinical research questions may be addressed by different study designs. This article describes when randomized controlled trials (RCT) are needed and when observational studies are more suitable. According to the Centre for Evidence-Based Medicine, study designs can be divided into analytic and non-analytic (descriptive) study designs. Analytic studies aim to quantify the association of an intervention (eg, treatment) or a naturally occurring exposure with an outcome. They can be subdivided into experimental (ie, RCT) and observational studies. The RCT is the best study design to evaluate the intended effect of an intervention, because the randomization procedure breaks the link between the allocation of the intervention and patient prognosis. If the randomization of the intervention or exposure is not possible, one needs to depend on observational analytic studies, but these studies usually suffer from bias and confounding. If the study focuses on unintended effects of interventions (ie, effects of an intervention that are not intended or foreseen), observational analytic studies are the most suitable study designs, provided that there is no link between the allocation of the intervention and the unintended effect. Furthermore, non-analytic studies (ie, descriptive studies) also rely on observational study designs. In summary, RCTs and observational study designs are inherently different, and depending on the study aim, they each have their own strengths and weaknesses.
Topics: Confounding Factors, Epidemiologic; Evidence-Based Medicine; Humans; Observational Studies as Topic; Randomized Controlled Trials as Topic; Research Design
PubMed: 32542836
DOI: 10.1111/nep.13742 -
Surgery For Obesity and Related... Jan 2022Metabolic and bariatric surgery helps women achieve a healthier weight, reduce co-morbid conditions, increase fertility rates, and improve pregnancy outcomes compared... (Review)
Review
Metabolic and bariatric surgery helps women achieve a healthier weight, reduce co-morbid conditions, increase fertility rates, and improve pregnancy outcomes compared with counterparts who are obese. Breastfeeding is known to provide both infant and maternal health benefits as well. Less is known about the impact of bariatric surgery on breastfeeding. The objective of this study was to review the impact of bariatric surgery on breastfeeding following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. PubMed and Medline databases were searched using terms such as "bariatric surgery," "postnatal care," "lactation," and "breastfeeding." Reference lists were also used to find relevant articles. A total of 49 records were identified. Abstracts were screened, and 11 observational studies were identified after meeting inclusion criteria, which included the use of original research on breastfeeding and women who have had bariatric surgery. The available research shows that breast milk after bariatric surgery is adequate in nutrients and that no long-term effects were reported in cases studies when nutrient deficiencies were corrected. Limitations include observational study design and small sample sizes. This systematic review suggests that breastfeeding after bariatric surgery should be recommended along with monitoring and micronutrient supplementation. However, additional research and increased sample sizes are needed to further examine the relationship, and such studies should be conducted to strengthen the evidence and explore ways to improve breastfeeding rates in this population.
Topics: Bariatric Surgery; Breast Feeding; Female; Humans; Infant; Observational Studies as Topic; Pregnancy; Pregnancy Outcome
PubMed: 34563465
DOI: 10.1016/j.soard.2021.08.021 -
Transfusion Medicine Reviews Jul 2022It has been proposed that blood donation could be protective against cardiovascular disease. The aim of this study is to systematically summarize and evaluate existing...
It has been proposed that blood donation could be protective against cardiovascular disease. The aim of this study is to systematically summarize and evaluate existing observational and experimental studies on effects of blood donation on cardiovascular risk and disease in donor and general populations. The electronic databases PubMed and EMBASE were searched until March 2019 for experimental and observational studies on blood donation and cardiovascular risk or disease. Excluded were studies performed in patient populations or with controls compared to a patient population, and studies performed in individuals aged <18 or >70. All identified studies were independently screened for eligibility and quality using validated scoring systems by 2 reviewers. A total of 44 studies met all criteria. We included 41 observational studies and 3 experimental studies. 14 studies had a quality assessment score of 7 or higher. Of those, a majority of 9 studies reported a protective effect of blood donation, while 5 studies found no effects on cardiovascular risk factors. Results on other various outcomes were inconsistent and study quality was generally poor. Whether or not blood donation protects against cardiovascular disease remains unclear. Studies showing beneficial effects may have inadequately dealt with the healthy donor effect. High quality studies are lacking and therefore definite conclusions cannot be drawn. Large RCTs or cohort studies of high quality with sufficient follow-up should be conducted to provide evidence on the possible association between blood donation and cardiovascular disease.
Topics: Blood Donors; Cardiovascular Diseases; Humans; Observational Studies as Topic
PubMed: 35606245
DOI: 10.1016/j.tmrv.2022.04.004 -
Journal of Bone and Mineral Research :... May 2020The Women's Health Initiative (WHI) is a large longitudinal study designed to investigate strategies for the prevention and control of common chronic diseases in... (Review)
Review
The Women's Health Initiative (WHI) is a large longitudinal study designed to investigate strategies for the prevention and control of common chronic diseases in postmenopausal women, including cardiovascular disease, cancer, and osteoporotic fractures. The WHI consisted of three overlapping clinical trials of hormone therapy, diet modification to reduce total dietary fat, and calcium/vitamin D supplementation. Women who were ineligible for the hormone therapy or diet modification trials or not interested were invited to participate in the observational study. Women were recruited into WHI from 1993 to 1998 at 40 US clinical centers. WHI enrolled 26,046 underrepresented minority women and 135,762 white women. Women could participate in each trial if eligible. The final enrollment included 27,347 women in the hormone trial; 48,835 women in the diet modification trial; 36,282 women in the calcium/vitamin D trial, and 93,676 in the observational study. After the main study ended in 2005, women were invited to continue follow-up for exposures and outcomes through two extensions to 2020. Proposals were recently submitted to continue follow-up through 2027. Information was collected on an extensive number of risk factors for fractures at baseline and over the follow-up, including fall and fracture history, weight patterns, comorbidities, diet, reproductive history, medications, anthropometry, and biomarkers. Bone mineral density was measured at three WHI clinical centers (n = 11,020) chosen to maximize race/ethnic diversity. WHI encourages outside investigators to make use of the publicly available WHI data and to access the biobank of specimens (www.whi.org). © 2020 American Society for Bone and Mineral Research.
Topics: Dietary Supplements; Female; Humans; Longitudinal Studies; Observational Studies as Topic; Osteoporotic Fractures; United States; Vitamin D; Women's Health
PubMed: 32286708
DOI: 10.1002/jbmr.4026 -
International Endodontic Journal Sep 2021To record the prevalence of a priori power calculations in manuscripts published in three endodontic journals between 2018 and 2020 and detect further associations with... (Review)
Review
AIM
To record the prevalence of a priori power calculations in manuscripts published in three endodontic journals between 2018 and 2020 and detect further associations with a number of study characteristics including journal, publication year, study design, geographic region, number of centres and authors, whether the primary outcome pertained to a statistically significant effect and whether confidence intervals (CIs) were reported.
METHODOLOGY
The contents of the three leading endodontic journals with the highest impact factor (International Endodontic Journal, IEJ; Journal of Endodontics, JOE; and Australian Endodontic Journal, AEJ) were assessed from January 2018 to December 2020. The proportion of articles reporting a priori power calculations were recorded, and relevant associations as described above were assessed. Univariable and multivariable logistic regression were used to identify significant predictors, whilst interaction and linear trend effects were also considered.
RESULTS
A total of 716 original research articles were included. The vast majority were published in the JOE (417/716; 58.2%), followed by the IEJ (225/716; 31.4%) and the AEJ (74/716; 10.4%). Overall, a priori power considerations were reported in 243 out of 716 articles (33.9%). The IEJ presented 1.61 times higher odds for including a priori power considerations compared to JOE (adjusted odds ratio, OR = 1.61; 95%CI: 1.11, 2.34), whilst for the AEJ, the corresponding odds were 41% lower in comparison to JOE (adjusted OR = 0.59; 95%CI: 0.31, 1.14). For each additional year indicating more recent publication, the odds for adopting appropriate reporting practices for power considerations were increased by 64% (adjusted OR = 1.64; 95%CIs: 1.32, 2.04). There was strong evidence that interventional research was associated with 10.54 times higher odds for a priori considerations compared to observational study design (adjusted OR = 10.54; 95%CIs: 5.50, 20.19).
CONCLUSIONS
The high prevalence of failure to include a priori power considerations was indicative of suboptimal reporting in endodontic research, in the three endodontic journals analysed. Although the condition improved over time, efforts to incorporate a correct determination of the required sample size at the design stage for any future study should be endorsed by journal editors, authors and the scientific community.
Topics: Australia; Endodontics; Humans; Observational Studies as Topic; Research Design
PubMed: 33872405
DOI: 10.1111/iej.13531 -
Nicotine & Tobacco Research : Official... Jan 2023Indigenous North Americans have the highest cigarette smoking prevalence among all racial and ethnic groups in the United States. We seek to identify effective... (Review)
Review
INTRODUCTION
Indigenous North Americans have the highest cigarette smoking prevalence among all racial and ethnic groups in the United States. We seek to identify effective components of smoking cessation interventions in Indigenous people in the United States associated with favorable cessation outcomes.
METHODS
A review of literature studying smoking cessation interventions in Indigenous North Americans (American Indians and Alaska Natives) from January 2010 through August 2021 was completed. The primary objective of this study was to identify components of interventions associated with positive smoking cessation outcomes in Indigenous people. The studies identified were synthesized in a meta-narrative approach.
RESULTS
Ten studies out of 608 titles were included (6 randomized trials, 2 single-arm studies, 1 cohort study, and 1 prospective observational study). Five categories of smoking cessation interventions were identified; phone or web-based tools, culturally-tailored interventions, the inclusion of Indigenous study personnel, pharmaceutical cessation aids, and behavioral health interventions. Phone and web tools, cultural tailoring, and inclusion of Indigenous personnel conditions inconsistently influenced smoking cessation. Pharmaceutical aids were viewed favorably among participants. Individualized behavioral counseling sessions were effective at promoting smoking cessation, as was input from local communities in the planning and implementation phases of study.
CONCLUSION
A successful smoking cessation intervention in Indigenous North Americans includes Tribal or community input in intervention design and implementation; should provide individualized counseling sessions for participants, and offer access to validated smoking cessation tools including pharmacotherapy.
IMPLICATIONS
This study identifies a paucity of smoking interventions utilizing standard of care interventions in Indigenous North Americans. Standard of care interventions including individualized cessation counseling and pharmacotherapy were effective at promoting cessation. The use of novel culturally tailored cessation interventions was not more effective than existing evidence-based care with the exception of including Tribal and local community input in intervention implementation. Future smoking cessation interventions in Indigenous North Americans should prioritize the use of standard of care cessation interventions.
Topics: Humans; United States; Smoking Cessation; Cohort Studies; Behavior Therapy; Counseling; Population Groups; Observational Studies as Topic
PubMed: 35869642
DOI: 10.1093/ntr/ntac181 -
Seminars in Radiation Oncology Oct 2019A principle goal of research in Oncology is to determine the optimal treatment for our patients. This often takes the form of comparing 2 existing therapies to one... (Review)
Review
A principle goal of research in Oncology is to determine the optimal treatment for our patients. This often takes the form of comparing 2 existing therapies to one another to determine which is superior, or to introduce a new therapy and determine if it is superior or noninferior to the existing standard of care. This type of research is termed comparative effectiveness research (CER), and the gold-standard is through the conduct of randomized trials. This is the preferred approach, and the only true methodologic approach that can assign a cause-and-effect relationship between a treatment effect and the observed outcome. An alternative approach that is gaining popularity is the use of population-based registry analysis given that it is quicker, cheaper, and easier to perform. However, there are unavoidable forms of bias and confounding that exist when using observational research to perform CER, and recent evidence suggests that population-based CER often results in erroneous results, and that statistical methods to minimize bias are ineffective to overcome the numerous limitations of these databases. In this article, the strengths and weaknesses of both randomized and observational research will be discussed.
Topics: Comparative Effectiveness Research; Data Management; Humans; Medical Oncology; Observational Studies as Topic; Research Design
PubMed: 31472729
DOI: 10.1016/j.semradonc.2019.05.011 -
Advances in Therapy Jun 2023Since their approval by the Food and Drug Administration (FDA) in 1989, proton pump inhibitors (PPIs) have become one of the most highly utilized drugs in the United... (Review)
Review
Since their approval by the Food and Drug Administration (FDA) in 1989, proton pump inhibitors (PPIs) have become one of the most highly utilized drugs in the United States, assuming a position as one of the top 10 most prescribed medications in the country. The purpose of PPIs is to limit the amount of gastric acid secreted by the parietal cells via irreversible inhibition of the H+/K+-ATPase pump, therefore maintaining an elevated gastric acid pH of greater than 4 for 15-21 h. Even though PPIs have many clinical uses, they are not without their adverse effects, mimicking achlorhydria. Besides electrolyte abnormalities and vitamin deficiencies, long-term use of PPIs has been linked to acute interstitial nephritis, bone fractures, poor COVID-19 infection outcomes, pneumonia, and possibly an increase in all-cause mortality. The causality between PPI use and increased mortality and disease risk can be questioned since most studies are observational. Confounding variables can greatly affect an observational study and explain the wide-ranging associations with the use of PPIs. Patients on PPIs are generally older, obese, sicker with a higher number of baseline morbidities, and on more medications than the compared PPI non-users. These findings suggest that PPI users are at a higher risk of mortality and complications based on pre-existing conditions. This narrative review aims to update readers on the concerning effects that proton pump inhibitor use can have on patients and give providers a resource to create informed decisions on appropriate PPI use.
Topics: Humans; Proton Pump Inhibitors; COVID-19; Fractures, Bone; Kidney; Observational Studies as Topic
PubMed: 37140707
DOI: 10.1007/s12325-023-02476-3 -
Skinmed 2021This study assessed relationship between hair loss and professional success by characterizing severity of hair loss among current white male chief executive officers... (Review)
Review
This study assessed relationship between hair loss and professional success by characterizing severity of hair loss among current white male chief executive officers (CEOs) in the United States. This observational study of androgenic alopecia among business executives was conducted by grading anterior and lateral view photographs of CEOs aged 50-69 years. Blinded, independent two-reviewer assessments of androgenic alopecia were performed based on the Hamilton-Norwood Hair Loss Scale. In all, 68 CEOs were included in this review, with 34 individuals each in the age groups of 50-59 and 60-69 years. Significant hair loss occurred in 18% (6/34) of the CEOs aged 50-59 years and in 35% (12/34) of those aged 60-69 years. The findings of the study established that among white male CEOs aged 50-69 years, significant hair loss occurred less frequently than previously reported for the general white male population.
Topics: Alopecia; Hair; Humans; Male; Observational Studies as Topic; United States
PubMed: 34526203
DOI: No ID Found