-
Journal of the American Pharmacists... 2017Polypharmacy has been linked to a myriad of adverse consequences, and escalating rates of polypharmacy present an emerging concern, particularly among older adults. This... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Polypharmacy has been linked to a myriad of adverse consequences, and escalating rates of polypharmacy present an emerging concern, particularly among older adults. This systematic review and meta-analysis summarizes the existing literature concerning the association between polypharmacy and mortality.
DATA SOURCES
A systematic literature review was done by searching the EMBASE, PubMed, Scopus, and International Pharmaceutical Abstract databases to identify studies assessing the association between polypharmacy and death published until June 2016.
STUDY SELECTION
Studies that investigated the association between polypharmacy and mortality were eligible for this systematic review and meta-analysis.
DATA EXTRACTION
Data were extracted by the first and second authors independently using a data extraction form. Disagreement was resolved by consensus. A meta-analysis was performed using random effect models. Heterogeneity was assessed using the I statistic.
RESULTS
Forty-seven studies were included in this meta-analysis. The underlying populations were heterogeneous (I= 91.5%). When defined as a discrete variable, pooled risk estimates demonstrated a significant association between polypharmacy and death (pooled-adjusted odds ratio [aOR] 1.08 [95% CI 1.04-1.12]). When defined categorically, a dose-response relationship was observed across escalating thresholds for defining polypharmacy. Categorical thresholds for polypharmacy using values of 1-4 medications, 5 medications, and 6-9 medications were significantly associated with death (P <0.05; aOR 1.24 [1.10-1.39], aOR 1.31 [1.17, 1.47], and aOR 1.59 [1.36-1.87], respectively). Excessive polypharmacy (ie, the use of 10 or more medications) was also associated with death (aOR 1.96 [1.42-2.71]).
CONCLUSIONS
Pooled risk estimates from this meta-analysis reveal that polypharmacy is associated with increased mortality risk, using both discrete and categorical definitions. The causality of this relationship remains unclear, but it emphasizes the need for approaches to health care delivery that achieve an optimal balance of risk and benefit in medication prescribing.
Topics: Cause of Death; Chi-Square Distribution; Dose-Response Relationship, Drug; Drug Interactions; Drug-Related Side Effects and Adverse Reactions; Humans; Odds Ratio; Polypharmacy; Risk Assessment; Risk Factors
PubMed: 28784299
DOI: 10.1016/j.japh.2017.06.002 -
European Journal of Preventive... Jun 2016To examine for a possible relationship between osteoarthritis and cardiovascular disease. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
To examine for a possible relationship between osteoarthritis and cardiovascular disease.
DESIGN
A systematic review and meta-analysis.
METHODS
Published and unpublished literature from: MEDLINE, EMBASE, CINAHL, the Cochrane Library, OpenGrey and clinical trial registers. Search to 22 November 2014. Cohort, case-control, randomised and non-randomised controlled trial papers reporting the prevalence of cardiovascular disease in osteoarthritis were included.
RESULTS
Fifteen studies with 32,278,744 individuals were eligible. Pooled prevalence for overall cardiovascular disease pathology in people with osteoarthritis was 38.4% (95% confidence interval (CI): 37.2% to 39.6%). Individuals with osteoarthritis were almost three times as likely to have heart failure (relative risk (RR): 2.80; 95% CI: 2.25 to 3.49) or ischaemic heart disease (RR: 1.78; 95% CI: 1.18 to 2.69) compared with matched non-osteoarthritis cohorts. No significant difference was detected between the two groups for the risk of experiencing myocardial infarction or stroke. There was a three-fold decrease in the risk of experiencing a transient ischaemic attack in the osteoarthritis cohort compared with the non-osteoarthritis group.
CONCLUSIONS
Prevalence of cardiovascular disease in patients with osteoarthritis is significant. There was an observed increased risk of incident heart failure and ischaemic heart disease in people with osteoarthritis compared with matched controls. However, the relationship between osteoarthritis and cardiovascular disease is not straightforward and there is a need to better understand the potential common pathways linking pathophysiological mechanisms.
Topics: Cardiovascular Diseases; Chi-Square Distribution; Humans; Incidence; Odds Ratio; Osteoarthritis; Prevalence; Prognosis; Risk Assessment; Risk Factors
PubMed: 26464295
DOI: 10.1177/2047487315610663 -
BMC Musculoskeletal Disorders Mar 2016Femoral neck fractures in the elderly make up a large proportion of Orthopaedic surgical admissions each year. Operating on patients with clopidogrel poses a challenge... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Femoral neck fractures in the elderly make up a large proportion of Orthopaedic surgical admissions each year. Operating on patients with clopidogrel poses a challenge because of the risk of bleeding and the difficulty deciding the optimal timing of surgery. The aim of this systematic review is to examine the published evidence to establish a set of guidelines for approaching neck of femur patients who are on clopidogrel.
METHODS
All comparative studies with an intervention group and a control group were considered. Data on patient blood transfusion exposures, units transfused, haemoglobin concentration and drop in haemoglobin were extracted and pooled using the fixed effects model. Heterogeneity of the intervention effect was assessed with the I (2) statistic.
RESULTS
A total of 4219 studies were identified. After removal of duplicates and after exclusion criteria were applied, there were 14 studies to be included. All 14 were case series with controls. There was no significant heterogeneity amongst the studies. Pooled odds ratio for transfusion exposures was 1.24 (95 % confidence interval 0.91 to 1.71) however this was not statistically significant (p = 0.14). No significant mean differences were found for other primary outcome measures.
CONCLUSIONS
On the available evidence, we recommend that these patients can be managed by normal protocols with early surgery. Operating early on patients on clopidogrel is safe and does not appear to confer any clinically significant bleeding risk. As reported in other studies, we believe clopidogrel, if possible, should not be withheld throughout the perioperative period due to increased risk of cardiovascular events associated with stopping clopidogrel. Care should be taken intraoperatively to minimise blood loss due to the increased potential for bleeding.
TRIAL REGISTRATION
This systematic review and meta-analysis has been registered on Research Registry on July 16, 2015. The Review Registry Unique Identifying Number is: reviewregistry61 .
Topics: Blood Loss, Surgical; Chi-Square Distribution; Clopidogrel; Drug Administration Schedule; Femoral Neck Fractures; Fracture Fixation; Humans; Odds Ratio; Platelet Aggregation Inhibitors; Risk Assessment; Risk Factors; Ticlopidine; Treatment Outcome
PubMed: 27005816
DOI: 10.1186/s12891-016-0988-9 -
European Respiratory Review : An... Jan 2017Asthma is a chronic, inflammatory lung disease affecting around 235 million people worldwide. Conventional medications in asthma are not curative and patients have... (Meta-Analysis)
Meta-Analysis Review
Asthma is a chronic, inflammatory lung disease affecting around 235 million people worldwide. Conventional medications in asthma are not curative and patients have significant concerns regarding their side-effects. Consequently, many asthma patients turn to complementary and alternative medicine (CAM) for a more holistic approach to care. We systematically reviewed the available evidence on the effectiveness of CAM in the management of asthma in adults.We searched the MEDLINE, EMBASE, CINAHL, AMED and Cochrane databases for randomised controlled trials published in English between 1990 and 2016 investigating the effectiveness of oral or topical CAM in asthmatic adults. The quality of the studies was assessed using the Cochrane Risk of Bias Assessment Tool.In all, 23 eligible trials were identified covering 19 different CAMs. Overall, there was limited evidence on the effectiveness of CAM in adult asthma as most CAMs were only assessed in a single trial. CAMs with multiple trials provided null or inconsistent results. Many of the trials were rated as having high risk of bias.The existing evidence is insufficient to recommend any of the oral and topical CAMs in the management of asthma in adults.
Topics: Administration, Oral; Administration, Topical; Adolescent; Adult; Anti-Asthmatic Agents; Asthma; Chi-Square Distribution; Complementary Therapies; Female; Holistic Health; Humans; Lung; Male; Middle Aged; Treatment Outcome; Young Adult
PubMed: 28143878
DOI: 10.1183/16000617.0092-2016 -
Iranian Journal of Kidney Diseases Mar 2018Uremic pruritus is characterized by an uncomfortable and unlimited sensation which leads to scratch, which strongly reduces the quality of life. Pruritus is a common... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Uremic pruritus is characterized by an uncomfortable and unlimited sensation which leads to scratch, which strongly reduces the quality of life. Pruritus is a common symptom in patients with end-stage renal disease. Various clinical trial studies have examined the effects of acupuncture and acupressure on treatment of uremic pruritus. This systematic review meta-analysis aimed to evaluate the effectiveness based on published studies.
MATERIALS AND METHODS
An electronic literature search was conducted to identify appropriate trial studies. The results for continuous outcomes were presented as weighted mean difference, with 95% confidence intervals.
RESULTS
A total of 5 articles, including 6 trials, were enrolled in this systematic review. Only 3 of the six trial studies used a visual analogue scale score for assessing pruritus and acupressure for intervention regime, which were considered for meta-analysis. The combined results showed that acupuncture or acupressure was effective in treatment of uremic pruritus (pooled mean difference, -1.994; 95% confidence interval, -2.544 to -1.445).
CONCLUSIONS
This study confirms that using acupuncture and acupressure is effective in treatment of uremic pruritus. However, further vigorous studies are needed to verify these findings.
Topics: Acupressure; Acupuncture Points; Acupuncture Therapy; Adult; Chi-Square Distribution; Female; Humans; Male; Middle Aged; Pruritus; Quality of Life; Risk Factors; Treatment Outcome; Uremia
PubMed: 29507269
DOI: No ID Found -
Vascular Aug 2017Introduction Acute mesenteric ischaemia is associated with a significant morbidity and mortality. Endovascular techniques have emerged as a viable alternative treatment... (Meta-Analysis)
Meta-Analysis Review
Introduction Acute mesenteric ischaemia is associated with a significant morbidity and mortality. Endovascular techniques have emerged as a viable alternative treatment option to conventional surgery. Our objective was to conduct a systematic review of the literature and perform a meta-analysis of reported outcomes. Methods Our review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards and the protocol was registered in PROSPERO (CRD42016035667). We searched electronic information sources (MEDLINE, EMBASE, CINAHL, CENTRAL) and bibliographic lists of relevant articles to identify studies reporting outcomes of endovascular treatment for acute mesenteric ischaemia of embolic or thrombotic aetiology. We defined 30-day or in-hospital mortality and bowel resection as the primary outcome measures. We used the Newcastle-Ottawa scale to assess the methodological quality of observational studies. We calculated combined overall effect sizes using random effects models; results are reported as the odds ratio and 95% confidence interval. Results We identified 19 observational studies reporting on a total of 3362 patients undergoing endovascular treatment for acute mesenteric ischaemia. The pooled estimate of peri-interventional mortality was 0.245 (95% confidence interval 0.197-0.299), that of the requirement for bowel resection 0.326 (95% confidence interval 0.229-0.439), and the pooled estimate for acute kidney injury was 0.132 (95% confidence interval 0.082-0.204). Eight studies reported comparative outcomes of endovascular versus surgical treatment for acute mesenteric ischaemia (endovascular group, 3187 patients; surgical group, 4998 patients). Endovascular therapy was associated with a significantly lower risk of 30-day mortality (odds ratio 0.45, 95% confidence interval 0.30-0.67, P = 0.0001), bowel resection (odds ratio 0.45, 95% confidence interval 0.34-0.59, P < 0.00001) and acute renal failure (odds ratio 0.58, 95% confidence interval 0.49-0.68, P < 0.00001). No differences were identified in septic complications or the development of short bowel syndrome. Conclusion Endovascular treatment for acute mesenteric ischaemia is associated with a considerable mortality and requirement of bowel resection. However, endovascular therapy confers improved outcomes compared to conventional surgery, as indicated be reduced mortality, risk of bowel resection and acute renal failure. An endovascular-first approach should be considered in patients presenting with acute mesenteric ischaemia.
Topics: Chi-Square Distribution; Endovascular Procedures; Humans; Mesenteric Ischemia; Mesenteric Vascular Occlusion; Odds Ratio; Risk Assessment; Risk Factors; Splanchnic Circulation; Stents; Treatment Outcome
PubMed: 28121281
DOI: 10.1177/1708538116689353 -
Systems Biology in Reproductive Medicine Apr 2017This study reviewed the efficacy and safety of the three surgical approaches for varicocele (microsurgical, laparoscopic, and open varicocelectomy). A systematic review... (Meta-Analysis)
Meta-Analysis Review
This study reviewed the efficacy and safety of the three surgical approaches for varicocele (microsurgical, laparoscopic, and open varicocelectomy). A systematic review of the relevant randomized clinical trials was performed. Trials were identified from specialized trials register of the Cochrane UGDP Group, the Cochrane library, additional electronic searches (mainly MEDLINE, EMBSAE, SCI, CBM), and handsearching. Clinical trials comparing microsurgical, laparoscopic and open varicocelectomies were included. Statistical analysis was managed using Review Manager 5.3. Seven clinical trials of 1,781 patients were included. The meta-analysis indicated that compared with open varicocelectomy, microsurgery had a higher pregnancy rate (p=0.002), while there was nonsignificant difference between microsurgical and laparoscopic varicocelectomies or between laparoscopic and open varicocelectomies. Both microsurgical and laparoscopic varicocelectomies had a greater increase in postoperative sperm concentration than open varicocelectomy (p=0.008 and p=0.001, respectively). Microsurgical varicocelectomy also showed better improvement in postoperative sperm motility (p=0.02). Compared with the other two, microsurgical varicocelectomy had the longest operative time (p=0.01 and p=0.0004 respectively). A nonsignificant difference was found in the hospital stay between the three approaches, whereas microsurgical and laparoscopic varicocelectomies had a shorter time to return to work. Moreover, microsurgical varicocelectomy had a lower incidence of postoperative complications and recurrence compared with the others. Analysis of current evidence shows that microsurgical varicocelectomy has a longer operative time, lower incidence of postoperative complications, and recurrence than laparoscopic and open varicocelectomies, and shows a higher pregnancy rate, with a greater increase in postoperative sperm concentration, better improvement in postoperative sperm motility, and shorter time to return to work than open varicocelectomy.
Topics: Adult; Chi-Square Distribution; Female; Fertility; Humans; Infertility, Male; Laparoscopy; Length of Stay; Male; Microsurgery; Odds Ratio; Postoperative Complications; Pregnancy; Pregnancy Rate; Recovery of Function; Return to Work; Risk Factors; Sperm Count; Sperm Motility; Time Factors; Treatment Outcome; Urogenital Surgical Procedures; Varicocele; Young Adult
PubMed: 28301253
DOI: 10.1080/19396368.2016.1265161 -
Sarcoidosis, Vasculitis, and Diffuse... Sep 2015Several chronic inflammatory disorders, such as rheumatoid arthritis, inflammatory myositis and systemic lupus erythematosus, have been linked to an increased risk of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several chronic inflammatory disorders, such as rheumatoid arthritis, inflammatory myositis and systemic lupus erythematosus, have been linked to an increased risk of venous thromboembolism (VTE). However, the data on sarcoidosis is unclear.
OBJECTIVES
To evaluate the risk of VTE among patients with sarcoidosis.
METHODS
We conducted a systematic review and meta-analysis of observational studies that reported odds ratio, relative risk, hazard ratio or standardized incidence ratio comparing risk of VTE in patients with sarcoidosis versus non-sarcoidosis participants. Estimated effects were extracted from each study and were pooled together using the random-effect, generic inverse variance method of DerSimonian and Laird.
RESULT
Out of 772 potentially relevant articles, three eligible studies were identified and included in the data analysis. The pooled risk ratio of VTE in patients with sarcoidosis was 1.42 (95% CI, 1.12-1.79). The statistical heterogeneity of this study was moderate with an I2 of 72%.
CONCLUSION
Our study demonstrated a statistically significant increased VTE risk among patients with sarcoidosis.
Topics: Chi-Square Distribution; Humans; Incidence; Odds Ratio; Prognosis; Risk Assessment; Risk Factors; Sarcoidosis; Venous Thromboembolism
PubMed: 26422561
DOI: No ID Found -
Age and Ageing Jan 2018light-to-moderate alcohol consumption is protective against all-cause mortality and cardiovascular diseases. There is limited evidence in the literature on how alcohol... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
light-to-moderate alcohol consumption is protective against all-cause mortality and cardiovascular diseases. There is limited evidence in the literature on how alcohol consumption is related to frailty.
METHODS
five databases (Embase, Scopus, MEDLINE, CINAHL, PsycINFO) were systematically searched in July 2016 for prospective studies published between 2000 and 2016 examining baseline alcohol consumption and subsequent frailty risk among middle-aged or older community-dwelling population. Odds ratios (ORs) for incident frailty were pooled using a random-effects model. Heterogeneity, methodological quality and publication bias were assessed.
RESULTS
of 926 studies identified by the systematic search, four studies were included (total n = 44,051, ≥55 years, 66.2% alcohol users). OR of incident frailty for the highest (at least 24 g of alcohol/day for men, 12g of alcohol/day for women) or the most frequent (≥5 days of drinking/week) alcohol consumption compared with no drinking were used for a meta-analysis. Pooled OR among three studies measuring alcohol consumption quantitatively showed that the highest alcohol consumption was associated with lower frailty risk (3 studies:pooled OR = 0.44, 95%CI = 0.19-1.00, P = 0.05). Adding the other study measuring frequency of alcohol consumption made little change (4 studies:pooled OR = 0.61, 95%CI = 0.44-0.77, P < 0.001). Two of the included studies suggested a possible U-shaped association with lowest risks for moderate drinkers. Heterogeneity was moderate in both analyses (I2 = 52-67%). There was no evidence of publication bias.
CONCLUSIONS
this systematic review and meta-analysis study provides the first pooled evidence suggesting that heavier alcohol consumption is associated with lower incident frailty compared with no alcohol consumption among community-dwelling middle-aged and older people. However, this association may be due to unadjusted effect measures, residual confounding, 'sick quitter' effect or survival bias.
Topics: Age Factors; Aged; Aged, 80 and over; Alcohol Drinking; Chi-Square Distribution; Female; Frail Elderly; Frailty; Geriatric Assessment; Humans; Incidence; Logistic Models; Male; Middle Aged; Odds Ratio; Prognosis; Prospective Studies; Protective Factors; Risk Assessment; Risk Factors; Time Factors
PubMed: 28541395
DOI: 10.1093/ageing/afx086 -
Plastic and Reconstructive Surgery Sep 2012Despite the availability of cadaveric, anatomic, and clinical models to identify peroneal artery perforators in the lower leg, there is no consensus on the optimal... (Review)
Review
BACKGROUND
Despite the availability of cadaveric, anatomic, and clinical models to identify peroneal artery perforators in the lower leg, there is no consensus on the optimal fibula interval to reliably capture perforators for flap and skin paddle design.
METHODS
A systematic review of the MEDLINE and Cochrane databases was performed to identify all anatomical, clinical, and radiographic reports of peroneal artery perforators in the lower leg. Locations were indexed along tenths of the total fibula length to incorporate a uniform format.
RESULTS
Three clinical and six cadaveric reports identified 445 legs and 1710 perforators. The 0.6 interval had the greatest total perforator frequency at 19.1 ± 1 percent, with 310 perforators and a positive probability of 79.1 ± 2.1 percent. Chi-square analysis found a statistical difference in perforator frequency at the flanking intervals of 0.5 and 0.8 (p = 0.0058 and p = 0.0019) and beyond. Subgroup analysis of septocutaneous perforators was based on 345 legs and 608 perforators. The 0.6 interval was the densest, with 110 perforators and a frequency of 18.1 ± 1.6 percent. The musculocutaneous subgroup analysis found 292 legs and 831 perforators, and a densest interval at 0.4, based on 157 perforators and a frequency of 18.9 ± 1.4 percent.
CONCLUSIONS
This systematic review and pooled analysis of all available and complete peroneal artery perforator data demonstrates clustering over the 0.6 interval of the lateral leg. This interval should be considered during flap design and elevation to reliably capture irrigating perforators for free and local flap applications.
Topics: Cadaver; Chi-Square Distribution; Fibula; Free Tissue Flaps; Humans; Leg; Perforator Flap; Skin
PubMed: 22575854
DOI: 10.1097/PRS.0b013e31825dbff3