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Critical Care (London, England) Apr 2024To perform a systematic review with meta-analysis with the dual intent of assessing the impact of attaining aggressive vs. conservative beta-lactams PK/PD target on the... (Meta-Analysis)
Meta-Analysis
Impact of attaining aggressive vs. conservative PK/PD target on the clinical efficacy of beta-lactams for the treatment of Gram-negative infections in the critically ill patients: a systematic review and meta-analysis.
BACKGROUND
To perform a systematic review with meta-analysis with the dual intent of assessing the impact of attaining aggressive vs. conservative beta-lactams PK/PD target on the clinical efficacy for treating Gram-negative infections in critical patients, and of identifying predictive factors of failure in attaining aggressive PK/PD targets.
METHODS
Two authors independently searched PubMed-MEDLINE and Scopus database from inception to 23rd December 2023, to retrieve studies comparing the impact of attaining aggressive vs. conservative PK/PD targets on clinical efficacy of beta-lactams. Independent predictive factors of failure in attaining aggressive PK/PD targets were also assessed. Aggressive PK/PD target was considered a100%fT, and clinical cure rate was selected as primary outcome. Meta-analysis was performed by pooling odds ratios (ORs) extrapolated from studies providing adjustment for confounders using a random-effects model with inverse variance method.
RESULTS
A total of 20,364 articles were screened, and 21 observational studies were included in the meta-analysis (N = 4833; 2193 aggressive vs. 2640 conservative PK/PD target). Attaining aggressive PK/PD target was significantly associated with higher clinical cure rate (OR 1.69; 95% CI 1.15-2.49) and lower risk of beta-lactam resistance development (OR 0.06; 95% CI 0.01-0.29). Male gender, body mass index > 30 kg/m, augmented renal clearance and MIC above the clinical breakpoint emerged as significant independent predictors of failure in attaining aggressive PK/PD targets, whereas prolonged/continuous infusion administration of beta-lactams resulted as protective factor. The risk of bias was moderate in 19 studies and severe in the other 2.
CONCLUSIONS
Attaining aggressive beta-lactams PK/PD targets provided significant clinical benefits in critical patients. Our analysis could be useful to stratify patients at high-risk of failure in attaining aggressive PK/PD targets.
Topics: Humans; Male; beta-Lactams; Anti-Bacterial Agents; Critical Illness; Treatment Outcome; Infusions, Intravenous
PubMed: 38627763
DOI: 10.1186/s13054-024-04911-5 -
BMJ Open Apr 2024A subset of patients with superficial venous thrombosis (SVT) experiences clot propagation towards deep venous thrombosis (DVT) and/or pulmonary embolism (PE). The aim... (Meta-Analysis)
Meta-Analysis
Predictive factors of clot propagation in patients with superficial venous thrombosis towards deep venous thrombosis and pulmonary embolism: a systematic review and meta-analysis.
OBJECTIVE
A subset of patients with superficial venous thrombosis (SVT) experiences clot propagation towards deep venous thrombosis (DVT) and/or pulmonary embolism (PE). The aim of this systematic review is to identify all clinically relevant cross-sectional and prognostic factors for predicting thrombotic complications in patients with SVT.
DESIGN
Systematic review.
DATA SOURCES
PubMed/MEDLINE and Embase were systematically searched until 3 March 2023.
ELIGIBILITY CRITERIA
Original research studies with patients with SVT, DVT and/or PE as the outcome and presenting cross-sectional or prognostic predictive factors.
DATA EXTRACTION AND SYNTHESIS OF RESULTS
The CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling (CHARMS) checklist for prognostic factor studies was used for systematic extraction of study characteristics. Per identified predictive factor, relevant estimates of univariable and multivariable predictor-outcome associations were extracted, such as ORs and HRs. Estimates of association for the most frequently reported predictors were summarised in forest plots, and meta-analyses with heterogeneity were presented. The Quality in Prognosis Studies (QUIPS) tool was used for risk of bias assessment and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) for assessing the certainty of evidence.
RESULTS
Twenty-two studies were included (n=10 111 patients). The most reported predictive factors were high age, male sex, history of venous thromboembolism (VTE), absence of varicose veins and cancer. Pooled effect estimates were heterogenous and ranged from OR 3.12 (95% CI 1.75 to 5.59) for the cross-sectional predictor cancer to OR 0.92 (95% CI 0.56 to 1.53) for the prognostic predictor high age. The level of evidence was rated very low to low. Most studies were scored high or moderate risk of bias.
CONCLUSIONS
Although the pooled estimates of the predictors high age, male sex, history of VTE, cancer and absence of varicose veins showed predictive potential in isolation, variability in study designs, lack of multivariable adjustment and high risk of bias prevent firm conclusions. High-quality, multivariable studies are necessary to be able to identify individual SVT risk profiles.
PROSPERO REGISTRATION NUMBER
CRD42021262819.
Topics: Humans; Male; Venous Thromboembolism; Cross-Sectional Studies; Risk Factors; Venous Thrombosis; Pulmonary Embolism; Neoplasms; Varicose Veins; Anticoagulants
PubMed: 38626964
DOI: 10.1136/bmjopen-2023-074818 -
Clinical Psychology Review Jun 2024Children can experience significant distress during hospitalisation, as a result of the treatment process and due to psychosocial factors impacting their adjustment to... (Review)
Review
Children can experience significant distress during hospitalisation, as a result of the treatment process and due to psychosocial factors impacting their adjustment to the hospital environment. Such factors can contribute to negative outcomes for the child. Despite this, limited research focus has been placed on understanding the psychosocial factors that contribute to a child's distress to inform support strategies that can improve the experience of hospitalisation across paediatric conditions. The objectives of this review were to synthesise the qualitative and quantitative literature on psychosocial factors associated with hospital adjustment and to identify risk and protective factors that influence the adjustment process. The literature search (1980 to February 2024: CINAHL / Embase / Medline / PsychINFO and Web of Science databases) identified thirty-four studies. Poor hospital adjustment, anxiety, depression and homesickness, were reported by the majority of hospitalised children. Several demographic and psychosocial factors were identified in the quantitative synthesis to contribute to poor adjustment. Child age, temperament, attachment style, past negative hospital experiences, homesickness and fear cognitions, were all associated with adjustment to the hospital environment. Homesickness was identified as a particularly understudied and important construct. Theoretical and methodological considerations are discussed, and recommendations made for future research that can further support inpatient children and their families.
Topics: Humans; Child; Child, Hospitalized; Loneliness; Adolescent; Adaptation, Psychological; Anxiety; Hospitalization
PubMed: 38626645
DOI: 10.1016/j.cpr.2024.102431 -
Journal of Neurotrauma May 2024Cognitive impairment is a common complication following spinal cord injury (SCI) and imposes a significant negative impact on adjustment, functional independence,... (Review)
Review
Cognitive impairment is a common complication following spinal cord injury (SCI) and imposes a significant negative impact on adjustment, functional independence, physical and mental health, and quality of life. It is unclear whether interventions for cognitive impairment following SCI are effective. A systematic review of controlled trials was performed to evaluate the effect of interventions on cognitive functions in adults with SCI using search engines: Embase, The Cochrane Library, MEDLINE, Scopus, CINAHL, and Web of Science up to December 2023. Two reviewers independently screened the articles, and study findings were synthesized and summarized. The risk of bias was evaluated using the Cochrane Risk of Bias 2.0 tool. Eight moderate-quality studies were found that investigated the effects of physical exercise/activity-based therapy plus cognitive training or intermittent hypoxia, diet modification and dietary supplements, tibial nerve or cortical stimulation, and drug therapy on cognitive function in SCI. Physical exercise/activity-based therapy plus cognitive training showed most promise for improving cognitive functions, while drug therapy, diet modification, and dietary supplements showed potential for improving cognitive function. However, about half of the participants experienced heightened instability in blood pressure following the administration of midodrine, and one participant reported gastrointestinal side effects after taking omega-3 fatty acids. There was no evidence of improvement in cognitive function for stimulation techniques. The current review highlights the scarcity of research investigating the effectiveness of interventions that target cognitive function after SCI. Further, the effects of these eight studies are uncertain due to concerns about the quality of designs and small sample sizes utilized in the trials, as well as the employment of insensitive neurocognitive tests when applied to adults with SCI. This review highlights a significant gap in knowledge related to SCI cognitive rehabilitation.
PubMed: 38623777
DOI: 10.1089/neu.2024.0032 -
Healthcare (Basel, Switzerland) Mar 2024The Patient Protection and Affordable Care Act (ACA) established the Hospital Quality Initiative in 2010 to enhance patient safety, reduce hospital readmissions, improve... (Review)
Review
BACKGROUND
The Patient Protection and Affordable Care Act (ACA) established the Hospital Quality Initiative in 2010 to enhance patient safety, reduce hospital readmissions, improve quality, and minimize healthcare costs. In response, this study aims to systematically review the literature and conduct a meta-analysis to estimate the average cost of procedure-specific 30-day risk-standardized unplanned readmissions for Acute Myocardial Infarction (AMI), Heart Failure (HF), Pneumonia, Coronary Artery Bypass Graft (CABG), and Total Hip Arthroplasty and/or Total Knee Arthroplasty (THA/TKA).
METHODS
Eligibility Criteria: This study included English language original research papers from the USA, encompassing various study designs. Exclusion criteria comprise studies lacking empirical evidence on hospital financial performance.
INFORMATION SOURCES
A comprehensive search using relevant keywords was conducted across databases from January 1990 to December 2019 (updated in March 2021), covering peer-reviewed articles and gray literature. Risk of Bias: Bias in the included studies was assessed considering study design, adjustment for confounding factors, and potential effect modifiers.
SYNTHESIS OF RESULTS
The review adhered to PRISMA guidelines. Employing Monte Carlo simulations, a meta-analysis was conducted with 100,000 simulated samples. Results indicated mean 30-day readmission costs: USD 16,037.08 (95% CI, USD 15,196.01-16,870.06) overall, USD 6852.97 (95% CI, USD 6684.44-7021.08) for AMI, USD 9817.42 (95% CI, USD 9575.82-10,060.43) for HF, and USD 21,346.50 (95% CI, USD 20,818.14-21,871.85) for THA/TKA.
DISCUSSION
Despite the financial challenges that hospitals face due to the ACA and the Hospital Readmissions Reduction Program, this meta-analysis contributes valuable insights into the consistent cost trends associated with 30-day readmissions.
CONCLUSIONS
This systematic review and meta-analysis provide comprehensive insights into the financial implications of 30-day readmissions for specific medical conditions, enhancing our understanding of the nexus between healthcare quality and financial performance.
PubMed: 38610171
DOI: 10.3390/healthcare12070750 -
Nutrition Reviews Apr 2024Gestational weight gain (GWG) is known to be a risk factor for offspring obesity, a precursor of cardiometabolic diseases. Accumulating studies have investigated the...
CONTEXT
Gestational weight gain (GWG) is known to be a risk factor for offspring obesity, a precursor of cardiometabolic diseases. Accumulating studies have investigated the association of GWG with offspring cardiometabolic risk factors (CRFs), leading to inconsistent results.
OBJECTIVE
This study synthesized available data from cohort studies to examine the effects of GWG on offspring CRFs.
DATA SOURCE
Four electronic databases, including PubMed, Web of Science, Scopus, and Embase, were searched through May 2023.
DATA EXTRACTION
Cohort studies evaluating the association between GWG and CRFs (fat mass [FM], body fat percentage [BF%], waist circumference [WC], systolic blood pressure [SBP] and diastolic blood pressure, high-density-lipoprotein cholesterol [HDL-C] and low-density-lipoprotein cholesterol, triglyceride [TG], total cholesterol, fasting blood glucose, and fasting insulin levels) were included. Regression coefficients, means or mean differences with 95% confidence intervals [CIs], or standard deviations were extracted.
DATA ANALYSIS
Thirty-three cohort studies were included in the meta-analysis. Higher GWG (per increase of 1 kg) was associated with greater offspring FM (0.041 kg; 95% CI, 0.016 to 0.067), BF% (0.145%; 95% CI, 0.116 to 0.174), WC (0.154 cm; 95% CI, 0.036 to 0.272), SBP (0.040 mmHg; 95% CI, 0.010 to 0.070), and TG (0.004 mmol/L; 95% CI, 0.001 to 0.007), and with lower HDL-C (-0.002 mmol/L; 95% CI, -0.004 to 0.000). Consistently, excessive GWG was associated with higher offspring FM, BF%, WC, and insulin, and inadequate GWG was associated with lower BF%, low-density lipoprotein cholesterol, total cholesterol, and TG, compared with adequate GWG. Most associations went non-significant or attenuated with adjustment for offspring body mass index or FM.
CONCLUSIONS
Higher maternal GWG is associated with increased offspring adiposity, SBP, TG, and insulin and decreased HDL-C in offspring, warranting a need to control GWG and to screen for cardiometabolic abnormalities of offspring born to mothers with excessive GWG.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration no. CRD42023412098.
PubMed: 38607346
DOI: 10.1093/nutrit/nuae027 -
JAMA Network Open Apr 2024Psilocybin has been studied in the treatment of depression and anxiety disorders. Clinical studies have mainly focused on efficacy, with systematic reviews showing... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Psilocybin has been studied in the treatment of depression and anxiety disorders. Clinical studies have mainly focused on efficacy, with systematic reviews showing favorable efficacy; however, none have primarily focused on psilocybin safety.
OBJECTIVE
To evaluate the acute adverse effects of psilocybin at therapeutic doses in the treatment of depression and anxiety.
DATA SOURCES
MEDLINE via PubMed, Web of Science, and ClinicalTrials.gov were searched for publications available between 1966 and November 30, 2023.
STUDY SELECTION
Randomized, double-blind clinical trials that reported adverse effects of psilocybin in patients treated for depression and anxiety were screened.
DATA EXTRACTION AND SYNTHESIS
Data were independently extracted by 2 authors and verified by 2 additional authors following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. The inverse variance method with the Hartung-Knapp adjustment for the random-effects model was used, with a continuity correction of 0.5 for studies with 0 cell frequencies. Sensitivity analysis was conducted by sequentially removing 1 study at a time to assess the robustness of the results.
MAIN OUTCOMES AND MEASURES
The primary outcome was considered as the adverse effects of psilocybin at high and moderate (ie, therapeutic) dose regimens and compared with placebo, low-dose psilocybin, or other comparator in the treatment of depression and/or anxiety.
RESULTS
Six studies met the inclusion criteria with a total sample of 528 participants (approximately 51% female; median age 39.8 years; IQR, 39.8-41.2). Seven adverse effects were reported in multiple studies and included in the analysis. Among these, headache (relative risk [RR], 1.99; 95% CI 1.06-3.74), nausea (RR, 8.85; 95% CI, 5.68-13.79), anxiety (RR, 2.27; 95% CI, 1.11-4.64), dizziness (RR, 5.81; 95% CI, 1.02-33.03), and elevated blood pressure (RR, 2.29; 95% CI, 1.15- 4.53) were statistically significant. Psilocybin use was not associated with risk of paranoia and transient thought disorder.
CONCLUSIONS AND RELEVANCE
In this meta-analysis, the acute adverse effect profile of therapeutic single-dose psilocybin appeared to be tolerable and resolved within 48 hours. However, future studies need to more actively evaluate the appropriate management of adverse effects.
Topics: Humans; Female; Adult; Male; Psilocybin; Drug-Related Side Effects and Adverse Reactions; Anxiety Disorders; Anxiety; Dizziness; Randomized Controlled Trials as Topic
PubMed: 38598236
DOI: 10.1001/jamanetworkopen.2024.5960 -
Cureus Mar 2024Mental health problems among children and adolescents are a significant global public health concern, with a prevalence of approximately 10-20%. Psychotropic... (Review)
Review
Mental health problems among children and adolescents are a significant global public health concern, with a prevalence of approximately 10-20%. Psychotropic medications, including stimulants, antipsychotics, antidepressants, and mood stabilizers, have been proven effective in treating various psychiatric disorders among children and adolescents. Despite the common use of these medications, they have various side effects and complications. This systematic review aimed to assess the trends and prevalence of psychotropic medication use among children and adolescents from 2013 to 2023. A comprehensive literature search was conducted in PubMed, Web of Science, Ovid, Scopus, and Cochrane databases using relevant keywords. Two independent researchers screened the studies for inclusion and exclusion criteria. Data were extracted using a Microsoft Excel spreadsheet (Microsoft Corporation, Redmond, WA), including information on study characteristics, participant demographics, psychiatric disorders, and psychotropic medications. The risk of bias assessment was performed using the ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) tool for non-randomized studies of interventions (NRSI) and Risk of Bias 2 (ROB2) for the randomized clinical trial. Data synthesis was conducted through a qualitative interpretation of the findings. A total of 52 papers were identified through the search, with 37 remaining after duplicate removal. After applying the inclusion and exclusion criteria, nine articles were considered suitable for the systematic review. A total of 9,034,109 patients suffered from several psychiatric diseases, such as autism, major depressive disorder, Down syndrome, attention-deficit/hyperactivity disorder, adjustment disorder, anxiety, bipolar disorder, conduct disorder, depression, personality disorder, psychotic disorder, tic disorder, pervasive developmental disorder, and disruptive behavior disorder. Stimulants showed a consistent prevalence rate over the years. Antidepressants, including selective serotonin reuptake inhibitors, have demonstrated variations over the years, with a substantial increase in 2015, followed by a decrease in subsequent years. In addition, antipsychotics, including atypical antipsychotics, have varied over the years; however, their use increased in 2023. Anticonvulsants and anxiolytics were also utilized, albeit at lower prevalence rates. This systematic review provides an overview of the trends and prevalence of psychotropic medication use among children and adolescents from 2013 to 2023. The prevalence of antipsychotic prescribing has shown fluctuations among different countries over the years, with a decline in recent years but a slight increase in 2023. Further research is warranted to explore the factors influencing these trends and to assess the long-term effectiveness and safety of psychotropic medications in children and adolescents.
PubMed: 38571846
DOI: 10.7759/cureus.55452 -
Heart, Lung & Circulation Apr 2024Risk adjustment following percutaneous coronary intervention (PCI) is vital for clinical quality registries, performance monitoring, and clinical decision-making. There... (Review)
Review
BACKGROUND AND AIM
Risk adjustment following percutaneous coronary intervention (PCI) is vital for clinical quality registries, performance monitoring, and clinical decision-making. There remains significant variation in the accuracy and nature of risk adjustment models utilised in international PCI registries/databases. Therefore, the current systematic review aims to summarise preoperative variables associated with 30-day mortality among patients undergoing PCI, and the other methodologies used in risk adjustments.
METHOD
The MEDLINE, EMBASE, CINAHL, and Web of Science databases until October 2022 without any language restriction were systematically searched to identify preoperative independent variables related to 30-day mortality following PCI. Information was systematically summarised in a descriptive manner following the Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies checklist. The quality and risk of bias of all included articles were assessed using the Prediction Model Risk Of Bias Assessment Tool. Two independent investigators took part in screening and quality assessment.
RESULTS
The search yielded 2,941 studies, of which 42 articles were included in the final assessment. Logistic regression, Cox-proportional hazard model, and machine learning were utilised by 27 (64.3%), 14 (33.3%), and one (2.4%) article, respectively. A total of 74 independent preoperative variables were identified that were significantly associated with 30-day mortality following PCI. Variables that repeatedly used in various models were, but not limited to, age (n=36, 85.7%), renal disease (n=29, 69.0%), diabetes mellitus (n=17, 40.5%), cardiogenic shock (n=14, 33.3%), gender (n=14, 33.3%), ejection fraction (n=13, 30.9%), acute coronary syndrome (n=12, 28.6%), and heart failure (n=10, 23.8%). Nine (9; 21.4%) studies used missing values imputation, and 15 (35.7%) articles reported the model's performance (discrimination) with values ranging from 0.501 (95% confidence interval [CI] 0.472-0.530) to 0.928 (95% CI 0.900-0.956), and four studies (9.5%) validated the model on external/out-of-sample data.
CONCLUSIONS
Risk adjustment models need further improvement in their quality through the inclusion of a parsimonious set of clinically relevant variables, appropriately handling missing values and model validation, and utilising machine learning methods.
PubMed: 38570260
DOI: 10.1016/j.hlc.2024.01.021 -
Expert Opinion on Drug Safety May 2024The cardiovascular (CV) safety of testosterone (T) replacement therapy (TRT) is still conflicting. Recent data suggested a TRT-related increased risk of atrial... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The cardiovascular (CV) safety of testosterone (T) replacement therapy (TRT) is still conflicting. Recent data suggested a TRT-related increased risk of atrial fibrillation (AF). The aim of this study was to systematic review and meta-analyze CV risk related to TRT as derived from placebo controlled randomized trials (RCTs).
AREAS COVERED
An extensive Medline, Embase, and Cochrane search was performed. All placebo-controlled RCTs reporting data on TRT-related CV safety were considered. To better analyze the role of T on AF, population-based studies investigating the relationship between endogenous circulating T levels and AF incidence were also included and analyzed.
EXPERT OPINION
Out of 3.615, 106 studies were considered, including 8.126 subjects treated with TRT and 7.310 patients allocated to placebo. No difference between TRT and placebo was observed when major adverse CV events were considered. Whereas the incidence of non-fatal arrhythmias and AF was increased in the only trial considering CV safety as the primary endpoint, this was not confirmed when all other studies were considered (MH-OR 1.61[0.84;3.08] and 1.44[0.46;4.46]). Similarly, no relationship between endogenous T levels and AF incidence was observed after the adjustment for confounders Available data confirm that TRT is safe and it is not related to an increased CV risk.
Topics: Humans; Male; Androgens; Atrial Fibrillation; Cardiovascular Diseases; Hormone Replacement Therapy; Incidence; Randomized Controlled Trials as Topic; Testosterone
PubMed: 38553429
DOI: 10.1080/14740338.2024.2337741