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Meta-Analysis

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Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium

Objective To investigate the impact of smoking and smoking cessation on cardiovascular mortality, acute coronary events, and stroke events in people aged 60 and older, and to calculate and report risk advancement periods for cardiovascular mortality in addition to traditional epidemiological relative risk measures.  
feeds.bmj.com
over 5 years ago
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Diverticulitis: Questioning Current Practice - emdocs

Questioning the current practice management of diverticulitis? Read about the most recent review of a large meta-analysis regarding this hot topic  
emdocs.net
over 5 years ago
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The Case of Dubious Squire - EM Nerd

I often get the sense that the makers of many biomarkers envision us as helpless damsels in distress drowning in an icy pond or trapped in a monumental tower with no obvious means of descent. I imagine they think in our desperate grasps for aid, we will cling to whatever assistance they may offer, independent of its buoyancy. But in these moments of fear and uncertainty we must remember for a test to be useful to a clinician not only does it have to be accurate and reliable, it must also add diagnostic value above the clinician’s own inherent aptitude. B-type natriuretic peptide (BNP) and its natriuretic derivatives are a classic example of such a test heralded for its isolated diagnostic properties without asking the simple question, how does it help the physician? Through statistical misdirection, the distributors of natriuretic peptides have published research hailing their diagnostic prowess when examined in isolation. Such publications have led to these assays becoming recommended components of the workup for any patient suspected of having acute decompensated heart failure (1,2,3). A recent meta-analysis performed by the helpful folks responsible for the NICE guidelines, sought to examine the validity of these recommendations and determine the true diagnostic accuracy of natriuretic peptides (4). And yet, I fear these authors in their effort to provide an accurate representation of the assay’s diagnostic accuracy, have forgotten to take into account the most important factor when evaluating any diagnostic test, the clinician.  
emnerd.com
over 5 years ago
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Digoxin is linked to raised risk of death in patients with atrial fibrillation

Digoxin is associated with increased mortality in patients treated for atrial fibrillation or heart failure, the largest meta-analysis to review this treatment has concluded. The researchers warned that digoxin should be used with great caution and that patients’ plasma levels should be monitored until randomised controlled trials are carried out.  
feeds.bmj.com
over 5 years ago
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Monoclonal antibodies are shown to be safe and effective in patients with dyslipidaemia

A new class of cholesterol drug, PCSK9 inhibitors, can reduce mortality and significantly reduce low density lipoprotein (LDL) cholesterol and lipoprotein in patients with hypercholesterolaemia, a meta-analysis published in the Annals of Internal Medicine has found.1  
feeds.bmj.com
over 5 years ago
Www.bmj
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No blood pressure lowering agents prolong survival in diabetes and kidney disease, review shows

No blood pressure lowering agents used either alone or in combination prolong survival in adults with diabetes and kidney disease, a meta-analysis published in the Lancet has found.1  
feeds.bmj.com
about 5 years ago
Www.bmj
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No blood pressure lowering agents prolong survival in diabetes and kidney disease, review shows

No blood pressure lowering agents used either alone or in combination prolong survival in adults with diabetes and kidney disease, a meta-analysis published in the Lancet has found.1  
feeds.bmj.com
about 5 years ago
Www.bmj
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No blood pressure lowering agents prolong survival in diabetes and kidney disease, review shows

No blood pressure lowering agents used either alone or in combination prolong survival in adults with diabetes and kidney disease, a meta-analysis published in the Lancet has found.1  
feeds.bmj.com
about 5 years ago
Www.bmj
0
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Outcome of delirium in critically ill patients: systematic review and meta-analysis

Objectives To determine the relation between delirium in critically ill patients and their outcomes in the short term (in the intensive care unit and in hospital) and after discharge from hospital.  
feeds.bmj.com
about 5 years ago
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Outcome of delirium in critically ill patients: systematic review and meta-analysis

Objectives To determine the relation between delirium in critically ill patients and their outcomes in the short term (in the intensive care unit and in hospital) and after discharge from hospital.  
feeds.bmj.com
about 5 years ago
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No blood pressure lowering agents prolong survival in diabetes and kidney disease, review shows

No blood pressure lowering agents used either alone or in combination prolong survival in adults with diabetes and kidney disease, a meta-analysis published in the Lancet has found.1  
feeds.bmj.com
about 5 years ago
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Critical Care

A recent meta-analysis showed that weaning with SmartCare™ (Dräger, Lübeck, Germany) significantly decreased weaning time in critically ill patients. However, its utility compared with respiratory physiotherapist–protocolized weaning is still a matter of debate. We hypothesized that weaning with SmartCare™ would be as effective as respiratory physiotherapy–driven weaning in critically ill patients.  
ccforum.com
about 5 years ago
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Critical Care

Neutrophil CD64 (nCD64) expression appears to be a promising marker of bacterial infections. The aim of this meta-analysis was to assess the accuracy of nCD64 expression for the diagnosis of sepsis in critically ill adult patients.  
ccforum.com
about 5 years ago
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Critical Care

Whether hydroxyethyl starch (HES) is safe for perioperative use is not known. Evaluating HES in cardiac surgery, Jacob and colleagues suggested conclusion was of a more favorable safety profile for HES 130/0.4 [1]. The authors, however, wrongly stated that they followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines because the meta-analysis lacked a table of included study characteristics, an assessment of bias, identification of any pre-specified subgroup analyses, and tests of interaction to compare different HES solutions. In many included studies, the control group received HES, patients with heavy bleeding were excluded post hoc, and anti-fibrinolytic drugs were used to minimize bleeding. For instance, in two included trials the group assigned to gelatin actually received significantly more postoperative HES 130/0.4 than the group allocated to HES 130/0.4 [2,3]. In an included trial of HES 130/0.4, the results from one of the four study centers were excluded post hoc without explanation [4]. Other sources of bias were aggregation of intra- with postoperative blood loss and preferential use of calculated rather than measured blood loss. Furthermore, no tests of interaction were presented even to address the question of whether HES 130/0.4 differs from other HES solutions in its effect on bleeding risk after cardiac surgery.  
ccforum.com
about 5 years ago
Www.bmj
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Perioperative blood transfusions

The debate regarding the impact of blood transfusions on outcomes spans decades, but many questions, especially concerning any associated cardiovascular risks, remain unanswered. Despite several high profile studies suggesting that a restrictive transfusion strategy might be superior to more liberal approaches,1 2 3 firm consensus is far from established. For example, the most recent meta-analysis published on this topic, with 31 trials and 9813 patients, found no difference in overall morbidity and mortality between liberal and restrictive strategies.4 Importantly, the statistical model in that study was unable to reach the “required information size” for the analysis of mortality and myocardial infarction, a consistent limitation of rare event research, even when data are pooled from a relatively large number of clinical trials.  
feeds.bmj.com
about 5 years ago
Www.bmj
0
10

Perioperative blood transfusions

The debate regarding the impact of blood transfusions on outcomes spans decades, but many questions, especially concerning any associated cardiovascular risks, remain unanswered. Despite several high profile studies suggesting that a restrictive transfusion strategy might be superior to more liberal approaches,1 2 3 firm consensus is far from established. For example, the most recent meta-analysis published on this topic, with 31 trials and 9813 patients, found no difference in overall morbidity and mortality between liberal and restrictive strategies.4 Importantly, the statistical model in that study was unable to reach the “required information size” for the analysis of mortality and myocardial infarction, a consistent limitation of rare event research, even when data are pooled from a relatively large number of clinical trials.  
feeds.bmj.com
about 5 years ago
Www.bmj
0
9

Perioperative blood transfusions

The debate regarding the impact of blood transfusions on outcomes spans decades, but many questions, especially concerning any associated cardiovascular risks, remain unanswered. Despite several high profile studies suggesting that a restrictive transfusion strategy might be superior to more liberal approaches,1 2 3 firm consensus is far from established. For example, the most recent meta-analysis published on this topic, with 31 trials and 9813 patients, found no difference in overall morbidity and mortality between liberal and restrictive strategies.4 Importantly, the statistical model in that study was unable to reach the “required information size” for the analysis of mortality and myocardial infarction, a consistent limitation of rare event research, even when data are pooled from a relatively large number of clinical trials.  
feeds.bmj.com
about 5 years ago
Sinaiem dark
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3894

This recent meta-analysis in the BMJ found that paracetamol (acetaminophen) was no better than placebo for the treatment of low back pain.  Low back pain (LBP) is an increasingly common condition, for which patients often present to the ED.  Treatment options are limited with NSAIDs and acetaminophen being two commonly prescribed medications for pain.  This recent meta-analysis in the BMJ found that paracetamol (acetaminophen) was no better than placebo for low back pain.  It included two trials including 1692 patients evaluated paracetamol on immediate pain reduction and found no difference compared to placebo (weighted mean difference 1.4, 95% CI -1.3 to 4.1).  One trial (1652 patients) found no effect on pain (-0.5, -2.9-1.9), disability (0.4, -1.7-2.5), or quality of life measured on a 12-item survey.  Patients received doses in the range of 3900-4000 mg/day and followed patients for up to 12 weeks.  
sinaiem.org
about 5 years ago
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Critical Care

Although rapid response system teams have been widely adopted by many health systems, their effectiveness in reducing hospital mortality is uncertain. We conducted a meta-analysis to examine the impact of rapid response teams on hospital mortality and cardiopulmonary arrest.  
ccforum.com
about 5 years ago
Www.bmj
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Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms

Objective To determine benefits and harms of arthroscopic knee surgery involving partial meniscectomy, debridement, or both for middle aged or older patients with knee pain and degenerative knee disease.  
feeds.bmj.com
about 5 years ago