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Treatment strategies for coronary in-stent restenosis: systematic review and hierarchical Bayesian network meta-analysis of 24 randomised trials and 4880 patients

Methods In a hierarchical Bayesian network meta-analysis, PubMed, Embase, Scopus, Cochrane Library, Web of Science, ScienceDirect, and major scientific websites were screened up to 10 August 2015. Randomised controlled trials of patients with any type of coronary in-stent restenosis (either of bare metal stents or drug eluting stents; and either first or recurrent instances) were included. Trials including multiple treatments at the same time in the same group or comparing variants of the same intervention were excluded. Primary endpoints were target lesion revascularisation and late lumen loss, both at six to 12 months. The main analysis was complemented by network subanalyses, standard pairwise comparisons, and subgroup and sensitivity analyses.  
feeds.bmj.com
over 4 years ago
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Treatment strategies for coronary in-stent restenosis: systematic review and hierarchical Bayesian network meta-analysis of 24 randomised trials and 4880 patients

Methods In a hierarchical Bayesian network meta-analysis, PubMed, Embase, Scopus, Cochrane Library, Web of Science, ScienceDirect, and major scientific websites were screened up to 10 August 2015. Randomised controlled trials of patients with any type of coronary in-stent restenosis (either of bare metal stents or drug eluting stents; and either first or recurrent instances) were included. Trials including multiple treatments at the same time in the same group or comparing variants of the same intervention were excluded. Primary endpoints were target lesion revascularisation and late lumen loss, both at six to 12 months. The main analysis was complemented by network subanalyses, standard pairwise comparisons, and subgroup and sensitivity analyses.  
feeds.bmj.com
over 4 years ago
Preview
0
2

Treatment strategies for coronary in-stent restenosis: systematic review and hierarchical Bayesian network meta-analysis of 24 randomised trials and 4880 patients

Methods In a hierarchical Bayesian network meta-analysis, PubMed, Embase, Scopus, Cochrane Library, Web of Science, ScienceDirect, and major scientific websites were screened up to 10 August 2015. Randomised controlled trials of patients with any type of coronary in-stent restenosis (either of bare metal stents or drug eluting stents; and either first or recurrent instances) were included. Trials including multiple treatments at the same time in the same group or comparing variants of the same intervention were excluded. Primary endpoints were target lesion revascularisation and late lumen loss, both at six to 12 months. The main analysis was complemented by network subanalyses, standard pairwise comparisons, and subgroup and sensitivity analyses.  
feeds.bmj.com
over 4 years ago
Preview
0
1

Treatment strategies for coronary in-stent restenosis: systematic review and hierarchical Bayesian network meta-analysis of 24 randomised trials and 4880 patients

Methods In a hierarchical Bayesian network meta-analysis, PubMed, Embase, Scopus, Cochrane Library, Web of Science, ScienceDirect, and major scientific websites were screened up to 10 August 2015. Randomised controlled trials of patients with any type of coronary in-stent restenosis (either of bare metal stents or drug eluting stents; and either first or recurrent instances) were included. Trials including multiple treatments at the same time in the same group or comparing variants of the same intervention were excluded. Primary endpoints were target lesion revascularisation and late lumen loss, both at six to 12 months. The main analysis was complemented by network subanalyses, standard pairwise comparisons, and subgroup and sensitivity analyses.  
feeds.bmj.com
over 4 years ago
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0

Ultrasound Boosts Breast Cancer Detection in Japanese Women

Adding ultrasound to mammography increased sensitivity and detection rates of early cancers in women with dense breasts.  
medscape.com
over 4 years ago
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Critical Care

In Critical Care recently, we read with great interest the systematic review and meta-analysis by van Zanten and colleagues, who compared enteral glutamine with control in critically ill patients in terms of clinical outcomes [1]. We enthusiastically congratulate and applaud them for their groundbreaking work on this topic. However, some issues in their study should be noted and further discussed. Firstly, a predefined subgroup analysis was adopted through excluding the randomized controlled trials (RCTs) done by van Zanten and colleagues, in which other supplemental nutrients were used [2]. To test the robustness of overall effects, these authors performed this sensitivity analysis appropriately. However, a sensitivity analysis was not performed in all subgroup analyses. Although subgroup analysis is one of the methods of sensitivity analysis, it should be carried out in order to further test the influence of an individual study on the overall results [3]. Secondly, the variations of each mean difference reported in all eligible RCTs are so obvious in terms of intensive care unit length of stay and thus a standardized mean difference (SMD) effect size rather than weighted mean difference should be selected to measure the pooled result, even though SMD does not resonate well with most clinicians [3]. Thirdly, these authors stated that “a unique feature of this meta-analysis is that no language restrictions are placed on the searches” [1]. However, it should be noted that only EMBASE, MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews were searched. Other databases such as the Chinese Biomedical Literature Database and the Chinese Science Citation Database were not retrieved. As a result, some potentially eligible RCTs which were incorporated into a systematic review and meta-analysis [4] performed by researchers from China are not included in this study.  
ccforum.com
over 4 years ago
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hs-Troponins Rival CCTA For Spotting Signficant CAD: BEACON

High-sensitivity troponin assays still have a big role to play in the emergency department, say researchers, despite trials suggesting advantages for coronary CT angiography.  
medscape.com
over 4 years ago
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JC: High sensitivity Troponin I on presentation. Is it enough to rule out ACS? St.Emlyn's - St.Emlyn's

Can high sensitivity troponin I rule out Acute coronary syndromes in the ED.  
feedproxy.google.com
over 4 years ago
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Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study

Methods In this diagnostic test study, pelvic radiographs were assessed for hip osteoarthritis in two cohorts: the Framingham Osteoarthritis Study (community of Framingham, Massachusetts) and the Osteoarthritis Initiative (a multicenter longitudinal cohort study of osteoarthritis in the United States). Using visual representation of the hip joint, participants reported whether they had hip pain on most days and the location of the pain: anterior, groin, lateral, buttocks, or low back. In the Framingham study, participants with hip pain were also examined for hip pain with internal rotation. The authors analysed the agreement between radiographic hip osteoarthritis and hip pain, and for those with hip pain suggestive of hip osteoarthritis they calculated the sensitivity, specificity, positive predictive value, and negative predictive value of radiographs as the diagnostic test.  
feeds.bmj.com
over 4 years ago
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1

Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study

Methods In this diagnostic test study, pelvic radiographs were assessed for hip osteoarthritis in two cohorts: the Framingham Osteoarthritis Study (community of Framingham, Massachusetts) and the Osteoarthritis Initiative (a multicenter longitudinal cohort study of osteoarthritis in the United States). Using visual representation of the hip joint, participants reported whether they had hip pain on most days and the location of the pain: anterior, groin, lateral, buttocks, or low back. In the Framingham study, participants with hip pain were also examined for hip pain with internal rotation. The authors analysed the agreement between radiographic hip osteoarthritis and hip pain, and for those with hip pain suggestive of hip osteoarthritis they calculated the sensitivity, specificity, positive predictive value, and negative predictive value of radiographs as the diagnostic test.  
feeds.bmj.com
over 4 years ago
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6

Management of chronic refractory cough

Chronic refractory cough (CRC) is defined as a cough that persists despite guideline based treatment. It is seen in 20-46% of patients presenting to specialist cough clinics and it has a substantial impact on quality of life and healthcare utilization. Several terms have been used to describe this condition, including the recently introduced term cough hypersensitivity syndrome. Key symptoms include a dry irritated cough localized around the laryngeal region. Symptoms are not restricted to cough and can include globus, dyspnea, and dysphonia. Chronic refractory cough has factors in common with laryngeal hypersensitivity syndromes and chronic pain syndromes, and these similarities help to shed light on the pathophysiology of the condition. Its pathophysiology is complex and includes cough reflex sensitivity, central sensitization, peripheral sensitization, and paradoxical vocal fold movement. Chronic refractory cough often occurs after a viral infection. The diagnosis is made once the main diseases that cause chronic cough have been excluded (or treated) and cough remains refractory to medical treatment. Several treatments have been developed over the past decade. These include speech pathology interventions using techniques adapted from the treatment of hyperfunctional voice disorders, as well as the use of centrally acting neuromodulators such as gabapentin and pregabalin. Potential new treatments in development also show promise.  
feeds.bmj.com
over 4 years ago
Www.bmj
0
7

Management of chronic refractory cough

Chronic refractory cough (CRC) is defined as a cough that persists despite guideline based treatment. It is seen in 20-46% of patients presenting to specialist cough clinics and it has a substantial impact on quality of life and healthcare utilization. Several terms have been used to describe this condition, including the recently introduced term cough hypersensitivity syndrome. Key symptoms include a dry irritated cough localized around the laryngeal region. Symptoms are not restricted to cough and can include globus, dyspnea, and dysphonia. Chronic refractory cough has factors in common with laryngeal hypersensitivity syndromes and chronic pain syndromes, and these similarities help to shed light on the pathophysiology of the condition. Its pathophysiology is complex and includes cough reflex sensitivity, central sensitization, peripheral sensitization, and paradoxical vocal fold movement. Chronic refractory cough often occurs after a viral infection. The diagnosis is made once the main diseases that cause chronic cough have been excluded (or treated) and cough remains refractory to medical treatment. Several treatments have been developed over the past decade. These include speech pathology interventions using techniques adapted from the treatment of hyperfunctional voice disorders, as well as the use of centrally acting neuromodulators such as gabapentin and pregabalin. Potential new treatments in development also show promise.  
feeds.bmj.com
over 4 years ago
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3

hs-Troponins Associated With Exercise-Induced Ischemia

High-sensitivity troponin levels pre- and post-stress testing can be a significant predictor of myocardial ischemia and "provide substantial incremental value to clinical judgement," say researchers.  
medscape.com
over 4 years ago
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Sensitivity to Wheat, Gluten, and FODMAPs in IBS

Does science support a low FODMAP diet in patients with irritable bowel syndrome?  
medscape.com
over 4 years ago
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Discussion: a price for advances in medicine. Phase I clinical trial fail in France

Let me suggest a topic for discussion that might be a bit provocative. It's about the prices that sometimes we have to pay for advances in medicine. Ist phase clinical trial of a new painkiller drug manufactured by Bial (Portugal) failed with one man brain-dead and another five ones in critical state with neurologic symptoms, three of them are suspected to have irreversable changes in their CNS. [Links to news articles below] What is your opinion: who carries responsibility for these cases? Bial, Biotrial clinic that carried out the trial or maybe somone else involved? What kind of responsibility must it be provided the fact people involved in the study are volunteers and must have been consulted about specificity and all the issues that can arise in phase I clinical trials? Could there take place unproperly done preclinical trial? What do you think about it? ||You can follow these links to get more information about the case: http://www.bbc.com/news/world-europe-35337671 http://www.medscape.com/viewarticle/857379  
Alina Ivaniuk
over 4 years ago
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Rapid Rule Out of AMI: Taking Cardiac Testing to the Next Level CME

The goal of this activity is to help clinicians understand recent clinical trial data on the use biomarkers, such as high-sensitivity cardiac troponin levels, to rapidly exclude acute myocardial infarction (AMI).  
medscape.org
over 4 years ago
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Net benefit approaches to the evaluation of prediction models, molecular markers, and diagnostic tests

Many decisions in medicine involve trade-offs, such as between diagnosing patients with disease versus unnecessary additional testing for those who are healthy. Net benefit is an increasingly reported decision analytic measure that puts benefits and harms on the same scale. This is achieved by specifying an exchange rate, a clinical judgment of the relative value of benefits (such as detecting a cancer) and harms (such as unnecessary biopsy) associated with models, markers, and tests. The exchange rate can be derived by asking simple questions, such as the maximum number of patients a doctor would recommend for biopsy to find one cancer. As the answers to these sorts of questions are subjective, it is possible to plot net benefit for a range of reasonable exchange rates in a “decision curve.” For clinical prediction models, the exchange rate is related to the probability threshold to determine whether a patient is classified as being positive or negative for a disease. Net benefit is useful for determining whether basing clinical decisions on a model, marker, or test would do more good than harm. This is in contrast to traditional measures such as sensitivity, specificity, or area under the curve, which are statistical abstractions not directly informative about clinical value. Recent years have seen an increase in practical applications of net benefit analysis to research data. This is a welcome development, since decision analytic techniques are of particular value when the purpose of a model, marker, or test is to help doctors make better clinical decisions.  
feeds.bmj.com
over 4 years ago
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Xanthochromia Detection: Visual Inspection vs. Spectrophotometry - R.E.B.E.L. EM - Emergency Medicine Blog

Background: Although non-contrast head CT (NCHCT) has near perfect sensitivity (98-100%) in detecting aneurysmal subarachnoid hemorrhage (SAH) when performed within 6 hours of headache onset, sensitivity declines after 6 hours. As a result of declining sensitivity, lumbar puncture (LP) continues to be part of the workup in suspected SAH. An LP gives providers the ability to perform CSF analysis for red blood cells and detect xanthochromia by visual inspection or spectrophotometry. In most of the world, including the United States, the predominant approach to identifying xanthochromia is visual detection. However, this technique is subjective and considered unreliable by many. Spectrophotometry is a more objective test but, has lower specificity, carries a higher cost and is unavailable in the majority of hospitals.  
rebelem.com
over 4 years ago