Home About us Contact
|
Home About us Contact | ||
|
|
||
Primary Study (primary + study)
Selected AbstractsReview of studies and guidelines on fasting and procedural sedation at the emergency departmentINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2010Joseph Antonio D Molina MD MSc(Public Health) Abstract Aim, Procedural sedation and analgesia allows urgent procedures to be performed safely by preserving patients' airway reflexes. Fasting, which is required before deeper levels of sedation, and where the airway reflexes are not preserved, is difficult to impose in emergencies. This paper aims to synthesise evidence on the need for pre-procedure fasting to minimise aspiration among adults undergoing procedural sedation and analgesia for emergency procedures. Methods, Overviews, guidelines with graded recommendations and primary studies on aspiration and pre-procedure fasting in procedural sedation and analgesia were retrieved from Medline, Cochrane, and Center for Reviews and Dissemination Databases. Terms searched were procedural sedation, fasting, emergency and sedation. Results, One primary study and one guideline were included. The American College of Emergency Physicians Clinical Policies Subcommittee on Procedural Sedation and Analgesia issued a recommendation based on ,preliminary, inconclusive or conflicting evidence, or on panel consensus'. The recommendation states: ,recent food intake is not a contraindication for administering procedural sedation and analgesia . . .'. The primary study conducted by Bell in an emergency department in Australia compared patients who last ate or drank more than 6 and 2 h from induction, respectively, with those who last ate or drank within 6 and 2 h. There were no cases of aspiration in both groups. Out of 118 patients who fasted, 1 (0.8%) vomited, as did one of 282 patients (0.4%) who did not fast. Conclusions, Aspiration risk is expected to be lower in procedural sedation and analgesia than in general anaesthesia. Current guidelines rely on expert consensus due to the lack of primary studies. Contextualisation of existing guidelines are quick and efficient strategies for developing locally relevant tools. [source] Optimal timing and dosing of platelet transfusionsISBT SCIENCE SERIES: THE INTERNATIONAL JOURNAL OF INTRACELLULAR TRANSPORT, Issue n1 2010N. M. Heddle Background, Over the past 20 years there have been more than 20 randomized controlled trials (RCTs) that have investigated various aspects of platelet transfusion therapy in haematology/oncology patients. These studies have focused on the best platelet product, the importance of ABO compatibility, pathogen inactivation of platelets, platelet triggers and the optimal platelet dose. Aims, This article summarizes current evidence to support the timing and dosing of platelet transfusions and to explore some ideas of where clinical research in this area may be heading. Materials and Methods, The articles reviewed in this presentation were identified through a search of PubMed using the term, platelet transfusion and setting limits to identify clinical studies, human studies and manuscripts in English. Results and Discussion, Three RCTs have informed practices around platelet transfusion trigger with the largest study by Rebulla et al., being the primary study that has changed practices worldwide, with a move towards a lower prophylactic platelet transfusion trigger of 10 × 109/l. Two groups (Germany and Oxford, UK) are currently investigating whether we can push the boundaries of prophylactic platelet transfusions even further by eliminating this form of therapy. Preliminary results from these studies have been published but we will await the final results to determine whether this research will indeed change practice. Over the past year there has also been two major studies (one by the BEST Collaborative, and the second by the US Transfusion Medicine/Hemostasis Network), that provide new information to guide platelet dosing. The Study by the BEST Collaborative (SToP) compared low dose platelets to standard dose platelets with WHO bleeding greater than or equal to Grade 2 as the primary outcome. The US study (PLADO) compared three doses (low, medium and high) and measured the same outcome (WHO bleeding , Grade 2). Conclusions, Although all of these studies further our knowledge to prescribe platelet transfusions, they also raise some interesting questions about the clinical relevance of the outcomes that we are currently using for these studies. The trend over the past decade has been to use bleeding as the primary outcome; however, bleeding is a complex composite outcome (Grades 2, 3 and 4) comprised of some surrogate components (Grades 2 and 3). It is also an outcome that may be difficult to measure and grade in a consistent and reliable manner. The clinical relevance of this outcome is also complex and may vary depending on the perspective from which it is viewed. [source] Meta-analysis of the effects of respiratory rehabilitation programmes on exercise capacity in accordance with programme characteristicsJOURNAL OF CLINICAL NURSING, Issue 1 2007HyunSoo Oh PhD Aims and objectives., This study was performed to investigate the effects of respiratory rehabilitation programmes on exercise capacity in terms of the programme type, the protocol used and other programme characteristics. Background., As the suitable rehabilitation programmes have not been specified, diverse programmes are provided in clinics. Design., Meta-analysis of the primary study results Methods., A computerized search through MEDLINE and CINHAL in addition to tracking down references cited in bibliographies of primarily searched studies were performed to obtain sample studies. Finally 19 research reports were examined. Results., The results of meta-regression showed that the combined effect size of the programmes on exercise capacity was unaffected by forced expiratory volume (in one second), age, the duration and frequency of the programme, or study quality. In addition, the results of meta- anova indicated that the combined effect size was not affected by (i) whether a programme was hospital based or not, (ii) whether a programme was lower-extremity or combined low- and upper-extremity exercise training, (iii) measurement time, and (iv) exercise intensity. Conclusions., The effects of programmes on exercise capacity were not differed in terms of the places where rehabilitation programmes were applied, programme content, measurement time, exercise target sites of body, and the duration and frequency of the programme. Relevance to clinical practice., The results of the present study can provide objective data when constructed or applied on a respiratory rehabilitation programme in clinics. [source] Long-term immunogenicity of preservative-free hepatitis B vaccine formulations in adults,JOURNAL OF MEDICAL VIROLOGY, Issue 10 2009Pierre Van Damme Abstract Vaccination with recombinant hepatitis B vaccines is highly effective in preventing hepatitis B infection. Recently, a preservative-free (PF) formulation of hepatitis B vaccine [GlaxoSmithKline (GSK) Biologicals, Rixensart, Belgium] has been licensed. The immunogenicity of the PF hepatitis B vaccine and antibody persistence 6 years later was assessed in this study. This formulation was compared with the preservative- containing (PC) formulation of the vaccine and a low-preservative (LP) content formulation. Five hundred forty-one healthy adult subjects were evaluated in the primary study. Over 94% of the subjects in the three study groups had seroprotective anti-HBs antibody concentrations (,10,mIU/ml) 1 month after completing primary vaccination. Antibody measurements in 242 healthy adults who returned for the follow-up study and who had received primary vaccination 6 years earlier showed that over 81% of subjects in the three study groups still had anti-HBs antibody concentrations ,10,mIU/ml. No apparent differences in antibody decline or distribution between the study groups were observed. These results indicate that the removal of preservatives from the hepatitis B vaccine does not affect adversely its immunogenicity both in the short and in the longer term. J. Med. Virol. 81:1710,1715, 2009. © 2009 Wiley-Liss, Inc. [source] Improving the early management of blood glucose in emergency admissions with chest painPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 3 2001Martin K Rutter MRCP (UK) Locum Consultant Physician Abstract Hyperglycaemia is associated with a worse prognosis after myocardial infarction and good blood glucose control in the peri-infarct period has been shown to improve outcome. Our primary study was undertaken with the aims of assessing the prevalence and management of hyperglycaemia in patients admitted with acute chest pain. Ninety-three patients admitted to either Coronary Care (CCU) or Emergency Medical Admission Units (EMAU) with chest pain were studied and of these 14 (15%) had severe hyperglycaemia (>11.0,mmol/L). Blood glucose was not measured in seven (8%) patients and in only 1/14 (7%) patient were established guidelines for the management of hyperglycaemia applied. A revision of management protocol was undertaken and after 18 months we repeated the review of management of hyperglycaemia. Of 114 patients 22 (21%) had severe hyperglycaemia, blood glucose was not measured in ten (9%) and management guidelines were followed in 13 (65%). A major improvement in management of blood glucose in emergency admissions with chest pain has been demonstrated. Further staff education, discussion and review of protocol are indicated to improve and maintain performance on CCU and EMAU. Copyright © 2001 John Wiley & Sons, Ltd. [source] Meta-Analysis of Studies with Missing DataBIOMETRICS, Issue 2 2009Ying Yuan Summary Consider a meta-analysis of studies with varying proportions of patient-level missing data, and assume that each primary study has made certain missing data adjustments so that the reported estimates of treatment effect size and variance are valid. These estimates of treatment effects can be combined across studies by standard meta-analytic methods, employing a random-effects model to account for heterogeneity across studies. However, we note that a meta-analysis based on the standard random-effects model will lead to biased estimates when the attrition rates of primary studies depend on the size of the underlying study-level treatment effect. Perhaps ignorable within each study, these types of missing data are in fact not ignorable in a meta-analysis. We propose three methods to correct the bias resulting from such missing data in a meta-analysis: reweighting the DerSimonian,Laird estimate by the completion rate; incorporating the completion rate into a Bayesian random-effects model; and inference based on a Bayesian shared-parameter model that includes the completion rate. We illustrate these methods through a meta-analysis of 16 published randomized trials that examined combined pharmacotherapy and psychological treatment for depression. [source] | ||||||||||