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Shiffman N, Gluska H, Margalit S, Mayer Y, Daher R, Elyasyan L, Elia N, Sharon Weiner M, Miremberg H, Kovo M, Biron-Shental T, Gabbay-Benziv R, Helpman L. Unfolding of maternal-infant bonding amidst the COVID-19 pandemic: Social support as a risk and protective factor. Dev Psychopathol 2024:1-9. [PMID: 38654408 DOI: 10.1017/s0954579424000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Social, familial, and physiological stressors may put maternal-infant bonding at risk. Therefore, it is plausible that the stressful conditions brought on by COVID-19 could influence maternal-infant bonding. This study aimed to elucidate the contribution of COVID-19-related experience to variance in maternal-infant bonding, beyond that of established risk factors and as moderated by social support. METHODS This longitudinal, multicenter study examined the relationship of demographic and obstetric variables, social support, postpartum depression, as well as COVID-19-related fear, exposure, and subjective difficulty with mother-infant bonding six months following birth. Participants (N = 246) were women who delivered during the pandemics' strict lockdown period and were recruited 10 weeks after a liveborn delivery and followed up six months later. RESULTS Relationship between fear of COVID-19 and maternal-infant bonding was moderated by social support: Amongst mothers with high levels of social support, fear of COVID-19 negatively predicted bonding. DISCUSSION Results indicate that social support, while overall a protective factor for mother-infant bonding, may lose its buffering effect when fear of COVID-19 is high. This relationship was maintained even when early bonding experiences such as forced separation and the risk incurred by postpartum depression were accounted for. Implications for providers are discussed.
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Affiliation(s)
- N Shiffman
- Psychiatry and Mental Health Division, Rambam Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - H Gluska
- Obstetrics and Gynecology, Meir Medical center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shiri Margalit
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Y Mayer
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel
| | - R Daher
- The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
- Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
| | - L Elyasyan
- The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
- Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
| | - N Elia
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - M Sharon Weiner
- Obstetrics and Gynecology, Meir Medical center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - H Miremberg
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - M Kovo
- Obstetrics and Gynecology, Meir Medical center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - T Biron-Shental
- Obstetrics and Gynecology, Meir Medical center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - R Gabbay-Benziv
- The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
- Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
| | - L Helpman
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel
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Fehlmann CA, Suppan L, Gaudet-Blavignac C, Elia N, Gariani K. Association Between Prehospital Blood Glucose Levels and Outcomes in Patients With COVID-19 Infection: A Retrospective Cohort Study. Exp Clin Endocrinol Diabetes 2023; 131:338-344. [PMID: 37015329 PMCID: PMC10437172 DOI: 10.1055/a-2068-6821] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/17/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Hyperglycaemia is associated with worse outcomes in many settings. However, the association between dysglycaemia and adverse outcomes remains debated in COVID-19 patients. This study determined the association of prehospital blood glucose levels with acute medical unit (intensive care unit or high dependency unit) admission and mortality among COVID-19-infected patients. METHODS This was a single-centre, retrospective cohort study based on patients cared for by the prehospital medical mobile unit from a Swiss university hospital between March 2020 and April 2021. All adult patients with confirmed or suspected COVID-19 infection during the study period were included. Data were obtained from the prehospital medical files. The main exposure was prehospital blood glucose level. A 7.8 mmol/L cut-off was used to define high blood glucose level. Restricted cubic splines were also used to analyse the exposure as a continuous variable. The primary endpoint was acute medical unit admission; secondary endpoints were 7-day and 30-day mortality. Multivariable logistic regressions were performed to compute odds ratios. RESULTS A total of 276 patients were included. The mean prehospital blood glucose level was 8.8 mmol/l, and 123 patients presented high blood glucose levels. The overall acute medical unit admission rate was 31.2%, with no statistically significant difference according to prehospital blood glucose levels. The mortality rate was 13.8% at 7 days and 25% at 30 days. The 30-day mortality rate was higher in patients with high prehospital blood glucose levels, with an adjusted odds ratio of 2.5 (1.3-4.8). CONCLUSIONS In patients with acute COVID-19 infection, prehospital blood glucose levels do not seem to be associated with acute medical unit admission. However, there was an increased risk of 30-day mortality in COVID-19 patients who presented high prehospital blood glucose levels.
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Affiliation(s)
- Christophe A. Fehlmann
- Division of Emergency Medicine, Department of Anesthesiology, Clinical
Pharmacology, Intensive Care and Emergency Medicine, University of Geneva
Hospitals and Faculty of Medicine, Geneva, Switzerland
- School of Epidemiology and Public Health, University of Ottawa, K1G 5Z3
Ottawa, Ontario, Canada.
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anesthesiology, Clinical
Pharmacology, Intensive Care and Emergency Medicine, University of Geneva
Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Christophe Gaudet-Blavignac
- Division of Medical Information Sciences, Geneva University Hospitals,
Geneva, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva,
Geneva, Switzerland
| | - Nadia Elia
- Division of Emergency Medicine, Department of Anesthesiology, Clinical
Pharmacology, Intensive Care and Emergency Medicine, University of Geneva
Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Karim Gariani
- Service of Endocrinology, Diabetes, Nutrition, and Therapeutic
Education, Faculty of Medicine, Geneva University Hospitals, Geneva,
Switzerland.
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3
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Dieudonné Rahm N, Zaccaria I, Gil Wey B, Pautex S, Habre W, Elia N. Intranasal Dexmedetomidine for Pain Management in Older Patients: A Cross-Over, Randomized, Double-Blinded, Active-Controlled Trial. Drugs Aging 2023; 40:527-538. [PMID: 37170043 PMCID: PMC10174599 DOI: 10.1007/s40266-023-01027-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Daily care procedures provoke breakthrough pain and anxiety in palliative situations. Dexmedetomidine may be an alternative to opioids during nursing procedures for older patients. OBJECTIVE We aimed to compare the efficacy of intranasal dexmedetomidine with subcutaneous opioids on the intensity of pain and anxiety during comfort management procedures. METHODS We conducted a randomized, active-controlled, double-blind, crossover trial (NCT03151863). Patients aged ≥ 65 years were randomized to receive, 45 min before nursing care, either intranasal dexmedetomidine together with subcutaneous placebo or intranasal placebo together with a subcutaneous opioid. Each of these two interventions were administered in a cross-over design and spaced out over a 24- or 48-h period. The primary outcome was the number of patients with an Elderly Caring Pain Assessment score > 5. Secondary outcomes included pain, sedation score, and vital signs. RESULTS Because of difficult recruitment, the trial was interrupted after the inclusion of 24 patients. Three patients withdrew after randomization, leaving 21 patients undergoing 42 complete sessions for descriptive analyses. Of the 21 patients, 12 (57.1%) were women, and their median age was 84 years, interquartile range (75-87 years). Nine (42.9%) patients presented an Elderly Caring Pain Assessment score > 5 when receiving subcutaneous opioids, and seven (33.3%) with intranasal dexmedetomidine. Hypoxemia occurred in a single patient receiving subcutaneous opioids. No episode of bradycardia was observed. CONCLUSIONS Intranasal dexmedetomidine is feasible in elderly patients and may be an alternative to opioids to ensure comfort during nursing care. Future studies are needed to confirm the efficacy and safety of this procedure.
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Affiliation(s)
- Nathalie Dieudonné Rahm
- Division of Palliative Medicine, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Hôpital de Bellerive, Chemin de la Savonnière 11, 1245 Collonge Bellerive, Geneva, Switzerland.
- Medical Faculty, University of Geneva, Geneva, Switzerland.
| | - Isabelle Zaccaria
- Unit for Anaesthesiological Investigations, Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland
| | - Béatrice Gil Wey
- Unit for Anaesthesiological Investigations, Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland
| | - Sophie Pautex
- Division of Palliative Medicine, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Hôpital de Bellerive, Chemin de la Savonnière 11, 1245 Collonge Bellerive, Geneva, Switzerland
- Medical Faculty, University of Geneva, Geneva, Switzerland
| | - Walid Habre
- Medical Faculty, University of Geneva, Geneva, Switzerland
- Unit for Anaesthesiological Investigations, Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland
| | - Nadia Elia
- Medical Faculty, University of Geneva, Geneva, Switzerland
- Unit for Anaesthesiological Investigations, Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland
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Maillard J, Elia N, Ris F, Courvoisier DS, Zekry D, Labidi Galy I, Toso C, Mönig S, Zaccaria I, Walder B. Changes of health-related quality of life 6 months after high-risk oncological upper gastrointestinal and hepatobiliary surgery: a single-centre prospective observational study ( ChangeQol Study). BMJ Open 2023; 13:e065902. [PMID: 36813502 PMCID: PMC9950916 DOI: 10.1136/bmjopen-2022-065902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Postoperative health-related quality of life (HRQoL) is an essential outcome in oncological surgery, particularly for elderly patients undergoing high-risk surgery. Previous studies have suggested that, on average, HRQoL returns to premorbid normal levels in the months following major surgery. However, the averaging of effect over a studied cohort may hide the variation of individual HRQoL changes. The proportions of patients who have a varied HRQoL response (stable, improvement, or a deterioration) after major oncological surgery is poorly understood. The study aims to describe the patterns of these HRQoL changes at 6 months after surgery, and to assess the patients and next-of-kin regret regarding the decision to undergo surgery. METHODS AND ANALYSIS This prospective observational cohort study is carried out at the University Hospitals of Geneva, Switzerland. We include patients over 18 years old undergoing gastrectomy, esophagectomy, pancreas resection or hepatectomy. The primary outcome is the proportion of patients in each group with changes in HRQoL (improvement, stability or deterioration) 6 months after surgery, using a validated minimal clinically important difference of 10 points in HRQoL. The secondary outcome is to assess whether patients and their next-of-kin may regret their decision to undergo surgery at 6 months. We measure the HRQoL using the EORTC QLQ-C30 questionnaire before and 6 months after surgery. We assess regret with the Decision Regret Scale (DRS) at 6 months after surgery. Key other perioperative data include preoperative and postoperative place of residence, preoperative anxiety and depression (HADS scale), preoperative disability (WHODAS V.2.0), preoperative frailty (Clinical Frailty Scale), preoperative cognitive function (Mini-Mental State Examination) and preoperative comorbidities. A follow-up at 12 months is planned. ETHICS AND DISSEMINATION The study was first approved by the Geneva Ethical Committee for Research (ID 2020-00536) on 28 April 2020. The results of this study will be presented at national and international scientific meetings, and publications will be submitted to an open-access peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04444544.
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Affiliation(s)
- Julien Maillard
- Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Nadia Elia
- Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Frédéric Ris
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Delphine S Courvoisier
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Quality of Care, University Hospitals of Geneva, Geneva, Switzerland
| | - Dina Zekry
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Internal Medicine for the Elderly, University Hospitals of Geneva, Geneva, Switzerland
| | - Intidhar Labidi Galy
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Oncology, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Toso
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Stefan Mönig
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Isabelle Zaccaria
- Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Bernhard Walder
- Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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5
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Maillard J, Beckmann TS, Tramèr MR, Elia N. Reviewing next of kin regrets in surgical decision-making: cross-sectional analysis of systematically searched literature. J Patient Rep Outcomes 2023; 7:5. [PMID: 36695927 PMCID: PMC9877257 DOI: 10.1186/s41687-023-00539-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Decision-making concerning relatives undergoing surgery is challenging. It remains unclear to what extent implicated next of kin eventually regret their decisions and how this regret is assessed. Our aim was to systematically review the literature on decisional regret of next of kin and to describe the assessment tools used and the surgical populations studied. METHODS We included interventional or observational, quantitative or qualitative studies reporting the measurement of decisional regret of next of kin concerning relatives undergoing surgery. We searched a variety of databases without restriction on publication year. We assessed the quality of reporting of quantitative studies using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and of qualitative studies using the Critical Appraisal Skills Program Checklist. RESULTS Thirteen cross-sectional, five prospective cohorts and five qualitative studies matched our inclusion criteria. In 18 studies (78%), patients were children, in five (22%), young or middle-aged adults. No study included elderly or frail patients. Thirteen studies (57%) used the original Decision Regret Scale which was validated for patients, but not for next of kin. Only 3 of the 18 (17%) quantitative studies and only one of the 4 (25%) qualitative studies were rated as "good" in the quality assessment. CONCLUSION None of the retrieved studies used validated tools to assess the decisional regret of next of kin and none of them examined this issue in elderly or frail surgical patients.
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Affiliation(s)
- Julien Maillard
- grid.150338.c0000 0001 0721 9812Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Tal S. Beckmann
- grid.150338.c0000 0001 0721 9812Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Martin R. Tramèr
- grid.150338.c0000 0001 0721 9812Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Nadia Elia
- grid.150338.c0000 0001 0721 9812Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
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6
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Gluska H, Shiffman N, Mayer Y, Elyasyan L, Elia N, Daher R, Sharon Weiner M, Miremberg H, Kovo M, Biron-Shental T, Gabbay-Benziv R. Maternal fear of COVID-19 and prevalence of postnatal depression symptoms, risk and protective factors. J Psychiatr Res 2022; 148:214-219. [PMID: 35134728 PMCID: PMC8782242 DOI: 10.1016/j.jpsychires.2022.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 08/12/2021] [Accepted: 01/06/2022] [Indexed: 12/16/2022]
Abstract
This is a multicenter prospective observational study, aimed to evaluate the relations between Fear of COVID-19 and postpartum depression (PPD) symptom, that included a cohort of women who delivered during COVID-19 lockdown between 03 and 05/2020. Participants were approached after delivery and asked to complete an online questionnaire. Data was verified with each center's perinatal database. The validated Fear of COVID-19 Scale was in use. PPD was evaluated using the EPDS questionnaire as a categorical (≥13) and as a continuous scale. Pre-existing maternal disability was defined as any prior physiological/psychological chronic health condition. Continuous medical supervision or stress contributing complications at birth included pregnancy and labor related complications. Regression analysis and ROC statistics were utilized to evaluate associations and control for confounders. Overall, 421 women completed the questionnaires. Of them, 53(12.6%) had a high EPDS score. Fear of COVID-19 was positively correlated with PPD symptoms (r = 0.35,p = 0.000), ROC-AUC 0.73, 95% CI 0.65-0.81, p = 0.000. Following adjustment to confounders (maternal age, nulliparity, ethnicity, marital status, financial difficulties, maternal disability, accessibility to medical services, and continuous medical supervision (, the most important factor that correlated with depression symptoms was maternal disability (aOR 4.61,95% CI 1.96-10.82) followed by Fear of COVID-19 (aOR 1.11,95% CI 1.05-1.17). High accessibility to medical services during pregnancy (aOR 0.62, 95%CI 0.45-0.84) was protective for PPD symptoms. To conclude, during the COVID-19 pandemic, maternal disability and Fear of COVID-19 are positively associated with a high EPDS score. High medical accessibility during pregnancy was found as a protective factor for PPD.
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Affiliation(s)
- H. Gluska
- Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - N. Shiffman
- Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel,The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Y. Mayer
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - L. Elyasyan
- Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel,The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - N. Elia
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - R. Daher
- Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel,The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - M. Sharon Weiner
- Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - H. Miremberg
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - M. Kovo
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - T. Biron-Shental
- Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - R. Gabbay-Benziv
- Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel,The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel,Corresponding author. Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center Hadera, 38100 , Israel
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7
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Plys E, Bovio N, Arveux P, Bergeron Y, Bulliard JL, Elia N, Fournier E, Konzelmann I, Maspoli M, Aylward ER, Canu IG. Research on occupational diseases in the absence of occupational data: a mixed-method study among cancer registries of Western Switzerland. Swiss Med Wkly 2022; 152:w30127. [PMID: 35201683 DOI: 10.4414/smw.2022.w30127] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The contribution of occupation-related diseases to the global burden of disease is greatly underestimated, mainly due to a shortage of occupational exposure data. This problem is particularly salient in Switzerland, where no estimates of occupation-related disease burden exist, even for the well-recognised occupational cancers, such as malignant pleural mesothelioma and lung cancer. To overcome this situation, we launched a research project "Examining Cancers and Labour Indicators to assess the Burden" (ExCaLIBur). Within this project, we aimed to assess the need for and quality (i.e., completeness, accuracy and precision) of occupation registration in all cancer registries of Western Switzerland. We also aimed to find a relevant and feasible strategy to collect this information in the future. We applied a mixed research method. We observed that, independently of the level of precision (5-3-2-1-digit aggregation level), the accuracy was lesser in the registries that were able to actively search and verify occupational information. Overall, the distinction of occupations based on the 3-digit code presents an acceptable compromise in terms of precision. Having such occupations registered in all, or most, Swiss cancer registries routinely would obviously be valuable for epidemiological surveillance of occupational cancers in Switzerland. However, it seems less obvious how these data could fulfill the research objectives, since a better precision than 3-digit occupational coding is challenging to achieve. Currently, the collection of occupational data by the Swiss cancer registries remains feasible in the frame of specific research projects on occupational cancers. However, available data sources, as well as lack of financial and human resources, will continue to affect quality of the collected occupation data. Therefore, the usage of the standardised questionnaire retracing the individual occupational history to enable further assessment of individual exposure to potential occupational hazards is recommended. However, this approach will disable the Swiss registries to insuring their epidemiological surveillance mission with respect to occupational cancers in Switzerland, for which national statistics remain limited.
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Affiliation(s)
- Ekaterina Plys
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Nicolas Bovio
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | | | | | - Jean-Luc Bulliard
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland.,Vaud Cancer Registry, Unisanté, Lausanne, Switzerland.,Neuchâtel and Jura Cancer Registry, Neuchâtel, Switzerland
| | - Nadia Elia
- Division of Anaesthesiology, University Hospital of Geneva, Switzerland
| | | | | | | | | | - Irina Guseva Canu
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
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8
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Gerstman MD, Rolland LR, Tramèr MR, Habre W, Elia N. Researchers' choice of pain scales in trials of children undergoing surgery: A cross-sectional analysis of systematically searched randomized controlled trials and survey of authors. Paediatr Anaesth 2021; 31:1194-1207. [PMID: 34328688 DOI: 10.1111/pan.14264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many pain scales are used post-operatively in pediatric trials, making the comparison of trials, and the pooling of data for meta-analyses difficult. The Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (PedIMMPACT) statement, published in 2008, attempted to address this issue. We aimed to investigate the reasons for authors' choice of pain scales and the potential impact of PedIMMPACT. METHODS We performed a cross-sectional analysis of systematically searched randomized controlled trials testing tramadol in children (up to 16 years) undergoing surgery, published between 2000 and 2020 (9 years prior to and 12 years following the publication of PedIMMPACT). RESULTS Among 76 trials (6211 children), 49 unique pain scales were used. The choice of the scales was explained in 18 trials (24%); in 13 of them, authors at least partly justified their choice by the fact that the pain scale was validated. In 52 trials (68%), the pain scales were referenced, with a total of 59 unique references, most often to prior studies using the same scale (36%) or to studies validating the chosen scale (31%). Twenty-three trials (30%) provided no explanation nor reference. One single trial referenced PedIMMPACT. There was no evidence of a change in the choice of pain scales after the publication of PedIMMPACT. CONCLUSIONS A large variety of pain scales are still used in pediatric post-operative pain trials 12 years after the publication of PedIMMPACT. Only a minority of trials provided an explanation for their choice of pain scale. The reasons given most often included that the scale was validated or it was justified by a reference to a prior study using that scale. The impact of the publication of the PedIMMPACT seems limited. The ethics of the ongoing usage of large numbers of pain scales in pediatric pain trials must be challenged.
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Affiliation(s)
- Michelle Diana Gerstman
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Department of Anesthetics, Perioperative Medicine and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Lucie Renée Rolland
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Division of Anesthesiology, Department of interdisciplinary centers, Lausanne University Hospital, Lausanne, Switzerland
| | - Martin Richard Tramèr
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Walid Habre
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nadia Elia
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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9
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Abstract
BACKGROUND Providing unawareness and pain relief are core elements of palliative sedation. In addition to clinical scales, nociception and electroencephalogram-based depth of sedation monitoring are used to assess the level of consciousness and analgesia during sedation in intensive care units and during procedures. AIM To determine whether reported devices impact the outcomes of palliative sedation. DESIGN Systematic review and narrative synthesis of research published between January 2000 and December 2020. DATA SOURCES Embase, Google Scholar, PubMed, CENTRAL, and the Cochrane Library. All reports describing the use of any monitoring device to assess the level of consciousness or analgesia during palliative sedation were screened for inclusion. Data concerning safety and efficacy were extracted. Patient comfort was the primary outcome of interest. Articles reporting sedation but that did not meet guidelines of the European Association for Palliative Care were excluded. RESULTS Six reports of five studies were identified. Four of these were case series and two were case reports. Together, these six reports involved a total of 67 sedated adults. Methodological quality was assessed fair to good. Medication regimens were adjusted to bispectral index monitoring values in two studies, which found poor correlation between monitoring values and observational scores. In another study, high nociception index values, representing absence of pain, were used to detect opioid overdosing. Relatives and caregivers found the procedures feasible and acceptable.
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Affiliation(s)
- Nathalie Dieudonné Rahm
- Division of Palliative Medicine, Department of Geriatrics and Rehabilitation, Geneva University Hospitals, Hôpital de Bellerive, Collonge-Bellerive, Geneva, Switzerland
| | - Ghizlaine Morawska
- Division of Palliative Medicine, Department of Geriatrics and Rehabilitation, Geneva University Hospitals, Hôpital de Bellerive, Collonge-Bellerive, Geneva, Switzerland
| | - Sophie Pautex
- Division of Palliative Medicine, Department of Geriatrics and Rehabilitation, Geneva University Hospitals, Hôpital de Bellerive, Collonge-Bellerive, Geneva, Switzerland
| | - Nadia Elia
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
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Lepot A, Elia N, Tramèr MR, Rehberg B. Preventing pain after breast surgery: A systematic review with meta-analyses and trial-sequential analyses. Eur J Pain 2020; 25:5-22. [PMID: 32816362 DOI: 10.1002/ejp.1648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this systematic review was to indirectly compare the efficacy of any intervention, administered perioperatively, on acute and persistent pain after breast surgery. DATABASES AND DATA TREATMENT We searched for randomized trials comparing analgesic interventions with placebo or no treatment in patients undergoing breast surgery under general anaesthesia. Primary outcome was intensity of acute pain (up to 6 hr postoperatively). Secondary outcomes were cumulative 24-hr morphine consumption, incidence of postoperative nausea and vomiting (PONV), and chronic pain. We used an original three-step approach. First, meta-analyses were performed when data from at least three trials could be combined; secondly, trial sequential analyses were used to separate conclusive from unclear evidence. And thirdly, the quality of evidence was rated with GRADE. RESULTS Seventy-three trials (5,512 patients) tested loco-regional blocks (paravertebral, pectoralis), local anaesthetic infiltrations, oral gabapentinoids or intravenous administration of glucocorticoids, lidocaine, N-methyl-D-aspartate antagonists or alpha2 agonists. With paravertebral blocks, pectoralis blocks and glucocorticoids, there was conclusive evidence of a clinically relevant reduction in acute pain (visual analogue scale > 1.0 cm). With pectoralis blocks, and gabapentinoids, there was conclusive evidence of a reduction in the cumulative 24-hr morphine consumption (> 30%). With paravertebral blocks and glucocorticoids, there was conclusive evidence of a relative reduction in the incidence of PONV of 70%. For chronic pain, insufficient data were available. CONCLUSIONS Mainly with loco-regional blocks, there is conclusive evidence of a reduction in acute pain intensity, morphine consumption and PONV incidence after breast surgery. For rational decision making, data on chronic pain are needed. SIGNIFICANCE This quantitative systematic review compares eight interventions, published across 73 trials, to prevent pain after breast surgery, and grades their degree of efficacy. The most efficient interventions are paravertebral blocks, pectoralis blocks and glucocorticoids, with moderate to low evidence for the blocks. Intravenous lidocaine and alpha2 agonists are efficacious to a lesser extent, but with a higher level of evidence. Data for chronic pain are lacking.
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Affiliation(s)
- Ariane Lepot
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nadia Elia
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Martin Richard Tramèr
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Benno Rehberg
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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11
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Chen A, Elia N, Dunaiceva J, Rudiger A, Walder B, Bollen Pinto B. Effect of ivabradine on major adverse cardiovascular events and mortality in critically ill patients: a systematic review and meta-analyses of randomised controlled trials with trial sequential analyses. Br J Anaesth 2020; 124:726-738. [PMID: 32147100 DOI: 10.1016/j.bja.2020.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/08/2020] [Accepted: 01/26/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Ivabradine lowers heart rate (HR) without affecting contractility or vascular tone. It is licensed for HR control in chronic heart diseases. We performed a systematic review and meta-analyses to examine whether ivabradine could decrease major adverse cardiovascular events (MACE) and mortality in critically ill patients. METHODS We searched Medline, Embase, Cochrane Library, and Web of Science for RCTs. Trial quality was assessed using the Cochrane risk of bias tool. Random-effects meta-analyses were performed if at least three trials or 100 patients were available. Results are reported as weighted mean difference (WMD), odds ratio (OR), and 95% confidence intervals (CIs). Trial sequential analyses were performed to estimate the sample size needed to reach definitive conclusions of efficacy or futility. RESULTS We included 13 RCTs (n=1497 patients). We found no evidence of an impact of ivabradine on MACE (three RCTs, 819 patients; OR=0.77; 95% CI, 0.53-1.11) or mortality (10 RCTs, 1356 patients; OR=1.07; 95% CI, 0.63-1.82), but sample sizes were not reached to allow definitive conclusions. Compared with placebo or standard care, ivabradine reduced HR (eight RCTs, 464 patients; WMD, -9.5 beats min-1; 95% CI, -13.3 to -5.8). Risk of bradycardia was not different between ivabradine and control (five RCTs, 434 patients; OR=1.2; 95% CI, 0.60-2.38). Risk of bias was overall high or unclear. CONCLUSIONS Ivabradine reduces HR compared with placebo or standard care. The effect on MACE or mortality in acute care remains unclear. Further RCTs powered to detect changes in clinically relevant outcomes are warranted. CLINICAL TRIAL REGISTRATION Prospero CRD42018086109.
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Affiliation(s)
- Aileen Chen
- Division of Anaesthesiology, Department of Acute Medicine, Geneva University Hospitals, Switzerland; Perioperative Basic, Translational and Clinical Research Group, Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Nadia Elia
- Division of Anaesthesiology, Department of Acute Medicine, Geneva University Hospitals, Switzerland; Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jelena Dunaiceva
- Division of Anaesthesiology, Department of Acute Medicine, Geneva University Hospitals, Switzerland
| | - Alain Rudiger
- Medical Department, Hospital Limmettal, Schlieren, Switzerland
| | - Bernhard Walder
- Division of Anaesthesiology, Department of Acute Medicine, Geneva University Hospitals, Switzerland; Perioperative Basic, Translational and Clinical Research Group, Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Bernardo Bollen Pinto
- Division of Anaesthesiology, Department of Acute Medicine, Geneva University Hospitals, Switzerland; Perioperative Basic, Translational and Clinical Research Group, Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland.
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12
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Kreienbühl L, Elia N, Pfeil-Beun E, Walder B, Tramèr MR. Patient-Controlled Versus Clinician-Controlled Sedation With Propofol: Systematic Review and Meta-analysis With Trial Sequential Analyses. Anesth Analg 2019; 127:873-880. [PMID: 29750696 DOI: 10.1213/ane.0000000000003361] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Sedation with propofol is frequently used to facilitate diagnostic and therapeutic procedures. Propofol can be administrated by the patient (patient-controlled sedation [PCS]) or by a clinician (clinician-controlled sedation [CCS]). We aimed to compare these 2 techniques. METHODS PubMed, Embase, CENTRAL, and trial registries were searched up to October 2017 for randomized controlled trials comparing PCS with CCS with propofol. The primary end points were the risks of presenting at least 1 episode of oxygen desaturation, arterial hypotension, and bradycardia, and the risk of requiring a rescue intervention (pharmacologic therapies or physical maneuvers) for sedation-related adverse events. Secondary end points were the dose of propofol administrated, operator and patient satisfaction, and the risk of oversedation. A random-effects model and an α level of .02 to adjust for multiple analyses were used throughout. Trial sequential analyses were performed for primary outcomes. Quality of evidence was assessed according to the Grades of Recommendation, Assessment, Development, and Evaluation system. RESULTS Thirteen trials (1103 patients; median age, 47 years; American Society of Anesthesiologists physical status I-III) describing various diagnostic and therapeutic procedures with propofol sedation were included. PCS had no impact on the risk of oxygen desaturation (11 trials, 31/448 patients [6.9%] with PCS versus 46/481 [9.6%] with CCS; risk ratio, 0.74 [98% confidence interval, 0.35-1.56]) but decreased the risk of requiring a rescue intervention for adverse events (11 trials, 29/449 patients [6.5%] with PCS versus 74/482 [15.4%] with CCS; risk ratio, 0.45 [98% confidence interval, 0.25-0.81]). For both outcomes, Trial sequential analyses suggested that further trials were unlikely to change the results, although the quality of evidence was graded very low for all primary outcomes. For the risk of arterial hypotension and bradycardia, the required sample size for a definitive conclusion had not been reached. Analysis of secondary outcomes suggested that PCS decreased the risk of oversedation and had no impact on propofol dose administrated, or on operator or patient satisfaction. CONCLUSIONS PCS with propofol, compared with CCS with propofol, had no impact on the risk of oxygen desaturation, but significantly decreased the risk of rescue interventions for sedation-related adverse events. Further high-quality trials are required to assess the risks and benefits of PCS.
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Affiliation(s)
- Lukas Kreienbühl
- From the Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Nadia Elia
- From the Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Elvire Pfeil-Beun
- From the Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Bernhard Walder
- From the Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Martin R Tramèr
- From the Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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13
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Wyssa D, Tramèr MR, Elia N. Reporting of conflicts of interest and of sponsorship of guidelines in anaesthesiology. A cross-sectional study. PLoS One 2019; 14:e0212327. [PMID: 30811517 PMCID: PMC6392260 DOI: 10.1371/journal.pone.0212327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/31/2019] [Indexed: 11/29/2022] Open
Abstract
Guideline recommendations may be biased due to conflicts of interest (COI) of panel members and sponsorship of the guideline. Potential impact of COI, and their management, should be transparently reported. We analysed 110 guidelines published in ten anaesthesia journals from 2007 to June 2018. We report on the number (%) that 1) published COI disclosures; 2) in a distinct paragraph; 3) described and explained the COI of panel members, and 4) of the Chairperson; 5) reported and described the presence or absence and potential impact of a sponsor of the guideline on the recommendations; and 6) reported how COI were managed. COI were published in 70/110 (64%) guidelines; in a distinct paragraph in 25/70 (36%). Panel members reported having no COI in 27/70 (39%) guidelines, disclosed COI without describing their potential impact in 41/70 (59%), and described their potential impact in 2/70 (3%). Chairpersons were identified in 50 guidelines, 32 of which published COI disclosures; 16/32 (50%) reported having no COI, 14/32 (44%) disclosed COI without describing their potential impact, 1/32 (3%) described their impact and 1/32 (3%) made no statement regarding COI. Presence or absence of a sponsor of the guideline was reported in 40 guidelines; 12/40 (30%) declared none, 24/40 (60%) reported sponsoring without explanation of the potential impact, and 4/40 (10%) described the potential influence of the sponsor on the guideline recommendations. Seventy-five guidelines reported COI of panel members and/or sponsorship of the guideline but only seven described how the COI had been managed. Disclosures of COI of panel members and of sponsors of guidelines have increased over the 12 year period, but remain insufficiently described and their potential influence on the guidelines' recommendations is poorly documented.
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Affiliation(s)
- Damien Wyssa
- Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Martin R. Tramèr
- Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nadia Elia
- Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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14
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Taban F, Elia N, Rapiti E, Rageth C, Fioretta G, Benhamou S, Than Lam G, David-Montefiore E, Bouchardy C. Impact of experience in breast cancer surgery on survival: the role of quality of care in a registry-based cohort. Swiss Med Wkly 2019; 149:w14704. [PMID: 30685868 DOI: 10.4414/smw.2019.14704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS OF THE STUDY Previous studies have suggested that the surgeon's experience in breast cancer surgery may affect patient survival. In this registry-based retrospective cohort study, we examined whether quality of care could partly explain this association. METHODS All invasive breast cancers operated on in the private sector between 2000 and 2009 were identified in the Geneva Cancer Registry and followed up for 5 years. Surgeons were classified according to their experience into three categories: ≤5, 6-10, >10 breast cancer operations performed per year. We extracted patient and tumour characteristics. Quality of care was scored as the proportion of 11 quality indicators correctly fulfilled for each patient. Breast cancer-specific mortality was examined with a Cox model adjusted for variables known to affect survival, surgeon experience, and quality of care. RESULTS A total of 1489 patients were operated on by 88 surgeons; 50 patients (3.4%) died from breast cancer during the 5 years of follow-up. Socioeconomic status and country of birth of the patients, as well as period of diagnosis, differed according to the surgeons' experience. Quality of care provided improved with surgeons' experience. Surgeons performing >10 operations/year more frequently assessed histology before surgery, excised sentinel lymph nodes, removed ≥10 lymph nodes, and prescribed adjuvant radiotherapy when indicated. Crude breast cancer-specific mortality was lower in patients treated by surgeons performing >10 compared with ≤5 operations/year (hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.17-0.67; p = 0.002). The strength of the association decreased after adjustment for patient and tumour characteristics (HR 0.45, 95% CI 0.21-0.94; p = 0.034) and decreased further after adjustment for quality of care (HR 0.51, 95% CI 0.24-1.08, p = 0.078). CONCLUSIONS The association between surgeon's experience and 5-year breast cancer survival is at least partly explained by quality of care, patient and tumour characteristics. Further investigations on the impact of other quality indicators such as multidisciplinary networks are needed.
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Affiliation(s)
- François Taban
- SONGe (Réseau de Sénologie et ONco-gynécologie Genevois), Breast Network of Geneva Private Practitioners, Geneva, Switzerland
| | - Nadia Elia
- Geneva Cancer Registry, Institute of Global Health, University of Geneva, Switzerland
| | - Elisabetta Rapiti
- Geneva Cancer Registry, Institute of Global Health, University of Geneva, Switzerland
| | - Christoph Rageth
- Breast Centre, Department of Gynaecology and Obstetrics, University Hospitals of Geneva, Switzerland
| | - Gérald Fioretta
- Geneva Cancer Registry, Institute of Global Health, University of Geneva, Switzerland
| | - Simone Benhamou
- Geneva Cancer Registry, Institute of Global Health, University of Geneva, Switzerland / INSERM U946, Genetic Variability and Human Diseases, Fondation Jean Dausset/CEPH, Paris, France
| | - Giang Than Lam
- Breast Centre, Department of Gynaecology and Obstetrics, University Hospitals of Geneva, Switzerland
| | - Emmanuel David-Montefiore
- Breast Centre, Department of Gynaecology and Obstetrics, University Hospitals of Geneva, Switzerland
| | - Chirstine Bouchardy
- Geneva Cancer Registry, Institute of Global Health, University of Geneva, Switzerland
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15
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Tschopp C, Tramèr MR, Schneider A, Zaarour M, Elia N. Benefit and Harm of Adding Epinephrine to a Local Anesthetic for Neuraxial and Locoregional Anesthesia. Anesth Analg 2018; 127:228-239. [DOI: 10.1213/ane.0000000000003417] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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16
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Zoccatelli D, Tramèr MR, Elia N. Identification of ethics committees based on authors' disclosures: cross-sectional study of articles published in the European Journal of Anaesthesiology and a survey of ethics committees. BMC Med Ethics 2018; 19:57. [PMID: 29884170 PMCID: PMC5994111 DOI: 10.1186/s12910-018-0289-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 05/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Since 2010, the European Journal of Anaesthesiology has required the reporting of five items concerning ethical approval in articles describing human research: ethics committee’s name and address, chairperson’s name, study’s protocol number and approval date. We aimed to assess whether this requirement has helped to identify and to contact the referenced ethics committees. Methods In this cross-sectional study, we analysed articles requiring ethical approval, according to the Swiss federal law for human research and published in the European Journal of Anaesthesiology in 2011. Ethics committees were searched through our institutional Internet access based on information provided in the articles. The last search was performed in November 2015. Numbers (%) of items reported, of ethics committees identified, and of those that confirmed having provided ethical approval are reported. Results Of 76 articles requiring ethical approval, 74 (97%) declared it. Ethics committees’ names and addresses were mentioned in 63/74 (85%), protocol numbers in 51/74 (69%), approval dates in 48/74 (65%), and chairpersons’ names in 45/74 (61%). We could identify 44/74 (59%) committees; 36/74 (49%) answered our inquiry and 24/74 (32%) confirmed their role. Thirty-four of 74 articles (46%) reported all five items; in 25/34 (74%), we were able to identify an ethics committee, 18/34 (53%) answered our inquiry, and 15/34 (44%) confirmed their role. Forty of 74 articles (54%) reported ≤4 items; in 19/40 (48%), we were able to identify an ethics committee, 18/40 (45%) answered our inquiry, and 9/40 (23%) confirmed their role. Reporting five items significantly increased identification of ethics committees (p = 0.023) and their confirmation of ethical approval (p = 0.048). Twelve of 74 ethics committees (16%) were unable to confirm their role in approving the study. Conclusions Even when details concerning ethical approval were reported in these studies of human research, we were unable to identify almost half of the ethics committees concerned. The reporting of five items, compared with reporting ≤4, was associated with facilitated identification of ethics committees, and increased the likelihood that they would be able to confirm the study’s approval. Future research should identify which information facilitates identification of, and contact with, ethics committees. Electronic supplementary material The online version of this article (10.1186/s12910-018-0289-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Davide Zoccatelli
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology and Intensive Care Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Martin R Tramèr
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology and Intensive Care Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1205, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1211, Geneva, Switzerland
| | - Nadia Elia
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology and Intensive Care Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1205, Geneva, Switzerland.,Institute of Global Health, University of Geneva, Chemin des Mines 9, 1202, Geneva, Switzerland
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17
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Bediang G, Stoll B, Elia N, Abena JL, Geissbuhler A. SMS reminders to improve adherence and cure of tuberculosis patients in Cameroon (TB-SMS Cameroon): a randomised controlled trial. BMC Public Health 2018; 18:583. [PMID: 29720146 PMCID: PMC5932834 DOI: 10.1186/s12889-018-5502-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 04/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Cameroon, the National Tuberculosis Control Program that applies selective directly observed treatments faces difficulties in its implementation for a lack of resources, leading to only 65% of patients with sputum smear-positive pulmonary tuberculosis being cured after 6 months of treatment. This study aimed to evaluate the effectiveness of daily Short Message Service reminders to increase adherence and the proportion of adult tuberculosis patients cured after 6 months of treatment. METHODS A simple blinded, randomised controlled, multicentre study carried out in 12 Treatment and Diagnostic Centres of Yaoundé. The patients included were randomly assigned to two groups: patients in the intervention group received daily SMS reminders in addition to the usual treatment; those in the control group received the usual treatment only. The primary outcomes were the number and proportion of treatment success at 5 months, and the number and proportion of patients cured at 6 months. Data analysis was by intention to treat. RESULTS Two hundred and seventy-nine participants were randomized into intervention group (n = 137) and control group (n = 142). At five months, there were 111 treatment success (81%) in the intervention group and 106 (74.6%) in the control group (OR = 1.45 [0.81, 2.56]; p = 0.203). At 6 months, there were 87 patients cured (63.5%) in the intervention group and 88 (62%) in the control group (OR = 1.06 [0.65, 1.73]; p = 0.791). The number of drop-outs at 6 months was 47 (34.3%) in intervention group, and 46 (32.4%) in the control group. 48.9% (23/47) and 39.1% (18/46) of these drop-outs were sputum-negative at 5 months. At three different appointments, there were no significant differences between the two groups in any secondary outcomes. Very high and similar satisfaction was found for general management of patients in both groups: 99.5 and 99.2% (p = 0.41). CONCLUSIONS Our study suggests that SMS reminders do not increase treatment success and cure proportions. However, the low proportion of patients cured at 6 month may be an underestimation due to a high dropout rate between the fifth and the sixth months of treatment. Future trials should focus on reducing the dropout rate. TRIAL REGISTRATION The trial was registered on the Pan-African Clinical Trials Registry ( PACTR201307000583416 of 22 July 2013) and the protocol was published.
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Affiliation(s)
- Georges Bediang
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, P.O Box: 1364, Yaoundé, Cameroon.
| | - Beat Stoll
- Geneva Tumour Registry, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nadia Elia
- Geneva Tumour Registry, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean-Louis Abena
- National Tuberculosis Control Program, Ministry of Public Health, Yaoundé, Cameroon
| | - Antoine Geissbuhler
- Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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18
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de Valence T, Elia N, Czarnetzki C, Dumont L, Tramèr MR, Lysakowski C. Effect of sufentanil on bispectral index in the elderly. Anaesthesia 2017; 73:216-222. [PMID: 29098683 DOI: 10.1111/anae.14102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 11/29/2022]
Abstract
We examined the impact of adding sufentanil during anaesthesia induction with propofol on bispectral index values in elderly patients (≥ 65 years). Patients were randomly assigned to receive a target-controlled sufentanil infusion (effect-site concentration of 0.3 ng.ml-1 ) or matching placebo, followed by a target-controlled propofol induction (initial effect-site concentration of 0.5 μg.ml-1 ; step-wise increase of 0.5 μg.ml-1 ) until loss of consciousness defined as an Observer's Assessment of Alertness/Sedation score < 2. Seventy-one patients (sufentanil 35, placebo 36) completed the study. Mean (SD) age was 72.3 (5.8) years; 41% were women. At loss of consciousness, mean (SD) bispectral index value was 75.0 (8.6) with sufentanil and 70.0 (8.0) with placebo; mean difference -5.0 (95% confidence interval -8.9 to -1.1), p = 0.013. Post-hoc analyses suggest that the difference was significant in men only (mean difference -7.3 (-11.8 to -2.6), p = 0.003). Sufentanil co-induction with propofol results in higher bispectral index values at loss of consciousness in elderly patients.
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Affiliation(s)
- T de Valence
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology and Intensive Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - N Elia
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology and Intensive Care Medicine, Geneva University Hospitals, Geneva, Switzerland.,Institute of Global Health, Medical Faculty, University of Geneva, Geneva, Switzerland
| | - C Czarnetzki
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology and Intensive Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - L Dumont
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology and Intensive Care Medicine, Geneva University Hospitals, Geneva, Switzerland.,Medical Faculty, University of Geneva, Geneva, Switzerland
| | - M R Tramèr
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology and Intensive Care Medicine, Geneva University Hospitals, Geneva, Switzerland.,Medical Faculty, University of Geneva, Geneva, Switzerland
| | - C Lysakowski
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology and Intensive Care Medicine, Geneva University Hospitals, Geneva, Switzerland.,Medical Faculty, University of Geneva, Geneva, Switzerland
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Lysakowski C, de Valence T, Elia N, Czarnetzki C, Dumont LB, Tramèr MR. Abstract PR158. Anesth Analg 2016. [DOI: 10.1213/01.ane.0000492559.54928.8e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Elia N, von Elm E, Chatagner A, Pöpping DM, Tramèr MR. How do authors of systematic reviews deal with research malpractice and misconduct in original studies? A cross-sectional analysis of systematic reviews and survey of their authors. BMJ Open 2016; 6:e010442. [PMID: 26936908 PMCID: PMC4785311 DOI: 10.1136/bmjopen-2015-010442] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To study whether systematic reviewers apply procedures to counter-balance some common forms of research malpractice such as not publishing completed research, duplicate publications, or selective reporting of outcomes, and to see whether they identify and report misconduct. DESIGN Cross-sectional analysis of systematic reviews and survey of their authors. PARTICIPANTS 118 systematic reviews published in four journals (Ann Int Med, BMJ, JAMA, Lancet), and the Cochrane Library, in 2013. MAIN OUTCOMES AND MEASURES Number (%) of reviews that applied procedures to reduce the impact of: (1) publication bias (through searching of unpublished trials), (2) selective outcome reporting (by contacting the authors of the original studies), (3) duplicate publications, (4) sponsors' and (5) authors' conflicts of interest, on the conclusions of the review, and (6) looked for ethical approval of the studies. Number (%) of reviewers who suspected misconduct are reported. The procedures applied were compared across journals. RESULTS 80 (68%) reviewers confirmed their data. 59 (50%) reviews applied three or more procedures; 11 (9%) applied none. Unpublished trials were searched in 79 (66%) reviews. Authors of original studies were contacted in 73 (62%). Duplicate publications were searched in 81 (69%). 27 reviews (23%) reported sponsors of the included studies; 6 (5%) analysed their impact on the conclusions of the review. Five reviews (4%) looked at conflicts of interest of study authors; none of them analysed their impact. Three reviews (2.5%) looked at ethical approval of the studies. Seven reviews (6%) suspected misconduct; only 2 (2%) reported it explicitly. Procedures applied differed across the journals. CONCLUSIONS Only half of the systematic reviews applied three or more of the six procedures examined. Sponsors, conflicts of interest of authors and ethical approval remain overlooked. Research misconduct is sometimes identified, but rarely reported. Guidance on when, and how, to report suspected misconduct is needed.
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Affiliation(s)
- Nadia Elia
- Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Erik von Elm
- Cochrane Switzerland, Institute of Social and Preventive Medicine, Lausanne, Switzerland
| | | | - Daniel M Pöpping
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Martin R Tramèr
- Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Czarnetzki C, Elia N, Frossard JL, Giostra E, Spahr L, Waeber JL, Pavlovic G, Lysakowski C, Tramèr MR. Erythromycin for Gastric Emptying in Patients Undergoing General Anesthesia for Emergency Surgery: A Randomized Clinical Trial. JAMA Surg 2015; 150:730-7. [PMID: 26083537 DOI: 10.1001/jamasurg.2015.0306] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Patients undergoing emergency procedures under general anesthesia have impaired gastric emptying and are at high risk for aspiration of gastric contents. Erythromycin has strong gastric prokinetic properties. OBJECTIVE To evaluate the efficacy of erythromycin lactobionate in gastric emptying in patients undergoing emergency surgery. DESIGN, SETTING, AND PARTICIPANTS The Erythro-Emerge trial was a single-center, randomized, double-blinded, placebo-controlled clinical trial in patients undergoing emergency surgery under general anesthesia at Geneva University Hospitals. We included 132 patients from March 25, 2009, through April 10, 2013, and all patients completed the study. Randomization was stratified for trauma and nontrauma procedures. The randomization code was opened on April 23, 2013, and analyses were performed through July 26, 2013. We performed an intention-to-treat analysis. INTERVENTIONS Patients were randomized to intravenous erythromycin lactobionate, 3 mg/kg, or placebo 15 minutes before tracheal intubation. Patients were followed up for 24 hours. MAIN OUTCOMES AND MEASURES The primary outcome was a clear stomach, defined as less than 40 mL of liquids and no solids and identified through endoscopy immediately after intubation. The secondary outcome was the pH level of residual gastric content. RESULTS A clear stomach was diagnosed in 42 of 66 patients (64%) receiving placebo compared with 53 of 66 patients (80%) receiving erythromycin (risk ratio, 1.26 [95% CI, 1.01-1.57]). In the population undergoing surgery for nontrauma, the association between receipt of erythromycin and having a clear stomach (adjusted odds ratio [95% CI]) was statistically significant (13.4 [1.49-120]; P = .02); in the population undergoing surgery for trauma, it was not (1.81 [0.64-5.16]; P = .26). Median (interquartile range) pH of the residual gastric liquid was 2 (1-4) in 36 patients receiving placebo and 6 (3-7) in 16 receiving erythromycin (P = .002). Patients receiving erythromycin had nausea (20 [30%] vs 4 [6%]) and stomach cramps (15 [23%] vs 2 [3%]) more often than those receiving placebo. One patient receiving erythromycin vomited before induction of anesthesia. CONCLUSIONS AND RELEVANCE In patients undergoing general anesthesia for emergency procedures, erythromycin administration increased the proportion with a clear stomach and decreased the acidity of residual gastric liquid. Erythromycin was particularly efficacious in the nontrauma population. Adverse effects were minor. Further large-scale studies are warranted to confirm the potential of erythromycin to reduce the incidence of bronchoaspiration in patients undergoing emergency surgery. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00827216.
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Affiliation(s)
| | - Nadia Elia
- Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland2Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Jean-Louis Frossard
- Division of Gastroenterology, Geneva University Hospitals, Geneva, Switzerland4Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Emiliano Giostra
- Division of Gastroenterology, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Spahr
- Division of Gastroenterology, Geneva University Hospitals, Geneva, Switzerland4Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean-Luc Waeber
- Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Gordana Pavlovic
- Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | | | - Martin R Tramèr
- Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland4Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Jeannot E, Mahler P, Elia N, Cerruti B, Chastonnay P. Sociodemographic and Economic Determinants of Overweight and Obesity for Public-school Children in Geneva State, Switzerland: A Cross-sectional Study. Int J Prev Med 2015; 6:39. [PMID: 26015862 PMCID: PMC4434497 DOI: 10.4103/2008-7802.156836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/16/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Obesity among children and adolescents is a growing public health problem. The purpose of this study is to assess the prevalence, socioeconomic and demographic determinants of overweight and obesity in schoolchildren from Geneva. METHODS A cross-sectional study was undertaken at the Public School of Geneva canton in Switzerland. A total of 8544 public school children were collected and analyzed: 2577 were in second grade, 2641 in fifth grade and 3326 in eighth grade. To identify overweight and obesity we used the definition issued by the International Obesity Task Force. Child characteristics included gender, age, socioeconomic status (SES) of father and mother, and school grade. The multivariate logistic regression model was used to examine potential predictors of overweight/obesity. RESULTS The prevalence of overweight or obese children was 14.4% in second grade, 17.3% in fifth grade and 18.6% in eighth grade. Multivariate logistic regression analyses reveal that children that have a low economic status or certain citizenships are more likely to be overweight or obese. Children of Kosovar origin, have a higher risk of OBO in second grade (adjusted odds ratio [OR] = 2.19; 95% confidence interval [CI]: 1.20-4.00), fifth grade (adjusted OR = 2.36 95% CI: 1.27-4.39) and in eighth grade (adjusted OR = 2.15 95% CI: 1.27-4.39). Association between SES and overweight was high with regards to the father's SES in fifth grade (adjusted OR = 4.21 95% CI: 2.83-6.25). CONCLUSIONS Overweight and obesity is associated to socioeconomic and sociodemographic factors. The analyzes reveals that children with a low economic status and/or from certain countries are more likely to be overweight or obese than Swiss children. There is an urgent need for action to prevent further increase in overweight or obesity among children.
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Affiliation(s)
- Emilien Jeannot
- University of Applied Sciences Western Switzerland, High School of Health, 1206 Geneva, Switzerland ; Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; School Health Service, Department of Public Instruction, Geneva, Switzerland
| | - Per Mahler
- School Health Service, Department of Public Instruction, Geneva, Switzerland
| | - Nadia Elia
- University of Applied Sciences Western Switzerland, High School of Health, 1206 Geneva, Switzerland
| | - Bernard Cerruti
- University of Applied Sciences Western Switzerland, High School of Health, 1206 Geneva, Switzerland
| | - P Chastonnay
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Maillard J, Elia N, Haller CS, Delhumeau C, Walder B. Preoperative and early postoperative quality of life after major surgery - a prospective observational study. Health Qual Life Outcomes 2015; 13:12. [PMID: 25649467 PMCID: PMC4333246 DOI: 10.1186/s12955-014-0194-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 12/16/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Changes in health-related quality of life (HRQoL) several days after surgery have rarely been investigated. We aimed to estimate the perioperative change of HRQoL, to identify patients with clinically relevant decrease in postoperative HRQoL and to establish factors associated with this decrease in HRQoL at day 30 after major surgery. METHODS Patients scheduled for major surgery at a university hospital were enrolled. Based on the HRQoL SF-12 questionnaire, the preoperative physical component summary (PCS) score, preoperative mental component summary (MCS) score, and postoperative PCS and MCS scores at day 30 were recorded. Minimal clinically important difference (MCID) was defined as those with a decrease of at least one half of the standard deviation (SD) of preoperative PCS or MCS scores. Differences between the groups with or without decreased HRQoL were investigated using univariate comparisons. A multiple logistic regression model was performed to evaluate the predictive value of potential perioperative variables. RESULTS The mean ± SD preoperative PCS score was 38.5 ± 10.6, postoperative score was 35.1 ± 7.8 (p = .004) in 85 patients. Thirty-five patients (41.2%) had a clinically relevant decrease of the postoperative PCS score. A normal to high preoperative exercise metabolic capacity measured with metabolic equivalent of task (MET) (p = .01) was a predictor of the decrease in postoperative PCS. The mean preoperative MCS scores (p = .395) were 42.2 (SD 12.8) preoperative, and 43.45 (SD 12.4) postoperative, respectively. CONCLUSIONS Major surgery decreases postoperative PCS scores of HRQoL at 30 days. A normal to high exercise capacity was a predictor of a clinically relevant decrease of postoperative PCS scores. TRIAL REGISTRATION 07-107 (Ethical Committee NAC of Geneva University Hospitals).
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Affiliation(s)
- Julien Maillard
- Division of Anesthesiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4 - 1206, Geneva, Switzerland.
| | - Nadia Elia
- Division of Anesthesiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4 - 1206, Geneva, Switzerland.
- Institute of Social and Preventive Medicine, Medical Faculty, University of Geneva, Chemin de la Tour de Champel 17 - 1206, Geneva, Switzerland.
| | - Chiara S Haller
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Harvard Medical School, 330 Brookline Avenue, Boston, 02215, MA, USA.
- Department of Psychology, Harvard University, Cambridge, 02138, MA, USA.
| | - Cécile Delhumeau
- Division of Anesthesiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4 - 1206, Geneva, Switzerland.
| | - Bernhard Walder
- Division of Anesthesiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4 - 1206, Geneva, Switzerland.
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Abstract
OBJECTIVE To examine whether, according to the conclusions of a 2000 systematic review with meta-analysis on interventions to prevent pain from propofol injection that provided a research agenda to guide further research on the topic, subsequently published trials were more often optimally blinded, reported on children, and used the most efficacious intervention as comparator; and to check whether the number of new trials published each year had decreased and whether the designs of trials that cited the review differed from those that did not. STUDY DESIGN Systematic review comparing old trials (published before, and included in, the review) with new trials (published afterwards). DATA SOURCES Medline, Cochrane, Embase, and bibliographies to January 2013. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised studies testing any intervention to prevent pain from propofol injection in humans. RESULTS 136 new trials (19,778 patients) were retrieved. Compared with the 56 old trials (6264 patients), the proportion of optimally blinded trials had increased from 10.7% to 38.2% (difference 27.5%, 95% confidence interval 16.0% to 39.0%, P<0.001), and the proportion of trials that used the most efficacious intervention as comparator had increased from 12.5% to 27.9% (difference 15.4%, 4.0% to 26.9%, P=0.022). The proportion of paediatric trials had increased from 5.4% to 12.5%, although this was not significant (difference 7.1%, -1.0% to 15.2%, P=0.141). The number of new trials published each year was significantly higher (median number/year 12 (range 7-20) v 2.5 (0-9), P<0.001) with no obvious decreasing trend. 72.8% (n=99) of the new trials cited the review, with their designs similar to trials not citing the review. Only 36.0% (n=49) of the new trials were considered clinically relevant since they used the most efficacious intervention as comparator or included a paediatric population. CONCLUSIONS The impact of the systematic review on the design of subsequent research was low. There was an improvement in the reporting of optimal blinding procedures and a tendency towards an increase in the proportion of paediatric trials. The most efficacious intervention was more often chosen as comparator but remained marginally used, and the number of trials published per year had not decreased. The use of systematic reviews should be encouraged to inform rational, and thus ethical, trial design and improve the relevance of new research.
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Affiliation(s)
- Céline Habre
- Department of Radiology, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14, Switzerland
| | - Martin R Tramèr
- Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Daniel M Pöpping
- Department of Anaesthesiology and Intensive Care, University Hospital Münster, Münster, Germany
| | - Nadia Elia
- Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Bediang G, Stoll B, Elia N, Abena JL, Nolna D, Chastonay P, Geissbuhler A. SMS reminders to improve the tuberculosis cure rate in developing countries (TB-SMS Cameroon): a protocol of a randomised control study. Trials 2014; 15:35. [PMID: 24460827 PMCID: PMC3902069 DOI: 10.1186/1745-6215-15-35] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 01/09/2014] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis is a public health problem in Cameroon, just like in many other countries in the world. The National Tuberculosis Control Programme (PNLT) put in place by the state, aims to fight tuberculosis through the implementation of international directives (Directly Observed Treatment Short, DOTS). Despite the deployment of this strategy across the world, its implementation is difficult in the context of low-resource countries. Some expected results are not achieved. In Cameroon, the cure rate for patients with sputum positive pulmonary tuberculosis (TPM+) after 6 months is only about 65%, 20% below the target. This is mainly due to poor patient adherence to treatment. By relying on the potential of mobile Health, the objective of this study is to evaluate the effect of SMS reminders on the cure rate of TPM + patients, measured using 6-month bacilloscopy. Methods/design This is a blinded, randomised controlled multicentre study carried out in Cameroon. The research hypothesis is that sending daily SMS messages to remind patients to take their prescribed tuberculosis medication, together with the standard DOTS strategy, will increase the cure rate from 65% (control group: DOTS, no SMS intervention) to 85% (intervention group: DOTS, with SMS intervention) in a group of new TPM + patients. In accordance with each treatment centre, the participants will be randomly allocated into the two groups using a computer program: the intervention group and the control group. A member of the research team will send daily SMS messages. Study data will be collected by health professionals involved in the care of patients. Data analysis will be done by the intention-to-treat method. Discussion The achieving of expected outcomes by the PNLT through implementation of DOTS requires several challenges. Although it has been demonstrated that the DOTS strategy is effective in the fight against tuberculosis, its application remains difficult in developing countries. This study explores the potential of mHealth to support DOTS strategy. It will gather new evidence on the effectiveness of mHealth-based interventions and SMS reminders in the improvement of treatment adherence and the cure rate of tuberculosis patients, especially in a low-resource country such as Cameroon. Trial registration The trial is registered on the Pan-African Clinical Trials Registry (http://www.pactr.org) under unique identification number: PACTR201307000583416.
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Affiliation(s)
- Georges Bediang
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, PO Box 1364 Yaoundé, Cameroon.
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Elia N, Wager E, Tramèr MR. Fate of articles that warranted retraction due to ethical concerns: a descriptive cross-sectional study. PLoS One 2014; 9:e85846. [PMID: 24465744 PMCID: PMC3899113 DOI: 10.1371/journal.pone.0085846] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 10/24/2013] [Indexed: 12/23/2022] Open
Abstract
Objective To study journals' responses to a request from the State Medical Association of Rheinland-Pfalz, Germany, to retract 88 articles due to ethical concerns, and to check whether the resulting retractions followed published guidelines. Design Descriptive cross-sectional study. Population 88 articles (18 journals) by the anaesthesiologist Dr. Boldt, that warranted retraction. Method According to the recommendations of the Committee on Publication Ethics, we regarded a retraction as adequate when a retraction notice was published, linked to the retracted article, identified the title and authors of the retracted article in its heading, explained the reason and who took responsibility for the retraction, and when the retracted article was freely accessible and marked using a transparent watermark that preserved original content. Two authors extracted data independently (January 2013) and contacted editors-in-chief and publishers for clarification in cases of inadequate retraction. Results Five articles (6%) fulfilled all criteria for adequate retraction. Nine (10%) were not retracted (no retraction notice published, full text article not marked). 79 (90%) retraction notices were published, 76 (86%) were freely accessible, but only 15 (17%) were complete. 73 (83%) full text articles were marked as retracted, of which 14 (16%) had an opaque watermark hiding parts of the original content, and 11 (13%) had all original content deleted. 59 (67%) retracted articles were freely accessible. One editor-in-chief stated personal problems as a reason for incomplete retractions, eight blamed their publishers. Two publishers cited legal threats from Dr. Boldt's co-authors which prevented them from retracting articles. Conclusion Guidelines for retracting articles are incompletely followed. The role of publishers in the retraction process needs to be clarified and standards are needed on marking retracted articles. It remains unclear who should check that retractions are done properly. Legal safeguards are required to allow retraction of articles against the wishes of authors.
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Affiliation(s)
- Nadia Elia
- Division of Anaesthesiology, Geneva University Hospitals, and Medical Faculty, University of Geneva, Geneva, Switzerland
- Institute of Social and Preventive Medicine, Medical Faculty, Geneva, Switzerland
- * E-mail:
| | | | - Martin R. Tramèr
- Division of Anaesthesiology, Geneva University Hospitals, and Medical Faculty, University of Geneva, Geneva, Switzerland
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Oros D, Altermir I, Elia N, Tuquet H, Pablo LE, Fabre E, Pueyo V. Pathways of neuronal and cognitive development in children born small-for-gestational age or late preterm. Ultrasound Obstet Gynecol 2014; 43:41-47. [PMID: 23836499 DOI: 10.1002/uog.12556] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 06/19/2013] [Accepted: 06/28/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To assess the effects of late small-for-gestational-age (SGA) birth and late prematurity on cognitive outcomes and structural changes in the central nervous system at primary school age, using a novel approach to examine changes in neuronal integrity of the retina. METHODS We conducted a cross-sectional study of 347 children aged 6-13 years, including in the analysis only infants born after 34 weeks' gestation. We recorded all perinatal outcomes through a survey of parents. Neuronal damage was evaluated using optical coherence tomography of the retina. In a subgroup of 112 children aged 6-8 years, visuospatial perception was evaluated with the Children's Bender Visual Motor Gestalt Test. RESULTS The proportions of SGA and late preterm children were 11.8 and 6.3%, respectively. Prematurity and SGA were simultaneously present in five children. When compared with controls, SGA children showed significantly lower than average retinal nerve fiber layer (RNFL) thickness (94.1 vs 98.8 μm; P = 0.007) and an increased percentage of abnormal Bender scores (27.3 vs 6.2%; P = 0.017) (odds ratio 5.6 (95% CI, 1.2-26.8)). These differences increased when late SGA infants with a birth weight below the 3(rd) percentile were compared with SGA infants with a birth weight between the 3(rd) and 10(th) percentiles and with controls, for RNFL thickness (92.5 vs 94.6 and 98.8 μm, respectively; P = 0.021) and abnormal Bender tests (33.3 vs 25.0 and 6.2%, respectively; P = 0.036). However, no differences were found in retinal structure and visuomotor performance between late preterm and term infants. CONCLUSIONS These data suggest that late SGA and late prematurity induce a distinct neuronal pattern of structural changes that persist at school age. Late-onset SGA infants are at increased risk for axonal loss in the retina and present specific visuomotor difficulties.
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Affiliation(s)
- D Oros
- Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Instituto Aragonés de Ciencias de la Salud, University of Zaragoza, Zaragoza, Spain
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Pöpping DM, Elia N, Wenk M, Tramèr MR. Combination of a reduced dose of an intrathecal local anesthetic with a small dose of an opioid: A meta-analysis of randomized trials. Pain 2013; 154:1383-90. [DOI: 10.1016/j.pain.2013.04.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 03/29/2013] [Accepted: 04/11/2013] [Indexed: 11/16/2022]
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Schaub I, Lysakowski C, Elia N, Tramèr MR. Reply to: Low-dose droperidol for prevention of postoperative nausea in adults. Eur J Anaesthesiol 2013; 30:444-445. [PMID: 23518670 DOI: 10.1097/eja.0b013e32836055dc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Aldenkortt M, Lysakowski C, Elia N, Brochard L, Tramèr MR. Ventilation strategies in obese patients undergoing surgery: a quantitative systematic review and meta-analysis. Br J Anaesth 2012; 109:493-502. [PMID: 22976857 DOI: 10.1093/bja/aes338] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pathophysiological changes due to obesity may complicate mechanical ventilation during general anaesthesia. The ideal ventilation strategy is expected to optimize gas exchange and pulmonary mechanics and to reduce the risk of respiratory complications. METHODS Systematic search (databases, bibliographies, to March 2012, all languages) was performed for randomized trials testing intraoperative ventilation strategies in obese patients (BMI ≥ 30 kg m(-2)), and reporting on gas exchange, pulmonary mechanics, or pulmonary complications. Meta-analyses were performed when data from at least three studies or 100 patients could be combined. RESULTS Thirteen studies (505 obese surgical patients) reported on a variety of ventilation strategies: pressure- or volume-controlled ventilation (PCV, VCV), various tidal volumes, and different PEEP or recruitment manoeuvres (RM), and combinations thereof. Definitions and reporting of endpoints were inconsistent. In five trials (182 patients), RM added to PEEP compared with PEEP alone improved intraoperative PaO2/FIO2 ratio [weighted mean difference (WMD), 16.2 kPa; 95% confidence interval (CI), 8.0-24.4] and increased respiratory system compliance (WMD, 14 ml cm H(2)O(-1); 95% CI, 8-20). Arterial pressure remained unchanged. In four trials (100 patients) comparing PCV with VCV, there was no difference in PaO2/FIO2 ratio, tidal volume, or arterial pressure. Comparison of further ventilation strategies or combination of other outcomes was not feasible. Data on postoperative complications were seldom reported. CONCLUSIONS The ideal intraoperative ventilation strategy in obese patients remains obscure. There is some evidence that RM added to PEEP compared with PEEP alone improves intraoperative oxygenation and compliance without adverse effects. There is no evidence of any difference between PCV and VCV.
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Affiliation(s)
- M Aldenkortt
- Division of Anaesthesia, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
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Pöpping DM, Elia N, Marret E, Wenk M, Tramèr MR. Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-analysis of randomized trials. Pain 2012; 153:784-793. [DOI: 10.1016/j.pain.2011.11.028] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 11/21/2011] [Accepted: 11/28/2011] [Indexed: 12/21/2022]
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Czarnetzki C, Lysakowski C, Elia N, Tramèr MR. Time course of rocuronium-induced neuromuscular block after pre-treatment with magnesium sulphate: a randomised study. Acta Anaesthesiol Scand 2010; 54:299-306. [PMID: 19919585 DOI: 10.1111/j.1399-6576.2009.02160.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND A previously published study suggested that pre-treatment with magnesium sulphate (MgSO(4)) had no impact on the speed of onset of rocuronium-induced neuromuscular block. We set out to verify this assumption. METHODS Eighty patients (18-60 years) were randomly allocated to MgSO(4) 60 mg/kg or placebo (saline). Study drugs were given intravenously for 15 min before induction of anaesthesia with propofol, sufentanil and rocuronium 0.6 mg/kg. Anaesthesia was maintained with a target-controlled propofol infusion. Neuromuscular transmission was measured using train-of-four (TOF)-Watch SX acceleromyography. RESULTS Onset was analysed in 37 MgSO(4) and 38 saline patients, and recovery in 35 MgSO(4) and 37 saline patients. Onset time (to 95% depression of T1) was on average 77 [SD=18] s with MgSO(4) and 120 [48] s with saline (P<0.001). The total recovery time (DurTOF0.9) was on average 73.2 [22] min with MgSO(4) and 57.8 [14.2] min with saline (P<0.003). The clinical duration (Dur25%) was on average 44.7 [14] min with MgSO(4) and 33.2 [8.1] min with saline (P<0.0002). The recovery index (Dur25-75%) was on average 14.0 [6] min with MgSO(4) and 11.2 [5.2] min with saline (P<0.02). The recovery time (Dur25%TOF0.9) was on average 28.5 [11.7] min with MgSO(4) and 24.7 [8.4] min with saline (P=0.28). CONCLUSION Magnesium sulphate given 15 min before propofol anaesthesia reduces the onset time of rocuronium by about 35% and prolongs the total recovery time by about 25%.
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Affiliation(s)
- C Czarnetzki
- Division of Anaesthesiology, University Hospitals of Geneva, CH-1211 Geneva 14, Switzerland.
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Rougemont M, Stoll BE, Elia N, Ngang P. Antiretroviral treatment adherence and its determinants in Sub-Saharan Africa: a prospective study at Yaounde Central Hospital, Cameroon. AIDS Res Ther 2009; 6:21. [PMID: 19821997 PMCID: PMC2770068 DOI: 10.1186/1742-6405-6-21] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 10/12/2009] [Indexed: 12/03/2022] Open
Abstract
Background With African health-care systems facing exploding demand for HIV care, reliable methods for assessing adherence and its influencing factors are needed to guide effective public-health measures. This study evaluated individual patient characteristics determining antiretroviral treatment (ART) adherence and the predictive values of different measures of adherence on virological treatment failure in a cohort of patients in a routine-care setting in Cameroon. Methods Longitudinal study over 6-months following ART introduction, using patients questionnaires and hospital and pharmacy records. Results At the end of the 6 months study period, 219 of 312 patients (70%) returned to the pharmacy to refill their medication, 17% (51) were lost to follow-up, 9% (28) were dead and 4% (14) were transferred to other care centres. Virological treatment failure at 6 months was experienced by 26 patients, representing 13% of patients with available viral load value. Pharmacy refill irregularity was the most powerful predictor (odds ratio 12.4; P < 0.001) of virological treatment failure, compared with CD4 cell count increase at 6 months (odds ratio 7.8; P = 0.002) or self-reported adherence at one month (odds ratio 1.1; P = 0.85). Low intensity of ART side-effects after one month was strongly associated with survival (odds ratio 0.11; P = 0.001). Patients starting ART with CD4 cell count <100 cells/mm3 had a greater risk of dying during the follow-up period (odds ratio 2.69; P = 0.02). Compared with asymptomatic CDC stage A patients, CDC stage B (odds ratio 5.72) and CDC stage C patients (odds ratio 16.9) had higher risk of becoming lost to follow-up (P < 0.001). In the multivariate analyses, pharmacy non-adherence was less frequent in women (adjusted odds ratio 0.56; P = 0.05) but more frequent in patients with high monthly income (odds ratio 3.24; P = 0.04). Conclusion Pharmacy-refill adherence might be considered as an alternative to CD4 count monitoring for identification of patients at risk of virological failure, especially in resources-scarce countries. The study confirmed the difficulty in demonstrating clear associations of individual patient factors and treatment outcomes. The substantial loss to follow-up and deaths occurring within 6 months after initiating ART emphasise the need to understand the best timing of ART initiation and further elucidate and educate on the underlying reasons for delaying initiation of ART in resource-limited countries
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Lysakowski C, Elia N, Czarnetzki C, Dumont L, Haller G, Combescure C, Tramèr M. Bispectral and spectral entropy indices at propofol-induced loss of consciousness in young and elderly patients. Br J Anaesth 2009; 103:387-93. [DOI: 10.1093/bja/aep162] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Meylan N, Elia N, Lysakowski C, Tramèr MR. Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery: meta-analysis of randomized trials. Br J Anaesth 2009; 102:156-67. [PMID: 19151046 DOI: 10.1093/bja/aen368] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Intrathecal morphine without local anaesthetic is often added to a general anaesthetic to prevent pain after major surgery. Quantification of benefit and harm and assessment of dose-response are needed. We performed a meta-analysis of randomized trials testing intrathecal morphine alone (without local anaesthetic) in adults undergoing major surgery under general anaesthesia. Twenty-seven studies (15 cardiac-thoracic, nine abdominal, and three spine surgery) were included; 645 patients received intrathecal morphine (dose-range, 100-4000 microg). Pain intensity at rest was decreased by 2 cm on the 10 cm visual analogue scale up to 4 h after operation and by about 1 cm at 12 and 24 h. Pain intensity on movement was decreased by 2 cm at 12 and 24 h. Opioid requirement was decreased intraoperatively, and up to 48 h after operation. Morphine-sparing at 24 h was significantly greater after abdominal surgery {weighted mean difference, -24.2 mg [95% confidence interval (CI) -29.5 to -19.0]}, compared with cardiac-thoracic surgery [-9.7 mg (95% CI -17.6 to -1.80)]. The incidence of respiratory depression was increased with intrathecal morphine [odds ratio (OR) 7.86 (95% CI 1.54-40.3)], as was the incidence of pruritus [OR 3.85 (95% CI 2.40-6.15)]. There was no evidence of linear dose-responsiveness for any of the beneficial or harmful outcomes. In conclusion, intrathecal morphine decreases pain intensity at rest and on movement up to 24 h after major surgery. Morphine-sparing is more pronounced after abdominal than after cardiac-thoracic surgery. Respiratory depression remains a major safety concern.
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Affiliation(s)
- N Meylan
- Division of Anaesthesiology, University Hospitals of Geneva, 24, rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland
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Czarnetzki C, Elia N, Lysakowski C, Dumont L, Landis BN, Giger R, Dulguerov P, Desmeules J, Tramèr MR. Dexamethasone and risk of nausea and vomiting and postoperative bleeding after tonsillectomy in children: a randomized trial. JAMA 2008; 300:2621-30. [PMID: 19066382 DOI: 10.1001/jama.2008.794] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Dexamethasone is widely used to prevent postoperative nausea and vomiting (PONV) in pediatric tonsillectomy. OBJECTIVE To assess whether dexamethasone dose-dependently reduces the risk of PONV at 24 hours after tonsillectomy. DESIGN, SETTING, AND PATIENTS Randomized placebo-controlled trial conducted among 215 children undergoing elective tonsillectomy at a major public teaching hospital in Switzerland from February 2005 to December 2007. INTERVENTIONS Children were randomly assigned to receive dexamethasone (0.05, 0.15, or 0.5 mg/kg) or placebo intravenously after induction of anesthesia. Acetaminophen-codeine and ibuprofen were given as postoperative analgesia. Follow-up continued until the 10th postoperative day. MAIN OUTCOME MEASURES The primary end point was prevention of PONV at 24 hours; secondary end points were decrease in the need for ibuprofen at 24 hours and evaluation of adverse effects. RESULTS At 24 hours, 24 of 54 participants who received placebo (44%; 95% confidence interval [CI], 31%-59%) had experienced PONV compared with 20 of 53 (38%; 95% CI, 25%-52%), 13 of 54 (24%; 95% CI, 13%-38%), and 6 of 52 (12%; 95% CI, 4%-23%) who received dexamethasone at 0.05, 0.15, and 0.5 mg/kg, respectively (P<.001 for linear trend). Children who received dexamethasone received significantly less ibuprofen. There were 26 postoperative bleeding episodes in 22 children. Two of 53 (4%; 95% CI, 0.5%-13%) children who received placebo had bleeding compared with 6 of 53 (11%; 95% CI, 4%-23%), 2 of 51 (4%; 95% CI, 0.5%-13%), and 12 of 50 (24%; 95% CI, 13%-38%) who received dexamethasone at 0.05, 0.15, and 0.5 mg/kg, respectively (P = .003). Dexamethasone, 0.5 mg/kg, was associated with the highest bleeding risk (adjusted relative risk, 6.80; 95% CI, 1.77-16.5). Eight children had to undergo emergency reoperation because of bleeding, all of whom had received dexamethasone. The trial was stopped early for safety reasons. CONCLUSION In this study of children undergoing tonsillectomy, dexamethasone decreased the risk of PONV dose dependently but was associated with an increased risk of postoperative bleeding. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00403806.
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Affiliation(s)
- Christoph Czarnetzki
- Division of Anesthesiology, University Hospitals of Geneva, 24 rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland
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Pöpping DM, Elia N, Marret E, Remy C, Tramèr MR. Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: a meta-analysis. ACTA ACUST UNITED AC 2008; 143:990-9; discussion 1000. [PMID: 18936379 DOI: 10.1001/archsurg.143.10.990] [Citation(s) in RCA: 298] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To review the impact of epidural vs systemic analgesia on postoperative pulmonary complications. DATA SOURCES Search of databases (1966 to March 2006) and bibliographies. STUDY SELECTION Inclusion criteria were randomized comparison of epidural vs systemic analgesia lasting 24 hours or longer postoperatively and reporting of pulmonary complications, lung function, or gas exchange. Fifty-eight trials (5904 patients) were included. DATA EXTRACTION Articles were reviewed and data extracted. Data were combined using fixed-effect and random-effects models. DATA SYNTHESIS The odds of pneumonia were decreased with epidural analgesia (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.43-0.68), independent of site of surgery or catheter insertion, duration of analgesia, or regimen. The effect was weaker in trials that used patient-controlled analgesia in controls (OR, 0.64; 95% CI, 0.49-0.83) compared with trials that did not (OR, 0.30; 95% CI, 0.18-0.49) and in larger studies (OR, 0.62; 95% CI, 0.47-0.81) compared with smaller studies (OR, 0.37; 95% CI, 0.23-0.58). From 1971-2006, the incidence of pneumonia with epidural analgesia remained about 8% but decreased from 34% to 12% with systemic analgesia (P < .001); consequently, the relative benefit of epidural analgesia decreased also. Epidural analgesia reduced the need for prolonged ventilation or reintubation, improved lung function and blood oxygenation, and increased the risk of hypotension, urinary retention, and pruritus. Technical failures occurred in 7%. CONCLUSION Epidural analgesia protects against pneumonia following abdominal or thoracic surgery, although this beneficial effect has lessened over the last 35 years because of a decrease in the baseline risk.
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Affiliation(s)
- Daniel M Pöpping
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum, Albert-Schweitzer-Strasse 33, D-48149 Münster, Germany.
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Elia N, Culebras X, Mazza C, Schiffer E, Tramèr MR. Clonidine as an adjuvant to intrathecal local anesthetics for surgery: systematic review of randomized trials. Reg Anesth Pain Med 2008; 33:159-67. [PMID: 18299097 DOI: 10.1016/j.rapm.2007.10.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 10/01/2007] [Accepted: 10/02/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Clonidine is added to intrathecal local anesthetics to improve intraoperative analgesia and to increase the duration of sensory and motor block. The aim of this systematic review is to quantify beneficial and harmful effects of clonidine when used as an adjuvant to intrathecal local anesthetics for surgery. METHODS We included data from 22 randomized trials (1,445 patients) testing a large variety of doses of clonidine, added to intrathecal bupivacaine, mepivacaine, prilocaine, or tetracaine. RESULTS Clonidine 15 to 150 microg prolonged in a linear, dose-dependent manner, the time to 2 segment regression (range of means, 14 to 75 minutes) and the time to regression to L2 (range of means, 11 to 128 minutes). The time to first analgesic request (median 101 minutes, range 35 to 310) and of motor block (median 47 minutes, range 6 to 131) was prolonged without evidence of dose-responsiveness. Time to achieve complete sensory or motor block, and extent of cephalic spread remained unchanged. There were fewer episodes of intraoperative pain with clonidine (relative risk, 0.24; 95% confidence interval [CI], 0.09-0.64; number needed to treat, 13) but more episodes of arterial hypotension (relative risk, 1.81; 95% CI 1.44-2.28; number needed to harm, 8) without evidence of dose-responsiveness. The risk of bradycardia was unchanged. CONCLUSIONS This study may serve as a rational basis to help clinicians decide whether or not to combine clonidine with an intrathecal local anesthetic for surgery. The optimal dose of clonidine, however, remains unknown.
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Affiliation(s)
- Nadia Elia
- Division of Anesthesiology, University Hospitals of Geneva, Geneva.
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Beatriz G, Elia N, Ana T, Idrissa L, Rocio M, Carmen V, Gisela G, Zaima M, Agustin L, Tania C. 114 POSTER Effective inhibition of the EGF/EGFR binding by anti-EGF antibodies increased survival of advanced NSCLC patients treated with the EGF cancer vaccine. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)70120-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Elia N, Lysakowski C, Tramèr MR. Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials. Anesthesiology 2005; 103:1296-304. [PMID: 16306743 DOI: 10.1097/00000542-200512000-00025] [Citation(s) in RCA: 390] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors analyzed data from 52 randomized placebo-controlled trials (4,893 adults) testing acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors given in conjunction with morphine after surgery. The median of the average 24-h morphine consumption in controls was 49 mg (range, 15-117 mg); it was significantly decreased with all regimens by 15-55%. There was evidence of a reduction in pain intensity at 24 h (1 cm on the 0- to 10-cm visual analog scale) only with nonsteroidal antiinflammatory drugs. Nonsteroidal antiinflammatory drugs also significantly reduced the incidence of nausea/vomiting from 28.8% to 22.0% (number needed to treat, 15) and of sedation from 15.4% to 12.7% (number needed to treat, 37) but increased the risk of severe bleeding from 0% to 1.7% (number needed to harm, 59). Selective cyclooxygenase-2 inhibitors increased the risk of renal failure in cardiac patients from 0% to 1.4% (number needed to harm, 73). A decrease in morphine consumption is not a good indicator of the usefulness of a supplemental analgesic. There is evidence that the combination of nonsteroidal antiinflammatory drugs with patient-controlled analgesia morphine offers some advantages over morphine alone.
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Affiliation(s)
- Nadia Elia
- Division of Anesthesiology, Geneva University Hospitals, 24 rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland.
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Elia N, Tramèr MR. Ketamine and postoperative pain – a quantitative systematic review of randomised trials. Pain 2005; 113:61-70. [PMID: 15621365 DOI: 10.1016/j.pain.2004.09.036] [Citation(s) in RCA: 324] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Revised: 09/10/2004] [Accepted: 09/28/2004] [Indexed: 01/28/2023]
Abstract
Ketamine, an N-methyl-D-aspartate receptor antagonist, is known to be analgesic and to induce psychomimetic effects. Benefits and risks of ketamine for the control of postoperative pain are not well understood. We systematically searched for randomised comparisons of ketamine with inactive controls in surgical patients, reporting on pain outcomes, opioid sparing, and adverse effects. Data were combined using a fixed effect model. Fifty-three trials (2839 patients) from 25 countries reported on a large variety of different ketamine regimens and surgical settings. Sixteen studies tested prophylactic intravenous ketamine (median dose 0.4 mg/kg, range (0.1-1.6)) in 850 adults. Weighted mean difference (WMD) for postoperative pain intensity (0-10 cm visual analogue scale) was -0.89 cm at 6 h, -0.42 at 12 h, -0.35 at 24 h and -0.27 at 48 h. Cumulative morphine consumption at 24 h was significantly decreased with ketamine (WMD -15.7 mg). There was no difference in morphine-related adverse effects. The other 37 trials tested in adults or children, prophylactic or therapeutic ketamine orally, intramuscularly, subcutaneously, intra-articulary, caudally, epidurally, transdermally, peripherally or added to a PCA device; meta-analyses were deemed inappropriate. The highest risk of hallucinations was in awake or sedated patients receiving ketamine without benzodiazepine; compared with controls, the odds ratio (OR) was 2.32 (95%CI, 1.09-4.92), number-needed-to-harm (NNH) 21. In patients undergoing general anaesthesia, the incidence of hallucinations was low and independent of benzodiazepine premedication; OR 1.49 (95%CI 0.18-12.6), NNH 286. Despite many published randomised trials, the role of ketamine, as a component of perioperative analgesia, remains unclear.
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Affiliation(s)
- Nadia Elia
- EBCAP Institute (Evidence-Based Critical care, Anaesthesia and Pain treatment), Division of Anaesthesiology, Geneva University Hospitals, 24 Rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland.
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Guibaud JP, Roques X, Laborde N, Elia N, Roubertie F, Ewald J, Baudet E. Extracorporeal Circulation as an Additional Method for Cerebral Protection in Simultaneous Carotid Endarterectomy and Coronary Artery Surgical Revascularization. J Card Surg 2004; 19:415-9. [PMID: 15383052 DOI: 10.1111/j.0886-0440.2004.04087.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Surgical management of patients with concomitant carotid and coronary artery stenosis remains controversial. Our policy was always to perform at the same time carotid endarterectomy (CE) and coronary artery bypass grafting (CABG), but it was also considered that extracorporeal circulation (ECC), because of full heparinization, hemodilution, pulsatile flow, and hypothermia could provide better cerebral protection during CE. Retrospective data of 124 patients undergoing simultaneous CE and CABGs between January 1994 and December 2001 were reviewed. CE was performed prior to ECC in 65 patients (Group 1-mean age: 70.4 years; sex ratio: 49 male/16 female) and under ECC, prior to CABGs in 59 patients (Group 2-mean age: 69.9 years; sex ratio: 46 male/13 female). Overall hospital mortality was 7.3% (9/124): cardiac-related in 5 patients, or due to septicemia (1 patient), or ARD syndrome (1 patient), or stroke in two others. Univariate analysis demonstrated overweight, unstable angina, and emergency to be significant risk factors. Bilateral carotid stenosis was a significant risk factor of neurologic event when CE was performed prior to ECC (p < 0.05). In Group 1, mortality was 9.2% (6/65), and the incidence of neurologic events was 10.7% (7/65), and was responsible for two of the early deaths in patients with bilateral carotid stenosis. In Group 2, mortality was 5.1% (3/59) but never related to CE, while the neurologic morbidity was 1.7% (1 transient ischemic attack). It is concluded that (1) hospital mortality in patients undergoing simultaneous CE and CABGs was mainly cardiac-related. (2) The combined approach of both localizations appears to be mandatory, when carotid stenosis, even asymptomatic, was hemodynamically significant, or with ulcerative lesions likely to be responsible for embolism. (3) CE, first performed under ECC, appears to be a safe procedure, combining, in terms of cerebral protection, the benefits previously called up. This approach is all the more interesting when carotid stenosis is bilateral; hypothermia < or = 28 degrees C during the carotid clamping time is obviously the optimal method for cerebral protection when ipsilateral or contralateral supply is reduced, or even absent.
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Affiliation(s)
- J P Guibaud
- Department of Cardiovascular and Pediatric Cardiac Surgery, Bordeaux Heart University Hospital, Bordeaux Pessac, France.
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Elia N, Tapponnier M, Matthay MA, Hamacher J, Pache JC, Brundler MA, Totsch M, De Baetselier P, Fransen L, Fukuda N, Morel DR, Lucas R. Functional identification of the alveolar edema reabsorption activity of murine tumor necrosis factor-alpha. Am J Respir Crit Care Med 2003; 168:1043-50. [PMID: 12842853 DOI: 10.1164/rccm.200206-618oc] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Tumor necrosis factor-alpha (TNF-alpha) activates sodium channels in Type II alveolar epithelial cells, an important mechanism for the reported fluid resorption capacity of the cytokine. Both TNF-alpha receptor-dependent and -independent effects were proposed for this activity in vitro, the latter mechanism mediated by the lectin-like domain of the molecule. In this study, the relative contribution of the receptor-dependent versus receptor-independent activities was investigated in an in situ mouse lung model and an ex vivo rat lung model. Fluid resorption due to murine TNF-alpha (mTNF-alpha) was functional in mice that were genetically deficient in both types of mTNF-alpha receptor, establishing the importance of mTNF-alpha receptor-independent effects in this species. In addition, we assessed the capacity of an mTNF-alpha-derived peptide (mLtip), which activates sodium transport by a receptor-independent mechanism, to reduce lung water content in an isolated, ventilated, autologous blood-perfused rat lung model. The results show that in this model, mLtip, in contrast to mTNF-alpha, produced a progressive recovery of dynamic lung compliance and airway resistance after alveolar flooding. There was also a significant reduction in lung water. These results indicate that the receptor-independent lectin-like domain of mTNF-alpha has a potential physiological role in the resolution of alveolar edema in rats and mice.
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Affiliation(s)
- Nadia Elia
- Division of Anesthesiological Investigations, University Medical Center, Geneva, Switzerland
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Walder B, Bründler MA, Tötsch M, Elia N, Morel DR. Influence of the type and rate of subarachnoid fluid infusion on lethal neurogenic pulmonary edema in rats. J Neurosurg Anesthesiol 2002; 14:194-203. [PMID: 12172291 DOI: 10.1097/00008506-200207000-00004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In patients who experience sudden death from spontaneous subarachnoid hemorrhage, more than 90% present with acute pulmonary edema. The underlying pathogenesis of this complication is poorly understood. In addition, the specific role of the extravasated blood products and the associated elevation in intracranial pressure leading to the systemic and pulmonary effects during subarachnoid hemorrhage are not well established. The authors tested a new model of acute and severe subarachnoid hemorrhage comparing fresh whole autologous blood (n = 20) with 5% albumin (n = 19) injected at two different rates (35 seconds versus 24 minutes) into the cisterna magna of anesthetized, mechanically ventilated rats. Cerebral and systemic hemodynamics and the corresponding pulmonary function were evaluated. The type of fluid injected had no influence on survival or hemodynamic and respiratory parameters. Rapid infusion of either blood or albumin (n = 14) produced an acute and transient rise in intracranial pressure (37.9 +/- 3.5 mm Hg) associated with systemic hypertension and increased cerebral perfusion pressure that was sustained in survivors but not in nonsurvivors. Slow infusion (n = 23) produced a more progressive increase in intracranial pressure to 31.2 +/- 7.1 mm Hg with a parallel and sustained increase of systemic blood pressure and preserved cerebral perfusion pressure in survivors, but produced a pattern of more severe hypertension followed by hypotension in nonsurvivors. Sixty-four percent of animals (rapid infusion) and 48% of animals (slow infusion) survived the challenge and presented no pulmonary alterations. In contrast, nonsurviving rats developed reduced lung compliance and gas exchange, an increased alveolar-arterial protein concentration ratio (0.36 +/- 0.02 versus 0.17 +/- 0.03 in survivors; P <.0001), and increased lung weight (5.7 +/- 0.3 g versus 2.0 +/- 0.1 g; P <.0001), demonstrating a fulminant increased permeability pulmonary edema, leading to death within one hour. These results indicate that the chosen rapid- and slow-injection rates resulted in a similar death rate of 50%. Mortality was similar for blood and albumin administration, pulmonary edema occurred in nonsurvivors in both the rapid- and slow-injection groups, and pulmonary edema is associated with more severe hypertension in the slow-injection group. Furthermore, these results suggest that the development of neurogenic pulmonary edema that is characterized by an acutely increased capillary permeability to proteins is independent of the degree of intracranial pressure increase or the type of fluid administrated.
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Affiliation(s)
- Bernhard Walder
- Division d'Investigations Anesthésiologiques, University Hospitals Geneva, Geneva, Switzerland
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Guibaud JP, Laborde MN, Dubrez J, Elia N, Remes J, Rosato F, Roques X, Baudet E. Surgical repair of an aneurysm of the innominate artery with fistulization into the trachea. Ann Vasc Surg 2001; 15:412-4. [PMID: 11414098 DOI: 10.1007/s100160010070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This report describes a 43-year-old patient presenting with an aneurysm located at the junction between the innominate artery and aorta, with spontaneous fistulization into the trachea. Emergency treatment of this unusually located lesion was undertaken to prevent intratracheal rupture. After ligation of the innominate artery, right common carotid artery, and right subclavian artery due to the risk of infection, the tracheal fistula was treated by direct closure and exclusion using an autologous pericardial flap. The procedure was performed under extracorporeal circulation and circulatory arrest with profound hypothermia.
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Affiliation(s)
- J P Guibaud
- Service de Chirurgie Cardiovasculaire and Service de Chirurgie Thoracique, Hôpital du Haut-Lévêque, CHU de Bordeaux, Bordeaux, France
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Walder B, Elia N, Henzi I, Romand JR, Tramèr MR. A lack of evidence of superiority of propofol versus midazolam for sedation in mechanically ventilated critically ill patients: a qualitative and quantitative systematic review. Anesth Analg 2001; 92:975-83. [PMID: 11273936 DOI: 10.1097/00000539-200104000-00033] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED Propofol and midazolam are often used for sedation in the intensive care unit. The aim of this systematic review was to estimate the efficacy and harm of propofol versus midazolam in mechanically ventilated patients. A systematic search (Medline, Cochrane Library, Embase, bibliographies), any language, up to June 1999 was performed for reports of randomized comparisons of propofol with midazolam. Data from 27 trials (1624 adults) were analyzed. The average duration of sedation varied between 4 and 339 h. In 10 trials, the duration of adequate sedation was longer with propofol (weighted mean difference 2.9 h; 95% confidence interval [CI], 0.2-5.6 h). In 13 trials (mostly postoperative), sedation lasted 4 to 35 h; in 9 of those, average weaning time from mechanical ventilation with propofol was 0.8-4.3 h; with midazolam it was 1.5-7.2 h (weighted mean difference 2.2 h [95% CI, 0.8 to 3.7 h]). In 8 trials, sedation lasted 54 to 339 h; there was a lack of evidence for difference in weaning times. Arterial hypotension (relative risk 2.5 [95% CI, 1.3 to 4.5]; number-needed-to-treat, 12), and hypertriglyceridemia (relative risk 12.1 [95%CI, 2.9 to 49.7]; number-needed-to-treat, 6) occurred more often with propofol. The duration of adequate sedation time is longer with propofol compared with midazolam. In postoperative patients with sedation <36 h, weaning is faster with propofol. IMPLICATIONS The duration of adequate sedation time is longer with propofol compared with midazolam. In postoperative patients with sedation < 36 h, weaning is faster with propofol.
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Affiliation(s)
- B Walder
- Divisions of Surgical Intensive Care, Department APSIC, University Hospitals of Geneva, Switzerland.
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Yamada K, Roques X, Elia N, Laborde MN, Jimenez M, Choussat A, Baudet E. The short- and mid-term results of bidirectional cavopulmonary shunt with additional source of pulmonary blood flow as definitive palliation for the functional single ventricular heart. Eur J Cardiothorac Surg 2000; 18:683-9. [PMID: 11113676 DOI: 10.1016/s1010-7940(00)00583-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of this study was to demonstrate the early and late outcomes of bidirectional cavopulmonary shunt (BCPS) as a definitive procedure for the functional single ventricular heart. METHOD From September 1991 to December 1997, 34 patients underwent a BCPS procedure without a routine conversion to Fontan circulation. The additional source of pulmonary blood flow was left in all patients. Conversion was performed only when it was required for excessive cyanosis. RESULTS The hospital mortality rate was 8.8% (3/34, 95% confidence limit; 1.9-23%) and the 5-year survival rate was 75% for a mean follow-up period of 33+/-22 months. Seven patients underwent a conversion procedure for remnant or recurrent cyanosis and deterioration of exercise tolerance. Four of these patients died after conversion to Fontan circulation. Twenty-five long-term survivors with BCPSs maintained an arterial oxygen saturation of 84+/-6.1%, and 52% of them had a normal exercise tolerance or mild limitation. No patients developed severe late complications other than recurrent cyanosis. CONCLUSION Due to the high mortality after conversion to Fontan circulation in patients whose conditions had deteriorated, we could not demonstrate the clear superiority of long-term BCPS over the construction of Fontan circulation for management of the functional single ventricular heart. If deteriorated conditions were successfully managed in the late period, the outcome of long-term BCPS would have been better.
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Affiliation(s)
- K Yamada
- Department of Cardiovascular Surgery, Haut-Lévêque's Cardiological Hospital, University of Bordeaux II, Bordeaux-Pessac, France
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Malachowski MR, Adams M, Elia N, Rheingold AL, Kelly RS. Enforcing geometrical constraints on metal complexes using biphenyl-based ligands: spontaneous reduction of copper(II) by sulfur-containing ligands. ACTA ACUST UNITED AC 1999. [DOI: 10.1039/a900223e] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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