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Qaseem A, Hicks LA, Etxeandia-Ikobaltzeta I, Shamliyan TA, Cooney TG. Pharmacologic Treatment of Primary Osteoporosis or Low Bone Mass to Prevent Fractures in Adults: A Living Clinical Guideline From the American College of Physicians (Version 1, Update Alert). Ann Intern Med 2024. [PMID: 38710077 DOI: 10.7326/l24-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania
| | - Lauri A Hicks
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Aronow WS, Avanesova AA, Frishman WH, Shamliyan TA. Inconsistent Benefits From Mobile Information Communication Technology in Adults With Peripheral Arterial Disease. Cardiol Rev 2024; 32:12-17. [PMID: 35674708 DOI: 10.1097/crd.0000000000000456] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Quality of evidence regarding telemedicine in adults with peripheral arterial disease has not been systematically appraised. OBJECTIVES To explore benefits and harms from mobile information communication technology devices and applications in peripheral arterial disease. METHODS Systematic rapid evidence review and appraisal with the grading of recommendations assessment, development, and evaluation working group approach. RESULTS Sixteen randomized controlled clinical trials (RCT) examined various self-monitoring devices, telemedicine platforms, and individualized telephone counseling. Low-quality evidence suggested that the odds of treatment failure (pooled Peto odds ratio 0.8; 95% CI, 0.4-1.7; 5 RCTs), adverse effects (pooled Peto odds ratio 0.9; 95% CI, 0.5-1.5; 2 RCTs), and physical performance (standardized mean difference in 6-minute walking test 0.2; 95% CI, -0.3-0.7; 4 RCTs) did not differ between mobile interventions and usual care. Single RCTs suggested large but inconsistent improvement in the quality of life: EuroQol5D standardized mean difference = 5.0 (95% CI, 4.4-5.7; 1 RCT) after telehealth program for promoting patient self-management and standardized mean difference = 1.4 (95% CI, 0.4-2.3; 1 RCT) after structured rehabilitation with mobile self-monitoring. Inconsistent reporting of patient-centered outcomes and small sample sizes hampered the quality of evidence. CONCLUSIONS Improved quality of life after specific mobile applications should be confirmed in powered RCTs and large postmarketing studies.
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Affiliation(s)
- Wilbert S Aronow
- From the Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Anna A Avanesova
- North-Caucasus Federal University, Stavropol, Russian Federation
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Shamliyan TA, Avanesova AA, Aronow WS. Insufficient evidence regarding benefits from sodium-glucose cotransporter-2 inhibitors in heart failure with preserved ejection fraction. VP 2020; 2020. [DOI: 10.20517/2574-1209.2020.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
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Abstract
INTRODUCTION Drug-induced QT prolongation is associated with higher cardiovascular mortality. MATERIAL AND METHODS We conducted a protocol-based comprehensive review of antidepressant-induced QT prolongation in people with mental disorders. RESULTS Based on findings from 47 published randomized controlled trials (RCTs), 3 unpublished RCTs, 14 observational studies, 662 case reports of torsades de pointes, and 168 cases of QT prolongation, we conclude that all antidepressants should be used only with licensed doses, and that all patients receiving antidepressants require monitoring of QT prolongation and clinical symptoms of cardiac arrhythmias. Large observational studies suggest increased mortality associated with all antidepressants (RR = 1.62, 95% CI: 1.60-1.63, number of adults: 1,716,552), high doses of tricyclic antidepressants (OR = 2.11, 85% CI 1.10-4.22), selective serotonin reuptake inhibitors (OR = 2.78, 95% CI: 1.24-6.24), venlafaxine (OR = 3.73, 95% CI: 1.33-10.45, number of adults: 4,040), and nortriptyline (OR = 4.60, 95% CI: 1.20-18.40, number of adults: 5,298). CONCLUSIONS Evidence regarding the risk of QT prolongation in children is sparse.
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Affiliation(s)
- Wilbert S. Aronow
- Department of Medicine and Cardiology Research, Westchester Medical Center and New York Medical College, New York, USA
| | - Tatyana A. Shamliyan
- Elsevier, Clinical Solutions, Philadelphia, USA
- Corresponding author: Tatyana A. Shamliyan MD, MS, Elsevier Clinical Solutions, 1600 Kennedy Blvd, 19103 Philadelphia, USA, Phone: 2675004863, E-mail:
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Avanesova AA, Shamliyan TA. Worldwide implementation of telemedicine programs in association with research performance and health policy. Health Policy and Technology 2019. [DOI: 10.1016/j.hlpt.2019.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Garcia JM, Shamliyan TA. Management of Opioid-Induced Constipation in Patients with Malignancy. Am J Med 2018; 131:1041-1051.e3. [PMID: 29621475 DOI: 10.1016/j.amjmed.2018.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Jose M Garcia
- Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle; Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Wash
| | - Tatyana A Shamliyan
- Quality Assurance, Evidence-Based Medicine Center, Elsevier, Philadelphia, Pa.
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Aronow WS, Shamliyan TA. Oral Anticoagulation for Primary Prophylaxis of Venous Thromboembolism in Patients with Cancer. Am J Med 2018; 131:902-907. [PMID: 29625082 DOI: 10.1016/j.amjmed.2018.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 02/22/2018] [Indexed: 11/25/2022]
Affiliation(s)
| | - Tatyana A Shamliyan
- Quality Assurance, Evidence-Based Medicine Center, Elsevier, Philadelphia, Pa.
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Garcia JM, Shamliyan TA. Cannabinoids in Patients with Nausea and Vomiting Associated with Malignancy and Its Treatments. Am J Med 2018; 131:755-759.e2. [PMID: 29909841 DOI: 10.1016/j.amjmed.2017.12.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Jose M Garcia
- Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, Wash; Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Wash
| | - Tatyana A Shamliyan
- Quality Assurance, Evidence-Based Medicine Center, Elsevier, Philadelphia, Pa.
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Aronow WS, Shamliyan TA. Blood pressure targets for hypertension in patients with type 2 diabetes. Ann Transl Med 2018; 6:199. [PMID: 30023362 PMCID: PMC6035980 DOI: 10.21037/atm.2018.04.36] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 04/19/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Clinical guidelines vary in determining optimal blood pressure targets in adults with diabetes mellitus. METHODS We systematically searched PubMed, EMBASE, Cochrane Library, and clinicaltrials.gov in March 2018; conducted random effects frequentist meta-analyses of direct aggregate data; and appraised the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. RESULTS From eligible 14 meta-analyses and 95 publications of randomized controlled trials (RCT), only 6 RCTs directly compared lower versus higher blood pressure targets; remaining RCTs aimed at comparative effectiveness of hypotensive drugs. In adults with diabetes mellitus and elevated systolic blood pressure (SBP), direct evidence (2 RCTs) suggests that intensive target SBP <120-140 mmHg decreases the risk of diabetes-related mortality [relative risk (RR) =0.68; 95% confidence interval (CI), 0.50-0.92], fatal (RR =0.41; 95% CI, 0.20-0.84) or nonfatal stroke (RR =0.60; 95% CI, 0.43-0.83), prevalence of left ventricular hypertrophy and electrocardiogram (ECG) abnormalities, macroalbuminuria, and non-spine bone fractures, with no differences in all-cause or cardiovascular mortality or falls. In adults with diabetes mellitus and elevated diastolic blood pressure (DBP) ≥90 mmHg, direct evidence (2 RCTs) suggests that intensive DBP target ≤80 versus 80-90 mmHg decreases the risk of major cardiovascular events. Published meta-analyses of aggregate data suggested a significant association between lower baseline and attained blood pressure and increased cardiovascular mortality. CONCLUSIONS We concluded that in adults with diabetes mellitus and arterial hypertension, in order to reduce the risk of stroke, clinicians should target blood pressure at 120-130/80 mmHg, with close monitoring for all drug-related harms.
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Affiliation(s)
- Wilbert S. Aronow
- Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Tatyana A. Shamliyan
- Quality Assurance, Evidence-Based Medicine Center, Elsevier, Philadelphia, PA, USA
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Aronow WS, Shamliyan TA. Comparative Effectiveness of Disease Management With Information Communication Technology for Preventing Hospitalization and Readmission in Adults With Chronic Congestive Heart Failure. J Am Med Dir Assoc 2018; 19:472-479. [PMID: 29730178 DOI: 10.1016/j.jamda.2018.03.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 12/28/2022]
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Aronow WS, Shamliyan TA. Dietary Sodium Interventions to Prevent Hospitalization and Readmission in Adults with Congestive Heart Failure. Am J Med 2018; 131:365-370.e1. [PMID: 29307539 DOI: 10.1016/j.amjmed.2017.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/08/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Wilbert S Aronow
- Westchester Medical Center, New York Medical College, Valhalla, NY
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Abstract
Background Drug-induced QT prolongation is associated with higher risk of cardiac arrhythmias and cardiovascular mortality. We investigated the effects of atypical antipsychotic drugs on QT interval in children and adults with mental disorders. Methods We conducted random-effects direct frequentist meta-analyses of aggregate data from randomized controlled trials (RCT) and appraised the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Our search in PubMed, EMBASE, the Cochrane Library, clinicaltrials.gov, and PharmaPendium up to October 2017 identified studies that examined aripiprazole, quetiapine, risperidone, olanzapine, ziprasidone and brexpiprazole. Results Low quality evidence suggests that aripiprazole (four meta-analyses and twelve RCTs), brexpiprazole (one systematic review and four RCTs) or olanzapine (five meta-analyses and twenty RCTs) do not increase QT interval. Low quality evidence suggests that ziprasidone (five meta-analyses and 11 RCTs) increases QT interval and the rates of QT prolongation while risperidone (four meta-analyses, 70 RCTs) and quetiapine (two meta-analyses and seven RCTs) are associated with QT prolongation and greater odds of torsades de pointes ventricular tachycardia especially in cases of drug overdose. Conclusions The main conclusion of our study is that in people with mental disorders and under treatment with atypical antipsychotic drugs, in order to avoid QT prolongation and reduce the risk of ventricular tachycardia clinicians may recommend aripiprazole, brexpiprazole or olanzapine in licensed doses. Long-term comparative safety needs to be established.
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Affiliation(s)
- Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Tatyana A Shamliyan
- Quality Assurance, Evidence-Based Medicine Center, Elsevier, Philadelphia, PA, USA
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Aronow WS, Shamliyan TA. Comparative effectiveness and safety of empagliflozin on cardiovascular mortality and morbidity in adults with type 2 diabetes. Ann Transl Med 2017; 5:455. [PMID: 29285488 DOI: 10.21037/atm.2017.08.43] [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] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Based on a single placebo-controlled randomized clinical trial, empagliflozin is licensed to reduce cardiovascular death in diabetes and comorbid cardiovascular disease. Methods We examined the comparative effectiveness of empagliflozin on mortality and cardiovascular morbidity in type 2 diabetes. We conducted random-effects direct frequentist meta-analyses of aggregate data and appraised the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Our search in PubMed, EMBASE, the Cochrane Library, clinicaltrials.gov, and PharmaPendium up to May 2017 identified 11 meta-analyses, multiple publications, and unpublished data from 29 randomized controlled trials (RCTs). Results Empagliflozin reduces all-cause mortality [relative risk (RR) of death, 0.69; 95% confidence interval (CI): 0.58-0.82; number needed to treat (NNT) to postpone mortality in one patient, 39; 95% CI: 26-79; 1 RCT of 7,020 patients) in patients with but not without (RR, 0.90; 95% CI: 0.36-2.23; 14 RCTs of 7,707 patients) established cardiovascular disease when compared with placebo. Empagliflozin reduces cardiovascular mortality (RR, 0.62; 95% CI: 0.50-0.78; NNT, 45; 95% CI: 30-90; 1 RCT of 7,020 patients) in patients with but not without (RR, 0.98; 95% CI: 0.29-3.33; 10 RCTs of 5,429 patients) established cardiovascular disease when compared with placebo. There are no differences in cardiovascular morbidity and mortality and all-cause mortality between empagliflozin and metformin (4 RCTs of 1,344 patients), glimepiride (1 RCT of 1,549 patients), linagliptin (2 RCTs of 1,348 patients), or sitagliptin (3 RCTs of 1,483 patients). Two network meta-analyses concluded that sodium-glucose cotransporter 2 (SGLT2) inhibitors, mostly due to empagliflozin, decrease all-cause and cardiovascular mortality but increase the risk of nonfatal stroke, genital infection, and volume depletion. Conclusions We conclude that empagliflozin reduces all-cause and cardiovascular mortality in patients with established cardiovascular disease and type 2 diabetes. Sparse direct evidence suggests no difference in mortality between empagliflozin and metformin, glimepiride, linagliptin, or sitagliptin. Long-term comparative safety needs to be established.
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Affiliation(s)
- Wilbert S Aronow
- Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
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Garcia JM, Shamliyan TA. Omega-3 Fatty Acids in Patients with Anorexia-Cachexia Syndrome Associated with Malignancy and Its Treatments. Am J Med 2017; 130:1151-1155. [PMID: 29016347 DOI: 10.1016/j.amjmed.2017.03.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Jose M Garcia
- Geriatrics Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, Wash
| | - Tatyana A Shamliyan
- Quality Assurance, Evidence-Based Medicine Center Elsevier, Philadelphia, Pa.
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Garcia JM, Shamliyan TA. Nonsteroidal Anti-Inflammatory Drugs in Patients with Anorexia-Cachexia Syndrome Associated with Malignancy and Its Treatments. Am J Med 2017; 130:1033-1036. [PMID: 29016346 DOI: 10.1016/j.amjmed.2017.03.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Jose M Garcia
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle; Geriatrics Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle
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Farlow MR, Shamliyan TA. Benefits and harms of atypical antipsychotics for agitation in adults with dementia. Eur Neuropsychopharmacol 2017; 27:217-231. [PMID: 28111239 DOI: 10.1016/j.euroneuro.2017.01.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 09/21/2016] [Revised: 11/13/2016] [Accepted: 01/05/2017] [Indexed: 01/12/2023]
Abstract
We evaluated the most current evidence regarding the benefits and harms of atypical antipsychotics in adults with dementia. In June 2016, following a protocol developed a priori, we systematically searched several databases for published and unpublished data from randomized controlled trials (RCT), observational studies, and meta-analyses; conducted direct meta-analyses using a random effects model; and graded the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. One high-quality meta-analysis and published and unpublished data from 8 RCTs and 12 large observational studies met inclusion criteria. When compared with placebo, aripiprazole, risperidone, and olanzapine but not quetiapine result in modest (standardized mean difference <0.5 standard deviations) improvement in neuropsychiatric symptoms. Aripiprazole, risperidone, quetiapine, and olanzapine are associated with increased odds of acute myocardial infraction, and risperidone and olanzapine are associated with increased odds of hip fracture. Observational studies suggest no differences in all-cause mortality between atypical antipsychotics. Observational studies suggest that atypical antipsychotics are associated with lower risk of all-cause mortality and extrapyramidal symptoms but higher risk of stroke when compared with conventional antipsychotics. To manage agitation in adults with progressive dementia, clinicians may recommend atypical antipsychotics with continuous monitoring of behavioral symptoms, informing patients and their families or caregivers of the significant risk of adverse effects and baseline risk of acute myocardial infraction and bone fractures.
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Affiliation(s)
- Martin R Farlow
- Department of Neurology, IU Alzheimer׳s Disease and Related Disorders, 355 W. 16th Street, Suite 4700, Indianapolis, IN 46202, USA.
| | - Tatyana A Shamliyan
- Evidence-Based Medicine Quality Assurance, Elsevier, 1600 JFK Blvd 20th floor, Philadelphia, PA 19103, USA.
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Shamliyan TA, Sundarrajan R, Camper D, Middleton M, Kadambalithaya AP. Sponsorship, conflict of interest, risk of bias, and reporting of participant's flow and baseline demographic information in studies applicable to the federal law to post the results in clinicaltrials.gov. Contemp Clin Trials Commun 2017; 5:19-25. [PMID: 29740619 PMCID: PMC5936697 DOI: 10.1016/j.conctc.2016.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/11/2016] [Accepted: 11/22/2016] [Indexed: 11/19/2022] Open
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Shamliyan TA, Middleton M, Borst C. Patient-centered Outcomes with Concomitant Use of Proton Pump Inhibitors and Other Drugs. Clin Ther 2017; 39:404-427.e36. [PMID: 28189362 DOI: 10.1016/j.clinthera.2017.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/19/2016] [Accepted: 01/06/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE We performed a systematic review of patient-centered outcomes after the concomitant use of proton pump inhibitors (PPIs) and other drugs. METHODS We searched 4 databases in July 2016 to find studies that reported mortality and morbidity after the concomitant use of PPIs and other drugs. We conducted direct meta-analyses using a random-effects model and graded the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation working group approach. FINDINGS We included data from 17 systematic reviews and meta-analyses, 16 randomized controlled trials, and 16 observational studies that examined the concomitant use of PPIs with medications from 10 drug classes. Low-quality evidence suggests that the use of PPIs is associated with greater morbidity when administered with antiplatelet drugs, bisphosphonates, antibiotics, anticoagulants, metformin, mycophenolate mofetil, or nelfinavir. Concomitant PPIs reduce drug-induced gastrointestinal bleeding and are associated with greater docetaxel and cisplatin response rates in patients with metastatic breast cancer. For demonstrated statistically significant relative risks and benefits from concomitant PPIs, the magnitudes of the effects are small, with <100 attributable events per 1000 patients treated, and the effects are inconsistent among specific drugs. Among individual PPIs, the concomitant use of pantoprazole or esomeprazole, but not omeprazole or lansoprazole, is associated with an increased risk for all-cause mortality, nonfatal myocardial infarction, or stroke. Clopidogrel is associated with a greater risk for myocardial infarction compared with prasugrel. Conflicting results between randomized controlled trials and observational studies and high risk for bias in the body of evidence lessened our confidence in the results. IMPLICATIONS Available evidence suggests a greater risk for adverse patient outcomes after the concomitant use of PPIs and medications from 9 drug classes and warns against inappropriate drug combinations.
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Affiliation(s)
- Tatyana A Shamliyan
- Evidence-Based Medicine Center, Quality Assurance, Elsevier, Philadelphia, Pennsylvania.
| | - Maria Middleton
- Evidence-Based Medicine Center, Elsevier, Philadelphia, Pennsylvania
| | - Clarissa Borst
- Clinical Drug Information, Elsevier, Philadelphia, Pennsylvania
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Shamliyan TA, Khalil DH, Middleton M. Interventions for Community-dwelling Patients with Multiple Chronic Illnesses. Am J Med 2017; 130:148-152. [PMID: 27838377 DOI: 10.1016/j.amjmed.2016.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Tatyana A Shamliyan
- Senior Director, Evidence-Based Medicine Quality Assurance, Elsevier, 1600 JFK Blvd 20(th) floor, Philadelphia, PA 19103.
| | - Dr Hanan Khalil
- Senior Lecturer/Pharmacist Academic, Faculty of Medicine, Nursing and Health Sciences, Monash Rural Heath, Monash University; Editor-in-Chief- International Journal of Evidence-Based Healthcare
| | - Maria Middleton
- Project Coordinator, Evidence-Based Medicine Center, Elsevier, 1600 JFK Blvd 20(th) floor, Philadelphia, PA 19103
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Abstract
The authors conducted a systematic literature review of preventive pharmacological treatments for episodic childhood migraines searching several databases through May 20, 2012. Episodic migraine prevention was examined in 24 publications of randomized controlled trials that enrolled 1578 children in 16 nonrandomized studies. Single randomized controlled trials provided low-strength evidence that propranolol would result in complete cessation of migraine attacks in 713 per 1000 children treated (95% confidence interval, 452-974); trazodone and nimodipine decreased migraine days, while topiramate, divalproex, and clonidine were no more effective than placebo in preventing migraines. Migraine prevention with multidisciplinary drug management was not sustained at 6 months. Divalproex resulted in treatment discontinuation due to adverse effects, and topiramate increased the risk of paresthesia, upper respiratory tract infection, and weight loss. Long-term preventive benefits and improvement in disability and quality of life are unknown. No studies examined quality of life or provided evidence for individualized treatment decisions.
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Affiliation(s)
- Tatyana A Shamliyan
- 1Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Shamliyan TA, Kane RL. Availability of results from clinical research: failing policy efforts. J Epidemiol Glob Health 2013; 4:1-12. [PMID: 24534330 PMCID: PMC7320403 DOI: 10.1016/j.jegh.2013.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 03/23/2013] [Revised: 08/20/2013] [Accepted: 08/24/2013] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Trial registration has a great potential to increase research transparency and public access to research results. This study examined the availability of results either in journal publications or in the trial registry from all studies registered at ClinicalTrials.gov. METHODS All 137,612 records from ClinicalTrials.gov in December 2012 were merged with all 19,158 PubMed records containing registration numbers in the indexing field or in the abstracts. A multivariate analysis was conducted to examine the association between the availability of the results with study and participant characteristics available in registration records. RESULTS Fewer than 10% of the registered studies and 15% of the registered and completed studies had published results. The highest publication rate of 22.4% was for randomized trials completed between 2005 (starting year for structured indexing in PubMed of study registration) and 2010. For 86% of overall and 78% of completed registered studies, no results were available in ClinicalTrials.gov or in journal publications. Studies funded by industry vs. other funding sources and drug studies vs. all studies of other interventions were published less often after adjustment for study type, subject characteristics, or posting of results in ClinicalTrials.gov. CONCLUSION Existing policy does not ensure availability of results from clinical research. International policy revisions should charge principal investigators with ensuring that the approved protocols and posted data elements are aligned and that results are available from all conducted studies.
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Affiliation(s)
- Tatyana A Shamliyan
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, United States; Minnesota Evidence-based Practice Center, Minneapolis, MN, United States; Elsevier Clinical Solutions, Evidence-Based Medicine Center, United States.
| | - Robert L Kane
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, United States; Minnesota Evidence-based Practice Center, Minneapolis, MN, United States
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Shamliyan TA, Choi JY, Ramakrishnan R, Miller JB, Wang SY, Taylor FR, Kane RL. Preventive pharmacologic treatments for episodic migraine in adults. J Gen Intern Med 2013; 28:1225-37. [PMID: 23592242 PMCID: PMC3744311 DOI: 10.1007/s11606-013-2433-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [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: 09/12/2012] [Revised: 12/10/2012] [Accepted: 03/15/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Systematic review of preventive pharmacologic treatments for community-dwelling adults with episodic migraine. DATA SOURCES Electronic databases through May 20, 2012. ELIGIBILITY CRITERIA English-language randomized controlled trials (RCTs) of preventive drugs compared to placebo or active treatments examining rates of ≥50 % reduction in monthly migraine frequency or improvement in quality of life. STUDY APPRAISAL AND SYNTHESIS METHODS We assessed risk of bias and strength of evidence and conducted random effects meta-analyses of absolute risk differences and Bayesian network meta-analysis. RESULTS Of 5,244 retrieved references, 215 publications of RCTs provided mostly low-strength evidence because of the risk of bias and imprecision. RCTs examined 59 drugs from 14 drug classes. All approved drugs, including topiramate (9 RCTs), divalproex (3 RCTs), timolol (3 RCTs), and propranolol (4 RCTs); off-label beta blockers metoprolol (4 RCTs), atenolol (1 RCT), nadolol (1 RCT), and acebutolol (1 RCT); angiotensin-converting enzyme inhibitors captopril (1 RCT) and lisinopril (1 RCT); and angiotensin II receptor blocker candesartan (1 RCT), outperformed placebo in reducing monthly migraine frequency by ≥50 % in 200-400 patients per 1,000 treated. Adverse effects leading to treatment discontinuation (68 RCTs) were greater with topiramate, off-label antiepileptics, and antidepressants than with placebo. Limited direct evidence as well as frequentist and exploratory network Bayesian meta-analysis showed no statistically significant differences in benefits between approved drugs. Off-label angiotensin-inhibiting drugs and beta-blockers were most effective and tolerable for episodic migraine prevention. LIMITATIONS We did not quantify reporting bias or contact principal investigators regarding unpublished trials. CONCLUSIONS Approved drugs prevented episodic migraine frequency by ≥50 % with no statistically significant difference between them. Exploratory network meta-analysis suggested that off-label angiotensin-inhibiting drugs and beta-blockers had favorable benefit-to-harm ratios. Evidence is lacking for long-term effects of drug treatments (i.e., trials of more than 3 months duration), especially for quality of life.
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Wang SY, Shamliyan TA, Talley KM, Ramakrishnan R, Kane RL. Not just specific diseases: Systematic review of the association of geriatric syndromes with hospitalization or nursing home admission. Arch Gerontol Geriatr 2013; 57:16-26. [DOI: 10.1016/j.archger.2013.03.007] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 03/11/2013] [Accepted: 03/14/2013] [Indexed: 12/01/2022]
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Xu D, Kane RL, Shamliyan TA. Effect of nursing home characteristics on residents' quality of life: a systematic review. Arch Gerontol Geriatr 2013; 57:127-42. [PMID: 23623273 DOI: 10.1016/j.archger.2013.03.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 03/27/2013] [Accepted: 03/30/2013] [Indexed: 11/20/2022]
Abstract
The association between nursing home (NH) characteristics and residents' quality of life (QOL) has not been systematically reviewed. This study synthesizes published evidence about the association between NH ownership, affiliation, location, chain membership, percentage of private rooms, facility size, and staffing with residents' QOL. We searched Medline, Web of Science, CINAHL, and Scirus for primary studies published between 1960 and March 31, 2012. We critically appraised risk of bias according to study design, QOL measurements, and adjustment for residents' characteristics. We analyzed the statistical and clinical significance, direction and magnitude of the association. From 1117 citations retrieved, we found one longitudinal quasi-experimental and 10 cross-sectional eligible studies. Variability in the NH characteristics reported and QOL measurements precluded meta-analysis. Studies with low and medium risk of bias (ROB) suggested that nonprofit NHs resulted in better QOL for residents. The low ROB study indicated that in certain QOL domains, rural facilities and facilities with a higher percentage of private rooms were associated with better self-reported resident QOL. All low and medium ROB studies found that RN, LVN/LPN and total nursing staff had no significant relationship with QOL. One longitudinal quasi-experimental study indicated that the Green House with individualized care had better QOL than conventional NHs. The available evidence does not permit strong conclusions about the association between NH characteristics and residents' QOL. The evidence does, however, raise questions about whether NH structure alone can improve residents' QOL and how residents' QOL should be measured and improved.
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Affiliation(s)
- Dongjuan Xu
- University of Minnesota School of Public Health, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
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Hong H, Carlin BP, Shamliyan TA, Wyman JF, Ramakrishnan R, Sainfort F, Kane RL. Comparing Bayesian and Frequentist Approaches for Multiple Outcome Mixed Treatment Comparisons. Med Decis Making 2013; 33:702-14. [DOI: 10.1177/0272989x13481110] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objectives. Bayesian statistical methods are increasingly popular as a tool for meta-analysis of clinical trial data involving both direct and indirect treatment comparisons. However, appropriate selection of prior distributions for unknown model parameters and checking of consistency assumptions required for modeling remain particularly challenging. We compared Bayesian and traditional frequentist statistical methods for mixed treatment comparisons with multiple binary outcomes. Data. We searched major electronic bibliographic databases, Food and Drug Administration reviews, trial registries, and research grant databases up to December 2011 to find randomized studies published in English that examined drugs for female urgency urinary incontinence (UI) on continence, improvement in UI, and treatment discontinuation due to harm. Methods. We describe and fit fixed and random effects models in both Bayesian and frequentist statistical frameworks. In a hierarchical model of 8 treatments, we separately analyze 1 safety and 2 efficacy outcomes. We produce Bayesian and frequentist treatment ranks and odds ratios across all drug v placebo comparisons, as well as Bayesian probabilities that each drug is best overall through a weighted scoring rule that trades off efficacy and safety. Results. In our study, Bayesian and frequentist random effects models generally suggest the same drugs as most attractive, although neither suggests any significant differences between drugs. However, the Bayesian methods more consistently identify one drug (propiverine) as best overall, produce interval estimates that are generally better at capturing all sources of uncertainty in the data, and also permit attractive “rankograms” that visually capture the probability that each drug assumes each possible rank. Conclusions. Bayesian methods are more flexible and their results more clinically interpretable, but they require more careful development and specialized software.
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Affiliation(s)
- Hwanhee Hong
- Division of Biostatistics (HH, BPC), University of Minnesota, Minneapolis
- Division of Health Policy and Management (TS, JFW, RR, FS, RLK), University of Minnesota, Minneapolis
| | - Bradley P. Carlin
- Division of Biostatistics (HH, BPC), University of Minnesota, Minneapolis
- Division of Health Policy and Management (TS, JFW, RR, FS, RLK), University of Minnesota, Minneapolis
| | - Tatyana A. Shamliyan
- Division of Biostatistics (HH, BPC), University of Minnesota, Minneapolis
- Division of Health Policy and Management (TS, JFW, RR, FS, RLK), University of Minnesota, Minneapolis
| | - Jean F. Wyman
- Division of Biostatistics (HH, BPC), University of Minnesota, Minneapolis
- Division of Health Policy and Management (TS, JFW, RR, FS, RLK), University of Minnesota, Minneapolis
| | - Rema Ramakrishnan
- Division of Biostatistics (HH, BPC), University of Minnesota, Minneapolis
- Division of Health Policy and Management (TS, JFW, RR, FS, RLK), University of Minnesota, Minneapolis
| | - François Sainfort
- Division of Biostatistics (HH, BPC), University of Minnesota, Minneapolis
- Division of Health Policy and Management (TS, JFW, RR, FS, RLK), University of Minnesota, Minneapolis
| | - Robert L. Kane
- Division of Biostatistics (HH, BPC), University of Minnesota, Minneapolis
- Division of Health Policy and Management (TS, JFW, RR, FS, RLK), University of Minnesota, Minneapolis
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Wang SY, Olson-Kellogg B, Shamliyan TA, Choi JY, Ramakrishnan R, Kane RL. Physical therapy interventions for knee pain secondary to osteoarthritis: a systematic review. Ann Intern Med 2012; 157:632-44. [PMID: 23128863 DOI: 10.7326/0003-4819-157-9-201211060-00007] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Osteoarthritis is a leading cause of disability. Nonsurgical treatment is a key first step. PURPOSE Systematic literature review of physical therapy (PT) interventions for community-dwelling adults with knee osteoarthritis. DATA SOURCES MEDLINE, the Cochrane Library, the Physiotherapy Evidence Database, Scirus, Allied and Complementary Medicine, and the Health and Psychosocial Instruments bibliography database. STUDY SELECTION 193 randomized, controlled trials (RCTs) published in English from 1970 to 29 February 2012. DATA EXTRACTION Means of outcomes, PT interventions, and risk of bias were extracted to pool standardized mean differences. Disagreements between reviewers abstracting and checking data were resolved through discussion. DATA SYNTHESIS Meta-analyses of 84 RCTs provided evidence for 13 PT interventions on pain (58 RCTs), physical function (36 RCTs), and disability (29 RCTs). Meta-analyses provided low-strength evidence that aerobic (11 RCTs) and aquatic (3 RCTs) exercise improved disability and that aerobic exercise (19 RCTs), strengthening exercise (17 RCTs), and ultrasonography (6 RCTs) reduced pain and improved function. Several individual RCTs demonstrated clinically important improvements in pain and disability with aerobic exercise. Other PT interventions demonstrated no sustained benefit. Individual RCTs showed similar benefits with aerobic, aquatic, and strengthening exercise. Adverse events were uncommon and did not deter participants from continuing treatment. LIMITATION Variability in PT interventions and outcomes measures hampered synthesis of evidence. CONCLUSION Low-strength evidence suggested that only a few PT interventions were effective. Future studies should compare combined PT interventions (which is how PT is generally administered for pain associated with knee osteoarthritis). PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Affiliation(s)
- Shi-Yi Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, Room 432, New Haven, CT 06520, USA
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Shamliyan TA, Kane RL, Wyman J, Sainfort F. Results availability from clinical research of female urinary incontinence. Neurourol Urodyn 2011; 31:22-9. [PMID: 22038753 DOI: 10.1002/nau.21220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 08/24/2011] [Indexed: 11/06/2022]
Abstract
AIMS To ascertain possible publication bias by examining the completeness and publication of studies on nonsurgical treatments for female urinary incontinence (UI). METHODS We analyzed information about studies from several trial registries through May 2010. We searched Medline using study registration identifiers to determine publication status, and compared percentages of completed and published studies by study and subject characteristics. RESULTS Among the 166 closed studies, we found 120 completed (73%), 12 terminated (7%), 3 withdrawn (2%), and 4 (2%) that provided no reasons for noncompletion. Only 17% of closed registered studies (28/166 studies) were published in peer-reviewed journals; publication that did occur was an average of 2.2 years after study completion. The proportion of studies published did not increase over time. Studies sponsored by industry were published less often than those funded by NIH (OR = 0.04; 95%CI: 0.004-0.38). Drug studies were published less often than studies of other interventions (OR = 0.22; 95%CI: 0.05-0.96). Of the 166 closed studies, 7 (4%) posted results on the ClinicalTrials.gov website. Of Phases III and IV trials, 7% and 3% posted results, respectively. CONCLUSIONS The absence of results from a substantial proportion of conducted studies suggests that treatment decisions for women with UI are based on selected rather than comprehensive evidence of benefits and harms. Regulatory policy for clinical research should guarantee availability of the outcomes for the public, clinicians, and policymakers.
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Affiliation(s)
- Tatyana A Shamliyan
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota 55455, USA.
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Shamliyan TA, Kane RL, Ansari MT, Raman G, Berkman ND, Grant M, Janes G, Maglione M, Moher D, Nasser M, Robinson KA, Segal JB, Tsouros S. Development quality criteria to evaluate nontherapeutic studies of incidence, prevalence, or risk factors of chronic diseases: pilot study of new checklists. J Clin Epidemiol 2010. [PMID: 21071174 DOI: 10.1016/j.jclinepi.2010.08.006.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVE To develop two checklists for the quality of observational studies of incidence or risk factors of diseases. STUDY DESIGN AND SETTING Initial development of the checklists was based on a systematic literature review. The checklists were refined after pilot trials of validity and reliability were conducted by seven experts, who tested the checklists on 10 articles. RESULTS The checklist for studies of incidence or prevalence of chronic disease had six criteria for external validity and five for internal validity. The checklist for risk factor studies had six criteria for external validity, 13 criteria for internal validity, and two aspects of causality. A Microsoft Access database produced automated standardized reports about external and internal validities. Pilot testing demonstrated face and content validities and discrimination of reporting vs. methodological qualities. Interrater agreement was poor. The experts suggested future reliability testing of the checklists in systematic reviews with preplanned protocols, a priori consensus about research-specific quality criteria, and training of the reviewers. CONCLUSION We propose transparent and standardized quality assessment criteria of observational studies using the developed checklists. Future testing of the checklists in systematic reviews is necessary to develop reliable tools that can be used with confidence.
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Affiliation(s)
- Tatyana A Shamliyan
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Shamliyan TA, Kane RL, Ansari MT, Raman G, Berkman ND, Grant M, Janes G, Maglione M, Moher D, Nasser M, Robinson KA, Segal JB, Tsouros S. Development quality criteria to evaluate nontherapeutic studies of incidence, prevalence, or risk factors of chronic diseases: pilot study of new checklists. J Clin Epidemiol 2010; 64:637-57. [PMID: 21071174 DOI: 10.1016/j.jclinepi.2010.08.006] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 08/01/2010] [Accepted: 08/22/2010] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To develop two checklists for the quality of observational studies of incidence or risk factors of diseases. STUDY DESIGN AND SETTING Initial development of the checklists was based on a systematic literature review. The checklists were refined after pilot trials of validity and reliability were conducted by seven experts, who tested the checklists on 10 articles. RESULTS The checklist for studies of incidence or prevalence of chronic disease had six criteria for external validity and five for internal validity. The checklist for risk factor studies had six criteria for external validity, 13 criteria for internal validity, and two aspects of causality. A Microsoft Access database produced automated standardized reports about external and internal validities. Pilot testing demonstrated face and content validities and discrimination of reporting vs. methodological qualities. Interrater agreement was poor. The experts suggested future reliability testing of the checklists in systematic reviews with preplanned protocols, a priori consensus about research-specific quality criteria, and training of the reviewers. CONCLUSION We propose transparent and standardized quality assessment criteria of observational studies using the developed checklists. Future testing of the checklists in systematic reviews is necessary to develop reliable tools that can be used with confidence.
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Affiliation(s)
- Tatyana A Shamliyan
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Abstract
BACKGROUND Lactose intolerance resulting in gastrointestinal symptoms is a common health concern. Diagnosis and management of this condition remain unclear. PURPOSE To assess the maximum tolerable dose of lactose and interventions for reducing symptoms of lactose intolerance among persons with lactose intolerance and malabsorption. DATA SOURCES Multiple electronic databases, including MEDLINE and the Cochrane Library, for trials published in English from 1967 through November 2009. STUDY SELECTION Randomized, controlled trials of individuals with lactose intolerance or malabsorption. DATA EXTRACTION Three investigators independently reviewed articles, extracted data, and assessed study quality. DATA SYNTHESIS 36 unique randomized studies (26 on lactase- or lactose-hydrolyzed milk supplements, lactose-reduced milk, or tolerable doses of lactose; 7 on probiotics; 2 on incremental lactose administration for colonic adaptation; and 1 on another agent) met inclusion criteria. Moderate-quality evidence indicated that 12 to 15 g of lactose (approximately 1 cup of milk) is well tolerated by most adults. Evidence was insufficient that lactose-reduced solution or milk with a lactose content of 0 to 2 g, compared with greater than 12 g, is effective in reducing symptoms of lactose intolerance. Evidence for probiotics, colonic adaptation, and other agents was also insufficient. LIMITATIONS Most studies evaluated persons with lactose malabsorption rather than lactose intolerance. Variation in enrollment criteria, outcome reporting, and the composition and dosing of studied agents precluded pooling of results and limited interpretation. CONCLUSION Most individuals with presumed lactose intolerance or malabsorption can tolerate 12 to 15 g of lactose. Additional studies are needed to determine the effectiveness of lactose intolerance treatment.
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Affiliation(s)
- Aasma Shaukat
- University of Minnesota and Minneapolis Veterans Affairs Medical Center, One Veterans Drive, Minneapolis, MN 55471, USA
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Shamliyan TA, Kane RL, Mueller C, Duval S, Wilt TJ. Cost savings associated with increased RN staffing in acute care hospitals: simulation exercise. Nurs Econ 2009; 27:302-331. [PMID: 19927445] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Increasing nurse-to-patient staffing has been recommended as a means to improve patient safety. In this study, researchers analyzed the savings-cost ratio of increased RN-to-patient ratios for patients in ICUs and patients in surgical and medical units based on a meta-analysis of published observational studies. Increased RN staffing was associated with lower hospital-related mortality and adverse patient events and generates societal net savings from avoided patient adverse events. This finding appears to hold in ICUs and, to some extent, in surgical units, but not in medical units. Hospitals do not experience sufficient monetary benefit from reduced length of stay corresponding to an increased RN staffing. Policy decisions about RN staffing should include cost-utility analyses.
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Affiliation(s)
- Tatyana A Shamliyan
- Minnesota Evidence-Based Practice Center, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Carlson KF, Wilt TJ, Taylor BC, Goldish GD, Niewoehner CB, Shamliyan TA, Kane RL. Effect of exercise on disorders of carbohydrate and lipid metabolism in adults with traumatic spinal cord injury: systematic review of the evidence. J Spinal Cord Med 2009; 32:361-78. [PMID: 19777857 PMCID: PMC2830675 DOI: 10.1080/10790268.2009.11754465] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [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] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Carbohydrate and lipid metabolism disorders may affect adults with spinal cord injuries (SCIs) differently than able-bodied individuals because of reduced physical activity in the SCI population. The objective of this study was to conduct a systematic review to determine the effectiveness of exercise to improve carbohydrate and lipid metabolism disorders in adults with chronic SCI. METHODS Studies were identified in MEDLINE (1996-2008), Cochrane Library, bibliographies of identified articles, and expert recommendations. English language articles were included if they evaluated adults with chronic SCI; evaluated exercise; and reported carbohydrate-, lipid-, and/or cardiovascular disease-related outcomes. RESULTS Twenty-two studies met inclusion criteria, including 15 intervention case-series and 7 cross-sectional surveys using self-reported physical activity measures. Intervention protocols involved active (n=7) or electrically stimulated (n=7) exercise or an educational program (n ) from 8 to 52 weeks in duration. Frequency of exercise was typically 2 to 3 sessions/week, lasting 30 to 60 minutes/session. Totals of 150 and 369 subjects participated in studies with carbohydrate (n=12) or lipid and cardiovascular (n=16) outcomes, respectively; 78% were men. Level of SCI ranged from C4 to L5 and included both incomplete and complete lesions. Outcomes measures included fasting and postload blood glucose and insulin concentrations and serum cholesterol levels. Small sample sizes and variations in study design, intervention, SCI characteristics, and reported outcomes precluded quantitative pooling of results or reliable assessment of metabolic efficacy. No intervention studies assessed cardiovascular outcomes. CONCLUSIONS Evidence is insufficient to determine whether exercise improves carbohydrate and lipid metabolism disorders among adults with SCI. Expert consensus, based on the preliminary evidence, is needed to inform future studies.
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Affiliation(s)
- Kathleen F Carlson
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, Minnesota 55417, USA.
| | - Timothy J Wilt
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, Minnesota
,Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Brent C Taylor
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, Minnesota
,Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Gary D Goldish
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, Minnesota
| | | | | | - Robert L Kane
- School of Public Health, University of Minnesota, Minneapolis, Minnesota
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Taylor BC, Yuan JM, Shamliyan TA, Shaukat A, Kane RL, Wilt TJ. Clinical outcomes in adults with chronic hepatitis B in association with patient and viral characteristics: A systematic review of evidence. Hepatology 2009; 49:S85-95. [PMID: 19399797 DOI: 10.1002/hep.22929] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We systematically reviewed the literature on the extent to which population characteristics or clinical features predict groups of individuals likely to develop advanced liver disease or die from chronic infection with hepatitis B virus (HBV). We searched Medline to include studies with reported cirrhosis, liver failure, liver cancer, or death outcomes after at least 1 year of follow-up from the measurement of predictive factors (age, age at infection, geographic location, race/ethnicity, sex, positive family history, presence of coinfections, HBV viral level, change in hepatitis B e antigen [HBeAg] status, genotype, HBV mutations, nonalcoholic fatty liver disease, alcohol consumption, liver enzymes, and liver biopsy finding). Evidence from 41 included articles suggested that cirrhosis, higher HBV viral level, and male sex were consistently associated with significantly increased risk of death and liver cancer. Evidence about the role of HBV genotype, HBeAg status, age and duration of infection, coinfections with hepatitis C virus, human immunodeficiency virus, hepatitis delta virus, and alanine aminotransferase levels were limited and inconsistent, but were deemed promising to identify patients at higher risk of clinical outcomes. Adults with chronic hepatitis B had increased risk for poorer health outcomes compared to the general population; however, the magnitude of risk varied greatly depending on baseline patient and disease characteristics, and typically clinical outcomes required many years to become manifest. Many adults with chronic hepatitis B had low absolute risks of clinical outcomes and likely would not benefit from immediate treatment. Baseline patient and disease characteristics provide important information about the risk of clinical outcomes and should be incorporated into monitoring or treatment decisions.
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Affiliation(s)
- Brent C Taylor
- Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN 55417, USA.
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Shamliyan TA, MacDonald R, Shaukat A, Taylor BC, Yuan JM, Johnson JR, Tacklind J, Rutks I, Kane RL, Wilt TJ. Antiviral therapy for adults with chronic hepatitis B: a systematic review for a National Institutes of Health Consensus Development Conference. Ann Intern Med 2009; 150:111-24. [PMID: 19124812 DOI: 10.7326/0003-4819-150-2-200901200-00101] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic hepatitis B infection can lead to liver failure, hepatocellular carcinoma, and death. PURPOSE To evaluate the effectiveness of antiviral therapy for adults with chronic hepatitis B infection. DATA SOURCES Randomized, controlled trials (RCTs) of interferon (alpha2b and pegylated alpha2a), lamivudine, adefovir, entecavir, and telbivudine published from 1990 to 2008. STUDY SELECTION Randomized, controlled clinical trials of adults with chronic hepatitis B published in English after 1989 that reported death; incidence of hepatocellular carcinoma or liver failure; prevalence and incidence of cirrhosis; presence or seroconversion of hepatitis B e antigen (HBeAg) or surface antigen (HBsAg), viral load of hepatitis B virus DNA; aspartate aminotransferase and alanine aminotransferase (ALT) levels; or fibrosis scores after therapy with interferon-alpha2b, pegylated interferon-alpha2a, lamivudine, adefovir, entecavir, and telbivudine. DATA EXTRACTION Data extracted with standard protocols to calculate risk difference for clinical outcomes, viral load, HBeAg and HBsAg, ALT, histologic scores, and adverse events. DATA SYNTHESIS In 16 RCTs (4431 patients), drug treatment did not improve clinical outcomes of chronic hepatitis B infection, but the trials were underpowered. In 60 RCTs that examined intermediate outcomes, no single treatment improved all intermediate outcomes. Low-quality evidence suggested HBsAg clearance after interferon-alpha2b (2 RCTs; 211 patients). Moderate-quality evidence suggested ALT normalization at follow-up after treatment with adefovir (2 RCTs; 600 patients) and HBeAg loss with lamivudine (2 RCTs; 318 patients). With interferon-alpha2b, moderate-quality evidence suggested HBeAg loss (3 RCTs; 351 patients), seroconversion (2 RCTs; 304 patients), and ALT normalization (2 RCTs; 131 patients). Pegylated interferon-alpha2a versus lamivudine improved HBeAg seroconversion (1 RCT; 814 patients) and ALT normalization (2 RCTs; 905 patients) off treatment. Pegylated interferon-alpha2a combined with lamivudine versus lamivudine improved HBeAg loss (1 RCT; 543 patients) and ALT normalization (2 RCTs; 905 patients). Adverse events during antiretroviral therapy occurred in more than 50% of patients but were not associated with increased treatment discontinuation. However, most studies excluded patients with hepatic or renal insufficiency or other serious comorbid conditions. LIMITATION Marked heterogeneity in study samples, interventions, and measured outcomes preclude definitive conclusions. CONCLUSION Evidence was insufficient to assess treatment effect on clinical outcomes or determine whether inconsistent improvements in selected intermediate measures are reliable surrogates. Future research is needed to provide evidence-based recommendations about optimal antiviral therapy in adults with chronic hepatitis B infection.
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Affiliation(s)
- Tatyana A Shamliyan
- Minnesota Evidence-based Practice Center, Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
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Shamliyan TA, Bliss DZ, Du J, Ping R, Wilt TJ, Kane RL. Prevalence and risk factors of fecal incontinence in community-dwelling men. Rev Gastroenterol Disord 2009; 9:E97-E110. [PMID: 20065920] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Fecal incontinence (FI) in community-dwelling men affects quality of life and increases the risk of institutionalization. Observational studies and randomized, controlled trials (RCTs) on epidemiology and prevention of FI published in English from 1990 to November 2007 were identified in several databases to abstract rates and adjusted odds ratios (ORs) of incontinence and to synthesize evidence with random effects models. Twenty-one observational studies and 4 RCTs were eligible for analysis. Pooled prevalence of FI in elderly men increased with age to 5% to 6%. Men over age 85 years (OR 2.5; 95% confidence interval [CI], 1.3-5) and with kidney diseases (OR 1.9; 95% CI, 1.2-3.3) had higher odds of incident FI. Significantly impaired cognitive status and general health were associated with FI. Men had increased risk of incontinence after radical prostatectomy or radiation for prostate cancer. Lower doses of radiation caused inconsistent reduction in FI across 2 RCTs. The prevalence of incontinence increased with age and functional dependency. Cognitive impairment, poor general health, surgery, and radiation for prostate cancer were associated with incontinence in community-dwelling men. No effective interventions are known at the present time.
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Shamliyan TA, Wyman JF, Ping R, Wilt TJ, Kane RL. Male urinary incontinence: prevalence, risk factors, and preventive interventions. Rev Urol 2009; 11:145-165. [PMID: 19918340 PMCID: PMC2777062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Urinary incontinence (UI) in community-dwelling men affects quality of life and increases the risk of institutionalization. Observational studies and randomized, controlled trials published in English from 1990 to November 2007 on the epidemiology and prevention of UI were identified in several databases to abstract rates and adjusted odds ratios (OR) of incontinence, calculate absolute risk difference (ARD) after clinical interventions, and synthesize evidence with random-effects models. Of 1083 articles identified, 126 were eligible for analysis. Pooled prevalence of UI increased with age to 21% to 32% in elderly men. Poor general health, comorbidities, severe physical limitations, cognitive impairment, stroke (pooled OR 1.54; 95% confidence interval [CI], 1.14-2.1), urinary tract infections (pooled OR 3.49; 95% CI, 2.33-5.23), prostate diseases, and diabetes (pooled OR 1.36; 95% CI, 1.14-1.61) were associated with UI. Treatment with tolterodine alone (ARD 0.17; 95% CI, 0.02-0.32) or combined with tamsulosin (ARD 0.17; 95% CI, 0.08-0.25) resulted in greater self-reported benefit compared with placebo. Radical prostatectomy or radiotherapy for prostate cancer compared with watchful waiting increased UI. Short-term prevention of UI with pelvic floor muscle rehabilitation after prostatectomy was not consistently seen across randomized, controlled trials. The prevalence of incontinence increased with age and functional dependency. Stroke, diabetes, poor general health, radiation, and surgery for prostate cancer were associated with UI in community-dwelling men. Men reported overall benefit from drug treatments. Limited evidence of preventive effects of pelvic floor rehabilitation requires future investigation.
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Wilt TJ, Shamliyan TA, Taylor BC, MacDonald R, Kane RL. Association between hospital and surgeon radical prostatectomy volume and patient outcomes: a systematic review. J Urol 2008; 180:820-8; discussion 828-9. [PMID: 18635233 DOI: 10.1016/j.juro.2008.05.010] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Indexed: 11/28/2022]
Abstract
PURPOSE We examined the association between hospital and surgeon volume, and patient outcomes after radical prostatectomy. MATERIALS AND METHODS Databases were searched from 1980 to November 2007 to identify controlled studies published in English. Information on study design, hospital and surgeon annual radical prostatectomy volume, hospital status and patient outcome rates were abstracted using a standardized protocol. Data were pooled with random effects models. RESULTS A total of 17 original investigations reported patient outcomes in categories of hospital and/or surgeon annual number of radical prostatectomies, and met inclusion criteria. Hospitals with volumes above the mean (43 radical prostatectomies per year) had lower surgery related mortality (rate of difference 0.62, 95% CI 0.47-0.81) and morbidity (rate difference -9.7%, 95% CI -15.8, -3.6). Teaching hospitals had an 18% (95% CI -26, -9) lower rate of surgery related complications. Surgeon volume was not significantly associated with surgery related mortality or positive surgical margins. However, the rate of late urinary complications was 2.4% lower (95% CI -5, -0.1) and the rate of long-term incontinence was 1.2% lower (95% CI -2.5, -0.1) for each 10 additional radical prostatectomies performed by the surgeon annually. Length of stay was lower, corresponding to surgeon volume. CONCLUSIONS Higher provider volumes are associated with better outcomes after radical prostatectomy. Greater understanding of factors leading to this volume-outcome relationship, and the potential benefits and harms of increased regionalization is needed.
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Affiliation(s)
- Timothy J Wilt
- Minnesota Evidence-based Practice Center, Minneapolis, Minnesota, USA.
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Wilt TJ, MacDonald R, Rutks I, Shamliyan TA, Taylor BC, Kane RL. Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med 2008; 148:435-48. [PMID: 18252677 DOI: 10.7326/0003-4819-148-6-200803180-00209] [Citation(s) in RCA: 400] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The comparative effectiveness of localized prostate cancer treatments is largely unknown. PURPOSE To compare the effectiveness and harms of treatments for localized prostate cancer. DATA SOURCES MEDLINE (through September 2007), the Cochrane Library (through Issue 3, 2007), and the Cochrane Review Group in Prostate Diseases and Urologic Malignancies registry (through November 2007). STUDY SELECTION Randomized, controlled trials (RCTs) published in any language and observational studies published in English that evaluated treatments and reported clinical or biochemical outcomes in localized prostate cancer. DATA EXTRACTION 2 researchers extracted information on study design, sample characteristics, interventions, and outcomes. DATA SYNTHESIS 18 RCTs and 473 observational studies met inclusion criteria. One [one randomized controlled trial] [corrected] RCT enrolled mostly men without prostate-specific antigen (PSA)-detected disease and reported that, compared with watchful waiting, radical prostatectomy reduced crude [corrected] all-cause mortality (24% vs. 30%; P = 0.04) and prostate cancer-specific mortality (10% [corrected] vs. 15% [corrected]; P = 0.01) at 10 years [corrected] Effectiveness was limited to men younger than age 65 years but was not associated with Gleason score or baseline PSA level. An older, smaller trial found no significant overall survival differences between radical prostatectomy and watchful waiting (risk difference, 0% [95% CI, -19% to 18%]). Radical prostatectomy reduced disease recurrence at 5 years compared with external-beam radiation therapy in 1 small, older trial (14% vs. 39%; risk difference, 21%; P = 0.04). No external-beam radiation regimen was superior to another in reducing mortality. No randomized trials evaluated primary androgen deprivation. Androgen deprivation used adjuvant to radical prostatectomy did not improve biochemical progression compared with radical prostatectomy alone (risk difference, 0% [CI, -7% to 7%]). No randomized trial evaluated brachytherapy, cryotherapy, robotic radical prostatectomy, or photon-beam or intensity-modulated radiation therapy. Observational studies showed wide and overlapping effectiveness estimates within and between treatments. Adverse event definitions and severity varied widely. The Prostate Cancer Outcomes Study reported that urinary leakage (> or =1 event/d) was more common with radical prostatectomy (35%) than with radiation therapy (12%) or androgen deprivation (11%). Bowel urgency occurred more often with radiation (3%) or androgen deprivation (3%) than with radical prostatectomy (1%). Erectile dysfunction occurred frequently after all treatments (radical prostatectomy, 58%; radiation therapy, 43%; androgen deprivation, 86%). A higher risk score incorporating histologic grade, PSA level, and tumor stage was associated with increased risk for disease progression or recurrence regardless of treatment. LIMITATIONS Only 3 randomized trials compared effectiveness between primary treatments. No trial enrolled patients with prostate cancer primarily detected with PSA testing. CONCLUSION Assessment of the comparative effectiveness and harms of localized prostate cancer treatments is difficult because of limitations in the evidence.
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Affiliation(s)
- Timothy J Wilt
- University of Minnesota School of Medicine, Minneapolis Veterans Affairs Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota 55417, USA.
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Abstract
BACKGROUND Urinary incontinence in women is a common problem that adversely affects quality of life. PURPOSE To synthesize evidence of management of urinary incontinence in women. DATA SOURCES MEDLINE, CINAHL, and the Cochrane Library. STUDY SELECTION 96 randomized, controlled trials (RCTs) and 3 systematic reviews published in English from 1990 through May 2007. DATA EXTRACTION Using standardized protocols, reviewers abstracted cases of continence, improvement of urinary incontinence, and prevalence of urinary incontinence to calculate risk difference. DATA SYNTHESIS Compared with regular care, pelvic floor muscle training plus bladder training resolved urinary incontinence (pooled risk difference, 0.13 [95% CI, 0.07 to 0.20]). Pelvic floor muscle training alone resolved or improved urinary incontinence compared with regular care, although the effect size was inconsistent across studies. Different injectable bulking agents and medical devices were associated with similar continence and improvement rates. Electrical stimulation failed to resolve urinary incontinence. Oral hormone administration increased rates of urinary incontinence compared with placebo in most RCTs (1243 women). Transdermal or vaginal estrogen resulted in inconsistent improvement of urinary incontinence. Adrenergic drugs did not resolve or improve urinary incontinence. Oxybutynin or tolterodine resolved urinary incontinence compared with placebo (pooled risk difference, 0.18 [CI, 0.13 to 0.22]). Duloxetine compared with placebo improved (pooled risk difference, 0.11 [CI, 0.07 to 0.14]) but did not resolve urinary incontinence, with no significant dose-response association. LIMITATIONS Inconsistent measurements of outcomes limited the findings. Predictors of better effect have not been identified in RCTs. CONCLUSION Moderate levels of evidence suggest that pelvic floor muscle training and bladder training resolved urinary incontinence in women. Anticholinergic drugs resolved urinary incontinence, with similar effects from oxybutynin or tolterodine. Duloxetine improved but did not resolve urinary incontinence. The effects of electrostimulation, medical devices, injectable bulking agents, and local estrogen therapy were inconsistent.
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Affiliation(s)
- Tatyana A Shamliyan
- Division of Health Policy and Management, University of Minnesota School of Public Health, D351 Mayo (MMC 197), 420 Delaware Street SE, Minneapolis, MN 55455, USA
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Shamliyan TA, Duval S, Du J, Kane RL. Just what the doctor ordered. Review of the evidence of the impact of computerized physician order entry system on medication errors. Health Serv Res 2008; 43:32-53. [PMID: 18211517 PMCID: PMC2323150 DOI: 10.1111/j.1475-6773.2007.00751.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the association between computerization of physician orders and prescribing medication errors. Data Sources. Studies published in English language were identified through MEDLINE (1990 through December 2005), Cochrane Central Register of Controlled Trials, and bibliographies of retrieved articles. Of 252 identified in the search, 12 (4.8 percent) original investigations that compared rates of prescribing medication errors with handwritten and computerized physician orders were included. DATA COLLECTION Information on study design, participant characteristics, clinical settings, and outcomes rates were abstracted independently by two investigators using a standardized protocol. PRINCIPAL FINDINGS Compared with handwritten orders, 80 percent of studies (8/10 studies) reported a significant reduction in total prescribing errors, 43 percent in dosing errors (3/7 studies), and 37.5 percent in adverse drug events (3/8 studies). The use of computerized orders was associated with a 66 percent reduction in total prescribing errors in adults (odds ratio [OR]=0.34; 95 percent confidence interval [CI] 0.22-0.52) and a positive tendency in children (p for interaction=.028). The benefit of computerized orders was larger when the rate of errors was more than 12 percent with handwritten orders (p for interaction=.022). Significant heterogeneity in the results compromised pooled relative risks. One randomized controlled intervention demonstrated the greatest benefits of computerized orders on total prescribing errors (OR=0.02, 95 percent CI 0.01-0.02) and dosing errors (OR=0.28; 95 percent CI 0.15-0.52) with 775 avoided prescribing errors (95 percent CI 752-811) per 1,000 orders in a pediatric hospital. CONCLUSIONS Computerization of physicians' orders shows great promise. It will be more effective when linked to other computerized systems to detect and prevent prescribing errors.
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Affiliation(s)
- Tatyana A Shamliyan
- Division of Health Policy and Management, University of Minnesota School of Public Health, MMC 729, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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Shamliyan TA, Jacobs DR, Raatz SK, Nordstrom DL, Keenan JM. Are your patients with risk of CVD getting the viscous soluble fiber they need? J Fam Pract 2006; 55:761-9. [PMID: 16948958] [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] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
A diet that includes 5 to 10 g/d of viscous soluble fiber reduces cardiovascular disease (CVD) events and death independent of baseline risk. Consuming foods rich in viscous soluble fiber reduces low-density lipoprotein cholesterol (LDL-C) blood levels 10% to 15% with expected reduction in CVD events by 10% to 15%. Routinely counsel adults at risk of CVD to promote a healthy diet: assess dietary fiber consumption; recommend specific foods rich in viscous soluble fiber; monitor LDL-C levels and encourage increased dietary fiber intake at follow-up visits; motivate patients to comply with recommendations.
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Affiliation(s)
- Tatyana A Shamliyan
- Department of Family Medicine and Community Health, School of Medicine, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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