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Soleimani H, Saeedian B, Pasebani Y, Babajani N, Pashapour Yeganeh A, Bahirai P, Navid H, Amin A, Samsky MD, Nanna MG, Hosseini K. Safety of sodium-glucose cotransporter 2 inhibitors drugs among heart failure patients: a systematic review and meta-analysis. ESC Heart Fail 2024; 11:637-648. [PMID: 38124239 DOI: 10.1002/ehf2.14633] [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] [Received: 10/10/2023] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 12/23/2023] Open
Abstract
Sodium-glucose cotransporter-2 inhibitors (SGLT2is) reduce morbidity and mortality for heart failure (HF) patients and are recommended as cornerstones for their medical therapy. Utilization in clinical practice remains low for multiple reasons, one of which may be adverse events. We investigated the incidence of these events to see if they are associated with SGLT2i use. A systematic search was performed in databases, including PubMed, Embase, Cochrane Library, Clinicaltrials.gov, and WHO's International Clinical Trials Registry Platform. Relevant randomized controlled trial studies assessing the safety outcomes of SGLT2i in HF patients were included in this study. We conducted the common-effect meta-analysis to estimate the relative risk (RR) and 95% confidence interval (CI) of safety outcomes in SGLT2i compared with placebo. Eighteen studies were included in the meta-analysis composed of 12 925 HF patients taking an SGLT2i and 12 747 taking a placebo. The meta-analysis indicated that the all-cause mortality and serious adverse events (SAEs) were lower in the SGLT2i group (RR, 0.91; 95% CI, 0.85-0.97; P = 0.005, I2 = 0%; and RR, 0.92; 95% CI, 0.90-0.95; P < 0.001, I2 = 43%, respectively). Volume depletion and genitourinary infections were more prevalent in the SGLT2i group (RR, 1.17; 95% CI, 1.06-1.28; P = 0.001, I2 = 0%; and RR, 1.27; 95% CI, 1.13-1.43; P < 0.001, I2 = 17%, respectively). Our meta-analysis demonstrated that using SGLT2is in HF patients was correlated with reduced mortality and SAEs, with a more prominent effect in HF with reduced ejection fraction patients and those taking dapagliflozin.
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Affiliation(s)
- Hamidreza Soleimani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Behrad Saeedian
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Yeganeh Pasebani
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nastaran Babajani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Pegah Bahirai
- Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Hossein Navid
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Amin
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Marc D Samsky
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Micheal G Nanna
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Kaveh Hosseini
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Segreti L, Bongiorni MG, Barletta V, Parollo M, Di Cori A, Fiorentini F, Giannotti Santoro M, De Lucia R, Viani S, Grifoni G, Paperini L, Sodati E, Mazzocchetti L, Canu AM, Zucchelli G. Transvenous lead extraction: Efficacy and safety of the procedure in female patients. Heart Rhythm O2 2023; 4:625-631. [PMID: 37936665 PMCID: PMC10626182 DOI: 10.1016/j.hroo.2023.09.002] [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] [Indexed: 11/09/2023] Open
Abstract
Background Existing data on the impact of sex differences on transvenous lead extraction (TLE) outcomes in cardiac device patients are limited. Objective The purpose of this study was to evaluate the safety and efficacy of mechanical TLE in female patients. Methods A retrospective evaluation was performed on 3051 TLE patients (group 1: female; group 2: male) from a single tertiary referral center. All individuals received treatment using single sheath mechanical dilation and various venous approaches as required. Results Our analysis included 3051 patients (group 1: 750; group 2: 2301), with a total of 5515 leads handled with removal. Female patients were younger, had a higher left ventricular ejection fraction, and lower prevalences of coronary artery disease and diabetes mellitus. Infection was more common in male patients, whereas lead malfunction or abandonment were more frequent in female patients. Radiologic success was lower in female patients (95.8% vs 97.5%; P = .003), but there was no significant difference in clinical success between groups (97.2% vs 97.5%; P = .872). However, major complications (1.33% vs 0.60%; P <.001) and procedural mortality (0.4% vs 0.1%; P <.001) were higher in females compared to male patients. After multivariate analysis, female sex emerged as the only predictor of major complications, including deaths (odds ratio 3.96; 95% confidence interval 1.39-11.24). Conclusion TLE using unpowered simple mechanical sheaths in female patients is safe and effective, but is associated with lower radiologic success and higher complication rates and mortality than in males. This finding underscores the importance of recognizing sex differences in TLE outcomes.
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Affiliation(s)
- Luca Segreti
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Valentina Barletta
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Matteo Parollo
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Andrea Di Cori
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Federico Fiorentini
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Mario Giannotti Santoro
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Raffaele De Lucia
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Stefano Viani
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Gino Grifoni
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Luca Paperini
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Ezio Sodati
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Lorenzo Mazzocchetti
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Antonio Maria Canu
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
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Kany S, Skibowski J, Müller CH, Geist V, Schmitt J, Niroomand F, Hailer B, Pleger S, Akin I, Hochadel M, Senges J, Lubos E. Association of atrial myopathy in mitral valve disease on safety outcomes in left atrial appendage closure. Clin Res Cardiol 2023; 112:824-833. [PMID: 36739561 PMCID: PMC10241670 DOI: 10.1007/s00392-022-02151-7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 12/23/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients undergoing left atrial appendage (LAA) occlusion (LAAO) are multi-morbid, including mitral valve disease (MVD) which is associated with anatomic changes of the left atrium (LA). This study aims to identify how atrial myopathy in MVD influences outcomes in LAAO. METHODS Atrial myopathy in MVD was defined as LA diameter > 45 mm (♀) and > 48 mm (♂) and existing MVD or history of surgical/interventional treatment. Patients were compared with controls from the prospective, multicentre LAArge registry of LAAO. RESULTS A total of 528 patients (52 MVD, 476 no-MVD) were included. The MVD group was significantly more likely to be older (78.2 years vs 75.9 years, p = 0.036) and female (59.6% vs 37.8%, p = 0.002). Altered LA anatomy was observed in MVD with significantly larger LA diameter (53 mm vs. 48 mm, p < 0.001) and LAA Ostia [at 135° 23.0 mm (20.5, 26.0) vs 20.0 mm (18.0, 23.0), p = 0.002]. Implant success was high with 96.2% and 97.9%, respectively, without differences in severe complications (7.7% vs 4.6%, p = 0.31). One-year mortality (17.8% vs 11.5%, p = 0.19) and a combined outcome of death, stroke, and systemic embolism (20.3% vs 12.4%, p = 0.13) were not different. Independent predictors of the combined outcome were peripheral artery disease (HR 2.41, 95% CI 1.46-3.98, p < 0.001) and chronic kidney disease (HR 3.46, 95% CI 2.02-5.93, p < 0.001) but not MVD and atrial myopathy. CONCLUSION Patients with MVD present with altered LA anatomy with increased LA and LAA diameter. However, procedural success and safety in LAAO are not compromised. One-year mortality is numerically higher in patients with MVD but driven by comorbidities.
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Affiliation(s)
- Shinwan Kany
- Division of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
| | - Johanna Skibowski
- Division of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | | | - Volker Geist
- Division of Cardiology, Segeberger Kliniken, Bad Segeberg, Germany
| | - Jörn Schmitt
- Division of Cardiology, University Hospital Giessen, Giessen, Germany
| | - Feraydoon Niroomand
- Division of Cardiology, St. Josefskrankenhaus Heidelberg, Heidelberg, Germany
| | - Birgit Hailer
- Division of Cardiology and Angiology, Phillipusstift Essen, Essen, Germany
| | - Sven Pleger
- Division of Cardiology, University Hospital Heilberg, Heidelberg, Germany
| | - Ibrahim Akin
- Division of Cardiology, University Hospital Mannheim, Mannheim, Germany
| | | | - Jochen Senges
- Stiftung Für Herzinfarktforschung, Ludwigshafen, Germany
| | - Edith Lubos
- Division of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
- Division of Cardiology, Marienkrankenhaus Hamburg, Hamburg, Germany
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Vishwanath V, Akseer S, Frankfurter C, Reza S, Farrell A, Horlick E, Abrahamyan L. Comparative effectiveness of devices for transcatheter closure of atrial septal defects: Systematic review and network meta-analysis. Arch Cardiovasc Dis 2022; 115:664-674. [PMID: 36336619 DOI: 10.1016/j.acvd.2022.09.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022]
Abstract
Atrial septal defect is a common congenital heart disease, producing a left-to-right shunt in the atrial septum; the current preferred treatment is transcatheter device closure. The aim is to conduct a systematic review to synthesize information on the comparative effectiveness and safety of atrial septal defect closure devices. The methods used: a comprehensive search of Ovid MEDLINE®, Embase, and Cochrane Central databases was conducted. Studies comparing procedural and follow-up outcomes of atrial septal defect devices were included. Network meta-analyses were conducted to generate direct and indirect evidence for comparative effectiveness and safety outcomes between devices. The results are as follows: Twelve studies met our inclusion criteria and were compared in network meta-analyses. The meta-analyses evaluated contemporary devices: the AMPLATZER Septal Occluder; the GORE CARDIOFORM Septal Occluder; the Figulla Flexible II Occluder; the CeraFlex Septal Occluder; and the HELEX Septal Occluder. These studies represented 3998 patients. The primary safety and efficacy outcomes were device embolization and follow-up residual shunt, respectively. Secondary clinical outcomes included procedural success and major and minor complications. No differences were found between devices in terms of device embolization and secondary clinical outcomes. Follow-up residual shunt was higher with the HELEX Septal Occluder compared with the AMPLATZER Septal Occluder (odds ratio 2.92, 95% confidence interval 1.12-7.61). To conclude: although most outcomes were similar between devices, evidence was largely based on observational low-quality studies. There were inconsistencies in outcome reporting and definitions; this merits future studies, with head-to-head device comparisons and standardization of outcomes.
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Affiliation(s)
- Varnita Vishwanath
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, ON M5G 2N2 Toronto, Canada
| | - Selai Akseer
- Toronto General Hospital Research Institute, University Health Network, 10th Floor Eaton North, Room 237, 200, Elizabeth Street, ON M5G 2C4 Toronto, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto ON M5T 3M6, Canada
| | - Claudia Frankfurter
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, ON M5G 2N2 Toronto, Canada
| | - Seleman Reza
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto ON M5T 3M6, Canada
| | - Ashley Farrell
- Library & Information Services, University Health Network, Toronto ON M5G 2C4, Canada
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, ON M5G 2N2 Toronto, Canada
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network, 10th Floor Eaton North, Room 237, 200, Elizabeth Street, ON M5G 2C4 Toronto, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto ON M5T 3M6, Canada.
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Younes AM, Salem M, Maraey A, Nomigolzar S, Sewell K, Khalil M, Elzanaty A, Saeyeldin A, Dar M. Safety outcomes of SGLT2i in the heart failure trials: A systematic review and Meta-analysis. Int J Cardiol 2022; 366:51-56. [PMID: 35777490 DOI: 10.1016/j.ijcard.2022.06.059] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/04/2022] [Accepted: 06/23/2022] [Indexed: 11/28/2022]
Abstract
AIMS Sodium-glucose co-transporter inhibitors (SGLT2i) are emerging as a new treatment for heart failure (HF) after demonstrating favorable clinical outcomes in several randomized controlled trials (RCTs). In this meta-analysis, we assessed the safety of SGLT2i in the trials that prespecified heart failure in their inclusion criteria. MATERIALS AND METHODS We searched the databases for RCTs comparing SGLT2i to placebo in heart failure patients. The primary outcome was the incidence of serious adverse events (SAEs). A sensitivity analysis according to the class of HF was also performed. RESULTS The incidence of SAEs was significantly lower in the SGLT2i group (OR, 0.85; 95% CI, 0.77-0.92; P, 0.0002) and SAEs remained significantly lower after performing the sensitivity analysis (OR, 0.82; 95% CI, 0.75-0.89; P, <0.00001). Genital infections, urinary tract infections (UTIs), and hypotension were significantly higher in the SGLT2i group. CONCLUSIONS SGLT2i remain a safe option for patients with HF with a lower incidence of SAEs. However, since they increase the risk of genital infection, UTIs and hypotension, the risks vs benefits in each patient should be weighed when making a prescribing decision.
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Affiliation(s)
- Ahmed M Younes
- Department of Internal Medicine, East Carolina University, Greenville, NC, USA.
| | - Mahmoud Salem
- Center for Advanced Heart and Lung Diseases, Baylor University Medical Center, Dallas, TX, USA
| | | | - Soroush Nomigolzar
- Department of Internal Medicine, East Carolina University, Greenville, NC, USA
| | - Kerry Sewell
- Laupus Library of Health Sciences, East Carolina University, Greenville, NC, USA
| | - Mahmoud Khalil
- Department of Medicine, Lincoln Medical Center, Bronx, NY, USA
| | - Ahmed Elzanaty
- Cardiovascular Department, University of Toledo, OH, USA
| | - Ayman Saeyeldin
- Department of Internal Medicine, Saint Mary's Hospital, Waterbury, CT, USA
| | - Moahad Dar
- Department of Internal Medicine, Division of Endocrinology & Metabolism, East Carolina University, Greenville, NC, USA; Dept of Veteran Affairs, Greenville VA Health Care Center, Greenville, NC, USA
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Chieng JHL, Sia TK, Teo YH, Wong JZA, Ng TJY, Teo YN, Syn NL, Cherian R, Lim YC, Chai P, Lin W, Wong RC, Sia CH. Evaluating the Initiation of Sodium/Glucose Cotransporter 2 Inhibitors within 2 Weeks of an Acute Hospital Admission: A Systematic Review and Meta-Analysis of Nine Clinical Trials. Med Princ Pract 2022; 31:215-223. [PMID: 35378527 PMCID: PMC9274826 DOI: 10.1159/000524435] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/20/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Recent studies have increasingly shown the benefits of using sodium/glucose cotransporter 2 inhibitor (SGLT2i). However, there are concerns regarding the initiation of SGLT2i during acute hospital admissions due to the potential increased risk of complications. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of SGLT2i initiation within 2 weeks of an acute hospital admission. METHODS Four electronic databases (PubMed, Embase, Cochrane, and Scopus) were searched for articles published from inception up to 27 March 2021 that evaluated the efficacy and/or safety of SGLT2i initiation within 2 weeks of an acute hospital admission. Random-effects pair-wise meta-analysis models were utilized to summarize the studies. The protocol was registered with PROSPERO (CRD42021245492). RESULTS Nine clinical trials were included with a combined cohort of 1,758 patients. Patients receiving SGLT2i had a mean increase in 24-h urine volume of +487.55 mL (95% CI 126.86-848.25; p = 0.008) compared to those not started on SGLT2i. Patients with heart failure treated with SGLT2i had a 27% relative risk reduction in rehospitalizations for heart failure, compared to controls (risk ratio 0.73; p = 0.005). There were no differences in other efficacy and safety outcomes examined. CONCLUSION There was no increased harm with initiation of SGLT2i within 2 weeks of an acute hospital admission, and its use reduced the relative risk of rehospitalizations for heart failure in patients with heart failure. It was also associated with increased urine output. However, current evidence pool is limited, especially in specific population subtypes.
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Affiliation(s)
- Jenny Hui Ling Chieng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tze Kai Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yao Hao Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joseph Zi An Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tricia Jing Ying Ng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yao Neng Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas L.X. Syn
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Robin Cherian
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Yoke-Ching Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Ping Chai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Weiqin Lin
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Raymond C.C. Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
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Qiu R, Zhong C, Wan S, Zhang Y, Wei X, Li M, Hu J, Chen S, Zhao C, Chen Z, Chen J, Shang H. Developing a core outcome set for assessing clinical safety outcomes of cardiovascular diseases in clinical trials of integrated traditional Chinese medicine and Western medicine: study protocol. Trials 2022; 23:239. [PMID: 35346338 PMCID: PMC8962576 DOI: 10.1186/s13063-022-06166-3] [Citation(s) in RCA: 2] [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: 06/17/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Integrative medicine is commonly used in China. Researchers prefer to report efficacy outcomes rather than safety outcomes in clinical trials; thus, evidence regarding safety in integrative medicine is unclear. Developing a core outcome set (COS) for safety outcomes is necessary. In this study, a representative example of the methodology for developing COS to assess safety outcomes of cardiovascular diseases in clinical trials investigating integrated medicine will be developed. Methods and analysis Safety information will be extracted from package inserts and through systematic reviews of treatments for cardiovascular diseases (including angina pectoris, myocardial infarction, heart failure, arrhythmia, and hypertension) to develop an extensive list of safety outcomes, which will then be categorized according to whether subjective or objective outcomes. Questionnaires for clinician-reported safety outcomes and patient-reported safety outcomes will be developed. Two rounds of the Delphi survey will then be conducted for different stakeholders (traditional Chinese medicine clinicians and researchers in cardiovascular diseases, Western medicine clinicians and researchers in cardiovascular diseases, integrated medicine clinicians and researchers of cardiovascular diseases, pharmacologists, methodologists of evidence-based medicine, and patients). After round 2 of the Delphi analysis, a face-to-face consensus meeting will be held to determine the final COS for assessing safety outcomes in cardiovascular diseases. Discussion A COS for safety outcomes in cardiovascular diseases may improve the consistency of reporting results and will help identify potential bias of selective reporting in the future. Trial registration This study was registered in the Core Outcome Measures in Effectiveness Trials database as study 1564. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06166-3.
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Affiliation(s)
- Ruijin Qiu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Changming Zhong
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Siqi Wan
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yao Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xuxu Wei
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Min Li
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Jiayuan Hu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Shiqi Chen
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chen Zhao
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhao Chen
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Chen
- Baokang Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
| | - Hongcai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
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Nævestad TO, Storesund Hesjevoll I, Elvik R. How can regulatory authorities improve safety in organizations by influencing safety culture? A conceptual model of the relationships and a discussion of implications. Accid Anal Prev 2021; 159:106228. [PMID: 34147704 DOI: 10.1016/j.aap.2021.106228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/12/2020] [Revised: 04/16/2021] [Accepted: 05/27/2021] [Indexed: 06/12/2023]
Abstract
Regulators have increasingly started to focus on safety culture. The causal link between regulatory initiatives to improve safety culture and a potential decline in accidents may, however, appear like a "black box", involving social processes that seem hard to foresee and influence. We need a better conceptual understanding of this. The aims of our study are to: 1) Map studies of regulatory efforts to influence safety culture in companies, 2) Use the identified studies to develop a conceptual model of the analytical relationships between regulatory initiatives to improve safety culture and accidents in these studies, including the factors influencing these analytical relationships and 3) discuss practical implications. The review is reported according to PRISMA-guidelines, and focuses on professional transport (aviation, sea, rail, road) and the Norwegian petroleum sector. Our review indicates at least six analytical relationships, mediating between regulatory attempts to influence organizational safety culture and accidents. These are between: 1) Rules and regulators, 2) Regulators and companies, 3) Managers and employees in the companies, 4) Organizational members' shared ways of thinking and acting, which are the two key elements of safety culture, 5) Safety culture and safety behaviour, and between 6) Safety behaviour and accidents. Regulatory attempts to influence safety culture may fail or succeed at each level, through factors involved in the different relationships.
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Affiliation(s)
- Tor-Olav Nævestad
- Institute of Transport Economics, Gaustadalléen 21, NO-0349 Oslo, Norway.
| | | | - Rune Elvik
- Institute of Transport Economics, Gaustadalléen 21, NO-0349 Oslo, Norway
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Kany S, Brachmann J, Lewalter T, Akin I, Sievert H, Zeymer U, Ledwoch J, Ince H, Thomas D, Hochadel M, Senges J, Kirchhof P, Rillig A. Impact of atrial fibrillation pattern on outcomes after left atrial appendage closure: lessons from the prospective LAARGE registry. Clin Res Cardiol 2021; 111:511-521. [PMID: 34043052 PMCID: PMC9054864 DOI: 10.1007/s00392-021-01874-3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Non-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death. METHODS Comparison of procedural details and long-term outcomes in patients (pts) with paroxysmal AF (PAF) against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC (LAARGE). RESULTS A total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The total CHA2DS2-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), while HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was comparable. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77). In the three-month echo follow-up, LA thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak > 5 mm (0.0% vs 7.1%, p = 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA2DS2-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95% CI 1.02-2.72, p = 0.041). CONCLUSION Atrial fibrillation type did not impair periprocedural safety or in-hospital MACE patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality.
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Affiliation(s)
- Shinwan Kany
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Johannes Brachmann
- Department of Cardiology, Angiology and Pneumology, Coburg Hospital, Coburg, Germany
| | - Thorsten Lewalter
- Department of Medicine-Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | - Ibrahim Akin
- Department of Cardiology, University Hospital Mannheim, Mannheim, Germany
| | - Horst Sievert
- Cardio Vascular Centre, Frankfurt, Frankfurt/Main, Germany
| | - Uwe Zeymer
- Department of Cardiology, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Jakob Ledwoch
- Department of Cardiology, Hospital Neuperlach, Munich, Germany
| | - Hüseyin Ince
- Department of Cardiology, University Hospital Rostock, Rostock, Germany
| | - Dierk Thomas
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Jochen Senges
- Stiftung Für Herzinfarktforschung (IHF), Ludwigshafen, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Andreas Rillig
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
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10
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Abstract
INTRODUCTION This study identifies determinants of safety climate at agricultural cooperatives. METHODS An extensive survey was designed to build upon past research done in collaboration with DuPont (Risch et al., 2014). In 2014 and 2015, the survey was administered to 1930 employees at 14 different agricultural cooperatives with 154 locations. Injury incidence data were also collected from each location to better understand the overall health and safety environment in this sector. An ordered probit model is used to identify variables that are associated with better safety climates. RESULTS Safety system components such as discipline programs, inspection programs, modified duty programs, off-the-job safety training programs, and recognition programs are positively related to individual safety climate for both managerial employees and nonmanagerial employees. Variables representing an employee's agricultural background, distance between their workplace and childhood home, and formal education are not associated with managerial safety climate. However, agricultural background and childhood home distance are associated with nonmanagerial safety climate. CONCLUSIONS Improving occupational health and safety is a priority for many agricultural cooperatives. Lower safety climate emerges as nonmanagerial employees have more experience with production agriculture and work nearer to their home community. Practical applications: Employees of agricultural cooperatives face a host of health and safety challenges that are likely to persist into the future. The safety system components associated with safety climate indicate that continuous feedback is important for improving occupational health and safety. Occupational health and safety programming should also acknowledge that many employees have experiences that influence their attitudes and behaviors.
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Affiliation(s)
- Erik Hanson
- Department of Agribusiness and Applied Economics, North Dakota State University, United States.
| | - Michael Boland
- Department of Applied Economics, University of Minnesota, United States
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11
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Gonzalez-Costello J, Cainzos-Achirica M, Lupón J, Farré N, Moliner-Borja P, Enjuanes C, de Antonio M, Fuentes L, Díez-López C, Bayés-Genis A, Manito N, Pujol R, Comin-Colet J. Use of intravenous iron in patients with iron deficiency and chronic heart failure: Real-world evidence. Eur J Intern Med 2020; 80:91-98. [PMID: 32439287 DOI: 10.1016/j.ejim.2020.04.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/15/2019] [Revised: 03/11/2020] [Accepted: 04/13/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Treatment with intravenous iron in patients with heart failure (HF) and iron deficiency (ID) improves symptoms, however its impact on survival and safety is unknown. We aimed to evaluate the management of ID and anemia with intravenous iron in patients with HF and long-term safety of intravenous iron. METHODS We evaluated anemia and ID in patients with chronic HF at 3 university hospitals. Anemia was defined using the World Health Organization definition and ID was defined as ferritin <100 ug/L or a Transferrin Saturation <20% if ferritin between 100 and 299 ug/L. We assessed treatment with intravenous iron during follow-up and its association with mortality and HF hospitalizations using multivariate cox regression analysis. RESULTS We included 2,114 patients, median age 72 years and 57% had reduced left ventricular ejection fraction. ID was present in 55% and ID and anemia in 29%. Treatment with intravenous iron was used in 24% of patients with ID and 34% of patients with ID and anemia. In patients with ID, after multivariate adjustment, treatment with intravenous iron was associated with lower all-cause mortality: HR = 0.38 (0.28-0.56), lower cardiovascular mortality: HR = 0.34 (0.20-0.57) and no differences in HF hospitalizations: HR = 1.15 (0.88-1.50). Similar outcomes were found for patients with anemia and ID. CONCLUSIONS In a real-world cohort of patients with HF, treatment with intravenous iron was used in one third of patients with ID and anemia and appears safe in mid-term follow-up.
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Affiliation(s)
- José Gonzalez-Costello
- Advanced heart failure and transplant Unit, Department of Cardiology, Heart Disease Institute, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Miguel Cainzos-Achirica
- Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Community Heart Failure Program, Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Valles, Barcelona, Spain
| | - Josep Lupón
- Heart Failure Unit and Cardiology Department. Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Nuria Farré
- Heart Diseases Biomedical Research Group Program of Research in Inflammatory and Cardiovascular Disorders, Hospital del Mar Biomedical Research Institute (IMIM), Barcelona, Spain; Heart Failure Program, Department of Cardiology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Pedro Moliner-Borja
- Heart Failure Unit and Cardiology Department. Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Enjuanes
- Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Community Heart Failure Program, Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta de Antonio
- Heart Failure Unit and Cardiology Department. Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Lara Fuentes
- Advanced heart failure and transplant Unit, Department of Cardiology, Heart Disease Institute, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carles Díez-López
- Advanced heart failure and transplant Unit, Department of Cardiology, Heart Disease Institute, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antoni Bayés-Genis
- Heart Failure Unit and Cardiology Department. Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Nicolás Manito
- Advanced heart failure and transplant Unit, Department of Cardiology, Heart Disease Institute, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ramón Pujol
- Department of Internal Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Comin-Colet
- Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Community Heart Failure Program, Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
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Fortin SP, Kalsekar I, Johnston S, Akincigil A. Comparison of safety and utilization outcomes in inpatient versus outpatient laparoscopic sleeve gastrectomy: a retrospective, cohort study. Surg Obes Relat Dis 2020; 16:1661-1671. [PMID: 32811709 DOI: 10.1016/j.soard.2020.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/15/2020] [Revised: 06/14/2020] [Accepted: 07/03/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is the most common type of bariatric surgery performed in the United States and may be performed on an outpatient basis. Limited literature exists comparing outcomes of outpatient and inpatient LSG, and study results are conflicting. OBJECTIVES To compare safety and utilization outcomes of outpatient versus inpatient LSG. SETTINGS Retrospective, multihospital database study (Optum Pan-Therapeutics Database). METHODS Patients 18 years of age and older who underwent LSG between October 1, 2015, and December 31, 2018, were identified from the Optum Pan-Therapeutics Database and classified as having undergone outpatient or inpatient surgery. Nearest neighbor propensity score matching and generalized estimating equations accounting for procedural physician-level clustering were used to compare the following outcomes between outpatient and inpatient LSG: all-cause 30-day patient morbidity, hospital readmission, readmission length of stay, bariatric reoperation. and mortality. RESULTS We identified 22,945 patients (outpatient: 1542; inpatient: 21,403) meeting the study inclusion criteria. After propensity score matching, the inpatient and outpatient groups contained 1542 and 13,903 patients, respectively. Bariatric reoperation (n = 13) and mortality (n = 5) were rare events occurring in <.1% of all cases. Compared with the inpatient group, the outpatient group had a statistically significant lower readmission length of stay (4.63 versus 3.23 days; P = .0057). Otherwise, there was no significant association between procedure setting and 30-day overall morbidity (4.8% versus 5.3%; P = .5775) or hospital readmission (2.6% versus 2.1%; P = .1841). CONCLUSIONS Safety and utilization outcomes were similar between outpatient and inpatient LSG, and outpatient LSG was associated with shorter hospital readmission length of stay.
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Affiliation(s)
- Stephen P Fortin
- Observational Health Data Analytics, Epidemiology, Raritan, New Jersey.
| | - Iftekhar Kalsekar
- Observational Health Data Analytics, Epidemiology, Raritan, New Jersey
| | - Stephen Johnston
- Medical Devices, Epidemiology, Johnson & Johnson, New Brunswick, New Jersey
| | - Ayse Akincigil
- Health Outcomes, Policy, and Economics, Ernest Mario School of Pharmacy, Rutgers, the State University of New Jersey, New Brunswick, New Jersey
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13
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Wu Y, Liu J, Feng Y, Fu S, Ji F, Ge L, Yao N, Luo X, Zhao Y, Chen Y, Yang Y, Chen T. Efficacy and safety of antiviral therapy for HBV in different trimesters of pregnancy: systematic review and network meta-analysis. Hepatol Int 2020; 14:180-189. [PMID: 32193814 PMCID: PMC7136311 DOI: 10.1007/s12072-020-10026-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/25/2019] [Accepted: 02/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several antiviral agents licenced for blocking mother-to-child transmission (MTCT) of HBV, but their relative efficacy beginning from different trimesters has scarce been evaluated. We aimed to conduct a network meta-analysis to statistically differ the efficacy and safety of each antiviral agents initiating on different timings in preventing mother-to-infant transmission of HBV. METHODS Studies were included from PubMed, EMBASE, Web of Science, and Cochrane databases through July 1, 2019. Eligible studies recruited randomized controlled trials and nonrandomized studies reporting about infant or/and maternal efficacy and safety outcomes and were screened by two investigators independently. Extracted data were analyzed by pair-wised and network meta-analysis, respectively. RESULTS 3 Randomized and 32 nonrandomized studies enrolling 6738 pregnant female were included. Using network analysis, any antiviral agent interrupted HBV vertical transmission much more effectively than placebo. No agent showed significant efficacy different from others, but a strong trend toward significance was found in telbivudine and tenofovir, of which had the highest probability of being ranked the first- or second-best treatment for reducing MTCT of HBV. The treatment applied in the first and second trimester had a similar efficacy in preventing MTCT. Compared with the initiation during the third trimester, lower rate of MTCT was revealed when antiviral therapy was administrated before third trimester, (RR = 0.045, 95% CI 0.0053 to 0.20); a similar effect at delivery on suppressing maternal HBV DNA level and converting serum HBeAg were achieved if the timing of antiviral treatment started prior, but an obvious improvement of normalizing ALT flare was calculated out; no statistically differences among maternal and fetal safety outcomes were found if mothers received antiviral agents before pregnant 28 weeks. CONCLUSION This network meta-analysis recommended the earlier use of telbivudine or tenofovir, tends to be better to prevent MTCT of HBV in pregnancy with no increased adverse maternal or fetal outcomes.
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Affiliation(s)
- Yuchao Wu
- Department of Infection Disease and Hepatopathy, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Jinfeng Liu
- Department of Infection Disease and Hepatopathy, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Yali Feng
- Department of Infection Disease and Hepatopathy, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Shan Fu
- Department of Infection Disease and Hepatopathy, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Fanpu Ji
- Department of Infection Disease and Hepatopathy, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Long Ge
- Evidence-Based Medicine Center, Basic Medical Sciences, Lanzhou University, Lanzhou, China.,WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Naijuan Yao
- Department of Infection Disease and Hepatopathy, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Xufei Luo
- Evidence-Based Medicine Center, Basic Medical Sciences, Lanzhou University, Lanzhou, China.,WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Yingren Zhao
- Department of Infection Disease and Hepatopathy, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, Basic Medical Sciences, Lanzhou University, Lanzhou, China. .,WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China.
| | - Yuan Yang
- Department of Infection Disease and Hepatopathy, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Tianyan Chen
- Department of Infection Disease and Hepatopathy, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
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14
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Huggins-Hoyt KY, Mowbray O, Briggs HE, Allen JL. Private vs public child welfare systems: A comparative analysis of national safety outcome performance. Child Abuse Negl 2019; 94:104024. [PMID: 31158599 DOI: 10.1016/j.chiabu.2019.104024] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 05/15/2019] [Accepted: 05/21/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Ensuring the safety of American children is one of the chief mandates of the U.S. Child Welfare System. Yet system differences, including privatization remain an area of concern for whether safety of children is achieved. OBJECTIVE This study examined the effect of privatization policy on the performance of state child welfare systems in terms of achieving national safety outcome standards. PARTICIPANTS AND SETTING N1 = 10 states systems (5 privatized and 5 public systems) with N2 = 118,761 foster care cases located throughout the U.S. METHOD Using data from the Adoption and Foster Care Analysis and Reporting System (AFCARS), safety outcome performance measures were assessed, as were child-/case factors to predict the likelihood of the system types meeting the national safety outcome standards. RESULTS Logistic regression models of child, case, and system factors predicting the likelihood state systems met national safety outcome performance standards were statistically significant. Private systems, compared to non-private systems, were found to have lower odds of meeting the safety outcome 1 standard (OR = 0.41, 95% CI = 0.40-0.42), but greater odds of meeting the safety outcome 2 standard (OR = 6.79, 95% CI = 6.56-7.02). CONCLUSIONS The implementation of privatization policy in state child welfare/foster care service delivery was found to have mixed results in terms of the national safety outcome standards.
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Affiliation(s)
- Kimberly Y Huggins-Hoyt
- Andrew Young School of Policy Studies, Georgia State University, 14 Marietta Street, NW, Atlanta, GA, 30303, USA.
| | - Orion Mowbray
- School of Social Work, University of Georgia, 279 Williams St. Athens, GA 30602, USA.
| | - Harold E Briggs
- School of Social Work, University of Georgia, 279 Williams St. Athens, GA 30602, USA.
| | - Junior Lloyd Allen
- School of Social Work, Wayne State University, 5447 Woodwared Ave., Detroit, MI 48202, USA.
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15
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De Caterina R, Kelly P, Monteiro P, Deharo JC, de Asmundis C, López-de-Sá E, Weiss TW, Waltenberger J, Steffel J, de Groot JR, Levy P, Bakhai A, Zierhut W, Laeis P, Kerschnitzki M, Reimitz PE, Kirchhof P. Characteristics of patients initiated on edoxaban in Europe: baseline data from edoxaban treatment in routine clinical practice for patients with atrial fibrillation (AF) in Europe (ETNA-AF-Europe). BMC Cardiovasc Disord 2019; 19:165. [PMID: 31299906 PMCID: PMC6625115 DOI: 10.1186/s12872-019-1144-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 03/14/2019] [Accepted: 06/27/2019] [Indexed: 01/26/2023] Open
Abstract
Background Non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) have substantially improved anticoagulation therapy for prevention of stroke and systemic embolism in patients with atrial fibrillation (AF). The available routine care data have demonstrated the safety of different NOACs; however, such data for edoxaban are scarce. Here, we report baseline characteristics of 13,638 edoxaban-treated patients with AF enrolled between November 2016 and February 2018. Methods ETNA-AF-Europe is a multinational, multi-centre, post-authorisation, observational study conducted in 825 sites in 10 European countries. Patients will be followed up for four years. Results Overall, 13,980 patients were enrolled of which 342 patients were excluded from the analysis. Mean patient age was 73.6 years with an average creatinine clearance of 69.4 mL/min. 56.6% were male. The calculated CHA2DS2-VASc and HAS-BLED mean scores were 3.1 and 2.6, respectively. Overall, 3.3, 14.6 and 82.0% of patients had low (CHA2DS2-VASc = 0), intermediate (CHA2DS2-VASc = 1) and high (CHA2DS2-VASc≥2) risks of stroke, respectively. High-risk patients (those with prior stroke, prior major bleeding, prior intracranial bleed or CHA2DS2-VASc ≥4) comprised 38.4% of the overall population. For 75.1% of patients edoxaban was their first anticoagulant prescription, whilst 16.9% switched from a VKA and 8.0% from another NOAC. A total of 23.4% of patients in ETNA-AF-Europe received the reduced dose of edoxaban 30 mg. Overall, 83.8% of patients received an edoxaban dose in line with the criteria outlined in the label. Conclusion Edoxaban was predominantly initiated in older, often anticoagulation-naïve, unselected European patients with AF, with a good overall adherence to the approved label. Trial registration NCT02944019; Date of registration: October 24, 2016.
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Affiliation(s)
| | - Peter Kelly
- HRB Stroke Clinical Trials Network Ireland, University College Dublin, Dublin, Ireland
| | - Pedro Monteiro
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | | | | | - Thomas W Weiss
- Karl Landsteiner Institute for Cardiometabolics and SFU, Vienna, Austria
| | | | - Jan Steffel
- University Hospital of Zurich, Zürich, Switzerland
| | - Joris R de Groot
- Amsterdam University Medical Centers/University of Amsterdam, Amsterdam, The Netherlands
| | - Pierre Levy
- Université Paris-Dauphine, PSL Research University, Paris, France
| | - Ameet Bakhai
- Royal Free London NHS Foundation Trust, Chase Farm Hospital, London, UK
| | | | | | | | | | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, SWBH and UHB NHS Trusts, IBR 136, Wolfson Drive, Birmingham, B15 2TT, UK. .,The Atrial Fibrillation NETwork (AFNET), Münster, Germany.
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16
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Baier N, Roth K, Felgner S, Henschke C. Burnout and safety outcomes - a cross-sectional nationwide survey of EMS-workers in Germany. BMC Emerg Med 2018; 18:24. [PMID: 30126358 PMCID: PMC6102842 DOI: 10.1186/s12873-018-0177-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 11/13/2017] [Accepted: 08/10/2018] [Indexed: 12/21/2022] Open
Abstract
Background The association between burnout and patient safety has been analyzed in many studies for nurses, physicians, and residents. However, studies concerning prehospital emergency medical services (EMS) workers are limited, although they are particularly under risk for emotional stress. This study aims to descriptively analyze the overall degree of burnout among EMS-workers, and potential adverse events that might harm patients as well as the relationship between burnout and perceived safety outcomes for EMS-workers in Germany. Methods EMS-workers were recruited via German EMS-journals, social media and a professional association to participate in an online survey. The questionnaire includes the ´Maslach Burnout Inventory´ (MBI), the ‘Emergency Medical Services Safety Inventory’ (EMS-SI), and items about job satisfaction and the individual person. Data was descriptively analyzed by calculating frequencies, means, percentages and Pearson correlation coefficients. The association between burnout and patient safety was analyzed using linear and logistic regression models. Results A total of n = 1101 questionnaires were considered for data analysis. The vast majority of participants were male, younger than 40 years old, and full-time employees with an EMS-experience of 12 years on average. Between 19.9 and 40% of the participants showed a high degree of burnout in one of the burnout dimensions. Safety compromising behavior was the outcome measure with the highest percentage of participants reporting a negative outcome measure. The dimensions emotional exhaustion and depersonalization were positively associated with the safety outcomes injury and safety compromising behavior. Additionally, experiences, job satisfaction and the intention to leave the current job were significantly associated with the outcome measures. Conclusion This is the first study that examines the association between the degree of burnout and patient safety for EMS-workers. The results suggest that an expansion of psychological support for EMS-workers should be considered. Further research should concentrate on the complex relations between working conditions, burnout and patient safety. Electronic supplementary material The online version of this article (10.1186/s12873-018-0177-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Natalie Baier
- Institute of Health Care Management, Berlin Centre of Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße des 17. Juni 135 (H80), 10623, Berlin, Germany.
| | - Karsten Roth
- Institute of Health Care Management, Berlin Centre of Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße des 17. Juni 135 (H80), 10623, Berlin, Germany.,ASB Köln e.V, Sülzburgstraße 146, 050937, Köln, Germany
| | - Susanne Felgner
- Institute of Health Care Management, Berlin Centre of Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße des 17. Juni 135 (H80), 10623, Berlin, Germany
| | - Cornelia Henschke
- Institute of Health Care Management, Berlin Centre of Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße des 17. Juni 135 (H80), 10623, Berlin, Germany
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