Systematic Reviews and Meta-analyses of the Procedure-specific Risks of Thrombosis and Bleeding in General Abdominal, Colorectal, Upper Gastrointestinal, and …

We report the short-and long-term results of the SOLIDARITY Finland on mortality and other patient-important outcomes in patients hospitalised for COVID-19. Between 08/2021 and 03/2023, we randomised 156 patients in 15 hospitals. In the imatinib group, 7.2% of patients had died at 30 days and 13.3% at 1 year and in the standard of care group 4.1% and 8.3%(adjusted HR at 30 days 1.09, 95% CI 0.23-5.07). In a meta-analysis of randomised trials of imatinib versus standard of care (n= 732), allocation to imatinib was associated with a mortality risk ratio of 0.73 (95% CI 0.32-1.63). At 1-year, self-reported recovery occurred in 79.0% in imatinib and in 88.3% in standard of care (RR 0.91, 95% CI 0.78-1.06). Of the 21 potential long COVID symptoms, patients often reported moderate or major bother from fatigue (24%), sleeping problems (19%) and memory difficulties (17%). We found no convincing difference between imatinib and standard of care groups in quality of life or symptom outcomes. The evidence raises serious doubts regarding the benefit of imatinib in reducing mortality, improving recovery and preventing potential long COVID symptoms when given to patients hospitalised for COVID-19.

Annals of Allergy, Asthma & Immunology

BackgroundGuidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology.ObjectiveTo produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD.MethodsA multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group …

JAMA

To the Editor Although sometimes considered the pinnacle of scientific evidence, meta-analyses can be problematic. Combining outcomes from heterogeneous trials performed in different settings or populations may give results directly applicable to few. Conclusions are also beholden to methodological design, often discordant from those of subsequent randomized clinical trials. 1 Such may be the case with the recently published dose-response meta-analysis of studies examining efficacy and tolerability of gefapixant for refractory or unexplained chronic cough. 2 Because gefapixant is the first novel efficacious therapy for refractory and unexplained chronic cough, its development involved changes in study design and participant inclusion criteria as well as drug formulation. 3 Four drug formulations were ultimately tested, with maximum bioavailability achieved for the formulation used in the phase 3 trials, such that …

The Lancet

Their stated aim is to summarise the “benefits and harms of weight-lowering drugs”, but the main findings and discussion focus on weight loss, without due consideration to the scarcity of evidence for benefits to health and wellbeing. For instance, quality of life and depression data are reported as low quality or insufficient, and there is no mention of the absence of long-term cardiovascular outcomes. A review on long-term effects of weight-reducing pharmacotherapy included only one trial with cardiovascular outcomes; it found no benefit.

Journal of Critical Care

IntroductionThe objective of this study was to create a definition of patient-important upper gastrointestinal bleeding during critical illness as an outcome for a randomized trial.DesignThis was a sequential mixed-methods qualitative-dominant multi-center study with an instrument-building aim. In semi-structured individual interviews or focus groups we elicited views from survivors of critical illness and family members of patients in the intensive care unit (ICU) regarding which features indicate important gastrointestinal bleeding. Quantitative demographic characteristics were collected. We analyzed qualitative data using inductive content analysis to develop a definition for patient-important upper gastrointestinal bleeding.SettingCanada and the United States.Participants51 ICU survivors and family members of ICU patients.ResultsParticipants considered gastrointestinal bleeding to be important if it resulted in death …

HPB

BackgroundApproximately 15% of patients experience post-hepatectomy liver failure after major hepatectomy. Poor hepatocyte uptake of gadoxetate disodium, a magnetic resonance imaging contrast agent, may be a predictor of post-hepatectomy liver failure.MethodsA retrospective cohort study of patients undergoing major hepatectomy (≥3 segments) with a preoperative gadoxetate disodium-enhanced magnetic resonance imaging was conducted. The liver signal intensity (standardized to the spleen) and the functional liver remnant was calculated to determine if this can predict post-hepatectomy liver failure after major hepatectomy.ResultsIn 134 patients, low signal intensity of the remnant liver standardized by signal intensity of the spleen in post-contrast images was associated with post-hepatectomy liver failure in multiple logistic regression analysis (Odds Ratio 0.112; 95 % CI 0.023 – 0.551). In a subgroup of …

Health and Technology

PurposeThis study assessed the performance of LLM-linked chatbots in providing accurate advice for colorectal cancer screening to both clinicians and patients.MethodsWe created standardized prompts for nine patient cases varying by age and family history to query ChatGPT, Bing Chat, Google Bard, and Claude 2 for screening recommendations to clinicians. Chatbots were asked to specify which screening test was indicated and the frequency of interval screening. Separately, the chatbots were queried with lay terminology for screening advice to patients. Clinician and patient advice was compared to guidelines from the United States Preventive Services Task Force (USPSTF), Canadian Cancer Society (CCS), and the U.S. Multi-Society Task Force (USMSTF) on Colorectal Cancer.ResultsBased on USPSTF criteria, clinician advice aligned with 3/4 (75.0%), 2/4 (50.0%), 3/4 (75.0%), and 1/4 (25.0%) cases for …

International Journal of Colorectal Disease

PurposeUp to 40% of patients with inflammatory bowel disease (IBD) are obese. Obesity is a well-known risk factor for increased perioperative morbidity, but this risk has never been quantified in IBD patients undergoing abdominal surgery using the United States National Inpatient Sample (NIS) database. This study aims to compare postoperative morbidity between obese and non-obese patients undergoing bowel resection for IBD using recent NIS data.MethodsAdult patients who underwent bowel resection for IBD from 2015 to 2019 were identified in the NIS using ICD-10-CM coding. Patients were stratified into obese (BMI > 30 kg/m2) and non-obese groups, then propensity score matched (PSM) for demographic, operative, and hospital characteristics. The primary outcome was postoperative in-hospital morbidity. Secondary outcomes included postoperative in-hospital mortality, system-specific postoperative …

REC: CardioClinics

La insuficiencia cardiaca (IC) se considera un problema de salud pública que afecta a una proporción importante de la población, especialmente adultos mayores, y genera una gran morbimortalidad y un elevado coste en salud, por lo que se hace necesario adoptar estrategias de prevención desde la atención médica inicial y en el seguimiento como medida de atención primaria en salud. Con el envejecimiento poblacional, el incremento de los factores de riesgo cardiovasculares en la población general, la mayor tasa de sobrevida a los eventos isquémicos cardiovasculares y el incremento en la expectativa de vida se espera que, en los próximos años, la prevalencia y la incidencia de la IC aumente. El desarrollo de la IC sintomática se asocia a un empeoramiento en el pronóstico a pesar del tratamiento realizado acorde a las guías actuales, lo cual entre otras cosas la convierte en una importante fuente de …

BJS open

Background It has previously been reported that there are similar reoperation rates after elective colorectal surgery but higher failure-to-rescue (FTR) rates in low-volume hospitals (LVHs) versus high-volume hospitals (HVHs). This study assessed the effect of hospital volume on reoperation rate and FTR after reoperation following elective colorectal surgery in a matched cohort. Methods Population-based retrospective multicentre cohort study of adult patients undergoing reoperation for a complication after an elective, non-centralized colorectal operation between 2006 and 2017 in 11 hospitals. Hospitals were divided into either HVHs (3 hospitals, median ≥126 resections per year) or LVHs (8 hospitals, <126 resections per year). Patients were propensity score–matched (PSM) for baseline characteristics as well as indication and type of elective surgery. Primary outcome was …

Contraception

ObjectivesTo examine the types of hormonal contraceptive methods chosen at the time of the abortion, and how they correspond to post-abortion hormonal contraceptive purchase.Study designThis was a prospective register-based study. We identified the present cohort of 8428 women undergoing induced abortion between July 1, 2017 and December 31, 2018, using the Prescription Centre, Social Insurance Institution database and the Finnish National Register of Induced Abortions. From the Register of Induced Abortions, we gathered information on planned post-abortion contraception. The redeemed prescriptions of hormonal contraception were identified from the Prescription Centre until December 31, 2019. We analyzed the hormonal contraceptive methods planned at the time of the abortion, and how they corresponded to hormonal contraceptive purchase during the 1-year follow-up. We also assessed …

INTRODUCTION AND OBJECTIVESmall renal masses (SRMs) are defined as tumors with a diameter ≤4 cm. The primary treatment options for SRMs include surgical excision, ablative therapy, and active surveillance (AS). Low metastatic potential and indolent growth of the SRMs suggest the possible merit of AS over the more aggressive alternatives. We conducted a systematic review and meta-analysis to examine mortality and oncologic outcomes within five years after partial nephrectomy (PN), percutaneous thermal ablation (PTA), and AS, aiming to provide additional evidence for treatment selection.METHODSWe conducted a literature search in MEDLINE, EMBASE, and CINAHL up until June 2023 and identified additional studies based on recommendations from two expert urologists and hand searching. We addressed 5-year estimates of overall mortality, cancer specific mortality, local recurrence …

Nederlands Tijdschrift Voor Geneeskunde

The accessibility of primary care is under pressure, because more and more responsibilities and tasks are being shifted to general practitioners. Changes will have to take place to safeguard the core values of primary care: person-oriented, medical-generalistic and continuous. The increase in chronic diseases and multimorbidity forces general practitioners to delve deeper into complex care and maintain their management role in healthcare. Because of their guiding function, general practitioners must orientate themselves on problem areas that were previously discussed less prominently, such as questions related to gender identity and diversity. The time required for this may become available through the disposal and delegation of tasks and through further digitization. Digital interdisciplinary consultation in particular may improve the efficiency and quality of care. Finally, patients must be better informed about the nature of their complaints and the indications for an assessment by the GP.

BackgroundThe use of cutting seton (CS) for the management of cryptoglandular fistula-in-ano has remained controversial because of reports of fecal incontinence, postoperative pain, and extended healing time. The aim of this review was to provide the first synthesis of studies investigating the use of CS for the treatment of cryptoglandular fistula-in-ano.MethodsMEDLINE, Embase, and CENTRAL were searched up to October 2022. Randomized controlled trials and observational studies comparing CS with alternative interventions were included, along with single-arm studies evaluating CS alone. The primary outcome was fistula-in-ano recurrence, and secondary outcomes included incontinence, healing time, proportion with complete healing, and postoperative pain. Inverse variance random-effects meta-analyses were used to pool effect estimates.ResultsAfter screening 661 citations, 29 studies were included …

Introducción: La microbiota se define como la comunidad de microorganismos presentes en un entorno concreto. Aunque el microbioma no ha sido claramente definido, el término se utiliza para referirse al hábitat.Objetivo: Identificar la relación entre el microbioma y el cáncer de pene.Adquisición de la evidencia: Esta revisión exploratoria se realizó siguiendo las recomendaciones del Instituto Joanna Briggs. Se encontraron cinco artículos que cumplían los criterios de inclusión. Nos hemos centrado en investigar la oncogénesis y los factores que alteran el microbioma del pene. No se establecieron limitaciones en cuanto al idioma o la localización. Se realizaron búsquedas en MEDLINE (Ovid), Embase, Registro Cochrane Central de Ensayos Controlados (CENTRAL) y LILACS desde el inicio hasta el momento actual.Síntesis de la evidencia: Se encontraron nueve estudios en los que se describen múltiples …

Continence

Aim: We aimed to assess the mid-to long-term outcome of Polyacrylamide Hydrogel urethral injections as a treatment for women with stress urinary incontinence (SUI), who are not eligible for treatment with midurethral slings. Methods: We performed a single-arm, patient cohort study using the subjective improvement rate as primary outcome, defined as an answer “(very) much better” on the Patient Global Impression of Improvement. Secondary outcomes were the subjective cure rate (a negative answer to the Urogenital Distress Inventory stress subscale question 4), patient satisfaction (Visual Analogue Scale of≥ 8.0), complication rate, the amount of Hydrogel injected, the number of reinjections and to what extent patients would recommend this treatment. Results: A total of 357 women with pure SUI, or mixed urinary incontinence with predominant SUI were included. Adverse events were retrieved from their …