Outcome ratio – ATRX http://atrx.net/ Tue, 27 Sep 2022 06:00:39 +0000 en-US hourly 1 https://wordpress.org/?v=5.9.3 https://atrx.net/wp-content/uploads/2021/10/icon-3-120x120.png Outcome ratio – ATRX http://atrx.net/ 32 32 Adjunctive Reslizumab Reduces Exacerbations, OCS Use in Severe Eosinophilic Asthma | Latest news for doctors, nurses and pharmacists https://atrx.net/adjunctive-reslizumab-reduces-exacerbations-ocs-use-in-severe-eosinophilic-asthma-latest-news-for-doctors-nurses-and-pharmacists/ Tue, 27 Sep 2022 02:36:33 +0000 https://atrx.net/adjunctive-reslizumab-reduces-exacerbations-ocs-use-in-severe-eosinophilic-asthma-latest-news-for-doctors-nurses-and-pharmacists/ Reslizumab, a biologic that targets interleukin (IL)-5, reduced the rate of severe asthma exacerbation and the use of oral corticosteroids (OCS) in people with severe eosinophilic asthma, according to a study. real-life study using RAPSODI* data at patient level. “Beneficial effects were evident not only in patients receiving reslizumab as a first add-on biologic, but […]]]>

Reslizumab, a biologic that targets interleukin (IL)-5, reduced the rate of severe asthma exacerbation and the use of oral corticosteroids (OCS) in people with severe eosinophilic asthma, according to a study. real-life study using RAPSODI* data at patient level.

“Beneficial effects were evident not only in patients receiving reslizumab as a first add-on biologic, but also demonstrated additive efficacy…in those who had previously failed another type 2 biologic and switched to reslizumab “, said the researchers.

Participants (n=134; mean age 53 years, 52% male) started reslizumab 0.3 mg/kg (infusions every 4 weeks) before April 2020 and had follow-up data for ≥ 6 months after the beginning. They were classified as either initiators (biologic naïve reslizumab initiators; n = 56) or switchers (those who switched from another type 2 biologic drug; n = 78). [J Allergy Clin Immunol Pract 2022;10:2099-2108.e6]

In the overall population, reslizumab significantly reduced the annualized exacerbation rate (AER; odds ratio [OR], 0.10; p<0.001) and the median daily maintenance dose of OCS (from 5 to 0 mg; p<0.001). These effects were observed in the same way in the initiators (p<0.001 [AER] and p=0.02 [OCS use]) and switches (p<0.001 and p<0.01, respectively).

The proportion of OCS users also dropped significantly in the overall cohort (from 58% to 40%; OR, 0.20; p<0.001) and both subgroups (from 48% to 35%; OR, 0.11;p=0.09 [initiators], and from 65% to 43%; OR, 0.23; p=0.003 [switchers]).

“Remarkably, reslizumab treatment [in switchers] showed further improvement in exacerbation rate and OCS use… [This] suggests reslizumab offered added value over previous type 2 biologics, including those targeting IL-5 in half of patients,” the researchers said.

Doctors’ opinions

These findings were reinforced by an anonymous survey of physicians conducted to determine whether the experts’ actual clinical experience with reslizumab matched the findings. The survey showed that asthma experts recognize the added benefit of reslizumab.

Although none of the 10 respondents prescribed reslizumab solely as a first adjunctive therapy, 40% did so as a second or third adjunctive biologic, while 60% prescribed reslizumab both as a first and second or third adjunct biological agent. Almost all were satisfied/very satisfied with reslizumab; 80% found reslizumab to have added value over other biologics.

“To justify the prescription of reslizumab, 50% responded that they expected patients to respond better to reslizumab than to other type 2 biologics,” the researchers said.

Other notable points

Most of the participants had different characteristics than the patients in the phase III trials, which the researchers believe could have prevented participation in the trials. “Despite these differences…the beneficial effects of reslizumab in the real world were broadly comparable to those in the phase III trials. This suggests that in the real world, reslizumab is effective even if the strict inclusion criteria for phase III trials are not fully met,” they said.

“Another remarkable finding…is that patients who were prescribed reslizumab in the real world appeared to have more severe asthma than those included in phase III trials,” they continued. Indeed, most participants were at the extreme end of asthma severity and complexity (>50% were OCS-dependent and almost all had comorbidities), “yet only a minority of patients ( 14%) did not improve with this therapy.”

Consequences

Patients with severe asthma usually have persistent symptoms that could interfere with activities of daily living. [Lancet 2018;391:783-800;
Eur Respir J 2017;50:1700765] “Furthermore, these patients are at increased risk of severe and life-threatening asthma exacerbations that often can only be prevented by frequent courses or continued use of OCS, which are associated with severe side effects at long term,” the researchers said.

“The observed additional effect of reslizumab as a second or third adjunctive therapy suggests that there may be value in switching patients who do not respond adequately to a specific type 2 biologic to a second biologic booster, even though this second biological agent targets the same molecular pathway,” they said.

Further studies need to determine whether greater drug potency, better dosing, pharmacodynamics or pharmacokinetics, or type of antibody or target resulted in improved response in switchers, or whether it is It’s just a longer-term inhibiting effect of the inflammatory process in the airways with so many effective agents, they added.




*RAPSODI: Dutch Registry of Adult Patients with Severe Asthma for Optimal Disease Management


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Florida Donation Report Highlights Donor Concerns https://atrx.net/florida-donation-report-highlights-donor-concerns/ Sat, 24 Sep 2022 17:42:50 +0000 https://atrx.net/florida-donation-report-highlights-donor-concerns/ Florida donors are concerned about the amount nonprofits spend on general and administrative costs. This is one of the big takeaways from the Giving in Florida report published by the Florida Nonprofit Alliance (FNA) with research conducted by Indiana University’s Lilly Family School of Philanthropy and funding from the Jessie Ball Dupont Fund. . Election […]]]>

Florida donors are concerned about the amount nonprofits spend on general and administrative costs.

This is one of the big takeaways from the Giving in Florida report published by the Florida Nonprofit Alliance (FNA) with research conducted by Indiana University’s Lilly Family School of Philanthropy and funding from the Jessie Ball Dupont Fund. .

Election period:Dos and Don’ts for Nonprofits During Election Season | Notes on non-profit organizations

Philanthropy:#GiveTLH 2022: “It’s getting harder” as the philanthropy campaign launches its 5th year

Cyber ​​security:Be part of the solution in the fight against cyber scams | Blake Dowling

I’m frustrated that we’re still talking about this issue nearly 10 years after author and activist Dan Pallotta’s TED Talk titled “The Way We Think About Charity Is Completely Wrong” went viral and was viewed over 4 million times. Shortly after Dan’s talk, Charity Navigator, Better Business Bureau Wise Giving Alliance, and Guidestar coined the name The Overhead Myth to dispel the misconception that administrative expenses are unrelated to mission.

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Associations of dietary folate, vitamin B6 and B12 intake with cardiovascular outcomes in 115,664 participants: a large UK population-based cohort https://atrx.net/associations-of-dietary-folate-vitamin-b6-and-b12-intake-with-cardiovascular-outcomes-in-115664-participants-a-large-uk-population-based-cohort/ Tue, 13 Sep 2022 17:19:57 +0000 https://atrx.net/associations-of-dietary-folate-vitamin-b6-and-b12-intake-with-cardiovascular-outcomes-in-115664-participants-a-large-uk-population-based-cohort/ Hansaem C, Ji-Yun H, Yun JA, Ji-Myung K, Tae-Jin S, Namsoo C, et al. Intake of antioxidants and B vitamins is inversely associated with ischemic stroke and cerebral atherosclerosis. Nutr Res Pr. 2016;10:516–23. Google Scholar article Shekelle P. Homocysteine ​​reduction with folic acid and B vitamins did not prevent vascular events in vascular disease. Evid […]]]>
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    Timing of lower limb amputation after race- and sex-linked diabetic foot ulcer https://atrx.net/timing-of-lower-limb-amputation-after-race-and-sex-linked-diabetic-foot-ulcer/ Fri, 09 Sep 2022 22:07:40 +0000 https://atrx.net/timing-of-lower-limb-amputation-after-race-and-sex-linked-diabetic-foot-ulcer/ Within a year of being diagnosed with a diabetic foot ulcer (DUP), new evidence suggests that black/African American people are more likely to experience earlier lower extremity amputation (LLA) than non-Hispanic people. These disparate patterns continued when examining the only DFU patients who were amputees and identified as Black/African American, Hispanic, Asian, Native American, or […]]]>

    Within a year of being diagnosed with a diabetic foot ulcer (DUP), new evidence suggests that black/African American people are more likely to experience earlier lower extremity amputation (LLA) than non-Hispanic people.

    These disparate patterns continued when examining the only DFU patients who were amputees and identified as Black/African American, Hispanic, Asian, Native American, or other.

    “This would suggest that the non-black/AA population may have more access to and use of conservative wound management techniques or that there is less access and adherence to these treatment options among the black/AA population. “wrote study author Shane R. Wurdeman. , PhD, Hanger Institute for Clinical Research and Education.

    Sex differences further suggest that women had a greater likelihood of delayed amputation than men.

    “The increased likelihood of delayed amputation may contribute to the overall increase in amputation prevalence among men, as women may die before amputation,” Wurdeman added.

    Previous findings on amputation secondary to DFU and race/ethnicity or gender disparities were mixed. Although there is evidence that disparities exist, there are few findings on when these differences begin to occur along the care pathway.

    The aim of Wurdeman and colleagues’ investigation was to examine variations in the timing of ALL by race, ethnicity, and gender in older adults with DFU. They hypothesized that a higher proportion of black/African American individuals were more likely to have post-DFU ALL earlier than non-Hispanic/white people and that more men would receive LLA sooner after. DFU.

    Retrospective cohort analysis used eligible Medicare beneficiaries enrolled in fee-for-service (FFS) beneficiaries with a diagnosis of DFU during the study period (2012 – 2017), up to 5 years later. the DFU.

    Individuals were placed into mutually exclusive groups based on LLA timing for the primary outcome. Investigators applied multinomial logistic regression to assess the likelihood of post-DFU group membership based on gender, race, and ethnicity.

    Their final analytical sample contained 643,287 Medicare fee-for-service enrollees. The subanalysis included 68,633 beneficiaries who experienced ALL during the 5-year study period, of which 49.7% survived >5 years after the DFU index.

    Full-sample regression results showed that the odds of ALL in the year after DFU were significantly higher across all racial categories, compared to non-Hispanic white recipients. Data show that Black/African American recipients were 2.18 (95% CI, 2.13, 2.23) times more likely to receive ALL within one year of DFU diagnosis.

    Investigators noted increased odds of ALL experienced across all race/ethnicity categories for black/African American recipients of receiving ALL between 1 and 3 years after DFU diagnosis, with an odds ratio (OR) of 1.38 (95% CI, 1.33 – 1.44).

    Additionally, female recipients were found to have an increased likelihood of receiving ALL later than males when controlling for covariates (OR, 1.07; 95% CI, 1.02–1.11 between 1 and 3 years and OR, 1.08; 95% CI, 1.03 – 1.12 in the ≥3 years group).

    “This evidence allows for more focused, evidence-based decision-making to modify potentially problematic care decisions made based on non-health factors,” Wurdeman concluded.

    The study, “Racial Disparities in Health Care with Timing of Amputation After Diabetic Foot Ulcer,” was published in Diabetic treatments.

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    Results of percutaneous thrombectomy in female and male patients with PE https://atrx.net/results-of-percutaneous-thrombectomy-in-female-and-male-patients-with-pe/ Thu, 01 Sep 2022 15:51:00 +0000 https://atrx.net/results-of-percutaneous-thrombectomy-in-female-and-male-patients-with-pe/ According to the results of a study published in CHEST. Although research has shown that female patients hospitalized for PE have poorer outcomes than male patients, evidence is lacking on gender-based differences in outcomes associated with interventional therapies for PE. The researchers therefore assessed the differences in outcomes between male and female patients with PE […]]]>

    According to the results of a study published in CHEST.

    Although research has shown that female patients hospitalized for PE have poorer outcomes than male patients, evidence is lacking on gender-based differences in outcomes associated with interventional therapies for PE. The researchers therefore assessed the differences in outcomes between male and female patients with PE undergoing percutaneous thrombectomy.

    The researchers conducted a retrospective cross-sectional study using national U.S. inpatient claims data collected between 2016 and 2018 on patients with a discharge diagnosis of PE who also underwent percutaneous thrombectomy. Data from a total of 5160 adult patients, including 2520 women and 2640 men, were included in the study. A multivariable regression model with patients as the categorical variable was used to assess the association between PE diagnosis and various outcomes, with in-hospital death being the primary outcome. The investigators’ analyzes also took into account demographic variables, comorbidities, discharge home, length of hospital stay and use of healthcare resources.


    Continue reading

    Investigators found a higher incidence of various adverse outcomes in female patients compared to male patients, including more perioperative bleeding (16.9% vs. 11.2%; P <.05), more blood transfusions (11.9% versus 5.7%; P < 0.05) and more vascular complications (5.0% versus 1.5%; P <.05). In-hospital mortality was also higher for women than for men (16.9% versus 9.3%, respectively; odds ratio adjusted [aOR], 1.9; 95% CI, 1.2-3.0; P =.003).

    Length of stay and use of health care resources were found to be similar for men and women, although women were less likely than men to be sent home (47.9% versus 60, 3%, respectively, aOR 0.7, 95% CI 0.50-0.99; P =.04) and instead required additional ambulatory care.

    Limitations of the study include the inability to assess the severity of PE; lack of pharmacotherapeutic details on anticoagulation; inability to distinguish between comorbidities and hospital complications; and missing data.

    “Our data suggest that patients undergoing percutaneous pulmonary artery thrombectomy represent a particularly vulnerable patient population,” the researchers concluded. Further studies are needed to validate and determine the causes, they added.

    Disclosure: Some study authors have disclosed affiliations with biotechnology, pharmaceutical and/or device companies. Please see the original citation for a full list of author disclosures.

    Reference

    Agarwal MA, Dhaliwal JS, Yang EH, et al. Gender differences in outcome of percutaneous pulmonary artery thrombectomy in patients with pulmonary embolism. Chest. Published online August 1, 2022. doi:10.1016/j.chest.2022.07.020

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    Rhonda Rebman Lopez ‘skeptical’ of main HD 120 result, weighing lawsuit over attack and ‘slander’ https://atrx.net/rhonda-rebman-lopez-skeptical-of-main-hd-120-result-weighing-lawsuit-over-attack-and-slander/ Tue, 30 Aug 2022 08:17:07 +0000 https://atrx.net/rhonda-rebman-lopez-skeptical-of-main-hd-120-result-weighing-lawsuit-over-attack-and-slander/ Key Largo businesswoman and two-time House District 120 candidate Rhonda Rebman Lopez fell just before knocking down the outgoing rep. Jim Mooney last Tuesday. Now she’s thinking of taking legal action for “slander” in a attack announcement which aired on television before primary election day. The ad in question, paid for by the Florida House […]]]>

    Key Largo businesswoman and two-time House District 120 candidate Rhonda Rebman Lopez fell just before knocking down the outgoing rep. Jim Mooney last Tuesday. Now she’s thinking of taking legal action for “slander” in a attack announcement which aired on television before primary election day.

    The ad in question, paid for by the Florida House Republican Campaign Committee, debuted in late July. He described Lopez as a “RINO” (Republican in name only) and quoted several Florida Political stories linking anti-Mooney ads broadcast in HD 120 to the political committee of disgraced former mayor of Tallahassee Andrew Gillum.

    Lopez already pushed back on charges, she and Gillum are in cahoots, touting her GOP good faith and claiming she’s never met him. But that’s not what bothers him the most.

    On the contrary, it is mentioned towards the end of the short video that she accepted traceable money from the Venezuelan president. by Nicolas Maduro socialist regime.

    Lopez was indeed the subject of a related article campaign finance complaint by the Miami-Dade Democratic Party during the 2020 election cycle. The complaint stemmed from a $1,000 donation his campaign received from Interamerican Consulting, which The New York Times found had links to PDVSAa Venezuelan oil company controlled by Maduro.

    Lopez kept the contributionexplaining to Florida Politics that the money came from a check she received from the former Republican U.S. Representative’s “schoolteacher and Democrat” sister. David Rivera. It turned out that Rivera’s sister actually served as an officer with Interamerican.

    In March 2021, the Florida Elections Commission ruled against the Miami-Dade Democratic Party after finding the complaint was “legally insufficientbecause it was based on “hearsay” and “speculation”.

    That hasn’t stopped the Florida House GOP from using that claim against her, said Lopez, who said she may sue.

    “They used it on TV — on ESPN, the Weather Channel, Fox News,” she told Florida Politics.

    “I’m considering a defamation suit because all I have is time and money, and that’s a dangerous combination. I don’t bow to this corruption. The FEC ruled that it was a lie based on hearsay and garbage, but Mooney and his campaign made it look like it was true when they knew it was in my favor.

    Lopez added that she was wary of the Republican primary result for HD 120, which saw her lose just 90 votes following an automatic recount after the initial tally showed just 43 votes separating her. by Moony.

    “They miraculously found (47) more votes,” she said. “I’m very skeptical about how it turned out.”

    She added, “I was called and told they didn’t care if it cost them a million dollars, they were going to make sure I didn’t win this election. And they did. They found the voices. And they lied.

    Mooney said he was not shocked that the race was tight, “especially given the low turnout in Monroe County.” Nor was he surprised by the “continental vote” of Miami Dade County this favored Lopez by a ratio of nearly two to one.

    “That’s something I’ll rectify next time,” he said.

    Regarding ads linking his campaign to Maduro, he noted the only ads extracted airwaves were those broadcast in his name.

    “None of our ads were taken down because we didn’t mention it,” he said. “She said she wouldn’t return the money from Venezuela – not directly from Venezuela, but she moved. (Meanwhile) we’ve had a lot of ads here that she ran because that they were manifestly false and misleading.

    “I’m not lying about our opponents. They are what they are and they do what they do. We ran a TV ad that was factual, and anyone who wants to dig deeper into that can definitely dive into it.

    Mooney, a former Islamorada mayor and village council member, now faces a Democratic ‘anti-corruption’ lawyer sweet adamwon last Tuesday with more than 55% of the vote.

    Mooney described Gentle as “a level-headed guy who just moved to the Keys”. Kind, who in January past a race for Congress to a campaign for HD 120, lived about 10 miles north of Key West for a year. He previously lived in Los Angeles.

    “I don’t know if he knows much about the issues we face in other parts of our district or, for that matter, the issues in the northern part, but he is very articulate and I don’t know. I have nothing to say about him other than the fact that I met him a few times, he was a gentleman to me and vice versa,” Mooney said, adding that he would like to see that mutual cordiality extend into the general election. .

    “I hope some of this nastiness that needs to be out there stops. If not, we will be prepared for it.


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    Short-course antibiotic therapy for community-acquired pneumonia is as effective as long-course therapy https://atrx.net/short-course-antibiotic-therapy-for-community-acquired-pneumonia-is-as-effective-as-long-course-therapy/ Sun, 28 Aug 2022 15:47:59 +0000 https://atrx.net/short-course-antibiotic-therapy-for-community-acquired-pneumonia-is-as-effective-as-long-course-therapy/ The real-world study adds to findings from previous randomized controlled trials suggesting that shorter courses of antibiotics may be sufficient for hospitalized patients with mild or moderate community-acquired pneumonia. Antibiotics are usually prescribed to treat community-acquired pneumonia (CAP), but with antimicrobial resistance being a growing concern in general health care, it is essential to minimize […]]]>

    The real-world study adds to findings from previous randomized controlled trials suggesting that shorter courses of antibiotics may be sufficient for hospitalized patients with mild or moderate community-acquired pneumonia.

    Antibiotics are usually prescribed to treat community-acquired pneumonia (CAP), but with antimicrobial resistance being a growing concern in general health care, it is essential to minimize antibiotic use whenever possible. A study published in the journal Clinical microbiology and infection suggests that short-course antibiotic therapy produces similar results to prolonged antibiotic therapy for patients with CAP showing an early clinical response.

    The multicenter observational cohort study aimed to build on previous research, particularly randomized controlled trials, suggesting that 3-5 days of antibiotic therapy may be sufficient for hospitalized patients with mild or moderate CAP who are clinically stable. before stopping treatment.

    In the study, patients with CAP at 4 hospitals in Denmark were evaluated to determine the effectiveness of short course antibiotic therapy (4-7 days of treatment) compared to long course antibiotic therapy (8 at 14 days of treatment). Mortality within 30 days of antibiotic therapy was the primary endpoint, with readmissions and new antibiotic prescriptions serving as secondary outcomes.

    Inclusion criteria included achieving clinical stability within 3 days of starting antibiotics and at least 1 day of follow-up after stopping treatment. Data were collected from medical records, the Danish national patient register, the Danish civil registration system and the Danish national prescription register.

    A total of 2264 patients hospitalized with CABG between 2017 and 2019 were identified, and 1151 achieved clinical stability within 3 days of antibiotic therapy and met the remaining inclusion criteria. About half of the patients had reported comorbidities, including chronic obstructive pulmonary disease (COPD). Patients who achieved clinical stability were generally younger, had fewer comorbidities, and had less severe disease than those who did not. The median duration of treatment was 6 days in the short-term cohort and 9 days in the long-term cohort.

    In the short-term treatment group, mortality within 30 days of the end of treatment was 3.36%, compared to 3.4% in the long-term treatment group (odds ratio adjusted [OR], 1.05; 95% CI, 0.38-1.88). The readmission rate was 15.6% in the short-term group and 14% in the long-term group (adjusted OR, 1.07; 95% CI, 0.75-1.69). The rates of new antibiotic prescriptions were 11.9% and 12.1% in the short-term and long-term cohorts, respectively.

    Given the similar results between the short- and long-course antibiotic regimens in the study, the results support the use of shorter antibiotic courses for patients with mild or moderate CAP who achieve clinical stability at the start of treatment.

    “These findings could serve as an important complement to randomized clinical trials by allowing their findings to be more applicable in routine clinical settings,” the authors wrote. They noted that it would have been interesting to explore the efficacy of an even shorter antibiotic course of 3 to 5 days, but the rarity of this approach at the time of the study prevented further sensitivity analyses.

    “Future studies should strive to implement clinical stability criteria to guide treatment in settings of different antibiotic classes and antimicrobial resistance,” the authors concluded. “Optimally, large, multicenter randomized controlled trials should allow evaluation of safety outcomes in the implementation of short-course antibiotic therapy, which would be reassuring for both patients and clinicians.”

    Reference

    Israelsen SB, Fally M, Tarp B, Kolte L, Ravn P, Benfield T. Short-course antibiotic therapy for hospitalized patients with early clinical response in community-acquired pneumonia: a multicenter cohort study. Clin Microbiol Infect. Published online August 18, 2022. doi:10.1016/j.cmi.2022.08.004

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    Small patient samples can affect the accuracy of radiology research https://atrx.net/small-patient-samples-can-affect-the-accuracy-of-radiology-research/ Thu, 25 Aug 2022 19:57:32 +0000 https://atrx.net/small-patient-samples-can-affect-the-accuracy-of-radiology-research/ Diagnostic imaging research is replete with studies with smaller sample sizes, which could lead to the exaggeration of larger and more favorable effects than might be found in studies of patient populations. more important. Researchers led by Dr Lucy Lu of Flinders University in Bedford Park wrote that evidence for this event – also known […]]]>

    Diagnostic imaging research is replete with studies with smaller sample sizes, which could lead to the exaggeration of larger and more favorable effects than might be found in studies of patient populations. more important. Researchers led by Dr Lucy Lu of Flinders University in Bedford Park wrote that evidence for this event – also known as the small study effect – can be found in their analysis of nearly 670 studies. and more than 80,000 patients.


    “These results have important implications for the conduct and interpretation of meta-analyses in the diagnostic imaging literature, as they suggest that the estimates of diagnostic accuracy presented by many meta-analyses may be gross overestimates” , wrote Lu et al.


    The idea behind small study effects is that studies with smaller sample sizes tend to report larger and more favorable effect estimates than studies with larger sample sizes. The most common reasons for this to happen are bias, heterogeneity, and pure coincidence.


    Small studies are more prone to publication bias, in which manuscripts with statistically significant or favorable results are more likely to be published. Outcome reporting bias, where selective reporting of only the most favorable outcomes occurs, is another contributor to the effects of small studies.


    The effects of small studies caused by bias can impact meta-analyses by increasing the estimated pooled effect sizes. Detecting such bias by retrieving unpublished data is usually not possible, so statistical tools such as funnel plots, Egger’s test, and Deek’s test are used to detect these effects.


    In diagnostic imaging, the effects of small studies are not well understood. The researchers pointed out that “most” diagnostic accuracy studies do not have a predefined study hypothesis, while most randomized clinical trials of interventions test a predefined hypothesis.


    Lu’s team wanted to uncover the presence and magnitude of the effects of small studies in diagnostic imaging accuracy meta-analyses. They reviewed data from 31 meta-analyses published between 2010 and 2019. The team included meta-analyses with 10 or more studies on the diagnostic accuracy of medical imaging, evaluating a single imaging modality. A total of 80,206 patients were included in these meta-analyses.


    The researchers also used the natural logarithm of the diagnostic odds ratio (ln[DOR]) to detect publication bias. The diagnostic odds ratio shows the effectiveness of a diagnostic test. From this, they created a composite funnel plot by plotting the effect size of the study against the precision of all the primary studies.


    The most studied imaging modalities were MRI (11 meta-analyses), ultrasound (8 meta-analyses), and computed tomography (5 meta-analyses), with the other modalities studied in two or fewer meta-analyses .


    By studying a composite funnel plot and using regression analysis, the researchers found that a “relative lack” of studies had higher study effects, with similar trends seen in individual imaging modalities. . They also found a regression coefficient of ln(DOR) on study effects of ln(DOR) of 2.19 (p < 0.001), with CT as the reference modality.


    The team also found an inverse association between effect size estimation and accuracy independent of imaging modality.


    In other words, the larger the study, the more precise its effects. The smaller the study, the more inflated its effects in diagnostic imaging.


    “Since studies with lower precision generally represent those with smaller sample sizes, these results are consistent with small study effects,” Lu and colleagues wrote. “The observation was consistent across all individual modalities.”


    The team also found that of 26 meta-analyses formally assessing publication bias using funnel plots and statistical tests, 21 found no evidence of such bias.


    The authors called for further research to uncover the different factors contributing to the effects of small studies. They wrote that these effects have implications for costs, imaging utilization, and patient outcomes due to suboptimal imaging test choice or unnecessary exposure to ionizing radiation.


    “To alleviate some of these issues, we suggest that readers and authors be aware that commonly used tests for funnel plot asymmetry are often underpowered in diagnostic imaging meta-analyses and therefore may underestimating or failing to detect the presence of an underlying bias,” they added.

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    August 23, 2022 Stewardship/Resistance Analysis https://atrx.net/august-23-2022-stewardship-resistance-analysis/ Tue, 23 Aug 2022 18:46:25 +0000 https://atrx.net/august-23-2022-stewardship-resistance-analysis/ Trial finds no impact on trachoma of massive azithromycin distribution A randomized clinical trial in Niger found that mass distribution of azithromycin to preschool children was no more effective in reducing the incidence of trachoma than placebo, researchers reported today. JAMA network open. The cluster-randomised trial, conducted by researchers from the Oral Macrolides to Reduce […]]]>

    Trial finds no impact on trachoma of massive azithromycin distribution

    A randomized clinical trial in Niger found that mass distribution of azithromycin to preschool children was no more effective in reducing the incidence of trachoma than placebo, researchers reported today. JAMA network open.

    The cluster-randomised trial, conducted by researchers from the Oral Macrolides to Reduce Deaths with an Eye on Resistance (MORDOR)-Niger study group, assessed the effects of six-monthly mass distribution of azithromycin to children aged from 1 to 59 months in 30 villages in a region of Niger considered to have hypoendemic trachoma. The World Health Organization (WHO) recommends mass distribution of azithromycin in districts affected by trachoma, the leading infectious cause of blindness worldwide, but fear that mass administration of antibiotics to entire communities promotes antibiotic resistance has led researchers to wonder if targeted distribution might be a better solution. strategy.

    A total of 4756 children in 30 communities were included, with 1695 children enrolled in 15 azithromycin communities and 3031 in 15 placebo communities. Enrolled children received a single dose of oral azithromycin or oral placebo every 6 months for 24 months. The primary outcome of the trial was the incidence of trachomatous inflammation follicular (TF).

    The mean prevalence of TF at baseline was 1.9% (95% confidence interval [CI], 0.5% to 3.5%) in the azithromycin group and 0.9% (95% CI, 0 to 1.9%) in the placebo group. At 24 months, the prevalence of TF was 0.2% (95% CI, 0 to 0.5%) in the azithromycin group and 0.8% (95% CI, 0.2% to 1, 6%) in the placebo group. The lower incidence of TF in the azithromycin group was not considered statistically significant (baseline-adjusted incidence rate ratio: 0.18 [95% CI, 0.01 to 1.20]).

    The study authors say the low baseline prevalence of trachoma in communities makes it difficult to determine whether targeted mass distribution of azithromycin to preschool children could be an effective strategy for trachoma elimination. It also suggests that trachoma may have been eliminated as a public health problem in these communities.

    “It remains unclear whether azithromycin distributions to preschoolers would be effective in other areas with hypoendemic trachoma that have slightly more infection than those assessed in the present study,” they wrote. .
    August 23 JAMA Netw Open study

    Treatment of multidrug-resistant tuberculosis more effective than expected

    A systematic review and meta-analysis of studies from West and Central African countries found higher than expected treatment success rates for multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB), reported yesterday researchers in the International Journal of Infectious Diseases.

    Analysis of 14 studies from 14 countries in the two regions, published from 2005 to 2020 and involving 4,268 people, found that the overall treatment success was 74.6% (95% confidence interval [CI], 65% to 82.2%), with a combined success rate of 80.8% (95% CI, 56% to 93.3%) for the Central African subgroup and 69.3% for the – West African group (95% CI, 56.3% to 79.7%). The estimated proportion of MDR/RR TB patients successfully treated was significantly higher than the WHO estimate of 59% and met the 2015 WHO target of 75% MDR TB treatment success .

    The results are surprising because the studies were conducted while countries in the region were using the standard treatment regimen for multidrug-resistant tuberculosis, which lasts 18 to 24 months and includes injectable drugs. Poor adherence to this regimen has been associated with low treatment success rates. The authors note that the results may be explained by the early introduction of a 9- to 11-month regimen in many of the included countries, as well as the lack of data from 12 countries in the region.

    “Whether this reflects the true treatment success rate or if the rate is skewed due to underreporting remains unknown,” they wrote.

    In 2022, the WHO approved a 6-month all-oral regimen for multidrug-resistant tuberculosis that experts hope will lead to even better treatment outcomes.
    August 22 Int J Infect Dis study

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    No improvement in disability seen in patients treated with tirofiban prior to endovascular thrombectomy https://atrx.net/no-improvement-in-disability-seen-in-patients-treated-with-tirofiban-prior-to-endovascular-thrombectomy/ Sun, 21 Aug 2022 19:02:17 +0000 https://atrx.net/no-improvement-in-disability-seen-in-patients-treated-with-tirofiban-prior-to-endovascular-thrombectomy/ Data from the randomized, double-blind, placebo-controlled RESCUE-BT trial showed that adding intravenous tirofiban before endovascular thrombectomy (EVT) had no impact on severity of disability in people who have had an acute ischemic stroke with great vessel occlusion (LVO). Therefore, the researchers concluded that the results do not support the use of tirofiban before VTE for […]]]>

    Data from the randomized, double-blind, placebo-controlled RESCUE-BT trial showed that adding intravenous tirofiban before endovascular thrombectomy (EVT) had no impact on severity of disability in people who have had an acute ischemic stroke with great vessel occlusion (LVO). Therefore, the researchers concluded that the results do not support the use of tirofiban before VTE for the treatment of acute ischemic stroke.1

    The study included 948 participants who received either tirofiban (n=463), a highly selective non-peptide glycoprotein 2b/3a receptor antagonist, or placebo (n=485) before undergoing VTE. All patients completed the trial, with modified Rankin Scale (mRS) scores of 3 (IQR, 1-4) and 3 (IQR, 1-4) recorded in the tirofiban and placebo groups, respectively. The adjusted pooled odds ratio (OR) for a favorable change to a lower mRS score at 90 days comparing tirofiban to placebo was 1.08 (95% CI, 0.86-1.36; P = .50).

    In an analysis by stroke etiology, there was a more favorable point estimate for tirofiban in the large artery atherosclerosis subgroup, but not in the other artery atherosclerosis subgroup; however, the results of the indication test were not statistically significant (joint OR adjusted for less disability, 1.40 [95% CI, 1.00-1.97]; against 0.84 [95% CI, 0.62-1.15]; P = 0.09).

    “These results do not support the routine use of intravenous tirofiban as an adjunct to thrombectomy within a ‘late’ time window (beyond the recommended use of thrombolysis therapy within 4.5 hours of onset of thrombectomy). symptoms) after acute ischemic stroke,” Craig S. Anderson, MD, PhD, Professor of Neurology, UNSW Syndey, wrote in a related editorial.2 “Since any delay in onset of symptoms relative to treatment time reduces the likelihood of a good outcome from great vessel occlusion, it is reassuring that both randomized groups achieved high rates of recanalization ( >90%) with single-pass application of a range of approaches Any modest potential benefit of tirofiban in the atherosclerosis of the large arteries subgroup was outweighed by the overall risk of serious bleeding as a complication unique major of thrombectomy.

    READ MORE: Trends in stroke incidence at younger ages call for re-examination of causes and methods of prevention

    Previous studies have shown that tirofiban may reduce the risk of thrombotic complications during percutaneous coronary intervention; however, most of the data evaluating the agent as an adjunctive therapy in OLV stroke are inconsistent. Until RESCUE-BT, no randomized trial had assessed the role of tirofiban in EVT of acute ischemic stroke. In this investigator-initiated trial, patients had National Institutes of Health Stroke Scale scores of 30 or less, an Alberta Stroke Program Early CT score of 6 or greater, and an occlusion of the intracranial carotid artery or the first or second segment of the middle cerebral artery. .

    There were several secondary technical efficacy outcomes, including substantial reperfusion on initial DSA before EVT, substantial reperfusion on final angiogram, use of rescue medication, recanalization on follow-up CTA or MRA within 48 hours, as well as secondary safety criteria such as any radiological examination. intracranial hemorrhage or 90-day mortality. For the 6 secondary clinical efficacy outcomes, no statistically significant differences were observed. For example, 36.3% of the tirofiban group and 32.4% of those on placebo had no disability or returned to their premorbid mRS score (difference, 3.9% [95% CI, –2.1% to 10%]; Adjusted OR, 1.21 [95% CI, 0.91-1.62]).

    Although no significant difference was detected in the incidence of symptomatic intracranial hemorrhage between the groups, those in the tirofiban group had a higher rate of radiological intracranial hemorrhage (34.9% versus 28.0% [95% CI, 1.0-12.8]; OR adjusted, 1.40 [95% CI, 1.06-1.86]; P = .02). In addition, 90-day mortality was 18.1% with tirofiban and 16.9% with placebo (difference of 1.2% [95% CI, –3.6 to 6.1]; Adjusted OR, 1.09 [95% CI, 0.77-1.55]; P = 0.63).

    REFERENCES
    1. RESCUE-BT trial investigators. Effect of intravenous tirofiban versus placebo before endovascular thrombectomy on functional outcomes in stroke by great vessel occlusion: the RESCUE-BT randomized clinical trial. JAMA Neurol. 2022;328(6):543-553. doi:10.1001/jama.2022.12584
    2. Anderson CS, Song L, Liu J. Therapeutic strategies for intracranial atherosclerosis. JAMA Neurol. 2022;328(6):529-531. doi:10.1001/jama.2022.11525.
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