scholarly journals Initial or early monotherapy with eslicarbazepine acetate for the management of adult patients with focal epilepsy in clinical practice: a meta-analysis of observational studies

2021 ◽  
pp. 1-16
Author(s):  
Silvia Fernández-Anaya ◽  
Vicente Villanueva ◽  
José M. Serratosa ◽  
Fernando Rico-Villademoros ◽  
Rosa Rojo ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Observational Studies ◽  
Focal Epilepsy ◽  
Meta Analysis ◽  
Adult Patients ◽  
Eslicarbazepine Acetate

scholarly journals Updating the Evidence Base for Suctioning Adult Patients: A Systematic Review

2009 ◽  
Vol 16 (3) ◽  
pp. e6-e17 ◽  
Author(s):  
Tom J Overend ◽  
Cathy M Anderson ◽  
Dina Brooks ◽  
Lisa Cicutto ◽  
Michael Keim ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Meta Analysis ◽  
Evidence Base ◽  
Health Care Team ◽  
Adult Patients ◽  
Cochrane Library ◽  
Open Versus ◽  
New Evidence

OBJECTIVES: To update a previous clinical practice guideline on suctioning in adult patients, published in theCanadian Respiratory Journalin 2001.METHODS: A primary search of the MEDLINE (from 1998), CINAHL, EMBASE and The Cochrane Library (all from 1996) databases up to November 2007, was conducted. These dates reflect the search limits reached in the previous clinical practice guideline. A secondary search of the reference lists of retrieved articles was also performed. Two reviewers independently appraised each study before meeting to reach consensus. Study quality was evaluated using the Jadad and PEDro scales. When sufficient data were available, a meta-analysis was conducted using a random effects model. Data are reported as ORs, weighted mean differences and 95% CIs. When no comparisons were possible, qualitative analyses of the data were completed.RESULTS: Eighty-one studies were critically appraised from a pool of 123. A total of 28 randomized controlled trials or randomized crossover studies were accepted for inclusion. Meta-analysis was possible for open versus closed suctioning only. Recommendations from 2001 with respect to hyperoxygenation, hyperinflation, use of a ventilator circuit adaptor and subglottic suctioning were confirmed. New evidence was identified with respect to indications for suctioning, open suction versus closed suction systems, use of medications and infection control.CONCLUSIONS: While new evidence continues to be varied in strength, and is still lacking in some areas of suctioning practice, the evidence base has improved since 2001. Members of the health care team should incorporate this evidence into their practice.

scholarly journals FRI0460 SAFETY OF BIOLOGICAL AGENTS IN JUVENILE IDIOPATHIC ARTHRITIS: A META-ANALYSIS OF OBSERVATIONAL STUDIES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 827.2-827
Author(s):  
N. Cabrera ◽  
G. Avila ◽  
A. Belot ◽  
J. P. Larbre ◽  
G. Cattivelli ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Clinical Practice ◽  
Incidence Rate ◽  
Observational Studies ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Serious Adverse Events ◽  
Serious Infections ◽  
Randomised Controlled

Background:Follow-up cohorts (observational studies) were initiated consecutively or simultaneously to the development of randomised controlled trials (RCTs) in JIA patients(1,2). They help to identify many complications observed only in clinical practice related to off label use, coadministration of treatments, drug misuse, and occurrence of rare or unexpected event. In addition, observational studies include a higher number of patients with a longer duration of follow-up compared to randomised trials. Hence, they have a higher power to capture the occurrence of serious adverse events (SAE) in daily clinical practice3.Objectives:To estimate the incidence of serious adverse events (SAEs) including serious infections, malignancies, and death in patients with juvenile idiopathic arthritis (JIA) treated with biological agents (BAs) in daily clinical practice, using meta-analysis techniques.Methods:We systematically searched, up to May 2019, Medline and Embase databases for observational studies performed in JIA disease under BAs treatment. Outcomes were SAEs, serious infections, malignancies and all-cause mortality. Complementary, the incidence of SAEs in randomised controlled trials (RCTs) with withdrawal and parallel designs was performed by meta-analysis.Results:A total of 31 observational studies were included (6811 patients totalizing 17530 patients-years [PY] of follow-up). The incidence rate of SAEs was similar in observational cohorts and withdrawal RCTs (4.46 events per 100 PY, 95% CI 2.85- 6.38, I2= 95%) and 3.71 events per 100 PY (95%CI 0.0-13.34), I2= 56%, respectively). The incidence of SAE was lower in parallel RCT. The incidence rate of serious infections, malignancies and death in observational cohorts was estimated at 0.74 events per 100 PY (95%CI 0.32-1.30, I2=83%), 0.10 events per 100 PY (95% CI 0.06-0.16, I2=0%) and 0.09 events per 100 PY (95% CI 0.05-0.14, I2=0%), respectively. Infections were the known cause of death in 8 of the 14 deaths. In meta-regression and subgroup analysis, variation of serious infections rates were partially explained by follow-up time (R2= 30.3%, p= 0.0008), JIA categories (all JIA versus polyarticular versus systemic JIA categories, p= 0.001) and cohort quality (Newcastle-Ottawa score ≥ to 6 versus ≤ to 5 stars, p= 0.0025).Conclusion:Our results suggest that the incidence rate of SAEs related to BAs in JIA disease is similar to those observed in randomised withdrawal trials. The overall incidence remained low. However, unsatisfactory description of SAEs prevents analysis of hospitalisation causes. Infection and, to a lesser extent, cancer and death, explain only part of burden of BAs.References:[1]Berard RA, Laxer RM. Learning the hard way: clinical trials in juvenile idiopathic arthritis. Ann Rheum Dis. 2018;77(1):1–2.[2]Swart J, Giancane G, Horneff G, Magnusson B, Hofer M, Alexeeva Е, et al. Pharmacovigilance in juvenile idiopathic arthritis patients treated with biologic or synthetic drugs: combined data of more than 15,000 patients from Pharmachild and national registries. Arthritis Res Ther. 2018 27;20(1):285.[3]Monti S, Grosso V, Todoerti M, Caporali R. Randomized controlled trials and real-world data: differences and similarities to untangle literature data. Rheumatol Oxf Engl. 2018 01;57(57 Suppl 7):vii54–Disclosure of Interests:None declared

Adjunctive Eslicarbazepine Acetate in Pediatric Patients with Focal Epilepsy: A Systematic Review and Meta-Analysis

CNS Drugs ◽  
2018 ◽  
Vol 32 (3) ◽  
pp. 189-196 ◽  
Author(s):  
Simona Lattanzi ◽  
Francesco Brigo ◽  
Elisabetta Grillo ◽  
Claudia Cagnetti ◽  
Alberto Verrotti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pediatric Patients ◽  
Focal Epilepsy ◽  
Meta Analysis ◽  
Eslicarbazepine Acetate

Incidence and Prevalence of Drug-Resistant Epilepsy

Neurology ◽  
2021 ◽  
Vol 96 (17) ◽  
pp. 805-817
Author(s):  
Bushra Sultana ◽  
Marie-Andrée Panzini ◽  
Ariane Veilleux Carpentier ◽  
Jacynthe Comtois ◽  
Bastien Rioux ◽  
...  
Keyword(s):  
Random Effects ◽  
Observational Studies ◽  
Focal Epilepsy ◽  
Meta Analysis ◽  
Drug Resistant ◽  
Eligibility Criteria ◽  
Random Effects Models ◽  
Arcsine Transformation ◽  
Drug Resistant Epilepsy ◽  
Meta Analyses

ObjectiveTo evaluate the incidence and prevalence of drug-resistant epilepsy (DRE) as well as its predictors and correlates, we conducted a systematic review and meta-analysis of observational studies.MethodsOur protocol was registered with PROSPERO, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology reporting standards were followed. We searched MEDLINE, Embase, and Web of Science. We used a double arcsine transformation and random-effects models to perform our meta-analyses. We performed random-effects meta-regressions using study-level data.ResultsOur search strategy identified 10,794 abstracts. Of these, 103 articles met our eligibility criteria. There was high interstudy heterogeneity and risk of bias. The cumulative incidence of DRE was 25.0% (95% confidence interval [CI]: 16.8–34.3) in child studies but 14.6% (95% CI: 8.8–21.6) in adult/mixed age studies. The prevalence of DRE was 13.7% (95% CI: 9.2–19.0) in population/community-based populations but 36.3% (95% CI: 30.4–42.4) in clinic-based cohorts. Meta-regression confirmed that the prevalence of DRE was higher in clinic-based populations and in focal epilepsy. Multiple predictors and correlates of DRE were identified. The most reported of these were having a neurologic deficit, an abnormal EEG, and symptomatic epilepsy. The most reported genetic predictors of DRE were polymorphisms of the ABCB1 gene.ConclusionsOur observations provide a basis for estimating the incidence and prevalence of DRE, which vary between populations. We identified numerous putative DRE predictors and correlates. These findings are important to plan epilepsy services, including epilepsy surgery, a crucial treatment option for people with disabling seizures and DRE.

Abstract 16339: Heparin Bridging in Atrial Fibrillation Patients After Temporary Interruption of Warfarin: Evidence From Meta-analysis

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Karam Ayoub ◽  
Ramez Nairooz ◽  
Ahmed Almomani ◽  
Meera Marji ◽  
Maria Pino ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Confidence Interval ◽  
Major Bleeding ◽  
Odds Ratio ◽  
Observational Studies ◽  
Meta Analysis ◽  
Chads2 Score ◽  
Significant Difference ◽  
All Cause Mortality

Background: Patients with atrial fibrillation often require temporary interruption of warfarin for procedures. However, the efficacy of periprocedural heparin bridging in clinical practice is still unclear. Methods: We searched the literature for trials that compared heparin bridging to no bridging in atrial fibrillation patients for whom warfarin was temporarily interrupted. The incidence of all-cause mortality, thromboembolism, and major and all bleeding was included, and meta-analysis was performed. Results: A total of 11,924 patients with atrial fibrillation were included in 4 observational studies and 1 randomized trial. Mean CHADS2 score for the no heparin bridging group is 2.26 vs heparin bridging 2.26. At 30 days and up to 3 months, no bridging group in comparison to bridging group did not show any significant difference in mortality (odds ratio (OR), 1.22; 95% confidence interval (CI), 0.04-37.43; P = 0.91) or thromboembolism (OR, 0.69; 95% CI, 0.12-4.05; P = 0.68), but no bridging group showed significantly less major bleeding (OR, 0.43; 95% CI, 0.21-0.86; P = 0.02) and less all bleeding (OR, 0.43; 95% CI, 0.24-0.79; P = 0.007). Conclusion: Among atrial fibrillation patients anticoagulated with warfarin with an intermediate CHADS2 score requiring temporary interruption of warfarin for a procedure, periprocedural bridging with heparin was associated more with major and all bleeding when compared to no bridging, with no significant difference in mortality and thromboembolism.

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