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Gorricho J, Leache L, Tamayo I, Sánchez-Sáez F, Almirantearena M, San Román E, Ballaz J, Turumbay J, Librero J. Data Resource Profile: Results Analysis Base of Navarre (BARDENA). Int J Epidemiol 2023; 52:e301-e307. [PMID: 37898988 PMCID: PMC10749752 DOI: 10.1093/ije/dyad144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/17/2023] [Indexed: 10/31/2023] Open
Affiliation(s)
- Javier Gorricho
- Servicio de Evaluación y Difusión de Resultados en Salud, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Leire Leache
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Ibai Tamayo
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
- Unidad de Metodología-Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Pamplona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
| | - Francisco Sánchez-Sáez
- School of Engineering and Technology, Universidad Internacional de La Rioja, Logroño, Spain
| | - Maite Almirantearena
- Servicio de Evaluación y Difusión de Resultados en Salud, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Edurne San Román
- Servicio de Tecnologías de Salud, Dirección General de Telecomunicaciones y Digitalización, Pamplona, Spain
| | - Jerónimo Ballaz
- Servicio de Tecnologías de Salud, Dirección General de Telecomunicaciones y Digitalización, Pamplona, Spain
| | - Javier Turumbay
- Subdirección de Sistemas y Tecnologías para la Salud, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Julián Librero
- Unidad de Metodología-Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Pamplona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
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Riefolo F, Castillo-Cano B, Martín-Pérez M, Messina D, Elbers R, Brink-Kwakkel D, Villalobos F, Ingrasciotta Y, Garcia-Poza P, Swart-Polinder K, Souverein P, Saiz LC, Bissacco CA, Leache L, Tari M, Crisafulli S, Grimaldi L, Vaz T, Gini R, Klungel O, Martín-Merino E. Effectiveness of homologous/heterologous booster COVID-19 vaccination schedules against severe illness in general population and clinical subgroups in three European countries. Vaccine 2023; 41:7007-7018. [PMID: 37858451 DOI: 10.1016/j.vaccine.2023.10.011] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/22/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
Using 4 data-sources (Spain, Italy, United Kingdom) data and a 1:1 matched cohort study, we aimed to estimate vaccine effectiveness (VE) in preventing SARS-CoV-2 infections with hospitalisations (±30 days) and death (±56 days) in general population and clinical subgroups with homologous/heterologous booster schedules (Comirnaty-BNT and Spikevax-MOD original COVID-19 vaccines) by comparison with unboosted individuals, during Delta and beginning of Omicron variants. Hazard Ratio (HR, by Cox models) and VE ([1-HR]*100) were calculated by inverse probability weights. Between December 2020-February 2022, in adults without prior SARS-CoV-2 infection, we matched 5.5 million people (>1 million with immunodeficiency, 343,727 with cancer) with a booster (3rd) dose by considering doses 1 and 2 vaccine brands and calendar time, age, sex, region, and comorbidities (immunodeficiency, cancer, severe renal disease, transplant recipient, Down Syndrome). We studied booster doses of BNT and MOD administered after doses 1 and 2 with BNT, MOD, or Oxford-AstraZeneca during a median follow-up between 9 and 16 weeks. BNT or MOD showed VE ranging from 70 to 86% across data sources as heterologous 3rd doses, whereas it was 42-88% as homologous 3rd doses. Depending on the severity and available follow-up, 3rd-dose effectiveness lasted between 1 and 5 months. In people with immunodeficiency and cancer, protection across data sources was detected with both heterologous (VE = 54-83%) and homologous (VE = 49-80%) 3rd doses. Overall, both heterologous and homologous 3rd doses with BTN or MOD showed additional protection against the severe effects of SARS-CoV-2 infections for the general population and for patients at potentially high risk of severe COVID-19 (elderly, people with immunodeficiency and cancer) in comparison with two doses schemes during Delta or early Omicron periods. The early VE after vaccination may be due to less testing among vaccinated pairs and unknown confounders, deserving cautious interpretation. The VE wane over time needs further in-depth research to properly envisage when or whether a booster of those vaccines should be administered.
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Affiliation(s)
- Fabio Riefolo
- Teamit Institute, Partnerships, Barcelona Health Hub, Barcelona, Spain; VAccine Monitoring Collaboration for Europe, Brussels, Belgium
| | | | - Mar Martín-Pérez
- Spanish Agency of Medicines and Medical Devices-AEMPS, Madrid, Spain
| | | | - Roel Elbers
- Department of Data Science and Biostatistics, University Medical Center Utrecht, the Netherlands
| | - Dorieke Brink-Kwakkel
- Department of Data Science and Biostatistics, University Medical Center Utrecht, the Netherlands
| | - Felipe Villalobos
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Ylenia Ingrasciotta
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | | | - Patrick Souverein
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands
| | - Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
| | - Carlo Alberto Bissacco
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
| | | | | | - Lamiae Grimaldi
- l'Assistance Publique-Hôpitaux de Paris (APHP), University Paris-Saclay, Paris, France
| | - Tiago Vaz
- Department of Data Science and Biostatistics, University Medical Center Utrecht, the Netherlands
| | - Rosa Gini
- VAccine Monitoring Collaboration for Europe, Brussels, Belgium; Agenzia Regionale di Sanita' Toscana, Florence, Italy
| | - Olaf Klungel
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands
| | - Elisa Martín-Merino
- VAccine Monitoring Collaboration for Europe, Brussels, Belgium; Spanish Agency of Medicines and Medical Devices-AEMPS, Madrid, Spain.
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Fernandez Elviro C, Longcroft-Harris B, Allin E, Leache L, Woo K, Bone JN, Pawliuk C, Tarabishi J, Carwana M, Wright M, Nama N. Conservative and Surgical Modalities in the Management of Pediatric Parapneumonic Effusion and Empyema: A Living Systematic Review and Network Meta-Analysis. Chest 2023; 164:1125-1138. [PMID: 37463660 DOI: 10.1016/j.chest.2023.06.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/08/2023] [Accepted: 06/08/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The optimal treatment for community-acquired childhood pneumonia complicated by empyema remains unclear. RESEARCH QUESTION In children with parapneumonic effusion or empyema, do hospital length of stay and other key clinical outcomes differ according to the treatment modality used? STUDY DESIGN AND METHODS A living systematic review of randomized controlled trials (RCTs) was conducted by searching the Cochrane Central Register of Controlled Trials, Embase, Latin American and Caribbean Health Sciences Literature, Ovid MEDLINE, and Web of Science Core Collection databases. Eligible RCTs included patients aged < 18 years and compared two of the following treatment modalities: antibiotics alone, chest tube insertion with or without fibrinolytics, video-assisted thoracoscopic surgery (VATS), and decortication via thoracotomy. A network meta-analysis was performed to evaluate treatment effects on hospital length of stay (LOS), the primary outcome. RESULTS Eleven trials including a total of 590 patients were selected for the network meta-analysis. Compared with a chest tube alone, a chest tube with fibrinolytics, thoracotomy, and VATS were all associated with shorter LOS, with a mean difference of 5.05 days (95% CI, 2.46-7.64), 6.33 days (95% CI, 3.17-9.50), and 5.86 days (95% CI, 3.38-8.35), respectively. No substantial differences in LOS were observed between the latter three interventions. None of the 11 RCTs compared antibiotics alone vs other types of treatment. Most trials reported peri-procedural complications and the need for reintervention, but the descriptions differed significantly between trials, preventing meta-analysis. In trials reporting health care-associated costs, fibrinolytics had cost advantages compared with VATS. Short- and long-term morbidity and mortality were very low, regardless of the treatment modality. INTERPRETATION The results of this network meta-analysis showed that a chest tube alone was associated with a longer LOS compared with other treatment modalities. The lower cost associated with a chest tube plus fibrinolytics warrants consideration when choosing between treatment options, given similar LOS and clinical outcomes compared with the other modalities.
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Affiliation(s)
- Clara Fernandez Elviro
- Division of Respiratory Medicine, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada; Department Woman-Mother-Child, Service of Paediatrics, Paediatric Pulmonology and Cystic Fibrosis Unit, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | | | - Emily Allin
- Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Leire Leache
- Unit of Innovation and Organization, Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Kellan Woo
- Vancouver-Fraser Medical Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jeffrey N Bone
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Colleen Pawliuk
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Jalal Tarabishi
- Department of Biological Sciences, Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Matthew Carwana
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada; Division of General Pediatrics, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Marie Wright
- Division of Respiratory Medicine, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nassr Nama
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA.
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Maestro C, Leache L, Gutiérrez-Valencia M, Saiz LC, Gómez H, Bacaicoa MC, Erviti J. Efficacy and safety of N-acetylcysteine for preventing post-intravenous contrast acute kidney injury in patients with kidney impairment: a systematic review and meta-analysis. Eur Radiol 2023; 33:6569-6581. [PMID: 37071164 DOI: 10.1007/s00330-023-09577-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES N-Acetylcysteine (NAC) may confer protection against post-contrast acute kidney injury (PC-AKI), although evidence is sparse and conflicting. The objective was to analyse the evidence on the efficacy and safety of NAC vs no administration of NAC in preventing PC-AKI in patients with pre-existing kidney impairment undergoing a non-interventional radiological examination requiring intravenous (IV) contrast media (CM) administration. METHODS We carried out a systematic review including randomised controlled trials (RCTs) published in MEDLINE, EMBASE, and Clinicaltrials.gov up to May 2022. The primary outcome was PC-AKI. Secondary outcomes included the requirement of renal replacement therapy, all-cause mortality, serious adverse events, and length of hospital stay. We conducted the meta-analyses using the Mantel-Haenszel method and following a random-effects model. RESULTS NAC was not associated with a significant reduction in PC-AKI (RR 0.47, 95%CI 0.20 to 1.11; 8 studies; 545 participants; I2: 56%; low certainty), all-cause mortality (RR 0.67, 95%CI 0.29 to 1.54; 2 studies; 129 participants; very low certainty), or length of hospital stay (mean difference 9.2 days, 95%CI - 20.08 to 38.48; 1 study; 42 participants; very low certainty). The impact on other outcomes could not be determined. CONCLUSIONS NAC may not reduce the risk of PC-AKI or all-cause mortality in people with kidney impairment who receive an IV CM prior to radiological imaging, although the certainty of the evidence is very low or low. CLINICAL RELEVANCE STATEMENT Our review concludes that prophylactic administration of N-acetylcysteine may not significantly reduce the risk of acute kidney injury in patients with kidney impairment receiving an intravenous contrast media prior to non-interventional radiological imaging, which may support decision making in this common clinical scenario. KEY POINTS • N-Acetylcysteine may not significantly reduce the risk of acute kidney injury in patients with kidney impairment receiving an intravenous contrast media prior to non-interventional radiological imaging. • All-cause mortality and length of hospital stay would not be decreased with the administration of N-Acetylcysteine in this setting.
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Affiliation(s)
| | - Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Tudela Street 20, first floor, 31003, Pamplona, Navarre, Spain.
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain.
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Tudela Street 20, first floor, 31003, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Tudela Street 20, first floor, 31003, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Helena Gómez
- Radiology Service, University Hospital of Navarre, Navarre Health Service, Pamplona, Navarre, Spain
| | - Maria Carmen Bacaicoa
- Radiology Service, University Hospital of Navarre, Navarre Health Service, Pamplona, Navarre, Spain
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Tudela Street 20, first floor, 31003, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
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Leache L, Gutiérrez-Valencia M, Saiz LC, Uriz J, Bolado F, García-Erce JA, Cantarelli L, Erviti J. Letter: Albumin-Does formulation matter? Authors' reply. Aliment Pharmacol Ther 2023; 57:1484-1485. [PMID: 37243460 DOI: 10.1111/apt.17546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Juan Uriz
- Department of Gastroenterology and Hepatology, University Hospital of Navarre, Pamplona, Spain
| | - Federico Bolado
- Department of Gastroenterology and Hepatology, University Hospital of Navarre, Pamplona, Spain
| | - José Antonio García-Erce
- Navarra's Blood and Tissue Bank, Navarre Health Service, Pamplona, Spain
- Grupo Español de Rehabilitación Multimodal (GERM), Aragon Health Science Institute, PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Lorenzo Cantarelli
- Department of Hospital Pharmacy, University Hospital of Canary Islands (CHUC), Santa Cruz de Tenerife, Spain
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
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Calvo DM, Saiz LC, Leache L, Celaya MC, Gutiérrez-Valencia M, Alonso A, Erviti J, Alzueta N, Echeverría A, Garjón J, Fontela C, Sanz L, Acín MT, Fernández ML, Gómez N. Effect of the combination of diuretics, renin-angiotensin-aldosterone system inhibitors, and non-steroidal anti-inflammatory drugs or metamizole (triple whammy) on hospitalisation due to acute kidney injury: a nested case-control study. Pharmacoepidemiol Drug Saf 2023. [PMID: 36960493 DOI: 10.1002/pds.5621] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE Concomitant use of diuretics, renin-angiotensin-aldosterone system (RAAS) inhibitors, and non-steroidal anti-inflammatory drugs (NSAIDs) or metamizole, known as "triple whammy" (TW), has been associated with an increased risk of acute kidney injury (AKI). Nevertheless, there is still uncertainty on its impact in hospitalisation and mortality. The aim of the study was to analyse the association between exposure to TW and the risk of hospitalisation for AKI, all-cause mortality and the need for renal replacement therapy (RRT). METHODS A case-control study nested in a cohort of adults exposed to at least one diuretic or RAAS inhibitor between 2009-2018 was carried out within the Pharmacoepidemiological Research Database for Public Health Systems (BIFAP). Patients hospitalised for AKI between 2010-2018 (cases) were matched with up to 10 patients of the same age, sex and region of Spain who had not been hospitalised for AKI as of the date of hospitalisation for AKI of the matching case (controls). The association between TW exposure vs non-exposure to TW and outcome variables was analysed using logistic regression models. RESULTS A total of 480,537 participants (44,756 cases and 435,781 controls) were included (mean age: 79 years). The risk of hospitalisation for AKI was significantly higher among those exposed to TW [adjusted odds ratio (aOR) 1.36, 95% confidence interval (95%CI) 1.32-1.40], being higher with current (aOR 1.60, 95%CI 1.52-1.69) and prolonged exposure (aOR 1.65, 95%CI 1.55-1.75). No significant association was found with the need of RRT. Unexpectedly, mortality was lower in those exposed to TW [aOR 0.81, 95%CI 0.71-0.93], which may be influenced by other causes. CONCLUSION Vigilance should be increased when diuretics, RAAS inhibitors, and NSAIDs or metamizole are used concomitantly, especially in patients at risk such as elderly patients.
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Affiliation(s)
| | - Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Maria Concepción Celaya
- Subdirectorate of Pharmacy and Health Benefits, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Natalia Alzueta
- Subdirectorate of Pharmacy and Health Benefits, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Amaya Echeverría
- Subdirectorate of Pharmacy and Health Benefits, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Javier Garjón
- Subdirectorate of Pharmacy and Health Benefits, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Carmen Fontela
- Pharmacy Service. Donostia University Hospital, OSI Donostialdea, Osakidetza, San Sebastián, Spain
| | - Lorea Sanz
- Subdirectorate of Pharmacy and Health Benefits, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Maria Teresa Acín
- Subdirectorate of Pharmacy and Health Benefits, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Maria Loreto Fernández
- Nephrology Service, Navarre University Hospital, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Nerea Gómez
- Nephrology Service, Navarre University Hospital, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
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Leache L, Gutiérrez-Valencia M, Saiz LC, Uriz J, Bolado F, García-Erce JA, Cantarelli L, Erviti J. Meta-analysis: Efficacy and safety of albumin in the prevention and treatment of complications in patients with cirrhosis. Aliment Pharmacol Ther 2023; 57:620-634. [PMID: 36524316 DOI: 10.1111/apt.17344] [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: 10/27/2022] [Revised: 11/13/2022] [Accepted: 11/26/2022] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Albumin is used in multiple situations in patients with cirrhosis, but the evidence of its benefit is not always clear. The aim was to synthesise the evidence on the efficacy and safety of albumin compared to other treatments or no active intervention in cirrhotic patients. MATERIALS AND METHODS We conducted a systematic review including randomised controlled trials (RCTs) published in MEDLINE, EMBASE and CENTRAL up to May 2022. We assessed all-cause mortality, liver transplant, cirrhosis complications of any type and serious adverse events (SAEs). Second, AEs, hospital readmission, length of hospital stay, need for paracentesis and quality of life (QoL) were evaluated. Meta-analyses with Mantel-Haenszel method and random-effects model were performed. RESULTS Fifty studies (5118 participants) were included. Albumin was associated with a reduction in mortality in cirrhotic patients with spontaneous bacterial peritonitis (SBP) (RR 0.49, 95% CI 0.32-0.75; low certainty) and hepatic encephalopathy (HE) (RR 0.53, 95% CI 0.34-0.83; low certainty) when compared to no administration of albumin, but not in other scenarios. In general, no additional benefit of albumin was found in liver transplants, SAEs or cirrhosis complications (low/very low certainty). Long-term administration (>3 months) of albumin led to a reduction in cirrhosis complications (RR 0.75, 95% CI 0.57-0.97; low certainty), hospital readmissions, length of hospital stay, need for paracentesis and improvement of QoL. CONCLUSION Albumin may reduce mortality risk in cirrhotic patients with SBP or HE. No benefit was identified in reducing liver transplants or SAEs. Long-term administration may be associated with a lower risk of cirrhosis complications and need for paracentesis.
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Affiliation(s)
- Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Juan Uriz
- Department of Gastroenterology and Hepatology, University Hospital of Navarre, Pamplona, Spain
| | - Federico Bolado
- Department of Gastroenterology and Hepatology, University Hospital of Navarre, Pamplona, Spain
| | - José Antonio García-Erce
- Navarra's Blood and Tissue Bank, Navarre Health Service, Pamplona, Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Aragon Health Science Institute, PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Lorenzo Cantarelli
- Department of Hospital Pharmacy, University Hospital of Canary Islands (CHUC), Santa Cruz de Tenerife, Spain
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
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Saiz LC, Erviti J, Leache L, Gutiérrez-Valencia M. Restoring Study PRGF: a randomized clinical trial on plasma rich in growth factors for knee osteoarthritis. Trials 2023; 24:37. [PMID: 36653802 PMCID: PMC9850713 DOI: 10.1186/s13063-022-07049-3] [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: 09/21/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A randomized clinical trial assessing plasma rich in growth factors (PRGF) versus hyaluronic acid for knee osteoarthritis was published in 2012 (sponsor trial ID BTI-01-EC/07/ART). Evidence of misreporting was discovered following access to unpublished materials. In accordance with the principles of the Restoring Invisible and Abandoned Trials (RIAT) initiative, we sought to re-analyse Study PRGF based on the unpublished trial materials. METHODS Reanalysis was made possible primarily based on two unpublished study documents (original trial protocol and final report) obtained from the authors of the original publication. A call to action, calling on the authors to correct the original publication, was publicly issued. The involved ethics committee was repeatedly approached and extensive discussion with the authors ensued. After no agreement to correct the paper was reached, we embarked on this restoration. Reanalysis was focused on providing updated analyses for efficacy and safety. RESULTS The efficacy of PRGF was not statistically different from hyaluronic acid for any prespecified primary or secondary efficacy outcomes. For the primary endpoint, the percent of patients on PRGF compared to hyaluronic acid with a decrease >40% in WOMAC pain subscale score was 5.4% higher; 95% confidence interval (CI) -10.4% to 21.3%; p = 0.505. This differs from the original publication that reported a non-prespecified primary endpoint (decrease >50% in WOMAC pain subscale score) which was 14.1% higher; 95% CI 0.5 to 27.6%; p=0.044. Furthermore, in contrast to the article statement that all the adverse events disappeared in 48 h, at least two patients in the hyaluronic arm and five patients in the PRGF arm reported persistent adverse events. Inadequate disclosure of conflicts of interest in the original publication was also noted. CONCLUSIONS This reanalysis of Study PRGF found no clinically or statistically significant benefit from PRGF compared to hyaluronic acid. The restoration of Study PRGF shows the urgency of important changes to trial reporting and oversight practices. In the future, timely access to all clinical trial documents is needed to minimize the risk of reporting bias. Similarly, ethics committees should be ready to intervene whenever a case of potential misconduct arises. TRIAL REGISTRATION This is a RIAT project, whose original trial was approved and registered on 19 December 2007 by the Ethics Committee of the Basque Country, Spain, as BTI-01-EC/07/ART.
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Affiliation(s)
- Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain ,grid.508840.10000 0004 7662 6114IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain ,grid.508840.10000 0004 7662 6114IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain ,grid.508840.10000 0004 7662 6114IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain ,grid.508840.10000 0004 7662 6114IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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Saiz LC, Leache L, Gutiérrez-Valencia M, Erviti J, Rojas Reyes MX. Efficacy and safety of chimeric antigen receptor T-cell (CAR-T) therapy in hematologic malignancies: a living systematic review on comparative studies. Ther Adv Hematol 2023; 14:20406207231168211. [PMID: 37138698 PMCID: PMC10150428 DOI: 10.1177/20406207231168211] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/05/2023] [Indexed: 05/05/2023] Open
Abstract
Background Chimeric antigen receptor T-cell (CAR-T) cell therapies have been claimed to be curative in responsive patients. Nonetheless, response rates can vary according to different characteristics, and these therapies are associated with important adverse events such as cytokine release syndrome, neurologic adverse events, and B-cell aplasia. Objectives This living systematic review aims to provide a timely, rigorous, and continuously updated synthesis of the evidence available on the role of CAR-T therapy for the treatment of patients with hematologic malignancies. Design A systematic review with meta-analysis of randomized controlled trials (RCTs) and comparative non-randomized studies of interventions (NRSI), evaluating the effect of CAR-T therapy versus other active treatments, hematopoietic stem cell transplantation, standard of care (SoC) or any other intervention, was performed in patients with hematologic malignancies. The primary outcome is overall survival (OS). Certainty of the evidence was determined using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Data sources and Methods Searches were performed in the Epistemonikos database, which collates information from multiple sources to identify systematic reviews and their included primary studies, including Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, DARE, HTA Database, Campbell database, JBI Database of Systematic Reviews and Implementation Reports, EPPI-Centre Evidence Library. A manual search was also carried out. We included the evidence published up to 1 July 2022. Results We included the evidence published up to 1 July 2022. We considered 139 RCTs and 1725 NRSI as potentially eligible. Two RCTs (N = 681) comparing CAR-T therapy with SoC in patients with recurrent/relapsed (R/R) B-cell lymphoma were included. RCTs did not show statistical differences in OS, serious adverse events, or total adverse events with grade ⩾ 3. Higher complete response with substantial heterogeneity [risk ratio = 1.59; 95% confidence interval (CI) = (1.30-1.93); I 2 = 89%; 2 studies; 681 participants; very low certainty evidence] and higher progression-free survival [hazard ratio for progression or death = 0.49; 95% CI = (0.37-0.65); 1 study; 359 participants; moderate certainty evidence] were reported with CAR-T therapies. Nine NRSI (N = 540) in patients with T or B-cell acute lymphoblastic leukemia or R/R B-cell lymphoma were also included, providing secondary data. In general, the GRADE certainty of the evidence for main outcomes was mostly low or very low. Conclusion So far, assuming important limitations in the level of certainty due to scarce and heterogenous comparative studies, CAR-T therapies have shown some benefit in terms of progression-free survival, but no overall survival, in patients with R/R B-cell lymphoma. Despite one-arm trials have already facilitated approval of CAR-T cell treatments, additional evidence from large comparative studies is still needed to better characterize the benefit-harm ratio of the use of CAR-T in a variety of patient populations with hematological malignancies. Registration https://doi.org/10.12688/openreseurope.14390.1. PROSPERO/OSF Preregistration 10.17605/OSF.IO/V6HDX.
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Affiliation(s)
| | - Leire Leache
- Unit of Innovation and Organization, Navarre
Health Service, Pamplona, Spain; Navarra Institute for Health Research
(IdiSNA), Pamplona, Spain
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre
Health Service, Pamplona, Spain; Navarra Institute for Health Research
(IdiSNA), Pamplona, Spain
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre
Health Service, Pamplona, Spain; Navarra Institute for Health Research
(IdiSNA), Pamplona, Spain
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10
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Saiz LC, Leache L, Gutiérrez-Valencia M, Erviti J. Is chimaeric antigen receptor T-cell therapy really superior to standard of care as second-line therapy for large B-cell lymphoma? Br J Haematol 2023; 200:e6-e7. [PMID: 36281751 DOI: 10.1111/bjh.18505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/28/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
| | - Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
| | | | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
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Erviti J, Wright J, Bassett K, Ben-Eltriki M, Jauca C, Saiz LC, Leache L, Gutiérrez-Valencia M, Perry TL. Restoring mortality data in the FOURIER cardiovascular outcomes trial of evolocumab in patients with cardiovascular disease: a reanalysis based on regulatory data. BMJ Open 2022; 12:e060172. [PMID: 36585131 PMCID: PMC9809302 DOI: 10.1136/bmjopen-2021-060172] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The FOURIER trial showed a benefit of the PCSK9 inhibitor evolocumab over placebo with respect to cardiovascular outcomes in patients with cardiovascular disease. However, we observed some inconsistencies between the information in the Clinical Study Report (CSR) and that in the 2017 primary trial results publication. We aimed to restore the mortality data in the FOURIER trial based on the information contained in the death narratives in the CSR. METHODS Mortality data in the primary results publication were compared with that in the CSR. In cases of discrepancy between the sources, an independent committee blindly readjudicated and restored the cause of death according to the information in the CSR narratives. RESULTS For 360/870 deaths (41.4%), the cause of death adjudicated by the FOURIER clinical events committee differed from that declared by the local clinical investigator. When comparing the CSR information with the 2017 primary results publication, we found 11 more deaths from myocardial infarction in the evolocumab group (36 vs 25) and 3 less deaths in the placebo group (27 vs 30, respectively). In the CSR, the number of deaths due to cardiac failure in the evolocumab group was almost double those in the placebo group (31 vs 16). While cardiac and vascular deaths were not assessed as separate outcomes in the original trial analysis, after readjudication, we noted that cardiac deaths were numerically, but non-significantly, higher in the evolocumab group (113) than in the placebo group (88; relative risk (RR) 1.28, 95% CI 0.97 to 1.69, p=0.078), whereas non-cardiac vascular deaths were similar between groups (37 in each; RR 1.00, 95% CI 0.63 to 1.58, p=0.999). The reported HR for cardiovascular mortality in the original trial analysis was 1.05 (95% CI 0.88 to 1.25); after readjudication, we found a greater (although still non-significant) relative increase in cardiovascular mortality in the evolocumab treatment group (RR 1.20, 95% CI 0.95 to 1.51, p=0.13). CONCLUSION After readjudication, deaths of cardiac origin were numerically higher in the evolocumab group than in the placebo group in the FOURIER trial, suggesting possible cardiac harm. At the time the trial was terminated early, a non-significantly higher risk of cardiovascular mortality was observed with evolocumab, which was numerically greater in our readjudication. A complete restoration of the FOURIER trial data is required. In the meantime, clinicians should be sceptical about prescribing evolocumab for patients with established atherosclerotic cardiovascular disease. TRIAL REGISTRATION NUMBERS NCT01764633.
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Affiliation(s)
- Juan Erviti
- Innovation and Organization Unit, Navarre Health Service, Pamplona, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - James Wright
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ken Bassett
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohamed Ben-Eltriki
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ciprian Jauca
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Luis Carlos Saiz
- Innovation and Organization Unit, Navarre Health Service, Pamplona, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Leire Leache
- Innovation and Organization Unit, Navarre Health Service, Pamplona, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Marta Gutiérrez-Valencia
- Innovation and Organization Unit, Navarre Health Service, Pamplona, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Thomas L Perry
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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Saiz LC, Gorricho J, Garjón J, Celaya MC, Erviti J, Leache L. Blood pressure targets for the treatment of people with hypertension and cardiovascular disease. Cochrane Database Syst Rev 2022; 11:CD010315. [PMID: 36398903 PMCID: PMC9673465 DOI: 10.1002/14651858.cd010315.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND This is the third update of the review first published in 2017. Hypertension is a prominent preventable cause of premature morbidity and mortality. People with hypertension and established cardiovascular disease are at particularly high risk, so reducing blood pressure to below standard targets may be beneficial. This strategy could reduce cardiovascular mortality and morbidity but could also increase adverse events. The optimal blood pressure target in people with hypertension and established cardiovascular disease remains unknown. OBJECTIVES To determine if lower blood pressure targets (systolic/diastolic 135/85 mmHg or less) are associated with reduction in mortality and morbidity compared with standard blood pressure targets (140 mmHg to 160mmHg/90 mmHg to 100 mmHg or less) in the treatment of people with hypertension and a history of cardiovascular disease (myocardial infarction, angina, stroke, peripheral vascular occlusive disease). SEARCH METHODS For this updated review, we used standard, extensive Cochrane search methods. The latest search date was January 2022. We applied no language restrictions. SELECTION CRITERIA We included randomized controlled trials (RCTs) with more than 50 participants per group that provided at least six months' follow-up. Trial reports had to present data for at least one primary outcome (total mortality, serious adverse events, total cardiovascular events, cardiovascular mortality). Eligible interventions involved lower targets for systolic/diastolic blood pressure (135/85 mmHg or less) compared with standard targets for blood pressure (140 mmHg to 160 mmHg/90 mmHg to 100 mmHg or less). Participants were adults with documented hypertension and adults receiving treatment for hypertension with a cardiovascular history for myocardial infarction, stroke, chronic peripheral vascular occlusive disease, or angina pectoris. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included seven RCTs that involved 9595 participants. Mean follow-up was 3.7 years (range 1.0 to 4.7 years). Six of seven RCTs provided individual participant data. None of the included studies was blinded to participants or clinicians because of the need to titrate antihypertensive drugs to reach a specific blood pressure goal. However, an independent committee blinded to group allocation assessed clinical events in all trials. Hence, we assessed all trials at high risk of performance bias and low risk of detection bias. We also considered other issues, such as early termination of studies and subgroups of participants not predefined, to downgrade the certainty of the evidence. We found there is probably little to no difference in total mortality (risk ratio (RR) 1.05, 95% confidence interval (CI) 0.91 to 1.23; 7 studies, 9595 participants; moderate-certainty evidence) or cardiovascular mortality (RR 1.03, 95% CI 0.82 to 1.29; 6 studies, 9484 participants; moderate-certainty evidence). Similarly, we found there may be little to no differences in serious adverse events (RR 1.01, 95% CI 0.94 to 1.08; 7 studies, 9595 participants; low-certainty evidence) or total cardiovascular events (including myocardial infarction, stroke, sudden death, hospitalization, or death from congestive heart failure (CHF)) (RR 0.89, 95% CI 0.80 to 1.00; 7 studies, 9595 participants; low-certainty evidence). The evidence was very uncertain about withdrawals due to adverse effects. However, studies suggest more participants may withdraw due to adverse effects in the lower target group (RR 8.16, 95% CI 2.06 to 32.28; 3 studies, 801 participants; very low-certainty evidence). Systolic and diastolic blood pressure readings were lower in the lower target group (systolic: mean difference (MD) -8.77 mmHg, 95% CI -12.82 to -4.73; 7 studies, 8657 participants; diastolic: MD -4.50 mmHg, 95% CI -6.35 to -2.65; 6 studies, 8546 participants). More drugs were needed in the lower target group (MD 0.56, 95% CI 0.16 to 0.96; 5 studies, 7910 participants), but blood pressure targets at one year were achieved more frequently in the standard target group (RR 1.20, 95% CI 1.17 to 1.23; 7 studies, 8699 participants). AUTHORS' CONCLUSIONS We found there is probably little to no difference in total mortality and cardiovascular mortality between people with hypertension and cardiovascular disease treated to a lower compared to a standard blood pressure target. There may also be little to no difference in serious adverse events or total cardiovascular events. This suggests that no net health benefit is derived from a lower systolic blood pressure target. We found very limited evidence on withdrawals due to adverse effects, which led to high uncertainty. At present, evidence is insufficient to justify lower blood pressure targets (135/85 mmHg or less) in people with hypertension and established cardiovascular disease. Several trials are still ongoing, which may provide an important input to this topic in the near future.
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Affiliation(s)
- Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Javier Gorricho
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
- Healthcare Business Intelligence Service, Navarre Health Service, Pamplona, Spain
| | - Javier Garjón
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
- Medicines Advice and Information Service, Navarre Health Service, Pamplona, Spain
| | - Mª Concepción Celaya
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
- Drug Prescribing Service, Navarre Health Service, Pamplona, Spain
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
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Leache L, Gutiérrez-Valencia M, Enguita-Germán M, Librero J, Gorricho J, Jericó C, García-Erce JA. COVID-19 infection and complications according to ABO blood group in the elderly: A population-based subcohort and meta-analysis. Vox Sang 2022; 117:1230-1234. [PMID: 35843888 PMCID: PMC9349979 DOI: 10.1111/vox.13334] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/24/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES It is reported that ABO antibodies have a role in COVID-19 infection and severity; however, ABO antibody titres vary with advanced age. The aim was to analyse the association between ABO blood group and risk of COVID-19 infection and complications in elderly patients, and to contrast this data with findings in the overall adult population. MATERIALS AND METHODS A prospective cohort study of the Navarre (Spain) population aged ≥60 years and a meta-analysis of published studies including participants of ≥60 years were carried out. RESULTS In the Navarre elderly population, a higher risk of COVID-19 infection was identified in the A versus non-A and O group and lower risk in O versus non-O, with no significant association between hospitalization, intensive care unit admission or mortality and any of the blood groups, results that coincide with those of the overall Navarre adult population. The meta-analyses using studies that included participants of ≥60 years demonstrated a higher risk of hospitalization and mortality in A versus non-A and a lower mortality risk with B versus non-B. Similar mortality results were found in the meta-analyses of the overall adult population. CONCLUSION There are no relevant differences between the overall adult population and population aged ≥60 years in the risk of COVID-19 infection and severity according to ABO blood groups, suggesting that age-related changes in ABO would be of limited clinical significance.
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Affiliation(s)
- Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Mónica Enguita-Germán
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Unit of Methodology, Navarrabiomed, Pamplona, Spain.,University Hospital of Navarra (HUN), Pamplona, Spain.,Public University of Navarre (UPNA), Pamplona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Julián Librero
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Unit of Methodology, Navarrabiomed, Pamplona, Spain.,University Hospital of Navarra (HUN), Pamplona, Spain.,Public University of Navarre (UPNA), Pamplona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Javier Gorricho
- Service of Evaluation and Dissemination of Results, Navarre Health Service, Pamplona, Spain
| | - Carlos Jericó
- Department of Internal Medicine, Hospital Sant Joan Despí-Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Jose Antonio García-Erce
- Blood and Tissue Bank of Navarre, Navarre Health Service, Pamplona, Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Aragon Health Sciences Institute (IACS), Zaragoza, Spain.,PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
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Enguita-Germán M, Librero J, Leache L, Gutiérrez-Valencia M, Tamayo I, Jericó C, Gorricho J, García-Erce JA. Role of the AB0 blood group in COVID-19 infection and complications: A population-based study. Transfus Apher Sci 2022; 61:103357. [PMID: 35148968 PMCID: PMC8762836 DOI: 10.1016/j.transci.2022.103357] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/05/2022] [Accepted: 01/15/2022] [Indexed: 12/16/2022]
Abstract
Since the beginning of the COVID-19 pandemic, the ABO blood group has been described as a possible biological marker of susceptibility for the disease. This study evaluates the role of ABO group on the risk of SARS-CoV-2 infection and related complications in a population-based cohort including 87,090 subjects from the Navarre population (Northern Spain) with no history of SARS-CoV-2 infection and with known ABO blood group, after one year of the pandemic (May 2020 - May 2021). The risk of infection, hospitalization, Intensive Care Unit (ICU) admission and death was analyzed using multivariate logistic regression, adjusting for possible confounding variables. A lower risk of infection was observed in group 0 vs non-0 groups [OR 0.94 (95 %CI 0.90-0.99)], a higher risk of infection in group A vs non-A groups [OR 1.09 (95 %CI 1.04-1.15)] and a higher risk of infection in group A vs group 0 [OR 1.08 (95CI 1.03-1.14)] (when the 4 groups are analyzed separately). No association was observed between blood groups and hospitalization, ICU admission, or death in SARS-CoV-2 infected subjects. Regarding the risk of SARS-CoV-2 infection, we observed a protective role of group O and a greater risk in the A group.
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Affiliation(s)
- Mónica Enguita-Germán
- Unidad de Metodología. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain.
| | - Julián Librero
- Unidad de Metodología. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain.
| | - Leire Leache
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Spain.
| | | | - Ibai Tamayo
- Unidad de Metodología. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain.
| | - Carlos Jericó
- Department of Internal Medicine, Hospital Sant Joan Despí-Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain.
| | - Javier Gorricho
- Servicios de Evaluación y Difusión de Resultados, Servicio Navarro de Salud-Osasunbidea, Spain.
| | - José Antonio García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain; Grupo idiPAZ de «Investigación en PBM», Madrid, Spain.
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Gutiérrez-Valencia M, Leache L, Saiz LC. [Review of the validity of fall risk assessment scales in hospitalised patients]. Rev Esp Geriatr Gerontol 2022; 57:186-194. [PMID: 35589476 DOI: 10.1016/j.regg.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/12/2021] [Revised: 02/23/2022] [Accepted: 03/16/2022] [Indexed: 06/15/2023]
Abstract
Falls in the hospital setting are a major health problem due to their high prevalence and their physical, functional, psychological or economic consequences. Since 1990s, different fall risk assessment scales have been developed to detect high-risk patients, which are also applied in the hospital setting. The aim of this review is to analyse the validity of different scales for assessing fall risk in adults in the hospital setting, especially in elderly patients. Following a literature search in April 2021, 36 primary studies were found that analysed the validity of the Downton, Morse, HendrichII, Stratify and Tinetti scales. Meta-analyses of sensitivity and specificity showed a high heterogeneity that does not allow recommending a specific tool that can be considered as standard in acute inpatients.
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Affiliation(s)
- Marta Gutiérrez-Valencia
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, España.
| | - Leire Leache
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Pamplona, España
| | - Luis Carlos Saiz
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, España
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Luri M, Leache L, Gastaminza G, Idoate A, Ortega A. A systematic review of drug allergy alert systems. Int J Med Inform 2022; 159:104673. [PMID: 34990941 DOI: 10.1016/j.ijmedinf.2021.104673] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/12/2021] [Accepted: 12/20/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Drug allergy alert systems (DAAS), have been considered an effective strategy to reduce preventable adverse drug events (ADEs), improving patient's safety. To date, no review has been conducted analyzing characteristics of DAAS in the hospital setting. Therefore, the aim of this study is to identify, describe and summarize the DAAS used in hospitals. The secondary objectives are to analyse drug allergy alerts (DAA) characteristics, the override rate (OvR) and the clinical consequences of alert overrides. METHODS Searches were conducted in Medline and Cochrane Library to identify studies describing DAAS. Systems characteristics, generated alerts, DAA, OvR, and its clinical consequences were extracted and analyzed. RESULTS Twenty-eight articles were included in the review. Seventeen different electronic DAAS were identified, of which 53% were commercially available. Systems differed in drug allergy information and rules for generating alerts. DAA were generally interruptive, triggered by non-exact match at drug prescribing and when ignored, an override reason was mandatory. The OvR ranged from 43.7% to 97%. The main override reason given by providers was that 'patient had previously tolerated or had taken the drug without allergic reaction'. Clinical consequences of overriding DAA were only analyzed in four studies, with an ADE incidence between 0% and 6%. CONCLUSIONS Different DAAS are used in hospitals with some degree of heterogeneity. Accurate and updated drug allergy information is important to generate only high value alerts. A regular review of DAAS and a standardization of alert rules, alert information and override reasons are necessary to optimize systems. Future studies should evaluate the impact of the DAAS aspects on preventing ADEs.
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Affiliation(s)
- Marta Luri
- Hospital Pharmacy Services, Clínica Universidad de Navarra, Pio XII Avenue 36, Zip code: 31008, Pamplona, Spain.
| | - Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Tudela Street 20, 1(st) floor, Zip code: 31003, Pamplona, Spain.
| | - Gabriel Gastaminza
- Allergology Department, Clínica Universidad de Navarra, Pio XII Avenue 36, Zip code: 31008, Pamplona, Spain.
| | - Antonio Idoate
- Hospital Pharmacy Services, Clínica Universidad de Navarra, Pio XII Avenue 36, Zip code: 31008, Pamplona, Spain.
| | - Ana Ortega
- Hospital Pharmacy Services, Clínica Universidad de Navarra, Pio XII Avenue 36, Zip code: 31008, Pamplona, Spain.
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17
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Gutiérrez‐Valencia M, Leache L, Librero J, Jericó C, Enguita Germán M, García‐Erce JA. ABO blood group and risk of COVID-19 infection and complications: A systematic review and meta-analysis. Transfusion 2022; 62:493-505. [PMID: 34773411 PMCID: PMC8661771 DOI: 10.1111/trf.16748] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Marta Gutiérrez‐Valencia
- Unit of Innovation and OrganizationNavarre Health ServicePamplonaSpain,Navarra Institute for Health Research (IdiSNA)PamplonaSpain
| | - Leire Leache
- Unit of Innovation and OrganizationNavarre Health ServicePamplonaSpain
| | - Julián Librero
- Navarra Institute for Health Research (IdiSNA)PamplonaSpain,Navarrabiomed ‐ Complejo Hospitalario de Navarra – UPNAPamplonaSpain,Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC)MadridSpain
| | - Carlos Jericó
- Department of Internal MedicineHospital Sant Joan Despí‐Moisès Broggi, Consorci Sanitari Integral. Sant Joan DespíBarcelonaSpain
| | - Mónica Enguita Germán
- Navarrabiomed ‐ Complejo Hospitalario de Navarra – UPNAPamplonaSpain,Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC)MadridSpain
| | - Jose Antonio García‐Erce
- Navarra's Blood and Tissue BankNavarre Health ServicePamplonaSpain,Grupo Español de Rehabilitación Multimodal (GERM)Aragon Health Science Institute, PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ)MadridSpain
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18
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Leache L, Gutiérrez-Valencia M, Finizola RM, Infante E, Finizola B, Pardo Pardo J, Flores Y, Granero R, Arai KJ. Pharmacotherapy for hypertension-induced left ventricular hypertrophy. Cochrane Database Syst Rev 2021; 10:CD012039. [PMID: 34628642 PMCID: PMC8502530 DOI: 10.1002/14651858.cd012039.pub3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hypertension is the leading preventable risk factor for cardiovascular disease and premature death worldwide. One of the clinical effects of hypertension is left ventricular hypertrophy (LVH), a process of cardiac remodelling. It is estimated that over 30% of people with hypertension also suffer from LVH, although the prevalence rates vary according to the LVH diagnostic criteria. Severity of LVH is associated with a higher prevalence of cardiovascular disease and an increased risk of death. The role of antihypertensives in the regression of left ventricular mass has been extensively studied. However, uncertainty exists regarding the role of antihypertensive therapy compared to placebo in the morbidity and mortality of individuals with hypertension-induced LVH. OBJECTIVES To assess the effect of antihypertensive pharmacotherapy compared to placebo or no treatment on morbidity and mortality of adults with hypertension-induced LVH. SEARCH METHODS Cochrane Hypertension's Information Specialist searched the following databases for studies: Cochrane Hypertension Specialised Register (to 26 September 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library; 2020, Issue 9), Ovid MEDLINE (1946 to 22 September 2020), and Ovid Embase (1974 to 22 September 2020). We searched the World Health Organization International Clinical Trials Registry Platform and the ClinicalTrials.gov for ongoing trials. We also searched Epistemonikos (to 19 February 2021), LILACS BIREME (to 19 February 2021), and Clarivate Web of Science (to 26 February 2021), and contacted authors and funders of the identified trials to obtain additional information and individual participant data. There were no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) with at least 12 months' follow-up comparing antihypertensive pharmacological therapy (monotherapy or in combination) with placebo or no treatment in adults (18 years of age or older) with hypertension-induced LVH were eligible for inclusion. The trials must have analysed at least one primary outcome (all-cause mortality, cardiovascular events, or total serious adverse events) to be considered for inclusion. DATA COLLECTION AND ANALYSIS Two review authors screened the search results, with any disagreements resolved by consensus amongst all review authors. Two review authors carried out the data extraction and analyses. We assessed risk of bias of the included studies following Cochrane methodology. We used the GRADE approach to assess the certainty of the body of evidence. MAIN RESULTS We included three multicentre RCTs. We selected 930 participants from the included studies for the analyses, with a mean follow-up of 3.8 years (range 3.5 to 4.3 years). All of the included trials performed an intention-to-treat analysis. We obtained evidence for the review by identifying the population of interest from the trials' total samples. None of the trials provided information on the cause of LVH. The intervention varied amongst the included trials: hydrochlorothiazide plus triamterene with the possibility of adding alpha methyldopa, spironolactone, or olmesartan. Placebo was administered to participants in the control arm in two trials, whereas participants in the control arm of the remaining trial did not receive any add-on treatment. The evidence is very uncertain regarding the effect of additional antihypertensive pharmacological therapy compared to placebo or no treatment on mortality (14.3% intervention versus 13.6% control; risk ratio (RR) 1.02, 95% confidence interval (CI) 0.74 to 1.40; 3 studies; 930 participants; very low-certainty evidence); cardiovascular events (12.6% intervention versus 11.5% control; RR 1.09, 95% CI 0.77 to 1.55; 3 studies; 930 participants; very low-certainty evidence); and hospitalisation for heart failure (10.7% intervention versus 12.5% control; RR 0.82, 95% CI 0.57 to 1.17; 2 studies; 915 participants; very low-certainty evidence). Although both arms yielded similar results for total serious adverse events (48.9% intervention versus 48.1% control; RR 1.02, 95% CI 0.89 to 1.16; 3 studies; 930 participants; very low-certainty evidence) and total adverse events (68.3% intervention versus 67.2% control; RR 1.07, 95% CI 0.86 to 1.34; 2 studies; 915 participants), the incidence of withdrawal due to adverse events may be significantly higher with antihypertensive drug therapy (15.2% intervention versus 4.9% control; RR 3.09, 95% CI 1.69 to 5.66; 1 study; 522 participants; very low-certainty evidence). Sensitivity analyses limited to blinded trials, trials with low risk of bias in core domains, and trials with no funding from the pharmaceutical industry did not change the results of the main analyses. Limited evidence on the change in left ventricular mass index prevented us from drawing any firm conclusions. AUTHORS' CONCLUSIONS We are uncertain about the effects of adding additional antihypertensive drug therapy on the morbidity and mortality of participants with LVH and hypertension compared to placebo. Although the incidence of serious adverse events was similar between study arms, additional antihypertensive therapy may be associated with more withdrawals due to adverse events. Limited and low-certainty evidence requires that caution be used when interpreting the findings. High-quality clinical trials addressing the effect of antihypertensives on clinically relevant variables and carried out specifically in individuals with hypertension-induced LVH are warranted.
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Affiliation(s)
- Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
| | | | - Rosa M Finizola
- Unit of Special Projects, Cardiovascular Association Centroccidental, Barquisimeto, Venezuela
| | - Elizabeth Infante
- Unit of Systems, Cardiovascular Association Centroccidental, Barquisimeto, Venezuela
| | - Bartolome Finizola
- General Coordination, Cardiovascular Association Centroccidental, Barquisimeto, Venezuela
| | - Jordi Pardo Pardo
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, Ottawa, Canada
| | - Yris Flores
- Echocardiography Department and Cardiac Tomography Department, Cardiovascular Association Centroccidental, Barquisimeto, Venezuela
| | | | - Kaduo J Arai
- Coronary Care Unit, Cardiovascular Association Centroccidental, Barquisimeto, Venezuela
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Leache L, Arrizibita O, Gutiérrez-Valencia M, Saiz LC, Erviti J, Librero J. Incidence of Attention Deficit Hyperactivity Disorder (ADHD) Diagnoses in Navarre (Spain) from 2003 to 2019. Int J Environ Res Public Health 2021; 18:ijerph18179208. [PMID: 34501798 PMCID: PMC8431029 DOI: 10.3390/ijerph18179208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 12/04/2022]
Abstract
(1) Background: Attention deficit hyperactivity disorder (ADHD) constitutes one of the leading mental health and behavioral disorders in childhood and adolescence. The main objective of this study was to analyze the time trend in the incidence of ADHD diagnoses in Navarre (Spain) from 2003 to 2019 in children and adolescents from 5 to 19 years old. Additionally, the seasonal trends of ADHD incidence and ADHD prevalence were determined. (2) Methods: A population-based observational retrospective study, which included people born between 1991 and 2011 and who attended compulsory education between 2007 and 2017 in Navarre (Spain), was carried out with data from both the Education and Health Department databases. (3) Results: The incidence rate increased from 4.18 cases per 1000 person-years in 2003 to 7.43 cases per 1000 person-years in 2009, before decreasing progressively to 2.1 cases per 1000 person-years in 2019. A peak incidence rate at 7–8 years of age was observed, which is consistent across the study period and for both genders. Males were more than twice as likely to be diagnosed with ADHD than females, with similar time trends in both. A seasonal pattern in ADHD diagnosis was found, with peaks in February–March and the lowest rates in the summer months. Inattentive cases were much more frequent than hyperactive cases, whereas combined cases remained low across the study period. (4) Conclusions: In this age-period-cohort analysis, a clear period and age effect was observed. We found a decreasing trend in the ADHD incidence rate since 2015. Further research is needed to confirm whether a change of trend is occurring globally.
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Affiliation(s)
- Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, 31003 Pamplona, Navarre, Spain; (L.L.); (M.G.-V.); (L.C.S.)
| | | | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, 31003 Pamplona, Navarre, Spain; (L.L.); (M.G.-V.); (L.C.S.)
- Navarre Institute for Health Research (IdiSNA), 31008 Pamplona, Navarre, Spain
| | - Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, 31003 Pamplona, Navarre, Spain; (L.L.); (M.G.-V.); (L.C.S.)
| | - Juan Erviti
- Therapeutics Initiative, Department of Anesthesiology, Pharmaceuticals and Therapeutics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Julián Librero
- Navarrabiomed Biomedical Research Centre, Navarre Institute for Health Research (IdiSNA), Complejo Hospitalario de Navarra, Public University of Navarre (UPNA), 31008 Pamplona, Navarre, Spain
- Correspondence: ; Tel.: +34-848-428-392
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Abstract
CONTEXT Urinary tract infections (UTIs) are the most common bacterial infections in infants <2 months of age. However, there are no clear guidelines on the appropriate duration of antibiotics in this age group. OBJECTIVE In this living systematic review, we compared different durations of parenteral antibiotics (≤3 vs >3 days) in neonates and young infants (<2 months) with UTIs. The secondary objective was to compare different durations of total antibiotic courses (≤10 vs >10 days). DATA SOURCES MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Google Scholar, and gray literature, up to March 2, 2021. STUDY SELECTION Citations were screened in triplicate by using a crowdsourcing methodology, to identify randomized controlled trials and observational studies. DATA EXTRACTION Data were extracted by 2 crowd members and verified by an expert investigator. Outcomes were pooled via random-effects models. RESULTS A total of 10 334 citations were screened, and 12 eligible studies were identified. A total of 59 of 3480 (1.7% [95% confidence interval (CI): 1.3% to 2.2%]) infants had a UTI recurrence within 30 days after short parenteral treatment (≤3 days), and 47 of 1971 (2.4% [95% CI: 1.8% to 3.2%]) after longer courses. The pooled adjusted odds ratio for UTI recurrence with a short versus long duration of parenteral antibiotics was 1.02 (95% CI: 0.64 to 1.61; P = .95; n = 5451). A total of 5 studies assessed the risk of recurrence on the basis of the total duration of antibiotics (≤10 vs >10 days) with no significant differences (pooled odds ratio: 1.29 [95% CI: 0.45 to 3.66; P = .63; n = 491). CONCLUSIONS On the basis of retrospective studies and Grading of Recommendations, Assessment, Development, and Evaluation level low evidence, short and long duration of parenteral antibiotics were associated with a similar risk of UTI recurrence in infants <2 months.
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Affiliation(s)
- Nassr Nama
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada .,Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Colleen Pawliuk
- Evidence to Innovation, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
| | - Manish Sadarangani
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Vaccine Evaluation Center
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21
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Saiz LC, Gorricho J, Garjón J, Celaya MC, Erviti J, Leache L. Blood pressure targets for the treatment of people with hypertension and cardiovascular disease. Cochrane Database Syst Rev 2020; 9:CD010315. [PMID: 32905623 PMCID: PMC8094921 DOI: 10.1002/14651858.cd010315.pub4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND This is the second update of the review first published in 2017. Hypertension is a prominent preventable cause of premature morbidity and mortality. People with hypertension and established cardiovascular disease are at particularly high risk, so reducing blood pressure to below standard targets may be beneficial. This strategy could reduce cardiovascular mortality and morbidity but could also increase adverse events. The optimal blood pressure target in people with hypertension and established cardiovascular disease remains unknown. OBJECTIVES To determine if lower blood pressure targets (135/85 mmHg or less) are associated with reduction in mortality and morbidity as compared with standard blood pressure targets (140 to 160/90 to 100 mmHg or less) in the treatment of people with hypertension and a history of cardiovascular disease (myocardial infarction, angina, stroke, peripheral vascular occlusive disease). SEARCH METHODS For this updated review, the Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials (RCTs) up to November 2019: Cochrane Hypertension Specialised Register, CENTRAL, MEDLINE (from 1946), Embase (from 1974), and Latin American Caribbean Health Sciences Literature (LILACS) (from 1982), along with the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov. We also contacted authors of relevant papers regarding further published and unpublished work. We applied no language restrictions. SELECTION CRITERIA We included RCTs with more than 50 participants per group that provided at least six months' follow-up. Trial reports had to present data for at least one primary outcome (total mortality, serious adverse events, total cardiovascular events, cardiovascular mortality). Eligible interventions involved lower targets for systolic/diastolic blood pressure (135/85 mmHg or less) compared with standard targets for blood pressure (140 to 160/90 to 100 mmHg or less). Participants were adults with documented hypertension and adults receiving treatment for hypertension with a cardiovascular history for myocardial infarction, stroke, chronic peripheral vascular occlusive disease, or angina pectoris. DATA COLLECTION AND ANALYSIS Two review authors independently assessed search results and extracted data using standard methodological procedures expected by Cochrane. We used GRADE to assess the quality of the evidence. MAIN RESULTS We included six RCTs that involved 9484 participants. Mean follow-up was 3.7 years (range 1.0 to 4.7 years). All RCTs provided individual participant data. None of the included studies was blinded to participants or clinicians because of the need to titrate antihypertensives to reach a specific blood pressure goal. However, an independent committee blinded to group allocation assessed clinical events in all trials. Hence, we assessed all trials at high risk of performance bias and low risk of detection bias. Other issues such as early termination of studies and subgroups of participants not predefined were also considered to downgrade the quality evidence. We found there is probably little to no difference in total mortality (risk ratio (RR) 1.06, 95% confidence interval (CI) 0.91 to 1.23; 6 studies, 9484 participants; moderate-quality evidence) or cardiovascular mortality (RR 1.03, 95% CI 0.82 to 1.29; 6 studies, 9484 participants; moderate-quality evidence). Similarly, we found there may be little to no differences in serious adverse events (RR 1.01, 95% CI 0.94 to 1.08; 6 studies, 9484 participants; low-quality evidence) or total cardiovascular events (including myocardial infarction, stroke, sudden death, hospitalization, or death from congestive heart failure) (RR 0.89, 95% CI 0.80 to 1.00; 6 studies, 9484 participants; low-quality evidence). The evidence was very uncertain about withdrawals due to adverse effects. However, studies suggest more participants may withdraw due to adverse effects in the lower target group (RR 8.16, 95% CI 2.06 to 32.28; 2 studies, 690 participants; very low-quality evidence). Systolic and diastolic blood pressure readings were lower in the lower target group (systolic: mean difference (MD) -8.90 mmHg, 95% CI -13.24 to -4.56; 6 studies, 8546 participants; diastolic: MD -4.50 mmHg, 95% CI -6.35 to -2.65; 6 studies, 8546 participants). More drugs were needed in the lower target group (MD 0.56, 95% CI 0.16 to 0.96; 5 studies, 7910 participants), but blood pressure targets were achieved more frequently in the standard target group (RR 1.21, 95% CI 1.17 to 1.24; 6 studies, 8588 participants). AUTHORS' CONCLUSIONS We found there is probably little to no difference in total mortality and cardiovascular mortality between people with hypertension and cardiovascular disease treated to a lower compared to a standard blood pressure target. There may also be little to no difference in serious adverse events or total cardiovascular events. This suggests that no net health benefit is derived from a lower systolic blood pressure target. We found very limited evidence on withdrawals due to adverse effects, which led to high uncertainty. At present, evidence is insufficient to justify lower blood pressure targets (135/85 mmHg or less) in people with hypertension and established cardiovascular disease. Several trials are still ongoing, which may provide an important input to this topic in the near future.
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Affiliation(s)
- Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
| | - Javier Gorricho
- Planning, Evaluation and Management Service, General Directorate of Health, Government of Navarre, Pamplona, Spain
| | - Javier Garjón
- Medicines Advice and Information Service, Navarre Health Service, Pamplona, Spain
| | | | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
| | - Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
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Leache L, Saiz LC, Gutiérrez-Valencia M, Erviti J. [Orphan drugs, incentives and uncertainty about their risk-benefit balance]. Gac Sanit 2020; 35:208-209. [PMID: 32723521 DOI: 10.1016/j.gaceta.2020.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Leire Leache
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Pamplona, España.
| | - Luis Carlos Saiz
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Pamplona, España
| | | | - Juan Erviti
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Pamplona, España
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Saiz LC, Erviti J, Leache L, Gutiérrez-Valencia M. Misreporting of a Plasma-Rich-in-Growth-Factors Trial on Knee Osteoarthritis. Arthroscopy 2020; 36:622-623. [PMID: 32139042 DOI: 10.1016/j.arthro.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/06/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
| | - Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
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24
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Affiliation(s)
- Juan Erviti
- Unit of Innovation and Organization Navarre Health Service Spain
| | - Luis Carlos Saiz
- Unit of Innovation and Organization Navarre Health Service Spain
| | - Leire Leache
- Unit of Innovation and Organization Navarre Health Service Spain
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Finizola RM, Infante E, Finizola B, Pardo Pardo J, Flores Y, Granero R, Arai KJ, Leache L. Pharmacotherapy for hypertension-induced left ventricular hypertrophy. Hippokratia 2019. [DOI: 10.1002/14651858.cd012039.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Rosa M Finizola
- Cardiovascular Association Centroccidental; Unit of Special Projects; Prolongation career 17 with street 12 Barrio La Feria Barquisimeto Lara Venezuela 3001
| | - Elizabeth Infante
- Cardiovascular Association Centroccidental; Unit of Systems; Prolongation career 17 with street 12 Barrio La Feria Barquisimeto Lara Venezuela 3001
| | - Bartolome Finizola
- Cardiovascular Association Centroccidental; General Coordination; Prolongation career 17 with street 12 Barrio La Feria Barquisimeto Lara Venezuela 3001
| | - Jordi Pardo Pardo
- Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus; Centre for Practice-Changing Research; 501 Smyth Road, Box 711 Room L1258 Ottawa ON Canada K1H 8L6
| | - Yris Flores
- Cardiovascular Association Centroccidental; Echocardiography Department and Cardiac Tomography Department; Prolongation career 17 with street 12 Barrio La Feria Barquisimeto Lara Venezuela 3001
| | - Ricardo Granero
- ASCARDIO; Epidemiology; Carrera 17 con Calle 11 Barquisimeto Lara Venezuela 3001
| | - Kaduo J Arai
- Cardiovascular Association Centroccidental; Coronary Care Unit; Prolongation career 17 with street 12 Barrio La Feria Barquisimeto Lara Venezuela 3001
| | - Leire Leache
- Navarre Health Service; Unit of Innovation and Organization; Pamplona Spain
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Erviti J, Saiz LC, Salzwedel DM, Leache L, Pijoan JI, Menéndez Orenga M, Méndez-López I. Blood pressure targets for hypertension in people with chronic renal disease. Hippokratia 2019. [DOI: 10.1002/14651858.cd008564.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Juan Erviti
- Navarre Health Service; Unit of Innovation and Organization; Pamplona Navarra Spain 31002
| | - Luis Carlos Saiz
- Navarre Health Service; Unit of Innovation and Organization; Pamplona Navarra Spain 31002
| | - Douglas M Salzwedel
- University of British Columbia; Department of Anesthesiology, Pharmacology and Therapeutics; 300C - 2176 Health Sciences Mall Vancouver BC Canada V6T 1Z3
| | - Leire Leache
- Navarre Health Service; Unit of Innovation and Organization; Pamplona Navarra Spain 31002
| | - José I Pijoan
- Hospital Universitario Cruces; Plaza de Cruces s/n Barakaldo Pais Vasco Spain 48903
| | - Miguel Menéndez Orenga
- Servicio Madrileño de Salud; Primary Care; San Martín de Porres Street, n.º 8 Madrid Spain 28035
| | - Iván Méndez-López
- Hospital of Estella, Navarre Health Service; Internal Medicine; C/Santa Soria 31200 Estella/Lizarra Navarra Spain 31200
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Leache L, Aquerreta I, Aldaz A, Monedero P, Idoate A, Ortega A. Clinical and economic impact of clinical pharmacist interventions regarding antimicrobials on critically ill patients. Res Social Adm Pharm 2019; 16:1285-1289. [PMID: 31327737 DOI: 10.1016/j.sapharm.2019.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/07/2019] [Accepted: 07/07/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Incorporating in the Intensive Care Unit (ICU) a clinical pharmacist who performs interventions on antimicrobials may be cost-effective. OBJECTIVES To evaluate the clinical and economic impact of clinical pharmacist interventions on antimicrobials in an ICU. To identify drug related problems and medication errors detected by the pharmacist. METHODS A retrospective observational study was performed to analyze drug related problems, medication errors and clinical pharmacist interventions related to antimicrobials in adults admitted to an ICU in a 5-month period. The economic impact of pharmacist interventions was estimated considering difference in cost derived from antimicrobial treatment, adverse drug events and clinical pharmacist time. RESULTS A total of 212 drug related problems were detected in 114 patients, 18 being medication errors. Clinical pharmacist developed one intervention for each problem identified. 204 interventions (96.2%) were considered important with improved patient care and 7 (3.3%) very important. No negative impact of any intervention was identified. Physicians accepted 97.6% of the interventions. A potential saving of 10,905 € was estimated as a result of pharmacist interventions and 4.8 € were avoided per euro invested in a clinical pharmacist. CONCLUSIONS A clinical pharmacist performing interventions on antimicrobials in the ICU has a positive impact on patient care and decreases costs.
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Affiliation(s)
- Leire Leache
- Pharmacy Service, Clínica Universidad de Navarra, Avenida Pío XII 36, Pamplona, 31008, Spain.
| | - Irene Aquerreta
- Pharmacy Service, Clínica Universidad de Navarra, Avenida Pío XII 36, Pamplona, 31008, Spain.
| | - Azucena Aldaz
- Pharmacy Service, Clínica Universidad de Navarra, Avenida Pío XII 36, Pamplona, 31008, Spain.
| | - Pablo Monedero
- Department of Anaesthesia and Intensive Care, Clínica Universidad de Navarra, Avenida Pío XII 36, Pamplona, 31008, Spain.
| | - Antonio Idoate
- Pharmacy Service, Clínica Universidad de Navarra, Avenida Pío XII 36, Pamplona, 31008, Spain.
| | - Ana Ortega
- Pharmacy Service, Clínica Universidad de Navarra, Avenida Pío XII 36, Pamplona, 31008, Spain.
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Saiz LC, Gorricho J, Garjón J, Celaya MC, Erviti J, Leache L. Blood pressure targets for the treatment of people with hypertension and cardiovascular disease. Cochrane Database Syst Rev 2018; 7:CD010315. [PMID: 30027631 PMCID: PMC6513382 DOI: 10.1002/14651858.cd010315.pub3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND This is the first update of the review published in 2017. Hypertension is a prominent preventable cause of premature morbidity and mortality. People with hypertension and established cardiovascular disease are at particularly high risk, so reducing blood pressure to below standard targets may be beneficial. This strategy could reduce cardiovascular mortality and morbidity but could also increase adverse events. The optimal blood pressure target in people with hypertension and established cardiovascular disease remains unknown. OBJECTIVES To determine if 'lower' blood pressure targets (≤ 135/85 mmHg) are associated with reduction in mortality and morbidity as compared with 'standard' blood pressure targets (≤ 140 to 160/90 to 100 mmHg) in the treatment of people with hypertension and a history of cardiovascular disease (myocardial infarction, angina, stroke, peripheral vascular occlusive disease). SEARCH METHODS For this updated review, the Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials up to February 2018: Cochrane Hypertension Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1946), Embase (from 1974), and Latin American Caribbean Health Sciences Literature (LILACS) (from 1982), along with the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov. We also contacted authors of relevant papers regarding further published and unpublished work. We applied no language restrictions. SELECTION CRITERIA We included randomized controlled trials (RCTs) that included more than 50 participants per group and provided at least six months' follow-up. Trial reports had to present data for at least one primary outcome (total mortality, serious adverse events, total cardiovascular events, cardiovascular mortality). Eligible interventions involved lower targets for systolic/diastolic blood pressure (≤ 135/85 mmHg) compared with standard targets for blood pressure (≤ 140 to 160/90 to 100 mmHg).Participants were adults with documented hypertension and adults receiving treatment for hypertension with a cardiovascular history for myocardial infarction, stroke, chronic peripheral vascular occlusive disease, or angina pectoris. DATA COLLECTION AND ANALYSIS Two review authors independently assessed search results and extracted data using standard methodological procedures expected by Cochrane. MAIN RESULTS We included six RCTs that involved a total of 9484 participants. Mean follow-up was 3.7 years (range 1.0 to 4.7 years). All RCTs provided individual participant data.We found no change in total mortality (risk ratio (RR) 1.06, 95% confidence interval (CI) 0.91 to 1.23) or cardiovascular mortality (RR 1.03, 95% CI 0.82 to 1.29; moderate-quality evidence). Similarly, we found no differences in serious adverse events (RR 1.01, 95% CI 0.94 to 1.08; low-quality evidence) or total cardiovascular events (including myocardial infarction, stroke, sudden death, hospitalization, or death from congestive heart failure) (RR 0.89, 95% CI 0.80 to 1.00; low-quality evidence). Studies reported more participant withdrawals due to adverse effects in the lower target arm (RR 8.16, 95% CI 2.06 to 32.28; very low-quality evidence). Blood pressures were lower in the lower target group by 8.9/4.5 mmHg. More drugs were needed in the lower target group, but blood pressure targets were achieved more frequently in the standard target group. AUTHORS' CONCLUSIONS We found no evidence of a difference in total mortality, serious adverse events, or total cardiovascular events between people with hypertension and cardiovascular disease treated to a lower or to a standard blood pressure target. This suggests that no net health benefit is derived from a lower systolic blood pressure target. We found very limited evidence on adverse events, which led to high uncertainty. At present, evidence is insufficient to justify lower blood pressure targets (≤ 135/85 mmHg) in people with hypertension and established cardiovascular disease. More trials are needed to examine this topic.
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Affiliation(s)
- Luis Carlos Saiz
- Navarre Health ServiceUnit of Innovation and OrganizationPamplonaNavarreSpain
| | - Javier Gorricho
- General Directorate of Health, Government of NavarrePlanning, Evaluation and Management ServicePamplonaNavarraSpain
| | - Javier Garjón
- Navarre Health ServiceDrug Prescribing ServicePlaza de la Paz s/n 4ªPamplonaNavarraSpain31002
| | - Mª Concepción Celaya
- Navarre Health ServiceDrug Prescribing ServicePlaza de la Paz s/n 4ªPamplonaNavarraSpain31002
| | - Juan Erviti
- Navarre Health ServiceUnit of Innovation and OrganizationPamplonaNavarreSpain
| | - Leire Leache
- Navarre Health ServiceUnit of Innovation and OrganizationPamplonaNavarreSpain
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Leache L, Aquerreta I, Aldaz A, Idoate A, Ortega A. Evidence of clinical and economic impact of pharmacist interventions related to antimicrobials in the hospital setting. Eur J Clin Microbiol Infect Dis 2018; 37:799-822. [PMID: 29322274 DOI: 10.1007/s10096-017-3166-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 12/11/2017] [Indexed: 01/13/2023]
Abstract
The purpose of this paper was to review the literature regarding the clinical and economic impact of pharmacist interventions (PIs) related to antimicrobials in the hospital setting. A PubMed literature search from January 2003 to March 2016 was conducted using the terms pharmacist* or clinical pharmacist* combined with antimicrobial* or antibiotic* or anti-infective*. Comparative studies that assessed the clinical and/or economic impact of PIs on antimicrobials in the hospital setting were reviewed. Outcomes were classified as: treatment-related outcomes (TROs), clinical outcomes (COs), cost and microbiological outcomes (MOs). Acceptance of pharmacist recommendations by physicians was collected. PIs were grouped into patient-specific recommendations (PSRs), policy, and education. Studies' risk of bias was analyzed using Cochrane's tool. Twenty-three studies were evaluated. All of them had high risk of bias. The design in most cases was uncontrolled before and after. PSRs were included in every study; five also included policy and four education. Significant impact of PI was found in 14 of the 18 studies (77.8%) that evaluated costs, 15 of the 20 studies (75.0%) that assessed TROs, 12 of the 22 studies (54.5%) that analyzed COs, and one of the two studies (50.0%) that evaluated MOs. None of the studies found significant negative impact of PIs. It could not be concluded that adding other strategies to PSRs would improve results. Acceptance of recommendations varied from 70 to 97.5%. Pharmacists improve TROs and COs, and decrease costs. Additional research with a lower risk of bias is unlikely to change this conclusion. Future research should focus on identifying the most efficient interventions.
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Affiliation(s)
- L Leache
- Pharmacy Services, Clínica Universidad de Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain.
| | - I Aquerreta
- Pharmacy Services, Clínica Universidad de Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain
| | - A Aldaz
- Pharmacy Services, Clínica Universidad de Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain
| | - A Idoate
- Pharmacy Services, Clínica Universidad de Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain
| | - A Ortega
- Pharmacy Services, Clínica Universidad de Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain
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Abstract
PURPOSE A case of severe bilateral sensorineural hearing loss associated with oral morphine is reported. SUMMARY A 52-year-old Spanish man was admitted to the intensive care unit with a Glasgow Coma Scale score of 3, a fever, and sudden hearing loss with tinnitus in both ears. His medical history included type 2 diabetes mellitus, depression, sleep disorder, and hypertension. The patient also had pyelonephritis in 2011 and pulmonary embolism in 2014, requiring the placement of an inferior vena cava filter and chronic anticoagulation. His hearing loss appeared after the initiation of oral morphine, specifically on the eighth day of treatment, with increasing dosages of up to 120 mg daily. We did not find any other possible causes of the hearing loss. Ototoxicity is an adverse reaction of ibuprofen and acetaminophen, but the patient received only three doses of ibuprofen 600 mg and did not require acetaminophen. The patient's other medications did not have ototoxicity as an adverse reaction, and the patient confirmed not to have received any salicylate product. Brain magnetic resonance imaging discarded other possible causes of hearing loss. Our patient's hearing loss did not resolve after opioid discontinuation, and the use of hearing aids was necessary. According to the Naranjo et al. adverse drug reaction probability scale, this event would be classified as "probable." CONCLUSION A 52-year-old man developed tinnitus and hearing loss after receiving high doses of oral morphine sulfate. His hearing loss did not fully resolve after the discontinuation of morphine, and he required the use of hearing aids.
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Affiliation(s)
- Leire Leache
- Pharmacy Services, Clínica Universidad de Navarra, Pamplona, Spain
| | - Irene Aquerreta
- Pharmacy Services, Clínica Universidad de Navarra, Pamplona, Spain.
| | - Libe Moraza
- Pharmacy Services, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ana Ortega
- Pharmacy Services, Clínica Universidad de Navarra, Pamplona, Spain
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Abstract
OBJECTIVE to determine the incidence of linezolid-induced haematological toxicity and study the influence of renal clearance on its appearance and the preventive effect of pyridoxine. METHODS a retrospective observational study was conducted. Every patient treated with linezolid in a university hospital during 6 months was included. Haematological toxicity was defined as a decrease of 25% in hemoglobin, of 25% in platelets and/or 50% in neutrophils from baseline. The incidence of haematological toxicity and the percentage decrease in analytical variables were compared in patients with and without renal failure (creatinine clearance lower than 50 mL/min), using the 30 mL/min threshold, and with or without pyridoxine; using Chi -Square and U Mann-Whitney tests, respectively. RESULTS thirty-eight patients were evaluated. Sixteen (42%) presented haematological toxicity (2 due to a decrease in haemoglobin, 9 in platelets and 8 in neutrophils). Two patients (5%) discontinued treatment due to thrombocytopenia. Toxicity incidence was similar in patients with and without renal failure, 42% vs 42%, p = 0.970, with more or less than 30 ml/min, 67% vs 40%, p = 0.369, or with or without pyridoxine, 47.8% vs 33%, p = 0.376. Patients with renal failure had a significantly greater reduction in platelet count, p = 0.0185. CONCLUSION forty-two percent of patients had haematological toxicity, being more frequent platelets and neutrophils reduction. This was not significantly higher in patients with renal failure or in those without pyridoxine. Greater reduction in platelet count was observed in patients with renal failure.
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Affiliation(s)
- Libe Moraza
- Pharmacy Unit, Clínica Universidad de Navarra, Pamplona, Spain..
| | - Leire Leache
- Pharmacy Unit, Clínica Universidad de Navarra, Pamplona, Spain..
| | - Irene Aquerreta
- Pharmacy Unit, Clínica Universidad de Navarra, Pamplona, Spain..
| | - Ana Ortega
- Pharmacy Unit, Clínica Universidad de Navarra, Pamplona, Spain..
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