152653 research outputs found
Sort by
Progression to decompensation of severe fibrosis compared to cirrhosis in MASLD:A Systematic Review and Meta-analysis
No full textBackground & Aims Metabolic associated steatotic liver disease (MASLD) is increasing in prevalence worldwide. Clinical practice is focused on identifying those with cirrhosis and monitoring for complications such as varices and hepatocellular carcinoma (HCC). Non-invasive tests of fibrosis differentiate between F3 and F4 fibrosis poorly. People with F3 fibrosis, may progress and develop decompensated liver disease. The aim of this review is to examine the progression to decompensated liver disease in patients with F3 fibrosis compared to those with F4 fibrosis. Methods Searches were carried out in four databases; articles were screened by two independent reviewers against pre-specified inclusion and exclusion criteria. Results29 studies were included in the review: 12 with paired liver biopsies, 2 progression to cirrhosis, 13 progression to decompensation, 2 portal hypertension in F3 fibrosis and 13 on HCC in F3 fibrosis. Rates of progression on paired biopsies were 16-30% over varied follow-up. Varices were found in 16% of patients with F3 fibrosis and rates of non-cirrhotic HCC varied from 37-75%. Pooled univariate HR for F3 progression and F4 progression to major adverse liver outcomes (MALO) were 8.15 (95%CI 3.42-19.43) and 38.16 (95%CI 11.58-125.76) respectively. Conclusions Progression to cirrhosis and decompensation events occurs in a significant proportion of patients with F3 fibrosis in MASLD. There is evidence of portal hypertension and HCC developing in F3 MASLD. Further work to identify risk groups, including those at risk of rapid progression to guide future clinical management are urgently required given the prognostic inflection of decompensated disease
Grading of Recommendations, Assessment, Development, and Evaluation guidance 44:strategies to enhance the utilization of randomized and nonrandomized studies in evidence syntheses of healthinterventions
No full textBackground and Objectives: Ideally, guideline developers and health technology assessment authors base intervention decisions on randomized controlled trials (RCTs). However, relying solely on RCTs is uncommon, especially for public health interventions and harms assessment. In these situations, nonrandomized studies of interventions (NRSIs) can provide valuable information. This article presents Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidance for integrating bodies of evidence RCT and NRSI in evidence syntheses of health interventions.Methods: Following standard GRADE methods, we developed this guidance through iterative discussions and examples with experts from the GRADE NRSI project group in multiple dedicated meetings. We presented findings of the group discussions for feedback at GRADE Working Group meetings in September 2023 and May 2024.Results: The resulting GRADE guidance outlines a structured approach: (1) assessing the certainty of evidence (CoE) after defining the number of decision thresholds and the target of the certainty rating; (2) evaluating congruency of effect estimates between RCTs and NRSIs; (3) identifying which GRADE domains are affected by certainty ratings to inform complementariness between RCTs and NRSIs and the overall CoE; and (4) deciding whether and how to use one or both types of studies.Conclusion: This GRADE guidance offers a structured and practical approach for integrating or not integrating RCTs and NRSIs in evidence syntheses. By addressing the interplay between affected GRADE domains and assessing the congruency of effects, it helps GRADE users determine when and how NRSIs can meaningfully complement or replace RCT evidence to inform certainty ratings and decision-making.</p
Boltzmann Sampling for Powersets without an Oracle
Get PDFWe show that powersets over structures with a bounded counting sequence can be sampled efficiently without evaluating the generating function. An algorithm is provided, implemented, and tested. Runtimes are comparable to existing Boltzmann samplers reported in the literature
Data sources:
Access Repository Dashboard
Do you manage University of Dundee Online Publications? Access insider analytics, issue reports and manage access to outputs from your repository in the CORE Repository Dashboard!