12 research outputs found
RAMESES publication standards: realist syntheses
No full textAbstract Background There is growing interest in realist synthesis as an alternative systematic review method. This approach offers the potential to expand the knowledge base in policy-relevant areas - for example, by explaining the success, failure or mixed fortunes of complex interventions. No previous publication standards exist for reporting realist syntheses. This standard was developed as part of the RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) project. The project's aim is to produce preliminary publication standards for realist systematic reviews. Methods We (a) collated and summarized existing literature on the principles of good practice in realist syntheses; (b) considered the extent to which these principles had been followed by published syntheses, thereby identifying how rigor may be lost and how existing methods could be improved; (c) used a three-round online Delphi method with an interdisciplinary panel of national and international experts in evidence synthesis, realist research, policy and/or publishing to produce and iteratively refine a draft set of methodological steps and publication standards; (d) provided real-time support to ongoing realist syntheses and the open-access RAMESES online discussion list so as to capture problems and questions as they arose; and (e) synthesized expert input, evidence syntheses and real-time problem analysis into a definitive set of standards. Results We identified 35 published realist syntheses, provided real-time support to 9 on-going syntheses and captured questions raised in the RAMESES discussion list. Through analysis and discussion within the project team, we summarized the published literature and common questions and challenges into briefing materials for the Delphi panel, comprising 37 members. Within three rounds this panel had reached consensus on 19 key publication standards, with an overall response rate of 91%. Conclusion This project used multiple sources to develop and draw together evidence and expertise in realist synthesis. For each item we have included an explanation for why it is important and guidance on how it might be reported. Realist synthesis is a relatively new method for evidence synthesis and as experience and methodological developments occur, we anticipate that these standards will evolve to reflect further methodological developments. We hope that these standards will act as a resource that will contribute to improving the reporting of realist syntheses. To encourage dissemination of the RAMESES publication standards, this article is co-published in the Journal of Advanced Nursing and is freely accessible on Wiley Online Library (http://www.wileyonlinelibrary.com/journal/jan). Please see related article http://www.biomedcentral.com/1741-7015/11/20 and http://www.biomedcentral.com/1741-7015/11/22</p
Intrauterine growth restriction with abnormal umbilical artery Dopplers: A harbinger for preeclampsia
No full textObjective: To determine whether abnormal umbilical artery Doppler velocimetry in the setting of unexplained intrauterine growth restriction (IUGR) is predictive of preeclampsia. Methods: This was a retrospective cohort study of singleton pregnancies diagnosed with unexplained IUGR between 2005 and 2008. Subjects were classified based on the presence or absence of abnormal Dopplers. The proportions of preeclampsia in the two groups were compared. Results: A total of 268 cases were included in the study. There were 57 cases with abnormal umbilical artery Dopplers. Of those, preeclampsia was diagnosed in 8 (14.0percent) cases. In turn, there were 211 cases with normal Dopplers. Of those, preeclampsia was diagnosed in 9 (4.3percent) cases. After controlling for age and parity, patients with abnormal Dopplers were 2.9 times more likely to be diagnosed with preeclampsia. Conclusions: Cases of unexplained IUGR with abnormal umbilical artery Dopplers appear to be at increased risk of preeclampsia compared to those with normal Dopplers. © 2012 Informa UK, Ltd.ACOG Committee on Practice Bulletins-Obstetrics, 2002, OBSTET GYNECOL, V99, P159, DOI DOI 10.1016-S0029-7844(01)01747-1.PUBMED:16175681; Baschat AA, 2000, AM J OBSTET GYNECOL, V182, P154, DOI 10.1016-S0002-9378(00)70505-9; BATTAGLI.FC, 1967, J PEDIATR, V71, P159, DOI 10.1016-S0022-3476(67)80066-0; BILARDO CM, 1990, AM J OBSTET GYNECOL, V162, P115; BURKE G, 1990, BRIT MED J, V300, P1044; CASPER FW, 1995, EXP CLIN ENDOCR DIAB, V103, P292; CUNNINGHAM FG, 1992, NEW ENGL J MED, V326, P927; Dekker GA, 1999, CLIN OBSTET GYNECOL, V42, P422, DOI 10.1097-00003081-199909000-00002; Duckitt K, 2005, BRIT MED J, V330, P565, DOI 10.1136-bmj.38380.674340.E0; GERRETSEN G, 1981, BRIT J OBSTET GYNAEC, V88, P876, DOI 10.1111-j.1471-0528.1981.tb02222.x; Huppertz B, 2008, HYPERTENSION, V51, P970, DOI 10.1161-HYPERTENSIONAHA.107.107607; KARSDORP VHM, 1994, LANCET, V344, P1664, DOI 10.1016-S0140-6736(94)90457-X; Kaufmann P, 2003, BIOL REPROD, V69, P1, DOI 10.1095-bioreprod.102.014977; Kleinbaum D, 1982, EPIDEMIOLOGIC RES; Matsuo K, 2007, AM J PERINAT, V24, P257, DOI 10.1055-s-2007-976548; Maulik D, 2005, DOPPLER ULTRASOUND O; McCowan LME, 2000, BRIT J OBSTET GYNAEC, V107, P916, DOI 10.1111-j.1471-0528.2000.tb11092.x; MEEKINS JW, 1994, BRIT J OBSTET GYNAEC, V101, P669, DOI 10.1111-j.1471-0528.1994.tb13182.x; Mitani M, 2009, J OBSTET GYNAECOL RE, V35, P882, DOI 10.1111-j.1447-0756.2009.01120.x; Moore-Maxwell CA, 2004, GYNECOL ONCOL, V92, P708, DOI 10.1016-j.ygyno.2003.10.048; Ness RB, 2006, AM J OBSTET GYNECOL, V195, P40, DOI 10.1016-j.ajog.2005.07.049; Nugent CE, 1996, OBSTET GYNECOL, V87, P829; PATTINSON RC, 1994, BRIT J OBSTET GYNAEC, V101, P114, DOI 10.1111-j.1471-0528.1994.tb13075.x; PEETERS LLH, 1979, AM J OBSTET GYNECOL, V135, P637; ROBERTS JM, 1993, LANCET, V341, P1447, DOI 10.1016-0140-6736(93)90889-O; SAFTLAS AF, 1990, AM J OBSTET GYNECOL, V163, P460; Sibai BM, 2003, OBSTET GYNECOL, V102, P181, DOI 10.1016-S0029-7844(03)00475-7; SIBAI BM, 1995, AM J OBSTET GYNECOL, V172, P642, DOI 10.1016-0002-9378(95)90586-3; SOOTHILL P W, 1986, Fetal Therapy, V1, P176; Srinivas SK, 2009, J PERINATOL, V29, P680, DOI 10.1038-jp.2009.83; Stella CL, 2006, AM J PERINAT, V23, P499, DOI 10.1055-s-2006-954961; Todros T, 1999, OBSTET GYNECOL, V93, P499, DOI 10.1016-S0029-7844(98)00440-2; Tranquilli AL, 1996, ANN NY ACAD SCI, V783, P337, DOI 10.1111-j.1749-6632.1996.tb26738.x; Tranquilli AL, 2005, EUR J OBSTET GYN R B, V122, P45, DOI 10.1016-j.ejogrb.2004.11.020; VALCAMONICO A, 1994, AM J OBSTET GYNECOL, V170, P796; YOON BH, 1993, AM J OBSTET GYNECOL, V169, P158623
Association of age with extubation failure in neurocritical intensive care unit patients--Insight from an international prospective study named ENIO
No full textObjective: To assess the association of age with extubation failure in neurocritical care patients. Design: Posthoc analysis of the ‘Extubation strategies in Neuro–Intensive care unit patients and associations with Outcomes (ENIO) study’, an international prospective observational study. Setting: ENIO was conducted in 73 centers in 18 countries from 2018 to 2020. Patients: Neurocritical care patients with a Glasgow Coma Scale score ≤ 12 and receiving ventilation for at least 24 h were included. We categorized patients into four age groups based on age quartiles. Main results: This analysis included 1095 patients with a median age of 53 [35 to 65] years. Younger patients were more likely to be admitted with traumatic brain injury, whereas older patients more often had cerebral hemorrhage, ischemic stroke, central nervous infection, or brain malignancies. Extubation failure occurred in 209 (19 %) patients. In the unadjusted analysis, older patients had a higher risk of extubation failure (odds ratio (OR), 1.012 [95 %–confidence interval (CI) 1.004 to 1.021]; P = 0.006). However, after adjusting for confounding factors, the effect of age on extubation failure was no longer significant (OR, 1.008 [0.997 to 1.019]; P = 0.172). Conclusions: In this international cohort of intubated and ventilated neurocritical care patients, after adjusting for baseline covariates and for previously identified risk factors for extubation failure, age was not associated with extubation failure. Age may not be a factor to consider in extubation decisions for brain–injured patients. Registration: ENIO is registered at clinicaltrials.gov (study identifier NCT 03400904)
Disease severity-specific neutrophil signatures in blood transcriptomes stratify COVID-19 patients
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Clinical practice and effect of carbon dioxide on outcomes in mechanically ventilated acute brain-injured patients: a secondary analysis of the ENIO study
No full textPurpose: The use of arterial partial pressure of carbon dioxide (PaCO2) as a target intervention to manage elevated intracranial pressure (ICP) and its effect on clinical outcomes remain unclear. We aimed to describe targets for PaCO2 in acute brain injured (ABI) patients and assess the occurrence of abnormal PaCO2 values during the first week in the intensive care unit (ICU). The secondary aim was to assess the association of PaCO2 with in-hospital mortality. Methods: We carried out a secondary analysis of a multicenter prospective observational study involving adult invasively ventilated patients with traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), intracranial hemorrhage (ICH), or ischemic stroke (IS). PaCO2 was collected on day 1, 3, and 7 from ICU admission. Normocapnia was defined as PaCO2 > 35 and to 45 mmHg; mild hypocapnia as 32-35 mmHg; severe hypocapnia as 26-31 mmHg, forced hypocapnia as < 26 mmHg, and hypercapnia as > 45 mmHg. Results: 1476 patients (65.9% male, mean age 52 [Formula: see text] 18 years) were included. On ICU admission, 804 (54.5%) patients were normocapnic (incidence 1.37 episodes per person/day during ICU stay), and 125 (8.5%) and 334 (22.6%) were mild or severe hypocapnic (0.52 and 0.25 episodes/day). Forced hypocapnia and hypercapnia were used in 40 (2.7%) and 173 (11.7%) patients. PaCO2 had a U-shape relationship with in-hospital mortality with only severe hypocapnia and hypercapnia being associated with increased probability of in-hospital mortality (omnibus p value = 0.0009). Important differences were observed across different subgroups of ABI patients. Conclusions: Normocapnia and mild hypocapnia are common in ABI patients and do not affect patients' outcome. Extreme derangements of PaCO2 values were significantly associated with increased in-hospital mortality
Complement Activation in the Disease Course of Coronavirus Disease 2019 and Its Effects on Clinical Outcomes
No full textBackground: Excessive activation of immune responses in coronavirus disease 2019 (COVID-19) is considered to be related to disease severity, complications, and mortality rate. The complement system is an important component of innate immunity and can stimulate inflammation, but its role in COVID-19 is unknown. Methods: A prospective, longitudinal, single center study was performed in hospitalized patients with COVID-19. Plasma concentrations of complement factors C3a, C3c, and terminal complement complex (TCC) were assessed at baseline and during hospital admission. In parallel, routine laboratory and clinical parameters were collected from medical files and analyzed. Results: Complement factors C3a, C3c, and TCC were significantly increased in plasma of patients with COVID-19 compared with healthy controls (P<.05). These complement factors were especially elevated in intensive care unit patients during the entire disease course (P<.005 for C3a and TCC). More intense complement activation was observed in patients who died and in those with thromboembolic events. Conclusions: Patients with COVID-19 demonstrate activation of the complement system, which is related to disease severity. This pathway may be involved in the dysregulated proinflammatory response associated with increased mortality rate and thromboembolic complications. Components of the complement system might have potential as prognostic markers for disease severity and as therapeutic targets in COVID-19. © 2020 The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America
Disease severity-specific neutrophil signatures in blood transcriptomes stratify COVID-19 patients
No full textAge and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study
No full textINTRODUCTION: Increased mortality has been demonstrated in older adults with COVID-19, but the effect of frailty has been unclear.METHODS: This multi-centre cohort study involved patients aged 18years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty, and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation, and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS), and delirium on risk of increased care requirements on discharge, adjusting for the same variables.RESULTS: Data from 5,711 patients from 55 hospitals in 12 countries were included (median age 74, IQR 54-83; 55.2% male). The risk of death increased independently with increasing age (>80 vs 18-49: HR 3.57, CI 2.54-5.02), frailty (CFS 8 vs 1-3: HR 3.03, CI 2.29-4.00) inflammation, renal disease, cardiovascular disease, and cancer, but not delirium. Age, frailty (CFS 7 vs 1-3: OR 7.00, CI 5.27-9.32), delirium, dementia, and mental health diagnoses were all associated with increased risk of higher care needs on discharge. The likelihood of adverse outcomes increased across all grades of CFS from 4 to 9.CONCLUSIONS: Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age
