Preoperative anemia management with intravenous iron: a systematic review

Background Iron deficiency anemia is a common condition in patients presenting for surgery, but despite its negative health impacts, the condition remains frequently unmanaged. Optimizing the patient's own red cell mass should be addressed in the preoperative period. Intravenous iron has been advocated as an effective treatment modality. Objectives The objective of this systematic review was to critically appraise and synthesize the best available evidence related to the effectiveness and economic aspects of intravenous iron administration on the correction of iron deficiency anemia in the preoperative period. Inclusion criteria Types of participants Adult patients 18 years of age and older receiving intravenous iron compared with those taking iron orally, and those who were not on iron or were transfused with red blood cells for the correction of anemia. Studies assessing the economic aspects of anemia management were also considered. Types of intervention(s)/phenomena of interest The quantitative component of the review considered studies that evaluated the management of anemia with iron infusions compared to oral iron treatment alone, oral iron in combination with erythropoietin, erythropoietin alone or hemoglobin correction with blood transfusion. The economic component of this review considered studies that evaluated the costs and benefits of iron infusions compared to oral iron treatment or hemoglobin correction with blood transfusion for the treatment of preoperative anemia. Types of studies The quantitative component of the review considered any experimental study design including randomized controlled trials (RCTs), non-RCTs and quasi-experimental studies for inclusion. The economic component of the review considered cost effectiveness, cost utility and cost benefit studies for inclusion. Types of outcomes The quantitative component of this review considered studies that reported on the impact of intravenous iron administration on: hemoglobin levels, red blood cell transfusion, length of stay in hospital, rate of readmission within 30 days of discharge, incidence of transfusion-related complications and changes in functional outcomes. The economic component of the review focused on cost benefits resulting from intravenous iron administration. Search strategy The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in this review. Studies published in English, German, Italian and Dutch from 2001 until December 2012 were considered for inclusion in this review. Methodological quality The studies were independently assessed by two reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute. Data collection Quantitative data was extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute, specifically the Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Economic data was extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute Analysis of Cost, Technology and Utilisation Assessment and Review Instrument (JBI-ACTUARI). Data synthesis This review set out to conduct both meta-analyses of the findings of effectiveness studies using JBI-MAStARI and pooling of economic findings using JBI-ACTUARI. Because of the number of studies found, this was not possible and the findings are therefore presented in tabular or narrative form. Results The quantitative component of the review identified two RCTs for inclusion with one of the trials favoring intravenous iron over oral iron for anemia correction. Only a subgroup could be included from the second trial and the results were inconclusive. Data was heterogeneous and did not allow a meta-analysis. The search for the economic component of the review revealed no examination of the cost effectiveness of preoperative correction of iron deficiency anemia with intravenous iron. Conclusions The review found insufficient data to make firm conclusions about the effectiveness of preoperative intravenous iron administration for the correction of anemia. Neither could we establish firm conclusions on the potential cost savings due to intravenous iron supplementation.Bernd Froessler, Catalin Tufanaru, Allan Cyna, Alan Pearso

Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence

Objectives: To reanalyse SmithKline Beecham’s Study 329 (published by Keller and colleagues in 2001), the primary objective of which was to compare the efficacy and safety of paroxetine and imipramine with placebo in the treatment of adolescents with unipolar major depression. The reanalysis under the restoring invisible and abandoned trials (RIAT) initiative was done to see whether access to and reanalysis of a full dataset from a randomised controlled trial would have clinically relevant implications for evidence based medicine. Design: Double blind randomised placebo controlled trial. Setting: 12 North American academic psychiatry centres, from 20 April 1994 to 15 February 1998. Participants: 275 adolescents with major depression of at least eight weeks in duration. Exclusion criteria included a range of comorbid psychiatric and medical disorders and suicidality. Interventions: Participants were randomised to eight weeks double blind treatment with paroxetine (20-40 mg), imipramine (200-300 mg), or placebo. Main outcome measures: The prespecified primary efficacy variables were change from baseline to the end of the eight week acute treatment phase in total Hamilton depression scale (HAM-D) score and the proportion of responders (HAM-D score ≤8 or ≥50% reduction in baseline HAM-D) at acute endpoint. Prespecified secondary outcomes were changes from baseline to endpoint in depression items in K-SADS-L, clinical global impression, autonomous functioning checklist, self-perception profile, and sickness impact scale; predictors of response; and number of patients who relapse during the maintenance phase. Adverse experiences were to be compared primarily by using descriptive statistics. No coding dictionary was prespecified. Results: The efficacy of paroxetine and imipramine was not statistically or clinically significantly different from placebo for any prespecified primary or secondary efficacy outcome. HAM-D scores decreased by 10.7 (least squares mean) (95% confidence interval 9.1 to 12.3), 9.0 (7.4 to 10.5), and 9.1 (7.5 to 10.7) points, respectively, for the paroxetine, imipramine and placebo groups (P=0.20). There were clinically significant increases in harms, including suicidal ideation and behaviour and other serious adverse events in the paroxetine group and cardiovascular problems in the imipramine group. Conclusions: Neither paroxetine nor high dose imipramine showed efficacy for major depression in adolescents, and there was an increase in harms with both drugs. Access to primary data from trials has important implications for both clinical practice and research, including that published conclusions about efficacy and safety should not be read as authoritative. The reanalysis of Study 329 illustrates the necessity of making primary trial data and protocols available to increase the rigour of the evidence base.Joanna Le Noury, John M Nardo, David Healy, Jon Jureidini, Melissa Raven, Catalin Tufanaru, Elia Abi-Jaoud

Use and uptake of web-based therapeutic interventions amongst Indigenous populations in Australia, New Zealand, the United States of America and Canada: a scoping review

Background: Barriers to receiving optimal healthcare exist for Indigenous populations globally for a range of reasons. To overcome such barriers and enable greater access to basic and specialist care, developments in information and communication technologies are being applied. The focus of this scoping review is on web-based therapeutic interventions (WBTI) that aim to provide guidance, support and treatment for health problems. Objectives: This review identifies and describes international scientific evidence on WBTI used by Indigenous peoples in Australia, New Zealand, Canada and USA for managing and treating a broad range of health conditions. Eligibility Criteria: Studies assessing WBTI designed for Indigenous peoples in Australia, Canada, USA and New Zealand, that were published in English, in peer-reviewed literature, from 2006 to 2018 (inclusive), were considered for inclusion in the review. Studies were considered if more than 50% of participants were Indigenous, or if results were reported separately for Indigenous participants. Sources of Evidence: Following a four-step search strategy in consultation with a research librarian, 12 databases were searched with a view to finding both published and unpublished studies. Charting Methods: Data was extracted, synthesised and reported under four main conceptual categories: (1) types of WBTI used, (2) community uptake of WBTI, (3) factors that impact on uptake and (4) conclusions and recommendations for practice. Results: A total of 31 studies met the inclusion criteria. The WBTI used were interactive websites, screening and assessment tools, management and monitoring tools, gamified avatar-based psychological therapy and decision support tools. Other sources reported the use of mobile apps, multimedia messaging or a mixture of intervention tools. Most sources reported moderate uptake and improved health outcomes for Indigenous people. Suggestions to improve uptake included as follows: tailoring content and presentation formats to be culturally relevant and appropriate, customisable and easy to use. Conclusions: Culturally appropriate, evidence-based WBTI have the potential to improve health, overcome treatment barriers and reduce inequalities for Indigenous communities. Access to WBTI, alongside appropriate training, allows health care workers to better support their Indigenous clients. Developing WBTI in partnership with Indigenous communities ensures that these interventions are accepted and promoted by the communities.Rachel Reilly, Jacqueline Stephens, Jasmine Micklem, Catalin Tufanaru, Stephen Harfield, Ike Fisher, Odette Pearson, and James War

The effectiveness of Theraplay for children under 12 – a systematic literature review

Background Theraplay is a relationship‐focused model of treatment based on attachment theory involving both adult and child. The study aims to review the quality of Theraplay research and Theraplay’s effectiveness for children aged 12 years and under with a range of presenting difficulties, to inform future practice and identify areas for further research. Methods A systematic literature search was conducted using PsycINFO, CINAHL, MEDLINE and Web of Science. Quantitative studies using Theraplay only as a treatment for children aged 12 years and under with any presenting difficulty were identified. Additional manual searching was conducted, including eligible studies’ reference lists. Critical appraisal tools were used to provide a narrative synthesis of Theraplay’s effectiveness and research quality. Results Only six eligible articles were identified, meaning there was a lack of rigorous evidence eligible to offer conclusions into Theraplay’s effectiveness. The review highlighted the small evidence base, mixed quality research methodology and high levels of heterogeneity in how Theraplay is practiced and evaluated. Of the eligible studies, Theraplay was found promising in its effectiveness when used with internalising and externalising difficulties, dual diagnoses and developmental disabilities. Conclusions Theraplay is regularly practiced across the world; however, the evidence base of rigorous research to inform Theraplay’s effectiveness and mechanisms of change is lacking. Firm conclusions could not be offered, although Theraplay was shown to be promising intervention for some presentations. Further research into Theraplay’s effectiveness and key mechanisms of change are recommended to enhance the quality and depth of Theraplay literature

Analiza Politicilor Din Domeniul Sanatatii

Cătălin Tufanar

Antidepressant medication and spontaneous abortion: "No significant association"? clinically significant association!

Catalin Tufanaru, Jon Jureidin

Synthesizing Economic Evidence

Systematic reviews of economic evidence select, critique and synthesize data from multiple economic evaluation primary research studies on the economic aspects of healthcare. They can provide relevant evidence on efficiency, resulting in less biased, decision-maker oriented information, which may be more likely to convince decision makers compared with evidence from single studies. This book presents step by step methodological guidance for systematic reviews of economic evidence that are designed to inform healthcare decision making.Catalin Tufanaru and Woan-Shin Tanhttp://www.nursingcenter.com/evidencebasedpracticenetwork/Home/JBI@LWW/JBI-Online-Books.asp

Medical Technologies Management in Hospitals

http://www.umf.ro/index.php/ro/prezentare/editura/poze/category/6-aparitii-editoriale-2010.htm