6 research outputs found
Update of the international HerniaSurge guidelines for groin hernia management
Background: Groin hernia repair is one of the most common operations performed globally, with more than 20 million procedures per year. The last guidelines on groin hernia management were published in 2018 by the HerniaSurge Group. The aim of this project was to assess new evidence and update the guidelines. The guideline is intended for general and abdominal wall surgeons treating adult patients with groin hernias. Method: A working group of 30 international groin hernia experts and all involved stakeholders was formed and examined all new literature on groin hernia management, available until April 2022. Articles were screened for eligibility and assessed according to GRADE methodologies. New evidence was included, and chapters were rewritten. Statements and recommendations were updated or newly formulated as necessary. Results: Ten chapters of the original HerniaSurge inguinal hernia guidelines were updated. In total, 39 new statements and 32 recommendations were formulated (16 strong recommendations). A modified Delphi method was used to reach consensus on all statements and recommendations among the groin hernia experts and at the European Hernia Society meeting in Manchester on October 21, 2022. Conclusion: The HerniaSurge Collaboration has updated the international guidelines for groin hernia management. The updated guidelines provide an overview of the best available evidence on groin hernia management and include evidence-based statements and recommendations for daily practice. Future guideline development will change according to emerging guideline methodology
Nebulization of Antiinfective Agents in Invasively Mechanically Ventilated Adults A Systematic Review and Meta-analysis
Background: Nebulization of antiinfective agents is a common but
unstandardized practice in critically ill patients.
Methods: A systematic review of 1,435 studies was performed in adults
receiving invasive mechanical ventilation. Two different administration
strategies (adjunctive and substitute) were considered clinically
relevant. Inclusion was restricted to studies using jet, ultrasonic, and
vibrating-mesh nebulizers. Studies involving children,
colonized-but-not-infected adults, and cystic fibrosis patients were
excluded.
Results: Five of the 11 studies included had a small sample size (fewer
than 50 patients), and only 6 were randomized. Diversity of case-mix,
dosage, and devices are sources of bias. Only a few patients had severe
hypoxemia. Aminoglycosides and colistin were the most common
antibiotics, being safe regarding nephrotoxicity and neurotoxicity, but
increased respiratory complications in 9% (95% CI, 0.01 to 0.18; I-2 =
52%), particularly when administered to hypoxemic patients. For
tracheobronchitis, a significant decrease in emergence of resistance was
evidenced (risk ratio, 0.18; 95% CI, 0.05 to 0.64; I-2 = 0%). Similar
findings were observed in pneumonia by susceptible pathogens, without
improvement in mortality or ventilation duration. In pneumonia caused by
resistant pathogens, higher clinical resolution (odds ratio, 1.96; 95%
CI, 1.30 to 2.96; I-2 = 0%) was evidenced. These findings were not
consistently evidenced in the assessment of efficacy against pneumonia
caused by susceptible pathogens.
Conclusions: Performance of randomized trials evaluating the impact of
nebulized antibiotics with more homogeneous populations, standardized
drug delivery, predetermined clinical efficacy, and safety outcomes is
urgently required. Infections by resistant pathogens might potentially
have higher benefit from nebulized antiinfective agents. Nebulization,
without concomitant systemic administration of the drug, may reduce
nephrotoxicity but may also be associated with higher risk of
respiratory complications
Update of the international HerniaSurge guidelines for groin hernia management
Background: Groin hernia repair is one of the most common operations performed globally, with more than 20 million procedures per year. The last guidelines on groin hernia management were published in 2018 by the HerniaSurge Group. The aim of this project was to assess new evidence and update the guidelines. The guideline is intended for general and abdominal wall surgeons treating adult patients with groin hernias.聽Method: A working group of 30 international groin hernia experts and all involved stakeholders was formed and examined all new literature on groin hernia management, available until April 2022. Articles were screened for eligibility and assessed according to GRADE methodologies. New evidence was included, and chapters were rewritten. Statements and recommendations were updated or newly formulated as necessary.聽Results: Ten chapters of the original HerniaSurge inguinal hernia guidelines were updated. In total, 39 new statements and 32 recommendations were formulated (16 strong recommendations). A modified Delphi method was used to reach consensus on all statements and recommendations among the groin hernia experts and at the European Hernia Society meeting in Manchester on October 21, 2022.聽Conclusion: The HerniaSurge Collaboration has updated the international guidelines for groin hernia management. The updated guidelines provide an overview of the best available evidence on groin hernia management and include evidence-based statements and recommendations for daily practice. Future guideline development will change according to emerging guideline methodology.</p
Update of the international HerniaSurge guidelines for groin hernia management
Background: Groin hernia repair is one of the most common operations performed globally, with more than 20 million procedures per year. The last guidelines on groin hernia management were published in 2018 by the HerniaSurge Group. The aim of this project was to assess new evidence and update the guidelines. The guideline is intended for general and abdominal wall surgeons treating adult patients with groin hernias.聽Method: A working group of 30 international groin hernia experts and all involved stakeholders was formed and examined all new literature on groin hernia management, available until April 2022. Articles were screened for eligibility and assessed according to GRADE methodologies. New evidence was included, and chapters were rewritten. Statements and recommendations were updated or newly formulated as necessary.聽Results: Ten chapters of the original HerniaSurge inguinal hernia guidelines were updated. In total, 39 new statements and 32 recommendations were formulated (16 strong recommendations). A modified Delphi method was used to reach consensus on all statements and recommendations among the groin hernia experts and at the European Hernia Society meeting in Manchester on October 21, 2022.聽Conclusion: The HerniaSurge Collaboration has updated the international guidelines for groin hernia management. The updated guidelines provide an overview of the best available evidence on groin hernia management and include evidence-based statements and recommendations for daily practice. Future guideline development will change according to emerging guideline methodology.</p
Update of the international HerniaSurge guidelines for groin hernia management
Background: Groin hernia repair is one of the most common operations performed globally, with more than 20 million procedures per year. The last guidelines on groin hernia management were published in 2018 by the HerniaSurge Group. The aim of this project was to assess new evidence and update the guidelines. The guideline is intended for general and abdominal wall surgeons treating adult patients with groin hernias.聽Method: A working group of 30 international groin hernia experts and all involved stakeholders was formed and examined all new literature on groin hernia management, available until April 2022. Articles were screened for eligibility and assessed according to GRADE methodologies. New evidence was included, and chapters were rewritten. Statements and recommendations were updated or newly formulated as necessary.聽Results: Ten chapters of the original HerniaSurge inguinal hernia guidelines were updated. In total, 39 new statements and 32 recommendations were formulated (16 strong recommendations). A modified Delphi method was used to reach consensus on all statements and recommendations among the groin hernia experts and at the European Hernia Society meeting in Manchester on October 21, 2022.聽Conclusion: The HerniaSurge Collaboration has updated the international guidelines for groin hernia management. The updated guidelines provide an overview of the best available evidence on groin hernia management and include evidence-based statements and recommendations for daily practice. Future guideline development will change according to emerging guideline methodology.</p
Environmental and societal factors associated with COVID-19-related death in people with rheumatic disease: an observational study
Published by Elsevier Ltd.Background: Differences in the distribution of individual-level clinical risk factors across regions do not fully explain the observed global disparities in COVID-19 outcomes. We aimed to investigate the associations between environmental and societal factors and country-level variations in mortality attributed to COVID-19 among people with rheumatic disease globally.
Methods: In this observational study, we derived individual-level data on adults (aged 18-99 years) with rheumatic disease and a confirmed status of their highest COVID-19 severity level from the COVID-19 Global Rheumatology Alliance (GRA) registry, collected between March 12, 2020, and Aug 27, 2021. Environmental and societal factors were obtained from publicly available sources. The primary endpoint was mortality attributed to COVID-19. We used a multivariable logistic regression to evaluate independent associations between environmental and societal factors and death, after controlling for individual-level risk factors. We used a series of nested mixed-effects models to establish whether environmental and societal factors sufficiently explained country-level variations in death.
Findings: 14 044 patients from 23 countries were included in the analyses. 10 178 (72路5%) individuals were female and 3866 (27路5%) were male, with a mean age of 54路4 years (SD 15路6). Air pollution (odds ratio 1路10 per 10 渭g/m3 [95% CI 1路01-1路17]; p=0路0105), proportion of the population aged 65 years or older (1路19 per 1% increase [1路10-1路30]; p<0路0001), and population mobility (1路03 per 1% increase in number of visits to grocery and pharmacy stores [1路02-1路05]; p<0路0001 and 1路02 per 1% increase in number of visits to workplaces [1路00-1路03]; p=0路032) were independently associated with higher odds of mortality. Number of hospital beds (0路94 per 1-unit increase per 1000 people [0路88-1路00]; p=0路046), human development index (0路65 per 0路1-unit increase [0路44-0路96]; p=0路032), government response stringency (0路83 per 10-unit increase in containment index [0路74-0路93]; p=0路0018), as well as follow-up time (0路78 per month [0路69-0路88]; p<0路0001) were independently associated with lower odds of mortality. These factors sufficiently explained country-level variations in death attributable to COVID-19 (intraclass correlation coefficient 1路2% [0路1-9路5]; p=0路14).
Interpretation: Our findings highlight the importance of environmental and societal factors as potential explanations of the observed regional disparities in COVID-19 outcomes among people with rheumatic disease and lay foundation for a new research agenda to address these disparities.MAG is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers K01 AR070585 and K24 AR074534 [JY]). KDW is supported by the Department of Veterans Affairs and the Rheumatology Research Foundation Scientist Development award. JAS is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers K23 AR069688, R03 AR075886, L30 AR066953, P30 AR070253, and P30 AR072577), the Rheumatology Research Foundation (K Supplement Award and R Bridge Award), the Brigham Research Institute, and the R. Bruce and Joan M. Mickey Research Scholar Fund. NJP is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (T32-AR-007258). AD-G is supported by grants from the Centers for Disease Control and Prevention and the Rheumatology Research Foundation. RH was supported by the Justus-Liebig University Giessen Clinician Scientist Program in Biomedical Research to work on this registry. JY is supported by grants from the National Institutes of Health (K24 AR074534 and P30 AR070155).info:eu-repo/semantics/publishedVersio