The interpretation of systematic reviews with meta-analyses: an objective or subjective process?

<p>Abstract</p> <p>Background</p> <p>Discrepancies between the conclusions of different meta-analyses (quantitative syntheses of systematic reviews) are often ascribed to methodological differences. The objective of this study was to determine the discordance in interpretations when meta-analysts are presented with identical data.</p> <p>Methods</p> <p>We searched the literature for all randomized clinical trials (RCT) and review articles on the efficacy of intravenous magnesium in the early post-myocardial infarction period. We organized the articles chronologically and grouped them in packages. The first package included the first RCT, and a summary of the review articles published prior to first RCT. The second package contained the second and third RCT, a meta-analysis based on the data, and a summary of all review articles published prior to the third RCT. Similar packages were created for the 5^thRCT, 10^thRCT, 20^thRCT and 23^rdRCT (all articles). We presented the packages one at a time to eight different reviewers and asked them to answer three clinical questions after each package based solely on the information provided. The clinical questions included whether 1) they believed magnesium is now proven beneficial, 2) they believed magnesium will eventually be proven to be beneficial, and 3) they would recommend its use at this time.</p> <p>Results</p> <p>There was considerable disagreement among the reviewers for each package, and for each question. The discrepancies increased when the heterogeneity of the data increased. In addition, some reviewers became more sceptical of the effectiveness of magnesium over time, and some reviewers became less sceptical.</p> <p>Conclusion</p> <p>The interpretation of the results of systematic reviews with meta-analyses includes a subjective component that can lead to discordant conclusions that are independent of the methodology used to obtain or analyse the data.</p

Back pain outcomes in primary care following a practice improvement intervention:- a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>Back pain is one of the UK's costliest and least understood health problems, whose prevalence still seems to be increasing. Educational interventions for general practitioners on back pain appear to have had little impact on practice, but these did not include quality improvement learning, involve patients in the learning, record costs or document practice activities as well as patient outcomes.</p> <p>Methods</p> <p>We assessed the outcome of providing information about quality improvement techniques and evidence-based practice for back pain using the Clinical Value Compass. This included clinical outcomes (Roland and Morris Disability Questionnaire), functional outcomes, costs of care and patient satisfaction. We provided workshops which used an action learning approach and collected before and after data on routine practice activity from practice electronic databases. In parallel, we studied outcomes in a separate cohort of patients with acute and sub-acute non-specific back pain recruited from the same practices over the same time period. Patient data were analysed as a prospective, split-cohort study with assessments at baseline and eight weeks following the first consultation.</p> <p>Results</p> <p>Data for 1014 patients were recorded in the practice database study, and 101 patients in the prospective cohort study. We found that practice activities, costs and patient outcomes changed little after the intervention. However, the intervention was associated with a small, but statistically significant reduction in disability in female patients. Additionally, baseline disability, downheartedness, self-rated health and leg pain had small but statistically significant effects (p < 0.05) on follow-up disability scores in some subgroups.</p> <p>Conclusions</p> <p>GP education for back pain that both includes health improvement methodologies and involves patients may yield additional benefits for some patients without large changes in patterns of practice activity. The effects in this study were small and limited and the reasons for them remain obscure. However, such is the impact of back pain and its frequency of consultation in general practice that this kind of improvement methodology deserves further consideration.</p> <p>Trial registration number</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN30420389">ISRCTN30420389</a></p

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Alien Registration- Rossignol, Louise (Waterville, Kennebec County)

https://digitalmaine.com/alien_docs/14528/thumbnail.jp

Alien Registration- Rossignol, Louise (Waterville, Kennebec County)

https://digitalmaine.com/alien_docs/14528/thumbnail.jp

Epidemiology of community urinary tract infections

Les infections urinaires (IUs) sont un motif très fréquent de consultation et de prescription d’antibiotique en médecine générale. Le choix de l’antibiotique repose sur les caractéristiques du patient, la susceptibilité des germes aux antibiotiques et des analyses de coût. Cette démarche thérapeutique est devenue de plus en plus complexe en raison de l’augmentation des résistantes aux antibiotiques. Dans ce contexte, mon travail de thèse repose sur deux principales études :A partir des données d’IMS-health France, une analyse spectrale des ventes d’antibiotiques urinaires a montré l’existence d’une saisonnalité annuelle entre 2001 et 2012 avec des pics estivaux. A partir des données de recherche de Google en France et dans six autres pays, le même phénomène a été observé. Ceci représente un argument en faveur d’une saisonnalité des cystites aigues simples.Une étude a été mise en place, visant à estimer l’incidence des IUs à germes résistants et à déterminer les facteurs associés à l’acquisition de ces germes. Un taux d'incidence annuel des IUs présumées en médecine générale a été estimé à 3 200 pour 100 000 femmes en France [IC 95%: 2 400-4 000], avec un taux d'incidence annuel des infections urinaires à E. coli résistant au fluoroquinolone en médecine générale à 102 pour 100 000 femmes en France [IC 95%: 30-50]. Les facteurs associés aux IU à entérobactéries résistantes à plus de trois classes d’antibiotique étaient l'utilisation de la pénicilline par la patiente (OR = 3,1 ; [1,2-8,0]), avoir fourni un hébergement à un résident d'un pays à haut risque de résistance aux antibiotiques (OR = 4,0 [1,2-15,1]) et la consommation de viande crue (OR = 0,3 ; [0,1-0,9]).Urinary tract infections (IUs) are a frequent reason for consultation and prescription of antibiotics in general practice. The choice of the antibiotic is based on the patient’s characteristics, the antibiotic susceptibility of bacteria and cost analyzes. This therapeutic approach has become increasingly complex due to the increase in antibiotic resistance. In this context, my thesis is based on two main studies:From the data of IMS health France, a spectral analysis of urinary antibiotic sales was shown the existence of an annual seasonality between 2001 and 2012 with summer peaks. The same phenomenon was been observed from Google search data in France and in six other countries. This is an argument for seasonality in acute cystitis.Another study was set up, to estimate the incidence of resistant germs in IUs and identify factors associated with the acquisition of these germs. An annual incidence rate of IUs in general practice was estimated at 3,200 per 100,000 women in France [95% CI: 2,400-4,000], with an annual incidence rate of IUs due to E. coli resistant to fluoroquinolone in general practice at 102 per 100,000 women in France [95% CI: 30-50]. Factors associated with IU due to Enterobacteriaceae resistant to more than three classes of antibiotic were having used penicillin by the patient (OR = 3.1; [1.2 to 8.0]), having provided accommodation to a resident of a country at high risk for antibiotic resistance (OR = 4.0 [1.2 to 15.1]) and raw meat consumption (OR = 0.3; [0.1-0.9] )

Epidémiologie des infections urinaires communautaires

Urinary tract infections (IUs) are a frequent reason for consultation and prescription of antibiotics in general practice. The choice of the antibiotic is based on the patient’s characteristics, the antibiotic susceptibility of bacteria and cost analyzes. This therapeutic approach has become increasingly complex due to the increase in antibiotic resistance. In this context, my thesis is based on two main studies:From the data of IMS health France, a spectral analysis of urinary antibiotic sales was shown the existence of an annual seasonality between 2001 and 2012 with summer peaks. The same phenomenon was been observed from Google search data in France and in six other countries. This is an argument for seasonality in acute cystitis.Another study was set up, to estimate the incidence of resistant germs in IUs and identify factors associated with the acquisition of these germs. An annual incidence rate of IUs in general practice was estimated at 3,200 per 100,000 women in France [95% CI: 2,400-4,000], with an annual incidence rate of IUs due to E. coli resistant to fluoroquinolone in general practice at 102 per 100,000 women in France [95% CI: 30-50]. Factors associated with IU due to Enterobacteriaceae resistant to more than three classes of antibiotic were having used penicillin by the patient (OR = 3.1; [1.2 to 8.0]), having provided accommodation to a resident of a country at high risk for antibiotic resistance (OR = 4.0 [1.2 to 15.1]) and raw meat consumption (OR = 0.3; [0.1-0.9] ).Les infections urinaires (IUs) sont un motif très fréquent de consultation et de prescription d’antibiotique en médecine générale. Le choix de l’antibiotique repose sur les caractéristiques du patient, la susceptibilité des germes aux antibiotiques et des analyses de coût. Cette démarche thérapeutique est devenue de plus en plus complexe en raison de l’augmentation des résistantes aux antibiotiques. Dans ce contexte, mon travail de thèse repose sur deux principales études :A partir des données d’IMS-health France, une analyse spectrale des ventes d’antibiotiques urinaires a montré l’existence d’une saisonnalité annuelle entre 2001 et 2012 avec des pics estivaux. A partir des données de recherche de Google en France et dans six autres pays, le même phénomène a été observé. Ceci représente un argument en faveur d’une saisonnalité des cystites aigues simples.Une étude a été mise en place, visant à estimer l’incidence des IUs à germes résistants et à déterminer les facteurs associés à l’acquisition de ces germes. Un taux d'incidence annuel des IUs présumées en médecine générale a été estimé à 3 200 pour 100 000 femmes en France [IC 95%: 2 400-4 000], avec un taux d'incidence annuel des infections urinaires à E. coli résistant au fluoroquinolone en médecine générale à 102 pour 100 000 femmes en France [IC 95%: 30-50]. Les facteurs associés aux IU à entérobactéries résistantes à plus de trois classes d’antibiotique étaient l'utilisation de la pénicilline par la patiente (OR = 3,1 ; [1,2-8,0]), avoir fourni un hébergement à un résident d'un pays à haut risque de résistance aux antibiotiques (OR = 4,0 [1,2-15,1]) et la consommation de viande crue (OR = 0,3 ; [0,1-0,9])

Pratiques et déterminants de la vaccination BCG en médecine générale, en France, depuis la suspension de l obligation vaccinale

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF