3 research outputs found
Prosthesisāpatient mismatch after mitral valve replacement: A pooled meta-analysis of KaplanāMeier-derived individual patient data
Objective: The hemodynamic effect and early and late survival impact of
prosthesisāpatient mismatch (PPM) after mitral valve replacement remains
insufficiently explored.
Methods: Pubmed, Embase, Web of Science, and Cochrane Library databases were
searched for English language original publications. The search yielded 791 potentially relevant studies. The final review and analysis included 19 studies compromising 11,675 patients.
Results: Prosthetic effective orifice area was calculated with the continuity equation
method in 7 (37%), pressure halfātime method in 2 (10%), and partially or fully obtained
from referenced values in 10 (53%) studies. Risk factors for PPM included gender (male),
diabetes mellitus, chronic renal disease, and the use of bioprostheses. When pooling
unadjusted data, PPM was associated with higher perioperative (odds ratio [OR]: 1.66;
95% confidence interval [CI]: 1.32ā2.10; p < .001) and late mortality (hazard ratio [HR]:
1.46; 95% CI: 1.21ā1.77; p < .001). Moreover, PPM was associated with higher late
mortality when Cox proportionalāhazards regression (HR: 1.97; 95% CI: 1.57ā2.47;
p < .001) and propensity score (HR: 1.99; 95% CI: 1.34ā2.95; p < .001) adjusted data were
pooled. Contrarily, moderate (HR: 1.01; 95% CI: 0.84ā1.22; p = .88) or severe (HR: 1.19;
95% CI: 0.89ā1.58; p = .24) PPM were not related to higher late mortality when adjusted
data were pooled individually. PPM was associated with higher systolic pulmonary pressures (mean difference: 7.88 mmHg; 95% CI: 4.72ā11.05; p < .001) and less pulmonary
hypertension regression (OR: 5.78; 95% CI: 3.33ā10.05; p < .001) late after surgery.
Conclusions: Mitral valve PPM is associated with higher postoperative pulmonary
artery pressure and might impair perioperative and overall survival. The relation
should be further assessed in properly designed studie
Effects of de-implementation strategies aimed at reducing low-value nursing procedures: A systematic review and meta-analysis
Background: In the last decade, there is an increasing focus on detecting and compiling lists of low-value nursing procedures. However, less is known about effective de-implementation strategie
European guidelines for the diagnosis, treatment and follow-up of breast lesions with uncertain malignant potential (B3 lesions) developed jointly by EUSOMA, EUSOBI, ESP (BWG) and ESSO
Introduction
Breast lesions of uncertain malignant potential (B3) include atypical ductal and lobular hyperplasias, lobular carcinoma in situ, flat epithelial atypia, papillary lesions, radial scars and fibroepithelial lesions as well as other rare miscellaneous lesions. They are challenging to categorise histologically, requiring specialist training and multidisciplinary input. They may coexist with in situ or invasive breast cancer (BC) and increase the risk of subsequent BC development. Management should focus on adequate classification and management whilst avoiding overtreatment. The aim of these guidelines is to provide updated information regarding the diagnosis and management of B3 lesions, according to updated literature review evidence.
Methods
These guidelines provide practical recommendations which can be applied in clinical practice which include recommendation grade and level of evidence. All sections were written according to an updated literature review and discussed at a consensus meeting. Critical appraisal by the expert writing committee adhered to the 23 items in the international Appraisal of Guidelines, Research and Evaluation (AGREE) tool.
Results
Recommendations for further management after core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB) diagnosis of a B3 lesion reported in this guideline, vary depending on the presence of atypia, size of lesion, sampling size, and patient preferences. After CNB or VAB, the option of vacuum-assisted excision or surgical excision should be evaluated by a multidisciplinary team and shared decision-making with the patient is crucial for personalizing further treatment. De-escalation of surgical intervention for B3 breast lesions is ongoing, and the inclusion of vacuum-assisted excision (VAE) will decrease the need for surgical intervention in further approaches. Communication with patients may be different according to histological diagnosis, presence or absence of atypia, or risk of upgrade due to discordant imaging. Written information resources to help patients understand these issues alongside with verbal communication is recommended. Lifestyle interventions have a significant impact on BC incidence so lifestyle interventions need to be suggested to women at increased BC risk as a result of a diagnosis of a B3 lesion.
Conclusions
These guidelines provide a state-of-the-art overview of the diagnosis, management and prognosis of B3 lesions in modern multidisciplinary breast practice