scholarly journals Value of adding second-trimester uterine artery Doppler to patient characteristics in identification of nulliparous women at increased risk for pre-eclampsia: an individual patient data meta-analysis

2013 ◽  
Vol 42 (3) ◽  
pp. 257-267 ◽  
Author(s):  
C. E. Kleinrouweler ◽  
P. M. M. Bossuyt ◽  
B. Thilaganathan ◽  
K. C. Vollebregt ◽  
J. Arenas Ramírez ◽  
...  
Keyword(s):  
Uterine Artery ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Characteristics ◽  
Patient Data ◽  
Second Trimester ◽  
Uterine Artery Doppler ◽  
Nulliparous Women ◽  
Increased Risk

scholarly journals Delayed antibiotic prescribing for respiratory tract infections: protocol of an individual patient data meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e026925 ◽  
Author(s):  
Beth Stuart ◽  
Hilda Hounkpatin ◽  
Taeko Becque ◽  
Guiqing Yao ◽  
Shihua Zhu ◽  
...  
Keyword(s):  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Characteristics ◽  
Patient Data ◽  
Published Data ◽  
Controlled Trials ◽  
Antibiotic Prescribing ◽  
Cochrane Central Register ◽  
Life Years ◽  
Tract Infections

IntroductionDelayed prescribing can be a useful strategy to reduce antibiotic prescribing, but it is not clear for whom delayed prescribing might be effective. This protocol outlines an individual patient data (IPD) meta-analysis of randomised controlled trials (RCTs) and observational cohort studies to explore the overall effect of delayed prescribing and identify key patient characteristics that are associated with efficacy of delayed prescribing.Methods and analysisA systematic search of the databases Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid Embase, EBSCO CINAHL Plus and Web of Science was conducted to identify relevant studies from inception to October 2017. Outcomes of interest include duration of illness, severity of illness, complication, reconsultation and patient satisfaction. Study authors of eligible papers will be contacted and invited to contribute raw IPD data. IPD data will be checked against published data, harmonised and aggregated to create one large IPD database. Multilevel regression will be performed to explore interaction effects between treatment allocation and patient characteristics. The economic evaluation will be conducted based on IPD from the combined trial and observational studies to estimate the differences in costs and effectiveness for delayed prescribing compared with normal practice. A decision model will be developed to assess potential savings and cost-effectiveness in terms of reduced antibiotic usage of delayed prescribing and quality-adjusted life years.Ethics and disseminationEthical approval was obtained from the University of Southampton Faculty of Medicine Research Ethics Committee (Reference number: 30068). Findings of this study will be published in peer-reviewed academic journals as well as General Practice trade journals and will be presented at national and international conferences. The results will have important public health implications, shaping the way in which antibiotics are prescribed in the future and to whom delayed prescriptions are issued.PROSPERO registration numberCRD42018079400.

CORRELATION OF ABNORMAL UTERINE ARTERY DOPPLER IN THE SECOND TRIMESTER OF PREGNANCY WITH MATERNAL AND FETAL OUTCOME.

2021 ◽  
pp. 18-19
Author(s):  
Sangeetha Menon ◽  
Jyotsna Nalinan
Keyword(s):  
High Risk ◽  
Uterine Artery ◽  
Subsequent Development ◽  
High Risk Population ◽  
Age Group ◽  
Second Trimester ◽  
Risk Population ◽  
Uterine Artery Doppler ◽  
Increased Risk ◽  
Doppler Indices

Introduction: Maternal – fetal circulation can be studied non-invasively by using doppler which can be used as a screening tool for fetal and maternal disease. Morphological changes in the uterine vasculature can be demonstrated by colour and pulsed doppler studies. The majority of the studies on uterine artery doppler have focused on a high risk population. The effectiveness of the uterine artery doppler to predict pre eclampsia or FGR in a low risk population has been shown to have a low to moderate predictive value1. Also the criteria for normal and abnormal uterine artery doppler continue to vary with no well accepted denition. Aim: To nd out the correlation between abnormal uterine artery doppler in the second trimester of pregnancy between 18-22 weeks, with the subsequent development of pre eclampsia and FGR. Materials and methods: This is a prospective cohort study carried out in the Department of Obstetrics and Gynecology for a period of one year. Antenatal patients in the age group of 18-35 years, between 18-22 weeks of gestation, who were included in the study underwent a uterine artery doppler. They were followed up until delivery. SPSS software was used to analyze the data. Results: 193 Obstetric patients in the age group 18-35 years were evaluated with uterine artery doppler. 77.7% had normal doppler indices. In the abnormal doppler group, 81.4% were in the high risk category and 48.8% of those with abnormal dopplers developed pre eclampsia and 34.9% with abnormal dopplers developed FGR. Conclusion: Patients with abnormal uterine artery doppler indices in the second trimester of pregnancy, had an 18 times increased risk of developing pre eclampsia and a 6 times increased risk of developing FGR when compared to those with normal doppler indices.

scholarly journals Predicting tuberculosis relapse in patients treated with the standard 6-month regimen: an individual patient data meta-analysis

Thorax ◽  
2018 ◽  
Vol 74 (3) ◽  
pp. 291-297 ◽  
Author(s):  
Kamila Romanowski ◽  
Robert F Balshaw ◽  
Andrea Benedetti ◽  
Jonathon R Campbell ◽  
Dick Menzies ◽  
...  
Keyword(s):  
Individual Patient Data ◽  
Reference Model ◽  
Meta Analysis ◽  
Area Under The Curve ◽  
Predictive Performance ◽  
Patient Data ◽  
Standard Regimen ◽  
Increased Risk ◽  
Cavitary Disease ◽  
Positive Smear

BackgroundRelapse continues to place significant burden on patients and tuberculosis (TB) programmes worldwide. We aimed to determine clinical and microbiological factors associated with relapse in patients treated with the WHO standard 6-month regimen and then evaluate the accuracy of each factor at predicting an outcome of relapse.MethodsA systematic review was performed to identify randomised controlled trials reporting treatment outcomes on patients receiving the standard regimen. Authors were contacted and invited to share patient-level data (IPD). A one-step IPD meta-analysis, using random intercept logistic regression models and receiver operating characteristic curves, was performed to evaluate the predictive performance of variables of interest.ResultsIndividual patient data were obtained from 3 of the 12 identified studies. Of the 1189 patients with confirmed pulmonary TB who completed therapy, 67 (5.6%) relapsed. In multipredictor analysis, the presence of baseline cavitary disease with positive smear at 2 months was associated with an increased odds of relapse (OR 2.3(95% CI 1.3 to 4.2)) and a relapse risk of 10%. When area under the curve for each multipredictor model was compared, discrimination between low-risk and higher-risk patients was modest and similar to that of the reference model which accounted for age, sex and HIV status.ConclusionDespite its poor predictive value, our results indicate that the combined presence of cavitary disease and 2-month positive smear status may be the best currently available marker for identifying individuals at an increased risk of relapse, particularly in resource-limited setting. Further investigation is required to assess whether this combined factor can be used to indicate different treatment requirements in clinical practice.

scholarly journals Role of early second-trimester uterine artery Doppler screening to predict small-for-gestational-age babies in nulliparous women

2017 ◽  
Vol 217 (5) ◽  
pp. 594.e1-594.e10 ◽  
Author(s):  
Samuel Parry ◽  
Anthony Sciscione ◽  
David M. Haas ◽  
William A. Grobman ◽  
Jay D. Iams ◽  
...  
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Uterine Artery ◽  
Second Trimester ◽  
Uterine Artery Doppler ◽  
Nulliparous Women

Systematic review and individual patient data based meta-analysis of palonosetron trials for chemotherapy induced nausea and vomiting.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21688-e21688
Author(s):  
Yuki Okada ◽  
Koji Oba ◽  
Naoto Furukawa ◽  
Yoshito Komatsu ◽  
Yoshimasa Kosaka ◽  
...  
Keyword(s):  
Systematic Review ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Characteristics ◽  
Complete Response ◽  
Fixed Effect Model ◽  
Significant Loss ◽  
Patient Data ◽  
Nausea And Vomiting ◽  
Complete Control

e21688 Background: Several clinical trials have evaluated the need for corticosteroid-containing antiemetic regimens on the days after the first 24 hours to control delayed chemotherapy-induced nausea and vomiting (CINV) during moderate emetogenic chemotherapy (MEC) or anthracycline and/or cyclophosphamide (AC)-containing chemotherapy. Methods:We conducted systematic review using research databases and trial registries for any randomized controlled trials reporting CINV outcomes for a single 1-day-dexamethasone (D1 group) containing antiemetic regimen in chemotherapy-naive adult patients scheduled to receive a MEC or AC-containing chemotherapy, compared with additional dexamethasone on days 2 and 3 (D3 group). We also gathered the individual patient data (IPD) from each study investigator. The primary endpoint was complete response (CR: no vomiting and no rescue antiemetics) in the 5-day study period. Secondary efficacy end points were CR rates in 0–24 h and CR rates in 24–120 h; complete control in the overall, acute, delayed periods. An IPD meta-analysis was conducted to quantify the pooled risk differences between D1 group and D3 group and its interaction with patient characteristics using a fixed effect model. Results: Of 887 articles screened, 5 eligible studies were identified comprising 1194 patients, all enrolled in the meta-analysis. Overall, D1 group was not significantly inferior to D3 group in CR rate as well as CC rate [pooled risk difference in CR rate -1.5%, 95% confidence interval (CI) -7.1–4.0%; in delayed CR rate -2.4%, 95% CI -7.7–2.9%]. There was no significant interaction between dexamethasone regimen and patient characteristics (sex, age category ( < 60 or 60 years), and alcohol consumption). Conclusions: These results strongly suggest that the dexamethasone-sparing regimen is not associated with a significant loss in overall antiemetic control in an adult patient undergoing MEC or AC-containing chemotherapy, irrespective of patient baseline characteristics. These data contribute to simplify antiemetic regimens and spare many patients from the potential side-effects of multiple-day corticosteroids.

scholarly journals Adjusted prognostic association of depression following myocardial infarction with mortality and cardiovascular events: individual patient data meta-analysis

2013 ◽  
Vol 203 (2) ◽  
pp. 90-102 ◽  
Author(s):  
A. Meijer ◽  
H. J. Conradi ◽  
E. H. Bos ◽  
M. Anselmino ◽  
R. M. Carney ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Disease Severity ◽  
Cardiac Disease ◽  
Cardiovascular Events ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
Hazard Ratios ◽  
Increased Risk ◽  
All Cause Mortality

BackgroundThe association between depression after myocardial infarction and increased risk of mortality and cardiac morbidity may be due to cardiac disease severity.AimsTo combine original data from studies on the association between post-infarction depression and prognosis into one database, and to investigate to what extent such depression predicts prognosis independently of disease severity.MethodAn individual patient data meta-analysis of studies was conducted using multilevel, multivariable Cox regression analyses.ResultsSixteen studies participated, creating a database of 10 175 post-infarction cases. Hazard ratios for post-infarction depression were 1.32 (95% CI 1.26–1.38, P<0.001) for all-cause mortality and 1.19 (95% CI 1.14–1.24, P<0.001) for cardiovascular events. Hazard ratios adjusted for disease severity were attenuated by 28% and 25% respectively.ConclusionsThe association between depression following myocardial infarction and prognosis is attenuated after adjustment for cardiac disease severity. Still, depression remains independently associated with prognosis, with a 22% increased risk of all-cause mortality and a 13% increased risk of cardiovascular events per standard deviation in depression z-score.

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