scholarly journals Anticoagulant interventions in hospitalized patients with COVID‐19: A scoping review of randomized controlled trials and call for international collaboration

2020 ◽  
Vol 18 (11) ◽  
pp. 2958-2967 ◽  
Author(s):  
Tobias Tritschler ◽  
Marie‐Eve Mathieu ◽  
Leslie Skeith ◽  
Marc Rodger ◽  
Saskia Middeldorp ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Scoping Review ◽  
International Collaboration ◽  
Hospitalized Patients ◽  
Controlled Trials ◽  
Randomized Controlled

scholarly journals Vitamin D supplementation, COVID-19 and disease severity: a meta-analysis

QJM ◽  
2021 ◽  
Author(s):  
K Shah ◽  
D Saxena ◽  
D Mavalankar
Keyword(s):  
Vitamin D ◽  
Randomized Controlled Trials ◽  
Usual Care ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Vitamin D Supplementation ◽  
Hospitalized Patients ◽  
Controlled Trials ◽  
Randomized Controlled

Abstract Objective: Current meta-analysis aims to understand the effect of oral supplementation of vitamin D on intensive care unit (ICU) requirement and mortality in hospitalized COVID-19 patients. Methods: Databases PubMed, preprint servers, and google scholar were searched from December 2019 to December 2020. Authors searched for the articles assessing role of vitamin D supplementation on COVID-19. Cochrane RevMan tool was used for quantitative assessment of the data, where heterogeneity was assessed using I2 and Q statistics and data was expressed using odds ratio with 95% confidence interval. Results: Final meta-analysis involved pooled data of 532 hospitalized patients (189 on vitamin D supplementation and 343 on usual care/placebo) of COVID-19 from three studies (Two randomized controlled trials, one retrospective case-control study). Statistically (p<0.0001) lower ICU requirement was observed in patients with vitamin D supplementation as compared to patients without supplementations (odds ratio: 0.36; 95% CI: 0.210-0.626). However, it suffered from significant heterogeneity, which reduced after sensitivity analysis. In case of mortality, vitamin D supplements has comparable findings with placebo treatment/usual care (odds ratio: 0.93; 95% CI: 0.413-2.113; p=0.87). The studies did not show any publication bias and had fair quality score. Subgroup analysis could not be performed due to limited number of studies and hence dose and duration dependent effect of vitamin D could not be evaluated. Conclusions: Although the current meta-analysis findings indicate potential role of vitamin D in improving COVID-19 severity in hospitalized patients, more robust data from randomized controlled trials are needed to substantiate its effects on mortality.

scholarly journals Tocilizumab in hospitalized patients with COVID-19: A meta analysis of randomized controlled trials

2021 ◽  
Author(s):  
Vijairam Selvaraj ◽  
Mohammad Saud Khan ◽  
Kwame Dapaah-Afriyie ◽  
Arkadiy Finn ◽  
Chirag Bavishi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Randomized Controlled Trials ◽  
Standard Therapy ◽  
Treatment Guidelines ◽  
Meta Analysis ◽  
Hospitalized Patients ◽  
Controlled Trials ◽  
Mortality And Morbidity ◽  
Randomized Controlled ◽  
All Cause Mortality

ABSTRACTBackgroundTo date, only dexamethasone has been shown to reduce mortality in COVID-19 patients. Tocilizumab has been recently added to the treatment guidelines for hospitalized COVID-19 patients, but data remains conflicting.MethodsElectronic databases such as MEDLINE, EMBASE and Cochrane central were searched from March 1, 2020, until February 28th, 2021, for randomized controlled trials evaluating the efficacy of tocilizumab in hospitalized COVID-19 patients. The outcomes assessed were all-cause mortality at 28 days, mechanical ventilation, and time to discharge.ResultsEight studies (with 6,311 patients) were included in the analysis. In total, 3,267 patients received tocilizumab, and 3,044 received standard care/placebo. Pooled analysis showed a significantly decreased risk of all-cause mortality at 28 days (RR 0.90, 95% CI 0.83-0.97, p=0.009) and progression to mechanical ventilation (RR 0.79, 95% CI 0.70-0.90, p=0.0002) in the tocilizumab arm compared to standard therapy or placebo. In addition, there was a trend towards improved median time to hospital discharge (RR 1.18, 95% CI 1.05-1.34, p=0.007).ConclusionsTocilizumab therapy improves outcomes of mortality and need for mechanical ventilation, in hospitalized patients with COVID-19 infection compared with standard therapy or placebo. Our findings suggest the efficacy of tocilizumab therapy in hospitalized COVID-19 patients and strengthen the concept that tocilizumab is a promising therapeutic intervention to improve mortality and morbidity in COVID-19 patients.

scholarly journals Treating COVID-19 With Hydroxychloroquine (TEACH): A Multicenter, Double-Blind Randomized Controlled Trial in Hospitalized Patients

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Robert J Ulrich ◽  
Andrea B Troxel ◽  
Ellie Carmody ◽  
Jaishvi Eapen ◽  
Martin Bäcker ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Disease Progression ◽  
Severe Disease ◽  
Small Sample ◽  
Hospitalized Patients ◽  
Controlled Trials ◽  
Double Blind ◽  
Randomized Controlled ◽  
End Point ◽  
Clinical Scores

Abstract Background Effective therapies to combat coronavirus 2019 (COVID-19) are urgently needed. Hydroxychloroquine (HCQ) has in vitro antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the clinical benefit of HCQ in treating COVID-19 is unclear. Randomized controlled trials are needed to determine the safety and efficacy of HCQ for the treatment of hospitalized patients with COVID-19. Methods We conducted a multicenter, double-blind randomized clinical trial of HCQ among patients hospitalized with laboratory-confirmed COVID-19. Subjects were randomized in a 1:1 ratio to HCQ or placebo for 5 days and followed for 30 days. The primary efficacy outcome was a severe disease progression composite end point (death, intensive care unit admission, mechanical ventilation, extracorporeal membrane oxygenation, and/or vasopressor use) at day 14. Results A total of 128 patients were included in the intention-to-treat analysis. Baseline demographic, clinical, and laboratory characteristics were similar between the HCQ (n = 67) and placebo (n = 61) arms. At day 14, 11 (16.4%) subjects assigned to HCQ and 6 (9.8%) subjects assigned to placebo met the severe disease progression end point, but this did not achieve statistical significance (P = .350). There were no significant differences in COVID-19 clinical scores, number of oxygen-free days, SARS-CoV-2 clearance, or adverse events between HCQ and placebo. HCQ was associated with a slight increase in mean corrected QT interval, an increased D-dimer, and a trend toward an increased length of stay. Conclusions In hospitalized patients with COVID-19, our data suggest that HCQ does not prevent severe outcomes or improve clinical scores. However, our conclusions are limited by a relatively small sample size, and larger randomized controlled trials or pooled analyses are needed.

scholarly journals Multidisciplinary Chronic Kidney Disease Clinic Practices: A Scoping Review

2019 ◽  
Vol 6 ◽  
pp. 205435811988266 ◽  
Author(s):  
David Collister ◽  
Lonnie Pyne ◽  
Jessie Cunningham ◽  
Maoliosa Donald ◽  
Amber Molnar ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Randomized Controlled Trials ◽  
Glomerular Filtration ◽  
Scoping Review ◽  
Observational Studies ◽  
Controlled Trials ◽  
Team Composition ◽  
Randomized Controlled

Background: Multidisciplinary chronic kidney disease (CKD) clinics improve patient outcomes but their optimal design is unclear. Objective: To perform a scoping review to identify and describe current practices (structure, function) associated with multidisciplinary CKD clinics. Design: Scoping review. Setting: Databases included Medline, EMBASE, Cochrane, and CINAHL. Patients: Patients followed in multidisciplinary CKD clinics globally. Measurements: Multidisciplinary CKD clinic composition, entry criteria, follow-up, and outcomes. Methods: We systematically searched the literature to identify randomized controlled trials, non-randomized interventional studies, or observational studies of multidisciplinary CKD clinics defined by an outpatient setting where two or more allied health members (with or without a nephrologist) provided longitudinal care to 50 or more adult or pediatric patients with CKD. Included studies were from 2002 to present. Searches were completed on August 10, 2018. Title, abstracts, and full texts were screened independently by two reviewers with disagreements resolved by a third. We abstracted data from included studies to summarize multidisciplinary CKD clinic team composition, entry criteria, follow-up, and processes. Results: 40 studies (8 randomized controlled trials and 32 non-randomized interventional studies or observational studies) involving 23 230 individuals receiving multidisciplinary CKD care in 12 countries were included. Thirty-eight focused on adults (27 with CKD, 10 incident dialysis patients, one conservative therapy) while two studies focused on adolescents or children with CKD. The multidisciplinary team included a mean of 4.6 (SD 1.5) members consisting of a nephrologist, nurse, dietician, social worker, and pharmacist in 97.4%, 86.8%, 84.2%, 57.9%, and 42.1% of studies respectively. Entry criteria to multidisciplinary CKD clinics ranged from glomerular filtration rates of 20 to 70 mL/min/1.73m2 or CKD stages 1 to 5 without any proteinuria or risk equation-based criteria. Frequency of follow-up was variable by severity of kidney disease. Team member roles and standardized operating procedures were infrequently reported. Limitations: Unstandardized definition of multidisciplinary CKD care, studies limited to CKD defined by glomerular filtration rate, and lack of representation from countries other than Canada, Taiwan, the United States, and the United Kingdom. Conclusions: There is heterogeneity in multidisciplinary CKD team composition, entry criteria, follow-up, and processes with inadequate reporting of this complex intervention. Additional research is needed to determine the best model for multidisciplinary CKD clinics. Trial registration: Not applicable.

A Scoping Review on the Use of Antibiotic-Impregnated Beads and Applications to Vascular Surgery

2019 ◽  
Vol 54 (2) ◽  
pp. 147-161 ◽  
Author(s):  
Brandon McGuinness ◽  
Khatija Pinky Ali ◽  
Steven Phillips ◽  
Michael Stacey
Keyword(s):  
High Risk ◽  
Vascular Surgery ◽  
Randomized Controlled Trials ◽  
Scoping Review ◽  
Graft Infection ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
High Risk Patients ◽  
Randomized Controlled ◽  
Risk Patients

Introduction: Surgical site infection (SSI) presents a ubiquitous concern to surgical specialties, especially in the presence of prosthetic material. Antibiotic-impregnated beads present a novel and evolving means to combat this condition. This review aims to analyze the quality of evidence and methods of antibiotic bead use, particularly for application within vascular surgery. Methods: A systematic scoping review was conducted within Embase, MEDLINE, and the Cochrane Registry of Randomized Controlled Trials. Articles were evaluated by 2 independent reviewers. Level of evidence was evaluated using the Oxford Center for Evidence-Based Medicine Criteria and the Cochrane Risk of Bias Tool for Randomized Controlled Trials. Results: The search yielded 6951 papers, with 275 included for final analysis. Publications increased in frequency from 1978 to the present. The most common formulation was polymethyl methacrylate; however publications on biodegradable formulations, including calcium sulfate beads, have been published with increasing frequency. Most publications had positive conclusions (94.2%); however, the data was mainly subjective and may be prone to publication bias. Only 11 randomized controlled trials were identified and all but one was evaluated to be at a high risk of bias. The most common indication was for osteomyelitis (52%), orthopedic prosthetic infections (20%), and trauma (9%). Within vascular surgery, beads have been used primarily for the treatment of graft infection, with freedom from recurrence rates being reported from 41% to 87.5%. Conclusions: Antibiotic-impregnated beads provide a means to deliver high doses of antibiotic directly to a surgical site, without the risks of parenteral therapy. There has yet to be significant high-level quality data published on their use. There is a large body of evidence that suggests antibiotic beads may be used in SSIs in high-risk patients, prosthetic infections, and other complex surgical infections. Important potential areas of application in vascular surgery include graft infection, prevention of wound infection in high-risk patients, and diabetic foot infection.

scholarly journals Tocilizumab in Hospitalized Patients with COVID-19: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Vijairam Selvaraj ◽  
Mohammad Saud Khan ◽  
Kwame Dapaah-Afriyie ◽  
Arkadiy Finn ◽  
Amos Lal ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Hospitalized Patients ◽  
Controlled Trials ◽  
Randomized Controlled

scholarly journals Pork consumption and its relationship to human nutrition and health: a scoping review

2021 ◽  
Author(s):  
Laura Paige Penkert ◽  
Ruogu Li ◽  
Jing Huang ◽  
Anil Gurcan ◽  
Mei Chun Chung ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Scoping Review ◽  
Case Control ◽  
Human Nutrition ◽  
Controlled Trials ◽  
Case Control Studies ◽  
Nutrition And Health ◽  
Randomized Controlled ◽  
Scoping Reviews ◽  
Pork Consumption

Pork is a frequently consumed red meat that provides substantial amounts of energy, macronutrients, and micronutrients to the diet. Its role in human nutrition and health is controversial and a plethora of data exist in the peer-reviewed scientific literature. Therefore, we conducted a scoping review of clinical and population-based studies to assess the effects of pork consumption on human nutrition and health. Results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Data were extracted from 86 studies, including 16 randomized controlled trials, 1 uncontrolled trial, 7 cohort studies, 4 nonrandomized controlled trials, 4 case-cohort and nested case-control studies, 33 case-control studies, and 21 cross-sectional studies. Intervention studies were conducted in healthy individuals and were short to moderate in duration. The effect of pork intake on patients’ nutrient status was the most commonly assessed outcome. The majority of observational studies assessed the effect of pork on cancer incidence, but no studies assessed the effects of pork on inflammation or oxidative stress. No interventional studies explored diabetes mellitus risk, and only one study assessed cancer risk associated with pork consumption. Several micronutrients in pork, including zinc, iron, selenium, choline, thiamin, and vitamins B6 and vitamin B12, are thought to influence cognitive function and may prove to be a unique area of research. To date, there is a dearth of high-quality randomized controlled trials assessing the effects of pork intake on disease risk factors and outcomes. This review helps highlight the many research gaps that future studies should be designed to address.

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