This is a systematic review article from BMJ looking into the evidence around the title from article published between 1997 to August 2014.
Cognitive impairment after cardiovascular surgery is uncommon in older people, a systematic evidence review published in the Annals of Internal Medicine has concluded. However, the researchers said that the evidence was limited and that the individual study quality was low.
Debate surrounds the possible relation between cardiovascular interventions and subsequent cognitive outcomes in older patients. Some early studies reported a high prevalence of cognitive impairment after coronary artery bypass grafts (CABGs), for example, but later studies have suggested that any such decline predated the procedure.
Safety of short, in-hospital delays before surgery for acute appendicitis: Multicentre cohort study, systematic review, and meta-analysis
Citation: Annals of Surgery, May 2014, vol./is. 259/5(894-903), 0003-4932;1528-1140 (May 2014)
Author(s): Bhangu A.; Panagiotopoulou I.G.; Chatzizacharias N.; Rana M.; Rollins K.; Ejtehadi F.; Jha B.; Tan Y.W.; Fanous N.; Markides G.; Tan A.; Marshal C.; Akhtar S.; Mullassery D.; P. Szatmary (East Cheshire NHS Trust, Macclesfield);
OBJECTIVE: To determine safety of short in-hospital delays before appendicectomy. BACKGROUND: Short organizational delays before appendicectomy may safely improve provision of acute surgical services.
METHODS: The primary endpoint was the rate of complex appendicitis (perforation, gangrene, and/or abscess). The main explanatory variable was timing of surgery, using less than 12 hours from admission as the reference. The first part of this study analyzed primary data from a multicentre study on appendicectomy from 95 centers. The second part combined this data with a systematic review and meta-analysis of published data.
RESULTS: The cohort study included 2510 patients with acute appendicitis, of whom 812 (32.4%) had complex findings. Adjusted multivariable binary regression modelling showed that timing of operation was not related to risk of complex appendicitis [12-24 hours odds ratio (OR) 0.98 (P = 0.869); 24-48 hours OR 0.88 (P = 0.329); 48+ hours OR 0.82 (P = 0.317)]. However, after 48 hours, the risk of surgical site infection and 30-day adverse events both increased [adjusted ORs 2.24 (P = 0.039) and 1.71 (P = 0.024), respectively]. Meta-analysis of 11 nonrandomized studies (8858 patients) revealed that delay of 12 to 24 hours after admission did not increase the risk of complex appendicitis (OR 0.97, P = 0.750).
CONCLUSIONS: Short delays of less than 24 hours before appendicectomy were not associated with increased rates of complex pathology in selected patients. These organizational delays may aid service provision, but planned delay beyond this should be avoided. However, where optimal surgical systems allow for expeditious surgery, prompt appendicectomy will still aid fastest resolution of pain for the individual patient.
Copyright 2014 by Lippincott Williams & Wilkins.
Publication Type: Journal: Article
Full Text: Available from Ovid in Annals of Surgery
17.10 The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients (Roberts)
17.09 A systematic review and economic evaluation of new-generation computed tomography scanners for imaging in coronary artery disease and congenital heart disease: Somatom Definition Flash, Aquilion ONE, Brilliance iCT and Discovery CT750 HD (Westwood)
17.07 Study of the use of antidepressants for depression in dementia: the HTA -SADD trial – a multicentre, randomised, double-blind, placebo-controlled trial of the clinical effectiveness and cost-effectiveness of sertraline and mirtazapine (Banerjee)
14 January 2013
A big ‘thank you’ to the BMJ who have identified a number of very useful articles that explain how to read and interpret different kinds of research papers:
- Papers that go beyond numbers (qualitative research) Trisha Greenhalgh, Rod Taylor
- Papers that summarise other papers (systematic reviews and meta-analyses) Trisha Greenhalgh
- Papers that tell you what things cost (economic analyses) Trisha Greenhalgh
- Papers that report diagnostic or screening tests Trisha Greenhalgh
- Papers that report drug trials Trisha Greenhalgh
- Statistics for the non-statistician. II: “Significant” relations and their pitfalls Trisha Greenhalgh
- Statistics for the non-statistician Trisha Greenhalgh
- Assessing the methodological quality of published papers Trisha Greenhalgh
- Getting your bearings (deciding what the paper is about) Trisha Greenhalgh
- The Medline database Trisha Greenhalgh
In addition to regular updates to systematic reviews and guidelines, the new Clinical Evidence website includes additional educational and practical resources. Discover more about evidence based medicine.
Estimates of prevalence of this condition vary widely depending on population and study recruitment criteria. What is clear, though, is that the condition is common, and that women with severe prolapse can suffer unpleasant and debilitating symptoms. Our latest update covers important new evidence on hormone treatments and surgical options.
Visit the Clinical Evidence website to see the full review.
For more information on all the above systematic reviews, visit the Clinical Evidence website.
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