Cognitive decline after heart surgery is uncommon, review finds

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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.

Szatmary, P, et al; Annals of Surgery, May 2014,

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
Source: EMBASE
Full Text: Available from Ovid in Annals of Surgery

New titles in the Health Technology Assessment Journal

17.11 Evaluation of mammographic surveillance services in women aged 40-49 years with a moderate family history of breast cancer: a single-arm cohort study  (Duffy)

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)

17.08 Adjunctive colposcopy technologies for examination of the uterine cervix – DySIS, LuViva Advanced Cervical Scan and Niris Imaging System: a systematic review and economic evaluation  (Wade)

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)

 

BMJ: How to read a paper

14 January 2013

readiconHow to read a paper

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:

Clinical Evidence Update

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.

See the new statistics calculator resource.

Resource Watch: HealthKnowledge

This online learning resource is for anyone working in health, social care and well-being across the NHS, local authorities, the voluntary, and the private sector. The resource allows you to access a broad range of learning materials for personal use or for teaching purposes in order to help everyone expand their public health knowledge.

HealthKnowledge is a ‘one stop shop’ that will provide you with all the public health learning materials, whatever your current competency. The resources on this site are very useful and relate not just to public health topics. Some useful tools included on this website:

  • e-Learning modules
  • Teaching modules
  • Interactive learning modules
  • Critical Appraisal
  • RCT
  • Finding the Evidence
  • Systematic Reviews
  • Economic Evaluations

Go to http://www.healthknowledge.org.uk/interactive-learning/finding-and-appraising-the-evidence