作者: Shafique, Muhammad Ashir ; Kumar, Aashish ; Shahid, Muhammad Saad ; Iqbal, Umer ; Arsal, Syed Ali ; Asuka, Emediong Santhus ; Amin, Shafin Bin ; Ali, Syed Muhammad Sinaan ; Naz, Aimen

PURPOSEPatients with heart failure and concomitant renal impairment are often prescribed loop diuretics, such as furosemide, as the primary treatment. The present meta-analysis is focused on analyzing the safety and efficacy of the implementation of tolvaptan as a novel approach in patients with renal impairment and heart failure.METHODSTwo reviewers conducted a screening of articles using online databases, including PubMed, Google Scholar, and Embase. Following a comprehensive literature search, seven articles that met all inclusion criteria (patients with heart failure and renal impairment) were selected for analysis. Subsequently, various primary and secondary outcomes were evaluated.RESULTSThe primary outcomes of our study included urine volume, worsening renal function, blood urea nitrogen (BUN) levels, and creatinine levels. Tolvaptan demonstrated superior efficacy in increasing urine output with a standardized mean difference of 2.18 (95% CI 0.62-3.75, p = 0.006) and resulted in a lower incidence of worsening renal function with odds ratio 0.41 (95% CI 0.22-0.77, p = 0.006). Additionally, there was no significant difference in the tolvaptan and conventional treatment groups in changing serum creatinine levels with a standardized mean difference of - 0.37 (95% CI - 0.86 to 0.12, p = 0.135), but tolvaptan tends to decrease blood urea nitrogen levels with a standardized mean difference - 0.18 (95% CI - 0.30 to - 0.06, p = 0.004) in comparison to conventional treatment group.CONCLUSIONWhile tolvaptan administration was related to better renal outcomes, unresolved heterogeneities and various factors could have influenced our findings. Further research is needed to evaluate the role of tolvaptan in the treatment of this patient population.

2025-01-23·British Journal of Surgery

BHSo5 A systematic review of randomized trials of weight loss before hernia surgery

作者: Findlay, John ; Mclurcan, Nadia

AbstractIntroductionObesity is one of the main modifiable risk factors of outcome following hernia surgery, and is strongly associated with hernia recurrence and complications. For this reason weight loss is strongly recommended before hernia surgery. However, weight loss can be extremely difficult for patients to achieve. A number of interventions have been described, however, the evidence for this before hernia surgery is unclear. The aim of this study was to systematically review the evidence for randomized controlled trials (RCTs) assessing weight loss interventions before hernia surgery.MethodsA literature search was performed of the PubMed, EMBASE (https://www.embase.com/) and CENTRAL databases on 30th May 2024 using the following search term: (weight OR obes* OR preoptimization OR prehabilitation OR BMI OR diet OR exercise) and (hernia OR abdominal wall reconstruction) AND randomized. Bibliographies of retrieved articles were searched. Studies were screened and reviewed independently by two authors.Results2921 articles were identified. After exclusion of duplicates 1707 studies were screened, 20 articles retrieved, and 4 included. Two described the 30 day and 2 year outcomes of a single RCT of non-pharmacological prehabilitation in ventral hernia surgery. Two described RCTs assessing short periods of very low calorie diet before operations which included hernia surgery. Interventions were associated with greater weight loss, with one RCT showing fewer short term complications.ConclusionsWeight loss before hernia surgery is strongly recommended, but the evidence for this is limited to 3 RCTs, with just one finding short-term benefit. This highlights the need for dedicated robust RCTs.

2025-01-22·Journal of Crohn's and Colitis

N28 The UK Inflammatory Bowel Disease Reasearch Network ; Preliminary results from advanced therapies in Inflammatory Bowel Disease a multi-centre evaluation of current practice

作者: Owen, H ; Campbell, R ; Robinson, K ; Avery, P ; Hawkins, S ; Gray, L ; KIrkham, B ; Wen, S ; Diaz, R ; Harrision, W ; Clarke, M ; Mason, I ; Cairnes, V ; Tyrrell, T ; Chan, M ; Devine, D ; LLoyd-Ford, G

AbstractBackgroundIn early 2024, 25 research-ready nurses specialising in IBD joined the United Kingdom IBD Nurse Research Network (UK IBD NRN). This network is dedicated to collaborating on national service evaluation and research initiatives, aiming to enhance service delivery and improve patient experiences within IBD care. Each year, the network will undertake one project, with a ballot for ideas held towards the end of the project. The first initiative focuses on monitoring advanced therapies (AT-IBD) used in the UK for treating IBD.Current recommendations for monitoring advanced therapies in IBD remain ambiguous, and the efficacy of proactive therapeutic drug monitoring (TDM) is still uncertain. To address this, we sought to explore the variations in monitoring practices across IBD services in the UK, focusing on key areas such as access to medication, adherence to monitoring protocols, and the effectiveness of therapeutic drug monitoring.MethodsData collection instruments using REDCap were created and launched in November 2024. Data includes site demographics, a minimum of ten and a maximum of 25 reactively and proactively monitored cases. The case data is collected from retrospective monitoring events and anonymised. Descriptive statistics are used to report results.ResultsSeventeen unique users are entering data from 15 sites. The survey is open to all four nations of the UK. Responses have been received in England and Wales. Of the 17 users (15;82.4%) reported having had training to interpret blood results. IBD patient population was reported by seven out of eleven sites, with a total of 39,843 reported. Two sites shared the entire local population, and three were reported as unknown. The seven sites that reported the IBD patient population used an electronic health record. There is variance in the pre-screening undertaken (Figure 1);access to advanced therapies appears different, with some sites not having access to newer small-molecule medications (Figure 2).There is wide variation in routine and TDM frequency across all therapies.ConclusionThe AT-IBD project is ongoing, with full results anticipated to provide insights into current practices for monitoring advanced therapies in the UK. The collected data may offer valuable insights regarding adherence and the effectiveness of advanced therapy monitoring, particularly concerning patient safety and outcomes. The UK IBD NRN remains committed to providing opportunities for training, collaboration, and research for IBD nurses across the UK.

100 项与 North Devon District Hospital 相关的药物交易

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