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  1. Article ; Online: Diarrhea in the critically ill: definitions, epidemiology, risk factors and outcomes.

    Dionne, Joanna C / Mbuagbaw, Lawrence

    Current opinion in critical care

    2023  Volume 29, Issue 2, Page(s) 138–144

    Abstract: Purpose of review: In this paper, we review the current evidence with respect to definitions, risk factors, and outcomes of diarrhea in the critically ill and highlight research gaps in the literature.: Recent findings: Definitions of diarrhea in the ...

    Abstract Purpose of review: In this paper, we review the current evidence with respect to definitions, risk factors, and outcomes of diarrhea in the critically ill and highlight research gaps in the literature.
    Recent findings: Definitions of diarrhea in the intensive care unit (ICU) include the World Health Organization quantified as >3 liquid bowel movements per day and the Bristol Stool Chart score of 7. Diarrhea incidence is 37.7-73.8% and varies based on definition applied. Clostridioides difficile associated diarrhea (CDAD) is uncommon with an incidence of 2.2%. Risk factors for diarrhea include total number of antibiotics, enteral nutrition, and suppository use. The composition of enteral nutrition including high osmolarity and high fiber feeds contributed to diarrhea occurrence. Opiates decrease diarrhea incidence whereas probiotics have no effect on the incidence or duration of diarrhea. Outcomes of diarrhea include increased length of stay in the ICU and hospital, however its impact on mortality is unclear.
    Summary: Diarrhea remains a common problem in clinical practice and attention must be paid to modifiable risk factors. Further research is needed on interventions to decrease its burden.
    MeSH term(s) Humans ; Critical Illness/epidemiology ; Critical Illness/therapy ; Risk Factors ; Intensive Care Units ; Diarrhea/epidemiology ; Diarrhea/therapy ; Enteral Nutrition/methods
    Language English
    Publishing date 2023-02-22
    Publishing country United States
    Document type Review ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1235629-3
    ISSN 1531-7072 ; 1070-5295
    ISSN (online) 1531-7072
    ISSN 1070-5295
    DOI 10.1097/MCC.0000000000001024
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Enhanced Recovery After Surgery (ERAS) protocols following emergency intra-abdominal surgery: A systematic review and meta-analysis protocol.

    McKechnie, Tyler / Parpia, Sameer / Bhandari, Mohit / Dionne, Joanna C / Eskicioglu, Cagla

    PloS one

    2023  Volume 18, Issue 9, Page(s) e0291140

    Abstract: Objective: The aim of this systematic review and meta-analysis is to evaluate whether the implementation of Enhanced Recovery After Surgery (ERAS) protocols for adult patients undergoing emergency intra-abdominal surgery decreases postoperative length ... ...

    Abstract Objective: The aim of this systematic review and meta-analysis is to evaluate whether the implementation of Enhanced Recovery After Surgery (ERAS) protocols for adult patients undergoing emergency intra-abdominal surgery decreases postoperative length of stay, postoperative morbidity, and mortality compared to conventional perioperative care.
    Methods: A systematic review and meta-analysis will be performed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). It has been registered on the International Prospective Register for Systematic Reviews (PROSPERO; CRD42023391709). A comprehensive, electronic search strategy will be used to identify studies published and indexed in MEDLINE, EMBASE, Web of Science, CENTRAL, and Pubmed databases since their inception. Trial registries and references of included studies and pertinent previous systematic reviews will also be searched. Studies will be included if they are randomized controlled trials or cohort studies evaluating adult patients undergoing emergency intra-abdominal surgery and comparing ERAS or modified ERAS protocols to conventional perioperative care and report one of the following outcomes: postoperative length of stay, overall 30-day morbidity, 30-day mortality, 30-day infectious morbidity, prolonged postoperative ileus, return of bowel function, and 30-day readmissions. A meta-analysis will be performed using a random effects model for all comparative data using Cochrane Review Manager 5.3 (London, United Kingdom).
    Discussion: ERAS protocols have become standard of care for patients undergoing elective surgery. Their use in the setting of emergency surgery is far less common. The aim of this systematic review and meta-analysis is to assess whether there are benefits in patient important outcomes with the implementation of ERAS protocols for patients undergoing emergency intra-abdominal surgery. Ultimately, we hope to promote their use and further large randomized controlled trials evaluating emergency surgery ERAS programs.
    Prospero registration number: CRD42023391709.
    MeSH term(s) Adult ; Humans ; Abdominal Cavity ; Elective Surgical Procedures ; Enhanced Recovery After Surgery ; Meta-Analysis as Topic ; Perioperative Care ; Randomized Controlled Trials as Topic ; Systematic Reviews as Topic ; Clinical Protocols
    Language English
    Publishing date 2023-09-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0291140
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  3. Article ; Online: In patients hospitalized with COVID-19, adding convalescent plasma to usual care did not reduce 28-d mortality.

    Dionne, Joanna C / Oczkowski, Simon J W

    Annals of internal medicine

    2021  Volume 174, Issue 10, Page(s) JC113

    Abstract: Source citation: RECOVERY Collaborative Group. ...

    Abstract Source citation: RECOVERY Collaborative Group.
    MeSH term(s) COVID-19/therapy ; Coronavirus Infections ; Humans ; Immunization, Passive ; SARS-CoV-2 ; Treatment Outcome
    Language English
    Publishing date 2021-10-05
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 336-0
    ISSN 1539-3704 ; 0003-4819
    ISSN (online) 1539-3704
    ISSN 0003-4819
    DOI 10.7326/ACPJ202110190-113
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  4. Article ; Online: Evidence related to a vegetarian diet and metabolic dysfunction-associated steatotic liver disease: protocol for a scoping review.

    Moss, Kasey / Gitman, Victor / Pinto Sanchez, M Ines / Oczkowski, Simon / Armstrong, David / Jayakumar, Saumya / Karvellas, Constantine Jason / Selzner, Nazia / Dionne, Joanna

    BMJ open

    2024  Volume 14, Issue 4, Page(s) e079750

    Abstract: Introduction: Metabolic dysfunction-associated fatty liver disease (MASLD) is the hepatic manifestation of metabolic syndrome and the leading cause of chronic liver disease worldwide. Given that there is no pharmacological treatment for MASLD, it is ... ...

    Abstract Introduction: Metabolic dysfunction-associated fatty liver disease (MASLD) is the hepatic manifestation of metabolic syndrome and the leading cause of chronic liver disease worldwide. Given that there is no pharmacological treatment for MASLD, it is imperative to understand whether lifestyle modifications may improve biochemical and pathological outcomes. One commonly proposed dietary modification is the Mediterranean diet; however, vegetarianism may also be a promising intervention. Vegetarianism has been shown to be associated with reduced morbidity and mortality in metabolic syndrome outcomes in coronary artery disease and diabetes; however, the relationship between vegetarian diet and MASLD is less clear. In this scoping review, we will provide a comprehensive overview of the current body of evidence related to a vegetarian diet and MASLD.
    Methods and analysis: The aim of this scoping review is to describe and summarise the current body of evidence related to MASLD and a vegetarian diet. This review will be conducted using Arksey and O'Malley's framework. The literature review will be conducted using the following databases: SCOPUS, Web of Science, CINAHL-Plus, Cochrane Library and Medline. No restriction will be made on publication date. Included studies will encompass clinical trials and observational designs that examine effects or association of vegetarian diet in adults (≥16 years) and report on the incidence, prevalence or progression of MASLD. Grey literature, non-human studies and articles focusing on changes in a specific food or nutraceutical will be excluded. Articles must have an English-language abstract available to be considered for inclusion. Screening and data extraction will be conducted by two independent reviewers. The findings will be summarised with descriptive statistics.
    Ethics and dissemination: Approval from a medical ethics committee is not required for this review. Once the review is complete, the findings will be submitted to a peer-reviewed journal.
    MeSH term(s) Adult ; Humans ; Metabolic Syndrome ; Metabolic Diseases ; Diet, Vegetarian ; Non-alcoholic Fatty Liver Disease ; Dietary Supplements ; Research Design ; Review Literature as Topic
    Language English
    Publishing date 2024-04-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2023-079750
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Continuous renal replacement therapy and survival in acute liver failure: A systematic review and meta-analysis.

    Dong, Victor / Robinson, Andrea M / Dionne, Joanna C / Cardoso, Filipe S / Rewa, Oleksa G / Karvellas, Constantine J

    Journal of critical care

    2024  Volume 81, Page(s) 154513

    Abstract: Objective: Acute liver failure (ALF) is a rare syndrome leading to significant morbidity and mortality. An important cause of mortality is cerebral edema due to hyperammonemia. Different therapies for hyperammonemia have been assessed including ... ...

    Abstract Objective: Acute liver failure (ALF) is a rare syndrome leading to significant morbidity and mortality. An important cause of mortality is cerebral edema due to hyperammonemia. Different therapies for hyperammonemia have been assessed including continuous renal replacement therapy (CRRT). We conducted a systematic review and meta-analysis to determine the efficacy of CRRT in ALF patients.
    Materials and methods: We searched MEDLINE, EMBASE, Cochrane Library, and Web of Science. Inclusion criteria included adult patients admitted to an ICU with ALF. Intervention was the use of CRRT for one or more indications with the comparator being standard care without the use of CRRT. Outcomes of interest were overall survival, transplant-free survival (TFS), mortality and changes in serum ammonia levels.
    Results: In total, 305 patients underwent CRRT while 1137 patients did not receive CRRT. CRRT was associated with improved overall survival [risk ratio (RR) 0.83, 95% confidence interval (CI) 0.70-0.99, p-value 0.04, I
    Conclusion: Use of CRRT in ALF patients is associated with improved overall and transplant-free survival compared to no CRRT.
    MeSH term(s) Adult ; Humans ; Continuous Renal Replacement Therapy ; Renal Replacement Therapy/adverse effects ; Ammonia ; Hyperammonemia/etiology ; Liver Failure, Acute/therapy ; Acute Kidney Injury/therapy
    Chemical Substances Ammonia (7664-41-7)
    Language English
    Publishing date 2024-01-09
    Publishing country United States
    Document type Meta-Analysis ; Systematic Review ; Journal Article
    ZDB-ID 632818-0
    ISSN 1557-8615 ; 0883-9441
    ISSN (online) 1557-8615
    ISSN 0883-9441
    DOI 10.1016/j.jcrc.2023.154513
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  6. Article ; Online: Management of severe upper gastrointestinal bleeding in the ICU.

    Al Duhailib, Zainab / Dionne, Joanna C / Alhazzani, Waleed

    Current opinion in critical care

    2020  Volume 26, Issue 2, Page(s) 212–218

    Abstract: Purpose of review: Upper gastrointestinal bleeding (UGIB) is a common condition that can lead to significant morbidity and mortality. Critical care physicians usually get involved in the care of patients with severe UGIB that is associated with ... ...

    Abstract Purpose of review: Upper gastrointestinal bleeding (UGIB) is a common condition that can lead to significant morbidity and mortality. Critical care physicians usually get involved in the care of patients with severe UGIB that is associated with hemodynamic compromise. We aim to provide the readers with evidence-based review of the management of patients with severe UGIB.
    Recent findings: Proton pump inhibitors are the main pharmacologic intervention for UGIB, along with adequate resuscitation and timely endoscopic intervention. Endoscopic therapy should be performed as soon as haemodynamics stabilization is achieved, which requires team collaboration. Several radiologic interventions are now commonly used as a second-line intervention after endoscopy.
    Summary: The management of severe UGIB requires multidisciplinary collaboration, prompt recognition and resuscitation, carful use of blood products, early correction of coagulopathy, and early endoscopic or radiologic interventions.
    MeSH term(s) Endoscopy, Gastrointestinal ; Gastrointestinal Hemorrhage/therapy ; Humans ; Intensive Care Units ; Proton Pump Inhibitors/therapeutic use ; Resuscitation
    Chemical Substances Proton Pump Inhibitors
    Language English
    Publishing date 2020-01-30
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1235629-3
    ISSN 1531-7072 ; 1070-5295
    ISSN (online) 1531-7072
    ISSN 1070-5295
    DOI 10.1097/MCC.0000000000000699
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  7. Article: Very low energy diets prior to bariatric surgery may reduce postoperative morbidity: a systematic review and meta-analysis of randomized controlled trials.

    McKechnie, Tyler / Lee, Yung / Dionne, Joanna / Doumouras, Aristithes / Parpia, Sameer / Bhandari, Mohit / Eskicioglu, Cagla

    Frontiers in nutrition

    2023  Volume 10, Page(s) 1211575

    Abstract: Purpose: To optimize patients prior to bariatric surgery, very low energy diets (VLEDs) are often employed for 2-4 weeks preoperatively. They are known to result in preoperative weight loss, decrease liver volume, and decrease surgeon-perceived ... ...

    Abstract Purpose: To optimize patients prior to bariatric surgery, very low energy diets (VLEDs) are often employed for 2-4 weeks preoperatively. They are known to result in preoperative weight loss, decrease liver volume, and decrease surgeon-perceived operative difficulty. Their impact on postoperative morbidity has been less extensively studied. We performed a focused systematic review and meta-analysis with the aim of comparing preoperative VLEDs prior to bariatric surgery with controls in terms of overall postoperative morbidity.
    Methods: MEDLINE, Embase, and CENTRAL were searched from database inception to February 2023. Articles were eligible for inclusion if they were randomized controlled trials (RCTs) comparing postoperative morbidity in adult patients (i.e., over the age of 18) receiving a VLED with liquid formulation to those receiving a non-VLED control prior to elective bariatric surgery. Outcomes included overall 30-day postoperative morbidity and preoperative weight loss. An inverse variance meta-analysis was performed with GRADE assessment of the quality of evidence.
    Results: After reviewing 2,525 citations, four RCTs with 294 patients receiving preoperative VLEDs with liquid formulation and 294 patients receiving a non-VLED control met inclusion. Patients receiving VLED experienced significantly more preoperative weight loss than patients receiving control (mean difference (MD) 3.38 kg, 95% confidence interval (CI) 1.06-5.70,
    Conclusion: The impact of preoperative VLEDs on postoperative outcomes following bariatric surgery remains unclear. It is possible that VLEDs may contribute to decreased postoperative morbidity, but further larger prospective trials are required to investigate the signal identified in this study.
    Language English
    Publishing date 2023-06-20
    Publishing country Switzerland
    Document type Systematic Review
    ZDB-ID 2776676-7
    ISSN 2296-861X
    ISSN 2296-861X
    DOI 10.3389/fnut.2023.1211575
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  8. Article ; Online: A history of bariatric surgery before surgery for colorectal cancer may improve short-term postoperative outcomes: Analysis of the national inpatient sample 2015-2019.

    McKechnie, Tyler / Lee, Yung / Hong, Dennis / Dionne, Joanna / Doumouras, Aristithes / Parpia, Sameer / Bhandari, Mohit / Eskicioglu, Cagla

    Surgery

    2023  Volume 174, Issue 5, Page(s) 1168–1174

    Abstract: Background: Bariatric surgery is the most effective and sustainable form of weight loss. Bariatric surgery before elective operations for colorectal pathology may improve postoperative outcomes. To compare patients with and without prior bariatric ... ...

    Abstract Background: Bariatric surgery is the most effective and sustainable form of weight loss. Bariatric surgery before elective operations for colorectal pathology may improve postoperative outcomes. To compare patients with and without prior bariatric surgery undergoing surgery for colorectal cancer in terms of postoperative morbidity and health care use.
    Methods: Adult patients undergoing resection for colorectal cancer from 2015 to 2019 were identified from the National Inpatient Sample. Patients were stratified according to their history of bariatric surgery. Propensity score matching with 4:1 nearest-neighbor matching was performed according to demographic, operative, and hospital characteristics. The primary outcome was postoperative morbidity. Secondary outcomes included system-specific postoperative complications, postoperative mortality, postoperative length of stay, total admission health care cost, and post-discharge disposition. McNemar's test and Wilcoxon matched-pairs signed-rank test were performed.
    Results: After propensity score matching, 1,197 patients without prior bariatric surgery and 376 patients with prior bariatric surgery were included. Patients with prior bariatric surgery had an absolute reduction of 6.5% in overall in-hospital postoperative morbidity (19.1% vs 25.6%, P < .0001), a $5,256 decrease in hospitalization cost ($70,344 vs $75,600, P = .034), and were more likely to be discharged home after their index operation (72.9% vs 63.9%, P < .0001).
    Conclusion: Bariatric surgery before surgery for colorectal cancer may be associated with decreased postoperative morbidity and health care use. Bariatric surgery and other forms of rapid and effective weight loss, such as very low-energy diets, should be evaluated further for the optimization of obese patients before nonbariatric abdominal surgery.
    Language English
    Publishing date 2023-09-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 202467-6
    ISSN 1532-7361 ; 0039-6060
    ISSN (online) 1532-7361
    ISSN 0039-6060
    DOI 10.1016/j.surg.2023.08.011
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  9. Article ; Online: Adjudication of a primary trial outcome: Results of a calibration exercise and protocol for a large international trial.

    Cook, Deborah / Deane, Adam / Dionne, Joanna C / Lauzier, François / Marshall, John C / Arabi, Yaseen M / Wilcox, M Elizabeth / Ostermann, Marlies / Al-Fares, Abdulrahman / Heels-Ansdell, Diane / Zytaruk, Nicole / Thabane, Lehana / Finfer, Simon

    Contemporary clinical trials communications

    2024  Volume 39, Page(s) 101284

    Abstract: Background: Ascertainment of the severity of the primary outcome of upper gastrointestinal (GI) bleeding is integral to stress ulcer prophylaxis trials. This protocol outlines the adjudication process for GI bleeding events in an international trial ... ...

    Abstract Background: Ascertainment of the severity of the primary outcome of upper gastrointestinal (GI) bleeding is integral to stress ulcer prophylaxis trials. This protocol outlines the adjudication process for GI bleeding events in an international trial comparing pantoprazole to placebo in critically ill patients (REVISE: Re-Evaluating the Inhibition of Stress Erosions). The primary objective of the adjudication process is to assess episodes submitted by participating sites to determine which fulfil the definition of the primary efficacy outcome of clinically important upper GI bleeding. Secondary objectives are to categorize the bleeding severity if deemed not clinically important, and adjudicate the bleeding site, timing, investigations, and treatments.
    Methods: Research coordinators follow patients daily for any suspected clinically important upper GI bleeding, and submit case report forms, doctors' and nurses' notes, laboratory, imaging, and procedural reports to the methods center. An international central adjudication committee reflecting diverse specialty backgrounds conducted an initial calibration exercise to delineate the scope of the adjudication process, review components of the definition, and agree on how each criterion will be considered fulfilled. Henceforth, bleeding events will be stratified by study drug, and randomly assigned to adjudicator pairs (blinded to treatment allocation, and study center).
    Results: Crude agreement, chance-corrected agreement, or chance-independent agreement if data have a skewed distribution will be calculated.
    Conclusions: Focusing on consistency and accuracy, central independent blinded duplicate adjudication of suspected clinically important upper GI bleeding events will determine which events fulfil the definition of the primary efficacy outcome for this stress ulcer prophylaxis trial.
    Registration: NCT03374800 (REVISE: Re-Evaluating the Inhibition of Stress Erosions).
    Language English
    Publishing date 2024-03-05
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2451-8654
    ISSN (online) 2451-8654
    DOI 10.1016/j.conctc.2024.101284
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  10. Article ; Online: Prophylactic acid suppressants in patients with primary neurologic injury: A systematic review and meta-analysis of randomized controlled trials.

    Daou, Marietou / Dionne, Joanna C / Teng, Jennifer F T / Taran, Shaurya / Zytaruk, Nicole / Cook, Deborah / Wilcox, M Elizabeth

    Journal of critical care

    2022  Volume 71, Page(s) 154093

    Abstract: Purpose: Neurocritical care patients are at risk of stress-induced gastrointestinal ulceration. We performed a systematic review and meta-analysis of stress ulcer prophylaxis (SUP) in critically ill adults admitted with a primary neurologic injury.: ... ...

    Abstract Purpose: Neurocritical care patients are at risk of stress-induced gastrointestinal ulceration. We performed a systematic review and meta-analysis of stress ulcer prophylaxis (SUP) in critically ill adults admitted with a primary neurologic injury.
    Materials and methods: We included randomized controlled trials (RCTs) comparing SUP with histamine-2-receptor antagonists (H2RAs) or proton pump inhibitors (PPIs) to placebo/no prophylaxis, as well as to each other. The primary outcome was in-ICU gastrointestinal bleeding (GIB). Predefined secondary outcomes were all-cause 30-day mortality, ICU length of stay (LOS), nosocomial pneumonia, and other complications.
    Results: We identified 14 relevant trials enrolling 1036 neurocritical care patients; 11 trials enrolling 930 patients were included in the meta-analysis. H2RAs resulted in a lower incidence of GIB as compared to placebo or no prophylaxis (Risk ratio [RR] 0.42, 95% CI 0.30-0.58; p < 0.001); PPIs with a lower risk of GIB compared to placebo/no prophylaxis (RR 0.37, 95% CI 0.23-0.59; p < 0.001). No significant difference was observed in GIB comparing PPIs with H2RAs (RR 0.53, 95% CI 0.26-1.06; p = 0.07; I
    Conclusions: In neurocritical care patients, the overall high or unclear risk of bias of individual trials, the low event rates, and modest sample sizes preclude strong clinical inferences about the utility of SUP.
    MeSH term(s) Adult ; Critical Illness ; Gastrointestinal Hemorrhage/chemically induced ; Histamine H2 Antagonists/therapeutic use ; Humans ; Peptic Ulcer/prevention & control ; Proton Pump Inhibitors/therapeutic use ; Randomized Controlled Trials as Topic ; Stomach Ulcer/prevention & control
    Chemical Substances Histamine H2 Antagonists ; Proton Pump Inhibitors
    Language English
    Publishing date 2022-06-14
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Review ; Systematic Review
    ZDB-ID 632818-0
    ISSN 1557-8615 ; 0883-9441
    ISSN (online) 1557-8615
    ISSN 0883-9441
    DOI 10.1016/j.jcrc.2022.154093
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