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  1. Article ; Online: Reporting conflicts of interest in randomised trials of patient blood management interventions in patients requiring major surgery

    Riccardo G Abbasciano / Gavin Murphy / Toby Richards / Marius Roman / Oluwatomini Fashina / Sara Tomassini / Florence Lai

    BMJ Open, Vol 12, Iss

    a systematic review and meta-analysis

    2022  Volume 8

    Abstract: Objective This study aimed to systematically review the effects of declared and undeclared conflicts of interest on randomised controlled trials (RCTs) of patient blood management (PBM) interventions.Design We performed a secondary analysis of a recently ...

    Abstract Objective This study aimed to systematically review the effects of declared and undeclared conflicts of interest on randomised controlled trials (RCTs) of patient blood management (PBM) interventions.Design We performed a secondary analysis of a recently published meta-analysis of RCTs evaluating five common PBM interventions in patients undergoing major surgery.Data sources The databases searched by the original systematic reviews were searched using subject headings and Medical Subject Headings terms according to search strategies from the final search time-points until 1 June 2019.Eligibility criteria RCTs on PBM irrespective of blinding, language, date of publication and sample size were included. Abstracts and unpublished trials were excluded. Conflicts of interest were defined as sponsorship, funding or authorship by industry, professional PBM advocacy groups or blood services.Data extraction and synthesis Three independent reviewers extracted the data and assessed the risk of bias. Pooled treatment effect estimates were reported as risk ratios (RRs) or standardised mean difference with 95% CIs. Heterogeneity was quantified using the I2 statistic.Results Three hundred and eighty-nine RCTs totalling 53 635 participants were included. Thirty-two trials (8%) were considered free from important sources of bias. There was reporting bias favouring PBM interventions on transfusion across all analyses. In trials with no declared author conflicts of interest, the treatment effect on mortality was RR 1.12 (0.86 to 1.45). In trials where author conflicts of interest were declared, the treatment effect on mortality was RR 0.84 (0.69 to 1.03), with significant reporting bias favouring PBM interventions. Trials with declared conflicts linked to professional PBM advocacy groups (five studies, n=977 patients) reported statistically significant reductions in mortality RR 0.40 (0.17 to 0.92), unlike other groups.Conclusions Low certainty of the evidence that guides PBM implementation is confounded by evidence of reporting ...
    Keywords Medicine ; R
    Subject code 610
    Language English
    Publishing date 2022-08-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: A systematic review of micro‐RNAs in aortic stenosis and cardiac fibrosis

    Jemima Osekafore Adewuyi / Roshan Patel / Riccardo Abbasciano / Gerry P. McCann / Gavin Murphy / Marcin J. Woźniak / Anvesha Singh

    Clinical and Translational Science, Vol 15, Iss 8, Pp 1809-

    2022  Volume 1817

    Abstract: Abstract Aortic stenosis (AS) is the commonest valve lesion requiring surgery in the Western world. The presence of myocardial fibrosis is associated with mortality even after valve replacement. MicroRNAs could serve as biomarkers of fibrosis and risk ... ...

    Abstract Abstract Aortic stenosis (AS) is the commonest valve lesion requiring surgery in the Western world. The presence of myocardial fibrosis is associated with mortality even after valve replacement. MicroRNAs could serve as biomarkers of fibrosis and risk stratify patients for earlier intervention. This study aimed to systematically review reports of micro‐RNA (miR) associated with fibrosis in AS and identify potential biomarkers. We searched EMBASE, Medline, and Web of Science up to May 2020. Studies that reported on the role of miRs in AS and cardiac fibrosis were included. Study quality was assessed using the Newcastle‐Ottawa scale. Of 4230 reports screened, 25 were included. All studies were of low to moderate quality. MiRs were analyzed in myocardial tissue (n = 10), aortic valve tissue (n = 5), plasma (n = 5), and serum (n = 5). A total of 365 miRs were reported, of which only a few were reported in more than one paper (3 in the myocardium, 5 in the aortic valve, and 1 in plasma). miR‐21 was upregulated in plasma and myocardial tissue. MiR‐19b was downregulated in the myocardium. Papers reporting myocardial miR‐1 contradicted each other, and miR‐133a was associated with increased left ventricular mass regression post‐surgery. In the aortic valve, miRs‐665, 602 and 939 were downregulated, and miRs‐193b and 214 were upregulated. The data on miR in fibrosis in AS is scarce and of low to moderate quality. Further studies are needed to identify novel miRs as biomarkers, especially at an earlier asymptomatic phase of the disease.
    Keywords Therapeutics. Pharmacology ; RM1-950 ; Public aspects of medicine ; RA1-1270
    Subject code 610
    Language English
    Publishing date 2022-08-01T00:00:00Z
    Publisher Wiley
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Mini-sternotomy versus conventional sternotomy for aortic valve replacement

    Enoch Akowuah / James Mason / Adetayo Kasim / Helen C Hancock / Rebecca H Maier / Gavin Murphy / Andrew Goodwin / W Andrew Owens

    BMJ Open, Vol 11, Iss

    a randomised controlled trial

    2021  Volume 1

    Abstract: Objective To compare clinical and health economic outcomes after manubrium-limited mini-sternotomy (intervention) and conventional median sternotomy (usual care).Design A single-blind, randomised controlled trial.Setting Single centre UK National Health ... ...

    Abstract Objective To compare clinical and health economic outcomes after manubrium-limited mini-sternotomy (intervention) and conventional median sternotomy (usual care).Design A single-blind, randomised controlled trial.Setting Single centre UK National Health Service tertiary hospital.Participants Adult patients undergoing aortic valve replacement (AVR) surgery.Interventions Intervention was manubrium-limited mini-sternotomy performed using a 5–7 cm midline incision. Usual care was median sternotomy performed using a midline incision from the sternal notch to the xiphisternum.Primary and secondary outcome measures The primary outcome was the proportion of patients who received a red cell transfusion postoperatively and within 7 days of index surgery. Secondary outcomes included proportion of patients receiving a non-red cell blood component transfusion and number of units transfused within 7 days and during index hospital stay, quality of life and cost-effectiveness analyses.Results 270 patients were randomised, received surgery and contributed to the intention to treat analysis. No difference between mini and conventional sternotomy in red-cell transfusion within 7 days was found; 23/135 patients in each arm received a transfusion, OR 1.0 (95% CI 0.5 to 2.0) and risk difference 0.0 (95% CI −0.1 to 0.1). Mini-sternotomy reduced chest drain losses (mean 181.6 mL (SD 138.7) vs conventional, mean 306·9 mL (SD 348.6)); this did not reduce red-cell transfusions. Mean valve size and postoperative valve function were comparable between mini-sternotomy and conventional groups; 23 mm vs 24 mm and 6/134 moderate or severe aortic regurgitation vs 3/130, respectively. Mini-sternotomy resulted in longer bypass (82.7 min (SD 23.5) vs 59.6 min (SD 15.1)) and cross-clamp times (64.1 min (SD 17.1) vs 46·3 min (SD 10.7)). Conventional sternotomy was more cost-effective with only a 5.8% probability of mini-sternotomy being cost-effective at a willingness to pay of £20 000/QALY (Quality Adjusted Life Years).Conclusions AVR via mini-sternotomy did not reduce red blood cell transfusion within 7 days following surgery when compared with conventional sternotomy.Trial registration number ISRCTN29567910; Results.
    Keywords Medicine ; R
    Subject code 610
    Language English
    Publishing date 2021-01-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Effect of high-flow nasal therapy on patient-centred outcomes in patients at high risk of postoperative pulmonary complications after cardiac surgery

    Melissa Earwaker / Sofia Villar / Julia Fox-Rushby / Melissa Duckworth / Sarah Dawson / Jo Steele / Yi-da Chiu / Edward Litton / Gudrun Kunst / Gavin Murphy / Guillermo Martinez / Vasileios Zochios / Val Brown / Geoff Brown / Andrew Klein

    Trials, Vol 23, Iss 1, Pp 1-

    a study protocol for a multicentre adaptive randomised controlled trial

    2022  Volume 18

    Abstract: Abstract Background High-flow nasal therapy is a non-invasive form of respiratory support that delivers low-level, flow dependent positive airway pressure. The device can be better tolerated by patients than alternatives such as continuous positive ... ...

    Abstract Abstract Background High-flow nasal therapy is a non-invasive form of respiratory support that delivers low-level, flow dependent positive airway pressure. The device can be better tolerated by patients than alternatives such as continuous positive airway pressure. The primary objective is to determine if prophylactic high-flow nasal therapy after tracheal extubation can result in an increase in the number of days alive and at home within the first 90 days after surgery, when compared with standard oxygen therapy. The co-primary objective is to estimate the incremental cost-effectiveness and cost-utility of high-flow nasal therapy vs standard oxygen therapy at 90 days, from the view-point of the public sector, the health service and patients. Methods This is an adaptive, multicentre, international parallel-group, randomised controlled trial with embedded cost-effectiveness analysis comparing the use of high-flow nasal therapy with control in patients at high risk of respiratory complications following cardiac surgery. Participants will be randomised before tracheal extubation and allocated either high-flow nasal therapy or standard oxygen therapy for a minimum of 16 h immediately post extubation. Participants will be followed up until 90 days after surgery. The total sample size needed to detect a 2-day increase in DAH90 with 90% power with an intention to treat analysis is 850 patients. The adaptive design includes an interim sample size re-estimation which will provide protection against deviations from the original sample size assumptions made from the single-centre pilot study and will allow for a maximum sample size increase to 1152 patients. Discussion Evidence to support routine use of high-flow nasal therapy will inform the development of effective enhanced recovery care bundles. Reducing complications should reduce length of stay and re-admission to hospital and provide an important focus for cost reduction. However; high-quality studies evaluating the clinical and cost effectiveness of high-flow nasal ...
    Keywords Cardiothoracic surgery ; High-flow nasal therapy ; Post-operative pulmonary complications ; Adaptive design ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2022-03-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Regional repositories, reintermediation and the new GMS contract

    Frank Sullivan / Neil McEwan / Gavin Murphy

    Journal of Innovation in Health Informatics, Vol 11, Iss 4, Pp 215-

    cardiovascular disease in Tayside

    2003  Volume 221

    Abstract: Background The new contract for general medical practitioners will make increasing demands on the primary care informatics community. There are a number of potential ways to provide reports which meet the requirements for data on the quality of care ... ...

    Abstract Background The new contract for general medical practitioners will make increasing demands on the primary care informatics community. There are a number of potential ways to provide reports which meet the requirements for data on the quality of care being provided by practices. In Scotland there are four components of the national information technology strategy which make meaningful comparisons of data possible. Objective Using cardiovascular data as an example, to describe how the community health index number, managed clinical networks (MCNs), increasing consistency of Read codes, and regional repositories of data make the acquisition, processing and use of data more straightforward. Method The cardiovascular MCN collects the majority of its data electronically and four properties are crucial to its success: automatic collection of electronic data from many sources, prioritisation of data derived from multiple sources, record linkage processes, and manual validation of electronic data. Results Clinicians in primary and secondary care enter data during consultations and see the results of consultations recorded elsewhere. Because all data from the region are able to be Read coded according to prespecified templates, we are able to indicate to practices where they are in relation to the new contract targets and indicate which patients need to be seen, or excluded from, calculations. Conclusion Effectively integrated management is facilitated by provision of regular prompted recall and review of people with chronic disease by multidisciplinary teams collaborating across the health service and into the community. In Scotland, use of newer informatics tools are proving to be useful contributions from primary care computing to equitable, evidence-based care.
    Keywords computerised medical records ; coronary heart disease ; data quality ; general practice ; quality improvement ; Computer applications to medicine. Medical informatics ; R858-859.7
    Subject code 310
    Language English
    Publishing date 2003-12-01T00:00:00Z
    Publisher BCS, The Chartered Institute for IT
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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