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Meta-analysis of Cardiovascular Events and Related Biomarkers Comparing Survivors Versus Non-survivors in Patients With COVID-19.
Shoar, S, Hosseini, F, Naderan, M, Mehta, JL
The American journal of cardiology. 2020;:50-61
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Abstract
Since the emergence of the coronavirus disease 19 (COVID-19), a number of studies have reported the presence of cardiovascular diseases in affected patients and linked them with a higher risk of mortality. We conducted an online search in Medline/PubMed to identify original cohorts comparing data between survivors and non-survivors from COVID-19. The presence of cardiovascular events and related biomarkers were compared between the 2 groups. Data on 1,845 hospitalized patients with COVID-19 were pooled from 12 comparative studies. The overall mortality rate in relation to COVID-19 was 17.6%. Men aged > 50 years old were more likely to die from COVID-19. Significant co-morbidities contributing to mortality were hypertension, diabetes mellitus, smoking, a previous history of cardiovascular disease including chronic heart failure, and cerebrovascular accidents. A significant relationship was observed between mortality and patient presentation with dyspnea, fatigue, tachycardia, and hypoxemia. Cardiovascular disease-related laboratory biomarkers related to mortality were elevated serum level of lactate dehydrogenase, creatine kinase, brain natriuretic peptide, and cardiac troponin I. Adverse cardiovascular disease-related clinical events preceding death were shock, arrhythmias, and acute myocardial injury. In conclusion, severe clinical presentation and elevated biomarkers in COVID-19 patients with established risk factors can predict mortality from cardiovascular causes.
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Effect and efficacy of lifestyle interventions as secondary prevention.
Liljehult, J, Christensen, T, Molsted, S, Overgaard, D, Mesot Liljehult, M, Møller, T
Acta neurologica Scandinavica. 2020;(4):299-313
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INTRODUCTION Improvements in health behaviour are often recommended as part of secondary prevention in patients with stroke and transient ischaemic attack. However, there is a lack of knowledge as to how this is applied in clinical practice. AIM: In this systematic review and meta-analysis, we examined the effect of counselling or educational intervention directed at individual or multiple behavioural risk factors on blood pressure and other reported outcomes. METHODS PubMed, Embase, PsycInfo, CINAHL, Scopus and Web of Science were systematically searched. Meta-analyses were conducted on all outcome measures if appropriate. A qualitative analysis of the content of the interventions was conducted to review which elements the interventions consisted of. RESULTS Twenty-nine randomized controlled trials were identified. Fourteen reported effects on systolic blood pressure, and pooled results showed a significant beneficial effect (n = 2,222; -3.85 mmHg [95%CI -6.43; -1.28]). The effect was greatest in the four interventions which included supervised training (n = 174; -9.83 mmHg [95%CI -16.56; -3.09]). CONCLUSION Modifying health behaviour in stroke survivors might have a moderate beneficial effect on blood pressure, especially if the intervention includes supervised physical training.
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Quality of life in survivors of oropharyngeal cancer: A systematic review and meta-analysis of 1366 patients.
Høxbroe Michaelsen, S, Grønhøj, C, Høxbroe Michaelsen, J, Friborg, J, von Buchwald, C
European journal of cancer (Oxford, England : 1990). 2017;:91-102
Abstract
Human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) is rapidly increasing in incidence and has a favourable prognosis compared with HPV-negative disease. Current combined therapies include significant risks of morbidity for the growing group of survivors. This systematic review and meta-analysis investigates how treatment affects quality of life (QoL) in survivors of oropharyngeal cancer. PubMed, EMBASE and the Cochrane Library were systematically searched for all studies reporting patient-assessed QoL at least 1 year after treatment for OPC. In a meta-analysis, weighted average QoL scores from the four most commonly utilised QoL instruments were compared with baseline and reference group scores using the concept of minimal clinically important difference. The meta-analysis included data from 1366 patients from 25 studies and 12 countries. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) was answered by 704 patients, 644 patients answered the EORTC QLQ Head and Neck-35 (H&N-35), 474 patients answered the University of Washington Quality of Life Questionnaire, and 381 patients answered the M. D. Anderson Dysphagia Inventory. Moderate to large clinically important deteriorations in QoL were found in the domains dry mouth and sticky saliva for the EORTC QLQ-H&N35, saliva, chewing, swallowing, speech, taste, appearance and shoulder for the University of Washington Quality of Life Questionnaire, and the global, physical and emotional subscales for the M. D. Anderson Dysphagia Inventory. In conclusion, survivors of OPC face clinically important deteriorations in QoL that most markedly centre on xerostomia, dysphagia and chewing. These ailments indicate a potential for improvement in patient management.
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Stroke survivors' and family members' perspectives of multimodal lifestyle interventions for secondary prevention of stroke and transient ischemic attack: a qualitative review and meta-aggregation.
Lawrence, M, Pringle, J, Kerr, S, Booth, J
Disability and rehabilitation. 2016;(1):11-21
Abstract
PURPOSE The incidence of stroke is of global concern, and the rates of recurrence are high. Many risk factors are related to lifestyle behaviours and, as such, are amenable to change. Implementation of effective secondary prevention interventions is essential; however, little is known about influences on participation and adherence. This review and meta-aggregation aimed to improve understanding of stroke survivor and family member perspectives of secondary prevention interventions. METHODS We searched 11 databases, e.g. Medline and PsycINFO. We included qualitative studies that focused on adult stroke survivors and family members who had participated in a multimodal stroke secondary prevention intervention. Critical appraisal and data extraction were performed independently by two reviewers. A meta-aggregation of qualitative findings was conducted. RESULTS Five papers were included. One hundred and three findings were extracted and grouped into 14 categories from which three synthesised findings emerged: feeling supported, acquiring knowledge and gaining confidence. CONCLUSIONS The findings highlight the perceived benefits of participation in secondary prevention group interventions from the perspective of stroke survivors and family members, i.e. feeling supported, by others with shared understanding and by knowledgeable health professionals, acquiring new knowledge and gaining confidence. These findings may be used to inform development of patient-centred interventions and thereby assist in improving health outcomes. IMPLICATIONS FOR REHABILITATION Health professionals should consider implementing group-based secondary prevention interventions. The content of group-based secondary prevention interventions should be person-centred, i.e. meaningful and relevant to the individual. Stroke survivors and family members are more likely to comply with advice and information provided by expert and experienced health professionals.
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The risk of developing a second primary cancer in melanoma patients: a comprehensive review of the literature and meta-analysis.
Caini, S, Boniol, M, Botteri, E, Tosti, G, Bazolli, B, Russell-Edu, W, Giusti, F, Testori, A, Gandini, S
Journal of dermatological science. 2014;(1):3-9
Abstract
The number of cutaneous melanoma survivors has been increasing for years due to improvements in early diagnosis and subsequent prolonged survival. These patients are at increased risk of developing a second melanoma and a second primary malignancy (SPM) at other sites as well. We performed a review of scientific literature and meta-analysis to evaluate the risk of developing a SPM (other than melanoma) among melanoma patients. Twenty-three independent papers and over 350,000 melanoma patients were included. Risk of cancer among melanoma survivors was increased overall (1.57, 95% CI 1.29-1.90) and at several sites: bone (2.09, 95% CI 1.08-4.05), non-melanoma skin cancer (4.01, 95% CI 1.81-8.87), soft tissue (6.80, 95% CI 1.29-35.98), colon-rectum (1.12, 95% CI 1.00-1.25), female breast (1.14, 95% CI 1.07-1.22), kidney (1.34, 95% CI 1.23-1.45), prostate (1.25, 95% CI 1.13-1.37) and non-Hodgkin lymphoma (1.37, 95% CI 1.22-1.54). The overall risk of SPM showed a tendency to decrease as the time from melanoma diagnosis lengthened. Most of our findings may be explained by the tendency of some exposures, which are risk factors for different tumors, to occur simultaneously in the same individuals. These results suggest primary and secondary cancer prevention counselling for melanoma survivors.
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Physical activity and quality of life of cancer survivors: a lack of focus for lifestyle redesign.
Lee, JE, Loh, SY
Asian Pacific journal of cancer prevention : APJCP. 2013;(4):2551-5
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BACKGROUND Physical activity is a component of lifestyle activity and one that has been increasingly seen as 'the medicine' to cure chronic diseases, including certain types of cancer. Physical activity has potent impact on mortality but only if it is well incorporated as lifestyle activity may it allow a better outcome of the quality of life of cancer survivors. This paper presents a review on the evidence of physical activity being actively promoted as lifestyle activity amongst cancer survivors, for the last five years. MATERIALS AND METHODS Electronic databases were systematically searched for randomized controlled trials incorporated as lifestyle activity through MEDLINE with the associated terms "physical activity or exercise", "quality of life" and "cancer survivor or people with cancer", 'lifestyle' and 'randomised controlled trial'. The period of search was confined to publication within January 2008 till December 2012 and further limits were to full text, peer reviewed, abstract available and English language. RESULTS Based on inclusion criteria, 45 articles were retrieved. Of these, 41 were excluded after examining the full paper. Four final articles on randomized controlled trials were studied to determine the effectiveness of PA to improve the quality of life in post treatment cancer survivors and positive associations were found. CONCLUSIONS Physical activity is related to better quality of life of cancer survivors. Only one paper had characteristics of lifestyle incorporation for a lifestyle redesign, but none overtly or actively promoting exercise interventions as an essential lifestyle activity. With increasing survivorship, the benefits of physical activity must be aggressively and overtly promoted to optimize its positive impact.
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The effect of androgen deprivation therapy on body composition in men with prostate cancer: systematic review and meta-analysis.
Haseen, F, Murray, LJ, Cardwell, CR, O'Sullivan, JM, Cantwell, MM
Journal of cancer survivorship : research and practice. 2010;(2):128-39
Abstract
INTRODUCTION The use of androgen deprivation therapy (ADT) in the treatment of prostate cancer is associated with changes in body composition including increased fat and decreased lean mass. Limited information exists regarding the rate and extent of these changes. This systematic review was conducted to determine the effects of ADT on body composition in prostate cancer patients. METHODS Literature searches were conducted on MEDLINE, EMBASE and Web of Science for studies until January 2009. Only longitudinal studies that examined ADT and body composition in prostate cancer patients were included. Data were extracted on body weight, BMI, percentage of fat mass and lean body mass. RESULTS Sixteen studies (14 cohorts and 2 RCTs) met the inclusion criteria. Pooled data, calculated according to a random effects model, showed that ADT increased % body fat by on average 7.7% (95% CI 4.3, 11.2, from seven studies, P < 0.0001) and decreased % lean body mass by on average -2.8% (95% CI -3.6, -2.0, from six studies, P < 0.0001) but for both there was marked heterogeneity between studies (I2 = 99% I2 = 73%, respectively). Similarly, body weight (2.1%, P < 0.0001 from nine studies) and BMI (2.2%, P < 0.0001, from eight studies) increased significantly. More extensive changes were seen with longer duration of treatment. CONCLUSIONS Substantial increases in fat and declines in lean mass were observed in prostate cancer patients treated with ADT. Lifestyle changes or suitable interventions to minimize the effect of ADT on body composition need to be investigated. IMPLICATIONS FOR CANCER SURVIVORS Prostate cancer survivors should be made aware of the side effect of treatment on body composition and further work is required to determine what interventions can minimize the impact of ADT on body composition and therefore what evidence based advice they should be provided with. In general, though recommendation of a healthy diet and moderate exercise is reasonable.