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1.
What is known and objective: Dabigatran and rivaroxaban are new oral anticoagulants for thromboprophylaxis after elective orthopaedic surgery. We aimed to systematically compare their relative benefits and harms through meta‐analysis, and adjusted indirect comparison. Methods: We searched PubMed, EMBASE, trial registries and regulatory documents through May 2009 for randomized controlled trials (RCTs) of dabigatran (150 and 220 mg daily) and rivaroxaban (10 mg daily) compared with enoxaparin (40–60 mg daily) in elective orthopaedic surgery. We used random effects meta‐analysis to calculate pooled relative risks (RRs) and 95% confidence intervals (95% CI) for the outcomes of total venous thromboembolism, VTE (deep venous thrombosis, non‐fatal pulmonary embolism and all‐cause mortality), and haemorrhagic adverse events (major and clinically relevant non‐major bleeds). Adjusted indirect comparison was used for the pooled RRs of dabigatran and rivaroxaban with enoxaparin as the common control. Results: Rivaroxaban was superior to enoxaparin for the prevention of venous thromoboembolism (RR 0·56, 95% CI 0·43–0·73, P < 0·0001), with a trend for increased haemorrhage (RR 1·26, 95% CI 0·94–1·69, P = 0·13). Dabigatran was not superior to enoxaparin for prevention of VTE (RR 1·12, 95% 0·97–1·29, P = 0·12), and did not reduce haemorrhage risk (RR 1·10, 95% 0·90–1·35, P = 0·32). Adjusted indirect comparison showed that rivaroxaban was superior to dabigatran in preventing VTE, RR 0·50 (95% CI 0·37–0·68), but with a slight trend towards increased haemorrhage RR 1·14 (95% CI 0·80–1·64). What is new and conclusion: Rivaroxaban may be more effective than dabigatran for prevention of VTE after elective orthopaedic surgery but might also slightly increase the risk of haemorrhage.  相似文献   

2.
This narrative review examines current research on risk factors, prevention methods and management strategies for vasovagal reactions (VVRs) that occur during or as a result of blood donation. VVRs are important to blood collection agencies (BCAs) as they negatively impact the number of completed collections, perceptions of the safety of blood donation and rates of donor return. There has been significant progress in understanding and preventing VVRs in blood donation in recent years, with a multitude of risk factors identified. This has resulted in many BCAs implementing evidence‐based strategies, such as donor age and weight restrictions. However, the profile of our most vulnerable donors and features of the donation setting that may protect these donors from experiencing a VVR have not been identified. Furthermore, an increased number of trials of physiological and psychological prevention interventions to reduce both immediate and delayed VVRs have been reported. However, a lack of methodological consistency in operationalising interventions to reduce or prevent VVRs means that the identification of effective VVR prevention strategies remains a challenge for practitioners. Furthermore, research is still required to determine how to successfully implement prevention and management strategies into standard operating procedures within collection centres. Finally, research in the management and mitigation of the effect of VVRs is currently only suggestive of what should be done to care for the donor who reacts and how to empower those donors to return. Collectively, research into these aspects of VVRs will provide support to donors and BCAs and improve the safety of blood donation.  相似文献   

3.
Background/aim: This study aimed to assess the effectiveness and safety of naloxone in the management of hepatic encephalopathy (HE). Methods: Cochrane collaboration methodology was used in a meta‐analysis of randomized controlled trials of naloxone therapy for HE. Results: Seventeen randomized trials were identified with 15 studies involving 1054 patients meeting criteria for inclusion. Naloxone use was associated with a significant improvement in HE [relative risk (RR) 1·46; 95% confidence interval (CI) 1·27–1·67; P = 0·0005]. This comparison showed statistical heterogeneity (P < 0·10, and χ2 = 44·93). Subgroup analysis indicated naloxone administered parenterally by intermittent or continuous infusions to be effective (RR 1·34; 95% CI 1·17–1·53; P < 0·0001). A significant in trials by infusion route (RR 1·42; 95% CI 1·19–1·69; P < 0·0001) interaction was observed. Conclusions: Naloxone may improve HE. However, published data are limited.  相似文献   

4.
5.
BACKGROUND: In Brazil little is known about adverse reactions during donation and the donor characteristics that may be associated with such events. Donors are offered snacks and fluids before donating and are required to consume a light meal after donation. For these reasons the frequency of reactions may be different than those observed in other countries. STUDY DESIGN AND METHODS: A cross‐sectional study was conducted of eligible whole blood donors at three large blood centers located in Brazil between July 2007 and December 2009. Vasovagal reactions (VVRs) along with donor demographic and biometric data were collected. Reactions were defined as any presyncopal or syncopal event during the donation process. Multivariable logistic regression was performed to identify predictors of VVRs. RESULTS: Of 724,861 donor presentations, 16,129 (2.2%) VVRs were recorded. Rates varied substantially between the three centers: 53, 290, and 381 per 10,000 donations in Recife, São Paulo, and Belo Horizonte, respectively. Although the reaction rates varied, the donor characteristics associated with VVRs were similar (younger age [18‐29 years], replacement donors, first‐time donors, low estimated blood volume [EBV]). In multivariable analysis controlling for differences between the donor populations in each city younger age, first‐time donor status, and lower EBV were the factors most associated with reactions. CONCLUSION: Factors associated with VVRs in other locations are also evident in Brazil. The difference in VVR rates between the three centers might be due to different procedures for identifying and reporting the reactions. Potential interventions to reduce the risk of reactions in Brazil should be considered.  相似文献   

6.
Objectives and Aim: We performed a study of hepatitis B virus (HBV) risk factors among blood donors in Bangalore, India. Background: HBV infection is prevalent in India and poses a potential risk of transmission by blood transfusion, but studies of risk factors for hepatitis B surface antigen (HBsAg) carriage among Indian blood donors are lacking. Methods/Materials: Using a case‐cohort design, we enrolled 71 cases with repeatedly reactive HBsAg results and a cohort of 212 contemporaneous blood donors with unknown HBsAg status. Questionnaire data were analysed using multivariable logistic regression. Results: In our multivariate analysis controlling for age, HBsAg positivity was associated with repeat donor status (OR = 0·34, 95% CI 0·17–0·71 vs first‐time donor status), residence outside Bangalore and Hosur (rural areas) (OR = 15·66, 95% CI 3·60–68·07vs Bangalore residence), having been a customer at a local barber shop (OR = 4·07, 95% CI 2·06–8·03), close contact with a person who had jaundice (OR = 13·64, 95% CI 3·71–50·24) and cigarette smoking (OR = 3·25, 95% CI 1·39–7·60). Conclusion: In addition to recognised demographic risk factors, associations with patronage of local barbers and contact with jaundiced individuals suggest behavioural risk factors that could be adopted as exclusionary criteria for blood donation in India.  相似文献   

7.
France CR  Ditto B  France JL  Himawan LK 《Transfusion》2008,48(9):1820-1826
BACKGROUND: Presyncopal reactions are among the most common systemic reactions experienced by blood donors, occur most frequently in novice donors, and can serve as a deterrent to future donation regardless of donation experience. This report describes the validation of a presyncopal reactions scale that can be used to standardize assessment of the donor's subjective experience. STUDY DESIGN AND METHODS: A psychometric analysis of the Blood Donation Reactions Inventory (BDRI), a measure of presyncopal reactions, was conducted using data obtained from two independent samples of volunteer blood donors. Based on these analyses, a new, brief version of the BDRI is proposed, and psychometric data regarding the reliability and construct validity of this instrument are presented. RESULTS: Results of confirmatory factor analyses indicate that a 4‐item version of the BDRI can be used to assess subjective perception of mild, prefaint symptoms. Additional analyses indicate that the BDRI has good internal consistency and demonstrates concurrent validity relative to other indices of donor reactions (e.g., donor chair reclines and loss of consciousness). Construct validity is supported by factor analyses, expected score differences in different donor groups, and convergent validation against measures of donor satisfaction and likelihood of repeat donation. CONCLUSION: The BDRI provides an assessment of subjective ratings of presyncopal symptoms that is brief, easily understood by donors, and quick to administer and score. The BDRI yields important information about the donor's experience that can be used to predict satisfaction and likelihood of repeat donation.  相似文献   

8.
What is known and Objective: The effect of a statin‐based medical intervention on prevention of fatal and non‐fatal stroke recurrence and the incidence of all‐causes mortality have been explored previously in aging populations within the scope of clinical trials research. However, such evidence needs to be explored under conditions of routine clinical practice. The objective of this study was to determine whether statin therapy in patients with a first stroke episode reduces the incidence of 6‐year recurrent fatal or non‐fatal stroke and all‐cause mortality in an aging Mediterranean population without known coronary heart disease followed in routine medical practice. Methods: A retrospective study was carried out using records on death, hospitalizations owing to stroke and history of statin therapy included in the Badalona Serveis Assistencials (BSA) database. The cohort studied consisted of consecutive patients covered by the BSA health provider plan with a first‐ever acute stroke episode during January 2003 until December 2008, for whom there was available information covering the 6‐year follow‐up period. Recurrence rate (RR) and incidence rate (IR) of fatal/non‐fatal stroke and all‐causes mortality were computed. Association with statin therapy was assessed by means of calculation of relative risk (RR) and hazard ratio (HR) using multivariate logistic regression and Cox proportional hazards models controlling for confounding covariates. Results and Discussion: The cohort comprised a series of 601 consecutive patients [57% men, 75·9 (12·4) years old (88% >60 years)]. Of these, 32% received statins, which were associated with lower fatal/non‐fatal recurrent stroke RR; 7% vs. 18% [adjusted RR = 0·32 (CI: 0·16–0·61), P = 0·001] and lower IR; 16·78 vs. 45·22 events/year‐1000 subjects [adjusted HR = 0·35 (0·19–0·64), P = 0·001]. Similarly, observed all‐causes mortality was lower in the cohort receiving statins; 11% vs. 16% [adjusted RR = 0·29 (CI: 0·08–1·12), P = 0·072], and also mortality rate; 26·09 vs. 36·25 deaths/year‐1000 subjects [adjusted HR = 0·23 (0·08–0·67), P = 0·007]. What is new and Conclusions:  Statin therapy in patients with first‐ever acute stroke lowers the risk of 6‐year stroke recurrence and improves survival in an aging Mediterranean cohort. These results add additional evidence in routine clinical practice to the observed effects of statins in clinical trials.  相似文献   

9.
BACKGROUND: This study investigates the effect of a vasovagal reaction (VVR) or needle reaction (NR) on the risk of stopping as a blood donor, taking into account variables from the Theory of Planned Behavior (TPB). Is stopping risk solely related to the adverse reaction itself, or do the TPB variables play a role as well? Emphasis is placed on possible sex differences. STUDY DESIGN AND METHODS: TPB variables were assessed within 12,051 whole blood donors. Also, donors reported the occurrence of adverse reactions during or after their last donation. Blood bank records were used to determine whether donors stopped donating within the next 2 years. Logistic regression analyses were performed to estimate the effect of self‐reported adverse reactions on stopping risk, adjusting for the TPB variables. Analyses were performed separately for both sexes. RESULTS: Men have a lower odds of reporting a NR or a VVR than women (odds ratio [OR] 0.34, 95% confidence interval [CI], 0.28‐0.43; and OR 0.26, 95% CI 0.19‐0.36, for NR and VVR, respectively). For both sexes, only a VVR was associated with stopping risk, which is higher in men (men, OR 3.95, 95% CI 2.19‐7.11; women, OR 1.78, 95% CI 1.35‐2.35). After adjusting for the TPB variables both ORs declined (men, OR 3.38, 95% CI 1.86‐6.15; women, OR 1.58, 95% CI 1.17‐2.14). Also, self‐efficacy and affective attitude are negatively associated with adverse reactions. CONCLUSION: Female donors report more VVRs than male donors, but male donors have a higher stopping risk after a VVR than female donors. Coping differences and possible reporting tendencies might play a role. For donor retention purposes, prevention and coping techniques should take sex differences into account.  相似文献   

10.
What is known and Objective: Dipeptidyl peptidase‐4 (DPP‐4) inhibitors are a relatively new class of drugs for the management of type 2 diabetes (T2DM). Vildagliptin is an oral DPP‐4 inhibitor approved in more than 70 countries. The purpose of this meta‐analysis is to provide an update on the clinical efficacy and safety of vildagliptin in patients with T2DM. Methods: A literature search identified 30 randomized controlled trials comparing vildagliptin with comparators (placebo or other hypoglycaemic agents). Meta‐analyses were conducted for HbA1c, weight, fasting plasma glucose (FPG), hypoglycaemia and other adverse events. The outcomes of HbA1c, weight and FPG were analysed as weighted mean differences (WMD), and the number of ADRs events as relative risks (RR). Results: Compared with placebo, vildagliptin lowered HbA1c {WMD, ?0·77% [95% confidence interval (CI), ?0·96% to ?0·58%] for 100 mg/day of vildagliptin and ?0·58% [95% CI, ?0·72% to ?0·44%] for 50 mg/day of vildagliptin}. The effect was non‐inferior to thiazolidinediones, sulfonylureas and α‐glycosidase inhibitors, but inferior to metformin. Compared with placebo, treatment with 50 mg/day of vildagliptin caused neutral weight changes, while 100 mg/day of vildagliptin resulted in slight weight gain [0·95 kg (95% CI, 0·73–1·17 kg)]. In addition, compared to comparators, vildagliptin was not associated with an increase in overall risk for any adverse events [RR, 0·97 (95% CI, 0·94–0·99)]. The incidence of hypoglycaemia was low with vildagliptin, and the risk with vildagliptin was not significantly different from the comparators [0·85 (95% CI, 0·49–1·47)]. The use of vildagliptin did not display any increased risks of infection [1·03 (95% CI, 0·94–1·13) for nasopharyngitis and 1·07 (95% CI, 0·90–1·27) for upper respiratory tract infection]. What is new and Conclusion: Vildagliptin is effective in glycaemic control with a low risk of hypoglycaemia and other adverse reactions. This may have an important impact on patient adherence to this medication.  相似文献   

11.
Objectives: Early identification of haemorrhage is difficult when a bleeding site is not apparent. This study explored the potential use of the finger photoplethysmographic (PPG) waveform derived left ventricular ejection time (LVETp) and pulse transit time (PTT) for detecting blood loss, by using blood donation as a model of controlled mild to moderate haemorrhage. Methods: This was a prospective, observational study carried out in a convenience sample of blood donors. LVETp, PTT and R‐R interval (RRi) were computed from simultaneous measurement of the electrocardiogram (ECG) and the finger infrared photoplethysmogram obtained from 43 healthy volunteers during blood donation. The blood donation process was divided into four stages: (i) Pre‐donation (PRE), (ii) first half of donation (FIRST), (iii) second half of donation (SECOND), (iv) post‐donation (POST). Results and conclusions: Shortening of LVETp from 303+/?2 to 293+/?3 ms (mean+/?SEM; P<0·01) and prolongation of PTT from 177+/?3 to 186+/?4 ms (P<0·01) were observed in 81% and 91% of subjects respectively when comparing PRE and POST. During blood donation, progressive blood loss produced falling trends in LVETp (P<0·01) and rising trends in PTT (P<0·01) in FIRST and SECOND, but a falling trend in RRi (P<0·01) was only observed in SECOND. Monitoring trends in timing variables derived from non‐invasive ECG and finger PPG signals may facilitate detection of blood loss in the early phase.  相似文献   

12.
BACKGROUND: At most blood centers in the United States routine testing of donations for Trypanosoma cruzi using an enzyme‐linked immunosorbent assay (ELISA) is followed by supplemental testing by radioimmunoprecipitation assay (RIPA). The objective of this study was to report the results of routine testing and risk factor data from allogeneic blood donors. STUDY DESIGN AND METHODS: T. cruzi testing data from January 2007 through December 2009 were analyzed, and risk factor interviews and follow‐up studies were conducted on seroreactive donors. Prevalences of confirmed infection and risk factors associated with infection were assessed using logistic and multivariable logistic regression. RESULTS: Of 2,940,491 allogeneic donations from 1,183,076 donors, 305 (0.01% per donation tested and 0.026% per blood donor) were repeat reactive (RR) and 89 of those were confirmed positive by RIPA, yielding an overall seroprevalence of 1 per 33,039 donations and 1 per 13,292 donors. Country of birth and US blood center location differences in the seroprevalence of T. cruzi were evident. The odds of confirmed infection were highest if the donor reported having been bitten by the reduviid (kissing) bug (odds ratio [OR], 76.1; 95% confidence interval [CI], 11.1‐3173) followed by having lived in a rural area of Latin America (OR, 38.6; 95% CI, 15.1‐102.5). In multivariable analyses, having spent 3 months or more in Mexico or Central and/or South America was associated with the highest odds of RIPA‐confirmed infection (OR, 8.5; 95% CI, 2.7‐26.5). Polymerase chain reaction (PCR) testing of ELISA RR donors exhibited low sensitivity (1/22 [4%] RIPA‐confirmed donors was PCR positive). CONCLUSION: Risk factors for confirmed infection in US blood donors are consistent with the known epidemiology of Chagas disease. Blood donors or transfusions do not substantially contribute to the burden of T. cruzi infection in the United States.  相似文献   

13.
Abstract

Background: Lower limb muscle strain injury (LLMSI) has a high incidence in sport. Reports of injury reduction after lower limb stretching and strengthening interventions have been inconsistent; however, it has been proposed that poor proximal control may predispose athletes to LLMSI. Deficits in lumbopelvic stabilizers, reduced trunk control, pelvic strength imbalance, poor balance and reduced hip flexibility have been reported as risk factors for leg muscle injuries including hamstring, groin and thigh strain. Exercise interventions targeting the lumbopelvic region may be effective in preventing LLMSI.

Objective: To determine if lumbopelvic exercise interventions reduce the incidence of LLMSI.

Methods: Databases were searched for exercise trials that targeted the lower back, abdomen, pelvis and hip. The search included a range of interventions: lumbopelvic stability, resistance training, muscle stretching and posture or balance exercise. Quality of included trials was assessed using the PEDro scale.

Results: Six studies were identified that compared lumbopelvic exercise with other interventions or usual training and reported the incidence of LLMSI. Lumbopelvic exercise intervention was favoured with a significant effect size both in a meta-analysis (OR?=?0·40, 95% CI 0·17–0·94, P?=?0·03) and in a sensitivity analysis based on one high quality study (OR?=?0·27, 95% CI 0·09–0·75, P?=?0·01). Sub-group analysis of three balance studies did not show a significant effect in reducing LLMSI.

Conclusions: Lumbopelvic exercise reduces the incidence of LLMSI. Stabilization, agility and neuromuscular were the most successful interventions.  相似文献   

14.
Background: Published literature addressing the efficacy of different antihypertensive drug classes among Asian patients is scarce. Methods: This cohort study included all patients prescribed their first‐ever antihypertensive monotherapy without concomitant use of chronic medications in two primary care clinics in Hong Kong during 1990–2002. The incidence of add‐on therapy within 48 weeks because of suboptimal blood pressure control was evaluated and compared among different age and gender groups. Results and discussion: Among the 2531 patients, the incidence of add‐on therapy among users of angiotensin converting enzyme inhibitors (ACEI) was highest in young females (31·1%, 95% CI 22·2%, 40·0%, P < 0·001) and elderly females (18·0%, 95% CI 11·3%, 24·7%, P = 0·049) as compared with thiazide diuretics, beta‐blockers and calcium channel blockers. The incidence of add‐on therapy among young males (20·3%, 95% CI 11·1%, 29·5%; P > 0·50) and elderly males (12·5%, 95% CI 3·8%, 21·2%) was also highest with the ACEI than other drug classes although statistical significance was not reached. Conclusion: The incidence of add‐on therapy among first‐time antiypertensives appear to be significantly different between drug classes. This deserves further investigation.  相似文献   

15.
What is Known and Objective: Inhaled long‐acting beta‐agonists have been licensed for the treatment of chronic obstructive pulmonary disease (COPD) since the late 1990s, and they improve lung function and symptoms of dyspnoea. However, the evidence that long‐acting beta‐agonists alone can reduce the rate of COPD exacerbations is not conclusive. This meta‐analysis was performed to evaluate their effect on the frequency of exacerbations. Methods: MEDLINE, EMBASE, CINAHL and the Cochrane trials database were searched for the review. Randomized controlled trials of greater than or equal to 24 weeks’ treatment duration comparing long‐acting beta‐agonists (LABAs) with placebo were reviewed. Studies were pooled to yield odds ratios (ORs) with 95% confidence intervals (CIs). Results and Discussion: Seventeen randomized controlled trials (11871 randomized subjects) met the inclusion criteria and were selected for analysis. Salmeterol, formoterol and indacaterol significantly reduced COPD exacerbations compared with placebo. Salmeterol significantly reduced COPD exacerbations with both study arms exposed or not exposed to inhaled corticosteroids (ICS). The summary ORs were 0·79 (95% CI: 0·67–0·92; P < 0·01) and 0·80 (95% CI: 0·65–0·99; P = 0·04), respectively. However, when both arms were not exposed to ICS, there was no significant reduction in exacerbations with formoterol compared with placebo. The 'summary OR was 0·93 (95% CI: 0·75–1·15; P = 0·50). What is New and Conclusion: Long‐acting beta‐agonists reduce the frequency of COPD exacerbations. Salmeterol, formoterol and indacaterol significantly reduced COPD exacerbations compared with placebo. Salmeterol but not formoterol decreased exacerbations significantly in the absence of ICS.  相似文献   

16.
Introduction: The fraction of transfusion‐related acute lung injury (TRALI) cases preventable by deferral of allo‐exposed donors has previously been estimated, under the assumption this indirectly estimated the contribution of leucocyte antibodies to the occurrence of TRALI. Our aim was to estimate the fraction preventable by deferral of leucocyte antibody positive donors and to investigate the validity of allo‐exposure as a marker for leucocyte antibodies. Methods: All donors involved in a series of previously published TRALI patients were tested for leucocyte antibodies. The observed number of antibody positive donors was compared to the expected number. From this comparison we estimated the contribution of leucocyte antibodies to the occurrence of TRALI and compared this to the previously reported estimate for allo‐exposed donors. Results: Sixty‐one TRALI patients were included. Of 288 involved donors 43 were expected and 67 were observed to be leucocyte antibody positive. The observed percentage of positive donors was 8·3% (95% confidence interval (CI): 5·1–11·5%) in excess of the expected. Overall 59% (95% CI: 34–85%) of TRALI cases was estimated to be preventable by the exclusion of all leucocyte antibody positive donors. For plasma‐poor products this was 16% (95% CI: ?5·0 to 36%). Conclusions: These estimates were similar to those previously published for allo‐exposed donors. This suggests allo‐exposure status can effectively be used in donor deferral strategies.  相似文献   

17.
Overactive bladder (OAB) is condition, characterized by urinary urgency, frequency and incontinence, which has the potential to disrupt everyday life considerably. Although there is evidence that antimuscarinic treatment is effective at treating physical symptoms, there is currently no systematic exploration of psychological factors associated with OAB after treatment. This study aimed to examine the quality of life, relationships, sexual functioning, psychological wellbeing and illness perceptions of individuals with OAB after they have received treatment. And to determine whether an individual's psychological wellbeing is directly related to the severity of their symptoms, or whether their illness perceptions mediate this relationship. This study used a cross‐sectional, questionnaire‐based quantitative design with a secondary care outpatient sample who were diagnosed with OAB and had been either previously or currently prescribed drug treatment. Patients reported moderately severe OAB symptoms, with approximately a third reporting moderate/severe anxiety and 12% reporting severe depression. There was no direct relationship between symptom severity and psychological wellbeing (β = ?0·03, t(31) = ?0·96, p = 0·34; β = ?0·02, t(31) = ?0·41, p = 0·68) – this relationship was mediated by the patient's sense of personal control over their OAB (β = 0·03 (SE = 0·02), 95% CI [0·004, 0·09]; β = 0·02 (SE = 0·02), 95% CI [0·0008, 0·08]). Including interventions to improve personal control alongside drug treatment may improve treatment adherence and outcomes.  相似文献   

18.
19.
What is known and Objective: Telmisartan is an angiotensin receptor blocker (ARB) originally developed for the treatment of hypertension. It can also partially activate peroxisome proliferator‐activated receptor (PPAR)‐γ, which may improve insulin sensitivity. This effect may prove useful in hypertensive patients with insulin resistance or diabetes mellitus. Such activity is more marked than that observed with other ARBs. This systematic review and meta‐analysis evaluated the benefit of telmisartan on insulin sensitivity compared with that of other ARBs in hypertensive patients who had either insulin resistance or diabetic states. Methods: Clinical trials of telmisartan were identified through electronic searches (MEDLINE, CINAHL, Scopus, and The Cochrane Library) up to and including May 2011. Studies were included if they met the following inclusion criteria: (i) randomized controlled trials that compared telmisartan with other ARBs in hypertensive patients who had insulin resistance or type 2 diabetes mellitus; (ii) using telmisartan as an add‐on therapy or a monotherapy for treating hypertension; and (iii) reporting fasting plasma glucose (FPG) and fasting plasma insulin (FPI), or homeostasis model assessment of insulin resistance (HOMA‐IR), or adiponectin as an outcome measure. Treatment effect was estimated with the mean difference in the final value of FPG, FPI, HOMA‐IR and adiponectin between the telmisartan and the control groups. Results and Discussion: Eight trials involving a total of 763 patients met the inclusion criteria. Telmisartan was superior to other ARBs in reducing FPG level (mean difference, ?8·63 mg/dL; 95% CI ?12·29 mg/dL to ?4·98 mg/dL; P < 0·00001) and increasing adiponectin level (mean difference, 0·93 μg/dL; 95% CI 0·28 μg/dL to 1·59 μg/dL; P = 0·005). At 80 mg dose, telmisartan may reduce FPI level and HOMA‐IR. What is new and Conclusions: The available evidence suggests a beneficial effect of telmisartan in improving insulin sensitivity in hypertensive patients with insulin resistance or diabetes as demonstrated by the decrease in FPG and increase in adiponectin levels. The effect in decreasing FPG was greater with 80 mg dose than with the 40 mg dose. FPI and insulin resistance may be improved with 80 mg of telmisartan.  相似文献   

20.
Background: The increase in demand for blood products because of new surgical and medical procedures seeks more research to find new ways to recruit people to donate blood. Objective/Aim: To determine the level of people's knowledge about donating blood considering its relation with infectious and chronic diseases, drug abuse, unsafe sexual intercourse, menstruation and anaemia. In addition, their attitude towards blood donation regarding their previous behaviour and factors such as altruism, religion, family, fears and availability of blood donation centres has been evaluated. Methods: This study was conducted in Tehran, Iran in 2009 on 1000 respondents. Data were collected through questionnaires that comprised 37 questions considering demographic and background characteristics, level of knowledge and positive and negative attitudes towards blood donation. Finally, data were analysed using SPSS software. Results: Of 1000 in this study, 26% were donors, of whom 55% had donated blood more than once. The mean knowledge score of the participants was 8·6, which was associated with the subjects' gender and level of education (P = 0·031 and P < 0·001, respectively). Age, gender and level of education were significantly associated with one's attitude towards blood donation (P = 0·021, P < 0·001 and P = 0·003,respectively). Ninety‐five percent of people have stated that their main motivation to donate blood was altruism. Conclusion: Altruism and being encouraged by others had the leading roles in peoples' positive attitude towards blood donation; whereas hard access to blood donation centres seemed to be the main inhibitory factor.  相似文献   

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