Post-infectious irritable bowel syndrome

Post-infectious irritable bowel syndrome （PI-IBS） is a common disorder wherein symptoms of IBS begin after an episode of acute gastroenteritis. Published studies have reported incidence of PI-IBS to range between 5% and 32%. The mechanisms underlying the development of PI-IBS are not fully understood, but are believed to include persistent sub-clinical inflammation, changes in intestinal permeability and alteration of gut flora. Individual studies have suggested that risk factors for PI-IBS include patients＇ demographics, psychological disorders and the severity of enteric illness. However, PI-IBS remains a diagnosis of exclusion with no specific disease markers and, to date, no definitive therapy exists. The prognosis of PI- IBS appears favorable with spontaneous and gradual resolution of symptoms in most patients.     

How Do Health Schemas Inform Healthy Behaviours During Pregnancy? Qualitative Findings from the Be Healthy in Pregnancy (BHIP) Study

Maternal and Child Health Journal - Excess gestational weight gain (GWG) is associated with adverse long and short-term outcomes for both woman and child, yet evidence demonstrates pregnant women...     

A shared care model pilot for palliative home care in a rural area: impact on symptoms, distress, and place of death

Context

Shared care models integrating family physician services with interdisciplinary palliative care specialist teams are critical to improve access to quality palliative home care and address multiple domains of end-of-life issues and needs.

Objectives

To examine the impact of a shared care pilot program on the primary outcomes of symptom severity and emotional distress (patient and family separately) over time and, secondarily, the concordance between patient preferences and place of death.

Methods

An inception cohort of patients (n = 95) with advanced, progressive disease, expected to die within six months, were recruited from three rural family physician group practices (21 physicians) and followed prospectively until death or pilot end. Serial measurement of symptoms, emotional distress (patient and family), and preferences for place of death was performed, with analysis of changes in distress outcomes assessed using t-tests and general linear models.

Results

Symptoms trended toward improvement, with a significant reduction in anxiety from baseline to 14 days noted. Symptom and emotional distress were maintained below high severity (7-10), and a high rate of home death compared with population norms was observed.

Conclusion

Future controlled studies are needed to examine outcomes for shared care models with comparison groups. Shared care models build on family physician capacity and as such are promising in the development of palliative home care programs to improve access to quality palliative home care and foster health system integration.     

Hip protectors decrease hip fracture risk in elderly nursing home residents: a Bayesian meta-analysis

OBJECTIVE: To design a Bayesian random effects model for pooling binary outcome data from cluster randomized trials (CRTs) with individually randomized trials (IRTs) and then use this model to determine if hip protectors decrease the risk of hip fracture in elderly nursing home residents. STUDY DESIGN AND SETTING: Eight electronic databases were searched; abstracts and papers were reviewed in duplicate. Randomized controlled trials of hip protectors in nursing homes were included. The pooled mean odds ratio (OR) of a hip fracture in an individual allocated to hip protectors with 95% credibility interval (CRI) was calculated. RESULTS: We included four trials of 1,922 individuals (including three CRTs). The pooled OR of an elderly nursing home resident sustaining one or more hip fractures with hip protector allocation was 0.40 (95% CRI 0.25, 0.61). The model was robust in multiple sensitivity analyses assuming alternative intracluster correlation coefficient values. CONCLUSION: The Bayesian approach may be used in meta-analyses of IRTs and CRTs. Using this approach, we have determined that hip protectors decrease the risk of hip fracture in elderly nursing home residents. Methodologic limitations of the included trials and a possible herd effect in CRTs may have influenced these results.     

The effect of pre-operative aspirin on bleeding, transfusion, myocardial infarction, and mortality in coronary artery bypass surgery: a systematic review of randomized and observational studies.

AIMS: To obtain estimates of the efficacy and safety of pre-operative aspirin in patients undergoing coronary artery bypass grafting (CABG). METHODS AND RESULTS: Eligible studies included randomized controlled trials (RCTs) and observational studies of patients undergoing CABG, comparing pre-operative aspirin with no aspirin/placebo, and reporting at least one of our primary outcomes. In eight RCTs (n = 805), pre-operative aspirin increased post-operative bleeding [Mean difference (MD), 104.9 mL; 95% confidence interval (CI), 19.2-190.6; P = 0.016] and reoperation [odds ratio (OR), 2.52; 95% CI, 1.18-5.38; P = 0.017), but not transfusion requirements (MD, 0.62 units; 95% CI, -0.06-1.30; P = 0.072). Subgroup analysis suggested that bleeding was increased with aspirin doses > or =325 mg/day, but not with lower doses. In 14 observational studies (n = 4485), pre-operative aspirin increased post-operative bleeding (MD, 113.6 mL; 95% CI, 45.2-182.0; P = 0.001) and transfusion requirements (MD, 0.34; 95% CI, 0.12-0.56 units; P = 0.002), but not reoperation (OR, 1.12; 95% CI, 0.69-1.83; P = 0.647). Neither analysis detected a significant effect on myocardial infarction or death. CONCLUSION: Pre-operative aspirin increases post-operative bleeding, but this may be avoided by the use of aspirin doses <325 mg/day. Most of the RCTs are old and the meta-analysis was underpowered for efficacy outcomes. A large randomized trial is necessary to determine the safety and efficacy of pre-operative aspirin in the setting of contemporary cardiac surgical practice.     

Second primary malignancy risk in thyroid cancer survivors: a systematic review and meta-analysis.

OBJECTIVE: To determine the risk of second primary malignancies (SPMs) in thyroid cancer survivors. DESIGN: We performed a systematic review and meta-analysis examining the standardized incidence ratios (SIRs) of SPMs in thyroid cancer survivors (compared to individuals without thyroid cancer). Two independent reviewers screened citations and reviewed all full-text papers deemed potentially relevant. Final consensus was reached on inclusion of papers in the review. Data were pooled using fixed effects models. MAIN OUTCOMES: Thirteen full-text papers were included. The incidence of SPMs in thyroid cancer survivors was increased with an SIR of 1.20 (95% confidence interval 1.17, 1.24) (based on pooled data from six studies of 70,844 thyroid cancer survivors). The SIR of the following SPMs was significantly increased: salivary gland, stomach, colon/colorectal, breast, prostate, kidney, brain/central nervous system, soft tissue sarcoma, non-Hodgkin's lymphoma, multiple myeloma, leukemia, bone/joints, and adrenal. A significantly reduced risk of lung and cervical cancers was observed. CONCLUSIONS: Thyroid cancer survivors are at increased risk of SPMs, which may be related to disease-specific treatments or genetic predisposition.     

Network Meta-analysis: Users’ Guide for Surgeons: Part II – Certainty

In the previous article (Network Meta-analysis: Users’ Guide for Surgeons—Part I, Credibility), we presented an approach to evaluating the credibility or methodologic rigor of network meta-analyses (NMA), an innovative approach to simultaneously addressing the relative effectiveness of three or more treatment options for a given medical condition or disease state. In the second part of the Users’ Guide for Surgeons, we discuss and demonstrate the application of criteria for determining the certainty in effect sizes and directions associated with a given treatment option through an example pertinent to clinical orthopaedics.