risk-benefit analysis Dotaz Zobrazit nápovědu
April 2004 19 s. : il. (převážně barev.)
sv.
- MeSH
- hodnocení rizik MeSH
- pravděpodobnost MeSH
- řízení rizik MeSH
- riziko MeSH
- Publikační typ
- periodika MeSH
2nd ed. 370 s.
- Konspekt
- Veřejné zdraví a hygiena
- NLK Obory
- environmentální vědy
BACKGROUND: Numerous acute reperfusion therapies (RPT) are currently investigated as potential new therapeutic targets in acute ischemic stroke (AIS). We conducted a comprehensive benefit-risk analysis of available clinical studies assessing different acute RPT, and investigated the utility of each intervention in comparison to standard intravenous thrombolysis (IVT) and in relation to the onset-to-treatment time (OTT). METHODS: A comprehensive literature search was conducted to identify all available published, peer-reviewed clinical studies that evaluated the efficacy of different RPT in AIS. Benefit-to-risk ratio (BRR), adjusted for baseline stroke severity, was estimated as the percentage of patients achieving favorable functional outcome (BRR1, mRS score: 0-1) or functional independence (BRR2, mRS score: 0-2) at 3 months divided by the percentage of patients who died during the same period. RESULTS: A total of 18 randomized (n = 13) and nonrandomized (n = 5) clinical studies fulfilled our inclusion criteria. IV therapy with tenecteplase (TNK) was found to have the highest BRRs (BRR1 = 5.76 and BRR2 = 6.82 for low-dose TNK; BRR1 = 5.80 and BRR2 = 6.87 for high-dose TNK), followed by sonothrombolysis (BRR1 = 2.75 and BRR2 = 3.38), while endovascular thrombectomy with MERCI retriever was found to have the lowest BRRs (BRR1 range, 0.31-0.65; BRR2 range, 0.52-1.18). A second degree negative polynomial correlation was detected between favorable functional outcome and OTT (R (2) value: 0.6419; P < 0.00001) indicating the time dependency of clinical efficacy of all reperfusion therapies. CONCLUSION: Intravenous thrombolysis (IVT) with TNK and sonothrombolysis have the higher BRR among investigational reperfusion therapies. The combination of sonothrombolysis with IV administration of TNK appears a potentially promising therapeutic option deserving further investigation.
- MeSH
- cévní mozková příhoda terapie MeSH
- fibrinolytika terapeutické užití MeSH
- hodnocení rizik MeSH
- ischemie mozku terapie MeSH
- klinické zkoušky jako téma MeSH
- lidé MeSH
- reperfuze metody MeSH
- tkáňový aktivátor plazminogenu terapeutické užití MeSH
- ultrazvuková terapie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
Developments in cardiovascular medicine : proceedings
1st ed. 16, 301 s.
- MeSH
- farmakoterapie MeSH
- kardiologie MeSH
- Publikační typ
- kongresy MeSH
- sborníky MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- kardiologie
- angiologie
Cíl studie: Sledování vlivu dlouhodobé léčby estrogeny na růst a vývoj dětí, vypracování vlastníhoteoretického modelu umožňujícího predikovat redukci finální výšky u dívek s konstitučně vyso-kým vzrůstem léčených estrogeny, rozbor časných a pozdních nežádoucích účinků léčby.Typ studie: Otevřená klinická studie.Název a sídlo pracoviště: Endokrinologická ambulance II. dětské kliniky a gynekologická ambu-lance pro děti a mladistvé Gynekologicko-porodnické kliniky 2. LF UK a FN, Praha-Motol.Metodika: Konstrukce vlastního teoretického modelu pro zbytkový růst dívek dlouhodobě léče-ných estrogeny vycházela z rozboru zbytkového růstu horního a dolního tělesného segmentuzdravých českých dívek.Výsledky: Rozsah předpokládané redukce finální výšky u dívek s konstitučně vysokým vzrůstemléčených estrogeny klesá se stoupajícím věkem na začátku léčby. Pro začátek léčby je optimálnívěk již mezi 10. - 11. rokem.Závěr: Léčbu lze doporučit jen u dívek s růstovou predikcí nad 185 cm a vážnými psychickýmiobtížemi vyplývajícími z nadměrného vzrůstu, vždy až po důkladné analýze biologického vývojea růstové predikce. V každém konkrétním případě je nutné posouzení možného přínosu léčby vevztahu k potenciálním rizikům. Největší problém je spatřován v pozdním začátku a v přeceněnímožnosti léčby.
Objective: Investigation of the effect of a long-term oestrogen treatment on the growth and deve-lopment of children, elaboration of a theoretical model for remaining growth of girls on a long-term oestrogen therapy predicting reduction of the final height in girls with constitutionally tallstature, analysis of early and late side-effects of therapy.Type of study: Open clinical study.Name and place of department: Endocrine out-patient clinic of the Second Paediatric Departmentand gynaecological out-patient clinic for children and adolescents of the Gynaecological-Obstet-ric Department, Second Medical School – Charles University and University Hospital Prague –Motol.Method: Elaboration of theoretical model for remaining growth of girls on a long-term oestrogentherapy was based on an analysis of the remaining growth of upper and lower body segment ofhealthy Czech girls.Results: The extent of assumed reduction of the final height in girls with constitutionally tallstature treated with oestrogen declines with advancing age at the onset of treatment. The optimalage for the onset of treatment is between 10 and 11 years.Conclusion: Treatment can be recommended only in girls with growth prediction above 185 cmand serious psychological difficulties resulting from excessive height, always after careful analy-sis of the biological development and growth prediction. In every case it is necessary to evaluate the possible benefit of treatment in relation to potential risks. The greatest problem is accordingto the authors late onset and overrating of the therapeutic possibilities.
AIMS: The 2021 European Society of Cardiology prevention guidelines recommend the use of (lifetime) risk prediction models to aid decisions regarding initiation of prevention. We aimed to update and systematically recalibrate the LIFEtime-perspective CardioVascular Disease (LIFE-CVD) model to four European risk regions for the estimation of lifetime CVD risk for apparently healthy individuals. METHODS AND RESULTS: The updated LIFE-CVD (i.e. LIFE-CVD2) models were derived using individual participant data from 44 cohorts in 13 countries (687 135 individuals without established CVD, 30 939 CVD events in median 10.7 years of follow-up). LIFE-CVD2 uses sex-specific functions to estimate the lifetime risk of fatal and non-fatal CVD events with adjustment for the competing risk of non-CVD death and is systematically recalibrated to four distinct European risk regions. The updated models showed good discrimination in external validation among 1 657 707 individuals (61 311 CVD events) from eight additional European cohorts in seven countries, with a pooled C-index of 0.795 (95% confidence interval 0.767-0.822). Predicted and observed CVD event risks were well calibrated in population-wide electronic health records data in the UK (Clinical Practice Research Datalink) and the Netherlands (Extramural LUMC Academic Network). When using LIFE-CVD2 to estimate potential gain in CVD-free life expectancy from preventive therapy, projections varied by risk region reflecting important regional differences in absolute lifetime risk. For example, a 50-year-old smoking woman with a systolic blood pressure (SBP) of 140 mmHg was estimated to gain 0.9 years in the low-risk region vs. 1.6 years in the very high-risk region from lifelong 10 mmHg SBP reduction. The benefit of smoking cessation for this individual ranged from 3.6 years in the low-risk region to 4.8 years in the very high-risk region. CONCLUSION: By taking into account geographical differences in CVD incidence using contemporary representative data sources, the recalibrated LIFE-CVD2 model provides a more accurate tool for the prediction of lifetime risk and CVD-free life expectancy for individuals without previous CVD, facilitating shared decision-making for cardiovascular prevention as recommended by 2021 European guidelines.
- MeSH
- časové faktory MeSH
- dospělí MeSH
- hodnocení rizik MeSH
- kardiovaskulární nemoci * prevence a kontrola epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- metody pro podporu rozhodování MeSH
- prognóza MeSH
- rizikové faktory kardiovaskulárních chorob * MeSH
- rizikové faktory MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa MeSH
BACKGROUND: Both anastomotic leak (AL) and conduit necrosis (CN) after oesophagectomy are associated with high morbidity and mortality. Therefore, the identification of preoperative, modifiable risk factors is desirable. The aim of this study was to generate a risk scoring model for AL and CN after oesophagectomy. METHODS: Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018-December 2018. Definitions for AL and CN were those set out by the Oesophageal Complications Consensus Group. Univariate and multivariate analyses were performed to identify risk factors for both AL and CN. A risk score was then produced for both AL and CN using the derivation set, then internally validated using the validation set. RESULTS: This study included 2247 oesophagectomies across 137 hospitals in 41 countries. The AL rate was 14.2% and CN rate was 2.7%. Preoperative factors that were independent predictors of AL were cardiovascular comorbidity and chronic obstructive pulmonary disease. The risk scoring model showed insufficient predictive ability in internal validation (area under the receiver-operating-characteristic curve [AUROC] = 0.618). Preoperative factors that were independent predictors of CN were: body mass index, Eastern Cooperative Oncology Group performance status, previous myocardial infarction and smoking history. These were converted into a risk-scoring model and internally validated using the validation set with an AUROC of 0.775. CONCLUSION: Despite a large dataset, AL proves difficult to predict using preoperative factors. The risk-scoring model for CN provides an internally validated tool to estimate a patient's risk preoperatively.
- MeSH
- anastomóza chirurgická * MeSH
- chronická obstrukční plicní nemoc MeSH
- ezofagektomie * MeSH
- ezofágus chirurgie patologie MeSH
- hodnocení rizik MeSH
- index tělesné hmotnosti MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory jícnu * chirurgie patologie MeSH
- nekróza * MeSH
- netěsnost anastomózy * epidemiologie etiologie MeSH
- rizikové faktory MeSH
- ROC křivka MeSH
- senioři MeSH
- žaludek chirurgie patologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
