Showing papers by "Alessandro Liberati published in 2012"

Timing Matters in Hip Fracture Surgery : Patients Operated within 48 Hours Have Better Outcomes. A Meta-Analysis and Meta-Regression of over 190,000 Patients

Abstract: Background To assess the relationship between surgical delay and mortality in elderly patients with hip fracture. Systematic review and meta-analysis of retrospective and prospective studies published from 1948 to 2011. Medline (from 1948), Embase (from 1974) and CINAHL (from 1982), and the Cochrane Library. Odds ratios (OR) and 95% confidence intervals for each study were extracted and pooled with a random effects model. Heterogeneity, publication bias, Bayesian analysis, and meta-regression analyses were done. Criteria for inclusion were retro- and prospective elderly population studies, patients with operated hip fractures, indication of timing of surgery and survival status. Methodology/Principal Findings There were 35 independent studies, with 191,873 participants and 34,448 deaths. The majority considered a cut-off between 24 and 48 hours. Early hip surgery was associated with a lower risk of death (pooled odds ratio (OR) 0.74, 95% confidence interval (CI) 0.67 to 0.81; P<0.000) and pressure sores (0.48, 95% CI 0.38 to 0.60; P<0.000). Meta-analysis of the adjusted prospective studies gave similar results. The Bayesian probability predicted that about 20% of future studies might find that early surgery is not beneficial for decreasing mortality. None of the confounders (e.g. age, sex, data source, baseline risk, cut-off points, study location, quality and year) explained the differences between studies. Conclusions/Significance Surgical delay is associated with a significant increase in the risk of death and pressure sores. Conservative timing strategies should be avoided. Orthopaedic surgery services should ensure the majority of patients are operated within one or two days.

Patient empowerment as a component of health system reforms: rights, benefits and vested interests.

Abstract: Different strategies have been developed across countries to foster citizens’ and patients’ involvement, from health policies to patients’ active participation in decisions regarding their health. The spectrum varies from systems where patients lead the reform of health care services, to others where a paternalistic approach still limits patients’ autonomy in decision-making. This paper describes: (1) different interventions for involving patients; (2) experiences to promote consumer evidence-based advocacy; and (3) barriers to consumer involvement in health system reforms, including vested interests in patients’ associations. Citizens’ involvement in health systems can vary substantially, but is gaining increasing weight.

Multiple systematic reviews: methods for assessing discordances of results.

Abstract: The process of systematically reviewing research evidence is useful for collecting, assessing and summarizing results from multiple studies planned to answer the same clinical question. The term “systematic” implies that the process, besides being organized and complete, is transparent and fully reported to allow other independent researchers to replicate the results, and therefore come to the same conclusions. Hundreds of new systematic reviews are indexed every year. The growing number increases the likelihood of finding multiple and discordant results. To clarify the impact of multiple and discordant systematic reviews, we designed a program aimed at finding out: (a) how often different systematic reviews are done on the same subject; (b) how often different systematic reviews on the same topic give different results or conclusions; (c) which methods or interpretation characteristics can explain the differences in results or conclusions. This paper outlines the method used to explore the frequency and the causes of discordance among multiple systematic reviews on the same topic. These methods were then applied to a few medical fields as case studies. This aim is particularly relevant for both clinicians and policy makers. Judgments about evidence and recommendation in health care are complex, and often rely on discordant results, especially when there are no empirical results to help serve as a guideline.

Efficacy and safety of venous angioplasty of the extracranial veins for multiple sclerosis. Brave dreams study (brain venous drainage exploited against multiple sclerosis): study protocol for a randomized controlled trial.

Abstract: Background Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system with a disabling progressive course. Chronic cerebrospinal venous insufficiency (CCSVI) has recently been described as a vascular condition characterized by restricted venous outflow from the brain, mainly due to blockages of the internal jugular and azygos veins. Despite a wide variability among studies, it has been found to be associated with MS. Data from a few small case series suggest possible improvement of the clinical course and quality of life by performing percutaneous balloon angioplasty (PTA) of the stenotic veins.