Showing papers by "Benoit Vallet published in 2020"
TL;DR: Gender has a great impact in students’ willingness to work in specific specialties, and policymakers should adapt their appealing strategies according to the country and the medical discipline concerned.
31 citations
20 citations
TL;DR: The increase in mean oxygen delivery following transfusion was associated with an increase inmean oxygen consumption after transfusion, especially in patients with sepsis, andTransfusion was not associated with a decrease in mean cardiac output or mean heart rate.
Abstract: OBJECTIVES RBC transfusions can increase oxygen availability to the tissues, but studies have provided conflicting results. The objectives of this study were, therefore, to evaluate, using systematic review and meta-analysis, the effects of transfusion on hemodynamic/oxygenation variables in patients without acute bleeding. DATA SOURCES PubMed, Scopus, Cochrane Database of Systematic Reviews, and Embase from inception until June 30, 2019. STUDY SELECTION All articles that reported values of prespecified hemodynamic or oxygenation variables before and after RBC transfusion. DATA EXTRACTION Publication year, number of patients, number of transfusions and the type of population studied, hemodynamic and oxygenation data (heart rate, cardiac index, mixed venous oxygen saturation or central venous oxygen saturation, oxygen delivery index, oxygen consumption index, oxygen extraction ratio, arteriovenous oxygen difference and arterial blood lactate) before and after transfusion. We performed a meta-analysis for each variable for which there were sufficient data to estimate mean differences. We also performed subgroup analyses comparing septic with nonseptic patients. DATA SYNTHESIS We retrieved 6,420 studies; 33 met the inclusion criteria, 14 of which were in patients with sepsis. In the meta-analysis, the estimated mean differences and 95% CIs comparing the periods before and after transfusion were -0.0 L/min/m (-0.1 to 0.1 L/min/m) (p = 0.86) for cardiac index; -1.8 beats/min (-3.7 to 0.1 beats/min) (p = 0.06) for heart rate; 96.8 mL/min/m (71.1-122.5 mL/min/m) (p < 0.01) for oxygen delivery index; 2.9% (2.2-3.5%) (p < 0.01) for mixed venous oxygen saturation or central venous oxygen saturation; -3.7% (-4.4% to -3.0%) (p < 0.01) for oxygen extraction ratio; and 4.9 mL/min/m (0.9-9.0 mL/min/m) (p = 0.02) for oxygen consumption index. The estimated mean difference for oxygen consumption index in the patients with sepsis was 8.4 mL/min/m (2.3-14.5 mL/min/m; p = 0.01). CONCLUSIONS Transfusion was not associated with a decrease in mean cardiac output or mean heart rate. The increase in mean oxygen delivery following transfusion was associated with an increase in mean oxygen consumption after transfusion, especially in patients with sepsis.
10 citations
TL;DR: An overview of the way hospital volume-outcome relationship was assessed is provided to identify potential gaps in the assessment to help researchers who want to pursue work in this field and, ultimately, to help policy makers interpret such analyses.
Abstract: Introduction Even if a positive volume-outcome correlation in surgery is mostly admitted in many surgical fields, the various ways to assess this relationship make it difficult for researchers and policymakers to use it. Our aim is therefore to provide an overview of the way hospital volume-outcome relationship was assessed. Through this overview, our goal is to identify potential gaps in the assessment of this relationship, to help researchers who want to pursue work in this field and, ultimately, to help policy makers interpret such analyses. Methods and analysis This review will be conducted using the six stages of the scoping review method: identifying the research question, searching for relevant studies, selecting studies, data extraction, collating, summarising and reporting the results and concluding. This review will address all the key questions used to assess the volume-outcome relationship in surgery. Primary research papers investigating the hospital volume-outcome relationship from 2009 will be included. Studies only looking at surgeons’ volume-outcome relationship or studies were the volume variable is not individualisable will be excluded. Both MEDLINE and Scopus will be searched along with grey literature. Two researchers will perform all the stages of the review: screen the titles and abstracts, review the full text of selected articles to determine final inclusions and extract the data. The results will be summarised quantitatively using numerical counts. Ethical considerations and dissemination Reviews of published articles are considered secondary analysis and do not need ethical approval. The findings will be disseminated through multiple channels like conferences and peer-reviewed journals.
1 citations