Seven Oaks General Hospital

About: Seven Oaks General Hospital is a healthcare organization based out in Winnipeg, Manitoba, Canada. It is known for research contribution in the topics: Kidney disease & Dialysis. The organization has 90 authors who have published 175 publications receiving 3370 citations. The organization is also known as: Seven Oaks Hospital.

Non-invasive endothelial function testing and the risk of adverse outcomes: a systematic review and meta-analysis

Abstract: Objectives We performed a systematic review and meta-analysis to understand the role of flow-mediated dilatation (FMD) of the brachial artery (BA) and peripheral arterial tonometry (PAT) in predicting adverse events, including cardiovascular (CV) events and all-cause mortality. Background FMD of the BA and PAT are non-invasive measures of endothelial function. Impairment of endothelial function is associated with increased CV events. While FMD is the more widely used and studied technique, PAT offers several advantages. The purpose of this systematic review and meta-analysis is to determine whether brachial FMD and PAT are independent risk factors for future CV events and mortality. Methods Multiple electronic databases were searched for articles relating FMD or PAT to CV events. Data were extracted on study characteristics, study quality, and study outcomes. Relative risks (RRs) from individual studies were combined and a pooled multivariate RR was calculated. Results Thirty-six studies for FMD were included in the systematic review, of which 32 studies consisting of 15, 191 individuals were meta-analysed. The pooled RR of CV events and all-cause mortality per 1% increase in brachial FMD, adjusting for potential confounders, was 0.90 (0.88–0.92). In contrast, only three studies evaluated the prognostic value of PAT for CV events, and the pooled RR per 0.1 increase in reactive hyperaemia index was 0.85 (0.78–0.93). Conclusion Brachial FMD and PAT are independent predictors of CV events and all-cause mortality. Further research to evaluate the prognostic utility of PAT is necessary to compare it with FMD as a non-invasive endothelial function test in clinical practice.

Risk Prediction Models for Patients With Chronic Kidney Disease: A Systematic Review

Abstract: Background Patients with chronic kidney disease (CKD) are at increased risk for kidney failure, cardiovascular events, and all-cause mortality. Accurate models are needed to predict the individual risk for these outcomes. Purpose To systematically review risk prediction models for kidney failure, cardiovascular events, and death in patients with CKD. Data sources MEDLINE search of English-language articles published from 1966 to November 2012. Study selection Cohort studies that examined adults with any stage of CKD who were not receiving dialysis and had not had a transplant; had at least 1 year of follow-up; and reported on a model that predicted the risk for kidney failure, cardiovascular events, or all-cause mortality. Data extraction Reviewers extracted data on study design, population characteristics, modeling methods, metrics of model performance, risk of bias, and clinical usefulness. Data synthesis Thirteen studies describing 23 models were found. Eight studies (11 models) involved kidney failure, 5 studies (6 models) involved all-cause mortality, and 3 studies (6 models) involved cardiovascular events. Measures of estimated glomerular filtration rate or serum creatinine level were included in 10 studies (17 models), and measures of proteinuria were included in 9 studies (15 models). Only 2 studies (4 models) met the criteria for clinical usefulness, of which 1 study (3 models) presented reclassification indices with clinically useful risk categories. Limitation A validated risk-of-bias tool and comparisons of the performance of different models in the same validation population were lacking. Conclusion Accurate, externally validated models for predicting risk for kidney failure in patients with CKD are available and ready for clinical testing. Further development of models for cardiovascular events and all-cause mortality is needed. Primary funding source None.

Frailty and perioperative outcomes: a narrative review

Abstract: Frailty has no single universally accepted definition or method for assessment. It is commonly defined from a physiological perspective as a disruption of homeostatic mechanisms ultimately leading to a vulnerable state. Numerous scoring indices and assessments exist to assist clinicians in determining the frailty status of a patient. The purpose of this review is to discuss the relationship between frailty and perioperative outcomes in surgical patients. We performed a review to determine the association of frailty with perioperative outcomes in patients undergoing a wide variety of surgical procedures. A scoping literature search was performed to capture studies from MEDLINE®, EMBASE™, and CENTRAL (Cochrane), which resulted in locating 175 studies across the three electronic databases. After an article screening process, 19 studies were found that examined frailty and perioperative outcomes. The studies used a range of assessments to determine frailty status and included patients in a variety of surgical fields. Regardless of surgical population and method of frailty assessment, a relationship existed between adverse perioperative outcomes and frailty status. Frail patients undergoing surgical procedures had a higher likelihood than non-frail patients of experiencing mortality, morbidity, complications, increased hospital length of stay, and discharge to an institution. Patients undergoing surgery who are deemed frail, regardless of the scoring assessment used, have a higher likelihood of experiencing adverse perioperative outcomes. With the lack of a unified definition for frailty, further research is needed to address which assessment method is most predictive of adverse postoperative outcomes.