Objective
To assess the use of balanced and unbalanced crystalloids in adult surgical patients.
Method
Prospective study of 65 adult emergency general surgical admissions in a UK acute district ...general hospital, with a further 45 patients studied following educational interventions.
Results
36.4% of patients studied were prescribed inappropriate saline for resuscitation/replacement before the intervention. This compared with no inappropriate prescriptions (0%) after educational intervention (p = 0.0137).
Conclusion
Simple multidisciplinary educational interventions can improve intravenous fluid prescription.
Abnormal saline: redressing the balance Findlay, John M; Spencer, Sarah; Bosworth, Kerry ...
British journal of hospital medicine (London, England : 2005)
72, Številka:
1
Journal Article
Self-monitoring of blood pressure (BP) appears to reduce BP in hypertension but important questions remain regarding effective implementation and which groups may benefit most. This individual ...patient data (IPD) meta-analysis was performed to better understand the effectiveness of BP self-monitoring to lower BP and control hypertension.
Medline, Embase, and the Cochrane Library were searched for randomised trials comparing self-monitoring to no self-monitoring in hypertensive patients (June 2016). Two reviewers independently assessed articles for eligibility and the authors of eligible trials were approached requesting IPD. Of 2,846 articles in the initial search, 36 were eligible. IPD were provided from 25 trials, including 1 unpublished study. Data for the primary outcomes-change in mean clinic or ambulatory BP and proportion controlled below target at 12 months-were available from 15/19 possible studies (7,138/8,292 86% of randomised participants). Overall, self-monitoring was associated with reduced clinic systolic blood pressure (sBP) compared to usual care at 12 months (-3.2 mmHg, 95% CI -4.9, -1.6 mmHg). However, this effect was strongly influenced by the intensity of co-intervention ranging from no effect with self-monitoring alone (-1.0 mmHg -3.3, 1.2), to a 6.1 mmHg (-9.0, -3.2) reduction when monitoring was combined with intensive support. Self-monitoring was most effective in those with fewer antihypertensive medications and higher baseline sBP up to 170 mmHg. No differences in efficacy were seen by sex or by most comorbidities. Ambulatory BP data at 12 months were available from 4 trials (1,478 patients), which assessed self-monitoring with little or no co-intervention. There was no association between self-monitoring and either lower clinic or ambulatory sBP in this group (clinic -0.2 mmHg -2.2, 1.8; ambulatory 1.1 mmHg -0.3, 2.5). Results for diastolic blood pressure (dBP) were similar. The main limitation of this work was that significant heterogeneity remained. This was at least in part due to different inclusion criteria, self-monitoring regimes, and target BPs in included studies.
Self-monitoring alone is not associated with lower BP or better control, but in conjunction with co-interventions (including systematic medication titration by doctors, pharmacists, or patients; education; or lifestyle counselling) leads to clinically significant BP reduction which persists for at least 12 months. The implementation of self-monitoring in hypertension should be accompanied by such co-interventions.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
BACKGROUND
Studies have shown that self-monitoring of blood pressure (BP) is effective when combined with co-interventions, but its efficacy varies in the presence of some co-morbidities. ...This study examined whether self-monitoring can reduce clinic BP in patients with hypertension-related co-morbidity.
METHODS
A systematic review was conducted of articles published in Medline, Embase, and the Cochrane Library up to January 2018. Randomized controlled trials of self-monitoring of BP were selected and individual patient data (IPD) were requested. Contributing studies were prospectively categorized by whether they examined a low/high-intensity co-intervention. Change in BP and likelihood of uncontrolled BP at 12 months were examined according to number and type of hypertension-related co-morbidity in a one-stage IPD meta-analysis.
RESULTS
A total of 22 trials were eligible, 16 of which were able to provide IPD for the primary outcome, including 6,522 (89%) participants with follow-up data. Self-monitoring was associated with reduced clinic systolic BP compared to usual care at 12-month follow-up, regardless of the number of hypertension-related co-morbidities (−3.12 mm Hg, 95% confidence intervals −4.78, −1.46 mm Hg; P value for interaction with number of morbidities = 0.260). Intense interventions were more effective than low-intensity interventions in patients with obesity (P < 0.001 for all outcomes), and possibly stroke (P < 0.004 for BP control outcome only), but this effect was not observed in patients with coronary heart disease, diabetes, or chronic kidney disease.
CONCLUSIONS
Self-monitoring lowers BP regardless of the number of hypertension-related co-morbidities, but may only be effective in conditions such obesity or stroke when combined with high-intensity co-interventions.
OBJECTIVE:Summary meta-analyses suggest that self-monitoring of blood pressure reduces blood pressure in hypertension but important questions remain regarding how best to utilise it and for which ...groups self-monitoring might be most appropriate. An Individual Patient Data meta-analysis aimed to investigate this further.
DESIGN AND METHOD:A systematic review captured randomized trials which compared hypertensive patients who self-monitored BP with those who did not. Individual patient data (IPD) were requested from all eligible studies and entered into a 2 stage meta-analysis stratified by trial and adjusting for age, sex, diabetes, baseline BP and intensity of intervention. The primary outcome was change in clinic BP at 12 months. Subgroup analyses assessed the impact of age, sex, baseline BP, baseline treatment and co-morbidities.
RESULTS:Of 2,508 articles in the initial search, 30 trials were eligible, 23 reported the primary outcome. Individual patient data were available from 21 trials, including one unpublished that had not appeared in the search (8,931 participants). Self-monitoring was associated with reduced clinic systolic blood pressure compared to usual care (−3×3 mmHg, 95% CI −5×0, −1×5 mmHg at 12 months). Systolic blood pressure reduction and control to target increased with intensity of co-intervention (ranging from no additional support to intensive support). Similar results were seen for diastolic blood pressure. Few data were available after 12 months. Self-monitoring was most effective in those with fewer antihypertensive medications and higher baseline systolic blood pressure up to 170 mmHg but there was no effect in people with previous stroke.
CONCLUSIONS:Self-monitoring of blood pressure leads to clinically significant blood pressure reduction when combined with more intensive co-interventions including systematic medication titration, education or lifestyle counselling which persists for at least 12 months. People with resistant hypertension or previous stroke may not benefit, perhaps reflecting maximal treatment.
IntroductionSelf-monitoring of blood pressure is effective in reducing blood pressure in hypertension. However previous meta-analyses have shown a considerable amount of heterogeneity between ...studies, only part of which can be accounted for by meta-regression. This may be due to differences in design, recruited populations, intervention components or results among patient subgroups. To further investigate these differences, an individual patient data (IPD) meta-analysis of self-monitoring of blood pressure will be performed.Methods and analysisWe will identify randomised trials that have compared patients with hypertension who are self-monitoring blood pressure with those who are not and invite trialists to provide IPD including clinic and/or ambulatory systolic and diastolic blood pressure at baseline and all follow-up points where both intervention and control groups were measured. Other data requested will include measurement methodology, length of follow-up, cointerventions, baseline demographic (age, gender) and psychosocial factors (deprivation, quality of life), setting, intensity of self-monitoring, self-monitored blood pressure, comorbidities, lifestyle factors (weight, smoking) and presence or not of antihypertensive treatment. Data on all available patients will be included in order to take an intention-to-treat approach. A two-stage procedure for IPD meta-analysis, stratified by trial and taking into account age, sex, diabetes and baseline systolic BP will be used. Exploratory subgroup analyses will further investigate non-linear relationships between the prespecified variables. Sensitivity analyses will assess the impact of trials which have and have not provided IPD.Ethics and disseminationThis study does not include identifiable data. Results will be disseminated in a peer-reviewed publication and by international conference presentations.ConclusionsIPD analysis should help the understanding of which self-monitoring interventions for which patient groups are most effective in the control of blood pressure.
Aims: Self-monitoring of blood pressure (BP) is effective in reducing BP in hypertension. Previous meta-analyses have shown significant heterogeneity between studies. This study aimed to investigate ...this heterogeneity and identify which self-monitoring interventions, for which patient groups are most effective in the control of blood pressure. Methods: A systematic review captured randomized trials which compared hypertensive patients who self-monitored BP with those who did not. Individual patient data (IPD) were requested from all eligible studies and entered into a meta-analysis stratified by trial and adjusting for age, sex, diabetes, baseline BP and intensity of intervention. The primary outcome was change in clinic BP at 12 months. Subgroup analyses assessed the impact of age, sex, baseline BP, baseline treatment and comorbidities. Results: 18/29 eligible studies shared IPD including 7,142 patients (mean age 62.7yrs; 41% female). Findings were similar for systolic and diastolic BP. Self-monitoring reduced systolic BP by -3.1 mmHg (95% CI -5.2, -1.0 mmHg) at 12 months. Intensity of intervention explained much of the heterogeneity with no effect for self-monitoring alone and larger reductions in BP seen with higher intensity interventions. Sub-group analyses demonstrated similar benefits of self-monitoring regardless of age, sex, baseline blood pressure or history of diabetes. The intervention appeared less effective for those prescribed three or more antihypertensives at baseline. Conclusions: Self-monitoring of BP is effective in reducing BP in hypertension when combined with an active intervention and is suitable for most patient groups. Self-monitoring may not add assist control in patients already prescribed three or more medications. doi: 10.1038/jhh.2015.90
Estimates are made of the rates of obsolescence of existing technical knowledge for the United Kingdom. Annual rates of decay in the usefulness of technical knowledge are well over 10% in the ...post-war period. This percentage is far in excess of the 5% adopted by Schott. The discrepancy found in the 2 studies can be explained partly by the different definitions of the stock of knowledge adopted. The rates in Bosworth's study reflect the life expectancy of technologies up to the point where they are embodied in new capital or products. The rate adopted by Schott is calculated up to the point where the technology is no longer used in the plant, in the case of capital goods.
PDF
![[OP.6B.04] INDIVIDUAL PATIE...](http://api.summon.serialssolutions.com/2.0.0/image/issn/XR4PS5YY4K/0263-6352/small "[OP.6B.04] INDIVIDUAL PATIENT DATA META-ANALYSIS OF SELF-MONITORING OF BLOOD PRESSURE (BP-SMART)")
