Objective: Chemotherapy-induced cognitive impairments are reported by many cancer survivors. Research to date has not provided a clear description of their nature, extent, mechanisms, and duration. ...To investigate the impairments and factors that could influence their identification and severity, the present meta-analysis brings together research on this topic in adult cancer patients. Method: Our random-model meta-analysis includes 44 studies investigating the cognitive performance of adults treated with chemotherapy for non-central nervous system malignancies, primarily breast and testicular cancer. We conducted several subgroup analyses to identify the level of cognitive impairments in longitudinal and cross-sectional studies. We also pursued several multilevel model regressions to investigate the impact of methodological (study quality) and clinical moderators (diagnosis, age, time since treatment) on the observed effect sizes. Results: Cognitive impairments were found in cross-sectional studies in immediate free recall, delayed memory, verbal memory, delayed recognition memory, selective attention, and attention capacity. Surprisingly, prior to chemotherapy, patients performed better than matched controls. In longitudinal studies, patients' performance increased from baseline to follow-up, an effect that was stronger in patients than controls. None of the chosen moderators influenced the magnitude of estimated summary effect sizes. Conclusions: The likelihood to identify impairments rests on the type of design employed, as memory and attention impairments are only detected in cross-sectional studies. We discuss the lack of significant impact of moderators on the effect sizes despite the heterogeneity of results, while providing recommendations toward decreasing the heterogeneity in future studies.
BackgroundNeonatal Encephalopathy (NE) describes central nervous system dysfunction from all causes and has a multifactorial aetiology. NE is difficult to diagnose, to treat and to predict outcome. ...Early prognostic information is important to initiate early intervention of therapies, to counsel parents and to redirect care. There is no gold standard early biomarker to predict outcome at present.MethodsThe review protocol was prospectively registered with Prospero. A comprehensive search with relevant search terms of online databases Em Base, PubMed, Cochrane and Web of Science for Biomarkers in Neonatal Encephalopathy to Predict outcome was performed. The short term outcomes examined include severity of Neonatal Encephalopathy, MRI brain and survival in the neonatal period.Two independent reviewers used Covidence software to select the studies. Quality assessment was performed using Cochrane Collaboration Tool for Risk of Bias Assessment and quantitative analysis was completed using Revman software (5.3).Results and Discussion1613 papers were identified after duplicates were excluded, and narrowed to 314 papers following abstract review for full text examination. Following full text review 107 papers were included to examine serum biomarkers to predict short term outcome.Raised mean serum levels of IL-6 (p value 0.04, 95% CI -44.5 to -0.66) and lactate (p value <0.001, 95% CI -6.19 to -2.81) are associated with worse short term outcome in NE. The large confidence intervals, however, reflect the small number of studies included and consequently the small population cohorts. Multiple other meta-analyses had substantial heterogeneity and were not statistically significant. A large proportion of studies were excluded due to variety of measured outcomes and methods of data reporting. Establishment of Core Outcomes in NE will benefit future research.
It would be very lovely if we could all do the evidence-based medicine thing without the effort of Ask a question, spend an hour Acquiring information, two more Appraising the papers and summarising ...them all to Apply in practice. If you do end up going to those lengths, it might be worth writing it up as an Archimedes.
The classic formulation of the answerable clinical question asks for patient, intervention, comparison and outcome (PICO). It can be modified when asking questions of prognosis to query the ‘risk ...factor of Interest’ and, in diagnostics, the ‘Innovative test’ just to keep the acronym unsullied. Thinking like this lets us focus clearly on the question which is best placed to help our patients, but it does forget a crucial element in medicine: time.
‘It’s all so subjective…’ is a frequent complaint made about trying to capture data in studies that does not result from the counting of sodium ions, or the measurement of height, or the duration of ...hospitalisation. How can we measure such subjective experiences as pain, or the cuteness of kittens, as everyone perceives these things differently?
PDF
