ORCID Profile
0000-0002-1786-6332
Current Organisations
University of Oxford
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PLOS ONE
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Publisher: American Medical Association (AMA)
Date: 31-01-2023
DOI: 10.1001/JAMANETWORKOPEN.2022.53942
Abstract: Each approach for primary total hip arthroplasty (THA) has a long learning curve, so a surgeon’s choice to change their preferred approach needs to be guided by clear justifications. However, current evidence does not suggest that any of the THA approaches are more beneficial than others, and the choice of approach is mainly based on the knowledge and experience of the surgeon and in idual patient characteristics. To assess the efficacy and safety associated with different surgical approaches for THA. A comprehensive search of PubMed, EMBASE, and Cochrane databases from inception to March 26, 2022 reference lists of eligible trials and related reviews. Randomized clinical trials (RCTs) comparing different surgical approaches, including the 2-incision approach, direct anterior approach (DAA), direct lateral approach (DLA), minimally invasive direct lateral approach (MIS-DLA), minimally invasive anterolateral approach (MIS-ALA), posterior approach (PA), minimally invasive posterior approach (MIS-PA), and supercapsular percutaneously assisted total hip arthroplasty (SuperPath), for primary THA. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 2 reviewers independently extracted data on study participants, interventions, and outcomes as well as assessed the risk of bias using the Cochrane risk of bias tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist framework was used to inform a series of random-effects network meta-analyses. The outcomes were hip score (range, 0-100, with higher scores indicating better overall hip condition), pain score (range, 0-100, with higher scores indicating more pain), hospitalization time, operation time, quality of life score, blood loss, cup abduction angle, and cup anteversion angle. Of 2130 retrieved studies, 63 RCTs including 4859 participants (median [IQR] age, 64.0 [60.3-66.5] years median [IQR] percentage male, 46.74% [38.64%-54.74%]) were eligible for analysis. Eight surgical approaches were evaluated. For hip score, DAA (mean difference [MD], 4.04 95% CI, 1.92 to 6.16 moderate certainty), MIS-ALA (MD, 3.00 95% CI, 0.43 to 5.59 moderate certainty), MIS-DLA (MD, 3.37 95% CI, 1.05 to 5.68 moderate certainty), MIS-PA (MD, 4.46 95% CI, 1.60 to 7.31 moderate certainty), PA (MD, 4.37 95% CI, 1.87 to 6.88 high certainty), and SuperPath (MD, 5.00 95% CI, 0.58 to 9.42 high certainty) were associated with greater improvement in hip score compared with DLA. DLA was associated with lower decrease in pain score than SuperPath (MD, 1.16 95% CI, 0.13 to 2.20 high certainty) and MIS-DLA (MD, 0.90 95% CI, 0.04 to 1.76 moderate certainty). PA was associated with shorter operation times compared with 2-incision (MD, −23.85 minutes 95% CI, −36.60 to −11.10 minutes high certainty), DAA (MD, −13.94 minutes 95% CI, −18.79 to −9.08 minutes moderate certainty), DLA (MD, −10.50 minutes 95% CI, −16.07 to −4.94 minutes high certainty), MIS-ALA (MD, −6.76 minutes 95% CI, −12.86 to −0.65 minutes moderate certainty), and SuperPath (MD, −13.91 minutes 95% CI, −21.87 to −5.95 minutes moderate certainty). The incidence of 6 types of complications did not differ significantly between the approaches. In this study, moderate to high certainty evidence indicated that compared with PA, all surgical approaches except DLA were associated with similar improvements of hip score but longer operation time. DLA was associated with smaller improvement of hip score. The safety of the different approaches did not show significant differences. These findings will help health professionals and patients with better clinical decision-making and also provide references for policy makers.
Publisher: Springer Science and Business Media LLC
Date: 25-08-2022
DOI: 10.1186/S13054-022-04120-Y
Abstract: Timing of initiation of kidney-replacement therapy (KRT) in critically ill patients remains controversial. The Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial compared two strategies of KRT initiation (accelerated versus standard) in critically ill patients with acute kidney injury and found neutral results for 90-day all-cause mortality. Probabilistic exploration of the trial endpoints may enable greater understanding of the trial findings. We aimed to perform a reanalysis using a Bayesian framework. We performed a secondary analysis of all 2927 patients randomized in multi-national STARRT-AKI trial, performed at 168 centers in 15 countries. The primary endpoint, 90-day all-cause mortality, was evaluated using hierarchical Bayesian logistic regression. A spectrum of priors includes optimistic, neutral, and pessimistic priors, along with priors informed from earlier clinical trials. Secondary endpoints (KRT-free days and hospital-free days) were assessed using zero–one inflated beta regression. The posterior probability of benefit comparing an accelerated versus a standard KRT initiation strategy for the primary endpoint suggested no important difference, regardless of the prior used (absolute difference of 0.13% [95% credible interval [CrI] − 3.30% 3.40%], − 0.39% [95% CrI − 3.46% 3.00%], and 0.64% [95% CrI − 2.53% 3.88%] for neutral, optimistic, and pessimistic priors, respectively). There was a very low probability that the effect size was equal or larger than a consensus-defined minimal clinically important difference. Patients allocated to the accelerated strategy had a lower number of KRT-free days (median absolute difference of − 3.55 days [95% CrI − 6.38 − 0.48]), with a probability that the accelerated strategy was associated with more KRT-free days of 0.008. Hospital-free days were similar between strategies, with the accelerated strategy having a median absolute difference of 0.48 more hospital-free days (95% CrI − 1.87 2.72) compared with the standard strategy and the probability that the accelerated strategy had more hospital-free days was 0.66. In a Bayesian reanalysis of the STARRT-AKI trial, we found very low probability that an accelerated strategy has clinically important benefits compared with the standard strategy. Patients receiving the accelerated strategy probably have fewer days alive and KRT-free. These findings do not support the adoption of an accelerated strategy of KRT initiation.
Publisher: American Thoracic Society
Date: 09-2022
Publisher: Public Library of Science (PLoS)
Date: 30-04-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 21-07-2020
Abstract: Loss to follow‐up ( LTFU ) is common in randomized controlled trials. However, its potential impact on primary outcomes from cardiovascular randomized controlled trials is not known. We conducted a prospective systematic review ( PROSPERO : CRD 42019121959) for randomized controlled trials published in 8 leading journals over 5 years from January 2014 to December 2018. Extent, reporting, and handling of LTFU data were recorded, and the proportion of a trial's primary outcome results that lose statistical significance was calculated after making plausible assumptions for the intervention and control arms. These assumptions could drive differential treatment effects between the groups considering relative event incidence between LTFU participants and those included in the primary outcome. We identified 117 randomized controlled trials of which 91 (78%) trials reported LTFU , 23 (20%) reported no LTFU , and 3 (3%) trials did not report on whether LTFU occurred. The median percentage of study participants lost to follow‐up was 2% (interquartile range, 0.33%–5.3%). Only 10 trials (9%) had a low cluster of risk factors for impairment in trial quality. The percentage of trials losing statistical significance varied from 2% when the relative event incidence for LTFU between the randomized groups was 1 for the intervention arm and 1.5 for the control arm to 16% when the relative event incidence was 3 for the intervention arm and 1 for the control arm. Almost 1 in 6 (16%) cardiovascular randomized trials published in leading journals may have a change in the primary outcome if plausible assumptions are made about differential event rates of participants lost to follow up. There is scope for improvement arising from LTFU in randomized trials in cardiovascular medicine. URL : www.crd.york.ac.uk rospero Unique identifier: CRD 42019121959.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 28-11-2017
DOI: 10.1161/CIRCULATIONAHA.117.028753
Abstract: Atrial fibrillation (AF) is a highly prevalent disorder leading to heart failure, stroke, and death. Enhanced understanding of modifiable risk factors may yield opportunities for prevention. The risk of AF is increased in subclinical hyperthyroidism, but it is uncertain whether variations in thyroid function within the normal range or subclinical hypothyroidism are also associated with AF. We conducted a systematic review and obtained in idual participant data from prospective cohort studies that measured thyroid function at baseline and assessed incident AF. Studies were identified from MEDLINE and EMBASE databases from inception to July 27, 2016. The euthyroid state was defined as thyroid-stimulating hormone (TSH) 0.45 to 4.49 mIU/L, and subclinical hypothyroidism as TSH 4.5 to 19.9 mIU/L with free thyroxine (fT4) levels within reference range. The association of TSH levels in the euthyroid and subclinical hypothyroid range with incident AF was examined by using Cox proportional hazards models. In euthyroid participants, we additionally examined the association between fT4 levels and incident AF. Of 30 085 participants from 11 cohorts (278 955 person-years of follow-up), 1958 (6.5%) had subclinical hypothyroidism and 2574 in iduals (8.6%) developed AF during follow-up. TSH at baseline was not significantly associated with incident AF in euthyroid participants or those with subclinical hypothyroidism. Higher fT4 levels at baseline in euthyroid in iduals were associated with increased AF risk in age- and sex-adjusted analyses (hazard ratio, 1.45 95% confidence interval, 1.26–1.66, for the highest quartile versus the lowest quartile of fT4 P for trend ≤0.001 across quartiles). Estimates did not substantially differ after further adjustment for preexisting cardiovascular disease. In euthyroid in iduals, higher circulating fT4 levels, but not TSH levels, are associated with increased risk of incident AF.
Publisher: Massachusetts Medical Society
Date: 16-07-2020
Publisher: The Endocrine Society
Date: 12-2016
DOI: 10.1210/JC.2016-2129
Publisher: Oxford University Press (OUP)
Date: 12-2014
Publisher: American Medical Association (AMA)
Date: 26-05-2015
Publisher: Springer Science and Business Media LLC
Date: 25-11-2021
DOI: 10.1038/S41467-021-27215-6
Abstract: Identifying febrile children at risk of sepsis in low-resource settings can improve survival, but recognition triage tools are lacking. Here we test the hypothesis that measuring circulating markers of immune and endothelial activation may identify children with sepsis at risk of all-cause mortality. In a prospective cohort study of 2,502 children in Uganda, we show that Soluble Triggering Receptor Expressed on Myeloid cells-1 (sTREM-1) measured at first clinical presentation, had high predictive accuracy for subsequent in-hospital mortality. sTREM-1 had the best performance, versus 10 other markers, with an AUROC for discriminating children at risk of death of 0.893 in derivation (95% CI 0.843–0.944) and 0.901 in validation (95% CI 0.856–0.947) cohort. sTREM-1 cutoffs corresponding to a negative likelihood ratio (LR) of 0.10 and a positive LR of 10 classified children into low (1,306 children, 53.1%), intermediate (942, 38.3%) and high (212, 8.6%) risk zones. The estimated incidence of death was 0.5%, 3.9%, and 31.8%, respectively, suggesting sTREM-1 could be used to risk-stratify febrile children. These findings do not attempt to derive a risk prediction model, but rather define sTREM-1 cutoffs as the basis for rapid triage test for all cause fever syndromes in children in low-resource settings.
Publisher: The Endocrine Society
Date: 05-05-2017
Abstract: Hyperthyroidism is associated with increased fracture risk, but it is not clear if lower thyroid-stimulating hormone (TSH) and higher free thyroxine (FT4) in euthyroid in iduals are associated with fracture risk. To evaluate the association of TSH and FT4 with incident fractures in euthyroid in iduals. In idual participant data analysis. Thirteen prospective cohort studies with baseline examinations between 1981 and 2002. Adults with baseline TSH 0.45 to 4.49 mIU/L. Primary outcome was incident hip fracture. Secondary outcomes were any, nonvertebral, and vertebral fractures. Results were presented as hazard ratios (HRs) with 95% confidence interval (CI) adjusted for age and sex. For clinical relevance, we studied TSH according to five categories: 0.45 to 0.99 mIU/L 1.00 to 1.49 mIU/L 1.50 to 2.49 mIU/L 2.50 to 3.49 mIU/L and 3.50 to 4.49 mIU/L (reference). FT4 was assessed as study-specific standard deviation increase, because assays varied between cohorts. During 659,059 person-years, 2,565 out of 56,835 participants had hip fracture (4.5% 12 studies with data on hip fracture). The pooled adjusted HR (95% CI) for hip fracture was 1.25 (1.05 to 1.49) for TSH 0.45 to 0.99 mIU/L, 1.19 (1.01 to 1.41) for TSH 1.00 to 1.49 mIU/L, 1.09 (0.93 to 1.28) for TSH 1.50 to 2.49 mIU/L, and 1.12 (0.94 to 1.33) for TSH 2.50 to 3.49 mIU/L (P for trend = 0.004). Hip fracture was also associated with FT4 [HR (95% CI) 1.22 (1.11 to 1.35) per one standard deviation increase in FT4]. FT4 only was associated with any and nonvertebral fractures. Results remained similar in sensitivity analyses. Among euthyroid adults, lower TSH and higher FT4 are associated with an increased risk of hip fracture. These findings may help refine the definition of optimal ranges of thyroid function tests.
Location: United Kingdom of Great Britain and Northern Ireland
Location: Canada
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Bruno R. da Costa.