Publications by authors named "Pandor A"
Article Synopsis
- D-dimer is the main biomarker recommended for diagnosing acute aortic syndrome (AAS), and this study aimed to explore other potential biomarkers.
- The researchers conducted a systematic review of relevant studies, identifying a total of 13 cohort studies but noting variable quality and significant bias in most.
- While some alternative biomarkers showed promise in sensitivity and specificity, overall findings were inconsistent, leading to the conclusion that these alternatives are not yet suitable for routine clinical use.
Objectives: To evaluate the diagnostic accuracy of the aortic dissection detection risk score (ADD-RS) used alone or in combination with D-dimer for detecting acute aortic syndrome (AAS) in patients presenting with symptoms suggestive of AAS.
Methods: We searched MEDLINE, EMBASE, and the Cochrane Library from inception to February 2024. Additionally, the reference lists of included studies and other systematic reviews were thoroughly searched.
Study Objective: Acute aortic syndrome is a life-threatening emergency condition. Previous systematic reviews of D-dimer diagnostic accuracy for acute aortic syndrome have been contradictory and based on limited data, but recently published studies offer potential for a more definitive overview. We aimed to perform a systematic review and meta-analysis to determine the diagnostic accuracy of D-dimer for diagnosing acute aortic syndrome.
View Article and Find Full Text PDFObjectives: To assess whether different cervical spine immobilisation strategies (full immobilisation, movement minimisation or no immobilisation), impact neurological and/or other outcomes for patients with suspected cervical spinal injury in the pre-hospital and emergency department setting.
Design: Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Data Sources: MEDLINE, EMBASE, CINAHL, Cochrane Library and two research registers were searched until September 2023.
Background: Pharmacological prophylaxis during hospital admission can reduce the risk of acquired blood clots (venous thromboembolism) but may cause complications, such as bleeding. Using a risk assessment model to predict the risk of blood clots could facilitate selection of patients for prophylaxis and optimise the balance of benefits, risks and costs.
Objectives: We aimed to identify validated risk assessment models and estimate their prognostic accuracy, evaluate the cost-effectiveness of different strategies for selecting hospitalised patients for prophylaxis, assess the feasibility of using efficient research methods and estimate key parameters for future research.
Article Synopsis
- Women at high risk for venous thromboembolism during and after pregnancy are recommended pharmacological prophylaxis, but determining who should receive it involves weighing various factors, which currently lacks clarity in the UK.
- The study aims to measure decision uncertainty regarding thromboprophylaxis selection for pregnant women and proposes future research to alleviate that uncertainty, while ensuring it’s practical and acceptable to patients and healthcare providers.
- A decision-analytic model revealed variable risk assessment model outcomes with significant biases, indicating a need for more focused future studies to improve decision-making in thromboprophylaxis use.
Objective: To determine the balance of costs, risks, and benefits for different thromboprophylaxis strategies for medical patients during hospital admission.
Design: Decision analysis modelling study.
Setting: NHS hospitals in England.
Background: Risk assessment models (RAMs) are used to select women at increased risk of venous thromboembolism (VTE) during pregnancy and the puerperium for thromboprophylaxis.
Objectives: To estimate the value of potential future studies that would reduce the decision uncertainty associated with offering thromboprophylaxis according to available RAMs in the following groups: high-risk antepartum women (eg, prior VTE), unselected postpartum women, and postpartum women with risk factors (obesity or cesarean delivery).
Methods: A decision-analytic model was developed to simulate clinical outcomes, lifetime costs, and quality-adjusted life-years for different thromboprophylaxis strategies, including thromboprophylaxis for all, thromboprophylaxis for none, and RAM-based thromboprophylaxis.
Background: Severe acute respiratory syndrome coronavirus 2 is the virus that causes coronavirus disease 2019. Over six million deaths worldwide have been associated with coronavirus disease 2019.
Objective: To assess the cost-effectiveness of treatments used for the treatment of coronavirus disease 2019 in hospital or used in the community in patients with coronavirus disease 2019 at high risk of hospitalisation.
Article Synopsis
- Surgical inpatients face a serious risk of venous thromboembolism (VTE), which can be reduced through thromboprophylaxis but comes with cost and bleeding risks; risk assessment models (RAMs) help identify high-risk patients.
- The study aimed to evaluate the cost-effectiveness of various thromboprophylaxis strategies for adult surgical inpatients, excluding those undergoing major orthopedic surgery or critical care.
- Results indicated that providing thromboprophylaxis for all inpatients was the most cost-effective approach, with findings showing that better outcomes were linked to interventions targeting VTE complications, influenced by factors like patient age and VTE risk.
Objectives: To assess the comparative accuracy of risk assessment models (RAMs) to identify women during pregnancy and the early postnatal period who are at increased risk of venous thromboembolism (VTE).
Design: Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Data Sources: MEDLINE, Embase, Cochrane Library and two research registers were searched until February 2021.
Article Synopsis
- Older adults with major trauma often receive inadequate triage, which may lead to serious health complications and higher mortality rates; this review aims to identify specific risk factors for better elderly triage tools.* -
- The review analyzed multiple studies that explored various predictors of major trauma in elderly patients, highlighting the significance of vital signs, EMS provider judgment, and certain crash scene conditions.* -
- The findings suggest that current triage methods could be improved for older patients by incorporating age-specific thresholds and calling for future research with more relevant standards for evaluation.*
Article Synopsis
- Hospital-acquired thrombosis contributes significantly to venous thromboembolism (VTE) in hospitals, but can be minimized through effective risk assessment and personalized prevention strategies.
- A systematic review analyzed various risk assessment models (RAMs) for predicting VTE in hospitalized patients, reviewing 51 studies from multiple databases.
- Most RAMs showed variable performance metrics, with C-statistics ranging from weak to excellent, indicating that no single model significantly outperformed the others in predicting thromboembolic events.
Background: Older adults with major trauma are frequently undertriaged, increasing the risk of preventable morbidity and mortality. The aim of this systematic review was to evaluate the diagnostic performance of prehospital triage tools to identify suspected elderly trauma patients in need of specialized trauma care.
Methods: Several electronic databases (including MEDLINE, EMBASE, and the Cochrane Library) were searched from inception to February 2019.
Glutaric aciduria type 1, homocystinuria, isovaleric acidaemia, long-chain hydroxyacyl CoA dehydrogenase deficiency and maple syrup urine disease are all inborn errors of metabolism that can be detected through newborn bloodspot screening. This evaluation was undertaken in 2013 to provide evidence to the UK National Screening Committee for the cost-effectiveness of including these five conditions in the UK Newborn Bloodspot Screening Programme. A decision-tree model with lifetable estimates of outcomes was built with the model structure and parameterisation informed by a systematic review and expert clinical judgment.
View Article and Find Full Text PDFBackground: Thromboprophylaxis can reduce the risk of venous thromboembolism (VTE) during lower-limb immobilisation, but it is unclear whether or not this translates into meaningful health benefit, justifies the risk of bleeding or is cost-effective. Risk assessment models (RAMs) could select higher-risk individuals for thromboprophylaxis.
Objectives: To determine the clinical effectiveness and cost-effectiveness of different strategies for providing thromboprophylaxis to people with lower-limb immobilisation caused by injury and to identify priorities for future research.
Venous thromboembolic disease is a major global cause of morbidity and mortality. An estimated 10 million episodes are diagnosed yearly; over half of these episodes are provoked by hospital admission/procedures and result in significant loss of disability adjusted life years. Temporary lower limb immobilisation after injury is a significant contributor to the overall burden of venous thromboembolism (VTE).
View Article and Find Full Text PDFBackground: Thromboprophylaxis has the potential to reduce venous thromboembolism (VTE) following lower limb immobilization resulting from injury.
Objectives: We aimed to estimate the effectiveness of thromboprophylaxis, compare different agents, and identify any factors associated with effectiveness.
Methods: We undertook a systematic review and network meta-analysis (NMA) of randomized trials reporting VTE or bleeding outcomes that compared thromboprophylactic agents with each other or to no pharmacological prophylaxis, for this indication.
Objectives: There are many rapid review methods; however, there is little pragmatic guidance on which methods to select. This study aimed to reach consensus among international rapid review experts outlining areas to consider when selecting approaches for rapid reviews.
Study Design And Setting: A two-round modified online Delphi survey was conducted between May and July 2018.
Article Synopsis
- - A systematic review examined various risk factors for venous thromboembolism (VTE) in patients immobilized due to lower limb injuries, highlighting age and injury type as significant predictors (odds ratio 1.5-3.48).
- - Despite 15 studies included in the analysis, the review found insufficient evidence supporting other commonly used risk factors in predicting VTE after immobilization.
- - The study suggests that while risk-based strategies for thromboprophylaxis are common, clinicians should be cautious due to the limited accuracy of these models in predicting VTE outcomes.
Background: Rheumatoid arthritis (RA) is a chronic, debilitating disease associated with reduced quality of life and substantial costs. It is unclear which tests and assessment tools allow the best assessment of prognosis in people with early RA and whether or not variables predict the response of patients to different drug treatments.
Objective: To systematically review evidence on the use of selected tests and assessment tools in patients with early RA (1) in the evaluation of a prognosis (review 1) and (2) as predictive markers of treatment response (review 2).
EMA and NICE Appraisal Processes for Cancer Drugs: Current Status and Uncertainties.
Appl Health Econ Health Policy
August 2018
As part of its single technology appraisal process, the UK National Institute for Health and Care Excellence (NICE) invited the manufacturer of obinutuzumab (Roche) to submit evidence on its clinical and cost effectiveness when used in combination with bendamustine in patients with follicular lymphoma (FL) refractory to rituximab. The Evidence Review Group (ERG), the School of Health and Related Research Technology Appraisal Group at the University of Sheffield, produced a document summarising the key points from the company submission alongside a critical review. Efficacy for progression-free survival (PFS) and safety was positively demonstrated in the pivotal GADOLIN trial, which compared obinutuzumab in combination with bendamustine followed by obinutuzumab maintenance (O-Benda+O) against bendamustine monotherapy.
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