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Dieberg, Gudrun
- PublicationLong-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass GraftingBACKGROUND When comparing effects of on- versus off-pump coronary artery bypass grafting (CABG), it is important to assess the long-term clinical outcomes. However, most research conducted thus far has concentrated on short-term outcomes and ignored the long-term clinical outcomes, especially the 5-year outcomes of the largest randomized controlled trials. OBJECTIVES The aim of this systematic review and meta-analysis was to investigate the long-term clinical outcomes of on- versus off-pump CABG. METHODS To identify potential studies systematic searches were carried out using various databases. The search strategy included the key concepts of cardiopulmonary bypass AND off-pump AND long term OR 5-year outcomes. This was followed by a meta-analysis investigating mortality, incidence of myocardial infarction, incidence of angina, need for revascularization, and incidence of stroke. RESULTS Six studies totaling 8,145 participants were analyzed. In the on-pump group mortality was 12.3%, compared with 13.9% in the off-pump group. The odds ratio (OR) for this comparison was 1.16 (95% confidence interval [CI]: 1.02 to 1.32; p = 0.03; 13.9% vs. 12.3%). In contrast, there were no differences in the incidence of myocardial infarction (OR: 1.06: 95% CI: 0.91 to 1.25; p = 0.45; 8.4% vs. 7.9%), incidence of angina (OR: 1.09; 95% CI: 0.75 to 1.57; p = 0.65; 2.3% vs. 2.1%), need for revascularization (OR: 1.15; 95% CI: 0.95 to 1.40; p = 0.16; 5.9% vs. 5.1%), and the incidence of stroke (OR: 0.78; 95% CI: 0.56 to 1.10; p = 0.16; 2.2% vs. 2.8%). CONCLUSIONS Statistically, on-pump CABG appeared to offer superior long-term survival, although the clinical significance of this may be more uncertain.
- PublicationClinical Outcomes and Functional Change with Exercise Training in Heart Failure Patients(2015)
; ; ; Background: Published trials and reviews have identified benefits of exercise therapy or training for people with heart failure, including fewer hospitalizations, increased cardiorespiratory fitness, better quality of life, reduced brain natriuretic peptides, increased left ventricular ejection fraction (LVEF) and possibly improved survival. This body of work seeks to add to the evidence-base of safe and practical guidelines for the implementation of exercise training in chronic heart failure (CHF) patients. Methods: Meta-analyses were conducted using various methods. First, a systematic review and meta-analysis was conducted to compare the effect of exercise training in heart failure patients taking beta-blockers vs. those who do not. Second, an analysis of published exercise training programs was conducted in order to investigate if variation in aerobic exercise training intensity produced different effect sizes for fitness, adherence, cardiac events, mortality and hospitalization rates in heart failure patients. Third, an analysis of published exercise training programs was conducted to establish which training characteristics (frequency, duration etc.) produced the largest improvements in fitness, adherence, event, mortality and hospitalization rates in heart failure patients. Fourth, after difficulties assessing study quality and reporting for meta-analyses, a study quality and reporting assessment tool was designed specifically for use in exercise training studies. In light of the findings above a randomized controlled trial was designed based upon what we interpret as a natural progression of the published literature. A short editorial paper on current understanding of the exercise training literature for heart failure patients was also published. - PublicationLonger exercise training programs do not produce larger reductions in risk factors of cardiovascular disease. Time to introduce periodized exercise training programs?The aims of this work were to (i) provide level 1 published evidence of non-uniform trends in outcome measures related to exercise training in patients with cardiovascular disease, (ii) provide possible explanations for the non-uniform improvements observed and (iii) make recommendations to improve desired exercise training outcomes in people with cardiovascular disease. Meta-analyses and landmark randomized, controlled trials of exercise training in people with, or at risk of, cardiovascular disease (CVD), with at least 2 post-intervention time points, were identified so changes in effects sizes could be compared. With the exception of patients with peripheral vascular disease, the data appear to suggest that exercise training programs >12 weeks appear to produce smaller improvements in a variety of outcome measures, when compared to exercise training programs <12 weeks. Several factors may explain why CVD patients do not continue to improve their fitness after exercise training beyond 12 weeks. We make recommendations for periodization (rest or active recovery) to be incorporated to exercise programming in an attempt to reduce illness related withdrawal from exercise training.
- PublicationEfficacy of inspiratory muscle training in chronic heart failure patients: A systematic review and meta-analysisIntroduction: Inspiratory muscle training (IMT) offers an alternative to exercise training (ExT) in the most severely deconditioned heart failure patients who are unable to exercise. We conducted a meta-analysis to determine magnitude of change in peak VO₂, six minute walk distance (6MWD), Quality of Life measured by the Minnesota Living with Heart Failure Questionnaire (MLWHFQ), maximal inspiratory pressure (PI max) and ventilatory equivalent for carbon dioxide (VE/VCO₂ slope) with IMT. Methods: A systematic search was conducted of randomized, controlled trials of IMT therapy in CHF patients using Medline (Ovid) (1950-February 2012), Embase.com (1974-February 2012), Cochrane Central Register of Controlled Trials and CINAHL (1981-February 2012). The search strategy included a mix of MeSH and free text terms for the key concepts heart failure, inspiratory or respiratory muscle training, exercise training. Results: The eleven included studies contained data on 287 participants: 148 IMT participants and 139 sham or sedentary control. Compared to control groups, CHF patients undergoing IMT showed a significant improvement in peak VO₂ (+ 1.83 ml kg⁻¹ min⁻¹, 95% C.I. 1.33 to 2.32 ml kg⁻¹ min⁻¹, p < 0.00001); 6MWD (+ 34.35 m, 95% C.I. 22.45 to 46.24 m, p < 0.00001); MLWHFQ (- 12.25, 95% C.I. - 17.08 to - 7.43, p < 0.00001); PImax (+ 20.01, 95% C.I. 13.96 to 26.06, p < 0.00001); and VE/VCO₂ slope (- 2.28, 95% C.I. - 3.25 to - 1.30, p < 0.00001). Conclusions: IMT improves cardio-respiratory fitness and quality of life to a similar magnitude to conventional exercise training and may provide an initial alternative to the more severely de-conditioned CHF patients who may then transition to conventional ExT.
- PublicationAssessment of Potentially Inappropriate Prescribing for People With Type 2 Diabetes Mellitus Using IMPACT2DM, a New Explicit Tool(Sage Publications, Inc, 2024-06)
; ; ; Background: People with type 2 diabetes mellitus (T2DM) are at greater risk of potentially inappropriate prescribing (PIP) due to multiple comorbidities and polypharmacy. IMPACT2DM (Inappropriate Medication Prescribing Assessment Criteria for Type 2 Diabetes Mellitus) is a tool designed to identify PIP for adults with T2DM.
Objectives: To assess PIP for adults with T2DM in Ethiopia using the IMPACT2DM and to test the face validity and clinical validity of the tool.
Methods: A cross-sectional study was undertaken using data extracted retrospectively from the medical records of adults being managed for T2DM at Debretabore Hospital. PIP was assessed using IMPACT2DM. Some items/item components of IMPACT2DM were modified to increase the tool’s applicability for the outpatient setting, to clarify content or to use the terms most common in this particular setting. Multivariant logistic regression analyses were conducted to identify factors associated with PIP.
Results: More than 90% of medical records had at least 1 PIP. Prescribing omission (80.9%) was the most commonly identified type of PIP. Adults with prescribing omissions are more likely to be ≥40 years old or to be prescribed with <5 medications. Adults with dosing problems were more likely ≥50 years old, or have had a fasting blood sugar (FBS) level out of the target range (80-130 mg/dL).
Conclusions: IMPACT2DM is a clinically valid PIP identification tool for application in an Ethiopian outpatient setting. Health professionals should be alert to check for potential prescribing omissions for adults ≥40 years old and dosing problems for adults with an FBS level out of the target range or >50 years.
- PublicationThe effect of exercise training in people with pre-dialysis chronic kidney disease: a systematic review with meta-analysis
Background Chronic kidney disease (CKD) is a global health issue with high mortality and economic costs. Exercise has potential benefits for pre-dialysis CKD management. This review examines the impact of exercise on CKD patients not on dialysis, focusing on improvement in various health parameters. Findings aim to inform the role of exercise in pre-dialysis CKD care.
Methods A systematic search of MEDLINE, EMBASE, the Cochrane Library of Controlled Trials, CINAHL, and SPORTDiscus, up to August 31, 2023, used key terms relating to pre-dialysis CKD and exercise. We pooled randomized controlled trials (RCTs) comparing exercise with usual care and conducted meta-analyses based on a random effects inverse variance model with the effect measure of mean difference.
Results Of 1162 identified studies, 37 RCTs met the inclusion criteria including 1248 participants. Significant improvements were identified for peak VO2, mean difference [MD] (2.66 mL/kg/min" 95% confidence interval [CI] 1.48, 3.83" p<0.00001)" the 6-min walk (MD 58.83 m" 95% CI 35.26, 82.41" p<0.00001), timed up and go (standardised mean difference − 0.35" 95% CI − 0.54, − 0.15" p=0.0006), 2-min step (MD 57.48 steps" 95% CI 27.80, 87.16" p=0.0001), and sit to stand tests (MD 4.55 repetitions" 95% CI 1.49, 7.60" p=0.004)" short form [SF]-36 general health (MD 4.26" 95% CI 0.04, 8.47" p=0.05)" SF-36 mental component summary (MD 1.84" 95% CI 0.18, 3.51" p=0.03)" estimated glomerular filtration rate (MD 2.19 mL/min/1.73 m2 " 95% CI 0.97, 3.50" p=0.001)" serum cystatin-C (MD − 0.06 mg/L" 95% CI − 0.11, − 0.02" p=0.004)" resting heart rate (MD − 1.97 bpm" 95% CI − 3.84, − 0.11" p=0.04)" triglycerides (MD − 12.97mg/dL" 95% CI − 17.30, − 8.63" p<0.00001)" glycosylated haemoglobin (MD − 0.25%" 95% CI − 0.50, − 0.01" p=0.04)" waist circumference (MD − 3.12 cm" 95% CI − 4.37, − 1.86" p<0.00001)" and interleukin-6 (MD − 2.24 pg/mL" 95% CI − 3.87. − 0.61" p=0.007).
Conclusions Analysis revealed improvements in aerobic capacity, functional ability, quality of life, estimated glomerular filtration rate, serum cystatin-C, resting heart rate, waist circumference, triglyceride, glycosylated haemoglobin, and interleukin-6 levels.
- PublicationEfficacy of estrogen replacement therapy on cognitive function in older women: a systematic review and meta-analysis(Australian Pharmaceutical Science Association (APSA), 2021-12-01)
; Introduction. Use of estrogen-based hormone therapy to prevent cognitive impairment is controversial. Most hormone replacement contains estrogens and/or progestogens, with estradiol being the most commonly used estrogen. Aims. To systematically review the evidence on the effects of estrogen replacement therapy on cognitive function in older women.
- PublicationAn Exploration of the Experiences of Adults that were Raised without Routine Childhood Vaccinations(2014)
; This thesis explores the experiences of adults raised without routine childhood vaccinations. This is a highly contentious topic and despite the substantial number of children that are raised in this way, there is a paucity of literature exploring this group of people and the outcomes of such health care decisions. This study's theoretical framework is constructed from a phenomenological perspective. A phenomenological methodology guiding this study allowed the researcher to hear the participants' voices as they had experienced this phenomenon. Using a mixed method of data collection enabled the researcher to gain a breadth and depth of the phenomenon in question. Sixty-seven participants completed the open-ended online survey questionnaire and thirteen participants participated in the in-depth interviews. The data was collected from the survey questionnaire, which then informed the in-depth interviews that followed. Participants were found to have a high regard for their health and displayed proactive health conscious behaviours. A high level of contentment was found amongst participants in regards to the vaccine decision that was made on their behalf, with a great majority of participants found to have made the same non-vaccination decision for their own children. This thesis revealed the existence of a significant gap between the lived experience of individual's and the vaccine imperative placed upon the populace. Contributing to the literature, this study gleaned intergenerational insights, directly related to asking participants about vaccine decision-making regarding their own children. In addition, the project elucidated the way in which participants navigated between heterodox and orthodox medicine, in an attempt to meet their health care needs and preferences. - PublicationRate Pressure Product Responses During An Acute Session Of Isometric Resistance Training: A Randomized TrialHypertension is a major modifiable risk factor for cardiovascular disease, responsible for approximately 31% of global mortality. The aim of this study was to examine the hypertensive responses and determine the peak rate pressure product, calculated by multiplying systolic blood pressure and heart rate, during isometric handgrip exercise. Rate pressure product is a surrogate measure of myocardial oxygen consumption. Hypertensive responses utilising rate pressure product during isometric handgrip exercise have not previously been reported. A randomized trial was conducted with 60 normotensive and 60 pre-hypertensive participants who attended once for an acute session of isometric handgrip exercise. Participants were randomized into groups exercising at 5%, 10% or 30% of their maximum voluntary contraction. Training was conducted using 4x2min isometric handgrip exercises each separated by a 3min rest period. There were no significant differences between peak systolic and diastolic blood pressure, mean arterial pressure, heart rate and rate pressure product across the four bouts of isometric handgrip exercise in all groups, all p>.05. Peak increases in rate pressure product were significantly higher than baseline at all intensities assessed; all normotensive groups p<.02, all pre-hypertensive groups p≤.001. Increases were relative to baseline blood pressure status and intensity of isometric handgrip exercise, with no significant differences between normotensive and pre-hypertensive groups. Rate pressure product responses to isometric handgrip exercise indicate that it may be a safe alternative for people unable to perform recommended levels of aerobic exercise for blood pressure management.
- PublicationIsometric Resistance Training to Manage Hypertension: Systematic Review and Meta-analysis
Purpose of Review Hypertension is the primary risk factor for cardiovascular disease and adequate blood pressure control is often elusive. The objective of this work was to conduct a meta-analysis of trial data of isometric resistance training (IRT) studies in people with hypertension, to establish if IRT produced an anti-hypertensive effect. A database search (PubMed, CINAHL, Cochrane Central Register of Controlled Trials, and MEDLINE) identified randomised controlled and crossover trials of IRT versus a sedentary or sham control group in adults with hypertension.
Recent FindingsWe included 12 studies (14 intervention groups) in the meta-analyses, with an aggregate of 415 participants. IRT reduced systolic blood pressure (SBP), mean difference (MD) - 7.47 mmHg (95%CI - 10.10, - 4.84), P < 0.01; diastolic blood pressure (DBP) MD - 3.17 mmHg (95%CI - 5.29, - 1.04), P < 0.01; and mean arterial blood pressure (MAP) MD - 7.19 mmHg (95%CI - 9.06, - 5.32), P < 0.0001. Office pulse pressure and resting heart rate was not significantly reduced, neither were 24-h or day-time ambulatory blood pressures (SBP, DBP). Night-time blood pressures, however, were significantly reduced with SBP MD - 4.28 mmHg (95%CI - 7.88, - 0.67), P = 0.02, and DBP MD - 2.22 mmHg (95%CI - 3.55, - 0.88), P < 0.01.
Summary IRT does lower SBP, DBP and MAP office and night-time ambulatory SBP and DBP, but not 24-h mean ambulatory blood pressures in people with hypertension.