Including Conference Abstracts Research Articles

Enteral Versus Parenteral Nutrition in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis

Purpose : The purpose of this study is to conduct a systematic review to compare the nutritional support level, tolerance, and clinical outcomes obtained with enteral and parenteral nutrition in patients undergoing hematopoietic stem cell transplantation(HSCT). Methods: A computerized search of studies published from database inception to June 12, 2023 was conducted in English language databases including Pubmed, Cochrane Library, Embase, and Web of Science, and in Chinese language databases including China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database, and Chinese Biomedical Literature Database (Sinomed). The search strategy was constructed using a combination of subject headings and free-text terms. Search terms included “Stem Cell Transplantat*” “Bone Marrow Transplantation” “Enteral Nutrition” “Parenteral Nutrition”. The inclusion criteria for this intervention study are studies that include patients undergoing hematopoietic stem cell transplantation and compare enteral nutrition versus parenteral nutrition as an intervention. The outcome measures include changes in patient nutritional status, nutritional support tolerance, incidence of infection, incidence of GVHD, length of hospital stay, and number of days to neutrophil engraftment. Studies including conference abstracts and those without full-text availability were excluded. Results: A total of 3,175 relevant articles were identified through the search, and after duplicates and screening, 10 studies with 339 patients were included. The literature screening process is shown in Figure 1, and the included study characteristics are presented in Table 1. The average duration of enteral nutrition in HSCT patients was 10-16 days, while parenteral nutrition lasted on average 14-17.5 days. Nasogastric tube feeding provided 50%-90% of the required nutrition, while intravenous nutrition provided 58%-97% of the required nutrition. Meta-analysis results showed that patients receiving enteral nutrition had a higher degree of weight loss compared to those receiving parenteral nutrition after HSCT [MD=1.97, 95%CI(0.81, 3.12), P<0.001], but had a lower degree of serum albumin decline [MD=2.49, 95%CI(0.82, 4.17), P=0.003], as shown in Figures 2-3. In terms of tolerance, 45%-100% of patients switched from enteral to parenteral nutrition before completing nutritional support, with common reasons being repeated tube displacement, inability to meet nutritional demands, nausea, and diarrhea. Only one study reported bleeding rates, which were 23% for the enteral nutrition group and 30% for the parenteral nutrition group. Meta-analysis results showed no significant differences in the incidence of grade 3-4 GVHD, grade 3-4 gastrointestinal mucositis, incidence of infection, and mean length of hospital stay between the two groups, as shown in Figures 4-7. The quality assessment of included studies is presented in Figure 8. Conclusion: Previous studies have suggested that enteral nutrition may be a cost-effective alternative to parenteral nutrition and could potentially prevent bacterial translocation by stimulating the gastrointestinal mucosa. The American Society for Parenteral and Enteral Nutrition recommends that enteral nutrition should be prioritized for HSCT patients who cannot meet their nutritional needs through oral intake. This study found that enteral and parenteral nutrition provided similar levels of nutritional support, and there were no statistically significant differences in clinical outcomes, such as the incidence of grade 3-4 GVHD, grade 3-4 gastrointestinal mucositis, incidence of infection, and mean length of hospital stay. However, based on patient tolerance, factors such as repeated tube displacement, inability to meet nutritional demands, nausea, and diarrhea may lead to the removal of the tube before reaching the nutritional target, and a switch to parenteral nutrition support. Therefore, when choosing enteral nutrition support, it is essential to evaluate the patient's nutritional needs, nasal and skin mucosa condition, and gastrointestinal function. As the studies included in this review were small sample studies, there may be some bias in the results. Future multi-center, large-sample prospective studies are needed to further compare the risks and benefits of different nutritional support modalities for HSCT patients.

Catheter ablation vs medical therapy for treatment of atrial fibrillation patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Catheter ablation (CA) is used as a treatment option in selected patients with atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) as studies have shown that it reduces heart failure (HF) hospitalization, improves survival, and reduces rates of AF recurrence when compared to medical therapy. However, it is not known whether this benefit persists in patients with heart failure with preserved ejection fraction (HFpEF). Purpose The aim of this meta-analysis is to compare CA versus medical therapy in patients with AF and HFpEF Methods MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched from August 2012 to August 2022. All randomized controlled trials (RCTs), propensity score matched (PSM) studies, and observational studies including conference abstracts providing outcomes in patients with HFpEF and AF after CA were included. Outcomes examined include all-cause mortality, HF hospitalizations, and AF recurrence. A random-effects model using R statistical software was used to calculate odds ratios (OR) and 95% confidence intervals (CI). Results Of 3151 studies screened, 8 studies (1 RCT, 4 PSM, 3 observational) were included with a pooled population of 2171 and 24087 patients with AF and HFpEF who underwent CA and medical therapy respectively. There were no significant differences in baseline age (70.6 vs 70.7, p = 0.16), proportion of hypertension (85.0% vs 86.4%, p = 0.58), diabetes (33.8% vs 35.8%, p = 0.39), coronary artery disease (40.2% vs 41.8%, p = 0.06), or men (42.3 vs 36.6%, p = 0.42). After a mean weighted follow-up of 9.45 months, there was no significant difference in all-cause mortality (OR 0.77 [0.47-1.26], p = 0.07), HF hospitalizations (OR 0.44 [0.18-1.08], p = 0.22), but a significantly lower rate of AF recurrence (OR 0.22 [0.09-0.54], p = 0.001) associated with CA. Conclusion In patient with HFpEF, CA significantly reduced AF recurrence compared with medical therapy but with no difference in mortality or HF hospitalization. CA continues to have an important role to play in treatment of AF even in HFpEF patients.

Targeted Literature Review of Patient Reported Outcomes (PROs) in Chronic Myeloid Leukemia (CML) Patients Receiving Second and Later Lines of Treatment

Background: Tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of chronic CML in the last several years; however, the failure rates associated with TKIs still remain high in second line (50%) and later lines (75%-80%) treatment. Also, patients often experience adverse events associated with these TKIs, but are often left with no alternative treatment in real world practice which might result in TKI cycling. There is a need to understand the quality of life (QoL) and symptom burden among these patients, in order to better manage their disease and also to explore new treatments. The objectives of this study were to summarize the PROs among patients with CML receiving 2nd/3rd/4th line (2L/3L/4L) treatment, and the instruments used for QoL and symptom burden assessment in clinical trials and real world studies. Methods: Embase, MEDLINE, and the Cochrane Library were searched using pre-defined search terms to identify studies published from 1/1/2010 to 6/15/2020. Following the title/abstract and full-text screening based on the inclusion/exclusion criteria (see Table), one reviewer independently extracted all relevant data with random quality check (~20% of the sample) by a 2nd reviewer. Included studies reported QoL, symptom burden, or any PROs of adult CML patients who received 2L/3L/4L treatment. Only clinical trials and observational studies published in English were included, including conference abstracts. Results: Database search identified 1,377 records, which were screened to identify 20 studies (5 observational studies and 15 clinical trial-based studies) that met eligibility criteria (see Figure). Of the included studies, 16 targeted chronic phase CML patients only. More than half of the studies (n=14) focused on patients receiving 2L treatment (bosutinib, dasatinib, or nilotinib) only, and six reported QoL data on patients receiving 2L/3L/4L treatment, out of which four studies reported results by line of therapy. Out of 15 studies reporting a follow-up period, 13 observed patients ≥ 12 months with a maximum of 24 months. The duration between observations were usually 12 weeks for observational studies; while shorter duration was observed in clinical trials. Six clinical trial-based studies were associated with one trial (NCT00261846). Instruments used to assess QoL included four generic instruments [Functional Assessment of Cancer Therapy - General (FACT-G), EuroQol 5 dimension (EQ-5D), 36-Item Short Form Survey (SF-36), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30)], three disease specific instruments [Functional Assessment of Cancer Therapy - Leukemia (FACT-Leu), MD Anderson Symptom Inventory chronic myeloid leukemia (MDASI-CML), Comprehensive Symptom Profile in Chronic Myeloid Leukemia Patients (CSP Leuk-CML)], one Work Productivity and Activity Impairment (WPAI) questionnaire, and two additional general questions on QoL. Ten studies applied both generic and disease specific instruments altogether to evaluate patients' QoL and symptom burden. For 2L TKI treatment, studies have shown improvement in QoL following treatment; however, one study indicated that although patients were content with their QoL, they reported poor symptom scores on mobility, usual activities, and pain/discomfort. Among four studies examining PROs by line of therapy, only one study reported results on the 4L cohort individually, which showed lowest baseline FACT-G and FACT-Leu score in the 4L cohort compared to other cohorts, especially in terms of the physical and emotional well-being domain. Discrepancies existed in QoL between 2L- and 3L cohorts. Two studies found QoL to be similar between the 2L- and 3L cohorts, while the other two observed the QoL was lower in the 3L cohorts. In addition, three reported that QoL scores remained stable throughout observation period regardless of the line of therapy, but one study demonstrated the utility score got improved in the 2L but not the 3L cohort. Conclusions: Evidence on PROs in CML patients receiving 3L/4L treatment is very limited, especially real-world data. Existing research indicates patients with CML receiving later lines of treatment may have poor quality of life. Robust real-world studies with longer follow-up period are needed to provide evidence on later lines treatment management among CML patients. Disclosures Zhang: Novartis Pharmaceutical Corporation: Current Employment. Maegawa:Novartis Pharmaceutical Corporation: Current Employment, Current equity holder in publicly-traded company. Patwardhan:Novartis Pharmaceutical Corporation: Current Employment, Current equity holder in publicly-traded company.

O9.6. SYSTEMATIC REVIEW AND META-ANALYSIS OF THE EFFECTS OF CANNABIS USE IN ADOLESCENCE ON IQ IN LONGITUDINAL STUDIES ACCOUNTING PRE-EXPOSURE BASELINE PERFORMANCE

BackgroundCannabis use in adolescence is a known risk factor for developing schizophrenia. Decline in intellectual functioning is a well-studied phenomenon of schizophrenia. Schizophrenia in its first classification was conceptualized as a dementia - ‘Dementia Praecox’ indicating a dominance of effect of cognitive symptoms on functioning at that time. First episode psychosis patients with histories of cannabis use compared to those without cannabis use have superior cognitive functioning suggesting different disease phenotypes. Our aim was to investigate whether cannabis had an effect on full scale IQ in general population samples to further inform understanding of this disease pathway.MethodsWe developed a search strategy through an iterative approach with a qualified information specialist. We searched three databases: Medline, Embase and PsychInfo. We included conference abstracts and full text publications in English. We contacted authors for additional information in cases where an effect size was not calculable. We included longitudinal studies of non-help-seeking young people in the community with a pre-drug exposure standardized measure of IQ prior to the age of 18 and a comparable measure at subsequent follow up. We defined the case group as individuals with a history of heavy cannabis use (more than 25 lifetime uses, at least weekly use for 6 months and/or meeting criteria for a cannabis use disorder) and the control group as similar young people who had no or very minimal experimental exposure to cannabis (<5 lifetime uses). Two reviewers independently extracted the data and assessed for bias using the Newcastle-Ottawa risk of bias tool. We performed random effects meta-analysis in Stata version 14 given expected heterogeneity in measurement of cannabis use across studies.ResultsWe identified 7 cohort studies detailed in 6 reports including over 650 subjects and 5600 controls. Study designs included twin cohorts, representative cluster sampled community cohorts and birth cohort studies. Range of follow up was between 2 and 23 years. All studies showed relative decline in IQ of which two were statistically significant. Our findings show that cannabis use in youth is associated with modest IQ differences that equate to approximately to a 2-point decrease in young cannabis users. Studies examining twin pairs showed that twins discordant for cannabis use did not have divergent cognitive trajectories, however these analyses were relatively underpowered to find an effect.DiscussionOur findings demonstrate the harmful effects of cannabis use on brain development in young people. These findings are of public health importance and provide further evidence for the detrimental effects of early cannabis use on mental health and cognition.

Publication bias in diagnostic imaging: conference abstracts with positive conclusions are more likely to be published.

To evaluate whether imaging diagnostic test accuracy conference abstracts with positive conclusions or titles are more likely to reach full-text publication than those with negative (or neutral) conclusions or titles. Diagnostic accuracy research abstracts were included if they were presented at the 2011 or 2012 Radiological Society of North America conference. Full-text publication status at 5 years post conference abstract submission was determined. Conclusion and title positivity of conference abstracts were extracted, as well as potential confounding factors. The associations of conclusion and title positivity with publication status at 5 years post conference abstract submission were assessed using a multivariable logistic regression model. Conditional odds ratios were calculated to express the strength of associations, adjusting for the confounders. In total, 282/400 (71%) of included conference abstracts reached full-text publication. A total of 246 out of 337 (74%) conference abstracts with positive conclusions resulted in full-text publications, compared with 26/48 (54%) with neutral conclusions and 5/15 (33%) with negative conclusions. In multivariable logistic regression, conclusion positivity was significantly associated with full-text publication (odds ratio 3.6; 95% CI 1.9-6.7 for conference abstracts with positive conclusions, compared with those with non-positive conclusions); this did not apply to title positivity (odds ratio 1.2; 95% CI 0.47-3.0). Imaging conference abstracts with positive conclusions were more likely to be published as full-text articles. Title positivity was not associated with publication. This preferential publication pattern may lead to an overrepresentation of positive studies in the literature. An overrepresentation of positive studies may contribute to inflated estimates of test accuracy and has the potential to adversely influence patient care. • Imaging diagnostic test accuracy conference abstracts with positive conclusions were more likely to be reported as full-text articles than those with non-positive conclusions. • The majority (75%) of imaging diagnostic test accuracy conference abstracts with positive conclusions were published, compared with only 53% and 33% with neutral and negative conclusions, respectively. • Conclusion positivity remained associated with the full-text publication of conference abstracts when controlling for multiple potential confounding variables.

Temozolomide for high grade glioma.

High grade glioma (HGG) is an aggressive form of brain cancer. Treatment of HGG usually entails biopsy, or resection if safe, followed by radiotherapy. Temozolomide is a novel oral chemotherapy drug that penetrates into the brain and purportedly has a low incidence of adverse events. To assess whether temozolomide has any advantage for treating HGG in either primary or recurrent disease settings. The following databases were searched: CENTRAL (Issue 10, 2012), MEDLINE, EMBASE, Science Citation Index, Physician Data Query and the Meta-Register of Controlled Trials in October, 2012. Reference lists of identified studies were searched. The Journal of Neuro-Oncology and Neuro-oncology were handsearched from 1999 to 2012 including conference abstracts. We contacted neuro-oncologists regarding ongoing and unpublished trials. Randomised controlled trials (RCTs) where the interventions were the use of temozolomide during primary therapy or for recurrent disease. Comparisons included no chemotherapy, non-temozolomide chemotherapy or different dosing schedules of temozolomide. Patients included those of all ages with histologically proven HGG. Two review authors undertook the quality assessment and data extraction. Outcome measures included: overall survival (OS); progression-free survival (PFS); quality of life (QoL); and adverse events. For primary therapy three RCTs were identified, enrolling a total of 745 patients, that investigated temozolomide in combination with radiotherapy versus radiotherapy alone for glioblastoma multiforme (GBM). Temozolomide increased OS (hazard ratio (HR) 0.60, 95% confidence interval (CI) 0.46 to 0.79, P value 0.0003) and increased PFS (HR 0.63, 95% CI 0.43 to 0.92, P value 0.02), when compared with radiotherapy alone, although these benefits only appear to emerge when therapy is given in both concomitant and adjuvant phases of treatment. A single RCT found that temozolomide did not have a statistically significant effect on QoL. Risk of haematological complications, fatigue and infections were increased with temozolomide.In recurrent HGG, two RCTs enrolling 672 patients in total found that temozolomide did not increase OS compared to standard chemotherapy (HR 0.9, 95% CI 0.76 to 1.06, P value 0.2) but it did increase PFS in a subgroup analysis of grade IV GBM tumours (HR 0.68, 95% CI 0.51 to 0.90, P value 0.008). Adverse events were similar between arms.In the elderly, 2 RCTs of 664 patients found OS and PFS was similar with temozolomide alone versus radiotherapy alone. QoL did not appear to differ between arms in a single trial but certain adverse events were significantly more common with temozolomide. Temozolomide when given in both concomitant and adjuvant phases is an effective primary therapy in GBM compared to radiotherapy alone. It prolongs survival and delays progression without impacting on QoL but it does increase early adverse events. In recurrent GBM, temozolomide compared with standard chemotherapy improves time-to-progression (TTP) and may have benefits on QoL without increasing adverse events but it does not improve overall. In the elderly, temozolomide alone appears comparable to radiotherapy in terms of OS and PFS but with a higher instance of adverse events.

A review of cost‐effectiveness of varenicline and comparison of cost‐effectiveness of treatments for major smoking‐related morbidities

This review aims to examine economic evaluations of varenicline, to compare the reported cost-effectiveness of varenicline with that of treatments for major smoking-related diseases and to evaluate the findings for decision making. A literature search was performed to identify published articles in English indexed in MEDLINE and the Cochrane Library (Issue 1, 2009), which includes the Economic Evaluation Database. Additional sources also were searched to identify unpublished varenicline studies, including conference abstracts. The search for varenicline studies was limited from 2006 to October 2009; searches for all other types of studies were limited from 1990 to October 2009. The search yielded a total of 20 relevant economic evaluations of varenicline. In addition, 37 reviews of economic evaluations in chronic obstructive pulmonary disease, non-small cell lung cancer and cardiovascular disease, as well as studies evaluating the impact of economic rewarding were considered in this review. From these identified economic evaluations, the incremental cost-effectiveness ratios for varenicline ranged from dominance (more effective and cost saving) to €18,582 per quality-adjusted life-year (including indirect costs). These estimates appeared substantially lower when compared with incremental cost-effectiveness ratios reported for secondary prevention of smoking-related diseases, which in some cases were as high as €66,218 per quality-adjusted life-year. Varenicline appears to be cost-effective from the perspective of both health care payers and employers, because of reduced health care consumption and costs. The cost-effectiveness of varenicline also compares favourably to that of interventions recommended for the treatment and prevention of smoking-related diseases.

Physical Activity Interventions in Latin America: What Value Might Be Added by Including Conference Abstracts in a Literature Review?

This review assessed whether conference abstracts yield useful information on the types and effectiveness of community-based physical activity (PA) interventions in Latin America, beyond that from interventions included in a recent systematic review of peer-reviewed literature. Abstracts from 9 conferences were searched for community-based interventions to promote PA in Latin America and summarized. Three reviewers classified and screened abstracts. Evaluated interventions that were not included in the previous review were assessed. Search of abstracts from 31 proceedings of 9 conferences identified 87 abstracts of studies on community-based interventions focused on increasing PA. Only 31 abstracts reported on studies with a control group and an outcome related to PA. Ten of these abstracts represented interventions that had not been included in the previous review of peer-reviewed literature, but the abstracts were insufficient in number or detail to make a practice recommendation for any single intervention. This review highlighted the challenges and low added value of including conference abstracts in a systematic review of community PA interventions in Latin America. Stronger evaluation design and execution and more published reports of evaluated interventions are needed to build an evidence base supporting interventions to increase PA in Latin America.

Reviewing Physical Activity Interventions In Latin America: Does Including Conference Abstracts Add Value?

Reviewing Physical Activity Interventions In Latin America: Does Including Conference Abstracts Add Value?