Heybati, Kiyan

AbstractThis systematic review and meta‐analysis of randomised controlled trials (RCTs) aimed to evaluate the efficacy, safety, and tolerability of fluvoxamine for the outpatient management of COVID‐19. We conducted this review in accordance with the PRISMA 2020 guidelines. Literature searches were conducted in MEDLINE, EMBASE, International Pharmaceutical Abstracts, CINAHL, Web of Science, and CENTRAL up to 14 September 2023. Outcomes included incidence of hospitalisation, healthcare utilization (emergency room visits and/or hospitalisation), mortality, supplemental oxygen and mechanical ventilation requirements, serious adverse events (SAEs) and non‐adherence. Fluvoxamine 100 mg twice a day was associated with reductions in the risk of hospitalisation (risk ratio [RR] 0.75, 95% confidence interval [CI] 0.58–0.97; I 2 = 0%) and reductions in the risk of healthcare utilization (RR 0.68, 95% CI 0.53–0.86; I 2 = 0%). While no increased SAEs were observed, fluvoxamine 100 mg twice a day was associated with higher treatment non‐adherence compared to placebo (RR 1.61, 95% CI 1.22–2.14; I 2 = 53%). In subgroup analyses, fluvoxamine reduced healthcare utilization in outpatients with BMI ≥30 kg/m2, but not in those with lower BMIs. While fluvoxamine offers potential benefits in reducing healthcare utilization, its efficacy may be most pronounced in high‐risk patient populations. The observed non‐adherence rates highlight the need for better patient education and counselling. Future investigations should reassess trial endpoints to include outcomes relating to post‐COVID sequelaes. Registration: This review was prospectively registered on PROSPERO (CRD42023463829).

ImportancePrior research has shown differences in postoperative outcomes for patients treated by female and male surgeons. It is important to understand, from a health system and payer perspective, whether surgical health care costs differ according to the surgeon’s sex.ObjectiveTo examine the association between surgeon sex and health care costs among patients undergoing surgery.Design, Setting, and ParticipantsThis population-based, retrospective cohort study included adult patients undergoing 1 of 25 common elective or emergent surgical procedures between January 1, 2007, and December 31, 2019, in Ontario, Canada. Analysis was performed from October 2022 to March 2023.ExposureSurgeon sex.Main Outcome and MeasureThe primary outcome was total health care costs assessed 1 year following surgery. Secondarily, total health care costs at 30 and 90 days, as well as specific cost categories, were assessed. Generalized estimating equations were used with procedure-level clustering to compare costs between patients undergoing equivalent surgeries performed by female and male surgeons, with further adjustment for patient-, surgeon-, anesthesiologist-, hospital-, and procedure-level covariates.ResultsAmong 1 165 711 included patients, 151 054 were treated by a female surgeon and 1 014 657 were treated by a male surgeon. Analyzed at the procedure-specific level and accounting for patient-, surgeon-, anesthesiologist-, and hospital-level covariates, 1-year total health care costs were higher for patients treated by male surgeons ($24 882; 95% CI, $20 780-$29 794) than female surgeons ($18 517; 95% CI, $16 080-$21 324) (adjusted absolute difference, $6365; 95% CI, $3491-9238; adjusted relative risk, 1.10; 95% CI, 1.05-1.14). Similar patterns were observed at 30 days (adjusted absolute difference, $3115; 95% CI, $1682-$4548) and 90 days (adjusted absolute difference, $4228; 95% CI, $2255-$6202).Conclusions and RelevanceThis analysis found lower 30-day, 90-day, and 1-year health care costs for patients treated by female surgeons compared with those treated by male surgeons. These data further underscore the importance of creating inclusive policies and environments supportive of women surgeons to improve recruitment and retention of a more diverse and representative workforce.

Abstract Background Catheter ablation of ventricular tachycardia (VT) may be performed under general anesthesia (GA) or monitored anesthesia care (MAC). There is a paucity of data studying these two sedation strategies with respect to intraprocedural characteristics, and outcomes of VT ablation. Purpose The purpose of this study was to assess the effects of anesthesia techniques on VT inducibility and outcomes. Methods A single-center, retrospective study of patients undergoing catheter ablation for scar-related VT, from 2016-2022, was conducted. Data collected included demographics, comorbidities, medications, relevant laboratory abnormalities, electrocardiograms, echocardiograms, detailed procedural characteristics, and outcomes. Results One hundred sixty-eight patients who underwent a total of 200 VT ablation procedures were included. The patients undergoing GA had a greater burden of comorbidities including congestive heart failure (77.2% vs. 60.9%), hypertension (66.9% vs. 60.0%), atrial arrhythmias (50.7% vs. 43.8%), diabetes mellitus (21.3% vs. 9.4%), chronic kidney disease (44.1% vs. 31.3%), prior stroke (11.8% vs. 10.9%), myocardial infarction (31.6% vs. 29.7%), pre-existing implantable cardioverter-defibrillator (86.8% vs. 71.9%) and had a higher median number of antiarrhythmic drugs at baseline (2 vs. 1) [Figure 1]. There was a greater percentage of patients with non-ischemic cardiomyopathy (58.1% vs. 51.6%) in the GA cohort. The mean left ventricular ejection fraction was not different among the two groups (39.3 ± 13.9 vs. 42.5 ± 15.3). The GA group had more hemodynamic instability at baseline (p < 0.01), and during VT induction (p < 0.01). There was no significant difference in the number of VT induced, or tachycardia cycle length, in each group. Despite higher radiofrequency energy delivery time in the GA group as compared to the MAC group, the GA group had higher VT inducibility post-procedure and were more likely to be discharged on antiarrhythmic drugs. Even though the recurrence of VT was higher in the GA group compared to the MAC group (41.9% vs. 31.3%), the VT-free survival curves were not significantly different by Kaplan-Meier analysis (p=0.19) [Figure 2]. In a multivariate regression analysis, the sedation strategy was not an independent predictor of VT recurrence (p=NS). However, baseline hemodynamic instability was an independent predictor of VT recurrence after accounting for all intraprocedural characteristics (p=0.008). Conclusion Patients undergoing VT ablation under GA have more comorbidities and tend to be on more antiarrhythmic drugs. The GA group had more hemodynamic instability during the procedure and had greater overall VT recurrence, however, not significant in a time-based analysis. The greater overall recurrence in the GA group could be because they represent a sicker population, or the hemodynamics during the procedure preclude adequate ablation of the VT circuit elements.Figure 1Figure 2