RESUMO
BACKGROUND: Aortic stenosis (AS) without surgical intervention is associated with morbidity and mortality and is the most common valvular disease in the western world. Transcatheter aortic valve implantation (TAVI) is a minimally invasive surgical option that has become a common treatment for people unable to undergo open aortic valve replacement; despite the increase in TAVI offerings in the last decade, patient quality of life (QoL) outcomes postoperatively are poorly understood. OBJECTIVE: The aim of this review was to determine whether TAVI is effective in improving QoL. METHOD: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted, and the protocol was registered on PROSPERO (CRD42019122753). MEDLINE, CINAHL, EMBASE, and PsycINFO were searched for studies published between 2008 and 2021. Search terms included "transcatheter aortic valve replacement" and "quality of life" and their synonyms. Included studies were evaluated, dependent on study design, using either the Risk of Bias-2 or the Newcastle-Ottawa Scale. Seventy studies were included in the review. RESULTS: Authors of the studies used a wide variety of QoL assessment instruments and follow-up durations; authors of most studies identified an improvement in QoL, and a small number identified a decline in QoL or no change from baseline. CONCLUSION: Although authors of the vast majority of studies identified an improvement in QoL, there was very little consistency in instrument choice or follow-up duration; this made analysis and comparison difficult. A consistent approach to measuring QoL for patients who undergo TAVI is needed to enable comparison of outcomes. A richer, more nuanced understanding of QoL outcomes after TAVI could help clinicians support patient decision making and evaluate outcomes.
RESUMO
Photosensitisation diseases can cause production and animal welfare losses world-wide. In North-West Europe a photosensitisation disease complex known as 'plochteach', 'yellowses', 'saut' and 'alveld' occurs in lambs on extensive pastures containing bog asphodel (Narthecium ossifragum). Affected lambs develop lesions on the ears, face and sometimes the back, with erythema, oedema, ulceration and necrosis that can be followed by secondary infection and death. Adult sheep appear unaffected, the incidence in lambs varies from year to year and there are variations in susceptibility between- and within-breeds. The definitive cause remains uncertain although ingestion of N. ossifragum, which contains hepatotoxic saponins, has been implicated in the aetiology. However, problems replicating the disease complex by feeding N. ossifragum in a controlled environment have led to alternative hypotheses, including possible intake of toxins from fungal spores and cyanobacteria. Further research is required to assess the putative role of N. ossifragum, the scale of economic and animal welfare losses associated with the disease, how best to identify affected animals before external clinical signs appear and the treatment and management of clinical cases. Given the challenges involved in isolating the causative agent(s) of plochteach, an animal breeding route may be effective if heritability of resistance/susceptibility can be demonstrated.
