The role of routine FIBERoptic bronchoscopy monitoring during percutaneous dilatational TRACHeostomy (FIBERTRACH): a study protocol for a randomized, controlled clinical trial.

BACKGROUND: Tracheostomy is one of the most frequent techniques in intensive care units (ICU). Fiberoptic bronchoscopy (FB) is a safety measure when performing a percutaneous dilatational tracheostomy (PDT), but the controversy surrounding the routine use of FB as part of the procedure remains open. National surveys in some European countries showed that the use of FB is non-standardized. Retrospective studies have not shown a significant difference in complications between procedures performed with or without a bronchoscope. International guidelines have not been able to establish recommendations regarding the use of FB in PDT due to lack of evidence. DESIGN: This is a multicenter (three centers at the time of  publishing this paper) randomized controlled clinical trial to examine the safety of percutaneous tracheostomy using FB. We will include all consecutive adult patients admitted to the ICU in whom percutaneous tracheostomy for prolonged mechanical ventilation is indicated and with no exclusion criteria for using FB. Eligible patients will be randomly assigned to receive blind PDT or PDT under endoscopic guidance. All procedures will be performed by experienced intensivists in PDT and FB. A Data Safety and Monitoring Board (DSMB) will monitor the trial. The primary outcome is the incidence of perioperative complications. DISCUSSION: FB is a safe technique when performing PDT although its use is not universally accepted in all ICUs as a routine practice. Should PDT be monitored routinely with endoscopic guidance? This study will assess the role of FB monitoring during PDT. TRIAL REGISTRATION: ClinicalTrials.gov NCT04265625. Registered on February 11, 2020.

Adherence to highly active antiretroviral therapy in Spain. A meta-analysis

Objectives: To estimate the percentage of adherence to highly-active antiretroviral therapy (HAART) inSpanish observational studies and to identify the variables associated with adherence.Methods: Seven electronic databases were used to locate the studies. Six inclusion criteria were established.Two coders codified the variables independently. Intercoder reliability was calculated. Publicationbias was analyzed through the Begg, Egger and Trim and Fill tests. Homogeneity was evaluated using theQ test and the l2 index. A random effects model was assumed to estimate both the overall percentage ofadherence and to explain heterogeneity.Results: This meta-analysis included 23 observational studies, yielding a total of 34 adherence estimates.The sample was composed of 9,931 HIV-positive individuals (72% men) older than 18 years under treatmentwithHAART. The percentage of patients adhering to an intake of>90%of the prescribed antiretroviraldrugs was 55%. Wide heterogeneity was detected (I2 = 91.20; 95%CI: 88.75-93.13). Adherence was mainlymeasured using a single strategy (47.8%), the most widely used being self-report (48.7%). In the univariateanalysis, the following factors were significant: infection stages A (= 0.68, p <0.001) and B (= –0.56,p <0.01), viral loads >200 copies/ml (= –0.41, p <0.05) and <200 (= 0.39, p <0.05), and universityeducation (= –0.66, p<0.05).Conclusions: The overall percentage of adherence was 55%, although this value may be an overestimate.Adherence was associated with infection stage A and with a viral load of <200 copies/ml (AU)

Objetivo: Calcular el porcentaje de adherencia al TARGA en estudios observacionales espa˜ noles, así comoidentificar las variables asociadas a ella.Métodos: Para localizar los estudios se emplearon siete bases bibliográficas. Se establecieron seis criteriosde inclusión. Dos codificadores realizaron la codificación de forma independiente. Se calculó la fiabilidadintercodificadores. El sesgo de publicación se evaluó mediante los tests de Begg y de Egger, y Trim & Fill.La homogeneidad se estimó mediante la pruebaQy el índice I2. Se asumió un modelo de efectos aleatoriostanto para la estimación del porcentaje global de adherencia como para explicar la heterogeneidad.Resultados: El metaanálisis incluyó 23 estudios observacionales que proporcionaron 34 estimaciones dela adherencia. La muestra está constituida por 9931 individuos VIH+ (72,2% hombres), mayores de 18 a˜nosy en tratamiento con TARGA. El porcentaje de pacientes con una adherencia al tratamiento de >90% deingestión de los antirretrovirales prescritos fue del 55%. Se detectó una gran heterogeneidad (I2 = 91.20;IC95%: 88.75-93.13). La adherencia fue evaluada principalmente con una única estrategia (47,8%); elautoinforme fue la más empleada (48,7%). En el análisis univariado resultaron significativo los estadiosA (= 0,68, p <0,001) y B (= -0,56, p <0,01), la carga viral >200 copias/ml (= -0,41, p <0,05) y <200copias/ml (= 0,39, p <0,05), y el nivel de educación de estudios superiores (= -0,66, p <0,05).Conclusiones: El porcentaje global de adherencia fue del 55%, pero este valor puede estar sobrestimado.La adherencia se asoció al estadio A de la infección y a una carga viral <200 copias/ml (AU)

Adherence to highly active antiretroviral therapy in Spain. A meta-analysis.

OBJECTIVES: To estimate the percentage of adherence to highly-active antiretroviral therapy (HAART) in Spanish observational studies and to identify the variables associated with adherence. METHODS: Seven electronic databases were used to locate the studies. Six inclusion criteria were established. Two coders codified the variables independently. Intercoder reliability was calculated. Publication bias was analyzed through the Begg, Egger and Trim and Fill tests. Homogeneity was evaluated using the Q test and the l² index. A random effects model was assumed to estimate both the overall percentage of adherence and to explain heterogeneity. RESULTS: This meta-analysis included 23 observational studies, yielding a total of 34 adherence estimates. The sample was composed of 9,931 HIV-positive individuals (72% men) older than 18 years under treatment with HAART. The percentage of patients adhering to an intake of >90% of the prescribed antiretroviral drugs was 55%. Wide heterogeneity was detected (I² =91.20; 95%CI: 88.75-93.13). Adherence was mainly measured using a single strategy (47.8%), the most widely used being self-report (48.7%). In the univariate analysis, the following factors were significant: infection stages A (ß=0.68, p <0.001) and B (ß=-0.56, p <0.01), viral loads >200 copies/ml (ß=-0.41, p <0.05) and <200 (ß=0.39, p <0.05), and university education (ß=-0.66, p<0.05). CONCLUSIONS: The overall percentage of adherence was 55%, although this value may be an overestimate. Adherence was associated with infection stage A and with a viral load of <200 copies/ml.

Adherence to highly active antiretroviral therapy (HAART): a meta-analysis.

This meta-analysis synthesizes eighty-four observational studies, conducted across twenty countries, to determine the mean proportion of people who reported ≥90% adherence to prescribed highly active antiretroviral therapy (HAART) and to identify the factors associated with high levels of adherence. Eight electronic databases were searched to locate all relevant studies available by January 2010, which were then coded for sample characteristics and adherence levels. The average rate of reporting ≥90% adherent HAART adherence is 62%. However, this proportion varies greatly across studies. In particular, a greater proportion of individuals maintaining ≥90% adherence to HAART is more likely in studies with higher proportions of men who have sex with men (MSM) and lower proportions of injection drug users (IDU), with participants in an earlier stage of infection, and in studies conducted in countries characterized by lower Human Development Index (HDI) scores.