Background and Aims. Radiofrequency ablation is a commonly used treatment for paroxysmal atrial fibrillation (AF), but postoperative rehabilitation exercises are needed to reverse left ventricular structural and functional abnormalities. This meta-analysis aimed to evaluate the intervention effect of exercise training in patients with AF after radiofrequency ablation. Methods. A systematic literature search was conducted to identify articles in PubMed, MEDLINE, EMBASE, and the Cochrane Library from January 1, 2010 to December 1, 2021. The mean difference with 95% CI was pooled for continuous variables. We used Review Manager 5.3 for the standard meta-analysis. This study followed the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results. Ten randomized controlled trials (RCTs) were included, with a total of 892 patients with AF. The quality of one study was grade A, and the rest were grade B. The results of the meta-analysis showed that the improvement of 6 min walking distance (MD = 34.42, 95% CI: 3.20 to 65.63, P = 0.03 ), peak oxygen uptake (MD = 1.96, 95% CI: 1.14 to 2.78, P < 0.001 ), left ventricular ejection fraction (LVEF) (MD = 0.09, 95% CI:0.01–0.17, P = 0.02 ), resting heart rate (MD = −4.50, 95% CI: −8.85 to −0.14, P = 0.04 ), and physical component summary (PCS) (MD = 3.00, 95% CI: 0.46 to 5.54, P = 0.02 ) in the experimental group was significantly better than that of the control group, and the difference was statistically significant. Conclusion. Exercise training can improve the level of exercise endurance and cardiac function in patients. However, the results were limited by the quantity and quality of the studies. Large samples and high-quality studies are still needed to verify its long-term efficacy.
IntroductionUrinary incontinence (UI) negatively impacts quality of life, potentially contributing to depression, urinary tract infection, and renal impairment. Early treatment includes behavioural modification and anticholinergics. Among the general population, ∼40% of patients with overactive bladder do not improve with such treatment. Diapers, pads, and intermittent catheterization may also be used. When earlier options fail, surgery is considered. Botox was approved by Health Canada for UI due to neurogenic detrusor overactivity (NDO), resulting from neurogenic bladder associated with multiple sclerosis or subcervical spinal cord injury in adults who had an inadequate response to or are intolerant of anticholinergic medications.Botox is a sterile form of botulinum neurotoxin type A, derived from the anaerobic bacterium Clostridium botulinum. It is believed to prevent muscle contractions by temporarily blocking nerve impulses to the bladder muscle.ObjectiveTo evaluate whether the benefit in urinary incontinence patients with neurogenic detrusor overactivity treated with Botox provides good value for Ontario public funding.MethodsA Markov model was used to estimate population outcomes and costs for NDO patients, receiving either Botox or best supportive care (oxybutynin). A Cost Utility Analysis was conducted, using 3 month cycles with a 2 year time horizon (discounted at 5%), plus one-way and probabilistic sensitivity analyses.ResultsFrom the incremental cost-effectiveness ratio (ICER) of $9,710/QALY, Botox is more cost-effective compared to oxybutynin. From the cost-effectiveness acceptability curve (CEAC), at a maximum acceptable ceiling ratio of $50,000/QALY, the probability that Botox is cost-effective compared to oxybutynin is 0.987.ConclusionBased on ICER and CEAC, Botox appears to be a cost-effective intervention for urinary incontinence due to neurogenic detrusor overactivity compared with anticholinergic.
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