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2. Prognostic models for mortality after cardiac surgery in patients with infective endocarditis: a systematic review and aggregation of prediction models

Author

Fernandez-Felix, Borja M., Barca, Laura Varela, Garcia-Esquinas, Esther, Correa-Pérez, Andrea, Fernández-Hidalgo, Nuria, Muriel, Alfonso, Lopez-Alcalde, Jesus, Álvarez-Diaz, Noelia, Pijoan, Jose I., Ribera, Aida, Elorza, Enrique Navas, Muñoz, Patricia, Fariñas, María del Carmen, Goenaga, Miguel Ángel, and Zamora, Javier

Published
2021
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6. Consensus on post COVID in the Spanish National Health System: results of the CIBERPOSTCOVID eDelphi study

Author

Universitat Politècnica de Catalunya. Doctorat en Sostenibilitat, Universitat Politècnica de Catalunya. Departament d’Enginyeria Gràfica i de Disseny, Torres López, Marta, Serra Sutton, Vicky, Soriano Ruiz, Joan Bautista, Ferrer Fores, Montserrat, Trejo Omeñaca, Alejandro, García Benavides, Fernando, Lumbreras, Blanca, Pérez-Gómez, Beatriz, Pijoan, José I, Monguet Fierro, José María, Barbé Illa, Ferran, Pollán, Marina, Alonso, Jordi, Espallargues Carreras, Mireia, Serrano-Blanco, Antoni, Universitat Politècnica de Catalunya. Doctorat en Sostenibilitat, Universitat Politècnica de Catalunya. Departament d’Enginyeria Gràfica i de Disseny, Torres López, Marta, Serra Sutton, Vicky, Soriano Ruiz, Joan Bautista, Ferrer Fores, Montserrat, Trejo Omeñaca, Alejandro, García Benavides, Fernando, Lumbreras, Blanca, Pérez-Gómez, Beatriz, Pijoan, José I, Monguet Fierro, José María, Barbé Illa, Ferran, Pollán, Marina, Alonso, Jordi, Espallargues Carreras, Mireia, and Serrano-Blanco, Antoni

Abstract

Background In 2021, the Spanish Ministry of Health launched the CIBERPOSTCOVID project to establish what post COVID was. The present study reports the level of agreement among stakeholders on post COVID and its clinical and diagnostic characteristics in the Spanish health system. Methods The agreement on post COVID among clinicians, public health managers, researchers and patients’ representatives was explored in a real-time, asynchronous online Delphi. In a two-wave consensus, respondents rated from 1 (total disagreement) to 6 (total agreement) 67 statements related to terminology, duration, etiology, symptoms, impact on quality of life, severity, elements to facilitate diagnosis, applicability in the pediatric population, and risk factors. Consensus was reached when 70% of ratings for a statement were 5 or 6, with an interquartile range equal or less than 1. Findings A total of 333 professionals and patients participated in this eDelphi study. There was agreement that post COVID was “a set of multi-organic symptoms that persist or fluctuate after acute COVID-19 infection and are not attributable to other causes” with a minimum duration of 3 months. The highest levels of agreement were found in the most frequent symptoms and its impacts on everyday activities. Aspects related to the diagnostic process and the measurement of its severity reached a lower level of consensus. There was agreement on the need to rule out previous health problems and assess severity using validated functional scales. However, no agreement was reached on the risk factors or specific features in the pediatric population. Interpretation This policy-based consensus study has allowed the characterization of post COVID generating collective intelligence and has contributed to an operational definition applicable in clinical practice, health services management and useful for research purposes in Spain and abroad. Agreements are consistent with existing evidence and reference institutions at Eur, The CIBERPOSTCOVID is a commissioned project of the Spanish Ministry of Health to the Ministry of Science and Innovation, funded through the Instituto de Salud Carlos III and CIBER -Consorcio Centro de Investigación Biomédica en Red- (ES21PI01)., Peer Reviewed, Postprint (published version)

Published
2023

7. Thirty-day suicidal thoughts and behaviors among hospital workers during the first wave of the Spain COVID-19 outbreak

Author

Mortier, Philippe, Vilagut, Gemma, Ferrer, Montse, Serra, Consol, Molina, Juan D, López-Fresneña, Nieves, Puig, Teresa, Pelayo-Terán, José M, Pijoan, José I, Emparanza, José I, Espuga, Meritxell, Plana, Nieves, González-Pinto, Ana, Ortí-Lucas, Rafael M, de Salázar, Alma M, Rius, Cristina, Aragonès, Enric, Del Cura-González, Isabel, Aragón-Peña, Andrés, Campos, Mireia, Parellada, Mara, Pérez-Zapata, Aurora, Forjaz, Maria João, Sanz, Ferran, Haro, Josep M, Vieta, Eduard, Pérez-Solà, Víctor, Kessler, Ronald C, Bruffaerts, Ronny, Alonso, Jordi, MINDCOVID Working group, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación (España), Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF), Government of Catalonia (España), European Regional Development Fund, and Ministerio de Universidades (España)

Subjects
suicidal thoughts and behaviors, Psychology, Clinical, Social Sciences, Suicide, Attempted, Disease Outbreaks, PHYSICIANS, 0302 clinical medicine, Risk Factors, Health care, Prevalence, Psychology, Suicidal thoughts and behaviors, Research Articles, Psychiatry, Hospitals, Psychiatry and Mental health, Clinical Psychology, COVID‐19 outbreak, COVID-19 outbreak, hospital workers, Preparedness, Cohort, Life Sciences & Biomedicine, Anxiety disorder, Research Article, EUROPE, Coronavirus disease 2019 (COVID-19), Hospital workers, Suicidal Ideation, 03 medical and health sciences, COVID‐19, medicine, Humans, IDEATION, Students, METAANALYSIS, Science & Technology, business.industry, SARS-CoV-2, Outbreak, COVID-19, Odds ratio, NATIONWIDE, medicine.disease, 030227 psychiatry, Mood, Spain, RISK-FACTORS, business, 030217 neurology & neurosurgery, Demography
Abstract

Background: Healthcare workers are a key occupational group at risk for suicidal thoughts and behaviors (STB). We investigated the prevalence and correlates of STB among hospital workers during the first wave of the Spain COVID-19 outbreak (March-July 2020). Methods: Data come from the baseline assessment of a cohort of Spanish hospital workers (n = 5450), recruited from 10 hospitals just after the height of the coronavirus disease 2019 (COVID-19) outbreak (May 5-July 23, 2020). Web-based self-report surveys assessed 30-day STB, individual characteristics, and potentially modifiable contextual factors related to hospital workers' work and financial situation. Results: Thirty-day STB prevalence was estimated at 8.4% (4.9% passive ideation only, 3.5% active ideation with or without a plan or attempt). A total of n = 6 professionals attempted suicide in the past 30 days. In adjusted models, 30-day STB remained significantly associated with pre-pandemic lifetime mood (odds ratio [OR] = 2.92) and anxiety disorder (OR = 1.90). Significant modifiable factors included a perceived lack of coordination, communication, personnel, or supervision at work (population-attributable risk proportion [PARP] = 50.5%), and financial stress (PARP = 44.1%). Conclusions and Relevance: Thirty-day STB among hospital workers during the first wave of the Spain COVID-19 outbreak was high. Hospital preparedness for virus outbreaks should be increased, and strong governmental policy response is needed to increase financial security among hospital workers. Fondo de Investigación Sanitaria, Instituto de Salud Carlos III (Ministerio de Ciencia e Innovación) /FEDER, Grant/Award Number: COV20/00711; ISCIII, Grant/Award Number: Sara Borrell, CD18/00049, PFIS, FI18/00012; FPU, Grant/Award Number: FPU15/05728; Generalitat de Catalunya, Grant/Award Number: 2017SGR452 Sí

Published
2021

8. Mental health impact of the first wave of COVID-19 pandemic on Spanish healthcare workers: A large cross-sectional survey

Author

Alonso, Jordi, Vilagut, Gemma, Mortier, Philippe, Ferrer, Montse, Alayo, Itxaso, Aragón-Peña, Andrés, Aragonès, Enric, Campos, Mireia, Cura-González, Isabel D, Emparanza, José I, Espuga, Meritxell, Forjaz, Maria Joao, González-Pinto, Ana, Haro, Josep M, López-Fresneña, Nieves, Salázar, Alma D Martínez de, Molina, Juan D, Ortí-Lucas, Rafael M, Parellada, Mara, Pelayo-Terán, José Maria, Pérez-Zapata, Aurora, Pijoan, José I, Plana, Nieves, Puig, Maria Teresa, Rius, Cristina, Rodriguez-Blazquez, Carmen, Sanz, Ferran, Serra, Consol, Kessler, Ronald C, Bruffaerts, Ronny, Vieta, Eduard, Pérez-Solà, Víctor, MINDCOVID Working Group, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación (España), European Regional Development Fund, Government of Catalonia (España), and Ministerio de Universidades (España)

Subjects
Adult, Male, Necesidad de atención, Adolescent, Health Personnel, Adverse Mental Health, COVID-19 pandemic, Pandemia de COVID-19, Young Adult, Trabajadores de la salud, Prevalence, Humans, Need for Care, Disability, Salud mental adversa, Mental Disorders, Healthcare Workers, COVID-19, Middle Aged, Occupational Diseases, Mental Health, Cross-Sectional Studies, Trastornos mentales, Spain, Discapacidad, Female
Abstract

[EN] Introduction: Healthcare workers are vulnerable to adverse mental health impacts of the COVID-19 pandemic. We assessed prevalence of mental disorders and associated factors during the first wave of the pandemic among healthcare professionals in Spain. Methods: All workers in 18 healthcare institutions (6 AACC) in Spain were invited to web-based surveys assessing individual characteristics, COVID-19 infection status and exposure, and mental health status (May 5 - September 7, 2020). We report: probable current mental disorders (Major Depressive Disorder-MDD- [PHQ-8≥10], Generalized Anxiety Disorder-GAD- [GAD-7≥10], Panic attacks, Posttraumatic Stress Disorder -PTSD- [PCL-5≥7]; and Substance Use Disorder -SUD-[CAGE-AID≥2]. Severe disability assessed by the Sheehan Disability Scale was used to identify probable "disabling" current mental disorders. Results: 9,138 healthcare workers participated. Prevalence of screen-positive disorder: 28.1% MDD; 22.5% GAD, 24.0% Panic; 22.2% PTSD; and 6.2% SUD. Overall 45.7% presented any current and 14.5% any disabling current mental disorder. Workers with pre-pandemic lifetime mental disorders had almost twice the prevalence than those without. Adjusting for all other variables, odds of any disabling mental disorder were: prior lifetime disorders (TUS: OR=5.74; 95%CI 2.53-13.03; Mood: OR=3.23; 95%CI:2.27-4.60; Anxiety: OR=3.03; 95%CI:2.53-3.62); age category 18-29 years (OR=1.36; 95%CI:1.02-1.82), caring "all of the time" for COVID-19 patients (OR=5.19; 95%CI: 3.61-7.46), female gender (OR=1.58; 95%CI: 1.27-1.96) and having being in quarantine or isolated (OR= 1.60; 95CI:1.31-1.95). Conclusions: One in seven Spanish healthcare workers screened positive for a disabling mental disorder during the first wave of the COVID-19 pandemic. Workers reporting pre-pandemic lifetime mental disorders, those frequently exposed to COVID-19 patients, infected or quarantined/isolated, female workers, and auxiliary nurses should be considered groups in need of mental health monitoring and support. [ES] Introducción: Los profesionales sanitarios son vulnerables al impacto negativo en salud mental de la pandemia COVID-19. Evaluamos la prevalencia de trastornos mentales y factores asociados durante la primera oleada de la pandemia en sanitarios españoles. Métodos: Se invitó a todos los trabajadores de 18 instituciones sanitarias españolas (6 CCAA) a encuestas en línea evaluando características individuales, estado de infección y exposición a COVID-19 y salud mental (5 Mayo – 7 Septiembre, 2020). Reportamos: probables trastornos mentales actuales (Trastorno depresivo mayor TDD [PHQ-8≥10], Trastorno de ansiedad generalizada TAG [GAD-7≥10], Ataques de pánico, Trastorno de estrés postraumático TEP [PCL-5≥7]; y Trastorno por uso de sustancias TUS [CAGE-AID≥2]. La interferencia funcional grave (Escala de Discapacidad de Sheehan) identificó los probables trastornos “discapacitantes”. Resultados: Participaron 9.138 sanitarios. Prevalencia de cribado positivo: 28,1% TDD; 22,5% TAG, 24,0% Pánico; 22,2% PTE; y 6,2% TUS. En general, el 45,7% presentó algún trastorno mental actual y el 14,5% algún trastorno discapacitante. Los sanitarios con trastornos mentales previos tuvieron el doble de prevalencia que aquellos sin patología mental previa. Ajustando por todas las variables, el trastorno mental incapacitante se asoció positivamente con: trastornos previos (TUS: OR=5.74; 95%CI 2.53-13.03; Ánimo: OR=3.23; 95%CI:2.27-4.60; Ansiedad: OR=3,03; IC 95%: 2,53-3,62); edad 18-29 años (OR=1,36; IC 95%: 1,02-1,82); atender “siempre” a pacientes COVID-19 (OR=5,19; IC 95%: 3,61-7,46), género femenino (OR=1,58; IC 95%: 1,27-1,96) y haber estado en cuarentena o aislado (OR=1,60; IC 95%: 1,31-1,95). Conclusiones: Uno de cada 7 sanitarios españoles presentaron un probable trastorno mental discapacitante durante la primera oleada de COVID-19. Aquéllos con trastornos mentales alguna vez antes de la pandemia, los que están expuestos con frecuencia a pacientes con COVID-19, los infectados o en cuarentena / aislados, las mujeres y las enfermeras auxiliares deben considerarse grupos que necesitan seguimiento y apoyo de su salud mental. This work was supported by Instituto de Salud Carlos III (Ministerio de Ciencia e Innovación)/FEDER (COV20/00711); ISCIII (Sara Borrell, CD18/00049) (PM); FPU (FPU15/05728)); ISCIII (PFIS, FI18/00012); Generalitat de Catalunya (2017SGR452). Sí

Published
2021

9. Mental Health Impact of the First Wave of COVID-19 Pandemic on Spanish Healthcare Workers: a Large Cross-sectional Survey

Author

Alonso, Jordi, Vilagut, Gemma, Mortier, Philippe, Ferrer, Montse, Alayo, Itxaso, Aragón-Peña, Andrés, Aragonès, Enric, Campos, Mireia, Cura-González, Isabel D., Emparanza, José I., Espuga, Meritxell, Forjaz, M. Joao, González-Pinto, Ana, Haro Abad, Josep Maria, López-Fresneña, Nieves, Salázar, Alma D. Martínez de, Molina, Juan D., Ortí-Lucas, Rafael M., Parellada, Mara, Pelayo-Terán, José Maria, Pérez-Zapata, Aurora, Pijoan, José I., Plana, Nieves, Puig, Maria Teresa, Rius, Cristina, Rodríguez-Blázquez, Carmen, Sanz, Ferran, Serra, Consol, Kessler, Ronald, Bruffaerts, Ronny, Vieta, Eduard, Pérez-Solà, Víctor, and Universitat Autònoma de Barcelona

Subjects
Adult, Male, medicine.medical_specialty, Necesidad de atención, MINDCOVID Working group, Adolescent, Cross-sectional study, Health Personnel, Adverse Mental Health, COVID-19 pandemic, Pandemia de COVID-19, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Prevalence of mental disorders, Trabajadores de la salud, Health care, Prevalence, medicine, Humans, Need for Care, Psychiatry, Disability, Salud mental adversa, business.industry, Mental Disorders, Healthcare Workers, COVID-19, Panic, General Medicine, Middle Aged, medicine.disease, Mental health, 030227 psychiatry, Occupational Diseases, Substance abuse, Psychiatry and Mental health, Mental Health, Cross-Sectional Studies, Mood, Trastornos mentales, Spain, Discapacidad, Anxiety, Original Article, Female, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

IntroductionHealthcare workers are vulnerable to adverse mental health impacts of COVID-19. We assessed prevalence of mental disorders and associated factors during the first wave of the pandemic among healthcare professionals in Spain.MethodsAll workers in 18 healthcare institutions (6 AACC) in Spain were invited to a series of online surveys assessing a wide range of individual characteristics, COVID-19 infection status and exposure, and mental health status. Here we report: current mental disorders (Major Depressive Disorder-MDD- [PHQ-8≥10], Generalized Anxiety Disorder-GAD- [GAD-7≥10], Panic attacks, Posttraumatic Stress Disorder –PTSD- [PCL-5≥7]; and Substance Use Disorder –SUD-[CAGE-AID≥2]. Severe disability assessed by the Sheehan Disability Scale was used to identify “disabling” current mental disorders.Results9,138 healthcare workers participated. Prevalence of screen-positive disorder: 28.1% MDD; 22.5% GAD, 24.0% Panic; 22.2% PTSD; and 6.2% SUD. Overall 45.7% presented any current and 14.5% any disabling current mental disorder. Healthcare workers with prior lifetime mental disorders had almost twice the prevalence of current disorders than those without. Adjusting for all other variables, odds of any disabling mental disorder were: prior lifetime disorders (TUS: OR=5.74; 95%CI 2.53-13.03; Mood: OR=3.23; 95%CI:2.27-4.60; Anxiety: OR=3.03; 95%CI:2.53-3.62); age category 18-29 years (OR=1.36; 95%CI:1.02-1.82), caring “all of the time” for COVID-19 patients (OR=5.19; 95%CI: 3.61-7.46), female gender (OR=1.58; 95%CI: 1.27-1.96) and having being in quarantine or isolated (OR= 1.60; 95CI:1.31-1.95).ConclusionsCurrent mental disorders were very frequent among Spanish healthcare workers during the first wave of COVID-19. As the pandemic enters its second wave, careful monitoring and support is needed for healthcare workers, especially those with previous mental disorders and those caring COVID-19 very often.

Published
2020
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11. Traumatic stress symptoms among Spanish healthcare workers during the COVID-19 pandemic: a prospective study

Author

Portillo-Van Diest, Ana, Vilagut, Gemma, Alayo, Itxaso, Ferrer, Montse, Amigo, Franco, Amann, Benedikt L., Aragón-Peña, Andrés, Aragonès, Enric, Asúnsolo Del Barco, Ángel, Campos, Mireia, Del Cura-González, Isabel, Espuga, Meritxell, González-Pinto, Ana, Haro, Josep M., Larrauri, Amparo, López-Fresneña, Nieves, Martínez de Salázar, Alma, Molina, Juan D., Ortí-Lucas, Rafael M., Parellada, Mara, Pelayo-Terán, José M., Pérez-Zapata, Aurora, Pijoan, José I., Plana, Nieves, Puig, Teresa, Rius, Cristina, Rodríguez-Blázquez, Carmen, Sanz, Ferran, Serra, Consol, Urreta-Barallobre, Iratxe, Kessler, Ronald C., Bruffaerts, Ronny, Vieta, Eduard, Pérez-Solá, Víctor, Alonso, Jordi, and Mortier, Philippe

Abstract

AbstractAimTo investigate the occurrence of traumatic stress symptoms (TSS) among healthcare workers active during the COVID-19 pandemic and to obtain insight as to which pandemic-related stressful experiences are associated with onset and persistence of traumatic stress.MethodsThis is a multicenter prospective cohort study. Spanish healthcare workers (N= 4,809) participated at an initial assessment (i.e., just after the first wave of the Spain COVID-19 pandemic) and at a 4-month follow-up assessment using web-based surveys. Logistic regression investigated associations of 19 pandemic-related stressful experiences across four domains (infection-related, work-related, health-related and financial) with TSS prevalence, incidence and persistence, including simulations of population attributable risk proportions (PARP).ResultsThirty-day TSS prevalence at T1 was 22.1%. Four-month incidence and persistence were 11.6% and 54.2%, respectively. Auxiliary nurses had highest rates of TSS prevalence (35.1%) and incidence (16.1%). All 19 pandemic-related stressful experiences under study were associated with TSS prevalence or incidence, especially experiences from the domains of health-related (PARP range 88.4–95.6%) and work-related stressful experiences (PARP range 76.8–86.5%). Nine stressful experiences were also associated with TSS persistence, of which having patient(s) in care who died from COVID-19 had the strongest association. This association remained significant after adjusting for co-occurring depression and anxiety.ConclusionsTSSs among Spanish healthcare workers active during the COVID-19 pandemic are common and associated with various pandemic-related stressful experiences. Future research should investigate if these stressful experiences represent truly traumatic experiences and carry risk for the development of post-traumatic stress disorder.

Published
2023
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13. Valor pronóstico de la biopsia renal preimplante en donantes fallecidos de edad avanzada en la función renal al an˜ o del trasplante.

Author

Amenábar, Juan J., Camacho, Jhon A., Gómez-Larrambe, Nerea, Visus, Teresa, Pijoan, José I., González del Tánago, Jaime, Zárraga, Sofía, García-Olaverri, Jorge, and Gaínza, Francisco J.

Abstract

Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2016
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14. Anti-vascular endothelial growth factor for proliferative diabetic retinopathy.

Author

Martinez-Zapata MJ, Salvador I, Martí-Carvajal AJ, Pijoan JI, Cordero JA, Ponomarev D, Kernohan A, Solà I, and Virgili G

Subjects
Aged, Female, Humans, Male, Middle Aged, Ranibizumab therapeutic use, Vascular Endothelial Growth Factor A antagonists & inhibitors, Vitreous Hemorrhage drug therapy, Vitreous Hemorrhage etiology, Vitreous Hemorrhage surgery, Diabetes Mellitus drug therapy, Diabetic Retinopathy drug therapy, Diabetic Retinopathy complications
Abstract

Background: Proliferative diabetic retinopathy (PDR) is an advanced complication of diabetic retinopathy that can cause blindness. It consists of the presence of new vessels in the retina and vitreous haemorrhage. Although panretinal photocoagulation (PRP) is the treatment of choice for PDR, it has secondary effects that can affect vision. Anti-vascular endothelial growth factor (anti-VEGF), which produces an inhibition of vascular proliferation, could improve the vision of people with PDR., Objectives: To assess the effectiveness and safety of anti-VEGFs for PDR and summarise any relevant economic evaluations of their use., Search Methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register; 2022, Issue 6); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov, and the WHO ICTRP. We did not use any date or language restrictions. We last searched the electronic databases on 1 June 2022., Selection Criteria: We included randomised controlled trials (RCTs) comparing anti-VEGFs to another active treatment, sham treatment, or no treatment for people with PDR. We also included studies that assessed the combination of anti-VEGFs with other treatments. We excluded studies that used anti-VEGFs in people undergoing vitrectomy., Data Collection and Analysis: Two review authors independently selected studies for inclusion, extracted data, and assessed the risk of bias (RoB) for all included trials. We calculated the risk ratio (RR) or the mean difference (MD), and 95% confidence intervals (CI). We used GRADE to assess the certainty of evidence., Main Results: We included 15 new studies in this update, bringing the total to 23 RCTs with 1755 participants (2334 eyes). Forty-five per cent of participants were women and 55% were men, with a mean age of 56 years (range 48 to 77 years). The mean glycosylated haemoglobin (Hb1Ac) was 8.45% for the PRP group and 8.25% for people receiving anti-VEGFs alone or in combination. Twelve studies included people with PDR, and participants in 11 studies had high-risk PDR (HRPDR). Twelve studies were of bevacizumab, seven of ranibizumab, one of conbercept, two of pegaptanib, and one of aflibercept. The mean number of participants per RCT was 76 (ranging from 15 to 305). Most studies had an unclear or high RoB, mainly in the blinding of interventions and outcome assessors. A few studies had selective reporting and attrition bias. No study reported loss or gain of 3 or more lines of visual acuity (VA) at 12 months. Anti-VEGFs ± PRP probably increase VA compared with PRP alone (mean difference (MD) -0.08 logMAR, 95% CI -0.12 to -0.04; I 2 = 28%; 10 RCTS, 1172 eyes; moderate-certainty evidence). Anti-VEGFs ± PRP may increase regression of new vessels (MD -4.14 mm 2 , 95% CI -6.84 to -1.43; I 2 = 75%; 4 RCTS, 189 eyes; low-certainty evidence) and probably increase a complete regression of new vessels (RR 1.63, 95% CI 1.19 to 2.24; I 2 = 46%; 5 RCTS, 405 eyes; moderate-certainty evidence). Anti-VEGFs ± PRP probably reduce vitreous haemorrhage (RR 0.72, 95% CI 0.57 to 0.90; I 2 = 0%; 6 RCTS, 1008 eyes; moderate-certainty evidence). Anti-VEGFs ± PRP may reduce the need for vitrectomy compared with eyes that received PRP alone (RR 0.67, 95% CI 0.49 to 0.93; I 2 = 43%; 8 RCTs, 1248 eyes; low-certainty evidence). Anti-VEGFs ± PRP may result in little to no difference in the quality of life compared with PRP alone (MD 0.62, 95% CI -3.99 to 5.23; I 2 = 0%; 2 RCTs, 382 participants; low-certainty evidence). We do not know if anti-VEGFs ± PRP compared with PRP alone had an impact on adverse events (very low-certainty evidence). We did not find differences in visual acuity in subgroup analyses comparing the type of anti-VEGFs, the severity of the disease (PDR versus HRPDR), time to follow-up (< 12 months versus 12 or more months), and treatment with anti-VEGFs + PRP versus anti-VEGFs alone. The main reasons for downgrading the certainty of evidence included a high RoB, imprecision, and inconsistency of effect estimates., Authors' Conclusions: Anti-VEGFs ± PRP compared with PRP alone probably increase visual acuity, but the degree of improvement is not clinically meaningful. Regarding secondary outcomes, anti-VEGFs ± PRP produce a regression of new vessels, reduce vitreous haemorrhage, and may reduce the need for vitrectomy compared with eyes that received PRP alone. We do not know if anti-VEGFs ± PRP have an impact on the incidence of adverse events and they may have little or no effect on patients' quality of life. Carefully designed and conducted clinical trials are required, assessing the optimal schedule of anti-VEGFs alone compared with PRP, and with a longer follow-up., (Copyright © 2023 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Published
2023
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