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Statins for primary prevention of cardiovascular disease: modelling guidelines and patient preferences based on an Irish cohort. Br J Gen Pract 2019; 69:e373-e380. [PMID: 31015226 DOI: 10.3399/bjgp19x702701] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 12/14/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Changes in clinical guidelines for primary prevention of cardiovascular disease (CVD) have widened eligibility for statin therapy. AIM To illustrate the potential impacts of changes in clinical guidelines. DESIGN AND SETTING Modelling the impacts of seven consecutive European guidelines based on a cohort of people aged ≥50 years from the Irish Longitudinal Study on Ageing. METHOD The eligibility for statin therapy of a sample of people without a history of CVD was established, according to changing guideline recommendations and modelled associated potential costs. The authors calculated the numbers needed to treat (NNT) to prevent one major vascular event in patients at the lowest baseline risk for which each of the seven guidelines recommended treatment, and for those at low, medium, high, and very-high risk according to 2016 guidelines. These were compared with the NNT that patients reported as required to justify taking a daily medicine. RESULTS The proportion of patients eligible for statins increased from approximately 8% in 1987 to 61% in 2016; associated costs rose from €13.9 million to €107.1 million per annum. The NNT for those at the lowest risk for which each guideline recommended treatment rose from 40 to 400. By 2016, the NNT for low-risk patients was 400 compared to ≤25 very-high risk patients. The proportion of patients eligible for statins achieving NNT levels that patients regarded as justified to taking a daily medicine fell as guidelines changed over time. CONCLUSION Increased eligibility for statin therapy impacts large proportions of the present population and healthcare budgets. Decisions to take and reimburse statins should be considered on the basis of expected cost-effectiveness and acceptability to patients.
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5152
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Arab-Zozani M, Pezeshki MZ, Khodayari-Zarnaq R, Janati A. Balancing Overuse and Underuse in the Iranian Healthcare System: A Force Field Theory Analysis. Ethiop J Health Sci 2019; 29:231-238. [PMID: 31011271 PMCID: PMC6460443 DOI: 10.4314/ejhs.v29i2.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Overuse and underuse of healthcare services occure within population, organizations and even patients around the world. Producing a balance between these two can increase efficiency, service quality and patient satisfaction. It also decrease extra costs. The aim of this study was to identify forces for change and forces against change for generating balance between overuse and underuse to achieve right care. Methods This study was conducted in five steps: 1) describe our plan or proposal for change; 2) identify forces for change; 3) identify forces against change; 4) assign forces; and 5) analyze and apply. We used purposive sampling strategy. The number of participants in the expert panel were eight. Each participant signed informed consent form before starting the study (Ethical code: IR.TBZMED.REC.1396.908). Results The driving factors for balancing overuse and underuse were education, preparing clinical guideline and standard protocols, resource allocation, using evidence-based medicine, evidence-based management and evidence-informed policy making approaches and social prescribing. The restraining factors for balancing overuse and underuse were conflict of interest issues, payment systems, paternalism and medicalization, patients and physicians' side problems and culture of consumerism in the community. The total scores for and against change were 14 and 17, respectively. Conclusion It seems that the emphasis on education and training in this field is essential for physicians, patients and all people in the community. Also, making reforms in payment systems and changing the rules and regulations in this area could be major drivers.
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Affiliation(s)
- Morteza Arab-Zozani
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Zakaria Pezeshki
- Social Determinants of Health Research Center, Department of Community and Family Medicine, Tabriz Medical School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rahim Khodayari-Zarnaq
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Janati
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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5153
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Kayser L, Karnoe A, Duminski E, Somekh D, Vera-Muñoz C. A new understanding of health related empowerment in the context of an active and healthy ageing. BMC Health Serv Res 2019; 19:242. [PMID: 31014350 PMCID: PMC6480610 DOI: 10.1186/s12913-019-4082-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 04/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently, several initiatives have focused on how to create true person-centred health services. This calls for a new understanding of health-related empowerment in relation to people living with one or more chronic conditions. We report on a Delphi investigation among participants in the European Innovation Partnership on Active and Healthy Ageing that has led to a new understanding of health-related empowerment. METHODS The Delphi process was conducted in three sequential rounds. In the first round, we presented a suggested first version for a definition of "health-related empowerment" divided into nine statements. One hundred and twenty-two experts were then asked if they agreed or not with each individual statement, and in the case they disagreed, to state the reasons for their disagreement. After revisions, the experts who had replied to the first version were asked again, if they agreed or not with each individual statement of the second version and to elaborate on disagreements. Finally, in the third round the experts were asked to provide comments to the final proposed definition in general and not by each statement. RESULTS A total of 33 experts responded to the first version. The following revision included a merging of two statements, and the addition of health literacy as part of the understanding. The second version was sent out to the 33 experts and a total of 19 experts commented with moderate consensus. Changes included removal of "self-esteem" and change of "self-confidence" to confidence. Third version was sent out to all 122 experts with 16 respondents. Strong consensus was obtained for this third version, and is with one minor change presented as the final version. CONCLUSION We propose a new understanding of the concept health-related empowerment, by focusing on the individual as a co-manager with freedom to choose and focus on their own well-being.
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Affiliation(s)
- Lars Kayser
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Astrid Karnoe
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Emily Duminski
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David Somekh
- European Health Futures Forum, Dromahair, Ireland
| | - Cecilia Vera-Muñoz
- Life Supporting Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
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5154
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Broholm-Jørgensen M, Kamstrup-Larsen N, Guassora AD, Reventlow S, Dalton SO, Tjørnhøj-Thomsen T. ‘It can’t do any harm’: A qualitative exploration of accounts of participation in preventive health checks. HEALTH RISK & SOCIETY 2019. [DOI: 10.1080/13698575.2019.1602251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Nina Kamstrup-Larsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ann Dorrit Guassora
- The research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Reventlow
- The research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark
- Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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5155
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Are the cardiovascular outcomes of participants with white-coat hypertension poor compared to those of participants with normotension? A systemic review and meta-analysis. Hypertens Res 2019; 42:825-833. [DOI: 10.1038/s41440-019-0254-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/17/2019] [Accepted: 02/20/2019] [Indexed: 11/08/2022]
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5156
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Use of point-of-care tests and antibiotic prescribing in sore throat and lower respiratory infections by general practitioners. Enferm Infecc Microbiol Clin 2019; 38:21-24. [PMID: 30981454 DOI: 10.1016/j.eimc.2019.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION This study was aimed at assessing general practitioners' (GP) reliance on patient history, examination findings and the influence of the utilisation of point-of-care tests (POCT) in antibiotic prescribing for sore throat and lower respiratory tract infections (LRTI). METHODS Audit-based study carried out in 2015. A group of GPs received an intervention six years earlier with provision of POCTs and another group of GPs acted as controls. Odds ratios for clinical variables predicting antibiotic prescribing were calculated by logistic regression analyses. RESULTS A total of 238 GPs included 1906 patients with sore throat and 1970 LRTIs. A negative POCT result was negatively associated with antibiotic prescribing, with odds ratios ranging from 0.09 to 0.23. GPs using POCTs attached less weight to clinical criteria. CONCLUSION GPs using rapid tests are mainly influenced by POCT results in the decision to prescribe antibiotics. However, antibiotic prescribing is still observed with negative POCT results.
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5157
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Mayor S. GPs should lead process of defining diseases to cut overdiagnosis, panel recommends. BMJ 2019; 365:l1660. [PMID: 30967388 DOI: 10.1136/bmj.l1660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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5158
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Barr PJ, Forcino RC, Dannenberg MD, Mishra M, Turner E, Zisman-Ilani Y, Matthews J, Hinn M, Bruce M, Elwyn G. Healthcare Options for People Experiencing Depression (HOPE*D): the development and pilot testing of an encounter-based decision aid for use in primary care. BMJ Open 2019; 9:e025375. [PMID: 30962232 PMCID: PMC6500310 DOI: 10.1136/bmjopen-2018-025375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To develop and pilot an encounter-based decision aid (eDA) for people with depression for use in primary care. DESIGN We developed an eDA for depression through cognitive interviews and pilot tested it using a one-group pretest, post-test design in primary care. Feasibility, fidelity of eDA use and acceptability were assessed using recruitment rates and semistructured interviews with patients, medical assistants and clinicians. Treatment choice and shared decision-making (SDM) were also assessed. SETTING Interviews with adult patients and the public were conducted in a mall and library in Grafton County, New Hampshire, while clinician interviews took place by phone or at the clinician's office. Pilot testing occurred in a New Hampshire primary care practice. PARTICIPANTS Cognitive interviews were conducted with adults, ≥18 years, who could read English from the following stakeholder groups: history of depression, the public and clinicians. Patients with a Patient Health Questionnaire-9 score of ≥5 were recruited for piloting. RESULTS Three stages of cognitive interviews were conducted (n=28). Changes to eDA included moving the combination therapy information and access to treatment information, adding colour, modifying pictograms and editing the talk-therapy description. Clinician concerns about patient health literacy were not reflected in patient interviews. Of 59 patients who reviewed study information, 56 were eligible and agreed to participate in pilot testing; however, only 29 could be reached for follow-up. The eDA was widely accepted, though clinicians did not always use it as intended. We found no impact of eDA use on SDM, though patients chose a wider range of treatment options. CONCLUSIONS We demonstrated the feasibility of the use of an eDA for depression in primary care that was widely accepted. Further research is needed to improve the fidelity with which the eDA is used and to assess its impact on SDM and related health outcomes.
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Affiliation(s)
- Paul J Barr
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Rachel C Forcino
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Michelle D Dannenberg
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Manish Mishra
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Erick Turner
- Behavioral Health and Neurosciences Division, Portland Veterans Affairs Medical Center, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Yaara Zisman-Ilani
- The Department of Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | | | | | - Martha Bruce
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Departments of Psychiatry and Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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5159
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Hutchison AR, Cartmill B, Wall LR, Ward EC, Hargrave C, Brown E. Practices, knowledge and inter-professional relationships between speech pathologists and radiation therapists managing patients with head and neck cancer. J Med Radiat Sci 2019; 66:103-111. [PMID: 30950231 PMCID: PMC6545474 DOI: 10.1002/jmrs.332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/19/2019] [Accepted: 03/16/2019] [Indexed: 12/25/2022] Open
Abstract
Introduction This study examined knowledge and practices of speech pathologists (SPs) and radiation therapists (RTs) regarding plan optimisation for head and neck cancer (HNC) patients, and the potential impacts on swallowing function. The secondary aim was to explore the level of interaction occurring between these professional groups within cancer centres. Methods Two electronic surveys, with matched questions for SPs and RTs, explored: service/institutional demographics; clinician awareness, practices regarding plan optimisation to swallowing structures and; relationships and interactions between SPs and RTs in the management of HNC patients. Participant recruitment occurred through specialist professional networks with additional snowball sampling. Data were analysed with descriptive statistics and thematic analysis. Results A total of 32 SPs and 41 RTs completed surveys. All SPs and 50% of RTs were aware of dose‐dysphagia relationships, though SPs rarely used dosimetric information to inform patient management. Only 33% of RTs indicated that their centres actively constrain dose to swallowing structures, reporting that staffing skill mixtures and lack of prescription by the treating RO were restrictive factors. Both SPs and RTs acknowledged the importance of collaborating with colleagues (SPs/RTs) and felt they could assist their colleagues in devising patient management plans, though current collaboration/interaction was minimal. Conclusions Levels of awareness were found to be higher in SP group. Despite high levels of awareness, limited use of swallowing structure dose constraints and hence dosimetric information specific to swallowing was rarely used to optimise/guide multidisciplinary HNC acute care. Opportunities for enhanced collaboration between SPs and RTs should be considered.
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Affiliation(s)
- Alana R Hutchison
- Division of Speech Pathology, School of Health and Rehabilitation Sciences, the University of Queensland, St Lucia, Queensland, Australia.,Centre for Functioning and Health Research, Queensland Health, Level 3, Centro Buranda, Buranda, Queensland, Australia
| | - Bena Cartmill
- Centre for Functioning and Health Research, Queensland Health, Level 3, Centro Buranda, Buranda, Queensland, Australia.,Speech Pathology Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Laurelie R Wall
- Division of Speech Pathology, School of Health and Rehabilitation Sciences, the University of Queensland, St Lucia, Queensland, Australia.,Centre for Functioning and Health Research, Queensland Health, Level 3, Centro Buranda, Buranda, Queensland, Australia
| | - Elizabeth C Ward
- Division of Speech Pathology, School of Health and Rehabilitation Sciences, the University of Queensland, St Lucia, Queensland, Australia.,Centre for Functioning and Health Research, Queensland Health, Level 3, Centro Buranda, Buranda, Queensland, Australia
| | - Catriona Hargrave
- Radiation Oncology Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Elizabeth Brown
- Radiation Oncology Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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5160
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Bhide A, Acharya G. Who should write and endorse clinical practice guidelines if our patients are to benefit from them? Acta Obstet Gynecol Scand 2019; 97:1413-1414. [PMID: 30411325 DOI: 10.1111/aogs.13490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Amar Bhide
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway.,St. Georges University Hospital, London, UK
| | - Ganesh Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
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5161
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Osses DF, Roobol MJ, Schoots IG. Prediction Medicine: Biomarkers, Risk Calculators and Magnetic Resonance Imaging as Risk Stratification Tools in Prostate Cancer Diagnosis. Int J Mol Sci 2019; 20:E1637. [PMID: 30986955 PMCID: PMC6480079 DOI: 10.3390/ijms20071637] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 12/11/2022] Open
Abstract
This review discusses the most recent evidence for currently available risk stratification tools in the detection of clinically significant prostate cancer (csPCa), and evaluates diagnostic strategies that combine these tools. Novel blood biomarkers, such as the Prostate Health Index (PHI) and 4Kscore, show similar ability to predict csPCa. Prostate cancer antigen 3 (PCA3) is a urinary biomarker that has inferior prediction of csPCa compared to PHI, but may be combined with other markers like TMPRSS2-ERG to improve its performance. Original risk calculators (RCs) have the advantage of incorporating easy to retrieve clinical variables and being freely accessible as a web tool/mobile application. RCs perform similarly well as most novel biomarkers. New promising risk models including novel (genetic) markers are the SelectMDx and Stockholm-3 model (S3M). Prostate magnetic resonance imaging (MRI) has evolved as an appealing tool in the diagnostic arsenal with even stratifying abilities, including in the initial biopsy setting. Merging biomarkers, RCs and MRI results in higher performances than their use as standalone tests. In the current era of prostate MRI, the way forward seems to be multivariable risk assessment based on blood and clinical parameters, potentially extended with information from urine samples, as a triaging test for the selection of candidates for MRI and biopsy.
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Affiliation(s)
- Daniël F Osses
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.
- Department of Urology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.
| | - Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.
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5162
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Ratnayake CBB, Loveday BP, Windsor JA, Lawrence B, Pandanaboyana S. Patient characteristics and clinical outcomes following initial surgical intervention for MEN1 associated pancreatic neuroendocrine tumours: A systematic review and exploratory meta-analysis of the literature. Pancreatology 2019; 19:462-471. [PMID: 30894303 DOI: 10.1016/j.pan.2019.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND This systematic review aimed to define the outcomes of different pancreatic resection procedures for multiple endocrine neoplasia type 1 (MEN1) associated pancreatic neuroendocrine neoplasms (pNENs). METHODS A search of PubMed, MEDLINE and SCOPUS databases were performed in accordance with PRISMA guidelines. RESULTS Twenty-seven studies including 533 patients undergoing initial pancreatic resection for MEN1 associated pNENs were included in this systematic review. Three hundred and sixty-six (68.7%) distal pancreatectomies (DP), 120 (22.5%) sole enucleations (SE) and 47 (8.8%) pancreaticoduodenectomies (PD) were identified. SE was associated with a higher rate of recurrence than DP (25/67, 37% vs 40/190, 21% respectively, P = 0.008) but a lower rate of endocrine insufficiency than PD (1/20, 5% vs 8/21, 38% respectively, P = 0.010). A meta-analysis of major pancreatic resections (PD or DP) vs SE in 15 studies showed that SE is associated with an increased rate of recurrence (Major resection 42/184, 23% vs SE 20/53, 38% RR 0.65 CI 0.43-0.96 P = 0.032) but reduced rate of postoperative endocrine insufficiency (Resection 37/93, 40% vs SE 0/24, 0% RR 7.37 CI 1.57-34.64 P = 0.008). Similarly, insulinomas and functional pNENs overall had lower rates of recurrence and reoperation with major resection. There was no difference in the reoperation rates or survival outcomes after SE compared with major pancreatic resections at follow-up (pooled overall mean duration: 85 months). CONCLUSION Major pancreatic resections for MEN1 associated pNENs have a lower risk of recurrence and a higher risk of postoperative endocrine insufficiency when compared to sole enucleation, but a similar rate of reoperation and survival.
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Affiliation(s)
| | - Benjamin Pt Loveday
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; HPB Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
| | - John Albert Windsor
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; HPB Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Benjamin Lawrence
- Regional Cancer and Blood Service, Auckland City Hospital, Auckland, New Zealand; Discipline of Oncology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sanjay Pandanaboyana
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; HPB Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand.
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Sonbol MB, Firwana BM, Hilal T, Murad MH. How to read a published clinical trial: A practical guide for clinicians. Avicenna J Med 2019; 10:68-75. [PMID: 32500045 PMCID: PMC7252615 DOI: 10.4103/ajm.ajm_186_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Over the last 5 years, there have been more than 140 new drug approvals in the field of Oncology alone, all based on newly published clinical trials. These approvals have led to an ongoing change in clinical practice, offering new therapeutic options for patients. Therefore, it is important for healthcare providers to be able to appraise a clinical trial and determine its validity, understand its results, and be able to apply such results to their patients. In this guide, we provide a simplified approach tailored to practicing clinicians and trainees. The same concepts and principles apply to other medical specialties.
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Affiliation(s)
| | - Belal M Firwana
- Heartland Cancer Research, National Cancer Institute Community Oncology Research Program (NCORP), Missouri Baptist Medical Center, St. Louis, Missouri, USA
| | - Talal Hilal
- University of Mississippi Medical Center, Jackson, Mississippi, USA
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5164
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Molino CDGRC, Leite-Santos NC, Gabriel FC, Wainberg SK, Vasconcelos LPD, Mantovani-Silva RA, Ribeiro E, Romano-Lieber NS, Stein AT, Melo DOD. Factors Associated With High-Quality Guidelines for the Pharmacologic Management of Chronic Diseases in Primary Care: A Systematic Review. JAMA Intern Med 2019; 179:553-560. [PMID: 30776060 DOI: 10.1001/jamainternmed.2018.7529] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE As the rate of publication of new and sometimes conflicting medical research increases, clinicians rely heavily on clinical practice guidelines (CPGs) to inform practice. However, CPGs are of widely variable quality, and there are no existing objective measures to rate the quality of CPGs. OBJECTIVE To systematically assess 421 CPGs for the management of common noncommunicable diseases in primary care using the validated Appraisal of Guidelines for Research and Evaluation Instrument, version II (AGREE-II) tool and elucidate the factors associated with quality of CPGs. EVIDENCE REVIEW MEDLINE, Embase, the Cochrane Library, and 12 websites for CPGs were searched for CPGs for the management of common noncommunicable diseases in primary care published between January 1, 2011, and August 30, 2017. The assessment of the quality of CPGs was performed by 3 appraisers using the 6 domains of the AGREE-II instrument. A multiple logistic regression was performed to identify factors associated with quality of CPGs. FINDINGS Of the 421 CPGs reviewed, 23.5% (99) were classified as high quality. Among included guidelines, clarity of presentation (70%) and scope and purpose (61%) had the highest median AGREE-II scores. The domains with the lowest median scores were applicability (22%) and rigor of development (33%). Factors associated with high-quality CPGs included having more than 20 authors (odds ratio, 9.08; 95% CI, 3.35-24.62), development at governmental institutions (odds ratio, 10.38; 95% CI, 2.72-39.60), and reporting funding (odds ratio, 10.34; 95% CI, 4.77-22.39). Year of publication, region, guideline version, and scope were not associated with quality among included CPGs. CONCLUSIONS AND RELEVANCE Primary care professionals and policymakers should be aware that CPGs in primary care are of widely variable quality, with less than 25% of included CPGs rated as high quality. High-quality CPGs were associated with a higher number of authors, governmental institutions, and the report of funding. Region of origin was not associated with quality of CPGs, which suggests that the improvement of the quality of CPGs should be an international concern.
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Affiliation(s)
| | | | - Franciele Cordeiro Gabriel
- Departamento de Farmácia, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Sheila Kalb Wainberg
- Departamento de Farmácia, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | | | - Rafael Augusto Mantovani-Silva
- Departamento de Ciências Farmacêuticas, Instituto de Ciências Ambientais, Químicas e Farmacêuticas, Universidade Federal de São Paulo, Diadema, São Paulo, Brazil
| | - Eliane Ribeiro
- Departamento de Farmácia, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | | | - Airton Tetelbom Stein
- Departamento de Saúde Pública, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Daniela Oliveira de Melo
- Departamento de Ciências Farmacêuticas, Instituto de Ciências Ambientais, Químicas e Farmacêuticas, Universidade Federal de São Paulo, Diadema, São Paulo, Brazil
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Riva C, Tinari S, Spinosa JP. Lessons learnt on transparency, scientific process and publication ethics. The short story of a long journey to get into the public domain unpublished data, methodological flaws and bias of the Cochrane HPV vaccines review. BMJ Evid Based Med 2019; 24:80-81. [PMID: 30523134 DOI: 10.1136/bmjebm-2018-111119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2018] [Indexed: 11/04/2022]
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5166
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5167
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Glick M, Carrasco-Labra A. Misinterpretations, mistakes, or just misbehaving. J Am Dent Assoc 2019; 150:237-239. [DOI: 10.1016/j.adaj.2019.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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5168
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Matteucci M, Fina D, Jiritano F, Blankesteijn WM, Raffa GM, Kowalewski M, Beghi C, Lorusso R. Sutured and sutureless repair of postinfarction left ventricular free-wall rupture: a systematic review. Eur J Cardiothorac Surg 2019; 56:840-848. [DOI: 10.1093/ejcts/ezz101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 12/29/2022] Open
Abstract
SummaryPostinfarction left ventricular free-wall rupture is a potentially catastrophic event. Emergency surgical intervention is almost invariably required, but the most appropriate surgical procedure remains controversial. A systematic review, from 1993 onwards, of all available reports in the literature about patients undergoing sutured or sutureless repair of postinfarction left ventricular free-wall rupture was performed. Twenty-five studies were selected, with a total of 209 patients analysed. Sutured repair was used in 55.5% of cases, and sutureless repair in the remaining cases. Postoperative in-hospital mortality was 13.8% in the sutured group, while it was 14% in the sutureless group. A trend towards a higher rate of in-hospital rerupture was observed in the sutureless technique. The most common cause of in-hospital mortality (44%) was low cardiac output syndrome. In conclusion, sutured and sutureless repair for postinfarction left ventricular free-wall rupture showed comparable in-hospital mortality. However, because of the limited number of patients and the variability of surgical strategies in each reported series, further studies are required to provide more consistent data and lines of evidence.
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Affiliation(s)
- Matteo Matteucci
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Dario Fina
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Department of Cardiology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Federica Jiritano
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Department of Cardiac Surgery, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - W Matthijs Blankesteijn
- Department of Pharmacology and Toxicology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Giuseppe Maria Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, ISMETT-IRCCS (Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Mariusz Kowalewski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland
| | - Cesare Beghi
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
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Chatrath V, Banerjee PS, Goodman GJ, Rahman E. Soft-tissue Filler-associated Blindness: A Systematic Review of Case Reports and Case Series. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2173. [PMID: 31321177 PMCID: PMC6554164 DOI: 10.1097/gox.0000000000002173] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND With the increase in the use of soft-tissue fillers worldwide, there has been a rise in the serious adverse events such as vascular compromise and blindness. This article aims to review the role of fillers in causing blindness and the association between hyaluronic acid (HA) filler and blindness. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used to report this review. RESULTS A total of 190 cases of blindness due to soft-tissue fillers were identified, of which 90 (47%) cases were attributed to autologous fat alone, and 53 (28%) cases were caused by HA. The rest of the cases were attributed to collagen, calcium hydroxylapatite, and other fillers. CONCLUSIONS Autologous fat was the most common filler associated with blindness despite HA fillers being the most commonly used across the globe. However, the blindness caused by other soft-tissue fillers like collagen and calcium hydroxylapatite was represented. It was also evident through the review that the treatment of HA-related blindness was likely to have better outcomes compared with other fillers due to hyaluronidase use.
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Affiliation(s)
- Vandana Chatrath
- From the Postgraduate Medical Institute, Faculty of Medical Sciences, Anglia Ruskin University, Chelmsford, Essex, CM1 1SQ United Kingdom
- Delhi Dermatology Group, New Delhi, India
| | | | | | - Eqram Rahman
- Institute of Medical and Biomedical Education, St. George’s University of London, Cranmer Terrace, Tooting Broadway, SW17 0RE London, United Kingdom
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5170
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Affiliation(s)
- Nicholas J DeVito
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ben Goldacre
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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5171
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Shokraneh F. Reproducibility and replicability of systematic reviews. World J Meta-Anal 2019; 7:66-71. [DOI: 10.13105/wjma.v7.i3.66] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 03/23/2019] [Accepted: 03/26/2019] [Indexed: 02/06/2023] Open
Abstract
Irreproducibility of research causes a major concern in academia. This concern affects all study designs regardless of scientific fields. Without testing the reproducibility and replicability it is almost impossible to repeat the research and to gain the same or similar results. In addition, irreproducibility limits the translation of research findings into practice where the same results are expected. To find the solutions, the Interacademy Partnership for Health gathered academics from established networks of science, medicine and engineering around a table to introduce seven strategies that can enhance the reproducibility: pre-registration, open methods, open data, collaboration, automation, reporting guidelines, and post-publication reviews. The current editorial discusses the generalisability and practicality of these strategies to systematic reviews and claims that systematic reviews have even a greater potential than other research designs to lead the movement toward the reproducibility of research. Moreover, I discuss the potential of reproducibility, on the other hand, to upgrade the systematic review from review to research. Furthermore, there are references to the successful and ongoing practices from collaborative efforts around the world to encourage the systematic reviewers, the journal editors and publishers, the organizations linked to evidence synthesis, and the funders and policy makers to facilitate this movement and to gain the public trust in research.
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Affiliation(s)
- Farhad Shokraneh
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham NG7 2TU, United Kingdom
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5172
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Tavoukjian V. Faecal microbiota transplantation for the decolonization of antibiotic-resistant bacteria in the gut: a systematic review and meta-analysis. J Hosp Infect 2019; 102:174-188. [PMID: 30926290 DOI: 10.1016/j.jhin.2019.03.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/20/2019] [Indexed: 02/08/2023]
Abstract
Antibiotic resistance is a growing global problem associated with increased morbidity and mortality, and presents a significant financial and economic burden on healthcare. Faecal microbiota transplantation (FMT) has been proven effective for curing recurrent Clostridium difficile infections, however no systematic review to date has addressed its effectiveness for decolonization of antibiotic-resistant bacteria from the gut. The aim of this study was to establish whether faecal microbiota transplantation decolonizes antibiotic-resistant bacteria from the gut of colonized adults. A systematic review was performed by undertaking a comprehensive search on MEDLINE, Embase, CENTRAL, PubMed and CINAHL databases for evidence up until May 2018. Randomized and non-randomized studies evaluating the effects of FMT on gut colonization of antibiotic-resistant bacteria in adults were eligible. Studies were assessed using the Joanna Briggs Institution critical appraisal checklists. Quality of reporting was assessed using PROCESS and CARE checklists. Data was synthesized narratively, along with a meta-analysis of proportions for the primary outcome. Five studies with a total number of 52 participants were included. Evidence of low quality showed that decolonization was achieved in half of the cases one month after FMT with higher response noted in Pseudomonas aeruginosa, and lower response in Klebsiella pneumoniae with New Delhi metallo-beta-lactamase 1 (NDM-1) and extended-spectrum β-lactamase (ESBL) mechanisms of resistance. In successful cases, 70% of decolonization cases occurred within the first week after FMT. Few temporary adverse events were identified. Despite the limitations of the included studies, evidence from this review indicates a potential benefit of FMT as a decolonization intervention, which can only be confirmed by future well-designed RCTs.
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Affiliation(s)
- V Tavoukjian
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
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5173
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Lee E, Hong SJ. Pharmacotherapeutic strategies for treating bronchiectasis in pediatric patients. Expert Opin Pharmacother 2019; 20:1025-1036. [PMID: 30897021 DOI: 10.1080/14656566.2019.1589453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The social and medical costs of bronchiectasis in children are becoming considerable due to its increasing prevalence. Early identification and intensive treatment of bronchiectasis are needed to decrease the morbidity and mortality associated with bronchiectasis in children. AREAS COVERED This review presents the current pharmacotherapeutic strategies for treating bronchiectasis in children with a focus on non-cystic fibrosis bronchiectasis. EXPERT OPINION Evidence for the effectiveness of diverse treatment strategies in bronchiectasis is lacking, particularly in children, although the disease burden is substantial for bronchiectasis. Most treatment strategies for non-cystic fibrosis bronchiectasis in children have been extrapolated from those in adults with bronchiectasis or children with cystic fibrosis. Antibiotics combined with an active airway clearance therapy via the inhalation of mucoactive agents can stabilize bronchiectasis. The timely and intensive administration of antibiotics during acute exacerbation of bronchiectasis is essential to prevent its progression in children. To suppress the bacterial loads in the airway, systemic or inhaled antibiotics can be administered intermittently or continuously. However, studies on these protocols, including the appropriate duration and effective dosages are lacking. Long-term administration of azithromycin for 12-24 months may reduce the exacerbation frequency with the increased carriage rate of azithromycin-resistant bacteria.
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Affiliation(s)
- Eun Lee
- a Department of Pediatrics , Chonnam National University Hospital, Chonnam National University Medical School , Gwangju , Korea
| | - Soo-Jong Hong
- b Department of Pediatrics , Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine , Seoul , Korea
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5174
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Chun K, Chung W, Kim AJ, Kim H, Ro H, Chang JH, Lee HH, Jung JY. Association between acute kidney injury and serum procalcitonin levels and their diagnostic usefulness in critically ill patients. Sci Rep 2019; 9:4777. [PMID: 30886220 PMCID: PMC6423019 DOI: 10.1038/s41598-019-41291-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/04/2019] [Indexed: 12/14/2022] Open
Abstract
Procalcitonin (PCT) is a useful marker for the diagnosis of systemic inflammatory response syndrome. In addition, PCT is affected by renal function. However, few studies have investigated the relationship between PCT and the development of acute kidney injury (AKI). Hence, we investigated whether serum PCT levels at the time of admission were associated with the development of AKI and clinical outcomes. A total of 790 patients in whom PCT was measured on admission to the intensive care unit (ICU) were analyzed retrospectively. We attempted to investigate whether serum PCT levels measured at the time of admission could be used as a risk factor for the development of AKI in septic and nonseptic patients or as a risk factor for all-cause mortality, and diagnostic usefulness of PCT was further assessed. Serum PCT levels were significantly higher in patients with AKI than in those without AKI (P < 0.001). After multivariable adjustment for clinical factors, laboratory findings, and comorbidities, PCT as a continuous variable showed a significant association with AKI (OR 1.006, 95% CI [1.000–1.011]; P = 0.035). However, PCT was not effective in predicting mortality. The cut-off value of PCT for the prediction of AKI incidence was calculated to be 0.315 ng/ml, with sensitivity and specificity of 60.9% and 56.9%, respectively. The odds ratios (ORs) from an equation adjusted for optimum thresholds of PCT levels for developing AKI with and without sepsis were 2.422 (1.222–4.802, P = 0.011) and 1.798 (1.101–2.937, P = 0.019), respectively. However, there were no absolute differences between the pre- and posttest probabilities after including the PCT value for AKI development. This study suggests that the PCT value was higher in AKI patients than in non-AKI patients, but PCT measurement at the time of admission did not improve the prediction model for AKI.
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Affiliation(s)
- Kayeong Chun
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Wookyung Chung
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Gachon University College of Medicine, Incheon, Korea
| | - Ae Jin Kim
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Gachon University College of Medicine, Incheon, Korea
| | - Hyunsook Kim
- Gachon Medical Research Institute, Incheon, Korea
| | - Han Ro
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Gachon University College of Medicine, Incheon, Korea
| | - Jae Hyun Chang
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Gachon University College of Medicine, Incheon, Korea
| | - Hyun Hee Lee
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Gachon University College of Medicine, Incheon, Korea
| | - Ji Yong Jung
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea. .,Gachon University College of Medicine, Incheon, Korea. .,Gachon Medical Research Institute, Incheon, Korea.
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5175
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Determining the Sample Size for Future Trials of Hearing Instruments for Unilaterally Deaf Adults: An Application of Network Meta-analysis. Otol Neurotol 2019; 40:e342-e348. [PMID: 30870348 DOI: 10.1097/mao.0000000000002186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Previous trials have compared the efficacy of hearing instruments to no intervention in adults with single-sided deafness (SSD) or the relative efficacy of different instruments. Network meta-analysis (NMA) was used to refine estimates of effect sizes to determine required sample sizes for further trials. DATA SOURCES PubMed, EMBASE, MEDLINE, Cochrane, CINAHL, and DARE databases were searched with no restrictions on language, with studies to February 2015 included. STUDY SELECTION Studies were included that 1) assessed hearing instruments in adults with SSD; 2) compared instruments with other instruments, placebo, or no intervention; 3) measured speech perception in quiet/noise and listening ability; 4) were prospective controlled or observational studies. DATA EXTRACTION The following data were extracted: sample size in each group, type of intervention and comparator, type of outcomes, mean outcome scores and their 95% confidence intervals. DATA SYNTHESIS Random-effects meta-analysis was conducted to determine pooled effects for each outcome based on direct evidence alone. NMA used graph-theoretical method to determine pooled effects based on indirect evidence. Sample size calculations were conducted for each outcome for each class of evidence. CONCLUSIONS The incorporation of indirect evidence had substantial impacts on some effect sizes but negligible impacts on other effects. The most notable impacts were on self-reported listening ability and measures of speech perception in noise. Changes in effect size estimates and required sample sizes resulting from the incorporation of indirect evidence highlight areas of uncertainty where trials may be feasible to conduct.
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5176
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Upfront Surgery versus Neoadjuvant Therapy for Resectable Pancreatic Cancer: Systematic Review and Bayesian Network Meta-analysis. Sci Rep 2019; 9:4354. [PMID: 30867522 PMCID: PMC6416273 DOI: 10.1038/s41598-019-40951-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/26/2019] [Indexed: 12/15/2022] Open
Abstract
Current treatment recommendations for resectable pancreatic cancer support upfront resection and adjuvant therapy. Randomized controlled trials offering comparison with the emerging neoadjuvant approach are lacking. This review aims to compare both treatment strategies for resectable pancreatic cancer. PubMed, MEDLINE, Embase, Cochrane Database and Cochrane Databases were searched for studies comparing neoadjuvant and surgery-first with adjuvant therapy for resectable pancreatic cancer. A Bayesian network meta-analysis was conducted using the Markov chain Monte Carlo method. Cochrane Collaboration’s risk of bias, ROBINS-I and GRADE tools were used to assess quality and risk of bias of included trials. 9 studies compared neoadjuvant therapy and surgery-first with adjuvant therapy (n = 22,285). Aggregate rate (AR) of R0 resection for neoadjuvant therapy was 0.8008 (0.3636–0.9144) versus 0.7515 (0.2026–0.8611) odds ratio (O.R.) 1.27 (95% CI 0.60–1.96). 1-year survival AR for neoadjuvant therapy was 0.7969 (0.6061–0.9500) versus 0.7481 (0.4848–0.8500) O.R. 1.38 (95% CI 0.69–2.96). 2-year survival AR for neoadjuvant therapy was 0.5178 (0.3000–0.5970) versus 0.5131 (0.2727–0.5346) O.R. 1.26 (95% CI 0.94–1.74). 5-year AR survival for neoadjuvant therapy was 0.2069 (0.0323–0.3300) versus 0.1783 (0.0606–0.2300) O.R. 1.19 (95% CI 0.65–1.73). In conclusion neoadjuvant therapy may offer benefit over surgery-first and adjuvant therapy. However, further randomized controlled trials are needed.
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5177
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Nowland R, Steeg S, Quinlivan LM, Cooper J, Huxtable R, Hawton K, Gunnell D, Allen N, Mackway-Jones K, Kapur N. Management of patients with an advance decision and suicidal behaviour: a systematic review. BMJ Open 2019; 9:e023978. [PMID: 30872542 PMCID: PMC6429970 DOI: 10.1136/bmjopen-2018-023978] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The use of advance care planning and advance decisions for psychiatric care is growing. However, there is limited guidance on clinical management when a patient presents with suicidal behaviour and an advance decision and no systematic reviews of the extant literature. OBJECTIVES To synthesise existing literature on the management of advance decisions and suicidal behaviour. DESIGN A systematic search of seven bibliographic databases was conducted to identify studies relating to advance decisions and suicidal behaviour. Studies on terminal illness or end-of-life care were excluded to focus on the use of advance decisions in the context of suicidal behaviour. A textual synthesis of data was conducted, and themes were identified by using an adapted thematic framework analysis approach. RESULTS Overall 634 articles were identified, of which 35 were retained for full text screening. Fifteen relevant articles were identified following screening. Those articles pertained to actual clinical cases or fictional scenarios. Clinical practice and rationale for management decisions varied. Five themes were identified: (1) tension between patient autonomy and protecting a vulnerable person, (2) appropriateness of advance decisions for suicidal behaviour, (3) uncertainty about the application of legislation, (4) the length of time needed to consider all the evidence versus rapid decision-making for treatment and (5) importance of seeking support and sharing decision-making. CONCLUSIONS Advance decisions present particular challenges for clinicians when associated with suicidal behaviour. Recommendations for practice and supervision for clinicians may help to reduce the variation in clinical practice.
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Affiliation(s)
- Rebecca Nowland
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
| | - Sarah Steeg
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
| | - Leah M Quinlivan
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- NHIR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Jayne Cooper
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
| | - Richard Huxtable
- Centre for Ethics in Medicine, University of Bristol, Bristol, UK
| | - Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - David Gunnell
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Neil Allen
- School of Law, University of Manchester, Manchester, UK
| | | | - Navneet Kapur
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- NHIR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Chorlton House, Manchester, UK
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5178
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The Grown in Wales Study: Examining dietary patterns, custom birthweight centiles and the risk of delivering a small-for-gestational age (SGA) infant. PLoS One 2019; 14:e0213412. [PMID: 30861017 PMCID: PMC6413917 DOI: 10.1371/journal.pone.0213412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/20/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives Maternal lifestyles, including diet, have been linked to infant birthweight. However, customised birthweight centiles (CBWC), which more accurately identify small babies that have increased fetal growth restriction and are at higher risk of newborn morbidity and later life health complications, are rarely considered when studying maternal diet. This study investigated maternal dietary patterns and their impact on infant CBWC within a cohort of women living in South Wales. Methods This study utilised cross-sectional data from the longitudinal Grown in Wales (GiW) cohort. Women 18–45 years old were recruited the morning prior to an elective caesarean section (ELCS). Women completed a food frequency questionnaire (FFQ). Additional data on pregnancy and birth outcomes was extracted from medical notes. Data from 303 participants was analysed. Results ‘Western’ and ‘Health conscious dietary patterns were identified. The ‘Health Conscious’ dietary pattern was significantly associated with maternal BMI, age, education, income and exercise. Adjusted regression analyses indicated that greater adherence to a ‘Health Conscious’ dietary pattern was significantly associated with increased CBWC (AOR = 4.75 [95% CI: 1.17, 8.33] p = .010) and reduced risk of delivering a small-for-gestational age (SGA) infant (AOR = .51 [95% CI: .26, .99] p = .046). Conclusion A healthier diet was significantly associated with higher birthweight using CBWC and a reduced risk of delivering an SGA infant suggesting that birthweight will be improved in areas of Wales by focused support encouraging healthier dietary habits.
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5179
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Su YJ, Yang HW. Risk factors of mortality in patients with purple urine bag syndrome. J Drug Assess 2019. [PMID: 30834162 DOI: 10.1080/21556660.2019.1579727.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022] Open
Abstract
Aim: Purple urine bag syndrome (PUBS) is rarely seen in clinical practice. Several studies have reported that PUBS is relatively benign in its clinical course, but this study aimed to identify risk factors for mortality related to PUBS. Materials and methods: In a PubMed search from October 1980 to August 2016, using the search term "Purple urine bag syndrome (PUBS)", 106 articles (n = 174 cases) were identified. This study excluded 58 cases. Among them, 14 cases did not include information on patient sex and four cases did not include information on patient age. Thirty-seven cases did not report the white blood cell (WBC) count, shock, fever, or etiology. Three cases did not report patient survival. This study considered 116 PUBS cases. Chi-square tests were used to compare the survival and mortality groups. Results: In relative risk analysis, uremia (17.8), shock (14.4), diabetes (4.8), leukocytosis (1.1), and female sex (1.1) were significant risk factors for mortality after PUBS. However, it is possible that PUBS cases are under-reported worldwide. Conclusions: PUBS is a warning sign of a urinary tract infection, and it often follows a relatively benign clinical course. This study found that female sex, leukocytosis, shock at presentation, comorbidity with diabetes, and uremia are risk factors for mortality associated with PUBS.
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Affiliation(s)
- Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Oral Hygiene College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Yuanpei University of Medical Technology, Hsinchu City, Taiwan
| | - Hsiu-Wu Yang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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5180
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Olsen A, Berg R, Tagel M, Must K, Deksne G, Enemark HL, Alban L, Johansen MV, Nielsen HV, Sandberg M, Lundén A, Stensvold CR, Pires SM, Jokelainen P. Seroprevalence of Toxoplasma gondii in domestic pigs, sheep, cattle, wild boars, and moose in the Nordic-Baltic region: A systematic review and meta-analysis. Parasite Epidemiol Control 2019; 5:e00100. [PMID: 30906889 PMCID: PMC6411595 DOI: 10.1016/j.parepi.2019.e00100] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 12/13/2022] Open
Abstract
Background Toxoplasma gondii is an important foodborne zoonotic parasite. Meat of infected animals is presumed to constitute a major source of human infection and may be a driver of geographical variation in the prevalence of anti-T. gondii antibodies in humans, which is substantial in the Nordic-Baltic region in northern Europe. However, data on seroprevalence of T. gondii in different animal species used for human consumption are scattered. Methods We conducted a systematic review of seroprevalence studies and meta-analysis to estimate the seroprevalence of T. gondii in five animal species that are raised or hunted for human consumption in the Nordic-Baltic region: domestic pigs (Sus scrofa domesticus), sheep (Ovis aries), cattle (Bos taurus), wild boars (Sus scrofa), and moose (Alces alces). We searched for studies that were conducted between January 1990 and June 2018, and reported in articles, theses, conference abstracts and proceedings, and manuscripts. Subgroup analyses were performed to identify variables influencing the seroprevalence. Findings From a total of 271 studies identified in the systematic review, 32 were included in the meta-analysis. These comprised of 13 studies on domestic pigs, six on sheep, three on cattle, six on wild boars, and four on moose. The estimated pooled seroprevalence of T. gondii was 6% in domestic pigs (CI95%: 3–10%), 23% in sheep (CI95%: 12–36%), 7% in cattle (CI95%: 1–21%), 33% in wild boars (CI95%: 26–41%), and 16% in moose (CI95%: 10–23%). High heterogeneity was observed in the seroprevalence data within each species. In all host species except wild boars, the pooled seroprevalence estimates were significantly higher in animals >1 year of age than in younger animals. Not all studies provided information on animal age, sensitivity and specificity of the serological method employed, and the cut-off values used for defining an animal seropositive. Conclusions A substantial proportion of animals raised or hunted for human consumption in the region had tested positive for T. gondii. This indicates widespread exposure to T. gondii among animals raised or hunted for human consumption in the region. Large variations were observed in the seroprevalence estimates between the studies in the region; however, studies were too few to identify spatial patterns at country-level.
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Affiliation(s)
- Abbey Olsen
- Section for Parasitology and Aquatic Pathobiology, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 100, DK-1870 Frederiksberg C, Denmark.,Department of Food Safety, Veterinary Issues & Risk Analysis, Danish Agriculture & Food Council, Axelborg, Axeltorv 3, DK-1609 Copenhagen, Denmark
| | - Rebecca Berg
- Section for Organismal Biology, Faculty of Science, University of Copenhagen, Thorvaldsensvej 40, DK-1871 Frederiksberg, Denmark
| | - Maarja Tagel
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Kreutzwaldi 62, 51006 Tartu, Estonia
| | - Kärt Must
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Kreutzwaldi 62, 51006 Tartu, Estonia
| | - Gunita Deksne
- Department of Parasitology, Institute of Food Safety, Animal Health and Environment "BIOR", Lejupes Str. 3, LV-1076 Riga, Latvia.,Department of Zoology and Animal Ecology, Faculty of Biology, University of Latvia, Jelgavas Str. 1, LV-1004 Riga, Latvia
| | - Heidi Larsen Enemark
- Norwegian Veterinary Institute, Department of Animal Health and Food Safety, P.O. Box 750, Sentrum, NO-0106 Oslo, Norway
| | - Lis Alban
- Department of Food Safety, Veterinary Issues & Risk Analysis, Danish Agriculture & Food Council, Axelborg, Axeltorv 3, DK-1609 Copenhagen, Denmark
| | - Maria Vang Johansen
- Section for Parasitology and Aquatic Pathobiology, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 100, DK-1870 Frederiksberg C, Denmark
| | - Henrik Vedel Nielsen
- Laboratory of Parasitology, Department of Bacteria, Parasites & Fungi, Infectious Disease Preparedness, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
| | - Marianne Sandberg
- Department of Food Safety, Veterinary Issues & Risk Analysis, Danish Agriculture & Food Council, Axelborg, Axeltorv 3, DK-1609 Copenhagen, Denmark
| | - Anna Lundén
- National Veterinary Institute, Department of Microbiology, SE-751 89 Uppsala, Sweden
| | - Christen Rune Stensvold
- Laboratory of Parasitology, Department of Bacteria, Parasites & Fungi, Infectious Disease Preparedness, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
| | - Sara M Pires
- National Food Institute, Technical University of Denmark, Kemitorvet 201, 2800 Kgs. Lyngby, Denmark
| | - Pikka Jokelainen
- Laboratory of Parasitology, Department of Bacteria, Parasites & Fungi, Infectious Disease Preparedness, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.,Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Kreutzwaldi 62, 51006 Tartu, Estonia.,Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 66, 00014 Helsinki, Finland
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5181
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Choe YJ, Shin JY. Trends in the use of antibiotics among Korean children. KOREAN JOURNAL OF PEDIATRICS 2019; 62:113-118. [PMID: 30852884 PMCID: PMC6477546 DOI: 10.3345/kjp.2018.07290] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/04/2019] [Indexed: 01/31/2023]
Abstract
Inappropriate antibiotic use is the most important factor causing increased bacterial resistance to antibiotics, thus affecting patient outcomes. Multidrug-resistant bacteria have become a serious public health threat, causing significant morbidity and mortality worldwide. In Korea, the burden of antibioticresistant bacteria has become an important public health issue. There is increasing evidence of overuse and misuse of antibiotics in Korea, as observed in cohorts with large sample sizes. Antibiotic use among children should receive particular attention because of the frequency of community-associated infections among this population and the elevated risk of transmission. Recent studies from Korea have demonstrated that the use of broad-spectrum antibiotics, either for inpatient or outpatient treatment, has increased among many age groups, especially children. In this review, we aim to describe the patterns of antibiotic prescription and evaluate recent trends in antibiotic use among children. Coordinated efforts toward communication and education in order to address misunderstandings regarding antibiotic use, involving interprofessional antimicrobial stewardship programs, are required in the near future.
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Affiliation(s)
- Young June Choe
- Division of Pediatric Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
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5182
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Thomas ET, Glasziou P, Dobler CC. Use of the terms "overdiagnosis" and "misdiagnosis" in the COPD literature: a rapid review. Breathe (Sheff) 2019; 15:e8-e19. [PMID: 31031840 PMCID: PMC6481986 DOI: 10.1183/20734735.0354-2018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Challenges in the diagnostic process of chronic obstructive pulmonary disease (COPD) can result in diagnostic misclassifications, including overdiagnosis. The term "overdiagnosis" in general has been associated with variable definitions. In connection with efforts to reduce low-value care, "overdiagnosis" has been defined as a true positive diagnosis of a condition that is not associated with any harm in the diagnosed person. It is, however, unclear how the term "overdiagnosis" is used in the COPD literature. We conducted a rapid review of the literature to explore how the terms "overdiagnosis" and "misdiagnosis" are used in the context of COPD. Electronic searches of Medline were conducted from inception to October 2018, to identify primary studies that reported on over- and/or misdiagnosis of COPD using these terms. 28 articles were included in this review. Overdiagnosis and misdiagnosis in COPD were found to be used to describe five main concepts: 1) physician COPD diagnosis despite normal spirometry (14 studies); 2) discordant results for COPD diagnosis based on different spirometry-based definitions for airflow obstruction (10 studies); 3) COPD diagnosis based on pre-bronchodilator spirometry results (three studies); 4) comorbidities (e.g. heart failure or asthma) that affect spirometry and have clinical features which overlap with COPD (two studies); and 5) normalisation of abnormal (post-bronchodilator) spirometry at follow-up (one study). The terms "overdiagnosis" and "misdiagnosis" were often used interchangeably and almost always referred to a false positive diagnosis. Performing (technically correct) spirometry with correct interpretation of the results could probably reduce misdiagnosis in a large proportion of the misdiagnosed cases of COPD. In addition, guidelines need to provide a more acceptable consensus spirometric definition of airflow obstruction. KEY POINTS In the COPD literature, the terms "overdiagnosis" and "misdiagnosis" are often used interchangeably and almost always refer to a false positive diagnosis.Use of spirometry with correct interpretation of the results can avoid a substantial proportion of cases of misdiagnosis of COPD. EDUCATIONAL AIMS To explore the use of the terms "overdiagnosis" and "misdiagnosis" in the COPD literature.To identify the main sources of overdiagnosis and misdiagnosis in COPD.
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Affiliation(s)
- Elizabeth T Thomas
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
- Gold Coast University Hospital, Southport, Australia
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Claudia C Dobler
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
- Gold Coast University Hospital, Southport, Australia
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
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5183
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Chamorro-Petronacci C, García-García A, Lorenzo-Pouso AI, Gómez-García FJ, Padín-Iruegas ME, Gándara-Vila P, Blanco-Carrión A, Pérez-Sayáns M. Management options for low-dose methotrexate-induced oral ulcers: A systematic review. Med Oral Patol Oral Cir Bucal 2019; 24:e181-e189. [PMID: 30818310 PMCID: PMC6441606 DOI: 10.4317/medoral.22851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/06/2019] [Indexed: 12/29/2022] Open
Abstract
Background Oral ulcers caused by methotrexate (MTX) at low doses are a known side effect of this drug. Although increasingly more patients are medicated with MTX, these painful ulcers, without traumatic origin and resistant to any type of treatment, are not usually identified by health professionals as a side effect of the medication. Material and Methods In the absence of a consensus protocol for the effective treatment of oral lesions produced by MTX, the objective of this article was to review and analyse the information from articles related to oral ulcers produced by low-dose MTX and to record the clinical management performed and the MTX dose given to the patient. Data sources - Medline, Web of Science, and Cochrane Library. Participants - Patients treated with low-dose MTX (less than 25 mg/week). Interventions - Management of oral lesions caused by MTX. Study eligibility criterion, study appraisal and synthesis method: An initial search was carried out in the aforementioned databases with the terms ‘methotrexate AND oral OR ulcer’. The search was carried out using both medical subject heading (MeSH) terms and a free search between January 2003 and January 2018. Of the results obtained, two independent researchers analysed abstracts that met the search criteria, that is, those that mentioned oral ulcers produced by MTX at low doses. Next, both researchers read the complete article and determined whether it met the following inclusion criteria: written in English, specified the dose of MTX prescribed for the patient and specified the protocol of action for the ulcers. A third investigator acted as a mediator in cases of dispute. Agreement was calculated using Cohen’s kappa coefficient, with a k value of 0.82. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide for systematic reviews was used. Results The initial search resulted in a total of 66 articles, of which 30 were selected to assess their inclusion in this study. Finally, 16 met the inclusion criteria. Using the Pierson and Newcastle-Ottawa scales and Bradford Hill criteria modified for studies of case series and “in relation to a case”, 2 were rated as high quality, 2 were rated as low quality and 12 were rated as medium quality. The limitations of this study are based on the fact that all of the articles available to carry out the systematic review were “in relation to a case or series of cases”, with the heterogeneity of data that this implies. Conclusions Evidence on the management of oral ulcers in the oral cavity produced by MTX at low doses is scarce due to the heterogeneity of data and the measures adopted in the selected studies. Therefore, it seems that this management is relegated to the perception of the clinician rather than to a specific protocol of action. Studies with a longer follow-up duration and larger sample size are needed to guide different health professionals on the management of these lesions. Key words:Methotrexate, Oral ulcers, Low-dose methotrexate.
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5184
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Affiliation(s)
- John P A Ioannidis
- Stanford Prevention Research Center, Departments of Medicine, Department of Health Research and Policy, Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California.,Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California.,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California
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5185
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Dobler CC. Too much or too little medicine? Overdiagnosis, underdiagnosis, overtreatment and undertreatment in respiratory diseases. Breathe (Sheff) 2019; 15:2-3. [PMID: 30838052 PMCID: PMC6395983 DOI: 10.1183/20734735.0006-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
At a time when technical possibilities for medical investigations are plentiful and ever expanding, there is growing awareness that more is not always better and that “too much medicine” may be harmful. In recent years, the global Choosing Wisely educational campaign has aimed to bring attention to unnecessary healthcare. Unnecessary healthcare includes overtesting, overdiagnosis and overtreatment [1]. The March issue of Breathe aims to challenge us to rethink our clinical practice, to reflect on the evidence, and to identify potential cognitive biases that might influence us to provide “too much” or “too little” medicine [2]. The March issue of Breathe focuses on overdiagnosis, underdiagnosis, overtreatment and undertreatment in respiratory diseaseshttp://ow.ly/63OW30ntCeu
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Affiliation(s)
- Claudia C Dobler
- Dept of Respiratory Medicine, Liverpool Hospital, and University of New South Wales, Sydney, Australia
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5186
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Pawson R. The shrinking scope of pragmatic trials: a methodological reflection on their domain of applicability. J Clin Epidemiol 2019; 107:71-76. [DOI: 10.1016/j.jclinepi.2018.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/05/2018] [Accepted: 11/23/2018] [Indexed: 11/26/2022]
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5187
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Gao Q, Gao W, Xia Q, Xie C, Ma J, Xie L. Effectiveness of therapeutic strategies for patients with neck pain: Protocol for a systematic review and network meta-analysis. Medicine (Baltimore) 2019; 98:e14890. [PMID: 30882704 PMCID: PMC6426582 DOI: 10.1097/md.0000000000014890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Neck pain is a common discomfort or more intense forms of pain in the cervical region. Neck pain has a large impact on individuals and their families, communities, healthcare systems, and businesses throughout the world. Therapeutic strategies are widely used for patients with neck pain in clinical practice, but the effectiveness of each therapeutic strategy is still unclear. The aim of this study is to assess the efficacy and safety of therapeutic strategies for neck pain. METHOD Seven electronic databases will be searched regardless of publication date or language. Randomized controlled trials will be included if they recruited participants with neck pain for assessing the effect of each therapy. Primary outcomes will include pain score. The risk of bias will be assessed by 2 authors using the Cochrane tool of risk of bias. Network meta-analysis in random effects model will be conducted to estimate the indirect and mixed effects of therapeutic strategies for neck pain by R-3.5.1 software. The confidence in cumulative evidence will be assessed by grading of recommendations assessment, development, and evaluation. RESULTS This study will be to assess the effect and safety of therapeutic strategies for neck pain. CONCLUSIONS This study will assess the effect of different therapeutic strategies for neck pain and provide reliable evidence for the choice of treatments. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42019102385).
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Affiliation(s)
| | | | - Qing Xia
- Heilongjiang University of Chinese Medicine
| | - Chunyu Xie
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Jian Ma
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Liangzhen Xie
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
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5188
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Sharp MK, Tokalić R, Gómez G, Wager E, Altman DG, Hren D. A cross-sectional bibliometric study showed suboptimal journal endorsement rates of STROBE and its extensions. J Clin Epidemiol 2019; 107:42-50. [PMID: 30423373 DOI: 10.1016/j.jclinepi.2018.11.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/10/2018] [Accepted: 11/06/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The STrengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement provides guidance on reporting observational studies. Many extensions have been created for specialized methods or fields. We determined endorsement prevalence and typology by journals in extension-related fields. STUDY DESIGN AND SETTING A published protocol defined search strategies to identify journals publishing observational studies (2007-2017) across seven fields relating to STROBE extensions. We extracted text regarding STROBE, seven STROBE extensions, reporting guidelines Consolidated Standards of Reporting Trials and Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and transparent reporting documents/groups: International Committee of Medical Journal Editors, Committee on Publication Ethics (COPE), and the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) networks. Relationships between endorsing STROBE, endorsing other guidelines, and journal impact factor were tested using chi square and Mann-Whitney tests. RESULTS Of 257 unique journals, 12 (5%) required STROBE on submission, 22 (9%) suggested use, 12 (5%) recommended a "relevant guideline," 72 (28%) mentioned it indirectly (via editorial policies or International Committee of Medical Journal Editors recommendations), and 139 (54%) did not mention STROBE. The relevant extension was required by 2 (<1%) journals; 4 (1%) suggested use. STROBE endorsement was not associated with journal impact indices but was with Consolidated Standards of Reporting Trials and Preferred Reporting Items for Systematic Reviews and Meta-Analyses endorsements. CONCLUSION Reporting guideline endorsement rates are low; information is vague and scattered. Unambiguous language is needed to improve adherence to reporting guidelines and increase the quality of reporting.
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Affiliation(s)
- Melissa K Sharp
- Department of Psychology, University of Split, Faculty of Humanities and Social Sciences, Split, Croatia; INSERM, U1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Methods of Therapeutic Evaluation of Chronic Diseases Team (METHODS), Paris, F-75014 France; Paris Descartes University, Sorbonne Paris Cité, France.
| | | | - Guadalupe Gómez
- Universitat Politècnica de Catalunya-BarcelonaTech, Departament d'Estadística i Investigació Operativa, Barcelona, Spain
| | - Elizabeth Wager
- Sideview, Buckinghamshire, UK; University of Split, School of Medicine, Split, Croatia
| | - Douglas G Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Darko Hren
- Department of Psychology, University of Split, Faculty of Humanities and Social Sciences, Split, Croatia
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5189
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Abedi G, Malekzadeh R, Moosazadeh M, Abedini E, Hasanpoor E. Nurses' Perspectives on the Impact of Marketing Mix Elements (7Ps) on Patients' Tendency to Kind of Hospital. Ethiop J Health Sci 2019; 29:223-230. [PMID: 31011270 PMCID: PMC6460454 DOI: 10.4314/ejhs.v29i2.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/26/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Marketing mix (7Ps) is a critical concept in healthcare management and health marketing. Hence, this study was conducted to investigating the role of 7Ps on patients' disposition to the kind of hospital from nurses' perspectives. METHODS A cross-sectional study design was used in 2015. The study was conducted in one state in Iran (Mazandaran). The statistical population included nurses (n=235) in public and private hospitals were selected randomly through the list. Data were collected by questionnaire and were analyzed using SPSS software (version 22). RESULTS The results showed that 38.6 percent of nurses were males and the others (61.4 percent) were females. Their mean age was 31.0±7.1 years, and the majority of them belonged to the 30-40 age group. The mean work experience of them was 11.42±6.5 years. The findings showed that there were significant differences between nurses' perspectives in public and private hospitals about the effect of 7Ps elements on patients' tendency to the public and private hospitals (p<0.05). CONCLUSIONS According to the results, the officials of public hospitals should take more attention to the elements like product, place, promotion, people, physical assets and process management more than the past because these elements cause that the patients are disposed to the private hospitals while the government make more investment in public hospitals.
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Affiliation(s)
- Ghasem Abedi
- Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roya Malekzadeh
- Educational Vice Chancellor, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ehsan Abedini
- Student Research Committee, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Edris Hasanpoor
- Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh, Iran
- Clinical Research Development Unit, Shahid Beheshti Hospital, Maragheh University of Medical Sciences, Maragheh, Iran
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5190
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Oxman AD, Paulsen EJ. Who can you trust? A review of free online sources of "trustworthy" information about treatment effects for patients and the public. BMC Med Inform Decis Mak 2019; 19:35. [PMID: 30786889 PMCID: PMC6381637 DOI: 10.1186/s12911-019-0772-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 02/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Information about effects of treatments based on unsystematic reviews of research evidence may be misleading. However, finding trustworthy information about the effects of treatments based on systematic reviews, which is accessible to patients and the public can be difficult. The objectives of this study were to identify and evaluate free sources of health information for patients and the public that provide information about effects of treatments based on systematic reviews. METHODS We reviewed websites that we and our colleagues knew of, searched for government sponsored health information websites, and searched for online sources of health information that provide evidence-based information. To be included in our review, a website had to be available in English, freely accessible, and intended for patients and the public. In addition, it had to have a broad scope, not limited to specific conditions or types of treatments. It had to include a description of how the information is prepared and the description had to include a statement about using systematic reviews. We compared the included websites by searching for information about the effects of eight treatments. RESULTS Three websites met our inclusion criteria: Cochrane Evidence, Informed Health, and PubMed Health. The first two websites produce content, whereas PubMed Health aggregated content. A fourth website that met our inclusion criteria, CureFacts, was under development. Cochrane Evidence provides plain language summaries of Cochrane Reviews (i.e. summaries that are intended for patients and the public). They are translated to several other languages. No information besides treatment effects is provided. Informed Health provides information about treatment effects together with other information for a wide range of topics. PubMed Health was discontinued in October 2018. It included a large number of systematic reviews of treatment effects with plain language summaries for Cochrane Reviews and some other reviews. None of the three websites included links to ongoing trials, and information about treatment effects was not reported consistently on any of the websites. CONCLUSION It is possible for patients and the public to access trustworthy information about the effects of treatments using the two of the websites included in this review.
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Affiliation(s)
- Andrew D Oxman
- Centre for Informed Health Choices, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403, Oslo, Norway. .,University of Oslo, Oslo, Norway.
| | - Elizabeth J Paulsen
- Centre for Informed Health Choices, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403, Oslo, Norway
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5191
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Bhanot A, Huntley A, Ridd MJ. Adverse Events from Emollient Use in Eczema: A Restricted Review of Published Data. Dermatol Ther (Heidelb) 2019; 9:193-208. [PMID: 30771093 PMCID: PMC6522630 DOI: 10.1007/s13555-019-0284-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Indexed: 01/15/2023] Open
Abstract
Atopic dermatitis/eczema is a chronic inflammatory skin condition, and emollients are the first-line treatment. Despite their widespread use, there is uncertainty about the frequency and type of adverse events associated with different emollients. We conducted a restricted review of published data on adverse events associated with emollient use in eczema. Medline (Ovid) was searched from inception (1946) to June 2018. All types of studies, with the exception of reviews, were included. Eligibility was assessed using a two-stage screening process against inclusion and exclusion criteria. References of all included papers were screened for any additional eligible papers. Data were subsequently extracted from all eligible publications. A limited body of data were found in the published data: 24 papers reported on adverse events with 29 different emollients (3 containing urea, 5 containing ceramide, 4 containing glycerol, 4 were herbal and 13 contained "other" ingredients). Interpretation of the results and comparison of the emollients were difficult due to poor reporting and missing data. Many publications contained no data at all on adverse events, and no study reported serious treatment-related adverse events for any emollient. The proportion of participants in the studies experiencing treatment-related adverse events varied between 2 and 59%. The most common adverse events were skin related and often mild. The range of participants experiencing non-treatment-related adverse events varied between 4 and 43%. From this restricted review, clinicians and patients can be reassured that the emollients studied appear to be generally safe to use. Better studies and reporting of adverse events associated with emollients in common use are needed.
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Affiliation(s)
- Alisha Bhanot
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Alyson Huntley
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Matthew J Ridd
- Population Health Sciences, University of Bristol, Bristol, UK.
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5192
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McDowell RD, Bennett K, Moriarty F, Clarke S, Barry M, Fahey T. Prescriber Variation in Relation to Prescribing Trends within the Preferred Drugs Initiative in Ireland (2012-2015): An Interrupted Time-Series Study Using Latent Curve Models. Med Decis Making 2019; 39:278-293. [PMID: 30741086 DOI: 10.1177/0272989x18818165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine the impact of the Preferred Drugs Initiative (PDI), an Irish health policy aimed at reducing prescribing variation. DESIGN Interrupted time series spanning 2012 to 2015. SETTING Health Service Executive pharmacy claims data for General Medical Services (GMS) patients, approximately 40% of the Irish population. PARTICIPANTS Prescribers issuing preferred drug group items to GMS adults before and after PDI guidelines. PRIMARY OUTCOME The percentage coverage of PDI medications within each drug class per calendar quarter per prescriber. METHODS Latent curve models with structured residuals (LCM-SRs) were used to model coverage of the preferred drugs over time. The number of GMS adults receiving medication and the percentage who were 65 years and older at the start of the study were included as covariates. RESULTS In the quarter following PDI guidelines, coverage of the preferred drugs increased most in absolute terms for proton pump inhibitors (PPIs) (1.50% [SE 0.15], P < 0.001) and selective and norepinephrine reuptake inhibitors (SNRIs) (1.17% [SE 0.26], P < 0.001). Variation between prescribers remained relatively unchanged and increased for urology medications. Prescribers who increased coverage of the preferred PPI also increased coverage of the preferred statin immediately following guidelines (correlation 0.47 [SE 0.13], P < 0.001). Where guidelines were disseminated simultaneously, coverage of one preferred drug did not significantly predict coverage of the other preferred drug in the next calendar quarter. Prescribing of preferred drugs was not moderated by prescriber-level factors. CONCLUSIONS Modest changes in prescribing of the preferred drugs have been observed over the course of the PDI. However, the guidelines have had little impact in reducing variation between prescribers. Further strategies may be necessary to reduce variation in clinical practice and enhance patient care.
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Affiliation(s)
- Ronald D McDowell
- Health Research Board (HRB) Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland Medical School, Dublin 2, Ireland.,Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Frank Moriarty
- Health Research Board (HRB) Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland Medical School, Dublin 2, Ireland
| | - Sarah Clarke
- Health Service Executive Medicines Management Programme, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
| | - Michael Barry
- National Centre for Pharmacoeconomics, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
| | - Tom Fahey
- Health Research Board (HRB) Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland Medical School, Dublin 2, Ireland
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5193
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Chang AB, Grimwood K. Contemporary Concise Review 2018: Bronchiectasis. Respirology 2019; 24:382-389. [PMID: 30743310 DOI: 10.1111/resp.13502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 01/27/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.,Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Department of Infectious Diseases, Gold Coast Health, Gold Coast, QLD, Australia.,Department of Paediatrics, Gold Coast Health, Gold Coast, QLD, Australia
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5194
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Catalá-López F, Ridao M, Núñez-Beltrán A, Gènova-Maleras R, Alonso-Arroyo A, Aleixandre-Benavent R, Catalá MA, Tabarés-Seisdedos R. Prevalence and comorbidity of attention deficit hyperactivity disorder in Spain: study protocol for extending a systematic review with updated meta-analysis of observational studies. Syst Rev 2019; 8:49. [PMID: 30744675 PMCID: PMC6371515 DOI: 10.1186/s13643-019-0967-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/28/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a childhood-onset disorder characterized by a persistent pattern of symptoms of developmentally inappropriate and impaired inattention and/or hyperactivity/impulsivity, with difficulties often continuing into adulthood. ADHD can come with other comorbid conditions. The aim of this study will be to quantify the prevalence and comorbidity of ADHD among children, adolescent, and adult population in Spain. METHODS/DESIGN We designed and registered a study protocol for an update and expansion of a systematic review and meta-analysis of pooled prevalence data. We will include cross-sectional observational studies reporting prevalence of ADHD in Spain and conducted in the general population, outpatient, and/or school settings. The primary outcome will be the prevalence of ADHD. Secondary outcomes will be the prevalence of any physical or mental comorbidity in association with ADHD. No limitations will be imposed on publication status, study conduct period, and language of dissemination. Comprehensive literature searches will be conducted in multiple electronic databases, including PubMed/MEDLINE, EMBASE, Scopus, Web of Science, PsycINFO, IME - Spanish Medical Index, and IBECS - Spanish Bibliographic Index of Health Sciences. We will also search Google Scholar, dissertation databases, and conference abstracts. Two team members will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The methodological quality (or risk of bias) of individual studies will be appraised using an appropriate tool. If feasible, we will conduct random effects meta-analysis. Prevalence estimates will be stratified according to gender, age, and geographical location. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., methodological quality, sample size, diagnostic criteria). DISCUSSION This systematic review and meta-analysis of observational data will provide an updated synthesis of the prevalence and comorbidity of ADHD in Spain. This study will also examine factors that may explain potential variations in prevalence data. The findings of this study will be published in a peer-reviewed journal. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018106082 .
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Affiliation(s)
- Ferrán Catalá-López
- Department of Health Planning and Economics, National School of Public Health, Institute of Health Carlos III, Madrid, Spain
- Department of Medicine, University of Valencia/INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain
- Fundación Instituto de Investigación en Servicios de Salud, Valencia, Spain
| | - Manuel Ridao
- Instituto Aragonés de Ciencias de la Salud (IACS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Zaragoza, Spain
| | | | - Ricard Gènova-Maleras
- Directorate General for Public Health, Madrid Regional Health Council, Madrid, Spain
| | - Adolfo Alonso-Arroyo
- Department of History of Science and Documentation, University of Valencia, Valencia, Spain
- Information and Social and Health Research Unit (UISYS), University of Valencia and Spanish National Research Council (CSIC), Valencia, Spain
| | - Rafael Aleixandre-Benavent
- Information and Social and Health Research Unit (UISYS), University of Valencia and Spanish National Research Council (CSIC), Valencia, Spain
- Institute for Innovation and Knowledge Management (INGENIO)/Spanish National Research Council (CSIC) and Polytechnic University of Valencia (UPV), Valencia, Spain
| | | | - Rafael Tabarés-Seisdedos
- Department of Medicine, University of Valencia/INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain
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5195
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Lin L. Graphical augmentations to sample-size-based funnel plot in meta-analysis. Res Synth Methods 2019; 10:376-388. [PMID: 30664834 DOI: 10.1002/jrsm.1340] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 01/08/2019] [Accepted: 01/15/2019] [Indexed: 12/14/2022]
Abstract
Assessing publication bias is a critical procedure in meta-analyses for rating the synthesized overall evidence. Because statistical tests for publication bias are usually not powerful and only give P values that inform either the presence or absence of the bias, examining the asymmetry of funnel plots has been popular to investigate potentially missing studies and the direction of the bias. Most funnel plots present treatment effects against their standard errors, and the contours depicting studies' significance levels have been used in the plots to distinguish publication bias from other factors (such as heterogeneity and subgroup effects) that may cause the plots' asymmetry. However, treatment effects and their standard errors are frequently associated even if no publication bias exists (eg, both variables depend on the four data cells in a 2 × 2 table for the odds ratio), so standard-error-based funnel plots may lead to false positive conclusions when such association may not be negligible. In addition, the missingness of studies may relate to their sample sizes besides P values (which are partly determined by standard errors); studies with more samples are more likely published. Therefore, funnel plots based on sample sizes can be an alternative tool. However, the contours for standard-error-based funnel plots cannot be directly applied to sample-size-based ones. This article introduces contours for sample-size-based funnel plots of various effect sizes, which may help meta-analysts properly interpret such plots' asymmetry. We provide five examples to illustrate the use of the proposed contours.
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Affiliation(s)
- Lifeng Lin
- Department of Statistics, Florida State University, Tallahassee, Florida
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5196
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Clinical Outcomes Associated with Drug–Drug Interactions of Oral Chemotherapeutic Agents: A Comprehensive Evidence-Based Literature Review. Drugs Aging 2019; 36:341-354. [DOI: 10.1007/s40266-019-00640-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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5197
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Chalmers I, Atkinson P, Badenoch D, Glasziou P, Austvoll-Dahlgren A, Oxman A, Clarke M. The James Lind Initiative: books, websites and databases to promote critical thinking about treatment claims, 2003 to 2018. RESEARCH INVOLVEMENT AND ENGAGEMENT 2019; 5:6. [PMID: 30766728 PMCID: PMC6360692 DOI: 10.1186/s40900-019-0138-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The James Lind Initiative (JLI) was a work programme inaugurated by Iain Chalmers and Patricia Atkinson to press for better research for better health care. It ran between 2003 and 2018, when Iain Chalmers retired. During the 15 years of its existence, the JLI developed three strands of work in collaboration with the authors of this paper, and with others. WORK THEMES The first work strand involved developing a process for use by patients, carers and clinicians to identify shared priorities for research - the James Lind Alliance. The second strand was a series of articles, meetings, prizes and other developments to raise awareness of the massive amounts of avoidable waste in research, and of ways of reducing it. The third strand involved using a variety of approaches to promote better public and professional understanding of the importance of research in clinical practice and public health. JLI work on the first two themes has been addressed in previously published reports. This paper summarises JLI involvement during the 15 years of its existence in giving talks, convening workshops, writing books, and creating websites and databases to promote critical thinking about treatment claims. CONCLUSION During its 15-year life, the James Lind Initiative worked collaboratively with others to create free teaching and learning resources to help children and adults learn how to recognise untrustworthy claims about the effects of treatments. These resources have been translated in more than twenty languages, but much more could be done to support their uptake and wider use.
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Affiliation(s)
| | | | - Douglas Badenoch
- Minervation Ltd, The Wheelhouse, First Floor, Angel Court, 81 St Clements Street Oxford, England, OX4 1AW UK
| | - Paul Glasziou
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4229 Australia
| | - Astrid Austvoll-Dahlgren
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Gullhaugveien 1-3, 0484 Oslo, Norway
| | - Andy Oxman
- Centre for Informed Health Choices, Norwegian Institute of Public Health, Box 4404, Nydalen, N-0403 Oslo, PO Norway
| | - Mike Clarke
- Centre for Public Health, Institute of Clinical Sciences, Block B, Queens University Belfast, Royal Hospitals, Grosvenor Road, Belfast, BT12 6BJ UK
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5198
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Lynøe N, Eriksson A. The Swedish systematic review of traumatic shaking is not flawed and should not be ignored. Acta Paediatr 2019; 108:381. [PMID: 30216589 DOI: 10.1111/apa.14575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Niels Lynøe
- Stockholm Centre for Healtcare Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Anders Eriksson
- Department of Community Medicine and Rehabilitation, Forensic Medicine, Umeå University, Umeå, Sweden
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5199
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Kutty S, Danford DA. Shunts and the Single Right Ventricle. Circ Cardiovasc Imaging 2019; 12:e008711. [DOI: 10.1161/circimaging.118.008711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Shelby Kutty
- The Helen B. Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)
| | - David A. Danford
- Division of Pediatric Cardiology, University of Nebraska College of Medicine and Children’s Hospital and Medical Center, Omaha, NE (D.A.D.)
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5200
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Hatling D, Høgset A, Guttormsen AB, Müller B. Iatrogenic cerebral gas embolism-A systematic review of case reports. Acta Anaesthesiol Scand 2019; 63:154-160. [PMID: 30203491 DOI: 10.1111/aas.13260] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/24/2018] [Accepted: 08/06/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cerebral gas embolism is a complication of several medical procedures and occurs when gas enters the cerebral circulation. Knowledge about etiology and outcome in affected patients is limited, and prospective trials on management and treatment are hardly feasible. Case reports are therefore an important source of information. METHODS A systematic literature search was conducted in June 2016 and May 2018, supplemented by a manual search. Titles and abstracts were systematically assessed for eligibility, followed by full-text screening for included papers. Screening and data extraction were performed independently by two researchers. Cases of cerebral gas embolism due to any iatrogenic cause were included. Criteria for exclusion were: animal studies, non-cerebral localization, extravascular gas only, and non-iatrogenic causes. 264 cases reported in 189 papers were included. RESULTS A broad range of procedures leading to iatrogenic cerebral gas embolism (ICGE) were identified and a comprehensive list is presented in this article. Procedures were mostly reported as conducted correctly, but procedure related error, patient activity, or defective equipment were also reported as causes. Neurological, neuropsychological, and cardiopulmonary symptoms were common. The diagnosis was frequently based on or confirmed by radiology, usually CT. Hyperbaric oxygen therapy was applied in a large number of cases. CONCLUSION The reported causes, symptoms and signs, and outcomes of ICGE vary significantly, and awareness of the condition in the medical community is essential. A standardized method of reporting could facilitate higher quality research in the field.
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Affiliation(s)
| | - Anne Høgset
- Medical Faculty; University of Bergen; Bergen Norway
| | - Anne Berit Guttormsen
- Haukeland University Hospital; Bergen Norway
- Department of Clinical Medicine 1; University of Bergen; Bergen Norway
| | - Bernd Müller
- Hyperbaric Medicine Unit; Department of Occupational Medicine; Haukeland University Hospital; Bergen Norway
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