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Bujarski SJ, Capron DW, Gratz KL, Tull MT. Conformity motives for alcohol use are associated with risky sexual behavior among alcohol-dependent patients in residential substance abuse treatment. JOURNAL OF SUBSTANCE USE 2017; 22:469-473. [PMID: 30906221 DOI: 10.1080/14659891.2016.1245792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Alcohol misuse is associated with a variety of negative outcomes, including risky sexual behavior (RSB). In an attempt to better identify the subset of individuals at greatest risk for these negative outcomes, a growing body of research has begun to examine the role of alcohol use motives in risk for alcohol use-related negative outcomes. Although the majority of research in this area has focused on coping motives, conformity motives may be particularly relevant to outcomes such as RSB. Specifically, conformity motives may operate as a proxy risk factor for RSB, reflecting the tendency to engage in interpersonally-oriented risk behaviors in order to avoid rejection, interpersonal conflict, or social ostracism. Therefore, the current study examined the relation between conformity motives for alcohol use and RSB in a sample of 94 patients in a residential substance abuse treatment center. Results indicated that conformity motives were associated with RSB above and beyond other motives for alcohol use, as well as relevant covariates. Findings support the notion that conformity motives may operate as a proxy risk factor that could assist in identifying individuals at elevated risk for engaging in RSB.
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Affiliation(s)
- Sarah J Bujarski
- VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA
| | - Daniel W Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
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O'Connor AM, Sargeant JM, Dohoo IR, Erb HN, Cevallos M, Egger M, Ersbøll AK, Martin SW, Nielsen LR, Pearl DL, Pfeiffer DU, Sanchez J, Torrence ME, Vigre H, Waldner C, Ward MP. Explanation and Elaboration Document for the
STROBE
‐Vet Statement: Strengthening the Reporting of Observational Studies in Epidemiology – Veterinary Extension. Zoonoses Public Health 2016; 63:662-698. [DOI: 10.1111/zph.12315] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Indexed: 01/10/2023]
Affiliation(s)
- A. M. O'Connor
- Department of Veterinary Diagnostic and Production Animal Medicine Iowa State University Ames IA USA
| | - J. M. Sargeant
- Centre for Public Health and Zoonoses University of Guelph Guelph ON Canada
- Department of Population Medicine Ontario Veterinary College Guelph ON Canada
| | - I. R. Dohoo
- Centre for Veterinary Epidemiological Research University of Prince Edward Island Charlottetown PEI Canada
| | - H. N. Erb
- Department of Population Medicine and Diagnostic Sciences Cornell University Ithaca NY USA
| | - M. Cevallos
- Institute of Social and Preventive Medicine University of Bern BernSwitzerland
| | - M. Egger
- Institute of Social and Preventive Medicine University of Bern BernSwitzerland
| | - A. K. Ersbøll
- National Institute of Public Health University of Southern Denmark Copenhagen Denmark
| | - S. W. Martin
- Department of Population Medicine Ontario Veterinary College Guelph ON Canada
| | - L. R. Nielsen
- Section for Animal Welfare and Disease Control University of Copenhagen Copenhagen Denmark
| | - D. L. Pearl
- Department of Population Medicine Ontario Veterinary College Guelph ON Canada
| | - D. U. Pfeiffer
- Department of Production and Population Health Royal Veterinary College London UK
| | - J. Sanchez
- Department of Health Management University of Prince Edward Island Charlottetown PEI Canada
| | - M. E. Torrence
- Food and Drug Administration Center for Food Safety and Applied Nutrition College Park MD USA
| | - H. Vigre
- National Food Institute Technical University of Denmark Lyngby Denmark
| | - C. Waldner
- Department of Large Animal Clinical Sciences Western College of Veterinary Medicine University of Saskatchewan Saskatoon SK Canada
| | - M. P. Ward
- Faculty of Veterinary Science The University of Sydney Sydney NSWAustralia
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Lin YS, Jan IS, Cheng SH. Comparative analysis of the cost and effectiveness of generic and brand-name antibiotics: the case of uncomplicated urinary tract infection. Pharmacoepidemiol Drug Saf 2016; 26:301-309. [PMID: 27862588 DOI: 10.1002/pds.4122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/06/2016] [Accepted: 10/11/2016] [Indexed: 11/11/2022]
Abstract
PURPOSE Generic medications used for chronic diseases are beneficial in containing healthcare costs and improving drug accessibility. However, the effects of generic drugs in acute and severe illness remain controversial. This study aims to investigate treatment costs and outcomes of generic antibiotics prescribed for adults with a urinary tract infection in outpatient settings. METHODS The data source was the Longitudinal Health Insurance Database of Taiwan. We included outpatients aged 20 years and above with a urinary tract infection who required one oral antibiotic for which brand-name and generic products were simultaneously available. Drug cost and overall healthcare expense of the index consultation, healthcare cost during a 42-day follow-up period, and treatment failure rates were the main dependent variables. Data were compared between brand-name and generic users from the entire cohort and a propensity score-matched samples. RESULTS Results from the entire cohort and propensity score-matched samples were similar. Daily antibiotic cost was significantly lower among generic users than brand-name users. Significant lower total drug claims of the index consultation only existed in patients receiving the investigated antibiotics, while the drug price between brand-name and generic versions were relatively large (e.g., >50%). The overall healthcare cost of the index consultation, healthcare expenditure during a 42-day follow-up period, and treatment failure rates were similar between the two groups. CONCLUSIONS Compared with those treated with brand-name antibiotics, outpatients who received generic antibiotics had equivalent treatment outcomes with lower drug costs. Generic antibiotics are effective and worthy of adoption among outpatients with simple infections indicating oral antibiotic treatment. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yu-Shiuan Lin
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - I-Shiow Jan
- National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shou-Hsia Cheng
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
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O'Connor AM, Sargeant JM, Dohoo IR, Erb HN, Cevallos M, Egger M, Ersbøll AK, Martin SW, Nielsen LR, Pearl DL, Pfeiffer DU, Sanchez J, Torrence ME, Vigre H, Waldner C, Ward MP. Explanation and Elaboration Document for the STROBE-Vet Statement: Strengthening the Reporting of Observational Studies in Epidemiology-Veterinary Extension. J Vet Intern Med 2016; 30:1896-1928. [PMID: 27859752 PMCID: PMC5115190 DOI: 10.1111/jvim.14592] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 06/24/2016] [Accepted: 08/29/2016] [Indexed: 01/15/2023] Open
Abstract
The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement was first published in 2007 and again in 2014. The purpose of the original STROBE was to provide guidance for authors, reviewers, and editors to improve the comprehensiveness of reporting; however, STROBE has a unique focus on observational studies. Although much of the guidance provided by the original STROBE document is directly applicable, it was deemed useful to map those statements to veterinary concepts, provide veterinary examples, and highlight unique aspects of reporting in veterinary observational studies. Here, we present the examples and explanations for the checklist items included in the STROBE-Vet statement. Thus, this is a companion document to the STROBE-Vet statement methods and process document (JVIM_14575 "Methods and Processes of Developing the Strengthening the Reporting of Observational Studies in Epidemiology-Veterinary (STROBE-Vet) Statement" undergoing proofing), which describes the checklist and how it was developed.
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Affiliation(s)
- A M O'Connor
- Department of Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, IA
| | - J M Sargeant
- Centre for Public Health and Zoonoses, University of Guelph, Guelph, ON, Canada.,Department of Population Medicine, Ontario Veterinary College, Guelph, ON, Canada
| | - I R Dohoo
- Centre for Veterinary Epidemiological Research, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - H N Erb
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY
| | - M Cevallos
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - M Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - A K Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - S W Martin
- Department of Population Medicine, Ontario Veterinary College, Guelph, ON, Canada
| | - L R Nielsen
- Section for Animal Welfare and Disease Control, University of Copenhagen, Copenhagen, Denmark
| | - D L Pearl
- Department of Population Medicine, Ontario Veterinary College, Guelph, ON, Canada
| | - D U Pfeiffer
- Department of Production and Population Health, Royal Veterinary College, London, UK
| | - J Sanchez
- Department of Health Management, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - M E Torrence
- Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD
| | - H Vigre
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - C Waldner
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - M P Ward
- Faculty of Veterinary Science, The University of Sydney, Sydney, Australia
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Aroian KJ, Templin TN, Hough ES. Daily hassles, mother-child relationship, and behavior problems in Muslim Arab American adolescents in immigrant families. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2016; 22:533-543. [PMID: 27055003 PMCID: PMC5053834 DOI: 10.1037/cdp0000084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This longitudinal study examines reciprocal and dynamic relations among daily hassles, the mother-child relationship, and adolescent behavior problems and whether the relations differed by sociodemographic variables. METHOD Three waves of data about adolescent daily hassles, quality of the mother-child relationship, and adolescent behavior problems were collected from 454 Arab Muslim adolescents and their immigrant mothers over a 3-year period. Cross-lagged structural equation modeling (SEM) was used to examine reciprocal relations among the study variables. RESULTS Relations between the mother-child relationship and adolescent behavior problems were reciprocal, with a poor mother-child relationship contributing to greater behavior problems and behavior problems contributing to a decline in the quality of the mother-child relationship. Relations involving daily hassles were unidirectional: A better mother-child relationship contributed to fewer daily hassles and behavior problems contributed to more daily hassles but daily hassles did not contribute to more behavior problems. Father's education was the only sociodemographic variable that was significant: Adolescents with more highly educated fathers had a better mother-child relationship and fewer behavioral problems. CONCLUSIONS Findings suggest that Arab American Muslim adolescents with behavior problems are differentially exposed to daily hassles but daily hassles are not the best point of intervention. Bidirectional relations between the mother-child relationship and adolescent behavior problems suggest intervening to improve the mother-child relationship and manage symptoms of adolescent behavior problems. (PsycINFO Database Record
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Roy J, Lum KJ, Daniels MJ. A Bayesian nonparametric approach to marginal structural models for point treatments and a continuous or survival outcome. Biostatistics 2016; 18:32-47. [PMID: 27345532 DOI: 10.1093/biostatistics/kxw029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/16/2016] [Accepted: 04/25/2016] [Indexed: 11/14/2022] Open
Abstract
Marginal structural models (MSMs) are a general class of causal models for specifying the average effect of treatment on an outcome. These models can accommodate discrete or continuous treatments, as well as treatment effect heterogeneity (causal effect modification). The literature on estimation of MSM parameters has been dominated by semiparametric estimation methods, such as inverse probability of treatment weighted (IPTW). Likelihood-based methods have received little development, probably in part due to the need to integrate out confounders from the likelihood and due to reluctance to make parametric modeling assumptions. In this article we develop a fully Bayesian MSM for continuous and survival outcomes. In particular, we take a Bayesian nonparametric (BNP) approach, using a combination of a dependent Dirichlet process and Gaussian process to model the observed data. The BNP approach, like semiparametric methods such as IPTW, does not require specifying a parametric outcome distribution. Moreover, by using a likelihood-based method, there are potential gains in efficiency over semiparametric methods. An additional advantage of taking a fully Bayesian approach is the ability to account for uncertainty in our (uncheckable) identifying assumption. To this end, we propose informative prior distributions that can be used to capture uncertainty about the identifying "no unmeasured confounders" assumption. Thus, posterior inference about the causal effect parameters can reflect the degree of uncertainty about this assumption. The performance of the methodology is evaluated in several simulation studies. The results show substantial efficiency gains over semiparametric methods, and very little efficiency loss over correctly specified maximum likelihood estimates. The method is also applied to data from a study on neurocognitive performance in HIV-infected women and a study of the comparative effectiveness of antihypertensive drug classes.
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Affiliation(s)
- Jason Roy
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
| | - Kirsten J Lum
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
| | - Michael J Daniels
- Department of Statistics and Data Science, and Department of Integrative Biology, The University of Texas, Austin, TX
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Dukes JW, Dewland TA, Vittinghoff E, Olgin JE, Pletcher MJ, Hahn JA, Gladstone RA, Marcus GM. Access to alcohol and heart disease among patients in hospital: observational cohort study using differences in alcohol sales laws. BMJ 2016; 353:i2714. [PMID: 27301557 PMCID: PMC4908314 DOI: 10.1136/bmj.i2714] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate the relation between alcohol consumption and heart disease by using differences in county level alcohol sales laws as a natural experiment. DESIGN Observational cohort study using differences in alcohol sales laws. SETTING Hospital based healthcare encounters in Texas, USA. POPULATION 1 106 968 patients aged 21 or older who were residents of "wet" (no alcohol restrictions) and "dry" (complete prohibition of alcohol sales) counties and admitted to hospital between 2005 and 2010, identified using the Texas Inpatient Research Data File. OUTCOME MEASURES Prevalent and incident alcohol misuse and alcoholic liver disease were used for validation analyses. The main cardiovascular outcomes were atrial fibrillation, acute myocardial infarction, and congestive heart failure. RESULTS Residents of wet counties had a greater prevalence and incidence of alcohol misuse and alcoholic liver disease. After multivariable adjustment, wet county residents had a greater prevalence (odds ratio 1.05, 95% confidence interval 1.01 to 1.09; P=0.007) and incidence (hazard ratio 1.07, 1.01 to 1.13; P=0.014) of atrial fibrillation, a lower prevalence (odds ratio 0.83, 0.79 to 0.87; P<0.001) and incidence (hazard ratio 0.91, 0.87 to 0.99; P=0.019) of myocardial infarction, and a lower prevalence (odds ratio 0.87, 0.84 to 0.90; P<0.001) of congestive heart failure. Conversion of counties from dry to wet resulted in statistically significantly higher rates of alcohol misuse, alcoholic liver disease, atrial fibrillation, and congestive heart failure, with no detectable difference in myocardial infarction. CONCLUSIONS Greater access to alcohol was associated with more atrial fibrillation and less myocardial infarction and congestive heart failure, although an increased risk of congestive heart failure was seen shortly after alcohol sales were liberalized.
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Affiliation(s)
- Jonathan W Dukes
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Ave, M-1180B, Box 0124, San Francisco, CA 94143-0124, USA
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Jeffrey E Olgin
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Ave, M-1180B, Box 0124, San Francisco, CA 94143-0124, USA
| | - Mark J Pletcher
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Judith A Hahn
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Rachel A Gladstone
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Ave, M-1180B, Box 0124, San Francisco, CA 94143-0124, USA
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Ave, M-1180B, Box 0124, San Francisco, CA 94143-0124, USA
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Maheu C, Lebel S, Courbasson C, Lefebvre M, Singh M, Bernstein LJ, Muraca L, Benea A, Jolicoeur L, Harris C, Ramanakumar AV, Ferguson S, Sidani S. Protocol of a randomized controlled trial of the fear of recurrence therapy (FORT) intervention for women with breast or gynecological cancer. BMC Cancer 2016; 16:291. [PMID: 27112319 PMCID: PMC4845394 DOI: 10.1186/s12885-016-2326-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 04/20/2016] [Indexed: 01/31/2023] Open
Abstract
Background Clinically significant levels of fear of cancer recurrence (FCR) affect up to 49 % of cancer survivors and are more prevalent among women. FCR is associated with psychological distress, lower quality of life, and increased use of medical resources. Despite its prevalence, FCR is poorly addressed in clinical care. To address this problem, we first developed, and pilot tested a 6-week, 2 h, Cognitive-existential group intervention therapy that targeted FCR in survivors of breast or gynecological cancer. Following the positive outcome of the pilot, we are now testing this approach in a randomized clinical trial (RCT). Goal and hypotheses: This multicenter, prospective RCT aims to test the efficacy of the intervention. The study hypotheses are that, compared to a control group, cancer survivors participating in the intervention (1) will have less FCR, (2) will show more favorable outcomes on the following measures: cancer-specific distress, quality of life, illness uncertainty, intolerance of uncertainty, perceived risk of cancer recurrence, and coping skills. We further postulate that the between-group differences will persist three and 6 months post-intervention. Methods Sixteen groups of seven to nine women are being allocated to the intervention or the control group. The control group receives a 6-week, 2 h, structurally equivalent support group. We are recruiting 144 cancer survivors from four hospital sites in three Canadian cities. The sample size was based on the moderate pre/post-test changes found in our pilot study and adjusted to the drop-out rates. Measurements: The primary outcome, FCR, is measured by the Fear of Cancer Recurrence Inventory. Secondary outcomes measured include cancer-specific distress, perceived risk of cancer recurrence, illness uncertainty, intolerance of uncertainty, coping, and quality of life. We use reliable and recognized valid scales. Participants are to complete the questionnaire package at four times: before the first group session (baseline), immediately after the sixth session, and 3 and 6 months post-intervention. Analysis: In the descriptive analysis, comparison of group equivalent baseline variables, identification of confounding/intermediate variables and univariate analysis are planned. Each participant’s trajectory is calculated using Generalized Estimating Equation models to determine the time and group effects, after considering the correlation structures of the groups. An intent-to-treat analysis approach may be adopted. Discussion Our Fear of Recurrence Therapy (FORT) intervention has direct implications for clinical service development to improve the quality of life for patients with breast (BC) and gynecological cancer (GC). Based on our pilot data, we are confident that the FORT intervention can guide the development of effective psychosocial cancer survivorship interventions to reduce FCR and improve psychological functioning among women with BC or GC. Trial registration Dr. Christine Maheu registered the trial with ISRCTN registry (Registration number: ISRCTN83539618, date assigned 03/09/2014).
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Affiliation(s)
- Christine Maheu
- Ingram School of Nursing, McGill University, Montreal, Quebec, J7V 0E2, Canada. .,Cancer Survivorship Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2C4, Canada.
| | - Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, Ontario, K1N 6N5, Canada
| | - Christine Courbasson
- Centre for Addition and Mental Health, CB, DB Therapy & H Therapy Centre, Toronto, Ontario, M4T 1Z2, Canada
| | - Monique Lefebvre
- Department of Psychology and Psychosocial Oncology Program, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, K1H 8L6, Canada
| | - Mina Singh
- School of Nursing, York University, Toronto, Ontario, M3J 1P3, Canada
| | - Lori J Bernstein
- Cancer Survivorship Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2C4, Canada
| | - Linda Muraca
- Auxiliary Breast Health Program, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, M5G 1X5, Canada
| | - Aronela Benea
- After Cancer Treatment Transition Clinic, Women's College Hospital, Toronto, Ontario, M5S 1B2, Canada
| | - Lynne Jolicoeur
- Integrated Cancer Program, The Ottawa Hospital, Ottawa, Ontario, K1H 8L6, Canada
| | - Cheryl Harris
- Centre for Addition and Mental Health, CB, DB Therapy & H Therapy Centre, Toronto, Ontario, M4T 1Z2, Canada
| | | | - Sarah Ferguson
- Obstetrics and Gynecology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2M9, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, M5B 2K3, Canada
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Schumacher SG, Sohn H, Qin ZZ, Gore G, Davis JL, Denkinger CM, Pai M. Impact of Molecular Diagnostics for Tuberculosis on Patient-Important Outcomes: A Systematic Review of Study Methodologies. PLoS One 2016; 11:e0151073. [PMID: 26954678 PMCID: PMC4783056 DOI: 10.1371/journal.pone.0151073] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/23/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Several reviews on the accuracy of Tuberculosis (TB) Nucleic Acid Amplification Tests (NAATs) have been performed but the evidence on their impact on patient-important outcomes has not been systematically reviewed. Given the recent increase in research evaluating such outcomes and the growing list of TB NAATs that will reach the market over the coming years, there is a need to bring together the existing evidence on impact, rather than accuracy. We aimed to assess the approaches that have been employed to measure the impact of TB NAATs on patient-important outcomes in adults with possible pulmonary TB and/or drug-resistant TB. METHODS We first develop a conceptual framework to clarify through which mechanisms the improved technical performance of a novel TB test may lead to improved patient outcomes and outline which designs may be used to measure them. We then systematically review the literature on studies attempting to assess the impact of molecular TB diagnostics on such outcomes and provide a narrative synthesis of designs used, outcomes assessed and risk of bias across different study designs. RESULTS We found 25 eligible studies that assessed a wide range of outcomes and utilized a variety of experimental and observational study designs. Many potentially strong design options have never been used. We found that much of the available evidence on patient-important outcomes comes from a small number of settings with particular epidemiological and operational context and that confounding, time trends and incomplete outcome data receive insufficient attention. CONCLUSIONS A broader range of designs should be considered when designing studies to assess the impact of TB diagnostics on patient outcomes and more attention needs to be paid to the analysis as concerns about confounding and selection bias become relevant in addition to those on measurement that are of greatest concern in accuracy studies.
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Affiliation(s)
- Samuel G. Schumacher
- McGill University Department of Epidemiology & Biostatistics, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - Hojoon Sohn
- McGill University Department of Epidemiology & Biostatistics, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - Zhi Zhen Qin
- McGill University Department of Epidemiology & Biostatistics, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - Genevieve Gore
- McGill University, Schulich Library of Science and Engineering, Montreal, Canada
| | - J. Lucian Davis
- UCSF Pulmonary & Critical Care Medicine, San Francisco, United States of America
| | - Claudia M. Denkinger
- McGill University Department of Epidemiology & Biostatistics, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
- Beth Israel Deaconess Medical Centre, Division of Infectious Disease, Boston, MA, United States of America
| | - Madhukar Pai
- McGill University Department of Epidemiology & Biostatistics, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
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Kumamaru H, Gagne JJ, Glynn RJ, Setoguchi S, Schneeweiss S. Comparison of high-dimensional confounder summary scores in comparative studies of newly marketed medications. J Clin Epidemiol 2016; 76:200-8. [PMID: 26931292 DOI: 10.1016/j.jclinepi.2016.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 01/16/2016] [Accepted: 02/04/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare confounding adjustment by high-dimensional propensity scores (hdPSs) and historically developed high-dimensional disease risk scores (hdDRSs) in three comparative study examples of newly marketed medications: (1) dabigatran vs. warfarin on major hemorrhage; (2) on death; and (3) cyclooxygenase-2 inhibitors vs. nonselective nonsteroidal anti-inflammatory drugs on gastrointestinal bleeds. STUDY DESIGN AND SETTING In each example, we constructed a concurrent cohort of new and old drug initiators using US claims databases. In historical cohorts of old drug initiators, we developed hdDRS models including investigator-specified plus empirically identified variables and using principal component analysis and lasso regression for dimension reduction. We applied the models to the concurrent cohorts to obtain predicted outcome probabilities, which we used for confounding adjustment. We compared the resulting estimates to those from hdPS. RESULTS The crude odds ratio (OR) comparing dabigatran to warfarin was 0.52 (95% confidence interval: 0.37-0.72) for hemorrhage and 0.38 (0.26-0.55) for death. Decile stratification yielded an OR of 0.64 (0.46-0.90) for hemorrhage using hdDRS vs. 0.70 (0.49-1.02) for hdPS. ORs for death were 0.69 (0.45-1.06) and 0.73 (0.48-1.10), respectively. The relative performance of hdDRS in the cyclooxygenase-2 inhibitors example was similar. CONCLUSION hdDRS achieved similar or better confounding adjustment compared to conventional regression approach but worked slightly less well than hdPS.
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Affiliation(s)
- Hiraku Kumamaru
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street (Suite 3030), Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
| | - Joshua J Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street (Suite 3030), Boston, MA, USA
| | - Robert J Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street (Suite 3030), Boston, MA, USA
| | - Soko Setoguchi
- Duke Clinical Research Institute, Duke University, 2400 Pratt St, Durham, NC 27705, USA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street (Suite 3030), Boston, MA, USA
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Low YS, Gallego B, Shah NH. Comparing high-dimensional confounder control methods for rapid cohort studies from electronic health records. J Comp Eff Res 2015; 5:179-92. [PMID: 26634383 PMCID: PMC4933592 DOI: 10.2217/cer.15.53] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aims: Electronic health records (EHR), containing rich clinical histories of large patient populations, can provide evidence for clinical decisions when evidence from trials and literature is absent. To enable such observational studies from EHR in real time, particularly in emergencies, rapid confounder control methods that can handle numerous variables and adjust for biases are imperative. This study compares the performance of 18 automatic confounder control methods. Methods: Methods include propensity scores, direct adjustment by machine learning, similarity matching and resampling in two simulated and one real-world EHR datasets. Results & conclusions: Direct adjustment by lasso regression and ensemble models involving multiple resamples have performance comparable to expert-based propensity scores and thus, may help provide real-time EHR-based evidence for timely clinical decisions.
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Affiliation(s)
- Yen Sia Low
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, CA 94305, USA
| | - Blanca Gallego
- Center for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Nigam Haresh Shah
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, CA 94305, USA
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Tagami T, Matsui H, Fushimi K, Yasunaga H. Intravenous immunoglobulin use in septic shock patients after emergency laparotomy. J Infect 2015; 71:158-66. [PMID: 25869539 DOI: 10.1016/j.jinf.2015.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/18/2015] [Accepted: 04/03/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The role of intravenous immunoglobulin (IVIG) as an adjunctive treatment for abdominal sepsis remains controversial. METHODS Mechanically ventilated septic shock patients following emergency laparotomy for perforation of the lower intestinal tract were identified in the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2013. The effect of IVIG use on 28-day mortality was evaluated using propensity score and instrumental variable analyses. RESULTS Eligible patients (n = 4919) treated at 845 hospitals were divided into IVIG (n = 2085) and control (n = 2834) groups. Propensity score matching created a matched cohort of 1081pairs with and without IVIG treatment. Although significant mortality differences existed between the IVIG and control groups in the unmatched analysis (20.6% vs. 18.3%; difference, 2.3%; 95% confidence interval [CI], 0.07-4.5), there were no significant differences in the propensity score-matched analysis (20.4% vs. 19.3%; difference, 1.1%; 95% CI, -2.3-4.5). Analysis employing the pattern of hospital IVIG use as an instrumental variable showed that IVIG use was not associated with reduced mortality (difference -2.5; 95% CI, -6.5-1.6). CONCLUSIONS There may be no significant association between IVIG use and mortality in mechanically ventilated septic shock patients after emergency laparotomy.
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Affiliation(s)
- Takashi Tagami
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8555, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8555, Japan.
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Tokyo Medical and Dental University, Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8555, Japan.
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Tagami T, Matsui H, Fushimi K, Yasunaga H. Use of recombinant human soluble thrombomodulin in patients with sepsis-induced disseminated intravascular coagulation after intestinal perforation. Front Med (Lausanne) 2015; 2:7. [PMID: 25767801 PMCID: PMC4341430 DOI: 10.3389/fmed.2015.00007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 02/08/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Anticoagulant therapy has been evaluated with respect to its potential usefulness in reducing the high mortality rates associated with severe sepsis, including sepsis-induced disseminated intravascular coagulation (DIC) after intestinal perforation. We examined the hypothesis that recombinant human soluble thrombomodulin (rhTM) is effective in the treatment of patients with septic shock with sepsis-induced DIC after laparotomy for intestinal perforation. METHODS We performed propensity-score and instrumental variable analyses of the Japanese Diagnosis Procedure Combination in-patient database, a nationwide administrative database. The main outcome was 28-day in-hospital all-cause mortality. RESULTS We categorized eligible patients (n = 2202) from 622 hospitals into the rhTM group (n = 726) and control group (n = 1476). Propensity-score matching created 621 matched pairs of patients with and without rhTM. There was neither significant difference in 28-day mortality between the two groups in the unmatched analysis (rhTM vs. control, 25.3 vs. 23.4%, respectively; difference, 1.9%; 95% CI, -1.9 to 5.7) nor in the propensity-score-matched analysis (rhTM vs. control, 26.1 vs. 24.8%, respectively; difference, 1.3%; 95% CI, -3.6 to 6.1). The logistic analysis showed no significant association between the use of rhTM and the mortality in propensity-score-matched patients (OR, 1.1; 95% CI, 0.82-1.4). The instrumental variable analyses, using the hospital rhTM-prescribing proportion as the variable, found that receipt of rhTM was not associated with the reduction in the mortality (risk difference, -6.7%; 95% CI, -16.4 to 3.0). CONCLUSION We found no association between administration of rhTM and 28-day mortality in mechanically ventilated patients with septic shock and concurrent DIC after intestinal perforation.
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Affiliation(s)
- Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Tagami T, Matsui H, Horiguchi H, Fushimi K, Yasunaga H. Recombinant human soluble thrombomodulin and mortality in severe pneumonia patients with sepsis-associated disseminated intravascular coagulation: an observational nationwide study. J Thromb Haemost 2015; 13:31-40. [PMID: 25393713 DOI: 10.1111/jth.12786] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/06/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND The association between recombinant human soluble thrombomodulin (rhTM) use and mortality in patients with sepsis-associated disseminated intravascular coagulation (DIC) remains controversial. OBJECTIVES To examine the hypothesis that rhTM could be effective in the treatment of patients with sepsis-associated DIC following severe pneumonia. METHODS Propensity score and instrumental variable analyses using a nationwide administrative database, the Japanese Diagnosis Procedure Combination inpatient database, were used. The main outcome was 28-day in-hospital all-cause mortality. RESULTS Eligible patients (n = 6342) from 936 hospitals were categorized into the rhTM group (n = 1280) or control group (n = 5062). Propensity score matching created a matched cohort of 1140 pairs with and without rhTM. No significant difference in 28-day mortality was documented between the two groups in the unmatched analysis (rhTM vs. control, 37.0%, 474/1280 vs. 36.9%, 1866/5062; odds ratio [OR], 1.00; 95%CI, 0.98-1.03), nor in the propensity-matched analysis (37.6%, 429/1140 vs. 37.0%, 886/1140; OR, 1.01; 95%CI, 0.93-1.10). The logistic regression analysis did not show a significant association between the use of rhTM and 28-day mortality in propensity-matched patients (OR, 1.00; 95%CI, 0.87-1.22). An analysis using the hospital rhTM-prescribing rate as an instrumental variable found that receipt of rhTM was not associated with reduction in mortality at 28 days (risk difference, 0.008; 95% CI, -0.08-0.98). CONCLUSIONS This large retrospective nationwide study demonstrated that there might be little association between the use of rhTM and mortality in severe pneumonia patients with sepsis-associated DIC. A multinational randomized trial is required to confirm this.
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Affiliation(s)
- T Tagami
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
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