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Muchadeyi MT, Hernandez-Villafuerte K, Schlander M. Quality appraisal for systematic literature reviews of health state utility values: a descriptive analysis. BMC Med Res Methodol 2022; 22:303. [PMID: 36434521 PMCID: PMC9700894 DOI: 10.1186/s12874-022-01784-6] [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] [Received: 04/24/2022] [Accepted: 11/04/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Health state utility values (HSUVs) are an essential input parameter to cost-utility analysis (CUA). Systematic literature reviews (SLRs) provide summarized information for selecting utility values from an increasing number of primary studies eliciting HSUVs. Quality appraisal (QA) of such SLRs is an important process towards the credibility of HSUVs estimates; yet, authors often overlook this crucial process. A scientifically developed and widely accepted QA tool for this purpose is lacking and warranted. OBJECTIVES To comprehensively describe the nature of QA in published SRLs of studies eliciting HSUVs and generate a list of commonly used items. METHODS A comprehensive literature search was conducted in PubMed and Embase from 01.01.2015 to 15.05.2021. SLRs of empirical studies eliciting HSUVs that were published in English were included. We extracted descriptive data, which included QA tools checklists or good practice recommendations used or cited, items used, and the methods of incorporating QA results into study findings. Descriptive statistics (frequencies of use and occurrences of items, acceptance and counterfactual acceptance rates) were computed and a comprehensive list of QA items was generated. RESULTS A total of 73 SLRs were included, comprising 93 items and 35 QA tools and good recommendation practices. The prevalence of QA was 55% (40/73). Recommendations by NICE and ISPOR guidelines appeared in 42% (16/40) of the SLRs that appraised quality. The most commonly used QA items in SLRs were response rates (27/40), statistical analysis (22/40), sample size (21/40) and loss of follow up (21/40). Yet, the most commonly featured items in QA tools and GPRs were statistical analysis (23/35), confounding or baseline equivalency (20/35), and blinding (14/35). Only 5% of the SLRS used QA to inform the data analysis, with acceptance rates of 100% (in two studies) 67%, 53% and 33%. The mean counterfactual acceptance rate was 55% (median 53% and IQR 56%). CONCLUSIONS There is a considerably low prevalence of QA in the SLRs of HSUVs. Also, there is a wide variation in the QA dimensions and items included in both SLRs and extracted tools. This underscores the need for a scientifically developed QA tool for multi-variable primary studies of HSUVs.
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Affiliation(s)
- Muchandifunga Trust Muchadeyi
- grid.7497.d0000 0004 0492 0584Division of Health Economics, German Cancer Research Center (DKFZ), Foundation Under Public Law, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany ,grid.7700.00000 0001 2190 4373Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Karla Hernandez-Villafuerte
- grid.7497.d0000 0004 0492 0584Division of Health Economics, German Cancer Research Center (DKFZ), Foundation Under Public Law, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany ,Health Economics, WifOR institute, Rheinstraße 22, Darmstadt, 64283 Germany
| | - Michael Schlander
- grid.7497.d0000 0004 0492 0584Division of Health Economics, German Cancer Research Center (DKFZ), Foundation Under Public Law, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany ,grid.7700.00000 0001 2190 4373Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany ,grid.7700.00000 0001 2190 4373Alfred Weber Institute for Economics (AWI), University of Heidelberg, Heidelberg, Germany
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Erre GL, Bassu S, Giordo R, Mangoni AA, Carru C, Pintus G, Zinellu A. Association between Paraoxonase/Arylesterase Activity of Serum PON-1 Enzyme and Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Antioxidants (Basel) 2022; 11:antiox11122317. [PMID: 36552525 PMCID: PMC9774899 DOI: 10.3390/antiox11122317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/14/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background: A decrease in serum paraoxonase (PON-1) and arylesterase (ARE) activity has been reported in rheumatoid arthritis (RA) patients and linked to chronic inflammation and impaired antioxidant defense. Methods: A systematic review and meta-analysis were performed to critically appraise the current evidence on plasma/serum concentrations of PON-1 and ARE activity in RA patients and healthy controls. The Web of Science, PubMed, Scopus, and Google Scholar databases were searched from inception to November 2021. We used random-effects meta-analysis. The risk of bias was estimated using the Joanna Briggs Institute Critical Appraisal Checklist tool. The certainty of the evidence was assessed with GRADE. The study complied with the PRISMA statements and was registered in PROSPERO (CRD42022345380). Results: Seventeen studies reported PON-1 activity (1144 RA patients, 797 controls) and ten reported ARE activity (1367 RA patients, 1037 controls). RA patients had significantly lower PON-1 (SMD = −1.32, 95% CI −1.94 to −0.70; p < 0.001) and ARE activity (SMD = −0.91, 95% CI −1.37 to −0.46; p < 0.001). There was substantial heterogeneity (PON, I2 97%; ARE, 95.7%, p < 0.001 for both). There was no publication bias. The pooled SMD values did not significantly change after sensitivity analysis. The certainty of the evidence was very low due to the observational nature of the studies and the large heterogeneity. Conclusion: Our meta-analysis has shown that both serum PON-1 and ARE activity are significantly lower in RA patients, suggesting a deficit in antioxidant defense mechanisms in this disease.
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Affiliation(s)
- Gian Luca Erre
- Dipartimento di Medicina, Chirurgia e Farmacia, Università degli Studi di Sassari, Viale San Pietro, 8, 07100 Sassari, Italy
- Correspondence: ; Tel.: +39-079228317; Fax: +39-079216282
| | - Stefania Bassu
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, 07100 Sassari, Italy
| | - Roberta Giordo
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai P.O. Box 505055, United Arab Emirates
| | - Arduino A. Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Flinders Drive, Bedford Park, SA 5042, Australia
| | - Ciriaco Carru
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, 07100 Sassari, Italy
| | - Gianfranco Pintus
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, 07100 Sassari, Italy
| | - Angelo Zinellu
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, 07100 Sassari, Italy
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Bassu S, Mangoni AA, Argiolas D, Carru C, Pirina P, Fois AG, Zinellu A. A systematic review and meta-analysis of paraoxonase-1 activity in asthma. Clin Exp Med 2022:10.1007/s10238-022-00930-0. [PMID: 36344783 PMCID: PMC10390600 DOI: 10.1007/s10238-022-00930-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/15/2022] [Indexed: 11/09/2022]
Abstract
AbstractHuman serum paraoxonase-1 (PON-1) is a critical antioxidant defence system against lipid oxidation. Decreased PON-1 activity has been associated with systemic oxidative stress in several disease states. We conducted a systematic review and meta-analysis of plasma/serum concentrations of PON-1 in asthma, a chronic inflammatory airway disease. The electronic databases PubMed, Web of Science, Scopus and Google Scholar were searched from inception to February 2022. In total, 8 studies in 355 asthmatic patients and 289 healthy controls were included in the meta-analysis. Serum PON-1 concentrations were significantly lower in asthmatic patients (SMD = −1.58, 95% CI −2.53 to −0.63; p = 0.001). The pooled SMD values were not substantially altered in sensitivity analysis. There was no publication bias. There were non-significant differences in PON-1 concentrations in patients with severe vs. mild-to-moderate asthma (SMD = − 0.39, 95% CI − 1.00 to 0.22, p = 0.21). Our meta-analysis has shown that serum PON-1 concentrations are significantly lower in patients with asthma, suggesting the presence of an impaired antioxidant defense in this group.
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Leth MF, Bukhari S, Laursen CCW, Larsen ME, Tornøe AS, Jakobsen JC, Maagaard M, Mathiesen O. Risk of serious adverse events associated with non-steroidal anti-inflammatory drugs in orthopaedic surgery. A protocol for a systematic review. Acta Anaesthesiol Scand 2022; 66:1257-1265. [PMID: 35986625 PMCID: PMC9826397 DOI: 10.1111/aas.14140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Postoperative pain is a common condition following orthopaedic surgeries and causes prolonged hospitalisation, delayed rehabilitation and hamper the quality of life. Non-steroidal anti-inflammatory drugs (NSAIDs) are effective analgesics and anti-inflammatory mediators in the treatment of postoperative pain. The association of NSAIDs with serious adverse events may however keep some clinicians and clinical decision makers from using NSAIDs perioperatively. The evidence regarding the risks of serious adverse events following perioperative use of NSAIDs in orthopaedic surgery is sparse and needs to be assessed in a systematic review. This is a protocol for a systematic review that aims to identify the risks of serious adverse events from perioperative use of NSAIDs in orthopaedic patients. METHODS Our methodology is based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and the eight-step assessment procedure suggested by Jakobsen and colleagues. We wish to assess if NSAIDs versus placebo, usual care or no intervention, will influence the risks of serious adverse events in patients undergoing orthopaedic surgery. We will include all randomised trials assessing the use of NSAIDs perioperatively. To identify trials we will search the Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Cochrane Central Register, Science Citation Index Expanded on Web of Science and BIOSIS. Two authors will screen the literature and extract data. We will use the 'Risk of Bias 2 tool' to assess trials. Extracted data will be analysed using RStudio and Trial Sequential Analysis. We will create a 'Summary of Findings' table in which we will present our primary and secondary outcomes. We will assess the quality of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). DISCUSSION This systematic review can potentially aid clinicians and clinical decision makers in the use of NSAIDs for treatment of postoperative pain following orthopaedic surgeries.
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Affiliation(s)
- Morten Fiil Leth
- Centre for Anaesthesiological Research, Department of AnaesthesiologyZealand University HospitalKøgeDenmark
| | - Shaheer Bukhari
- Centre for Anaesthesiological Research, Department of AnaesthesiologyZealand University HospitalKøgeDenmark
| | | | - Mia Esta Larsen
- Department of AnaesthesiologyJuliane Marie Centre ‐ RigshospitaletCopenhagenDenmark
| | | | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812Copenhagen University Hospital – RigshospitaletCopenhagenDenmark,Department of Regional Health Research, Faculty of Health SciencesUniversity of Southern DenmarkOdenseDenmark
| | - Mathias Maagaard
- Centre for Anaesthesiological Research, Department of AnaesthesiologyZealand University HospitalKøgeDenmark
| | - Ole Mathiesen
- Centre for Anaesthesiological Research, Department of AnaesthesiologyZealand University HospitalKøgeDenmark,Department of Clinical MedicineCopenhagen UniversityCopenhagenDenmark
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Choudhary D, Thomas M, Pacheco-Barrios K, Zhang Y, Alonso-Coello P, Schünemann H, Hazlewood G. Methods to Summarize Discrete-Choice Experiments in a Systematic Review: A Scoping Review. THE PATIENT 2022; 15:629-639. [PMID: 35829927 DOI: 10.1007/s40271-022-00587-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Systematic reviews of discrete-choice experiments (DCEs) are being increasingly conducted. The objective of this scoping review was to identify and describe the methodologies that have been used to summarize results across DCEs. METHODS We searched the electronic databases MEDLINE and EMBASE from inception to March 18, 2021, to identify English-language systematic reviews of patient preferences that included at least two DCEs and extracted data on attribute importance. The methods used to summarize results across DCEs were classified into narrative, semi-quantitative, and quantitative (meta-analytic) approaches and compared. Approaches to characterize the extent of preference heterogeneity were also described. RESULTS From 7362 unique records, we identified 54 eligible reviews from 2010 to Mar 2021, across a broad range of health conditions. Most (83%) used a narrative approach to summarize findings of DCEs, often citing differences in studies as the reason for not formally pooling findings. Semi-quantitative approaches included summarizing the frequency of the most important attributes, the frequency of attribute statistical significance, or tabulated comparisons of attribute importance for each pair of attributes. One review conducted a meta-analysis using the maximum acceptable risk. While reviews often commented on the heterogeneity of patient preferences, few (6%) addressed this systematically across studies. CONCLUSION While not commonly used, several semi-quantitative and one quantitative approach for synthesizing results of DCEs were identified, which may be useful for generating summary estimates across DCEs when appropriate. Further work is needed to assess the validity and usefulness of these approaches.
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Affiliation(s)
- Daksh Choudhary
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Megan Thomas
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA, USA
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Sintesis de Evidencias en Salud, Lima, Peru
| | - Yuan Zhang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Pablo Alonso-Coello
- Instituto de Investigación Biomédica (IIB Sant Pau), Centro Cochrane Iberoamericano, Barcelona, Spain
| | - Holger Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Glen Hazlewood
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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Bennett A, Beck A, Shaver N, Grad R, LeBlanc A, Limburg H, Gray C, Abou-Setta A, Klarenbach S, Persaud N, Thériault G, Thombs BD, Todd KJ, Bell N, Dahm P, Loblaw A, Del Giudice L, Yao X, Skidmore B, Rolland-Harris E, Brouwers M, Little J, Moher D. Screening for prostate cancer: protocol for updating multiple systematic reviews to inform a Canadian Task Force on Preventive Health Care guideline update. Syst Rev 2022; 11:230. [PMID: 36289518 PMCID: PMC9609189 DOI: 10.1186/s13643-022-02099-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To inform updated recommendations by the Canadian Task Force on Preventive Health Care on screening for prostate cancer in adults aged 18 years and older in primary care. This protocol outlines the planned scope and methods for a series of systematic reviews. METHODS Updates of two systematic reviews and a de novo review will be conducted to synthesize the evidence on the benefits and harms of screening for prostate cancer with a prostate-specific antigen (PSA) and/or digital rectal examination (DRE) (with or without additional information) and patient values and preferences. Outcomes for the benefits of screening include reduced prostate cancer mortality, all-cause mortality, and incidence of metastatic prostate cancer. Outcomes for the harms of screening include false-positive screening tests, overdiagnosis, complications due to biopsy, and complications of treatment including incontinence (urinary or bowel), and erectile dysfunction. The quality of life or functioning (overall and disease-specific) and psychological effects outcomes are considered as a possible benefit or harm. Outcomes for the values and preferences review include quantitative or qualitative information regarding the choice to screen or intention to undergo screening. For the reviews on benefits or harms, we will search for randomized controlled trials, quasi-randomized, and controlled studies in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. For the review on values and preferences, we will search for experimental or observational studies in MEDLINE, Embase, and PsycInfo. For all reviews, we will also search websites of relevant organizations, gray literature, and reference lists of included studies. Title and abstract screening, full-text review, data extraction, and risk of bias assessments will be completed independently by pairs of reviewers with any disagreements resolved by consensus or by consulting with a third reviewer. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach will be used to assess the certainty of the evidence for each outcome. DISCUSSION The series of systematic reviews will be used by the Canadian Task Force on Preventive Health Care to update their 2014 guideline on screening for prostate cancer in adults aged 18 years and older. Systematic review registration This review has been registered with PROSPERO (CRD42022314407) and is available on the Open Science Framework (osf.io/dm32k).
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Affiliation(s)
- Alexandria Bennett
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Andrew Beck
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicole Shaver
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Roland Grad
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Allana LeBlanc
- Global Health and Guidelines Division, Public Health Agency of Canada, Ottawa, Canada
| | - Heather Limburg
- Global Health and Guidelines Division, Public Health Agency of Canada, Ottawa, Canada
| | - Casey Gray
- Global Health and Guidelines Division, Public Health Agency of Canada, Ottawa, Canada
| | - Ahmed Abou-Setta
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott Klarenbach
- Department of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Navindra Persaud
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Guylène Thériault
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Brett D Thombs
- Lady Davis Institute of the Jewish General Hospital and Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Keith J Todd
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Neil Bell
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Philipp Dahm
- Urology Section, Minneapolis VA Healthcare System and Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew Loblaw
- Evaluative Clinical Sciences, Odette Cancer Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Del Giudice
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Xiaomei Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | | | - Melissa Brouwers
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Julian Little
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Moher
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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León-García M, Humphries B, Maraboto A, Rabassa M, Boehmer KR, Perestelo-Perez L, Xie F, Pelayo I, Eckman M, Bates S, Selva A, Alonso-Coello P. Women's values and preferences on low-molecular-weight heparin and pregnancy: a mixed-methods systematic review. BMC Pregnancy Childbirth 2022; 22:747. [PMID: 36199014 PMCID: PMC9533610 DOI: 10.1186/s12884-022-05042-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/09/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) in pregnancy is an important cause of maternal morbidity and mortality. Low-molecular-weight heparin (LMWH) is the cornerstone of prophylaxis and treatment of thrombotic events during pregnancy. LMWH has fewer adverse effects than other anticoagulants, does not cross the placenta, and is safe for the fetus. However, the use of LMWH during pregnancy is sensitive to womens' underlying preferences. The objective of this review is to systematically assess women's values and preferences research evidence on this topic. METHODS We searched four electronic databases from inception to March 2022, and included studies examining values and preferences of using LMWH among pregnant women at risk of VTE. We followed a convergent integrated mixed-methods design to compare and contrast quantitative outcomes (utility and non-utility measures) and qualitative findings. We assessed the certainty of the values and preferences evidence with the GRADE approach for quantitative findings, and with GRADE-CERqual for qualitative evidence. Results were presented in a conjoint display. RESULTS We screened 3,393 references and identified seven eligible studies. The mixed methods analysis resulted in four themes. Datasets confirmed each other in that: 1) the majority of women consider that benefits of treatment outweigh the inconveniences of daily injections; and 2) main concerns around medication are safety and injections administration. Quantitative outcomes expanded on the qualitative findings in that: 3) participants who perceived a higher risk of VTE were more willing to take LMWH. Finally, we found a discrepancy between the datasets around: 4) the amount of information preferred to make the decision; however, qualitative data expanded to clarify that women prefer making informed decisions and receive support from their clinician in their decision-making process. CONCLUSIONS We are moderately confident that in the context of pregnancy, using LMWH is preferred by women given its net beneficial balance. Integrating data from different sources of evidence, and representing them in a jointly manner helps to identify patient's values and preferences. Our results may inform clinical practice guidelines and support shared decision-making process in the clinical encounter for the management of VTE in the context of pregnancy.
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Affiliation(s)
- Montserrat León-García
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
- Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain.
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Brittany Humphries
- Cytel Inc, Toronto, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Andrea Maraboto
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Lilisbeth Perestelo-Perez
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
- Research Network On Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Irene Pelayo
- Department of Obstetrics and Gynecology, Ramón y Cajal Hospital, Madrid, Spain
- Faculty of Medicine, Alcalá de Henares University, Madrid, Spain
| | - Mark Eckman
- Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Shannon Bates
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Anna Selva
- Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
- Clinical Epidemiology and Cancer Screening, Corporació Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
| | - Pablo Alonso-Coello
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain
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Dambi JM, Cowan FM, Martin F, Sibanda S, Simms V, Willis N, Bernays S, Mavhu W. Conceptualisation and psychometric evaluation of positive psychological outcome measures used in adolescents and young adults living with HIV: a mixed scoping and systematic review protocol. BMJ Open 2022; 12:e066129. [PMID: 36130750 PMCID: PMC9494580 DOI: 10.1136/bmjopen-2022-066129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Sub-Saharan Africa bears the greatest burden of HIV. Concomitant mental disorders are common, necessitating the integration of mental healthcare into routine HIV care. Consequently, it is necessary to holistically evaluate the mental health of adolescents and young adults living with HIV (AYALHIV, 10-24 years old) by measuring negative and positive psychological constructs (eg, anxiety and self-acceptance, respectively). There has been a proliferation of positive psychological outcome measures, but the evidence of their psychometric robustness is fragmented. This review, therefore, seeks to (1) identify positive psychological outcomes used in AYALHIV in sub-Saharan Africa and map the constructs onto corresponding measures and (2) critically appraise the psychometrics of the identified outcomes METHODS AND ANALYSIS: This mixed review will be done in two parts. First, a scoping review will identify positive psychological outcomes and map them onto corresponding outcome measures. Subsequently, we will systematically evaluate the psychometric properties of the outcomes identified from the scoping review. Independent and blinded reviewers will search articles in PubMed, Scopus, Web of Science, Africa-Wide Information, CINAHL, PsychINFO and Google Scholar from inception through 30 September 2022. Thereafter, separate independent reviewers will screen the retrieved articles. We will apply a narrative synthesis to map the key constructs emerging from the scoping review. For the systematic review, the risk of bias across studies will be evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. The quality of the psychometric properties will be rated using the COSMIN checklist and qualitatively synthesised using the modified Grading of Recommendations Assessment, Development and Evaluation checklist. ETHICS AND DISSEMINATION No ethical approvals are needed. The mixed-review outputs will collectively inform the development, implementation and evaluation of bespoke interventions for AYALHIV. Review outcomes will be disseminated in a peer-reviewed journal, on social media and through policy briefs. PROSPERO REGISTRATION CRD42022325172.
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Affiliation(s)
- Jermaine M Dambi
- Primary Healthcare Sciences, University of Zimbabwe Faculty of Medicine, Harare, Zimbabwe
| | - Frances M Cowan
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Faith Martin
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK
| | - Sharon Sibanda
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
| | - Victoria Simms
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Sarah Bernays
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Webster Mavhu
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Xie Z, Chen J, Or CK. Consumers’ Willingness to Pay for eHealth and Its Influencing Factors: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e25959. [PMID: 36103227 PMCID: PMC9520394 DOI: 10.2196/25959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 06/15/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite the great potential of eHealth, substantial costs are involved in its implementation, and it is essential to know whether these costs can be justified by its benefits. Such needs have led to an increased interest in measuring the benefits of eHealth, especially using the willingness to pay (WTP) metric as an accurate proxy for consumers’ perceived benefits of eHealth. This offered us an opportunity to systematically review and synthesize evidence from the literature to better understand WTP for eHealth and its influencing factors. Objective This study aimed to provide a systematic review of WTP for eHealth and its influencing factors. Methods This study was performed and reported as per the Cochrane Collaboration and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, CINAHL Plus, Cochrane Library, EconLit, and PsycINFO databases were searched from their inception to April 19, 2022. We conducted random-effects meta-analyses to calculate WTP values for eHealth (at 2021 US dollar rates) and meta-regression analyses to examine the factors affecting WTP. Results A total of 30 articles representing 35 studies were included in the review. We found that WTP for eHealth varied across studies; when expressed as a 1-time payment, it ranged from US $0.88 to US $191.84, and when expressed as a monthly payment, it ranged from US $5.25 to US $45.64. Meta-regression analyses showed that WTP for eHealth was negatively associated with the percentages of women (β=−.76; P<.001) and positively associated with the percentages of college-educated respondents (β=.63; P<.001) and a country’s gross domestic product per capita (multiples of US $1000; β=.03; P<.001). Compared with eHealth provided through websites, people reported a lower WTP for eHealth provided through asynchronous communication (β=−1.43; P<.001) and a higher WTP for eHealth provided through medical devices (β=.66; P<.001), health apps (β=.25; P=.01), and synchronous communication (β=.58; P<.001). As for the methods used to measure WTP, single-bounded dichotomous choice (β=2.13; P<.001), double-bounded dichotomous choice (β=2.20; P<.001), and payment scale (β=1.11; P<.001) were shown to obtain higher WTP values than the open-ended format. Compared with ex ante evaluations, ex post evaluations were shown to obtain lower WTP values (β=−.37; P<.001). Conclusions WTP for eHealth varied significantly depending on the study population, modality used to provide eHealth, and methods used to measure it. WTP for eHealth was lower among certain population segments, suggesting that these segments may be at a disadvantage in terms of accessing and benefiting from eHealth. We also identified the modalities of eHealth that were highly valued by consumers and offered suggestions for the design of eHealth interventions. In addition, we found that different methods of measuring WTP led to significantly different WTP estimates, highlighting the need to undertake further methodological explorations of approaches to elicit WTP values.
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Affiliation(s)
- Zhenzhen Xie
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Jiayin Chen
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Calvin Kalun Or
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China (Hong Kong)
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Matthews D, Cancino EE, Falla D, Khatibi A. Exploring pain interference with motor skill learning in humans: A systematic review. PLoS One 2022; 17:e0274403. [PMID: 36099284 PMCID: PMC9470002 DOI: 10.1371/journal.pone.0274403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/26/2022] [Indexed: 11/20/2022] Open
Abstract
Motor learning underpins successful motor skill acquisition. Although it is well known that pain changes the way we move, it’s impact on motor learning is less clear. The aim of this systematic review was to synthesize evidence on the impact of experimental and clinical pain on task performance and activity-dependent plasticity measures across learning and explore these findings in relation to different pain and motor learning paradigms. Five databases were searched: Web of Science, Scopus, MEDLINE, Embase and CINAHL. Two reviewers independently screened the studies, extracted data, and assessed risk of bias using the Cochrane ROB2 and ROBIN-I. The overall strength of evidence was rated using the GRADE guidelines. Due to the heterogeneity of study methodologies a narrative synthesis was employed. Twenty studies were included in the review: fifteen experimental pain and five clinical pain studies, covering multiple motor paradigms. GRADE scores for all outcome measures suggested limited confidence in the reported effect for experimental pain and clinical pain, on motor learning. There was no impact of pain on any of the task performance measures following acquisition except for ‘accuracy’ during a tongue protrusion visuomotor task and ‘timing of errors’ during a motor adaptation locomotion task. Task performance measures at retention, and activity dependent measures at both acquisition and retention showed conflicting results. This review delivers a detailed synthesis of research studies exploring the impact of pain on motor learning. This is despite the challenges provided by the heterogeneity of motor learning paradigms, outcome measures and pain paradigms employed in these studies. The results highlight important questions for further research with the goal of strengthening the confidence of findings in this area.
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Affiliation(s)
- David Matthews
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Edith Elgueta Cancino
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ali Khatibi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
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Wei X, Guo K, Shang X, Wang S, Yang C, Li J, Li Y, Yang K, Zhang X, Li X. Effects of different interventions on smoking cessation in chronic obstructive pulmonary disease patients: A systematic review and network meta-analysis. Int J Nurs Stud 2022; 136:104362. [DOI: 10.1016/j.ijnurstu.2022.104362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 07/21/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022]
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Enhancing the evidence-based healthcare principles in clinical practice guidelines development in the Czech Republic: a best practice implementation project. INT J EVID-BASED HEA 2022; 20:S67-S75. [DOI: 10.1097/xeb.0000000000000337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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63
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GRADE Guidance article 35: Update on rating imprecision for assessing contextualized certainty of evidence and making decisions. J Clin Epidemiol 2022; 150:225-242. [DOI: 10.1016/j.jclinepi.2022.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/19/2022]
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Nurse-Led Interventions in Chronic Obstructive Pulmonary Disease Patients: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159101. [PMID: 35897469 PMCID: PMC9368558 DOI: 10.3390/ijerph19159101] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 12/10/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, causing 3.32 million deaths in 2019. COPD management has increasingly become a major component of general and hospital practice and has led to a different model of care. Nurse-led interventions have shown beneficial effects on COPD patient satisfaction and clinical outcomes. This systematic review was conducted to identify and assess nurse-led interventions in COPD patients in terms of mental, physical, and clinical status. The review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The relevance of each manuscript was assessed according to the inclusion criteria, and we retrieved full texts, as required, to reach our conclusions. Data extraction was performed independently by two reviewers, and the risk of bias was assessed using the Cochrane Risk of Bias tool. Forty-eight articles were included in the analysis, which focused on the management of COPD patients by hospital, respiratory and primary nursing care. Nursing management was shown to be highly effective in improving quality of life, emotional state, and pulmonary and physical capacity in COPD patients. In comparison, hospital and respiratory nurses carried out interventions with higher levels of effectiveness than community nurses.
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Mendez-Rebolledo G, Orozco-Chavez I, Morales-Verdugo J, Ramirez-Campillo R, Cools AM. Electromyographic analysis of the serratus anterior and upper trapezius in closed kinetic chain exercises performed on different unstable support surfaces: a systematic review and meta-analysis. PeerJ 2022; 10:e13589. [PMID: 35791364 PMCID: PMC9250763 DOI: 10.7717/peerj.13589] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/24/2022] [Indexed: 01/17/2023] Open
Abstract
Background Multiple investigations have compared the electromyographic (EMG) activity of the scapular muscles between stable and unstable support surfaces during the execution of closed kinetic chain exercises. However, these comparative analyses have grouped different unstable surfaces (wobble board, BOSU, therapeutic ball, and suspension equipment) into a single data pool, without considering the possible differences in neuromuscular demand induced by each unstable support surface. This study aimed to analyze the individual effect of different unstable support surfaces compared to a stable support surface on scapular muscles EMG activity during the execution of closed kinetic chain exercises. Methodology A literature search was conducted of the Pubmed Central, ScienceDirect and SPORTDiscus databases. Studies which investigated scapular muscles EMG during push-ups and compared at least two support surfaces were included. The risk of bias of included articles was assessed using a standardized quality assessment form for descriptive, observational and EMG studies, and the certainty of the evidence was measured with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A random-effects model was used to calculate effect sizes (ES, Hedge's g). Results Thirty studies were selected in the systematic review. Of these, twenty-three low-to-high quality studies (498 participants) were included in the meta-analysis. The main analyzes revealed, in decreasing order, greater UT EMG activity during push-ups performed on suspension equipment (ES = 2.92; p = 0.004), therapeutic ball (ES = 1.03; p < 0.001) and wobble board (ES = 0.33; p = 0.003); without effect on the BOSU ball. In addition, no effect was observed for SA on any unstable device. The certainty of the evidence ranged from low to very low due to the inclusion of descriptive studies, as well as high imprecision, inconsistency, and risk of publication bias. Conclusion These findings could be applied in scapular muscles strengthening in healthy individuals. The use of suspension equipment achieves higher UT activation levels. Conversely, the use of any type of unstable devices to increase the activation levels of the SA in shoulder musculoskeletal dysfunctions is not recommended. These conclusions should be interpreted with caution as the available evidence showed a low to very low certainty of evidence, downgraded mostly by inconsistency and imprecision.
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Affiliation(s)
| | - Ignacio Orozco-Chavez
- Departamento de Ciencias del Movimiento Humano, Facultad de Ciencias de la Salud, Universidad de Talca, Talca, Chile
| | - Juan Morales-Verdugo
- Departamento de Ciencias Preclínicas, Facultad de Medicina, Universidad Católica del Maule, Talca, Chile
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Ann M.J. Cools
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Zinellu A, Mangoni AA. Effect of statin treatment on homocysteine concentrations: an updated systematic review and meta-analysis with meta-regression. Expert Rev Clin Pharmacol 2022; 15:443-459. [PMID: 35482022 DOI: 10.1080/17512433.2022.2072293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Statins might exert atheroprotective effects through lowering the pro-atherogenic amino acid homocysteine. We conducted an updated systematic review and meta-analysis of the effect of statins on circulating homocysteine. METHODS A systematic literature search was conducted in PubMed, Web of Science, and Scopus, from inception to July 2021. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for analytical studies. Certainty of evidence was assessed using GRADE. RESULTS In 61 treatment arms in 2,218 patients (mean age 55 years, 52% males), statins significantly reduced homocysteine concentrations (weighted mean difference, WMD = -2.46 µmol/L, 95% CI -3.17 to -1.75 µmol/L, p < 0.001; high certainty of evidence). Similar results were observed in a subgroup of 10 randomized placebo-controlled studies (WMD = -2.45 µmol/L, 95% CI -4.43 to -0.47 µmol/L, p = 0.015). The extreme heterogeneity observed was virtually removed in a subgroup of 10 studies using fluorescence polarization immunoassay for homocysteine measurement. There was no publication bias. In sensitivity analysis, the pooled WMD values were not modified when individual studies were sequentially removed. In meta-regression, the WMD was significantly associated with proportion of males and publication year. CONCLUSIONS Statins significantly lower homocysteine concentrations.
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Affiliation(s)
- Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Arduino A Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia
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A systematic review and meta-analysis of homocysteine concentrations in chronic obstructive pulmonary disease. Clin Exp Med 2022:10.1007/s10238-022-00833-0. [PMID: 35513742 DOI: 10.1007/s10238-022-00833-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/15/2022] [Indexed: 11/03/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) often suffer from other conditions, such as cardiovascular disease, that further increase the risk of adverse outcomes in this group. Serum homocysteine concentrations are positively associated with cardiovascular risk and have also been reported to be increased in COPD. This meta-analysis investigated the association between homocysteine concentrations and COPD. A systematic search of publications in the electronic databases PubMed, Web of Science, Scopus, and Google Scholar, from inception to September 2021, was conducted using the following terms: "Homocysteine" or "Hcy" and "Chronic Obstructive Pulmonary Disease" or "COPD". Weighted mean differences (WMDs) were calculated to evaluate differences in homocysteine concentrations between COPD patients and non-COPD subjects. Risk of bias and certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively. Nine studies in 432 COPD patients (mean age 65 years, 65% males) and 311 controls (mean age 65 years, 56% males) were identified. Pooled results showed that serum homocysteine concentrations were significantly higher in patients with COPD (WMD = 2.91 µmol/L, 95% CI 2.00-3.82 µmol/L; p < 0.001; high certainty of evidence). No publication bias was observed. Our results support the hypothesis that increased homocysteine concentrations are significantly associated with COPD and may account, at least in part, for the increased cardiovascular risk in these patients.
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Zinellu A, Mangoni AA. A systematic review and meta-analysis of the effect of statin treatment on sVCAM-1 and sICAM-1. Expert Rev Clin Pharmacol 2022; 15:601-620. [PMID: 35485866 DOI: 10.1080/17512433.2022.2072294] [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: 11/04/2022]
Abstract
BACKGROUND AND AIMS Statins might prevent cell adhesion to the endothelium, a key step in atherosclerosis. We conducted a systematic review and meta-analysis of the effect of statins on soluble vascular (sVCAM-1) and intercellular (sICAM-1) adhesion molecule 1. METHODS A systematic literature search was conducted in PubMed, Web of Science, and Scopus, from inception to July 2021. Risk of bias and certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist for analytical studies and GRADE, respectively. RESULTS Statins significantly reduced both sVCAM-1 (standard mean difference, SMD=-0.28, 95% CI -0.44 to -0.12, p=0.001; 46 treatment arms; low certainty of evidence) and sICAM-1 (SMD=-0.75, 95% CI -1.00 to -0.50, p<0.001; 61 treatment arms; moderate certainty of evidence) concentrations. In sensitivity analysis, the SMD values were not modified when individual studies were sequentially removed. There were significant associations between SMD and publication year and, for sICAM-1, statin-induced changes in HDL-cholesterol. In subgroup analysis, the lowering effect was significant with liphophilic, but not hydrophilic, statins, and similar, for sICAM-1, in participants with or without clinically overt atherosclerosis. CONCLUSIONS Statins significantly lower sVCAM-1/sICAM-1. Prospective studies are required to determine whether this mediates their atheroprotective effects (PROSPERO registration number: CRD42021276825).
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Affiliation(s)
- Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Arduino A Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia
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Pau MC, Zinellu A, Zinellu E, Pintus G, Carru C, Fois AG, Mangoni AA, Pirina P. Paraoxonase-1 Concentrations in Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis. Antioxidants (Basel) 2022; 11:antiox11040766. [PMID: 35453451 PMCID: PMC9028830 DOI: 10.3390/antiox11040766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 02/01/2023] Open
Abstract
Obstructive sleep apnoea (OSA) is characterized by overproduction of reactive oxygen species and oxidative stress. The antioxidant enzyme paraoxonase-1 (PON-1) may be useful for monitoring the antioxidant defence systems and the effect of treatments in OSA patients. We investigated, by means of systematic review and meta-analysis, the serum concentrations of PON-1 in OSA patients and non-OSA controls. A literature search was conducted in PubMed, Web of Science, Scopus and Google Scholar databases, from the outset to November 2021, utilizing the terms: “paraoxonase” or “PON” or “paraoxonase-1” or “PON-1” and “obstructive sleep apnoea syndrome” or “OSAS” or “OSA”. Eleven studies in 429 OSA patients and 258 non-OSA controls were involved in the meta-analysis. The pooled serum PON-1 concentrations were significantly lower in OSA (standardized mean difference (SMD) = −0.70, 95% CI −1.13 to −0.28; p = 0.001). Despite the extreme between-study heterogeneity, the SMD values were not substantially affected by the sequential omission of individual studies. There was no publication bias. Our systematic review and meta-analysis supports the presence of an impaired antioxidant defence system in OSA, possibly the consequence of intermittent hypoxia. Further studies are required to determine the clinical use of PON-1 measurements for risk stratification and monitoring in OSA patients.
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Affiliation(s)
- Maria Carmina Pau
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (M.C.P.); (A.G.F.)
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (A.Z.); (G.P.); (C.C.)
| | - Elisabetta Zinellu
- Clinical and Interventional Pneumology, University Hospital Sassari (AOU), 07100 Sassari, Italy;
| | - Gianfranco Pintus
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (A.Z.); (G.P.); (C.C.)
- Department of Medical Laboratory Sciences, Sharjah Institute for Medical Research, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (A.Z.); (G.P.); (C.C.)
- Quality Control Unit, University Hospital of Sassari (AOU), Viale San Pietro, 07100 Sassari, Italy
| | - Alessandro G. Fois
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (M.C.P.); (A.G.F.)
- Clinical and Interventional Pneumology, University Hospital Sassari (AOU), 07100 Sassari, Italy;
| | - Arduino A. Mangoni
- Flinders Medical Centre, Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
| | - Pietro Pirina
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (M.C.P.); (A.G.F.)
- Clinical and Interventional Pneumology, University Hospital Sassari (AOU), 07100 Sassari, Italy;
- Correspondence:
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Bautista-Molano W, Saldarriaga-Rivera LM, Junca-Ramírez A, Fernández-Aldana AR, Fernández-Ávila DG, Jaimes DA, Jauregui EA, Segura-Charry JS, Romero-Sanchez C, Felipe-Diaz OJ. 2021 clinical practice guideline for the early detection, diagnosis, treatment, and monitoring of patients with axial spondyloarthritis. Colombian Association of Rheumatology. REUMATOLOGIA CLINICA 2022; 18:191-199. [PMID: 35305953 DOI: 10.1016/j.reumae.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/29/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Axial Spondyloarthritis is a rheumatic condition affecting young patients with social and occupational consequences. Diagnosis delay is associated with functional impairment and impact on quality of life, requiring a multidisciplinary approach. OBJECTIVE To develop a set of recommendations based on the best available evidence for early detection, diagnosis, treatment and monitoring adult patients with axial spondyloarthritis. METHODS A working group was established, questions were developed, outcomes were graded, and a systematic search for evidence was conducted. A multidisciplinary panel of members was established (including patient representatives), minimizing bias in relation to conflicts of interest. The GRADE approach "Grading of Recommendations Assessment, Development and Evaluation" was used to assess the quality of the evidence as well as the direction and strength of recommendations. In total, 11 recommendations with regard to diagnosis (n = 2), pharmacological treatment (n = 6), non-pharmacological treatment (n = 2) and monitoring (n = 1) are presented. RESULTS Sacroiliac joint radiography as the first diagnostic method, and the use of disease activity scales for patient monitoring (ASDAS or BASDAI), are recommended. Nonsteroidal anti-inflammatory drugs are the first treatment option; in case of intolerance or residual pain, acetaminophen or opioids are recommended. In patients with axial involvement, it is recommended not to use conventional disease-modifying antirheumatic drugs or systemic or local glucocorticoids. In patients with failure to non-steroidal anti-inflammatory drugs, anti-TNF or anti-IL17A is recommended. In those patients presenting with anti-TNF failure, starting an anti-IL17A is recommended. Exercise, physical and occupational therapy are recommended as part of treatment. It is recommended not to use unconventional therapies as the only treatment option. CONCLUSIONS This set of recommendations provides an updated guide on the diagnosis, treatment and monitoring of patients with axial spondyloarthritis.
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Affiliation(s)
- Wilson Bautista-Molano
- Sección de Reumatología, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad El Bosque, Bogotá, Colombia.
| | - Lina M Saldarriaga-Rivera
- Servicio de Reumatología, Hospital Universitario San Jorge, Facultad de Medicina, Universidad Tecnológica de Pereira, Institución Universitaria Visión de las Américas, Clínica Los Rosales, Pereira, Colombia
| | - Alejandro Junca-Ramírez
- Servicio de Reumatología, Colsanitas, IPS Especializada, Colombia Bienestar IPS, Bogotá, Colombia
| | | | - Daniel G Fernández-Ávila
- Servicio de Reumatología, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Diego A Jaimes
- Universidad de la Sabana, Clínicos IPS, Bogotá, Colombia
| | - Edwin A Jauregui
- Servicio de Reumatología, Riesgo de Fractura SA, Cayre IPS, Bogotá, Colombia
| | - Juan S Segura-Charry
- Servicio de Reumatología, Clínica Medilaser Neiva, Clínicos IPS, Bogotá, Colombia
| | - Consuelo Romero-Sanchez
- Servicio de Reumatología e Inmunología, Hospital Militar Central, Grupo Inmunología Celular y Molecular, Universidad del Bosque, Bogotá, Colombia
| | - Oscar J Felipe-Diaz
- Servicio de Reumatología, Medicarte SA, Clínica Las Vegas, Medellín, Colombia
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McLaughlin EC, Bartley J, Ashe MC, Butt DA, Chilibeck PD, Wark JD, Thabane L, Stapleton J, Giangregorio LM. The effects of Pilates on health-related outcomes in individuals with increased risk of fracture: a systematic review. Appl Physiol Nutr Metab 2022; 47:369-378. [PMID: 35080990 DOI: 10.1139/apnm-2021-0462] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This systematic review examined the effect of Pilates on health-related outcomes in individuals with increased fracture risk to inform the 2021 Clinical Practice Guidelines for Management of Osteoporosis and Fracture Prevention in Canada. Seven electronic databases were searched to December 2020. Studies of Pilates in men and postmenopausal women aged ≥50 years with low bone mineral density (BMD), history of fragility fracture, or moderate-high risk of fragility fracture were included. Two reviewers independently screened studies and performed risk of bias assessment. Of 7286 records and 504 full-text articles, 5 studies were included, encompassing data from 143 participants (99% female). Data were insufficient for meta-analyses. There is low-certainty evidence that Pilates improved physical functioning and health-related quality of life. The effect of Pilates on falls and BMD is uncertain. No evidence was available for the effect of Pilates on mortality, fractures, or adverse events. Overall, Pilates may improve physical functioning and quality of life. Evidence of benefits relative to harms of Pilates in people with increased fracture risk, particularly males, is limited. PROSPERO registration: CRD42019122685. Novelty: Pilates may improve physical functioning and quality of life in women with osteoporosis. Evidence of the effect of Pilates on BMD, falls, fractures, or adverse events is limited.
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Affiliation(s)
| | - Joan Bartley
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, Toronto, ON M3C 3G8, Canada
| | - Maureen C Ashe
- Department of Family Practice, The University of British Columbia, Vancouver, BC V5Z 1M0, Canada
| | - Debra A Butt
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Philip D Chilibeck
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5A2, Canada
| | - John D Wark
- University of Melbourne Department of Medicine, Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Jackie Stapleton
- University of Waterloo Library, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Lora M Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, ON N2L 3G1, Canada.,Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, ON N2J 0E2, Canada
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GRADE summary of findings tables Enhanced Understanding of Values and Preferences Evidence. J Clin Epidemiol 2022; 147:60-68. [PMID: 35364232 DOI: 10.1016/j.jclinepi.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/08/2022] [Accepted: 03/20/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We conceptualize patient values and preferences as the relative importance of health outcomes (RIO) which are often obtained through utility elicitation research. A transparent and structured approach to present synthesized RIO evidence and the certainty of this evidence is needed. This study aims to adapt the summary of findings (SoF) table to describe the RIO. STUDY DESIGN AND SETTING We performed three interactive workshops with a protype version of the SoF table for RIO evidence adapted from the SoF table for intervention effects. We then tested the new format through semi-structured interviews with professionals who interpret RIO evidence (e.g., systematic review authors and guideline developers). RESULTS We adapted the SoF table for the presentation of RIO evidence. This SoF table may be easy to use but bears one risk: some participants misunderstood the utility information and the variability around the RIO. We added a visual analogue scale to clarify the concept of utilities. CONCLUSION Through a multi-stage process including brainstorming sessions and interviews, we adapted the SoF table to present RIO evidence. This table may enhance understanding of evidence synthesis of values and preferences, facilitating the incorporation of this type of evidence in decision making.
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Bassu S, Mangoni AA, Satta R, Argiolas D, Carru C, Zinellu A. Paraoxonase and arylesterase activity of serum PON-1 enzyme in psoriatic patients: a systematic review and meta-analysis. Clin Exp Med 2022; 23:301-311. [PMID: 35313365 DOI: 10.1007/s10238-022-00818-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/28/2022] [Indexed: 11/30/2022]
Abstract
Human serum paraoxonase-1 (PON-1) is a critical antioxidant defense system against lipid oxidation. Decreased PON-1 activity has been associated with systemic oxidative stress in several disease states. We conducted a systematic review and meta-analysis of plasma/serum concentrations of PON-1 paraoxonase and arylesterase activity in psoriasis, a chronic immune-mediated and inflammatory skin disease. The electronic databases PubMed, Web of Science, and Scopus were searched from inception to November 2021. In total, 14 studies in 691 psoriatic patients and 724 healthy controls were included in the meta-analysis. Serum paraoxonase activity was significantly lower in psoriatic patients (SMD = - 2.30, 95% CI - 3.17 to - 1.42; p < 0.001); however, no significant between-group differences were observed in serum arylesterase activity (SMD = - 0.34, 95% CI - 0.11 to 0.80; p = 0.14). The pooled SMD values were not substantially altered in sensitivity analysis. There was no publication bias. In conclusion, our meta-analysis has shown that serum paraoxonase, but not arylesterase, activity is significantly lower in psoriasis, suggesting an impaired antioxidant defense in these patients.
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Affiliation(s)
- Stefania Bassu
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy.
| | - Arduino A Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Rosanna Satta
- Department of Clinical, Surgical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Dario Argiolas
- Department of Clinical, Surgical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
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Zhang YQ, Lu L, Xu N, Tang X, Shi X, Carrasco-Labra A, Schünemann H, Chen Y, Xia J, Chen G, Liu J, Liu B, Wang J, Qaseem A, Jing X, Guyatt G, Zhao H. Increasing the usefulness of acupuncture guideline recommendations. BMJ 2022; 376:e070533. [PMID: 35217506 PMCID: PMC8868046 DOI: 10.1136/bmj-2022-070533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Yu-Qing Zhang and colleagues examine the progress and pitfalls in guideline recommendations for acupuncture and provide suggestions for improvement
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Affiliation(s)
- Yu-Qing Zhang
- CEBIM (Center for Evidence Based Integrative Medicine)-Clarity Collaboration, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- Nottingham Ningbo GRADE Centre, University of Nottingham Ningbo, China
| | - Liming Lu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Nenggui Xu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaorong Tang
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoshuang Shi
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Alonso Carrasco-Labra
- Center for Integrative Global Oral Health, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Holger Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yaolong Chen
- Institute of Health Data Science, Lanzhou University, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China]
| | - Jun Xia
- Nottingham Ningbo GRADE Centre, University of Nottingham Ningbo, China
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK
| | - Guang Chen
- Harvard Medical School, Harvard University, Boston, USA
| | - Jianping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Baoyan Liu
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiyao Wang
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania, USA
| | - Xianghong Jing
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Hong Zhao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- Shenzhen Luohu District Hospital of TCM, Shenzhen, China
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75
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The Effect of Exercise for the Prevention of Bone Mass After Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg 2022; 32:912-923. [PMID: 35031954 DOI: 10.1007/s11695-021-05873-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/24/2021] [Accepted: 12/29/2021] [Indexed: 12/14/2022]
Abstract
We aimed to assess if exercise applied after bariatric surgery (BS) improves bone mineral density (BMD) compared to usual care. Systematic search was conducted up to January 2021. Effect measures were determined using standardized mean difference (SMD) with 95% confidence interval (CI). Certainty evidence was assessed according to GRADE. Four clinical trials encompassing 340 patients were included. Exercise induced a positive BMD effect at total hip (SMD = 0.37 [95% CI 0.02, 0.71]; very low certainty evidence), femoral neck (SMD = 0.63 [95% CI 0.19, 1.06]; low certainty evidence), lumbar spine (SMD = 0.41 [95% CI 0.19, 0.62]; low certainty evidence), and 1/3 radius (SMD = 0.58 [95% CI 0.19, 0.97]; low certainty evidence). Exercise undertaken after BS seems to induce a positive effect on BMD.
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76
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Zinellu A, Mangoni AA. An updated systematic review and meta-analysis of the effect of statins on asymmetric dimethylarginine. Nitric Oxide 2022; 120:26-37. [PMID: 35032642 DOI: 10.1016/j.niox.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/06/2022] [Accepted: 01/10/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES We conducted an updated systematic review and meta-analysis of the effect of statins on serum or plasma concentrations of the endogenous inhibitor of endothelial nitric oxide synthase, asymmetric NG,NG-dimethyl-l-arginine (ADMA). METHODS A systematic literature search was conducted in the electronic databases PubMed, Web of Science, and Scopus, from inception to July 2021. Risk of bias and certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist for analytical studies and GRADE, respectively. RESULTS In 23 studies, reporting 25 treatment arms in 845 participants (mean age 53 years, 57% males, treatment duration 4-48 weeks), statins significantly reduced ADMA concentrations (SMD = -0.39, 95% CI -0.62 to -0.16, p = 0.001; moderate certainty of evidence). The extreme heterogeneity observed was substantially reduced in study subgroups of specific class and individual statins, regional areas, and analytical methods for ADMA concentrations. There was no publication bias. In sensitivity analysis, the corresponding SMD values were not substantially modified when individual studies were sequentially removed. Significant associations were observed, in meta-regression, between the SMD and publication year (t = -3.25, p = 0.003), but not baseline cholesterol concentrations. CONCLUSION Statin treatment significantly lowers ADMA concentrations. This effect is independent of baseline cholesterol. Prospective studies are required to determine whether ADMA-lowering mediates, at least partly, the protective effects of statins against atherosclerotic cardiovascular disease. (PROSPERO registration number: CRD42021275123).
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Affiliation(s)
- Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Arduino A Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, Australia; Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia.
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Saldarriaga-Rivera LM, Bautista-Molano W, Junca-Ramírez A, Fernández-Aldana AR, Fernández-Ávila DG, Jaimes DA, Jáuregui EA, Segura-Charry JS, Romero-Sánchez C, Felipe-Diaz OJ. 2021 clinical practice guidelines for the diagnosis, treatment, and follow-up of patients with peripheral spondyloarthritis. Colombian Association of Rheumatology. REUMATOLOGIA CLINICA 2022; 18:5-14. [PMID: 35033487 DOI: 10.1016/j.reumae.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Peripheral spondyloarthritis is a chronic inflammatory disease in which clinical presentation is related to the presence of arthritis, enthesitis and/or dactylitis. This term is used interchangeably with some of its subtypes such as psoriatic arthritis, reactive arthritis, and undifferentiated spondyloarthritis. OBJECTIVE To develop and formulate a set of specific recommendations based on the best available evidence for the diagnosis, treatment and monitoring of adult patients with peripheral spondyloarthritis. METHODS A working group was established, clinical questions were formulated, outcomes were graded, and a systematic search for evidence was conducted. The guideline panel was multidisciplinary (including patient representatives) and balanced. Following the formal expert consensus method, the GRADE methodology "Grading of Recommendations Assessment, Development and Evaluation" was used to assess the quality of the evidence and generate the recommendations. The Clinical Practice Guideline includes ten recommendations; related to monitoring of disease activity (n = 1) and treatment (n = 9). RESULTS In patients with peripheral spondyloarthritis, the use of methotrexate or sulfasalazine as the first line of treatment is suggested, and local injections of glucocorticoids is recommended conditionally. In patients with failure to cDMARDs, an anti TNFα or an anti IL17A is recommended. In case of failure to bDMARDs, it is suggested to use another bDMARD or JAK inhibitor. In patients with peripheral spondyloarthritis associated to inflammatory bowel disease, it is recommended to start treatment with cDMARDs; in the absence of response, the use of an anti TNFα over an anti-IL-17 or an anti-IL-12-23 is recommended as a second line of treatment. In patients with psoriatic arthritis, the combined use of methotrexate with bDMARD is conditionally recommended for optimization of dosing. To assess disease activity in Psoriatic Arthritis, the use of DAPSA or MDA is suggested for patient monitoring. CONCLUSIONS This set of recommendations provides an updated guide on the diagnosis and treatment of peripheral spondyloarthritis.
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Affiliation(s)
- Lina M Saldarriaga-Rivera
- Hospital Universitario San Jorge, Facultad de Medicina, Universidad Tecnológica de Pereira, Institución Universitaria Visión de las Américas, Clínica Los Rosales, Pereira, Colombia.
| | - Wilson Bautista-Molano
- Hospital Universitario Fundación Santa Fe de Bogotá, Universidad El Bosque, Bogotá, Colombia
| | | | | | - Daniel G Fernández-Ávila
- Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Diego A Jaimes
- Universidad de la Sabana, Clínicos IPS, Bogotá, Colombia
| | - Edwin A Jáuregui
- Servicio de Reumatología, Riesgo de Fractura S.A. Cayre IPS, Bogotá, Colombia
| | - Juan S Segura-Charry
- Servicio de Reumatología, Clínica Medilaser, Neiva, Colombia, Clínicos IPS, Bogotá, Colombia
| | | | - Oscar J Felipe-Diaz
- Servicio de Reumatología, Clínica Medilaser, Neiva, Colombia, Clínicos IPS, Bogotá, Colombia; Servicio de Reumatología, Medicarte S.A. Clínica Las Vegas, Bogotá, Colombia
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78
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Johnston BC, Merdad R, Sherifali D, Kebbe M, Birken CS, Buchholz A, Ge L, Gehring ND, Hadjiyannakis S, Hamilton J, Hatanaka D, Henderson M, Lebel T, Moore SA, Morrison KM, Salas XR, Sebastianski M, Zenlea IS, Ball GDC. Updating the Canadian clinical practice guideline for managing pediatric obesity: a protocol. CMAJ Open 2022; 10:E155-E164. [PMID: 35232814 PMCID: PMC8896489 DOI: 10.9778/cmajo.20200289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Since the first national guideline for managing obesity in adults and children in Canada was published in 2007, new evidence has emerged and guideline standards have evolved. Our purpose is to describe the protocol used to update the Canadian clinical practice guideline for managing pediatric obesity. METHODS This guideline will update the pediatric components of the 2007 Canadian clinical practice guideline for the management of obesity. In partnership with Obesity Canada, we began preliminary work in 2019; activities are scheduled for completion in 2022. The guideline will follow standards developed by the National Academy of Medicine and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group. Guideline development will be informed by 5 complementary literature reviews: a scoping review that focuses on clinical assessment in pediatric obesity management and 4 systematic reviews to synthesize evidence regarding families' values and preferences as well as the safety and effectiveness of interventions (psychological and behavioural; pharmacotherapeutic; and surgical). We will use standard systematic review methodology, including summarizing and assessing the certainty of evidence and determining the strength of recommendations. Competing interests will be managed proactively according to recommendations from the Guidelines International Network. Diverse stakeholders, including families and clinicians, will be engaged throughout guideline development. INTERPRETATION The guideline will support Canadian families and clinicians to make informed, value-sensitive and evidence-based clinical decisions related to managing pediatric obesity. The guideline and accompanying resources for end-users will be published in English and French, and we will partner with Obesity Canada to optimize dissemination using integrated and end-of-project knowledge translation.
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Affiliation(s)
- Bradley C Johnston
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Roah Merdad
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Diana Sherifali
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Maryam Kebbe
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Catherine S Birken
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Annick Buchholz
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Long Ge
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Nicole D Gehring
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Stasia Hadjiyannakis
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Jill Hamilton
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Dawn Hatanaka
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Mélanie Henderson
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Tracy Lebel
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Sarah A Moore
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Katherine M Morrison
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Ximena Ramos Salas
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Meghan Sebastianski
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Ian S Zenlea
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Geoff D C Ball
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont.
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79
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Fierro V, Piscitelli AL, Battaglia E, Fiocchi A. Doxofylline for Pediatric Asthma Steps 1-4. Pediatric Asthma: New Role for an Old Drug. Front Pediatr 2022; 10:772704. [PMID: 35813377 PMCID: PMC9256910 DOI: 10.3389/fped.2022.772704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
The panoply of anti-asthma drugs for children between 6 and 18 years is not limited to those reported in the guidelines. In this review, we will re-assess the role of doxofylline, a xanthine characterized by a much higher handling than that of theophylline, as add-on treatment in pediatric asthma grade 1-4. Ten studies evaluated doxofylline in the treatment of asthma of patients non-responsive to the first-line inhaled corticosteroids. Of these, two included children and one was exclusively pediatric. According to their results, doxofylline exerts a powerful bronchodilator and anti-inflammatory activity, which can be exploited when the inhaled oral corticosteroids are not sufficient to get the desired effect of reducing symptoms. Unlike theophylline, doxofylline does not require blood testing. It can be administered together with or as an alternative to a series of other drugs considered in additional therapy.
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Affiliation(s)
- Vincenzo Fierro
- Predictive and Preventive Medicine Research Unit, Multifactorial and Systemic Diseases Research Area, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Anna Lucia Piscitelli
- Predictive and Preventive Medicine Research Unit, Multifactorial and Systemic Diseases Research Area, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | | | - Alessandro Fiocchi
- Predictive and Preventive Medicine Research Unit, Multifactorial and Systemic Diseases Research Area, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
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80
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Connor MJ, Genie MG, Burns D, Bass EJ, Gonzalez M, Sarwar N, Falconer A, Mangar S, Dudderidge T, Khoo V, Winkler M, Ahmed HU, Watson V. A Systematic Review of Patients' Values, Preferences, and Expectations for the Treatment of Metastatic Prostate Cancer. EUR UROL SUPPL 2021; 36:9-18. [PMID: 34977691 PMCID: PMC8703228 DOI: 10.1016/j.euros.2021.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 12/01/2022] Open
Abstract
CONTEXT Advances in systemic agents have increased overall survival for men diagnosed with metastatic prostate cancer. Additional cytoreductive prostate treatments and metastasis-directed therapies are under evaluation. These confer toxicity but may offer incremental survival benefits. Thus, an understanding of patients' values and treatment preferences is important for counselling, decision-making, and guideline development. OBJECTIVE To perform a systematic review of patients' values, preferences, and expectations regarding treatment of metastatic prostate cancer. EVIDENCE ACQUISITION The MEDLINE, Embase, and CINAHL databases were systematically searched for qualitative and preference elucidation studies reporting on patients' preferences for treatment of metastatic prostate cancer. Certainty of evidence was assessed using Grading of Recommendation, Assessment, Development and Evaluation (GRADE) or GRADE Confidence in the Evidence from Reviews of Qualitative Research (CERQual). The protocol was registered on PROSPERO as CRD42020201420. EVIDENCE SYNTHESIS A total of 1491 participants from 15 studies met the prespecified eligibility for inclusion. The study designs included were discrete choice experiments (n = 5), mixed methods (n = 3), and qualitative methods (n = 7). Disease states reported per study were: metastatic castration-resistant prostate cancer in nine studies (60.0%), metastatic hormone-sensitive prostate cancer in two studies (13.3%), and a mixed cohort in four studies (26.6%). In quantitative preference elicitation studies, patients consistently valued treatment effectiveness and delay in time to symptoms as the two top-ranked treatment attributes (low or very low certainty). Patients were willing to trade off treatment-related toxicity for potential oncological benefits (low certainty). In qualitative studies, thematic analysis revealed cancer progression and/or survival, pain, and fatigue as key components in treatment decisions (low or very low certainty). Patients continue to value oncological benefits in making decisions on treatments under qualitative assessment. CONCLUSIONS There is limited understanding of how patients make treatment and trade-off decisions following a diagnosis of metastatic prostate cancer. For appropriate investment in emerging cytoreductive local tumour and metastasis-directed therapies, we should seek to better understand how this cohort weighs the oncological benefits against the risks. PATIENT SUMMARY We looked at how men with advanced (metastatic) prostate cancer make treatment decisions. We found that little is known about patients' preferences for current and proposed new treatments. Further studies are required to understand how patients make decisions to help guide the integration of new treatments into the standard of care.
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Affiliation(s)
- Martin J. Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK,Corresponding author at: Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Campus, Fulham Palace Road, London W6 8RF, UK.
| | - Mesfin G. Genie
- Health Economic Research Unit (HERU), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - David Burns
- Health Economic Research Unit (HERU), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Edward J. Bass
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Michael Gonzalez
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Naveed Sarwar
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Alison Falconer
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Stephen Mangar
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Vincent Khoo
- Department of Clinical Oncology, The Royal Marsden Hospital & Institute of Cancer Research, London, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U. Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Verity Watson
- Health Economic Research Unit (HERU), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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81
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Wiercioch W, Nieuwlaat R, Zhang Y, Alonso-Coello P, Dahm P, Iorio A, Manja V, Mustafa RA, Neumann I, Ortel TL, Rochwerg B, Santesso N, Vesely SK, Akl EA, Schünemann HJ. New methods facilitated the process of prioritizing questions and health outcomes in guideline development. J Clin Epidemiol 2021; 143:91-104. [PMID: 34843861 DOI: 10.1016/j.jclinepi.2021.11.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/06/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Health guideline development requires sequential prioritization of the guideline topic, questions, and health outcomes. In this paper we report on new approaches for prioritizing questions and outcomes in guidelines. METHODS Ten guideline panels on venous thromboembolism rated potential guideline questions on a 9-point scale according to their overall importance and 6 criteria: common in practice, uncertainty in practice, variation in practice, new evidence available, cost consequences, not previously addressed. We randomized panelists to rate one potential question with and without the 6 criteria. Panelists rated importance of outcomes, defined with health outcome descriptors (HODs), using a 9-point scale, and health utility of outcomes on a visual analogue scale. RESULTS Of 469 potential questions identified, 72.5% were rated as important but not of high priority, and 25.4% as high priority. Each criterion was significantly associated with the overall importance rating. The overall importance rating means were 5.96 (SD 2.38) and 6.53 (SD 2.45) (P = 0.25) for those randomized to rate questions with and without the criteria, respectively. The mean importance rating for 121 outcomes was 6.01 (SD 1.25), with 35.5% rated as critical for decision-making. Panelists provided health utility ratings for 127 outcomes, with a minimum mean rating of 0.12 (SD 0.10) and maximum of 0.91 (SD 0.15). CONCLUSION Our structured process provided information to help explain perspectives of question importance, to facilitate panels' outcome prioritization, and to facilitate decision-making in guideline development.
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Affiliation(s)
- Wojtek Wiercioch
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Robby Nieuwlaat
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yuan Zhang
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Philipp Dahm
- Minneapolis VAMC, Urology Section and University of Minnesota Department of Urology, Minneapolis, Minnesota
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Canada
| | - Veena Manja
- Department of Surgery, University of California Davis, California, USA; Department of Medicine, Veterans Affairs Northern California Health Care System, Mather, California
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Division of Nephrology and Hypertension, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ignacio Neumann
- Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Thomas L Ortel
- Departments of Medicine and Pathology, Duke University Medical Center, Durham, North Carolina
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Canada
| | - Nancy Santesso
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sara K Vesely
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Elie A Akl
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Internal Medicine, American University of Beirut, Lebanon
| | - Holger J Schünemann
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Canada; Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Motahari-Nezhad H, Péntek M, Gulácsi L, Zrubka Z. Outcomes of Digital Biomarker-Based Interventions: Protocol for a Systematic Review of Systematic Reviews. JMIR Res Protoc 2021; 10:e28204. [PMID: 34821568 PMCID: PMC8663678 DOI: 10.2196/28204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/19/2021] [Accepted: 04/13/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Digital biomarkers are defined as objective, quantifiable, physiological, and behavioral data that are collected and measured using digital devices such as portables, wearables, implantables, or digestibles. For their widespread adoption in publicly financed health care systems, it is important to understand how their benefits translate into improved patient outcomes, which is essential for demonstrating their value. OBJECTIVE The paper presents the protocol for a systematic review that aims to assess the quality and strength of the evidence reported in systematic reviews regarding the impact of digital biomarkers on clinical outcomes compared to interventions without digital biomarkers. METHODS A comprehensive search for reviews from 2019 to 2020 will be conducted in PubMed and the Cochrane Library using keywords related to digital biomarkers and a filter for systematic reviews. Original full-text English publications of systematic reviews comparing clinical outcomes of interventions with and without digital biomarkers via meta-analysis will be included. The AMSTAR-2 tool will be used to assess the methodological quality of these reviews. To assess the quality of evidence, we will evaluate the systematic reviews using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. To detect the possible presence of reporting bias, we will determine whether a protocol was published prior to the start of the studies. A qualitative summary of the results by digital biomarker technology and outcomes will be provided. RESULTS This protocol was submitted before data collection. Search, screening, and data extraction will commence in December 2021 in accordance with the published protocol. CONCLUSIONS Our study will provide a comprehensive summary of the highest level of evidence available on digital biomarker interventions, providing practical guidance for health care providers. Our results will help identify clinical areas in which the use of digital biomarkers has led to favorable clinical outcomes. In addition, our findings will highlight areas of evidence gaps where the clinical benefits of digital biomarkers have not yet been demonstrated. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/28204.
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Affiliation(s)
- Hossein Motahari-Nezhad
- Doctoral School of Business and Management, Corvinus University of Budapest, Budapest, Hungary
| | - Márta Péntek
- Health Economics Research Center, University Research and Innovation Center, Obuda University, Budapest, Hungary
| | - László Gulácsi
- Health Economics Research Center, University Research and Innovation Center, Obuda University, Budapest, Hungary.,Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
| | - Zsombor Zrubka
- Health Economics Research Center, University Research and Innovation Center, Obuda University, Budapest, Hungary.,Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
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83
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Zinellu A, Paliogiannis P, Carru C, Mangoni AA. Serum hydroxybutyrate dehydrogenase and COVID-19 severity and mortality: a systematic review and meta-analysis with meta-regression. Clin Exp Med 2021; 22:499-508. [PMID: 34799779 PMCID: PMC8603904 DOI: 10.1007/s10238-021-00777-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/06/2021] [Indexed: 12/14/2022]
Abstract
Alterations in cardiac and renal biomarkers have been reported in coronavirus disease 19 (COVID-19). We conducted a systematic review and meta-analysis to investigate serum concentrations of hydroxybutyrate dehydrogenase (HBDH), a combined marker of myocardial and renal injury, in hospitalized COVID-19 patients with different disease severity and survival status. We searched PubMed, Web of Science and Scopus, between December 2019 and April 2021, for studies reporting HBDH in COVID-19. Risk of bias was assessed using the Newcastle–Ottawa scale, publication bias was assessed with the Begg’s and Egger’s tests, and certainty of evidence was assessed using GRADE. In 22 studies in 15,019 COVID-19 patients, serum HBDH concentrations on admission were significantly higher in patients with high disease severity or non-survivor status when compared to patients with low severity or survivor status (standardized mean difference, SMD = 0.90, 95% CI 0.74 to 1.07, p < 0.001; moderate certainty of evidence). Extreme between-study heterogeneity was observed (I2 = 93.5%, p < 0.001). Sensitivity analysis, performed by sequentially removing each study and re-assessing the pooled estimates, showed that the magnitude and the direction of the effect size were not substantially modified. A significant publication bias was observed. In meta-regression, the SMD of HBDH concentrations was significantly associated with markers of inflammation, sepsis, liver damage, non-specific tissue damage, myocardial injury, and renal function. Higher HBDH concentrations were significantly associated with higher COVID-19 severity and mortality. This biomarker of cardiac and renal injury might be useful for risk stratification in COVID-19. (PROSPERO registration number: CRD42021258123).
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Affiliation(s)
- Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | | | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Quality Control Unit, University Hospital (AOUSS), Sassari, Italy
| | - Arduino A Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Bedford Park, Adelaide, SA, 5042, Australia.
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia.
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84
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A Systematic Review and Meta-Analysis of the Effect of Statins on Glutathione Peroxidase, Superoxide Dismutase, and Catalase. Antioxidants (Basel) 2021; 10:antiox10111841. [PMID: 34829712 PMCID: PMC8614838 DOI: 10.3390/antiox10111841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 12/22/2022] Open
Abstract
Statins may exert protective effects against oxidative stress by upregulating specific antioxidant mechanisms. We conducted a systematic review and meta-analysis of the effect of statins on three key antioxidant enzymes: glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase. The electronic databases PubMed, Web of Science, and Scopus were searched from inception to July 2021. The risk of bias was assessed with the Joanna Briggs Institute Critical Appraisal Checklist and certainty of evidence was assessed using the GRADE framework. In 15 studies, reporting 17 treatment arms in 773 patients (mean age 53 years, 54% males), statins significantly increased the concentrations of both GPx (standardized mean difference, SMD = 0.80, 95% confidence interval, CI 0.13 to 1.46, p = 0.018; high certainty of evidence) and SOD (SMD = 1.54, 95% CI 0.71 to 2.36, p < 0.001; high certainty of evidence), but not catalase (SMD = −0.16, 95% CI −0.51 to 0.20, p = 0.394; very low certainty of evidence). The pooled SMD values were not altered in sensitivity analysis. There was no publication bias. In conclusion, statin treatment significantly increases the circulating concentrations of GPx and SOD, suggesting an antioxidant effect of these agents (PROSPERO registration number: CRD42021271589).
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85
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Zinellu A, Mangoni AA. Systematic Review and Meta-Analysis of the Effect of Statins on Circulating E-Selectin, L-Selectin, and P-Selectin. Biomedicines 2021; 9:biomedicines9111707. [PMID: 34829936 PMCID: PMC8615864 DOI: 10.3390/biomedicines9111707] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/30/2022] Open
Abstract
The pleiotropic effects of statins might involve preventing inflammatory cell adhesion to the endothelium, which is a critical step in the pathogenesis of atherosclerosis. We conducted a systematic review and meta-analysis of the effects of statins on the circulating cell adhesion molecules E-Selectin, L-Selectin, and P-Selectin. A literature search was conducted in PubMed, Web of Science, and Scopus, from inception to July 2021. Risk of bias and certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively. In 61 studies, statins significantly reduced P-selectin (standard mean difference, SMD = -0.39, 95% CI -0.55 to -0.22, p < 0.001; moderate certainty of evidence), L-selectin (SMD = -0.49, 95% CI -0.89 to -0.10, p = 0.014; very low certainty of evidence), and E-Selectin (SMD = -0.73, 95% CI -1.02 to -0.43, p < 0.001; moderate certainty of evidence), independently of baseline lipid profile and other study and patient characteristics. The corresponding pooled SMD values in sensitivity analysis were not substantially altered when individual studies were sequentially removed. Simvastatin had a significant lowering effect on both P-selectin and E-selectin. Therefore, statins significantly reduce circulating selectins. Further studies are required to investigate whether selectin lowering mediates cardiovascular risk reduction with these agents. (PROSPERO registration number: CRD42021282778).
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Affiliation(s)
- Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Arduino A. Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, SA 5042, Australia
- Correspondence:
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86
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Madden LK, Rajajee V, Human T, Wainwright MS, Guanci M, Mainali S, Rowe S, McLaughlin D, Lunde J, Lele A, Fried H. Neurocritical Care Society Guidelines Update: Lessons from a Decade of GRADE Guidelines. Neurocrit Care 2021; 36:1-10. [PMID: 34729676 PMCID: PMC8562933 DOI: 10.1007/s12028-021-01375-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/07/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Lori K Madden
- Center for Nursing Science, University of California Davis Health, 2315 Stockton Blvd, North Addition 3015, Sacramento, CA, 95817, USA.
| | | | | | - Mark S Wainwright
- Division of Pediatric Neurology, University of Washington, Seattle, WA, USA
| | - Mary Guanci
- Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Shraddha Mainali
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Shaun Rowe
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, The University of Tennessee Health Science Center, Knoxville, TN, USA
| | - Diane McLaughlin
- Departments of Neurology and Neurocritical Care, University of Florida Health, Jacksonville, FL, USA
| | - John Lunde
- Division of Critical Care, Intensive Care Consortium/Orange Park Medical Center, Orange Park, FL, USA
| | - Abhijit Lele
- Departments of Neurosurgery and Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Herb Fried
- Division of Neurosurgery, Denver Health Medical Center, Denver, CO, USA
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87
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The certainty of the evidence in oral health has not improved according to GRADE: a meta-epidemiological study. J Clin Epidemiol 2021; 142:29-37. [PMID: 34718122 DOI: 10.1016/j.jclinepi.2021.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/03/2021] [Accepted: 10/19/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this meta-epidemiological study was to provide an update of the certainty of the evidence in oral health by using the GRADE rating reported in oral health Cochrane systematic reviews (CSR). STUDY DESIGN AND SETTING All interventional oral health CSR published between 2003-2021 were sourced. Study characteristics were extracted at the level of the CSR and the outcome/meta-analysis. One-hundred-five CSR were eligible and analysed. RESULTS Almost a third of CSR (n=67) were excluded as a GRADE rating was not available. The most prevalent type of primary studies included in the CSR were randomized studies (93.4%) and the most used measure of effect was the risk ratio (67.3%). Overall, the certainty of the evidence according to the GRADE rating for all examined outcomes was very low/low (88%). The two most common reasons for downgrading the confidence in the evidence were study limitations (Risk of bias) and imprecision. The odds of moderate/high vs. low/very low-GRADE rating are higher for the primary compared to the secondary outcomes after adjusting for year and number of trials (OR 2.49; 95% CI: 1.09, 5.65; P=0.02). Per year (2010-2021 period) the odds of moderate/high vs. low/very low-GRADE rating decrease (OR 0.73; 95% CI: 0.60, 0.90; P=0.01), and as the number of trials per comparison increase the odds of moderate/high vs. low/very low GRADE rating increase (OR 1.13; 95% CI: 1.01, 1.25; P=0.001). CONCLUSIONS The certainty of the evidence in oral health when assessed with the GRADE rating remains predominantly low or very low.
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88
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Zeng L, Lytvyn L, Wang X, Kithulegoda N, Agterberg S, Shergill Y, Esfahani MA, Heen AF, Agoritsas T, Guyatt GH, Busse JW. Values and preferences towards medical cannabis among people living with chronic pain: a mixed-methods systematic review. BMJ Open 2021; 11:e050831. [PMID: 34493521 PMCID: PMC8451285 DOI: 10.1136/bmjopen-2021-050831] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/24/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To explore values and preferences towards medical cannabis among people living with chronic pain. DESIGN Mixed-methods systematic review. DATA SOURCES We searched MEDLINE, EMBASE and PsycINFO from inception to 17 March 2020. STUDY SELECTION Pairs of reviewers independently screened search results and included quantitative, qualitative and mixed-methods studies reporting values and preferences towards medical cannabis among people living with chronic pain. REVIEW METHODS We analysed data using meta-narrative synthesis (quantitative findings were qualitised) and tabulated review findings according to identified themes. We used the Grading of Recommendations Assessment, Development and Evaluation approach to assess certainty of evidence. RESULTS Of 1838 initial records, 15 studies proved eligible for review. High to moderate certainty evidence showed that patient's use of medical cannabis for chronic pain was influenced by both positive (eg, support from friends and family) and negative social factors (eg, stigma surrounding cannabis use). Most patients using medical cannabis favoured products with balanced ratios of tetrahydrocannabinol (THC) and cannabidiol (CBD), or high levels of CBD, but not high THC preparations. Many valued the effectiveness of medical cannabis for symptom management even when experiencing adverse events related to concentration, memory or fatigue. Reducing use of prescription medication was a motivating factor for use of medical cannabis, and concerns regarding addiction, losing control or acting strangely were disincentives. Out-of-pocket costs were a barrier, whereas legalisation of medical cannabis improved access and incentivised use.Low to very low certainty evidence suggested highly variable values towards medical cannabis among people living with chronic pain. Individuals with pain related to life-limiting disease were more willing to use medical cannabis, and preferred oral over inhaled administration. CONCLUSIONS Our findings highlight factors that clinicians should consider when discussing medical cannabis. The variability of patients' values and preferences emphasise the need for shared decision making when considering medical cannabis for chronic pain.
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Affiliation(s)
- Linan Zeng
- Pharmacy Department/Evidence-based Pharmacy Center, West China Second University Hospital, Chengdu, Sichuan, China
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Xiaoqin Wang
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Natasha Kithulegoda
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Silvana Agterberg
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, New York, USA
| | - Yaad Shergill
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Meisam Abdar Esfahani
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anja Fog Heen
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- The Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
- Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Ontario, Canada
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89
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Chou KT, Tsai YL, Yeh WY, Chen YM, Huang N, Cheng HM. Risk of work-related injury in workers with obstructive sleep apnea: A systematic review and meta-analysis. J Sleep Res 2021; 31:e13446. [PMID: 34384138 DOI: 10.1111/jsr.13446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Abstract
The objective of this study is to elucidate the relationship between obstructive sleep apnea (OSA) and the risk of work-related injuries (WRIs), synthesize the latest clinical evidence and conduct a systematic review and meta-analysis adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA 2020). Observational studies published before April 2020 in PubMed, Cochrane library, PsycINFO, Scopus, Google Scholar and Web of Science were included. Random-effects Mantel-Haenszel meta-analysis was performed. A total of 15 studies with 21,507 participants were included. Prespecified subgroup analyses based on study design and the characteristics of the enrollees were conducted. Overall, workers with OSA had 1.64-fold increased odds of being involved in WRIs compared to their counterparts (OR = 1.64, 95% CI = 1.24-2.16, p = 0.0005). In addition to the professional drivers that have been studied in the past, such a trend also existed in the general working population (OR = 1.68, 95% CI = 1.14-2.49, p = 0.01). We also found that workers with excessive daytime sleepiness (Epworth Sleepiness Scale score >10) had a 1.68-fold increased risk of WRIs compared to those with lower ESS scores (OR = 1.68, 95% CI = 1.22-2.30, p = 0.002). This study verified that OSA workers had a higher risk of WRIs, and such correlations do not show obvious differences in subgroups with different sample sizes, OSA diagnosis methods, job types or definitions of WRI. Based on the association between OSA and WRIs identified in our study, further studies investigating the protective effects of early identification and management of OSA on WRIs are warranted.
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Affiliation(s)
- Kun-Ta Chou
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Yu-Lun Tsai
- International Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wan-Yu Yeh
- Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuh-Min Chen
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
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90
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Hansson E, Sandman L, Davidson T. A systematic review of direct preference measurements in health states treated with plastic surgery. J Plast Surg Hand Surg 2021; 56:180-190. [PMID: 34369280 DOI: 10.1080/2000656x.2021.1953039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
One way to compare health care needs and outcomes on common scales is by estimating the strength of preferences or willingness-to-pay (WTP). The aim of this study was to review directly measured preference values and WTP estimates for health states treated by plastic surgery. The included articles had to meet the criteria defined in the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type). Relevant databases were searched using predetermined strings. Data were extracted in a standardised manner. Included studies were appraised according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for rating the importance of outcomes. In total, 213 abstracts were retrieved. Of these, 179 did not meet the inclusion criteria and were excluded, leaving 34 studies in the review. The risk of bias was considered moderate in four studies and serious in the rest. The overall certainty of evidence for directly measured preference values and WTP estimates for health states treated by plastic surgery is low (Grade ƟƟОО). The lowest preference scores were generally elicited for facial defects/anomalies and the highest for excess skin after massive weight loss. Scientific knowledge about preferences and the resulting health gains might play an essential role in deciding which procedures should be considered for public funding or rather rationed within the system. Better quality studies are required to allow for such applications.
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Affiliation(s)
- Emma Hansson
- Department of Plastic and Reconstructive Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Lars Sandman
- National Centre for Priorities in Health, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Västra Götaland Region, Gothenburg, Sweden.,Faculty of Police Work, Department of Campus Police Education, Borås University, Borås, Sweden
| | - Thomas Davidson
- National Centre for Priorities in Health, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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91
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Kim MS, Kim WJ, Khera AV, Kim JY, Yon DK, Lee SW, Shin JI, Won HH. Association between adiposity and cardiovascular outcomes: an umbrella review and meta-analysis of observational and Mendelian randomization studies. Eur Heart J 2021; 42:3388-3403. [PMID: 34333589 PMCID: PMC8423481 DOI: 10.1093/eurheartj/ehab454] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 06/29/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS The aim of this study was to investigate the causal relationship and evidence of an association between increased adiposity and the risk of incident cardiovascular disease (CVD) events or mortality. METHODS AND RESULTS Observational (informing association) and Mendelian randomization (MR) (informing causality) studies were assessed to gather mutually complementary insights and elucidate perplexing epidemiological relationships. Systematic reviews and meta-analyses of observational and MR studies that were published until January 2021 and evaluated the association between obesity-related indices and CVD risk were searched. Twelve systematic reviews with 53 meta-analyses results (including over 501 cohort studies) and 12 MR studies were included in the analysis. A body mass index (BMI) increase was associated with higher risks of coronary heart disease, heart failure, atrial fibrillation, all-cause stroke, haemorrhagic stroke, ischaemic stroke, hypertension, aortic valve stenosis, pulmonary embolism, and venous thrombo-embolism. The MR study results demonstrated a causal effect of obesity on all indices but stroke. The CVD risk increase for every 5 kg/m2 increase in BMI varied from 10% [relative risk (RR) 1.10; 95% confidence interval (CI) 1.01-1.21; certainty of evidence, low] for haemorrhagic stroke to 49% (RR 1.49; 95% CI 1.40-1.60; certainty of evidence, high) for hypertension. The all-cause and CVD-specific mortality risks increased with adiposity in cohorts, but the MR studies demonstrated no causal effect of adiposity on all-cause mortality. CONCLUSION High adiposity is associated with increased CVD risk despite divergent evidence gradients. Adiposity was a causal risk factor for CVD except all-cause mortality and stroke. Half (49%; 26/53) of the associations were supported by high-level evidence. The associations were consistent between sexes and across global regions. This study provides guidance on how to integrate evidence from observational (association) and genetics-driven (causation) studies accumulated to date, to enable a more reliable interpretation of epidemiological relationships.
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Affiliation(s)
- Min Seo Kim
- College of Medicine, Korea University, Seoul, Republic of Korea.,Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Irwon-ro 81, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Won Jun Kim
- College of Medicine, Korea University, Seoul, Republic of Korea.,Gangneung Prison Medical Department, Ministry of Justice, Republic of Korea
| | - Amit V Khera
- Center for Genomic Medicine and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jong Yeob Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Keon Yon
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Data Science, College of Software Convergence, Sejong University, Seoul, Republic of Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hong-Hee Won
- Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Irwon-ro 81, Gangnam-gu, Seoul 06351, Republic of Korea.,Samsung Genome Institute, Samsung Medical Center, Seoul, Republic of Korea
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92
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Luong R, Ribeiro RV, Cunningham J, Chen S, Hirani V. The short- and long-term effects of dietary patterns on cardiometabolic health in adults aged 65 years or older: a systematic review. Nutr Rev 2021; 80:329-350. [PMID: 34272960 DOI: 10.1093/nutrit/nuab032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
CONTEXT Cardiometabolic diseases are leading causes of death and morbidity. Aging increases the risk of disease development. Diet has protective and causal effects on cardiometabolic health. OBJECTIVE To consolidate the current evidence on the short- and long-term effects of dietary patterns on cardiometabolic health in adults aged ≥ 65 years. DATA SOURCES The Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Scopus, Global Health, and Pre-Medline databases, along with ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched. DATA EXTRACTION A total of 40 042 records were identified. Quality assessment involved using the revised Cochrane risk-of-bias tool for randomized trials and Joanna Briggs Institute checklists. The certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation. RESULTS Thirteen articles were included (n = 5 cohort studies and n = 3 randomized controlled trials). The low-fat dietary pattern reduced adiposity; however, no effects were evident for hypertension incidence, composite coronary heart disease incidence (including myocardial infarction, coronary heart disease, and coronary revascularization), high-density lipoprotein cholesterol level, and increased blood pressure in the long term. The Mediterranean dietary pattern resulted in reduced triglyceride levels and systolic blood pressure, and had no effects on diastolic blood pressure and glucose in the short term. Other dietary patterns had inconclusive effects. CONCLUSIONS The Mediterranean dietary pattern showed the most benefits without harm on cardiometabolic health in older adults. The current body of evidence is small, indicating the need for more research to confirm these findings at a high certainty of evidence, and to include dietary patterns combined with other dietary components, subgroups with cardiometabolic disease or risk factors, longer follow-up, and outcomes that have not yet been investigated. Studies including these factors may help identify the most effective dietary pattern for cardiometabolic health benefits in older adults, to inform future guidelines. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020141400.
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Affiliation(s)
- Rebecca Luong
- R. Luong, R. Ribeiro, J. Cunningham, S. Chen, and V. Hirani are with the School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, New South Wales, Australia
| | - Rosilene V Ribeiro
- R. Luong, R. Ribeiro, J. Cunningham, S. Chen, and V. Hirani are with the School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, New South Wales, Australia
| | - Jessica Cunningham
- R. Luong, R. Ribeiro, J. Cunningham, S. Chen, and V. Hirani are with the School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, New South Wales, Australia
| | - Siting Chen
- R. Luong, R. Ribeiro, J. Cunningham, S. Chen, and V. Hirani are with the School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, New South Wales, Australia
| | - Vasant Hirani
- R. Luong, R. Ribeiro, J. Cunningham, S. Chen, and V. Hirani are with the School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, New South Wales, Australia
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Pittas S, Theodoridis X, Haidich AB, Bozikas PV, Papazisis G. The effect of N-acetylcysteine on bipolar depression: a systematic review and meta-analysis of randomized controlled trials. Psychopharmacology (Berl) 2021; 238:1729-1736. [PMID: 33641060 DOI: 10.1007/s00213-021-05789-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/04/2021] [Indexed: 11/28/2022]
Abstract
RATIONALE The current pharmacotherapy of bipolar depression often presents limited efficacy and increased risk for adverse events. N-acetylcysteine (NAC) has been suggested as potentially effective and well-tolerated adjunctive treatment for bipolar disorder (BD). OBJECTIVES This systematic review and meta-analysis aimed to examine the efficacy of N-acetylcysteine, as an adjunctive therapy, for treating bipolar depression. METHODS PubMed, Cochrane Library, Scopus databases, and grey literature were searched for studies retrieval. Randomized controlled trials including patients with a diagnosed bipolar disorder and a current depressive episode were included in the analysis. The measured variables included symptoms, functioning, and quality of life scales. The mean change in Montgomery-Åsberg Depression Rating Scale (MADRS) was set as the primary outcome. RESULTS A total of five studies were included in the analysis. A significant improvement was not observed from the addition of NAC to standard therapy in symptomatology [MADRS (MD = -3.32; 95% CI = -12.79 to 6.16), Young Mania Rating Scale (MD = -0.7; 95% CI = -2.15 to 0.75), Bipolar Depression Rating Scale (MD = -3.19; 95% CI = -15.48 to 9.1), and Clinical Global Impression for severity (MD = -0.13; 95% CI = -0.33 to 0.08)], functioning, [Global Assessment of Functioning Scale (MD = 3.21; 95% CI = -12.55 to 18.97), Social and Occupational Functioning Assessment Scale (MD = 0.47; 95% CI = -4.60 to 5.53), or quality of life [Quality of Life Enjoyment and Satisfaction Questionnaire (MD = 2.27; 95% CI = -9.13 to 13.67)]. CONCLUSIONS There is no evidence indicating that NAC has beneficial effects as an adjunctive treatment for bipolar depression. Future trials with improved methodological design and efficient sample sizes are required to draw safer conclusions.
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Affiliation(s)
- Stefanos Pittas
- Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Xenophon Theodoridis
- Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Anna-Bettina Haidich
- Laboratory of Hygiene, Preventive Medicine, and Medical Statistics, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panteleimon-Vasilios Bozikas
- 2nd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Papazisis
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Macey R, Walsh T, Riley P, Glenny AM, Worthington HV, O'Malley L, Clarkson JE, Ricketts D. Visual or visual-tactile examination to detect and inform the diagnosis of enamel caries. Cochrane Database Syst Rev 2021; 6:CD014546. [PMID: 34124773 PMCID: PMC8428329 DOI: 10.1002/14651858.cd014546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The detection and diagnosis of caries at the initial (non-cavitated) and moderate (enamel) levels of severity is fundamental to achieving and maintaining good oral health and prevention of oral diseases. An increasing array of methods of early caries detection have been proposed that could potentially support traditional methods of detection and diagnosis. Earlier identification of disease could afford patients the opportunity of less invasive treatment with less destruction of tooth tissue, reduce the need for treatment with aerosol-generating procedures, and potentially result in a reduced cost of care to the patient and to healthcare services. OBJECTIVES To determine the diagnostic accuracy of different visual classification systems for the detection and diagnosis of non-cavitated coronal dental caries for different purposes (detection and diagnosis) and in different populations (children or adults). SEARCH METHODS Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 30 April 2020); Embase Ovid (1980 to 30 April 2020); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 30 April 2020); and the World Health Organization International Clinical Trials Registry Platform (to 30 April 2020). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA We included diagnostic accuracy study designs that compared a visual classification system (index test) with a reference standard (histology, excavation, radiographs). This included cross-sectional studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. Studies reporting at both the patient or tooth surface level were included. In vitro and in vivo studies were considered. Studies that explicitly recruited participants with caries into dentine or frank cavitation were excluded. We also excluded studies that artificially created carious lesions and those that used an index test during the excavation of dental caries to ascertain the optimum depth of excavation. DATA COLLECTION AND ANALYSIS We extracted data independently and in duplicate using a standardised data extraction and quality assessment form based on QUADAS-2 specific to the review context. Estimates of diagnostic accuracy were determined using the bivariate hierarchical method to produce summary points of sensitivity and specificity with 95% confidence intervals (CIs) and regions, and 95% prediction regions. The comparative accuracy of different classification systems was conducted based on indirect comparisons. Potential sources of heterogeneity were pre-specified and explored visually and more formally through meta-regression. MAIN RESULTS We included 71 datasets from 67 studies (48 completed in vitro) reporting a total of 19,590 tooth sites/surfaces. The most frequently reported classification systems were the International Caries Detection and Assessment System (ICDAS) (36 studies) and Ekstrand-Ricketts-Kidd (ERK) (15 studies). In reporting the results, no distinction was made between detection and diagnosis. Only two studies were at low risk of bias across all four domains, and 15 studies were at low concern for applicability across all three domains. The patient selection domain had the highest proportion of high risk of bias studies (49 studies). Four studies were assessed at high risk of bias for the index test domain, nine for the reference standard domain, and seven for the flow and timing domain. Due to the high number of studies on extracted teeth concerns regarding applicability were high for the patient selection and index test domains (49 and 46 studies respectively). Studies were synthesised using a hierarchical bivariate method for meta-analysis. There was substantial variability in the results of the individual studies: sensitivities ranged from 0.16 to 1.00 and specificities from 0 to 1.00. For all visual classification systems the estimated summary sensitivity and specificity point was 0.86 (95% CI 0.80 to 0.90) and 0.77 (95% CI 0.72 to 0.82) respectively, diagnostic odds ratio (DOR) 20.38 (95% CI 14.33 to 28.98). In a cohort of 1000 tooth surfaces with 28% prevalence of enamel caries, this would result in 40 being classified as disease free when enamel caries was truly present (false negatives), and 163 being classified as diseased in the absence of enamel caries (false positives). The addition of test type to the model did not result in any meaningful difference to the sensitivity or specificity estimates (Chi2(4) = 3.78, P = 0.44), nor did the addition of primary or permanent dentition (Chi2(2) = 0.90, P = 0.64). The variability of results could not be explained by tooth surface (occlusal or approximal), prevalence of dentinal caries in the sample, nor reference standard. Only one study intentionally included restored teeth in its sample and no studies reported the inclusion of sealants. We rated the certainty of the evidence as low, and downgraded two levels in total for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the in vitro studies, and inconsistency of results. AUTHORS' CONCLUSIONS Whilst the confidence intervals for the summary points of the different visual classification systems indicated reasonable performance, they do not reflect the confidence that one can have in the accuracy of assessment using these systems due to the considerable unexplained heterogeneity evident across the studies. The prediction regions in which the sensitivity and specificity of a future study should lie are very broad, an important consideration when interpreting the results of this review. Should treatment be provided as a consequence of a false-positive result then this would be non-invasive, typically the application of fluoride varnish where it was not required, with low potential for an adverse event but healthcare resource and finance costs. Despite the robust methodology applied in this comprehensive review, the results should be interpreted with some caution due to shortcomings in the design and execution of many of the included studies. Studies to determine the diagnostic accuracy of methods to detect and diagnose caries in situ are particularly challenging. Wherever possible future studies should be carried out in a clinical setting, to provide a realistic assessment of performance within the oral cavity with the challenges of plaque, tooth staining, and restorations, and consider methods to minimise bias arising from the use of imperfect reference standards in clinical studies.
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Affiliation(s)
- Richard Macey
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Philip Riley
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Lucy O'Malley
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Janet E Clarkson
- Division of Oral Health Sciences, Dundee Dental School, University of Dundee, Dundee, UK
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Zinellu A, Mangoni AA. Serum Complement C3 and C4 and COVID-19 Severity and Mortality: A Systematic Review and Meta-Analysis With Meta-Regression. Front Immunol 2021; 12:696085. [PMID: 34163491 PMCID: PMC8215447 DOI: 10.3389/fimmu.2021.696085] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/21/2021] [Indexed: 12/15/2022] Open
Abstract
Activation of the complement system has been observed in coronavirus disease 19 (COVID-19). We conducted a systematic review and meta-analysis with meta-regression to investigate possible differences in the serum concentrations of two routinely measured complement components, C3 and C4, in COVID-19 patients with different severity and survival status. We searched PubMed, Web of Science and Scopus, between January 2020 and February 2021, for studies reporting serum complement C3 and C4, measures of COVID-19 severity, and survival. Eligibility criteria were a) reporting continuous data on serum C3 and C4 concentrations in COVID-19 patients, -b) investigating COVID-19 patients with different disease severity and/or survival status, c) adult patients, d) English language, e) ≥10 patients, and f) full-text available. Using a random-effects model, standardized mean differences (SMD) with 95% confidence intervals (CIs) were calculated to evaluate differences in serum C3 and C4 concentrations between COVID-19 patients with low vs. high severity or survivor vs. non-survivor status. Risk of bias was assessed using the Newcastle-Ottawa scale whereas publication bias was assessed with the Begg’s and Egger’s tests. Certainty of evidence was assessed using GRADE. Nineteen studies in 3,764 COVID-19 patients were included in the meta-analysis. Both C3 and C4 concentrations were significantly lower in patients with high disease severity or non-survivor status than patients with low severity or survivor status (C3 SMD=-0.40, 95% CI -0.60 to -0.21, p<0.001; C4 SMD=-0.29, 95% CI -0.49 to -0.09, p=0.005; moderate certainty of evidence). Extreme between-study heterogeneity was observed (C3, I2 = 82.1%; C4, I2 = 84.4%). Sensitivity analysis, performed by sequentially removing each study and re-assessing the pooled estimates, showed that the magnitude and direction of the effect size was not modified. There was no publication bias. In meta-regression, the SMD of C3 was significantly associated with white blood cell count, C-reactive protein (CRP), and pro-thrombin time, whereas the SMD of C4 was significantly associated with CRP, pro-thrombin time, D-dimer, and albumin. In conclusion, lower concentrations of C3 and C4, indicating complement activation, were significantly associated with higher COVID-19 severity and mortality. C3 and C4 might be useful to predict adverse clinical consequences in these patients. Systematic Review Registration: PROSPERO, Registration number: CRD42021239634.
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Affiliation(s)
- Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Arduino A Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA, Australia
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96
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Chys M, Cagnie B, De Meulemeester K, Bontinck J, Meeus M, Dewitte V. Evaluating the effectiveness of patient tailored treatment for patients with non-specific low back pain: A systematic review. Musculoskeletal Care 2021; 20:31-46. [PMID: 34058064 DOI: 10.1002/msc.1572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This systematic review summarizes the relevant literature on the effectiveness of tailored interventions in non-specific low back pain (NSLBP). METHODS The search strategy has been executed in December 2019 in the electronic databases PubMed, Web of Science and Embase. Study selection, data extraction and quality assessment were done independently by two authors. RESULTS A total six eligible studies were identified. Five out of six articles used a classification system to subgroup patients. All active patient tailored interventions had similar or better results than the non-patient tailored interventions, most importantly on pain (short- and mid-term, not for long term follow-up). Two motor control interventions revealed sustained or increased effects at 12 months follow-up for disability. For cost-effectiveness, medication use and work absenteeism, results were inconclusive. Global rating of change evaluation confirmed significant between-group results at 10 weeks to 4 months follow-up, but results were not maintained at 12-month evaluation. DISCUSSION & CONCLUSION: Our findings support the preliminary evidence for the use of patient tailored treatment for reductions in pain and disability. However, our results are of very low to moderate quality evidence and the observed effects strongly depend on the subgroups and the chosen interventions. More high-quality RCT's with homogenous designs and larger sample sizes are needed.
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Affiliation(s)
- M Chys
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - B Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - K De Meulemeester
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - J Bontinck
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - M Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - V Dewitte
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Patel D, Kumar A, Black-Maier E, Morgan RL, Trulock K, Wilner B, Nemer D, Donnellan E, Tarakji KG, Cantillon DJ, Varma N, Saba SF, Al-Khatib SM, Wilkoff BL, Rickard JW. Cardiac Resynchronization Therapy With or Without Defibrillation in Patients With Nonischemic Cardiomyopathy: A Systematic Review and Meta-Analysis. Circ Arrhythm Electrophysiol 2021; 14:e008991. [PMID: 33999647 DOI: 10.1161/circep.120.008991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Divyang Patel
- Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.)
| | - Anirudh Kumar
- Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.)
| | - Eric Black-Maier
- Duke Clinical Research Institute, Duke University Medical System, Durham, NC (E.B.-M., S.M.A.-K.)
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada (R.L.M.)
| | - Kevin Trulock
- Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.)
| | - Bryan Wilner
- Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.)
| | - David Nemer
- Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.)
| | - Eoin Donnellan
- Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.)
| | - Khaldoun G Tarakji
- Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.)
| | - Daniel J Cantillon
- Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.)
| | - Niraj Varma
- Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.)
| | - Samir F Saba
- The Heart and Vascular Institute, Department of Medicine, University of Pittsburgh Medical Center, PA (S.F.S.)
| | - Sana M Al-Khatib
- Duke Clinical Research Institute, Duke University Medical System, Durham, NC (E.B.-M., S.M.A.-K.)
| | - Bruce L Wilkoff
- Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.)
| | - John W Rickard
- Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.)
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A user guide to the American Society of Hematology clinical practice guidelines. Blood Adv 2021; 4:2095-2110. [PMID: 32396622 DOI: 10.1182/bloodadvances.2020001755] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/25/2020] [Indexed: 12/19/2022] Open
Abstract
Since November 2018, Blood Advances has published American Society of Hematology (ASH) clinical practice guidelines on venous thromboembolism, immune thrombocytopenia, and sickle cell disease. More ASH guidelines on these and other topics are forthcoming. These guidelines have been developed using consistent processes, methods, terminology, and presentation formats. In this article, we describe how patients, clinicians, policymakers, researchers, and others may use ASH guidelines and the many related derivates by describing how to interpret information and how to apply it to clinical decision-making. Also, by exploring how these documents are developed, we aim to clarify their limitations and possible inappropriate usage.
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Risk factors for musculoskeletal injuries in military personnel: a systematic review with meta-analysis. Int Arch Occup Environ Health 2021; 94:1173-1189. [PMID: 33987772 DOI: 10.1007/s00420-021-01700-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/25/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the risk factors for musculoskeletal injuries in military personnel. METHODS A systematic literature search was carried out in August 2019 and updated in July 2020 without language or time filters. The inclusion criteria were prospective studies that investigated the risk factors for injuries in military personnel. Only risk factors analyzed by at least ten studies were selected for the meta-analysis. For data analysis, the RevMan5.3 program was used to compare the number of participants with injuries between high- or low-risk groups. The measurement of dichotomous variables was one of the selected parameters for the analysis, as well as the Mantel-Haenszel statistical method, random-effects model, and analysis with a relative risk (RR) and 95% confidence interval for the included studies. RESULTS A total of 2,629 studies were identified through databases. Thirty-four studies met the inclusion criteria. The groups considered at risk were the oldest [RR = 1.22; (95% CI 1.06-1.41)], with overweight or obesity [RR = 1.27; (95% CI 1.08-1, 48)], with previous injuries [RR = 1.15; (95% CI 1.01-1.30)], and with the worst performance in running tests of 1,600-3,200 m [RR = 1.87; (95% CI 1.28-2.71)]. Gender, ethnicity, and smoking were not associated with injuries. However, a subgroup analysis showed that among studies with a follow-up of fewer than 12 months, women presented RR = 2.44 (95% CI 1.65-3.60) more likely to develop injuries. CONCLUSION Age, overweight or obesity, previous injuries, and performance in the 1600-3200 m run are associated with an increased risk of injury in the military.
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Li S, Vandvik PO, Lytvyn L, Guyatt GH, Palmer SC, Rodriguez-Gutierrez R, Foroutan F, Agoritsas T, Siemieniuk RAC, Walsh M, Frere L, Tunnicliffe DJ, Nagler EV, Manja V, Åsvold BO, Jha V, Vermandere M, Gariani K, Zhao Q, Ren Y, Cartwright EJ, Gee P, Wickes A, Ferns L, Wright R, Li L, Hao Q, Mustafa RA. SGLT-2 inhibitors or GLP-1 receptor agonists for adults with type 2 diabetes: a clinical practice guideline. BMJ 2021; 373:n1091. [PMID: 33975892 DOI: 10.1136/bmj.n1091] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CLINICAL QUESTION What are the benefits and harms of sodium-glucose cotransporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists when added to usual care (lifestyle interventions and/or other diabetes drugs) in adults with type 2 diabetes at different risk for cardiovascular and kidney outcomes? CURRENT PRACTICE Clinical decisions about treatment of type 2 diabetes have been led by glycaemic control for decades. SGLT-2 inhibitors and GLP-1 receptor agonists are traditionally used in people with elevated glucose level after metformin treatment. This has changed through trials demonstrating atherosclerotic cardiovascular disease (CVD) and chronic kidney disease (CKD) benefits independent of medications' glucose-lowering potential. RECOMMENDATIONS The guideline panel issued risk-stratified recommendations concerning the use of SGLT-2 inhibitors or GLP-1 receptor agonists in adults with type 2 diabetes• Three or fewer cardiovascular risk factors without established CVD or CKD: Weak recommendation against starting SGLT-2 inhibitors or GLP-1 receptor agonists.• More than three cardiovascular risk factors without established CVD or CKD: Weak recommendation for starting SGLT-2 inhibitors and weak against starting GLP-1 receptor agonists.• Established CVD or CKD: Weak recommendation for starting SGLT-2 inhibitors and GLP-1 receptor agonists.• Established CVD and CKD: Strong recommendation for starting SGLT-2 inhibitors and weak recommendation for starting GLP-1 receptor agonists.• For those committed to further reducing their risk for CVD and CKD outcomes: Weak recommendation for starting SGLT-2 inhibitors rather than GLP-1 receptor agonists. HOW THIS GUIDELINE WAS CREATED An international panel including patients, clinicians, and methodologists created these recommendations following standards for trustworthy guidelines and using the GRADE approach. The panel applied an individual patient perspective. THE EVIDENCE A linked systematic review and network meta-analysis (764 randomised trials included 421 346 participants) of benefits and harms found that SGLT-2 inhibitors and GLP-1 receptor agonists generally reduce overall death, and incidence of myocardial infarctions, and end-stage kidney disease or kidney failure (moderate to high certainty evidence). These medications exert different effects on stroke, hospitalisations for heart failure, and key adverse events in different subgroups. Absolute effects of benefit varied widely based on patients' individual risk (for example, from five fewer deaths in the lowest risk to 48 fewer deaths in the highest risk, for 1000 patients treated over five years). A prognosis review identified 14 eligible risk prediction models, one of which (RECODe) informed most baseline risk estimates in evidence summaries to underpin the risk-stratified recommendations. Concerning patients' values and preferences, the recommendations were supported by evidence from a systematic review of published literature, a patient focus group study, a practical issues summary, and a guideline panel survey. UNDERSTANDING THE RECOMMENDATION We stratified the recommendations by the levels of risk for CVD and CKD and systematically considered the balance of benefits, harms, other considerations, and practical issues for each risk group. The strong recommendation for SGLT-2 inhibitors in patients with CVD and CKD reflects what the panel considered to be a clear benefit. For all other adults with type 2 diabetes, the weak recommendations reflect what the panel considered to be a finer balance between benefits, harms, and burdens of treatment options. Clinicians using the guideline can identify their patient's individual risk for cardiovascular and kidney outcomes using credible risk calculators such as RECODe. Interactive evidence summaries and decision aids may support well informed treatment choices, including shared decision making.
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Affiliation(s)
- Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- Chinese Evidence-based Medicine Center, Cochrane China Center and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, China
| | - Per Olav Vandvik
- University of Oslo, Oslo, Norway
- MAGIC Evidence Ecosystem Foundation
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Suetonia C Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - René Rodriguez-Gutierrez
- Plataforma INVEST Medicina UANL - KER Unit (KER Unit México), Subdirección de Investigación, Universidad Autónoma de Nuevo León, Monterrey, 64460, México
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, 55905, USA
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González," Universidad Autónoma de Nuevo León, Monterrey, 64460, México
| | | | - Thomas Agoritsas
- Service of Endocrinology, Diabetes, Nutrition and Patient Therapeutic Education, Geneva University Hospitals, Geneva, Switzerland
| | - Reed A C Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Michael Walsh
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - David J Tunnicliffe
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Evi V Nagler
- Renal Division, Ghent University Hospital, Belgium
| | | | - Bjørn Olav Åsvold
- Department of Endocrinology, Clinic of Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Vivekanand Jha
- The George Institute for Global Health, UNSW, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Mieke Vermandere
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Karim Gariani
- Service of Endocrinology, Diabetes, Nutrition and Patient Therapeutic Education, Geneva University Hospitals, Geneva, Switzerland
| | - Qian Zhao
- International Medical Center / Ward of General Practice, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Ren
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | | | - Patrick Gee
- Founder & CEHD, iAdvocate, Inc., Virginia, Patient partner
| | | | | | | | - Ling Li
- Chinese Evidence-based Medicine Center, Cochrane China Center and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qiukui Hao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- The Center of Gerontology and Geriatrics/National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Internal Medicine, Division of Nephrology and Hypertension, University of Kansas, Kansas City, USA
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