151
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Damen JAAG, Hooft L. The increasing need for systematic reviews of prognosis studies: strategies to facilitate review production and improve quality of primary research. Diagn Progn Res 2019; 3:2. [PMID: 31093572 PMCID: PMC6460843 DOI: 10.1186/s41512-019-0049-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/11/2019] [Indexed: 02/06/2023] Open
Abstract
Personalized, precision, and risk-based medicine are becoming increasingly important in medicine. These involve the use of information about the prognosis of a patient, to make individualized treatment decisions. This has led to an accumulating amount of literature available on prognosis studies. To summarize and evaluate this information overload, high-quality systematic reviews are essential, additionally helping us to facilitate interpretation and usability of prognosis study findings and to identify gaps in literature. Four types of prognosis studies can be identified: overall prognosis, prognostic factors, prognostic models, and predictors of treatment effect. Methodologists have focussed on developing methods and tools for every step of a systematic review for reviews of all four types of prognosis studies, from formulating the review question and writing a protocol to searching for studies, assessing risk of bias, meta-analysing results, and interpretation of results. The growing attention for prognosis research has led to the introduction of the Cochrane Prognosis Methods Group (PMG). Since 2016, reviews of prognosis studies are formally implemented within Cochrane. With these recent methodological developments and tools, and the implementation within Cochrane, it becomes increasingly feasible to perform high-quality reviews of prognosis studies that will have an impact on clinical practice.
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Affiliation(s)
- Johanna A. A. G. Damen
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, 3508 GA The Netherlands
| | - Lotty Hooft
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, 3508 GA The Netherlands
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152
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Moons KGM, Wolff RF, Riley RD, Whiting PF, Westwood M, Collins GS, Reitsma JB, Kleijnen J, Mallett S. PROBAST: A Tool to Assess Risk of Bias and Applicability of Prediction Model Studies: Explanation and Elaboration. Ann Intern Med 2019; 170:W1-W33. [PMID: 30596876 DOI: 10.7326/m18-1377] [Citation(s) in RCA: 661] [Impact Index Per Article: 132.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Prediction models in health care use predictors to estimate for an individual the probability that a condition or disease is already present (diagnostic model) or will occur in the future (prognostic model). Publications on prediction models have become more common in recent years, and competing prediction models frequently exist for the same outcome or target population. Health care providers, guideline developers, and policymakers are often unsure which model to use or recommend, and in which persons or settings. Hence, systematic reviews of these studies are increasingly demanded, required, and performed. A key part of a systematic review of prediction models is examination of risk of bias and applicability to the intended population and setting. To help reviewers with this process, the authors developed PROBAST (Prediction model Risk Of Bias ASsessment Tool) for studies developing, validating, or updating (for example, extending) prediction models, both diagnostic and prognostic. PROBAST was developed through a consensus process involving a group of experts in the field. It includes 20 signaling questions across 4 domains (participants, predictors, outcome, and analysis). This explanation and elaboration document describes the rationale for including each domain and signaling question and guides researchers, reviewers, readers, and guideline developers in how to use them to assess risk of bias and applicability concerns. All concepts are illustrated with published examples across different topics. The latest version of the PROBAST checklist, accompanying documents, and filled-in examples can be downloaded from www.probast.org.
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Affiliation(s)
- Karel G M Moons
- Julius Center for Health Sciences and Primary Care and Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (K.G.M., J.B.R.)
| | - Robert F Wolff
- Kleijnen Systematic Reviews, York, United Kingdom (R.F.W., M.W.)
| | - Richard D Riley
- Centre for Prognosis Research, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom (R.D.R.)
| | - Penny F Whiting
- Bristol Medical School of the University of Bristol and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom (P.F.W.)
| | - Marie Westwood
- Kleijnen Systematic Reviews, York, United Kingdom (R.F.W., M.W.)
| | - Gary S Collins
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom (G.S.C.)
| | - Johannes B Reitsma
- Julius Center for Health Sciences and Primary Care and Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (K.G.M., J.B.R.)
| | - Jos Kleijnen
- Kleijnen Systematic Reviews, York, United Kingdom, and School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands (J.K.)
| | - Sue Mallett
- Institute of Applied Health Research, National Institute for Health Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom (S.M.)
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153
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Pinart M, Kunath F, Lieb V, Tsaur I, Wullich B, Schmidt S. Prognostic models for predicting overall survival in metastatic castration-resistant prostate cancer: a systematic review. World J Urol 2018; 38:613-635. [PMID: 30554274 DOI: 10.1007/s00345-018-2574-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/20/2018] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Prognostic models are developed to estimate the probability of the occurrence of future outcomes incorporating multiple variables. We aimed to identify and summarize existing multivariable prognostic models developed for predicting overall survival in patients with metastatic castration-resistant prostate cancer (mCRPC). METHODS The protocol was prospectively registered (CRD42017064448). We systematically searched Medline and reference lists up to May 2018 and included experimental and observational studies, which developed and/or internally validated prognostic models for mCRPC patients and were further externally validated or updated. The outcome of interest was overall survival. Two authors independently performed literature screening and quality assessment. RESULTS We included 12 studies that developed models including 8750 patients aged 42-95 years. Models included 4-11 predictor variables, mostly hemoglobin, baseline PSA, alkaline phosphatase, performance status, and lactate dehydrogenase. Very few incorporated Gleason score. Two models included predictors related to docetaxel and mitoxantrone treatments. Model performance after internal validation showed similar discrimination power ranging from 0.62 to 0.73. Overall survival models were mainly constructed as nomograms or risk groups/score. Two models obtained an overall judgment of low risk of bias. CONCLUSIONS Most models were not suitable for clinical use due to methodological shortcomings and lack of external validation. Further external validation and/or model updating is required to increase prognostic accuracy and clinical applicability prior to their incorporation in clinical practice as a useful tool in patient management.
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Affiliation(s)
- M Pinart
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany
| | - F Kunath
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany
| | - V Lieb
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - I Tsaur
- Department of Urology, University Medicine Mainz, Mainz, Germany
| | - B Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Stefanie Schmidt
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany.
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154
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Kennedy G, Gallego B. Clinical prediction rules: A systematic review of healthcare provider opinions and preferences. Int J Med Inform 2018; 123:1-10. [PMID: 30654898 DOI: 10.1016/j.ijmedinf.2018.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 10/29/2018] [Accepted: 12/11/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The act of predicting clinical endpoints and patient trajectories based on past and current states is on the precipice of a technological revolution. This systematic review summarises the available evidence describing healthcare provider opinions and preferences with respect to the use of clinical prediction rules. The primary goal of this work is to inform the design and implementation of future systems, and secondarily to identify gaps for the development of clinician education programs. METHODS Five databases were systematically searched in May 2016 for studies collecting empirical opinions of healthcare providers regarding clinical prediction rule usage. Reference lists were scanned for additional eligible materials and an update search was made in August 2017. Data was extracted on high-level study features, before in-depth thematic analysis was performed. RESULTS 45 articles were identified from 9 countries. Most studies utilised surveys (28) or interviews (14). Fewer employed focus groups (9) or formal usability testing (4). Three high-level themes were identified, which form the basis of healthcare provider opinions of clinical prediction rules and their implementation - utility, credibility and usability. CONCLUSIONS Some of the objections and preferences stated by healthcare providers are inherent to the nature of the clinical problem addressed, which may or may not be within the designer's capacity to change; however, others (in particular - actionability, validation, integration and provision of high quality education materials) should be considered by prediction rule designers and implementation teams, in order to increase user acceptance and improve uptake of these tools. We summarise these findings across the clinical prediction rule lifecycle and pose questions for the rule developers, in order to produce tools that are more likely to successfully translate into clinical practice.
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Affiliation(s)
- Georgina Kennedy
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney 2113, Australia.
| | - Blanca Gallego
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney 2113, Australia
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155
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McGarrigle SA, Hanhauser YP, Mockler D, Gallagher DJ, Kennedy MJ, Bennett K, Connolly EM. Risk prediction models for familial breast cancer. Hippokratia 2018. [DOI: 10.1002/14651858.cd013185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sarah A McGarrigle
- Trinity College Dublin; Department of Surgery; Dublin Leinster Ireland Dublin 8
| | - Yvonne P Hanhauser
- St James's Hospital; Breast Care Unit; James' Street Dublin Leinster Ireland Dublin 8
| | - David Mockler
- Trinity Centre for Health Sciences, St James Hospital; John Stearne Library; Dublin Ireland
| | - David J Gallagher
- St James's Hospital and Trinity College Dublin; HOPE Directorate; James' Street Dublin Leinster Ireland Dublin 8
| | - Michael J Kennedy
- St James's Hospital and Trinity College Dublin; HOPE Directorate; James' Street Dublin Leinster Ireland Dublin 8
| | - Kathleen Bennett
- Royal College of Surgeons in Ireland; Division of Population Health Sciences; St Stephens' Green Dublin Ireland
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156
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Skin status for predicting pressure ulcer development: A systematic review and meta-analyses. Int J Nurs Stud 2018; 87:14-25. [DOI: 10.1016/j.ijnurstu.2018.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/15/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
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157
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Deliu N, Cottone F, Collins GS, Anota A, Efficace F. Evaluating methodological quality of Prognostic models Including Patient-reported HeAlth outcomes iN oncologY (EPIPHANY): a systematic review protocol. BMJ Open 2018; 8:e025054. [PMID: 30361409 PMCID: PMC6224737 DOI: 10.1136/bmjopen-2018-025054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/31/2018] [Accepted: 09/20/2018] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION While there is mounting evidence of the independent prognostic value of patient-reported outcomes (PROs) for overall survival (OS) in patients with cancer, it is known that the conduct of these studies may hold a number of methodological challenges. The aim of this systematic review is to evaluate the quality of published studies in this research area, in order to identify methodological and statistical issues deserving special attention and to also possibly provide evidence-based recommendations. METHODS AND ANALYSIS An electronic search strategy will be performed in PubMed to identify studies developing or validating a prognostic model which includes PROs as predictors. Two reviewers will independently be involved in data collection using a predefined and standardised data extraction form including information related to study characteristics, PROs measures used and multivariable prognostic models. Studies selection will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with data extraction form using fields from the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist for multivariable models. Methodological quality assessment will also be performed and will be based on prespecified domains of the CHARMS checklist. As a substantial heterogeneity of included studies is expected, a narrative evidence synthesis will also be provided. ETHICS AND DISSEMINATION Given that this systematic review will use only published data, ethical permissions will not be required. Findings from this review will be published in peer-reviewed scientific journals and presented at major international conferences. We anticipate that this review will contribute to identify key areas of improvement for conducting and reporting prognostic factor analyses with PROs in oncology and will lay the groundwork for developing future evidence-based recommendations in this area of research. PROSPERO REGISTRATION NUMBER CRD42018099160.
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Affiliation(s)
- Nina Deliu
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Francesco Cottone
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Gary S Collins
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Amélie Anota
- Methodology and Quality of Life in Oncology Unit (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
| | - Fabio Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
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158
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Critical appraisal of predictive tools to assess the difficulty of laparoscopic liver resection: a systematic review. Surg Endosc 2018; 33:366-376. [DOI: 10.1007/s00464-018-6479-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/11/2018] [Indexed: 12/12/2022]
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159
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Vernooij LM, Damen JAAG, van Klei WA, Moons K, Peelen LM. The added value of different biomarkers to the Revised Cardiac Risk Index to predict major adverse cardiac events and all-cause mortality after noncardiac surgery. Hippokratia 2018. [DOI: 10.1002/14651858.cd013139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lisette M Vernooij
- University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care; Universiteitsweg 100 Utrecht Netherlands
- University Medical Center Utrecht, Utrecht University; Department of Anesthesiology; Utrecht Netherlands
| | - Johanna AAG Damen
- University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care; Universiteitsweg 100 Utrecht Netherlands
- University Medical Center Utrecht, Utrecht University; Dutch Cochrane Centre; P.O.Box 85500 Utrecht Netherlands 3508 GA
| | - Wilton A van Klei
- University Medical Center Utrecht, Utrecht University; Department of Anesthesiology; Utrecht Netherlands
| | - Karel Moons
- University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care; Universiteitsweg 100 Utrecht Netherlands
- University Medical Center Utrecht, Utrecht University; Dutch Cochrane Centre; P.O.Box 85500 Utrecht Netherlands 3508 GA
| | - Linda M Peelen
- University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care; Universiteitsweg 100 Utrecht Netherlands
- University Medical Center Utrecht, Utrecht University; Department of Anesthesiology; Utrecht Netherlands
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160
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Whittle R, Peat G, Belcher J, Collins GS, Riley RD. Measurement error and timing of predictor values for multivariable risk prediction models are poorly reported. J Clin Epidemiol 2018; 102:38-49. [PMID: 29782997 DOI: 10.1016/j.jclinepi.2018.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/26/2018] [Accepted: 05/14/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Measurement error in predictor variables may threaten the validity of clinical prediction models. We sought to evaluate the possible extent of the problem. A secondary objective was to examine whether predictors are measured at the intended moment of model use. METHODS A systematic search of Medline was used to identify a sample of articles reporting the development of a clinical prediction model published in 2015. After screening according to a predefined inclusion criteria, information on predictors, strategies to control for measurement error, and intended moment of model use were extracted. Susceptibility to measurement error for each predictor was classified into low and high risks. RESULTS Thirty-three studies were reviewed, including 151 different predictors in the final prediction models. Fifty-one (33.7%) predictors were categorized as high risk of error; however, this was not accounted for in the model development. Only 8 (24.2%) studies explicitly stated the intended moment of model use and when the predictors were measured. CONCLUSION Reporting of measurement error and intended moment of model use is poor in prediction model studies. There is a need to identify circumstances where ignoring measurement error in prediction models is consequential and whether accounting for the error will improve the predictions.
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Affiliation(s)
- Rebecca Whittle
- Centre for Prognosis Research, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK.
| | - George Peat
- Centre for Prognosis Research, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - John Belcher
- Centre for Prognosis Research, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Richard D Riley
- Centre for Prognosis Research, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
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161
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Nagai T, Sundaram V, Rothnie K, Quint JK, Shoaib A, Shiraishi Y, Kohsaka S, Piper S, McDonagh TA, Hardman SMC, Goda A, Mizuno A, Kohno T, Rigby AS, Yoshikawa T, Clark AL, Anzai T, Cleland JGF. Mortality after admission for heart failure in the UK compared with Japan. Open Heart 2018; 5:e000811. [PMID: 30228905 PMCID: PMC6135420 DOI: 10.1136/openhrt-2018-000811] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/24/2018] [Indexed: 12/13/2022] Open
Abstract
Objective Mortality amongst patients hospitalised for heart failure (HHF) in Western and Asian countries may differ, but this has not been investigated using individual patient-level data (IPLD). We sought to remedy this through rigorous statistical analysis of HHF registries and variable selection from a systematic literature review. Methods and results IPLD from registries of HHF in Japan (n=3781) and the UK (n=894) were obtained. A systematic literature review identified 23 models for predicting outcome of HHF. Five variables appearing in 10 or more reports were strongly related to prognosis (systolic blood pressure, serum sodium concentration, age, blood urea nitrogen and creatinine). To compare mortality in the UK and Japan, variables were imputed in a propensity model using inverse probability of treatment weighting (IPTW) and IPTW with logistic regression (doubly robust IPTW). Overall, patients in the UK were sicker and in-patient and post-discharge mortalities were greater, suggesting that the threshold for hospital admission was higher. Covariate-adjusted in-hospital mortality was similar in the UK and Japan (IPTW OR: 1.14, 95% CI 0.70 to 1.86), but 180-day postdischarge mortality was substantially higher in the UK (doubly robust IPTW OR: 2.33, 95% CI 1.58 to 3.43). Conclusions Despite robust methods to adjust for differences in patient characteristics and disease severity, HHF patients in the UK have roughly twice the mortality at 180 days compared with those in Japan. Similar analyses should be done using other data sets and in other countries to determine the consistency of these findings and identify factors that might inform healthcare policy and improve outcomes.
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Affiliation(s)
- Toshiyuki Nagai
- National Heart & Lung Institute, Imperial College London, London, UK.,Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Varun Sundaram
- National Heart & Lung Institute, Imperial College London, London, UK.,Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.,Royal Brompton and Harefield Hospitals, London, UK
| | - Kieran Rothnie
- National Heart & Lung Institute, Imperial College London, London, UK
| | | | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, University of Keele and Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Susan Piper
- Cardiology Department, King's College Hospital, London, UK
| | | | - Suzanna Marie C Hardman
- Clinical and Academic Department of Cardiovascular Medicine, Whittington Hospital, London, UK
| | - Ayumi Goda
- Division of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiology, St Luke's International Hospital, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Alan S Rigby
- Department of Statistics, Hull York Medical School, University of Hull, Kingston-upon-Hull, UK
| | | | - Andrew L Clark
- Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull, UK
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - John G F Cleland
- Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull, UK.,Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow and National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College London, London, UK
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162
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Westby MJ, Dumville JC, Stubbs N, Norman G, Wong JKF, Cullum N, Riley RD. Protease activity as a prognostic factor for wound healing in venous leg ulcers. Cochrane Database Syst Rev 2018; 9:CD012841. [PMID: 30171767 PMCID: PMC6513613 DOI: 10.1002/14651858.cd012841.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Venous leg ulcers (VLUs) are a common type of complex wound that have a negative impact on people's lives and incur high costs for health services and society. It has been suggested that prolonged high levels of protease activity in the later stages of the healing of chronic wounds may be associated with delayed healing. Protease modulating treatments have been developed which seek to modulate protease activity and thereby promote healing in chronic wounds. OBJECTIVES To determine whether protease activity is an independent prognostic factor for the healing of venous leg ulcers. SEARCH METHODS In February 2018, we searched the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase and CINAHL. SELECTION CRITERIA We included prospective and retrospective longitudinal studies with any follow-up period that recruited people with VLUs and investigated whether protease activity in wound fluid was associated with future healing of VLUs. We included randomised controlled trials (RCTs) analysed as cohort studies, provided interventions were taken into account in the analysis, and case-control studies if there were no available cohort studies. We also included prediction model studies provided they reported separately associations of individual prognostic factors (protease activity) with healing. Studies of any type of protease or combination of proteases were eligible, including proteases from bacteria, and the prognostic factor could be examined as a continuous or categorical variable; any cut-off point was permitted. The primary outcomes were time to healing (survival analysis) and the proportion of people with ulcers completely healed; the secondary outcome was change in ulcer size/rate of wound closure. We extracted unadjusted (simple) and adjusted (multivariable) associations between the prognostic factor and healing. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion at each stage, and undertook data extraction, assessment of risk of bias and GRADE assessment. We collected association statistics where available. No study reported adjusted analyses: instead we collected unadjusted results or calculated association measures from raw data. We calculated risk ratios when both outcome and prognostic factor were dichotomous variables. When the prognostic factor was reported as continuous data and healing outcomes were dichotomous, we either performed regression analysis or analysed the impact of healing on protease levels, analysing as the standardised mean difference. When both prognostic factor and outcome were continuous data, we reported correlation coefficients or calculated them from individual participant data.We displayed all results on forest plots to give an overall visual representation. We planned to conduct meta-analyses where this was appropriate, otherwise we summarised narratively. MAIN RESULTS We included 19 studies comprising 21 cohorts involving 646 participants. Only 11 studies (13 cohorts, 522 participants) had data available for analysis. Of these, five were prospective cohort studies, four were RCTs and two had a type of case-control design. Follow-up time ranged from four to 36 weeks. Studies covered 10 different matrix metalloproteases (MMPs) and two serine proteases (human neutrophil elastase and urokinase-type plasminogen activators). Two studies recorded complete healing as an outcome; other studies recorded partial healing measures. There was clinical and methodological heterogeneity across studies; for example, in the definition of healing, the type of protease and its measurement, the distribution of active and bound protease species, the types of treatment and the reporting of results. Therefore, meta-analysis was not performed. No study had conducted multivariable analyses and all included evidence was of very low certainty because of the lack of adjustment for confounders, the high risk of bias for all studies except one, imprecision around the measures of association and inconsistency in the direction of association. Collectively the research indicated complete uncertainty as to the association between protease activity and VLU healing. AUTHORS' CONCLUSIONS This review identified very low validity evidence regarding any association between protease activity and VLU healing and there is complete uncertainty regarding the relationship. The review offers information for both future research and systematic review methodology.
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Affiliation(s)
- Maggie J Westby
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Jo C Dumville
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Nikki Stubbs
- St Mary's HospitalLeeds Community Healthcare NHS Trust3 Greenhill RoadLeedsUKLS12 3QE
| | - Gill Norman
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Jason KF Wong
- Manchester University NHS Foundation TrustManchester Centre for Plastic Surgery and Burns, Wythenshawe HospitalSouthmoor Road, WythenshaweManchesterUKM23 9LT
| | - Nicky Cullum
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Richard D Riley
- Keele UniversityResearch Institute for Primary Care and Health SciencesDavid Weatherall Building, Keele University CampusKeeleStaffordshireUKST5 5BG
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163
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Cooper C, Varley-Campbell J, Booth A, Britten N, Garside R. Systematic review identifies six metrics and one method for assessing literature search effectiveness but no consensus on appropriate use. J Clin Epidemiol 2018. [DOI: 10.1016/j.jclinepi.2018.02.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Traverso A, Wee L, Dekker A, Gillies R. Repeatability and Reproducibility of Radiomic Features: A Systematic Review. Int J Radiat Oncol Biol Phys 2018; 102:1143-1158. [PMID: 30170872 PMCID: PMC6690209 DOI: 10.1016/j.ijrobp.2018.05.053] [Citation(s) in RCA: 474] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 05/15/2018] [Accepted: 05/20/2018] [Indexed: 12/15/2022]
Abstract
Purpose: An ever-growing number of predictive models used to inform clinical decision making have included quantitative, computer-extracted imaging biomarkers, or “radiomic features.” Broadly generalizable validity of radiomics-assisted models may be impeded by concerns about reproducibility. We offer a qualitative synthesis of 41 studies that specifically investigated the repeatability and reproducibility of radiomic features, derived from a systematic review of published peer-reviewed literature. Methods and Materials: The PubMed electronic database was searched using combinations of the broad Haynes and Ingui filters along with a set of text words specific to cancer, radiomics (including texture analyses), reproducibility, and repeatability. This review has been reported in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. From each full-text article, information was extracted regarding cancer type, class of radiomic feature examined, reporting quality of key processing steps, and statistical metric used to segregate stable features. Results: Among 624 unique records, 41 full-text articles were subjected to review. The studies primarily addressed non-small cell lung cancer and oropharyngeal cancer. Only 7 studies addressed in detail every methodologic aspect related to image acquisition, preprocessing, and feature extraction. The repeatability and reproducibility of radiomic features are sensitive at various degrees to processing details such as image acquisition settings, image reconstruction algorithm, digital image preprocessing, and software used to extract radiomic features. First-order features were overall more reproducible than shape metrics and textural features. Entropy was consistently reported as one of the most stable first-order features. There was no emergent consensus regarding either shape metrics or textural features; however, coarseness and contrast appeared among the least reproducible. Conclusions: Investigations of feature repeatability and reproducibility are currently limited to a small number of cancer types. Reporting quality could be improved regarding details of feature extraction software, digital image manipulation (preprocessing), and the cutoff value used to distinguish stable features. We offer a qualitative synthesis of 41 studies that specifically investigated the repeatability and reproducibility of radiomic features. The repeatability and reproducibility of radiomic features are sensitive at various degrees to image quality and to software used to extract radiomic features. Investigations of feature repeatability and reproducibility are currently limited to a small number of cancer types. No consensus was found regarding the most repeatable and reproducible features with respect to different settings.
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Affiliation(s)
- Alberto Traverso
- Department of Radiation Oncology, MAASTRO Clinic, Maastricht, The Netherlands; School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands.
| | - Leonard Wee
- Department of Radiation Oncology, MAASTRO Clinic, Maastricht, The Netherlands; School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
| | - Andre Dekker
- Department of Radiation Oncology, MAASTRO Clinic, Maastricht, The Netherlands; School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
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Daines L, McLean S, Buelo A, Lewis S, Sheikh A, Pinnock H. Clinical prediction models to support the diagnosis of asthma in primary care: a systematic review protocol. NPJ Prim Care Respir Med 2018; 28:15. [PMID: 29777106 PMCID: PMC5959853 DOI: 10.1038/s41533-018-0086-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/26/2018] [Accepted: 04/26/2018] [Indexed: 02/01/2023] Open
Abstract
Substantial over-diagnosis and under-diagnosis of asthma in adults and children has recently been reported. As asthma is mostly diagnosed in non-specialist settings, a clinical prediction model (CPM) to aid the diagnosis of asthma in primary care may help improve diagnostic accuracy. We aim to systematically identify, describe, compare, and synthesise existing CPMs designed to support the diagnosis of asthma in children and adults presenting with symptoms suggestive of the disease, in primary care settings or equivalent populations. We will systematically search Medline, Embase and CINAHL from 1 January 1990 to present. Any CPM derived for use in a primary care population will be included. Equivalent populations in countries without a developed primary care service will also be included. The probability of asthma diagnosis will be the primary outcome. We will include CPMs designed for use in clinical practice to aid the diagnostic decision making of a healthcare professional during the assessment of an individual with symptoms suggestive of asthma. We will include derivation studies, and external model validation studies. Two reviewers will independently screen titles/abstracts and full texts for eligibility and extract data from included papers. The CHARMS checklist (or PROBAST if available) will be used to assess risk of bias within each study. Results will be summarised by narrative synthesis with meta-analyses completed if possible. This systematic review will provide comprehensive information about existing CPMs for the diagnosis of asthma in primary care and will inform the development of a future diagnostic model.
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Affiliation(s)
- L Daines
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland.
| | - S McLean
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland
| | - A Buelo
- Scottish Collaboration for Public Health Research and Policy, The University of Edinburgh, Edinburgh, Scotland
| | - S Lewis
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland
| | - A Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland
| | - H Pinnock
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland
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166
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Gurusamy KS, Debray TPA, Rompianesi G. Prognostic models for predicting the severity and mortality in people with acute pancreatitis. Hippokratia 2018. [DOI: 10.1002/14651858.cd013026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical School; Department of Surgery; Royal Free Hospital Rowland Hill Street London UK NW3 2PF
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care; Cochrane Netherlands; PO Box 85500 3508 GA Utrecht Utrecht Netherlands
| | - Gianluca Rompianesi
- University of Modena and Reggio Emilia; International Doctorate School in Clinical and Experimental Medicine; Modena Italy
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167
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van Mens TE, van der Pol LM, van Es N, Bistervels IM, Mairuhu ATA, van der Hulle T, Klok FA, Huisman MV, Middeldorp S. Sex-specific performance of pre-imaging diagnostic algorithms for pulmonary embolism. J Thromb Haemost 2018; 16:858-865. [PMID: 29460484 DOI: 10.1111/jth.13984] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Indexed: 11/30/2022]
Abstract
Essentials Decision rules for pulmonary embolism are used indiscriminately despite possible sex-differences. Various pre-imaging diagnostic algorithms have been investigated in several prospective studies. When analysed at an individual patient data level the algorithms perform similarly in both sexes. Estrogen use and male sex were associated with a higher prevalence in suspected pulmonary embolism. SUMMARY Background In patients suspected of pulmonary embolism (PE), clinical decision rules are combined with D-dimer testing to rule out PE, avoiding the need for imaging in those at low risk. Despite sex differences in several aspects of the disease, including its diagnosis, these algorithms are used indiscriminately in women and men. Objectives To compare the performance, defined as efficiency and failure rate, of three pre-imaging diagnostic algorithms for PE between women and men: the Wells rule with fixed or with age-adjusted D-dimer cut-off, and a recently validated algorithm (YEARS). A secondary aim was to determine the sex-specific prevalence of PE. Methods Individual patient data were obtained from six studies using the Wells rule (fixed D-dimer, n = 5; age adjusted, n = 1) and from one study using the YEARS algorithm. All studies prospectively enrolled consecutive patients with suspected PE. Main outcomes were efficiency (proportion of patients in which the algorithm ruled out PE without imaging) and failure rate (proportion of patients with PE not detected by the algorithm). Outcomes were estimated using (multilevel) logistic regression models. Results The main outcomes showed no sex differences in any of the separate algorithms. With all three, the prevalence of PE was lower in women (OR, 0.66, 0.68 and 0.74). In women, estrogen use, adjusted for age, was associated with lower efficiency and higher prevalence and D-dimer levels. Conclusions The investigated pre-imaging diagnostic algorithms for patients suspected of PE show no sex differences in performance. Male sex and estrogen use are both associated with a higher probability of having the disease.
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Affiliation(s)
- T E van Mens
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - L M van der Pol
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
- Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands
| | - N van Es
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - I M Bistervels
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
- Department of Internal Medicine, Flevo Hospital, Almere, the Netherlands
| | - A T A Mairuhu
- Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands
| | - T van der Hulle
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - F A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - M V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - S Middeldorp
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
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168
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Loymans RJB, Debray TPA, Honkoop PJ, Termeer EH, Snoeck-Stroband JB, Schermer TRJ, Assendelft WJJ, Timp M, Chung KF, Sousa AR, Sont JK, Sterk PJ, Reddel HK, Ter Riet G. Exacerbations in Adults with Asthma: A Systematic Review and External Validation of Prediction Models. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1942-1952.e15. [PMID: 29454163 DOI: 10.1016/j.jaip.2018.02.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/11/2018] [Accepted: 02/05/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several prediction models assessing future risk of exacerbations in adult patients with asthma have been published. Applicability of these models is uncertain because their predictive performance has often not been assessed beyond the population in which they were derived. OBJECTIVE This study aimed to identify and critically appraise prediction models for asthma exacerbations and validate them in 2 clinically distinct populations. METHODS PubMed and EMBASE were searched to April 2017 for reports describing adult asthma populations in which multivariable models were constructed to predict exacerbations during any time frame. After critical appraisal, the models' predictive performances were assessed in a primary and a secondary care population for author-defined exacerbations and for American Thoracic Society/European Respiratory Society-defined severe exacerbations. RESULTS We found 12 reports from which 24 prediction models were evaluated. Three predictors (previous health care utilization, symptoms, and spirometry values) were retained in most models. Assessment was hampered by suboptimal methodology and reporting, and by differences in exacerbation outcomes. Discrimination (area under the receiver-operating characteristic curve [c-statistic]) of models for author-defined exacerbations was better in the primary care population (mean, 0.71) than in the secondary care population (mean, 0.60) and similar (0.65 and 0.62, respectively) for American Thoracic Society/European Respiratory Society-defined severe exacerbations. Model calibration was generally poor, but consistent between the 2 populations. CONCLUSIONS The preservation of 3 predictors in models derived from variable populations and the fairly consistent predictive properties of most models in 2 distinct validation populations suggest the feasibility of a generalizable model predicting severe exacerbations. Nevertheless, improvement of the models is warranted because predictive performances are below the desired level.
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Affiliation(s)
- Rik J B Loymans
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands.
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands; Cochrane Netherlands, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Persijn J Honkoop
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Evelien H Termeer
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jiska B Snoeck-Stroband
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Tjard R J Schermer
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Willem J J Assendelft
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Merel Timp
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands
| | - Kian Fan Chung
- Experimental Airway Disease, National Heart and Lung Institute, Imperial College, London, United Kingdom; Royal Brompton NIHR Biomedical Research Unit, London, United Kingdom
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GlaxoSmithKline, Uxbridge, United Kingdom
| | - Jacob K Sont
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter J Sterk
- Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Helen K Reddel
- Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Gerben Ter Riet
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands
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169
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Nguyen E, Caranfa JT, Lyman GH, Kuderer NM, Stirbis C, Wysocki M, Coleman CI, Weeda ER, Kohn CG. Clinical prediction rules for mortality in patients with pulmonary embolism and cancer to guide outpatient management: a meta-analysis. J Thromb Haemost 2018; 16:279-292. [PMID: 29215781 DOI: 10.1111/jth.13921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Indexed: 01/27/2023]
Abstract
Essentials Clinical prediction rules (CPRs) can stratify patients with pulmonary embolism (PE) and cancer. A meta-analysis was done to assess prognostic accuracy in CPRs for mortality in these patients. Eight studies evaluating ten CPRs were included in this study. CPRs should continue to be used with other patient factors for mortality risk stratification. SUMMARY Background Cancer treatment is commonly complicated by pulmonary embolism (PE), which remains a leading cause of morbidity and mortality in these patients. Some guidelines recommend the use of clinical prediction rules (CPRs) to help clinicians identify patients at low risk of mortality and therefore guide care. Objective To determine and compare the accuracy of available CPRs for identifying cancer patients with PE at low risk of mortality. Methods A literature search of Medline and Scopus (January 2000 to August 2017) was performed. Studies deriving/validating ≥ 1 CPR for early post-PE all-cause mortality were included. A bivariate, random-effects model was used to pool sensitivity and specificity estimates for each CPR. Traditional random-effects meta-analysis was performed to estimate the weighted proportion of patients deemed at low risk of early mortality, mortality in low risk patients and odds ratios for death compared with higher-risk patients. Results Eight studies evaluating 10 CPRs were included. The highest sensitivities were observed with Hestia (98.1%, 95% confidence interval [CI] = 75.6-99.9%) and the EPIPHANY index (97.4%, 95% CI = 93.2-99.0%); sensitivities of remaining rules ranged from 59.9 to 96.6%. Of the six CPRs with sensitivities ≥ 95%, none had specificities > 33%. Random-effects meta-analysis suggested that 6.6-51.6% of cancer patients with PE were at low risk of mortality, 0-14.3% of low-risk patients died and low-risk patients had a 43-94% lower odds of death compared with those at higher risk. Conclusions Because of the limited total body of evidence regarding CPRs, their results, in conjunction with other pertinent patient-specific clinical factors, should continue to be used in identifying appropriate management for PE in patients with cancer.
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Affiliation(s)
- E Nguyen
- Idaho State University College of Pharmacy, Meridian, ID, USA
| | - J T Caranfa
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - G H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | - N M Kuderer
- University of Washington School of Medicine, Seattle, WA, USA
| | - C Stirbis
- University of Saint Joseph School of Pharmacy, Hartford, CT, USA
| | - M Wysocki
- University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - C I Coleman
- University of Connecticut School of Pharmacy, Storrs, CT, USA
- UConn/Hartford Hospital Evidence-based Practice Center, Hartford, CT, USA
| | - E R Weeda
- Medical University of South Carolina College of Pharmacy, Charleston, SC, USA
| | - C G Kohn
- University of Connecticut School of Medicine, Farmington, CT, USA
- UConn/Hartford Hospital Evidence-based Practice Center, Hartford, CT, USA
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170
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Fahey M, Crayton E, Wolfe C, Douiri A. Clinical prediction models for mortality and functional outcome following ischemic stroke: A systematic review and meta-analysis. PLoS One 2018; 13:e0185402. [PMID: 29377923 PMCID: PMC5788336 DOI: 10.1371/journal.pone.0185402] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/12/2017] [Indexed: 01/22/2023] Open
Abstract
Objective We aim to identify and critically appraise clinical prediction models of mortality and function following ischaemic stroke. Methods Electronic databases, reference lists, citations were searched from inception to September 2015. Studies were selected for inclusion, according to pre-specified criteria and critically appraised by independent, blinded reviewers. The discrimination of the prediction models was measured by the area under the curve receiver operating characteristic curve or c-statistic in random effects meta-analysis. Heterogeneity was measured using I2. Appropriate appraisal tools and reporting guidelines were used in this review. Results 31395 references were screened, of which 109 articles were included in the review. These articles described 66 different predictive risk models. Appraisal identified poor methodological quality and a high risk of bias for most models. However, all models precede the development of reporting guidelines for prediction modelling studies. Generalisability of models could be improved, less than half of the included models have been externally validated(n = 27/66). 152 predictors of mortality and 192 predictors and functional outcome were identified. No studies assessing ability to improve patient outcome (model impact studies) were identified. Conclusions Further external validation and model impact studies to confirm the utility of existing models in supporting decision-making is required. Existing models have much potential. Those wishing to predict stroke outcome are advised to build on previous work, to update and adapt validated models to their specific contexts opposed to designing new ones.
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Affiliation(s)
- Marion Fahey
- Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- * E-mail:
| | - Elise Crayton
- Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Charles Wolfe
- Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Abdel Douiri
- Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
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171
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Geersing GJ, Kraaijpoel N, Büller HR, van Doorn S, van Es N, Le Gal G, Huisman MV, Kearon C, Kline JA, Moons KGM, Miniati M, Righini M, Roy PM, van der Wall SJ, Wells PS, Klok FA. Ruling out pulmonary embolism across different subgroups of patients and healthcare settings: protocol for a systematic review and individual patient data meta-analysis (IPDMA). Diagn Progn Res 2018; 2:10. [PMID: 31093560 PMCID: PMC6460525 DOI: 10.1186/s41512-018-0032-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/18/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Diagnosing pulmonary embolism in suspected patients is notoriously difficult as signs and symptoms are non-specific. Different diagnostic strategies have been developed, usually combining clinical probability assessment with D-dimer testing. However, their predictive performance differs across different healthcare settings, patient subgroups, and clinical presentation, which are currently not accounted for in the available diagnostic approaches. METHODS This is a protocol for a large diagnostic individual patient data meta-analysis (IPDMA) of currently available diagnostic studies in the field of pulmonary embolism. We searched MEDLINE (search date January 1, 1995, till August 25, 2016) to retrieve all primary diagnostic studies that had evaluated diagnostic strategies for pulmonary embolism. Two authors independently screened titles, abstracts, and subsequently full-text articles for eligibility from 3145 individual studies. A total of 40 studies were deemed eligible for inclusion into our IPDMA set, and principal investigators from these studies were invited to participate in a meeting at the 2017 conference from the International Society on Thrombosis and Haemostasis. All authors agreed on data sharing and participation into this project. The process of data collection of available datasets as well as potential identification of additional new datasets based upon personal contacts and an updated search will be finalized early 2018. The aim is to evaluate diagnostic strategies across three research domains: (i) the optimal diagnostic approach for different healthcare settings, (ii) influence of comorbidity on the predictive performance of each diagnostic strategy, and (iii) optimize and tailor the efficiency and safety of ruling out PE across a broad spectrum of patients with a new, patient-tailored clinical decision model that combines clinical items with quantitative D-dimer testing. DISCUSSION This pre-planned individual patient data meta-analysis aims to contribute in resolving remaining diagnostic challenges of time-efficient diagnosis of pulmonary embolism by tailoring available diagnostic strategies for different healthcare settings and comorbidity. SYSTEMATIC REVIEW REGISTRATION Prospero trial registration: ID 89366.
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Affiliation(s)
- G.-J. Geersing
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - N. Kraaijpoel
- 0000000084992262grid.7177.6Academic Medical Center, Vascular Medicine, University of Amsterdam, Amsterdam, the Netherlands
| | - H. R. Büller
- 0000000084992262grid.7177.6Academic Medical Center, Vascular Medicine, University of Amsterdam, Amsterdam, the Netherlands
| | - S. van Doorn
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - N. van Es
- 0000000084992262grid.7177.6Academic Medical Center, Vascular Medicine, University of Amsterdam, Amsterdam, the Netherlands
| | - G. Le Gal
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Thrombosis Research Group, Ottawa, Canada
| | - M. V. Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - C. Kearon
- 0000 0004 1936 8227grid.25073.33Department of Medicine, The Thrombosis and Atherosclerosis Research Institute, Mc Master University, Hamilton, Canada
| | - J. A. Kline
- 0000 0001 2287 3919grid.257413.6School of Medicine, Indiana University, Indianapolis, IN USA
| | - K. G. M. Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - M. Miniati
- 0000 0004 1757 2304grid.8404.8Department of Medicine, University of Florence, Florence, Italy
| | - M. Righini
- 0000 0001 0721 9812grid.150338.cDivision of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - P.-M. Roy
- 0000 0001 2248 3363grid.7252.2Emergency Department, University of Angers, Angers, France
| | - S. J. van der Wall
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - P. S. Wells
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Thrombosis Research Group, Ottawa, Canada
| | - F. A. Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
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172
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The Prognostic Value of MRI in Moderate and Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Crit Care Med 2017; 45:e1280-e1288. [PMID: 29028764 DOI: 10.1097/ccm.0000000000002731] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Traumatic brain injury is a major cause of death and disability, yet many predictors of outcome are not precise enough to guide initial clinical decision-making. Although increasingly used in the early phase following traumatic brain injury, the prognostic utility of MRI remains uncertain. We thus undertook a systematic review and meta-analysis of studies evaluating the predictive value of acute MRI lesion patterns for discriminating clinical outcome in traumatic brain injury. DATA SOURCES MEDLINE, EMBASE, BIOSIS, and CENTRAL from inception to November 2015. STUDY SELECTION Studies of adults who had MRI in the acute phase following moderate or severe traumatic brain injury. Our primary outcomes were all-cause mortality and the Glasgow Outcome Scale. DATA EXTRACTION Two authors independently performed study selection and data extraction. We calculated pooled effect estimates with a random effects model, evaluated the risk of bias using a modified version of Quality in Prognostic Studies and determined the strength of evidence with the Grading of Recommendations, Assessment, Development, and Evaluation. DATA SYNTHESIS We included 58 eligible studies, of which 27 (n = 1,652) contributed data to meta-analysis. Brainstem lesions were associated with all-cause mortality (risk ratio, 1.78; 95% CI, 1.01-3.15; I = 43%) and unfavorable Glasgow Outcome Scale (risk ratio, 2.49; 95% CI, 1.72-3.58; I = 81%) at greater than or equal to 6 months. Diffuse axonal injury patterns were associated with an increased risk of unfavorable Glasgow Outcome Scale (risk ratio, 2.46; 95% CI, 1.06-5.69; I = 74%). MRI scores based on lesion depth demonstrated increasing risk of unfavorable neurologic outcome as more caudal structures were affected. Most studies were at high risk of methodological bias. CONCLUSIONS MRI following traumatic brain injury yields important prognostic information, with several lesion patterns significantly associated with long-term survival and neurologic outcome. Given the high risk of bias in the current body of literature, large well-controlled studies are necessary to better quantify the prognostic role of early MRI in moderate and severe traumatic brain injury.
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173
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Aluvaala J, Collins GS, Maina M, Berkley JA, English M. A systematic review of neonatal treatment intensity scores and their potential application in low-resource setting hospitals for predicting mortality, morbidity and estimating resource use. Syst Rev 2017; 6:248. [PMID: 29212522 PMCID: PMC5719732 DOI: 10.1186/s13643-017-0649-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/28/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Treatment intensity scores can predict mortality and estimate resource use. They may therefore be of interest for essential neonatal care in low resource settings where neonatal mortality remains high. We sought to systematically review neonatal treatment intensity scores to (1) assess the level of evidence on predictive performance in predicting clinical outcomes and estimating resource utilisation and (2) assess the applicability of the identified models to decision making for neonatal care in low resource settings. METHODS We conducted a systematic search of PubMed, EMBASE (OVID), CINAHL, Global Health Library (Global index, WHO) and Google Scholar to identify studies published up until 21 December 2016. Included were all articles that used treatments as predictors in neonatal models. Individual studies were appraised using the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS). In addition, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used as a guiding framework to assess certainty in the evidence for predicting outcomes across studies. RESULTS Three thousand two hundred forty-nine articles were screened, of which ten articles were included in the review. All of the studies were conducted in neonatal intensive care units with sample sizes ranging from 22 to 9978, with a median of 163. Two articles reported model development, while eight reported external application of existing models to new populations. Meta-analysis was not possible due heterogeneity in the conduct and reporting of the identified studies. Discrimination as assessed by area under receiver operating characteristic curve was reported for in-hospital mortality, median 0.84 (range 0.75-0.96, three studies), early adverse outcome and late adverse outcome (0.78 and 0.59, respectively, one study). CONCLUSION Existing neonatal treatment intensity models show promise in predicting mortality and morbidity. There is however low certainty in the evidence on their performance in essential neonatal care in low resource settings as all studies had methodological limitations and were conducted in intensive care. The approach may however be developed further for low resource settings like Kenya because treatment data may be easier to obtain compared to measures of physiological status. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016034205.
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Affiliation(s)
- Jalemba Aluvaala
- KEMRI-Wellcome Trust Research Programme, P.O Box 43640 – 00100, Nairobi, Kenya
- Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenyatta National Hospital, P. O. Box 19676-00202, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ UK
| | - Gary S. Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD UK
| | - Michuki Maina
- KEMRI-Wellcome Trust Research Programme, P.O Box 43640 – 00100, Nairobi, Kenya
| | - James A. Berkley
- KEMRI-Wellcome Trust Research Programme, P.O Box 43640 – 00100, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ UK
- The Childhood Acute Illness & Nutrition (CHAIN) Network, P.O Box 43640 – 00100, Nairobi, Kenya
| | - Mike English
- KEMRI-Wellcome Trust Research Programme, P.O Box 43640 – 00100, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ UK
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Tseli E, Grooten WJA, Stålnacke BM, Boersma K, Enthoven P, Gerdle B, Äng BO. Predictors of multidisciplinary rehabilitation outcomes in patients with chronic musculoskeletal pain: protocol for a systematic review and meta-analysis. Syst Rev 2017; 6:199. [PMID: 29020989 PMCID: PMC5637325 DOI: 10.1186/s13643-017-0598-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic musculoskeletal pain is a major public health problem. Early prediction for optimal treatment results has received growing attention, but there is presently a lack of evidence regarding what information such proactive management should be based on. This study protocol, therefore, presents our planned systematic review and meta-analysis on important predictive factors for health and work-related outcomes following multidisciplinary rehabilitation (MDR) in patients with chronic musculoskeletal pain. METHODS We aim to perform a synthesis of the available evidence together with a meta-analysis of published peer-reviewed original research that includes predictive factors preceding MDR. Included are prospective studies of adults with benign, chronic (> 3 months) musculoskeletal pain diagnoses who have taken part in MDR. In the studies, associations between personal and rehabilitation-based factors and the outcomes of interest are reported. Outcome domains are pain, physical functioning including health-related quality of life, and work ability with follow-ups of 6 months or more. We will use a broad, explorative approach to any presented predictive factors (demographic, symptoms-related, physical, psychosocial, work-related, and MDR-related) and these will be analyzed through (a) narrative synthesis for each outcome domain and (b) if sufficient studies are available, a quantitative synthesis in which variance-weighted pooled proportions will be computed using a random effects model for each outcome domain. The strength of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation. DISCUSSION The strength of this systematic review is that it aims for a meta-analysis of prospective cohort or randomized controlled studies by performing an extensive search of multiple databases, using an explorative study approach to predictive factors, rather than building on single predictor impact on the outcome or on predefined hypotheses. In this way, an overview of factors central to MDR outcome can be made and will help strengthen the evidence base and inform a wide readership including health care practitioners and policymakers. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016025339.
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Affiliation(s)
- Elena Tseli
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 23100, 141 83, Huddinge, Sweden.
| | - Wilhelmus Johannes Andreas Grooten
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 23100, 141 83, Huddinge, Sweden.,Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Britt-Marie Stålnacke
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.,Department of Clinical Sciences, Department of Rehabilitation Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Katja Boersma
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Paul Enthoven
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Björn Olov Äng
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 23100, 141 83, Huddinge, Sweden.,Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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175
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Hodgson LE, Sarnowski A, Roderick PJ, Dimitrov BD, Venn RM, Forni LG. Systematic review of prognostic prediction models for acute kidney injury (AKI) in general hospital populations. BMJ Open 2017; 7:e016591. [PMID: 28963291 PMCID: PMC5623486 DOI: 10.1136/bmjopen-2017-016591] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Critically appraise prediction models for hospital-acquired acute kidney injury (HA-AKI) in general populations. DESIGN Systematic review. DATA SOURCES Medline, Embase and Web of Science until November 2016. ELIGIBILITY Studies describing development of a multivariable model for predicting HA-AKI in non-specialised adult hospital populations. Published guidance followed for data extraction reporting and appraisal. RESULTS 14 046 references were screened. Of 53 HA-AKI prediction models, 11 met inclusion criteria (general medicine and/or surgery populations, 474 478 patient episodes) and five externally validated. The most common predictors were age (n=9 models), diabetes (5), admission serum creatinine (SCr) (5), chronic kidney disease (CKD) (4), drugs (diuretics (4) and/or ACE inhibitors/angiotensin-receptor blockers (3)), bicarbonate and heart failure (4 models each). Heterogeneity was identified for outcome definition. Deficiencies in reporting included handling of predictors, missing data and sample size. Admission SCr was frequently taken to represent baseline renal function. Most models were considered at high risk of bias. Area under the receiver operating characteristic curves to predict HA-AKI ranged 0.71-0.80 in derivation (reported in 8/11 studies), 0.66-0.80 for internal validation studies (n=7) and 0.65-0.71 in five external validations. For calibration, the Hosmer-Lemeshow test or a calibration plot was provided in 4/11 derivations, 3/11 internal and 3/5 external validations. A minority of the models allow easy bedside calculation and potential electronic automation. No impact analysis studies were found. CONCLUSIONS AKI prediction models may help address shortcomings in risk assessment; however, in general hospital populations, few have external validation. Similar predictors reflect an elderly demographic with chronic comorbidities. Reporting deficiencies mirrors prediction research more broadly, with handling of SCr (baseline function and use as a predictor) a concern. Future research should focus on validation, exploration of electronic linkage and impact analysis. The latter could combine a prediction model with AKI alerting to address prevention and early recognition of evolving AKI.
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Affiliation(s)
- Luke Eliot Hodgson
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Alexander Sarnowski
- Intensive Care Department, The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Paul J Roderick
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Borislav D Dimitrov
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Richard M Venn
- Anaesthetics Department, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, UK
| | - Lui G Forni
- Intensive Care Department, The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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176
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Sullivan S, Northstone K, Gadd C, Walker J, Margelyte R, Richards A, Whiting P. Models to predict relapse in psychosis: A systematic review. PLoS One 2017; 12:e0183998. [PMID: 28934214 PMCID: PMC5608199 DOI: 10.1371/journal.pone.0183998] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/12/2017] [Indexed: 12/02/2022] Open
Abstract
Background There is little evidence on the accuracy of psychosis relapse prediction models. Our objective was to undertake a systematic review of relapse prediction models in psychosis. Method We conducted a literature search including studies that developed and/or validated psychosis relapse prediction models, with or without external model validation. Models had to target people with psychosis and predict relapse. The key databases searched were; Embase, Medline, Medline In-Process Citations & Daily Update, PsychINFO, BIOSIS Citation Index, CINAHL, and Science Citation Index, from inception to September 2016. Prediction modelling studies were assessed for risk of bias and applicability using the PROBAST tool. Results There were two eligible studies, which included 33,088 participants. One developed a model using prodromal symptoms and illness-related variables, which explained 14% of relapse variance but was at high risk of bias. The second developed a model using administrative data which was moderately discriminative (C = 0.631) and associated with relapse (OR 1.11 95% CI 1.10, 1.12) and achieved moderately discriminative capacity when validated (C = 0.630). The risk of bias was low. Conclusions Due to a lack of high quality evidence it is not possible to make any specific recommendations about the predictors that should be included in a prognostic model for relapse. For instance, it is unclear whether prodromal symptoms are useful for predicting relapse. The use of routine data to develop prediction models may be a more promising approach, although we could not empirically compare the two included studies.
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Affiliation(s)
- Sarah Sullivan
- NIHR CLAHRC West, United Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Kate Northstone
- NIHR CLAHRC West, United Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Caroline Gadd
- Otsuka Pharmaceutical Europe Ltd, trading as Otsuka Health Solutions, Wexham Springs, Slough, United Kingdom
| | - Julian Walker
- Avon & Wiltshire Mental Health NHS Trust, Jenner House, Chippenham, Wilts, United Kingdom
| | - Ruta Margelyte
- NIHR CLAHRC West, United Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Alison Richards
- NIHR CLAHRC West, United Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Penny Whiting
- NIHR CLAHRC West, United Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
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177
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de Ruiter EJ, Ooft ML, Devriese LA, Willems SM. The prognostic role of tumor infiltrating T-lymphocytes in squamous cell carcinoma of the head and neck: A systematic review and meta-analysis. Oncoimmunology 2017; 6:e1356148. [PMID: 29147608 PMCID: PMC5674970 DOI: 10.1080/2162402x.2017.1356148] [Citation(s) in RCA: 213] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/29/2017] [Accepted: 07/01/2017] [Indexed: 12/22/2022] Open
Abstract
Background - The presence of tumor-infiltrating lymphocytes (TILs) in the tumor microenvironment is associated with an improved prognosis and a better response to therapy in different types of cancer. In this systematic review and meta-analysis, we investigated the prognostic value of T cells in head and neck squamous cell carcinoma (HNSCC). Methods - In a systematic review, Pubmed and Embase were searched for publications that investigated the prognostic value of T cells in HNSCC. A meta-analysis was performed including all studies assessing the association between CD3+, CD4+, CD8+, and FoxP3+ TILs and overall survival (OS), disease-free survival (DFS), or locoregional control (LRC). Results - A pooled analysis indicated a favorable, prognostic role for CD3+ TILs (HR 0.64 (95%CI 0.47-0.85) for OS, HR 0.63 (95%CI 0.49-0.82) for DFS) and CD8+ TILs (HR 0.67 (95%CI 0.58-0.79) for OS, HR 0.50 (95%CI 0.37-0.68) for DFS, and HR 0.82 (95%CI 0.70-0.96) for LRC) in the clinical outcome of HNSCC. FoxP3+ TILs were also associated with better OS (HR 0.80 (95%CI 0.70-0.92)). Conclusion - This systematic review and meta-analysis confirmed the favorable, prognostic role of CD3+ and CD8+ T cell infiltration in HNSCC patients and found an association between FoxP3+ TILs and improved overall survival. Future studies using homogeneous patient cohorts with regard to tumor subsite, stage and treatment are necessary to provide more insight in the predictive value of TILs in HNSCC.
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Affiliation(s)
- Emma J de Ruiter
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - Marc L Ooft
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - Lot A Devriese
- Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - Stefan M Willems
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
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178
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Kohn CG, Weeda ER, Kumar N, Wells PS, Peacock WF, Fermann GJ, Wang L, Baser O, Schein JR, Crivera C, Coleman CI. External validation of a claims-based and clinical approach for predicting post-pulmonary embolism outcomes among United States veterans. Intern Emerg Med 2017; 12:613-619. [PMID: 28185131 DOI: 10.1007/s11739-017-1625-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/30/2017] [Indexed: 11/28/2022]
Abstract
The In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) rule can accurately identify pulmonary embolism (PE) patients at low risk of early complications using claims data. We sought to externally validate the IMPACT and simplified Pulmonary Embolism Severity Index (sPESI) tools for predicting all-cause mortality and readmission. We used Veteran Health Administration data (10/1/2010-9/30/2015) to identify adults with ≥1 inpatient diagnosis code for acute PE, ≥12 months continuous medical and pharmacy benefits prior to the index PE, ≥90 days of post-event follow-up (unless death occurred) and ≥1 claim for an anticoagulant during the index PE stay. Prognostic accuracies of IMPACT and sPESI for 30- and 90-day all-cause mortality and 90-day readmission were estimated. Of 6,746 PE patients, 7.5 and 12.6% died at 30 and 90 days. Within 90 days, 20.1% were readmitted for any reason. Hospitalization for recurrent VTE and major bleeding occurred in 5.6 and 1.7% of patients. IMPACT classified 15.2% as low risk, while 28.4% were low risk per sPESI. Both tools displayed sensitivity >90% and negative predictive values (NPVs) >97% for 30-day mortality, but low specificity (range 16.2-30.0) and positive predictive values (PPVs) (range 8.7-9.5); with similar results observed for 90-day mortality. IMPACT's sensitivity for all-cause readmission was numerically higher than sPESI (88.2 vs. 79.0%), but both had comparable NPVs (85.1 vs. 84.2%). Similar trends were observed for VTE or major bleeding readmissions. IMPACT classified patients for post-PE outcomes with similar accuracy as sPESI. IMPACT appears useful for identifying PE patients at low risk for early mortality or readmission in claims-based studies.
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Affiliation(s)
- Christine G Kohn
- School of Pharmacy, University of Saint Joseph, Hartford, CT, USA
| | - Erin R Weeda
- School of Pharmacy, University of Connecticut, 69 North Eagleville Road, Unit 3092, Storrs, CT, 06269, USA
| | - Neela Kumar
- School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Philip S Wells
- Department of Medicine, University of Ottawa, Ottawa, ON, USA
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Gregory J Fermann
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Li Wang
- STATinMed Research, Plano, TX, USA
| | - Onur Baser
- STATinMed Research, Plano, TX, USA
- Department of Internal Medicine, Columbia University, New York, NY, USA
| | - Jeff R Schein
- Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Raritan, NJ, USA
| | - Concetta Crivera
- Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Raritan, NJ, USA
| | - Craig I Coleman
- School of Pharmacy, University of Connecticut, 69 North Eagleville Road, Unit 3092, Storrs, CT, 06269, USA.
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Tweehuysen L, van den Ende CH, Beeren FMM, Been EMJ, van den Hoogen FHJ, den Broeder AA. Little Evidence for Usefulness of Biomarkers for Predicting Successful Dose Reduction or Discontinuation of a Biologic Agent in Rheumatoid Arthritis: A Systematic Review. Arthritis Rheumatol 2017; 69:301-308. [PMID: 27696778 PMCID: PMC5299504 DOI: 10.1002/art.39946] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/22/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To systematically review studies addressing prediction of successful dose reduction or discontinuation of a biologic agent in rheumatoid arthritis (RA). METHODS PubMed, Embase, and Cochrane Library databases were searched for studies that examined the predictive value of biomarkers for successful dose reduction or discontinuation of a biologic agent in RA. Two reviewers independently selected studies, and extracted data and assessed the risk of bias. A biomarker was classified as a "potential predictor" if the univariate association was either strong (odds ratio or hazard ratio >2.0 or <0.5) or statistically significant. For biomarkers that were studied multiple times, qualitative best-evidence synthesis was performed separately for the prediction of successful dose reduction and discontinuation. Biomarkers that were defined in ≥75% of the studies as potential predictors were regarded as "predictor" for the purposes of our study. RESULTS Of 3,029 nonduplicate articles initially searched, 16 articles regarding 15 cohorts were included in the present study. Overall, 17 biomarkers were studied multiple times for the prediction of successful dose reduction, and 33 for the prediction of successful discontinuation of a biologic agent. Three predictors were identified: higher adalimumab trough level for successful dose reduction and lower Sharp/van der Heijde erosion score and shorter symptom duration at the start of a biologic agent for successful discontinuation. CONCLUSION The predictive value of a wide variety of biomarkers for successful dose reduction or discontinuation of biologic treatment in RA has been investigated. We identified only 3 biomarkers as predictors, in just 2 studies. The strength of the evidence is limited by the low quality of the included studies and the likelihood of reporting bias and multiple testing.
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180
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van Doorn S, Debray TPA, Kaasenbrood F, Hoes AW, Rutten FH, Moons KGM, Geersing GJ. Predictive performance of the CHA2DS2-VASc rule in atrial fibrillation: a systematic review and meta-analysis. J Thromb Haemost 2017; 15:1065-1077. [PMID: 28375552 DOI: 10.1111/jth.13690] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Indexed: 11/29/2022]
Abstract
Essentials The widely recommended CHA2DS2-VASc shows conflicting results in contemporary validation studies. We performed a systematic review and meta-analysis of 19 studies validating CHA2DS2-VASc. There was high heterogeneity in stroke risks for different CHA2DS2-VASc scores. This was not explained by differences between setting of care, or by performing meta-regression. SUMMARY Background The CHA2DS2-VASc decision rule is widely recommended for estimating stroke risk in patients with atrial fibrillation (AF), although validation studies show ambiguous and conflicting results. Objectives To: (i) review existing studies validating CHA2DS2-VASc in AF patients who are not (yet) anticoagulated; (ii) meta-analyze estimates of stroke risk per score; and (iii) explore sources of heterogeneity across the validation studies. Methods We performed a systematic literature review and random effects meta-analysis of studies externally validating CHA2DS2-VASc in AF patients not receiving anticoagulants. To explore between-study heterogeneity in stroke risk, we stratified studies to the clinical setting in which patient enrollment started, and performed meta-regression. Results In total, 19 studies were evaluated, with over two million person-years of follow-up. In studies recruiting AF patients in hospitals, stroke risks for scores of 0, 1 and 2 were 0.4% (approximate 95% prediction interval [PI] 0.2-3.2%), 1.2% (95% PI 0.1-3.8%), and 2.2% (95% PI 0.03-7.8%), respectively. These were consistently higher than those in studies recruiting patients from the open general population, with risks of 0.2% (95% PI 0.0-0.9%), 0.7% (95% PI 0.3-1.2%) and 1.5% (95% PI 0.4-3.3%) for scores of 0, 1, and 2, respectively. Heterogeneity, as reflected by the wide PIs, could not be fully explained by meta-regression. Conclusions Studies validating CHA2DS2-VASc show high heterogeneity in predicted stroke risks for different scores.
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Affiliation(s)
- S van Doorn
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - T P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - F Kaasenbrood
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - F H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - K G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - G J Geersing
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Skoetz N, Collins G, Moons K, Estcourt LJ, Engert A, Kobe C, von Tresckow B, Trivella M. Interim PET for prognosis in adults with Hodgkin lymphoma: a prognostic factor exemplar review. Hippokratia 2017. [DOI: 10.1002/14651858.cd012643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Nicole Skoetz
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Kerpener Str. 62 Cologne Germany 50937
| | - Gary Collins
- University of Oxford; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; Windmill Road Oxford UK OX3 7LD
| | - Karel Moons
- University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care; PO Box 85500 Utrecht Netherlands 3508 GA
| | - Lise J Estcourt
- NHS Blood and Transplant; Haematology/Transfusion Medicine; Level 2, John Radcliffe Hospital Headington Oxford UK OX3 9BQ
| | - Andreas Engert
- University Hospital of Cologne; Department I of Internal Medicine; Kerpener Str. 62 Cologne Germany 50924
| | - Carsten Kobe
- University Hospital of Cologne; Department for Nuclear Medicine; Cologne Germany
| | - Bastian von Tresckow
- University Hospital of Cologne; Department I of Internal Medicine; Kerpener Str. 62 Cologne Germany 50924
| | - Marialena Trivella
- University of Oxford; Centre for Statistics in Medicine; Botnar Research Centre Windmill Road Oxford UK OX3 7LD
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Corp N, Jordan JL, Hayden JA, Irvin E, Parker R, Smith A, van der Windt DA. Protocol: a systematic review of studies developing and/or evaluating search strategies to identify prognosis studies. Syst Rev 2017; 6:88. [PMID: 28427475 PMCID: PMC5399431 DOI: 10.1186/s13643-017-0482-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/10/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Prognosis research is on the rise, its importance recognised because chronic health conditions and diseases are increasingly common and costly. Prognosis systematic reviews are needed to collate and synthesise these research findings, especially to help inform effective clinical decision-making and healthcare policy. A detailed, comprehensive search strategy is central to any systematic review. However, within prognosis research, this is challenging due to poor reporting and inconsistent use of available indexing terms in electronic databases. Whilst many published search filters exist for finding clinical trials, this is not the case for prognosis studies. This systematic review aims to identify and compare existing methodological filters developed and evaluated to identify prognosis studies of any of the three main types: overall prognosis, prognostic factors, and prognostic [risk prediction] models. METHODS Primary studies reporting the development and/or evaluation of methodological search filters to retrieve any type of prognosis study will be included in this systematic review. Multiple electronic bibliographic databases will be searched, grey literature will be sought from relevant organisations and websites, experts will be contacted, and citation tracking of key papers and reference list checking of all included papers will be undertaken. Titles will be screened by one person, and abstracts and full articles will be reviewed for inclusion independently by two reviewers. Data extraction and quality assessment will also be undertaken independently by two reviewers with disagreements resolved by discussion or by a third reviewer if necessary. Filters' characteristics and performance metrics reported in the included studies will be extracted and tabulated. To enable comparisons, filters will be grouped according to database, platform, type of prognosis study, and type of filter for which it was intended. DISCUSSION This systematic review will identify all existing validated prognosis search filters and synthesise evidence about their applicability and performance. These findings will identify if current filters provide a proficient means of searching electronic bibliographic databases or if further prognosis filters are needed and can feasibly be developed for systematic searches of prognosis studies.
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Affiliation(s)
- Nadia Corp
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Joanne L Jordan
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, 5790 University Avenue, Room 403, Halifax, NS, B3H 1V7, Canada
| | - Emma Irvin
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
| | - Robin Parker
- W.K. Kellogg Health Sciences Library, Dalhousie University, 5850 College St, Halifax, NS, B3H 4R2, Canada
| | | | - Danielle A van der Windt
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
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Linsell L, Malouf R, Morris J, Kurinczuk JJ, Marlow N. Risk Factor Models for Neurodevelopmental Outcomes in Children Born Very Preterm or With Very Low Birth Weight: A Systematic Review of Methodology and Reporting. Am J Epidemiol 2017; 185:601-612. [PMID: 28338817 DOI: 10.1093/aje/kww135] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/03/2016] [Indexed: 01/08/2023] Open
Abstract
The prediction of long-term outcomes in surviving infants born very preterm (VPT) or with very low birth weight (VLBW) is necessary to guide clinical management, provide information to parents, and help target and evaluate interventions. There is a large body of literature describing risk factor models for neurodevelopmental outcomes in VPT/VLBW children, yet few, if any, have been developed for use in routine clinical practice or adopted for use in research studies or policy evaluation. We sought to systematically review the methods and reporting of studies that have developed a multivariable risk factor model for neurodevelopment in surviving VPT/VLBW children. We searched the MEDLINE, Embase, and PsycINFO databases from January 1, 1990, to June 1, 2014, and identified 78 studies reporting 222 risk factor models. Most studies presented risk factor analyses that were not intended to be used for prediction, confirming that there is a dearth of specifically designed prognostic modeling studies for long-term outcomes in surviving VPT/VLBW children. We highlight the strengths and weaknesses of the research methodology and reporting to date, and provide recommendations for the design and analysis of future studies seeking to analyze risk prediction or develop prognostic models for VPT/VLBW children.
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Lee A, Mu JL, Joynt GM, Chiu CH, Lai VKW, Gin T, Underwood MJ. Risk prediction models for delirium in the intensive care unit after cardiac surgery: a systematic review and independent external validation. Br J Anaesth 2017; 118:391-399. [PMID: 28186224 DOI: 10.1093/bja/aew476] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2016] [Indexed: 09/19/2023] Open
Abstract
Numerous risk prediction models are available for predicting delirium after cardiac surgery, but few have been directly compared with one another or been validated in an independent data set. We conducted a systematic review to identify validated risk prediction models of delirium (using the Confusion Assessment Method-Intensive Care Unit tool) after cardiac surgery and assessed the transportability of the risk prediction models on a prospective cohort of 600 consecutive patients undergoing cardiac surgery at a university hospital in Hong Kong from July 2013 to July 2015. The discrimination (c-statistic), calibration (GiViTI calibration belt), and clinical usefulness (decision curve analysis) of the risk prediction models were examined in a stepwise manner. Three published high-quality intensive care unit delirium risk prediction models (n=5939) were identified: Katznelson, the original PRE-DELIRIC, and the international recalibrated PRE-DELIRIC model. Delirium occurred in 83 patients (13.8%, 95% CI: 11.2-16.9%). After updating the intercept and regression coefficients in the Katznelson model, there was fair discrimination (0.62, 95% CI: 0.58-0.66) and good calibration. As the original PRE-DELIRIC model was already validated externally and recalibrated in six countries, we performed a logistic calibration on the recalibrated model and found acceptable discrimination (0.75, 95% CI: 0.72-0.79) and good calibration. Decision curve analysis demonstrated that the recalibrated PRE-DELIRIC risk model was marginally more clinically useful than the Katznelson model. Current models predict delirium risk in the intensive care unit after cardiac surgery with only fair to moderate accuracy and are insufficient for routine clinical use.
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Affiliation(s)
- A Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - J L Mu
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - G M Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - C H Chiu
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - V K W Lai
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - T Gin
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - M J Underwood
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
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185
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Clinical prediction rules for prognosis and treatment prescription in neck pain: A systematic review. Musculoskelet Sci Pract 2017; 27:155-164. [PMID: 27852530 DOI: 10.1016/j.math.2016.10.066] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/12/2016] [Accepted: 10/12/2016] [Indexed: 12/21/2022]
Abstract
Clinical prediction rules (CPRs) developed to identify sub-groups of people with neck pain for different prognoses (i.e. prognostic) or response to treatments (i.e. prescriptive) have been recommended as a research priority to improve health outcomes for these conditions. A systematic review was undertaken to identify prognostic and prescriptive CPRs relevant to the conservative management of adults with neck pain and to appraise stage of development, quality and readiness for clinical application. Six databases were systematically searched from inception until 4th July 2016. Two independent reviewers assessed eligibility, risk of bias (PEDro and QUIPS), methodological quality and stage of development. 9840 records were retrieved and screened for eligibility. Thirty-two studies reporting on 26 CPRs were included in this review. Methodological quality of included studies varied considerably. Most prognostic CPR development studies employed appropriate designs. However, many prescriptive CPR studies (n = 12/13) used single group designs and/or analysed controlled trials using methods that were inadequate for identifying treatment effect moderators. Most prognostic (n = 11/15) and all prescriptive (n = 11) CPRs have not progressed beyond the derivation stage of development. Four prognostic CPRs relating to acute whiplash (n = 3) or non-traumatic neck pain (n = 1) have undergone preliminary validation. No CPRs have undergone impact analysis. Most prognostic and prescriptive CPRs for neck pain are at the initial stage of development and therefore routine clinical use is not yet supported. Further validation and impact analyses of all CPRs are required before confident conclusions can be made regarding clinical utility.
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186
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Lamain – de Ruiter M, Kwee A, Naaktgeboren CA, Franx A, Moons KGM, Koster MPH. Prediction models for the risk of gestational diabetes: a systematic review. Diagn Progn Res 2017; 1:3. [PMID: 31093535 PMCID: PMC6457144 DOI: 10.1186/s41512-016-0005-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/28/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Numerous prediction models for gestational diabetes mellitus (GDM) have been developed, but their methodological quality is unknown. The objective is to systematically review all studies describing first-trimester prediction models for GDM and to assess their methodological quality. METHODS MEDLINE and EMBASE were searched until December 2014. Key words for GDM, first trimester of pregnancy, and prediction modeling studies were combined. Prediction models for GDM performed up to 14 weeks of gestation that only include routinely measured predictors were eligible.Data was extracted by the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS). Data on risk predictors and performance measures were also extracted. Each study was scored for risk of bias. RESULTS Our search yielded 7761 articles, of which 17 were eligible for review (14 development studies and 3 external validation studies). The definition and prevalence of GDM varied widely across studies. Maternal age and body mass index were the most common predictors. Discrimination was acceptable for all studies. Calibration was reported for four studies. Risk of bias for participant selection, predictor assessment, and outcome assessment was low in general. Moderate to high risk of bias was seen for the number of events, attrition, and analysis. CONCLUSIONS Most studies showed moderate to low methodological quality, and few prediction models for GDM have been externally validated. External validation is recommended to enhance generalizability and assess their true value in clinical practice.
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Affiliation(s)
- Marije Lamain – de Ruiter
- grid.7692.a0000000090126352Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, KE.04.123.1, PO BOX 85090, 3508 AB Utrecht, The Netherlands
| | - Anneke Kwee
- grid.7692.a0000000090126352Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, KE.04.123.1, PO BOX 85090, 3508 AB Utrecht, The Netherlands
| | - Christiana A. Naaktgeboren
- grid.7692.a0000000090126352Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Str. 6.131, PO BOX 85500, 3508 AB Utrecht, The Netherlands
| | - Arie Franx
- grid.7692.a0000000090126352Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, KE.04.123.1, PO BOX 85090, 3508 AB Utrecht, The Netherlands
| | - Karel G. M. Moons
- grid.7692.a0000000090126352Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Str. 6.131, PO BOX 85500, 3508 AB Utrecht, The Netherlands
| | - Maria P. H. Koster
- grid.7692.a0000000090126352Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, KE.04.123.1, PO BOX 85090, 3508 AB Utrecht, The Netherlands
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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187
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Rogers M, Bethel A, Boddy K. Development and testing of a medline search filter for identifying patient and public involvement in health research. Health Info Libr J 2017; 34:125-133. [PMID: 28042699 PMCID: PMC6191645 DOI: 10.1111/hir.12157] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Research involving the public as partners often proves difficult to locate due to the variations in terms used to describe public involvement, and inability of medical databases to index this concept effectively. OBJECTIVE To design a search filter to identify literature where patient and public involvement (PPI) was used in health research. METHODS A reference standard of 172 PPI papers was formed. The references were divided into a development set and a test set. Search terms were identified from common words, phrases and synonyms in the development set. These terms were combined as a search strategy for medline via OvidSP, which was then tested for sensitivity against the test set. The resultant search filter was then assessed for sensitivity, specificity and precision using a previously published systematic review. RESULTS The search filter was found to be highly sensitive 98.5% in initial testing. When tested against results generated by a 'real-life' systematic review, the filter had a specificity of 81%. However, sensitivity dropped to 58%. Adjustments to the population group of terms increased the sensitivity to 73%. CONCLUSION The PPI filter designed for medline via OvidSP could aid information specialists and researchers trying to find literature specific to PPI.
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Affiliation(s)
- Morwenna Rogers
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Alison Bethel
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Kate Boddy
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
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188
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Elias SG, Kok L, Witteman BJM, Goedhard JG, Romberg-Camps MJL, Muris JWM, de Wit NJ, Moons KGM. Published diagnostic models safely excluded colorectal cancer in an independent primary care validation study. J Clin Epidemiol 2016; 82:149-157.e8. [PMID: 27989951 DOI: 10.1016/j.jclinepi.2016.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 08/27/2016] [Accepted: 09/06/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To validate published diagnostic models for their ability to safely reduce unnecessary endoscopy referrals in primary care patients suspected of significant colorectal disease. STUDY DESIGN AND SETTING Following a systematic literature search, we independently validated the identified diagnostic models in a cross-sectional study of 810 Dutch primary care patients with persistent lower abdominal complaints referred for endoscopy. We estimated diagnostic accuracy measures for colorectal cancer (N = 37) and significant colorectal disease (N = 141; including colorectal cancer, inflammatory bowel disease, diverticulitis, or >1-cm adenomas). RESULTS We evaluated 18 models-12 specific for colorectal cancer-, of which most were able to safely rule out colorectal cancer: the best model (National Institute for Health and Care Excellence-1) prevented 59% of referrals (95% confidence interval [CI]: 56-63%), with 96% sensitivity (95% CI: 83-100%), 100% negative predictive value (NPV; 95% CI: 99-100%), and an area under the receiver operating characteristics curve (AUC) of 0.86 (95% CI: 0.80-0.92). The models performed less for significant colorectal disease: the best model (Brazer) prevented 23% of referrals (95% CI: 20-26%), with 95% sensitivity (95% CI: 90-98%), 96% NPV (95% CI: 92-98%), and an AUC of 0.73 (95% CI: 0.69-0.78). CONCLUSION Most models safely excluded colorectal cancer in many primary care patients with lower gastrointestinal complaints referred for endoscopy. Models performed less well for significant colorectal disease.
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Affiliation(s)
- Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, Utrecht, GA 3508, The Netherlands.
| | - Liselotte Kok
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, Utrecht, GA 3508, The Netherlands
| | - Ben J M Witteman
- Department of Gastroenterology, Gelderse Vallei Hospital, PO Box 9025, Ede, HN 6710, The Netherlands
| | - Jelle G Goedhard
- Department of Gastroenterology, Atrium Medical Center, PO Box 4446, Heerlen, CX 6401, The Netherlands
| | - Mariëlle J L Romberg-Camps
- Department of Gastroenterology, Orbis Medical Center, PO Box 5500, Sittard-Geleen, MB 6130, The Netherlands
| | - Jean W M Muris
- Department of General Practice, Care and Public Health Research Institute (Caphri), Maastricht University, PO Box 616, Maastricht, MD 6200, The Netherlands
| | - Niek J de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, Utrecht, GA 3508, The Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, Utrecht, GA 3508, The Netherlands
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189
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Bijlsma MW, Brouwer MC, Bossuyt PM, Heymans MW, van der Ende A, Tanck MWT, van de Beek D. Risk scores for outcome in bacterial meningitis: Systematic review and external validation study. J Infect 2016; 73:393-401. [PMID: 27519619 DOI: 10.1016/j.jinf.2016.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/03/2016] [Accepted: 08/05/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To perform an external validation study of risk scores, identified through a systematic review, predicting outcome in community-acquired bacterial meningitis. METHODS MEDLINE and EMBASE were searched for articles published between January 1960 and August 2014. Performance was evaluated in 2108 episodes of adult community-acquired bacterial meningitis from two nationwide prospective cohort studies by the area under the receiver operating characteristic curve (AUC), the calibration curve, calibration slope or Hosmer-Lemeshow test, and the distribution of calculated risks. FINDINGS Nine risk scores were identified predicting death, neurological deficit or death, or unfavorable outcome at discharge in bacterial meningitis, pneumococcal meningitis and invasive meningococcal disease. Most studies had shortcomings in design, analyses, and reporting. Evaluation showed AUCs of 0.59 (0.57-0.61) and 0.74 (0.71-0.76) in bacterial meningitis, 0.67 (0.64-0.70) in pneumococcal meningitis, and 0.81 (0.73-0.90), 0.82 (0.74-0.91), 0.84 (0.75-0.93), 0.84 (0.76-0.93), 0.85 (0.75-0.95), and 0.90 (0.83-0.98) in meningococcal meningitis. Calibration curves showed adequate agreement between predicted and observed outcomes for four scores, but statistical tests indicated poor calibration of all risk scores. INTERPRETATION One score could be recommended for the interpretation and design of bacterial meningitis studies. None of the existing scores performed well enough to recommend routine use in individual patient management.
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Affiliation(s)
- Merijn W Bijlsma
- Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthijs C Brouwer
- Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Arie van der Ende
- Department of Medical Microbiology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; The Netherlands Reference Laboratory for Bacterial Meningitis, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael W T Tanck
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Diederik van de Beek
- Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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190
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Prognostic Models in Adults Undergoing Physical Therapy for Rotator Cuff Disorders: Systematic Review. Phys Ther 2016; 96:961-71. [PMID: 26637648 DOI: 10.2522/ptj.20150475] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/22/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND Rotator cuff-related disorders represent the largest subgroup of shoulder complaints. Despite the availability of various conservative and surgical treatment options, the precise indications for these options remain unclear. PURPOSE The purpose of this systematic review was to synthesize the available research on prognostic models for predicting outcomes in adults undergoing physical therapy for painful rotator cuff disorders. DATA SOURCES The MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, and PEDro databases and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to October 2015 were searched. STUDY SELECTION The review included primary studies exploring prognostic models in adults undergoing physical therapy, with or without other conservative measures, for painful rotator cuff disorders. Primary outcomes were pain, disability, and adverse events. Inclusion was limited to prospective investigations of prognostic factors elicited at the baseline assessment. Study selection was independently performed by 2 reviewers. DATA EXTRACTION A pilot-tested form was used to extract data on key aspects of study design, characteristics, analyses, and results. Risk of bias and applicability were independently assessed by 2 reviewers using the Prediction Study Risk of Bias Assessment tool (PROBAST). DATA SYNTHESIS Five studies were included in the review. These studies were extremely heterogeneous in many aspects of design, conduct, and analysis. The findings were analyzed narratively. LIMITATIONS All included studies were rated as at high risk of bias, and none of the resulting prognostic models was found to be usable in clinical practice. CONCLUSIONS There are no prognostic models ready to inform clinical practice in the context of the review question, highlighting the need for further research on prognostic models for predicting outcomes in adults who undergo physical therapy for painful rotator cuff disorders. The design and conduct of future studies should be receptive to developing methods.
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191
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Wynants L, Collins GS, Van Calster B. Key steps and common pitfalls in developing and validating risk models. BJOG 2016; 124:423-432. [DOI: 10.1111/1471-0528.14170] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2016] [Indexed: 01/09/2023]
Affiliation(s)
- L Wynants
- KU Leuven Department of Electrical Engineering‐ESAT STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics KU Leuven iMinds Medical IT Department Leuven Belgium
| | - GS Collins
- Centre for Statistics in Medicine Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK
| | - B Van Calster
- KU Leuven Department of Development and Regeneration Leuven Belgium
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192
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Baggen VJM, Driessen MMP, Post MC, van Dijk AP, Roos-Hesselink JW, van den Bosch AE, Takkenberg JJM, Sieswerda GT. Echocardiographic findings associated with mortality ortransplant in patients with pulmonary arterial hypertension:A systematic review and meta-analysis. Neth Heart J 2016; 24:374-389. [PMID: 27189216 PMCID: PMC4887306 DOI: 10.1007/s12471-016-0845-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Identification of patients at risk of deterioration is essential to guide clinical management in pulmonary arterial hypertension (PAH). This study aims to provide a comprehensive overview of well-investigated echocardiographic findings that are associated with clinical deterioration in PAH. Methods MEDLINE and EMBASE databases were systematically searched for longitudinal studies published by April 2015 that reported associations between echocardiographic findings and mortality, transplant or clinical worsening. Meta-analysis using random effect models was performed for echocardiographic findings investigated by four or more studies. In case of statistical heterogeneity a sensitivity analysis was conducted. Results Thirty-seven papers investigating 51 echocardiographic findings were included. Meta-analysis of univariable hazard ratios (HRs) and sensitivity analysis showed that presence of pericardial effusion (pooled HR 1.70; 95 % CI 1.44–1.99), right atrial area (pooled HR 1.71; 95 % CI 1.38–2.13) and tricuspid annular plane systolic excursion (TAPSE; pooled HR 1.72; 95 % CI 1.34–2.20) were the most well-investigated and robust predictors of mortality or transplant. Conclusions This meta-analysis substantiates the clinical yield of specific echocardiographic findings in the prognostication of PAH patients in day-to-day practice. In particular, pericardial effusion, right atrial area and TAPSE are of prognostic value. Electronic supplementary material The online version of this article (doi: 10.1007/s12471-016-0845-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- V J M Baggen
- Department of Cardiology, University Medical Centre Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - M M P Driessen
- Department of Cardiology, University Medical Centre Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - M C Post
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - A P van Dijk
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J W Roos-Hesselink
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - A E van den Bosch
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - J J M Takkenberg
- Department of Cardio-Thoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - G T Sieswerda
- Department of Cardiology, University Medical Centre Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
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193
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Linsell L, Malouf R, Morris J, Kurinczuk JJ, Marlow N. Prognostic factors for cerebral palsy and motor impairment in children born very preterm or very low birthweight: a systematic review. Dev Med Child Neurol 2016; 58:554-69. [PMID: 26862030 PMCID: PMC5321605 DOI: 10.1111/dmcn.12972] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 12/20/2022]
Abstract
AIM There is a large literature reporting risk factor analyses for poor neurodevelopment in children born very preterm (VPT: ≤32wks) or very low birthweight (VLBW: ≤1250g), which to date has not been formally summarized. The aim of this paper was to identify prognostic factors for cerebral palsy (CP) and motor impairment in children born VPT/VLBW. METHOD A systematic review was conducted using Medline, Embase, and Pyscinfo databases to identify studies published between 1 January 1990 and 1 June 2014 reporting multivariable prediction models for poor neurodevelopment in VPT/VLBW children (registration number CRD42014006943). Twenty-eight studies for motor outcomes were identified. RESULTS There was strong evidence that intraventricular haemorrhage and periventricular leukomalacia, and some evidence that the use of postnatal steroids and non-use of antenatal steroids, were prognostic factors for CP. Male sex and gestational age were of limited use as prognostic factors for CP in cohorts restricted to ≤32 weeks gestation; however, in children older than 5 years with no major disability, there was evidence that male sex was a predictive factor for motor impairment. INTERPRETATION This review has identified factors which may be of prognostic value for CP and motor impairment in VPT/VLBW children and will help to form the basis of future prognostic research.
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Affiliation(s)
- Louise Linsell
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Headington, Oxford
| | - Reem Malouf
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Headington, Oxford
| | - Joan Morris
- Queen Mary University of London, Centre for Environmental and Preventive Medicine, Barts and The London School of Medicine and Dentistry, London
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Headington, Oxford
| | - Neil Marlow
- Institute of Women’s Health, University College London, London, UK
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194
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Goldstein BA, Navar AM, Pencina MJ, Ioannidis JPA. Opportunities and challenges in developing risk prediction models with electronic health records data: a systematic review. J Am Med Inform Assoc 2016; 24:198-208. [PMID: 27189013 DOI: 10.1093/jamia/ocw042] [Citation(s) in RCA: 424] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/25/2016] [Accepted: 02/20/2016] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Electronic health records (EHRs) are an increasingly common data source for clinical risk prediction, presenting both unique analytic opportunities and challenges. We sought to evaluate the current state of EHR based risk prediction modeling through a systematic review of clinical prediction studies using EHR data. METHODS We searched PubMed for articles that reported on the use of an EHR to develop a risk prediction model from 2009 to 2014. Articles were extracted by two reviewers, and we abstracted information on study design, use of EHR data, model building, and performance from each publication and supplementary documentation. RESULTS We identified 107 articles from 15 different countries. Studies were generally very large (median sample size = 26 100) and utilized a diverse array of predictors. Most used validation techniques (n = 94 of 107) and reported model coefficients for reproducibility (n = 83). However, studies did not fully leverage the breadth of EHR data, as they uncommonly used longitudinal information (n = 37) and employed relatively few predictor variables (median = 27 variables). Less than half of the studies were multicenter (n = 50) and only 26 performed validation across sites. Many studies did not fully address biases of EHR data such as missing data or loss to follow-up. Average c-statistics for different outcomes were: mortality (0.84), clinical prediction (0.83), hospitalization (0.71), and service utilization (0.71). CONCLUSIONS EHR data present both opportunities and challenges for clinical risk prediction. There is room for improvement in designing such studies.
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Affiliation(s)
- Benjamin A Goldstein
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC 27710, USA .,Center for Predictive Medicine, Duke Clinical Research Institute, Duke University, Durham, NC 27710, USA
| | - Ann Marie Navar
- Center for Predictive Medicine, Duke Clinical Research Institute, Duke University, Durham, NC 27710, USA.,Division of Cardiology at Duke University Medical Center, Duhram, NC 27710, USA
| | - Michael J Pencina
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC 27710, USA.,Center for Predictive Medicine, Duke Clinical Research Institute, Duke University, Durham, NC 27710, USA
| | - John P A Ioannidis
- Department of Medicine, Stanford University, Palo Alto, CA 94305, USA.,Department of Health Research and Policy, and Statistics and Meta-Research Innovation Center at Stanford, Stanford University, Palo Alto, CA 94305, USA
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195
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Huang Y, Yang Z, Wang J, Zhuo L, Li Z, Zhan S. Performance of search strategies to retrieve systematic reviews of diagnostic test accuracy from the Cochrane Library. J Evid Based Med 2016; 9:77-83. [PMID: 27152676 DOI: 10.1111/jebm.12200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 05/01/2016] [Indexed: 02/05/2023]
Abstract
AIM To compare the performance of search strategies to retrieve systematic reviews of diagnostic test accuracy from The Cochrane Library. METHODS Databases of Cochrane Database of Systematic Reviews and Cochrane Database of Abstracts of Reviews of Effects in the Cochrane Library were searched for systematic reviews of diagnostic test accuracy published between 2008 and 2012 through nine search strategies. Each strategy consists of one group or combination of groups of searching filters about diagnostic test accuracy. Four groups of diagnostic filters were used. The strategy combing all the filters was used as the reference to determine the sensitivity, precision, and the sensitivity × precision product for another eight strategies. RESULTS The reference strategy retrieved 8029 records, of which 832 were eligible. The strategy only composed of MeSH terms about "accuracy measures" achieved the highest values in both precision (69.71%) and product (52.45%) with a moderate sensitivity (75.24%). The combination of MeSH terms and free text words about "accuracy measures" contributed little to increasing the sensitivity. Strategies composed of filters about "diagnosis" had similar sensitivity but lower precision and product to those composed of filters about "accuracy measures." MeSH term "exp'diagnosis'" achieved the lowest precision (9.78%) and product (7.91%), while its hyponym retrieved only half the number of records at the expense of missing 53 target articles. The precision was negatively correlated with sensitivities among the nine strategies. CONCLUSIONS Compared to the filters about "diagnosis," the filters about "accuracy measures" achieved similar sensitivities but higher precision. When combining both terms, sensitivity of the strategy was enhanced obviously. The combination of MeSH terms and free text words about the same concept seemed to be meaningless for enhancing sensitivity.
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Affiliation(s)
- Yuansheng Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Zhirong Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Shantou-Oxford Clinical Research Unit, Shantou University Medical College, Shantou, Guangdong, China
| | - Jing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Lin Zhuo
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Zhixia Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Kingston MR, Evans BA, Nelson K, Hutchings H, Russell I, Snooks H. Costs, effects and implementation of routine data emergency admission risk prediction models in primary care for patients with, or at risk of, chronic conditions: a systematic review protocol. BMJ Open 2016; 6:e009653. [PMID: 26932140 PMCID: PMC4785313 DOI: 10.1136/bmjopen-2015-009653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Emergency admission risk prediction models are increasingly used to identify patients, typically with one or more chronic conditions, for proactive management in primary care to avoid admissions, save costs and improve patient experience. AIM To identify and review the published evidence on the costs, effects and implementation of emergency admission risk prediction models in primary care for patients with, or at risk of, chronic conditions. METHODS We shall search for studies of healthcare interventions using routine data-generated emergency admission risk models. We shall report: the effects on emergency admissions and health costs; clinician and patient views; and implementation findings. We shall search ASSIA, CINAHL, the Cochrane Library, HMIC, ISI Web of Science, MEDLINE and Scopus from 2005, review references in and citations of included articles, search key journals and contact experts. Study selection, data extraction and quality assessment will be performed by two independent reviewers. ETHICS AND DISSEMINATION No ethical permissions are required for this study using published data. Findings will be disseminated widely, including publication in a peer-reviewed journal and through conferences in primary and emergency care and chronic conditions. We judge our results will help a wide audience including primary care practitioners and commissioners, and policymakers. TRIAL REGISTRATION NUMBER CRD42015016874; Pre-results.
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Affiliation(s)
| | | | | | | | - Ian Russell
- Swansea University Medical School, Swansea, UK
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197
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Cardiac magnetic resonance findings predicting mortality in patients with pulmonary arterial hypertension: a systematic review and meta-analysis. Eur Radiol 2016; 26:3771-3780. [PMID: 26847041 PMCID: PMC5052291 DOI: 10.1007/s00330-016-4217-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/04/2016] [Accepted: 01/13/2016] [Indexed: 01/20/2023]
Abstract
Objectives To provide a comprehensive overview of all reported cardiac magnetic resonance (CMR) findings that predict clinical deterioration in pulmonary arterial hypertension (PAH). Methods MEDLINE and EMBASE electronic databases were systematically searched for longitudinal studies published by April 2015 that reported associations between CMR findings and adverse clinical outcome in PAH. Studies were appraised using previously developed criteria for prognostic studies. Meta-analysis using random effect models was performed for CMR findings investigated by three or more studies. Results Eight papers (539 patients) investigating 21 different CMR findings were included. Meta-analysis showed that right ventricular (RV) ejection fraction was the strongest predictor of mortality in PAH (pooled HR 1.23 [95 % CI 1.07–1.41], p = 0.003) per 5 % decrease. In addition, RV end-diastolic volume index (pooled HR 1.06 [95 % CI 1.00–1.12], p = 0.049), RV end-systolic volume index (pooled HR 1.05 [95 % CI 1.01–1.09], p = 0.013) and left ventricular end-diastolic volume index (pooled HR 1.16 [95 % CI 1.00–1.34], p = 0.045) were of prognostic importance. RV and LV mass did not provide prognostic information (p = 0.852 and p = 0.983, respectively). Conclusion This meta-analysis substantiates the clinical yield of specific CMR findings in the prognostication of PAH patients. Decreased RV ejection is the strongest and most well established predictor of mortality. Key Points • Cardiac magnetic resonance imaging is useful for prognostication in pulmonary arterial hypertension. • Right ventricular ejection fraction is the strongest predictor of mortality. • Serial CMR evaluation seems to be of additional prognostic importance. • Accurate prognostication can aid in adequate and timely intensification of PAH-specific therapy. Electronic supplementary material The online version of this article (doi:10.1007/s00330-016-4217-6) contains supplementary material, which is available to authorized users.
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198
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Skoetz N, Trivella M, Kreuzer KA, Collins G, Köhler N, Wolff R, Moons K, Estcourt LJ. Prognostic models for chronic lymphocytic leukaemia: an exemplar systematic review and meta-analysis. Hippokratia 2016. [DOI: 10.1002/14651858.cd012022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Nicole Skoetz
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Kerpener Str. 62 Cologne Germany 50937
| | - Marialena Trivella
- University of Oxford; Centre for Statistics in Medicine; Botnar Research Centre Windmill Road Oxford UK OX3 7LD
| | - Karl-Anton Kreuzer
- University Hospital of Cologne; Department I of Internal Medicine; Cologne Germany
| | - Gary Collins
- University of Oxford; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; Windmill Road Oxford UK OX3 7LD
| | - Nicola Köhler
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Kerpener Str. 62 Cologne Germany 50937
| | - Robert Wolff
- Kleijnen Systematic Reviews Ltd; Unit 6 Escrick Business Park Riccall Road, Escrick York North Yorkshire UK YO19 6FD
| | - Karel Moons
- University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care; PO Box 85500 Utrecht Netherlands 3508 GA
| | - Lise J Estcourt
- NHS Blood and Transplant; Haematology/Transfusion Medicine; Level 2, John Radcliffe Hospital Headington Oxford UK OX3 9BQ
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199
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Prognostic Factors for Behavioral Problems and Psychiatric Disorders in Children Born Very Preterm or Very Low Birth Weight: A Systematic Review. J Dev Behav Pediatr 2016; 37:88-102. [PMID: 26703327 PMCID: PMC5330463 DOI: 10.1097/dbp.0000000000000238] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Risk factors associated with adverse behavioral outcomes in very preterm (VPT) or very low birth weight (VLBW) infants are poorly understood. The aim of this article is to identify prognostic factors for behavioral problems and psychiatric disorders in children born ≤32 weeks gestational age or with birth weight ≤1250 g. METHOD A systematic review was conducted using MEDLINE, Embase, and Pyscinfo databases to identify studies published between January 1, 1990 and June 1, 2014 reporting multivariable prediction models for behavioral problems or psychiatric disorders in VPT/VLBW children. Fifteen studies were identified and 2 independent reviewers extracted key information on study design, outcome definition, risk factor selection, model development, reporting, and conducted a risk of bias assessment. RESULTS The 15 studies included reported risk factor analyses for the following domains: general behavioral problems (n = 8), any psychiatric disorder (n = 2), autism spectrum symptoms/disorders (n = 5), and attention deficit/hyperactivity disorder (n = 1). Findings were inconclusive because of the following: small number of studies in each domain, heterogeneity in outcome measures, lack of overlap in the risk factors examined, and differences in strategies for dealing with children with neurological impairments. CONCLUSION There is a lack of evidence concerning risk factors for behavior problems and psychiatric disorders among VPT/VLBW survivors. This review has identified the need for further research examining the etiology of disorders of psychological development in the VPT/VLBW population to refine risk prediction and identify targets for intervention. Large well-conducted studies that use standard diagnostic evaluations to assess psychiatric disorders throughout childhood and adolescence are required.
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Predicting surgical outcome in patients with International Federation of Gynecology and Obstetrics stage III or IV ovarian cancer using computed tomography: a systematic review of prediction models. Int J Gynecol Cancer 2015; 25:407-15. [PMID: 25695545 DOI: 10.1097/igc.0000000000000368] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Maximal cytoreduction to no residual disease is an important predictor of prognosis in patients with advanced-stage epithelial ovarian cancer. Preoperative prediction of outcome of surgery should guide treatment decisions, for example, primary debulking or neoadjuvant chemotherapy followed by interval debulking surgery. The objective of this study was to systematically review studies evaluating computed tomography imaging based models predicting the amount of residual tumor after cytoreductive surgery for advanced-stage epithelial ovarian cancer. METHODS We systematically searched the literature for studies investigating multivariable models that predicted the amount of residual disease after cytoreductive surgery in advanced-stage epithelial ovarian cancer using computed tomography imaging. Detected studies were scored for quality and classified as model derivation or validation studies. We summarized their performance in terms of discrimination when possible. RESULTS We identified 11 studies that described 13 models. The 4 models that were externally validated all had a poor discriminative capacity (sensitivity, 15%-79%; specificity, 32%-64%). The only internal validated model had an area under the receiver operating characteristic curve of 0.67. Peritoneal thickening, mesenterial and diaphragm disease, and ascites were most often used as predictors in the final models. We did not find studies that assessed the impact of prediction model on outcomes. CONCLUSIONS Currently, there are no external validated studies with a good predictive performance for residual disease. Studies of better quality are needed, especially studies that focus on predicting any residual disease after surgery.
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