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Saqib M, Perswani P, Muneem A, Mumtaz H, Neha F, Ali S, Tabassum S. Machine learning in heart failure diagnosis, prediction, and prognosis: review. Ann Med Surg (Lond) 2024; 86:3615-3623. [PMID: 38846887 PMCID: PMC11152866 DOI: 10.1097/ms9.0000000000002138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/24/2024] [Indexed: 06/09/2024] Open
Abstract
Globally, cardiovascular diseases take the lives of over 17 million people each year, mostly through myocardial infarction, or MI, and heart failure (HF). This comprehensive literature review examines various aspects related to the diagnosis, prediction, and prognosis of HF in the context of machine learning (ML). The review covers an array of topics, including the diagnosis of HF with preserved ejection fraction (HFpEF) and the identification of high-risk patients with HF with reduced ejection fraction (HFrEF). The prediction of mortality in different HF populations using different ML approaches is explored, encompassing patients in the ICU, and HFpEF patients using biomarkers and gene expression. The review also delves into the prediction of mortality and hospitalization rates in HF patients with mid-range ejection fraction (HFmrEF) using ML methods. The findings highlight the significance of a multidimensional approach that encompasses clinical evaluation, laboratory assessments, and comprehensive research to improve our understanding and management of HF. Promising predictive models incorporating biomarkers, gene expression, and consideration of epigenetics demonstrate potential in estimating mortality and identifying high-risk HFpEF patients. This literature review serves as a valuable resource for researchers, clinicians, and healthcare professionals seeking a comprehensive and updated understanding of the role of ML diagnosis, prediction, and prognosis of HF across different subtypes and patient populations.
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Affiliation(s)
| | | | - Abraar Muneem
- College of Medicine, The Pennsylvania State University, Hershey, United States
| | | | - Fnu Neha
- Jinnah Sindh Medical University, Karachi
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2
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Aboseif A, Roos I, Krieger S, Kalincik T, Hersh CM. Leveraging Real-World Evidence and Observational Studies in Treating Multiple Sclerosis. Neurol Clin 2024; 42:203-227. [PMID: 37980116 DOI: 10.1016/j.ncl.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Randomized controlled trials (RCTs) are essential for regulatory approval of disease-modifying therapies (DMTs), yet their strict selection criteria often lead to limited generalizability. Observational studies using real-world data (RWD) allow for more inclusive heterogeneous cohorts resulting in higher external validity to inform treatment practices. As reviewed in this article, well-designed comparative effectiveness studies are an important application of RWD. Although, like RCTs, observational studies have their own set of limitations, including various biases that may confound results, advanced statistical methods can mitigate many of these limitations. A focus on personalized treatment will continue to add value to individualize MS care.
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Affiliation(s)
- Albert Aboseif
- Department of Neurology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue S10, Cleveland, OH 44195, USA
| | - Izanne Roos
- Department of Neurology, Neuroimmunology Centre, Royal Melbourne Hospital, L7 635 Elizabeth Street, Melbourne 3000, Australia; Department of Medicine, CORe, University of Melbourne, Melbourne, Australia
| | - Stephen Krieger
- Corinne Goldsmith Dickinson Center for MS Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1138, New York, NY 10029, USA
| | - Tomas Kalincik
- Department of Medicine, CORe, University of Melbourne, Melbourne, Australia; Department of Neurology, Neuroimmunology Centre, Royal Melbourne Hospital, L6 635 Elizabeth Street, Melbourne 3000, Australia
| | - Carrie M Hersh
- Lou Ruvo Center for Brain Health, Cleveland Clinic, 888 West Bonneville Avenue, Las Vegas, NV 89106, USA.
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3
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Sharathkumar A, Wendt L, Ortman C, Srinivasan R, Chute CG, Chrischilles E, Takemoto CM. COVID-19 outcomes in persons with hemophilia: results from a US-based national COVID-19 surveillance registry. J Thromb Haemost 2024; 22:61-75. [PMID: 37182697 PMCID: PMC10181864 DOI: 10.1016/j.jtha.2023.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/29/2023] [Accepted: 04/25/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Hypercoagulable state contributing to thrombotic complications worsens COVID-19 severity and outcomes, whereas anticoagulation improves outcomes by alleviating hypercoagulability. OBJECTIVES To examine whether hemophilia, an inherent hypocoagulable condition, offers protection against COVID-19 severity and reduces venous thromboembolism (VTE) risk in persons with hemophilia (PwH). METHODS A 1:3 propensity score-matched retrospective cohort study used national COVID-19 registry data (January 2020 through January 2022) to compare outcomes between 300 male PwH and 900 matched controls without hemophilia. RESULTS Analyses of PwH demonstrated that known risk factors (older age, heart failure, hypertension, cancer/malignancy, dementia, and renal and liver disease) contributed to severe COVID-19 and/or 30-day all-cause mortality. Non-central nervous system bleeding was an additional risk factor for poor outcomes in PwH. Odds of developing VTE with COVID-19 in PwH were associated with pre-COVID VTE diagnosis (odds ratio [OR], 51.9; 95% CI, 12.8-266; p < .001), anticoagulation therapy (OR, 12.7; 95% CI, 3.01-48.6; p < .001), and pulmonary disease (OR, 16.1; 95% CI, 10.4-25.4; p < .001). Thirty-day all-cause mortality (OR, 1.27; 95% CI, 0.75-2.11; p = .3) and VTE events (OR, 1.32; 95% CI, 0.64-2.73; p = .4) were not significantly different between the matched cohorts; however, hospitalizations (OR, 1.58; 95% CI, 1.20-2.10; p = .001) and non-central nervous system bleeding events (OR, 4.78; 95% CI, 2.98-7.48; p < .001) were increased in PwH. In multivariate analyses, hemophilia did not reduce adverse outcomes (OR, 1.32; 95% CI, 0.74-2.31; p = .2) or VTE (OR, 1.14; 95% CI, 0.44-2.67; p = .8) but increased bleeding risk (OR, 4.70; 95% CI, 2.98-7.48; p < .001). CONCLUSION After adjusting for patient characteristics/comorbidities, hemophilia increased bleeding risk with COVID-19 but did not protect against severe disease and VTE.
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Affiliation(s)
- Anjali Sharathkumar
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.
| | - Linder Wendt
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa, USA
| | - Chris Ortman
- Department of Bioinformatics, University of Iowa, Iowa City, Iowa, USA; Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ragha Srinivasan
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Elizabeth Chrischilles
- Department of Bioinformatics, University of Iowa, Iowa City, Iowa, USA; Department of Epidemiology, School of Public Health, University of Iowa, Iowa, USA
| | - Clifford M Takemoto
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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4
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Cochand L, Filipovic MG, Huber M, Luedi MM, Urman RD, Bello C. Systems Anesthesiology: Systems of Care Delivery and Optimization in the Operating Room. Anesthesiol Clin 2023; 41:847-861. [PMID: 37838388 DOI: 10.1016/j.anclin.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Anesthesiology presents a challenge to a traditional simplifying approach given the ever-increasing amount of medical data and a more demanding environment. Systems anesthesiology is a modern approach to perioperative care, integrating the complexity of multifactorial knowledge and data to achieve a more adequate representation of reality, while including both patient-related medical aspects as well as economic and organizational challenges. We discuss the value of some innovative technologies such as the emergence of anesthesia information systems, the use of tele-medicine, predictive monitoring, or closed-loop systems as it pertains to the changes in the current standards of care in anesthesiology. Furthermore, we highlight the importance of systems anesthesiology in operating room planning, anesthesia research, and education.
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Affiliation(s)
- Laure Cochand
- Department of Anesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mark G Filipovic
- Department of Anesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus Huber
- Department of Anesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus M Luedi
- Department of Anesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Richard D Urman
- Department of Anesthesiology, The Ohio State University College of Medicine, OH, USA.
| | - Corina Bello
- Department of Anesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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5
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Pirmani A, De Brouwer E, Geys L, Parciak T, Moreau Y, Peeters LM. The Journey of Data Within a Global Data Sharing Initiative: A Federated 3-Layer Data Analysis Pipeline to Scale Up Multiple Sclerosis Research. JMIR Med Inform 2023; 11:e48030. [PMID: 37943585 PMCID: PMC10667980 DOI: 10.2196/48030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/25/2023] [Accepted: 09/30/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Investigating low-prevalence diseases such as multiple sclerosis is challenging because of the rather small number of individuals affected by this disease and the scattering of real-world data across numerous data sources. These obstacles impair data integration, standardization, and analysis, which negatively impact the generation of significant meaningful clinical evidence. OBJECTIVE This study aims to present a comprehensive, research question-agnostic, multistakeholder-driven end-to-end data analysis pipeline that accommodates 3 prevalent data-sharing streams: individual data sharing, core data set sharing, and federated model sharing. METHODS A demand-driven methodology is employed for standardization, followed by 3 streams of data acquisition, a data quality enhancement process, a data integration procedure, and a concluding analysis stage to fulfill real-world data-sharing requirements. This pipeline's effectiveness was demonstrated through its successful implementation in the COVID-19 and multiple sclerosis global data sharing initiative. RESULTS The global data sharing initiative yielded multiple scientific publications and provided extensive worldwide guidance for the community with multiple sclerosis. The pipeline facilitated gathering pertinent data from various sources, accommodating distinct sharing streams and assimilating them into a unified data set for subsequent statistical analysis or secure data examination. This pipeline contributed to the assembly of the largest data set of people with multiple sclerosis infected with COVID-19. CONCLUSIONS The proposed data analysis pipeline exemplifies the potential of global stakeholder collaboration and underlines the significance of evidence-based decision-making. It serves as a paradigm for how data sharing initiatives can propel advancements in health care, emphasizing its adaptability and capacity to address diverse research inquiries.
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Affiliation(s)
- Ashkan Pirmani
- ESAT, STADIUS, KU Leuven, Leuven, Belgium
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
- Data Science Institute, Hasselt University, Diepenbeek, Belgium
- University Multiple Sclerosis Center, Hasselt University, Diepenbeek, Belgium
| | | | - Lotte Geys
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
- Data Science Institute, Hasselt University, Diepenbeek, Belgium
- University Multiple Sclerosis Center, Hasselt University, Diepenbeek, Belgium
| | - Tina Parciak
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
- Data Science Institute, Hasselt University, Diepenbeek, Belgium
- University Multiple Sclerosis Center, Hasselt University, Diepenbeek, Belgium
| | | | - Liesbet M Peeters
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
- Data Science Institute, Hasselt University, Diepenbeek, Belgium
- University Multiple Sclerosis Center, Hasselt University, Diepenbeek, Belgium
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Soldatenkova A, Calabrese A, Levialdi Ghiron N, Tiburzi L. Emergency department performance assessment using administrative data: A managerial framework. PLoS One 2023; 18:e0293401. [PMID: 37917787 PMCID: PMC10621983 DOI: 10.1371/journal.pone.0293401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023] Open
Abstract
Administrative data play an important role in performance monitoring of healthcare providers. Nonetheless, little attention has been given so far to the emergency department (ED) evaluation. In addition, most of existing research focuses on a single core ED function, such as treatment or triage, thus providing a limited picture of performance. The goal of this study is to harness the value of routinely produced records proposing a framework for multidimensional performance evaluation of EDs able to support internal decision stakeholders in managing operations. Starting with the overview of administrative data, and the definition of the desired framework's characteristics from the perspective of decision stakeholders, a review of the academic literature on ED performance measures and indicators is conducted. A performance measurement framework is designed using 224 ED performance metrics (measures and indicators) satisfying established selection criteria. Real-world feedback on the framework is obtained through expert interviews. Metrics in the proposed ED performance measurement framework are arranged along three dimensions: performance (quality of care, time-efficiency, throughput), analysis unit (physician, disease etc.), and time-period (quarter, year, etc.). The framework has been judged as "clear and intuitive", "useful for planning", able to "reveal inefficiencies in care process" and "transform existing data into decision support information" by the key ED decision stakeholders of a teaching hospital. Administrative data can be a new cornerstone for health care operation management. A framework of ED-specific indicators based on administrative data enables multi-dimensional performance assessment in a timely and cost-effective manner, an essential requirement for nowadays resource-constrained hospitals. Moreover, such a framework can support different stakeholders' decision making as it allows the creation of a customized metrics sets for performance analysis with the desired granularity.
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Affiliation(s)
- Anastasiia Soldatenkova
- Dipartimento di Ingegneria dell’Impresa Mario Lucertini, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | - Armando Calabrese
- Dipartimento di Ingegneria dell’Impresa Mario Lucertini, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | - Nathan Levialdi Ghiron
- Dipartimento di Ingegneria dell’Impresa Mario Lucertini, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | - Luigi Tiburzi
- Dipartimento di Ingegneria dell’Impresa Mario Lucertini, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
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Debray TPA, Simoneau G, Copetti M, Platt RW, Shen C, Pellegrini F, de Moor C. Methods for comparative effectiveness based on time to confirmed disability progression with irregular observations in multiple sclerosis. Stat Methods Med Res 2023; 32:1284-1299. [PMID: 37303120 PMCID: PMC10500950 DOI: 10.1177/09622802231172032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Real-world data sources offer opportunities to compare the effectiveness of treatments in practical clinical settings. However, relevant outcomes are often recorded selectively and collected at irregular measurement times. It is therefore common to convert the available visits to a standardized schedule with equally spaced visits. Although more advanced imputation methods exist, they are not designed to recover longitudinal outcome trajectories and typically assume that missingness is non-informative. We, therefore, propose an extension of multilevel multiple imputation methods to facilitate the analysis of real-world outcome data that is collected at irregular observation times. We illustrate multilevel multiple imputation in a case study evaluating two disease-modifying therapies for multiple sclerosis in terms of time to confirmed disability progression. This survival outcome is derived from repeated measurements of the Expanded Disability Status Scale, which is collected when patients come to the healthcare center for a clinical visit and for which longitudinal trajectories can be estimated. Subsequently, we perform a simulation study to compare the performance of multilevel multiple imputation to commonly used single imputation methods. Results indicate that multilevel multiple imputation leads to less biased treatment effect estimates and improves the coverage of confidence intervals, even when outcomes are missing not at random.
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Affiliation(s)
- Thomas PA Debray
- Julius Centrum voor Gezondheidswetenschappen en Eerstelijns Geneeskunde, Utrecht, Netherlands
- Smart Data Analysis and Statistics B.V., Utrecht, Netherlands
| | | | | | - Robert W Platt
- Department of Epidemiology, Bioastatistics and Occupational Health, McGill University, Quebec, Canada
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8
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N. Tornberg H, Cohen JS, Gu A, Wei C, Mortman R, Sculco PK, Thakkar SC, Campbell JC. Impact of Large Database Studies on Orthopedic Surgery Literature: Are We Advancing the Field? HSS J 2023; 19:198-204. [PMID: 37065108 PMCID: PMC10090843 DOI: 10.1177/15563316221129556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/05/2022] [Indexed: 04/18/2023]
Abstract
Background: While database studies have become more prevalent in the literature, there is concern over their value. In addition, the questions they are suitable to answer are limited. Questions/Purposes: We sought to determine the incidence of database studies in the orthopedic literature and in each subspecialty. In addition, we wanted to assess the impact of database studies on the literature by determining whether citations and Altmetric Attention Scores (AAS) varied by study type (studies using internal or external databases and those not using databases). Methods: We searched PubMed for articles published in impactful orthopedic surgery journals in the year 2018. All articles were discoverable on the Altmetric explorer portal database. Impact was determined by journal impact factor. Study design, subspecialty, number of citations, and AAS were obtained. Univariable analyses were conducted between study type, demographic variables, and the outcome of either citation count or AAS. Multivariable analyses were performed to identify independent predictors of the primary outcomes. Subgroup analyses were performed to differentiate the impact of external and internal database studies compared with non-database studies. Results: A total of 2684 total articles were eligible for inclusion. Of these, 366 studies (13.6%) were database studies. Hip and knee articles had the greatest incidence of database studies. Database studies had significantly more citations (5.9 vs 4.0) and significantly higher AAS (12.8 vs 11.3) compared with non-database studies. External database studies had significantly more citations (6.7 vs 4.8) and significantly higher AAS (14.0 vs 10.7) than internal database studies. Internal database studies had higher traditional citation counts but similar AAS to non-database studies. Conclusions: In 2018, database studies in well-reputed orthopedic journals had a greater number of citations but similar AAS compared with non-database studies. Further studies are warranted.
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Affiliation(s)
| | - Jordan S. Cohen
- Department of Orthopaedic Surgery,
University of Pennsylvania, Philadelphia, PA, USA
| | - Alex Gu
- Department of Orthopaedic Surgery,
George Washington School of Medicine & Health Sciences, Washington, DC,
USA
| | - Chapman Wei
- Department of Orthopaedic Surgery,
George Washington School of Medicine & Health Sciences, Washington, DC,
USA
| | - Ryan Mortman
- Department of Orthopaedic Surgery,
George Washington School of Medicine & Health Sciences, Washington, DC,
USA
| | - Peter K. Sculco
- Adult Reconstruction & Joint
Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Savyasachi C. Thakkar
- Johns Hopkins Department of Orthopaedic
Surgery, Adult Reconstruction Division, Columbia, MD, USA
| | - Joshua C. Campbell
- Department of Orthopaedic Surgery,
George Washington School of Medicine & Health Sciences, Washington, DC,
USA
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9
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Findlay C, Edwards M, Hough K, Grasmeder M, Newman TA. Leveraging real-world data to improve cochlear implant outcomes: Is the data available? Cochlear Implants Int 2023:1-12. [PMID: 37088565 DOI: 10.1080/14670100.2023.2198792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
OBJECTIVES A small but persistent proportion of individuals do not gain the expected benefit from cochlear implants(CI). A step-change in the understanding of factors affecting outcomes could come through data science. This study evaluates clinical data capture to assess the quality and utility of CI user's health records for data science, by assessing the recording of otitis media. Otitis media was selected as it is associated with the development of sensorineural hearing loss and may affect cochlear implant outcomes. METHODS A retrospective service improvement project evaluating the medical records of 594 people with a CI under the care of the University of Southampton Auditory Implant Service between 2014 and 2020. RESULTS The clinical records are suitable for data science research. Of the cohort studied 20% of Adults and more than 40% of the paediatric cases have a history of middle ear inflammation. DISCUSSION Data science has potential to improve cochlear implant outcomes and improve understanding of the mechanisms underlying poor performance, through retrospective secondary analysis of real-world data. CONCLUSION Implant centres and the British Cochlear Implant Group National Hearing Implant Registry are urged to consider the importance of consistently and accurate recording of patient data over time for each CI user. Data where links to hearing loss have been identified, such as middle ear inflammation, may be particularly valuable in future analyses and to inform clinical trials.
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Affiliation(s)
- Callum Findlay
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Building 85, Highfield Campus, Southampton S017 1BJ, UK
- Department of Otolaryngology, University Hospital Southampton NHS FT, Tremona Road, Southampton SO16 6YD, UK
| | - Mathew Edwards
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Building 85, Highfield Campus, Southampton S017 1BJ, UK
| | - Kate Hough
- Faculty of Engineering and Physical Sciences, Highfield Campus, University of Southampton, Building 85, Southampton, UK
| | - Mary Grasmeder
- Faculty of Physical Sciences, Highfield Campus, University of Southampton Auditory Implant Services, B19, Southampton SO171BJ, UK
| | - Tracey A Newman
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Building 85, Highfield Campus, Southampton S017 1BJ, UK
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Maier D, Vehreschild JJ, Uhl B, Meyer S, Berger-Thürmel K, Boerries M, Braren R, Grünwald V, Hadaschik B, Palm S, Singer S, Stuschke M, Juárez D, Delpy P, Lambarki M, Hummel M, Engels C, Andreas S, Gökbuget N, Ihrig K, Burock S, Keune D, Eggert A, Keilholz U, Schulz H, Büttner D, Löck S, Krause M, Esins M, Ressing F, Schuler M, Brandts C, Brucker DP, Husmann G, Oellerich T, Metzger P, Voigt F, Illert AL, Theobald M, Kindler T, Sudhof U, Reckmann A, Schwinghammer F, Nasseh D, Weichert W, von Bergwelt-Baildon M, Bitzer M, Malek N, Öner Ö, Schulze-Osthoff K, Bartels S, Haier J, Ammann R, Schmidt AF, Guenther B, Janning M, Kasper B, Loges S, Stilgenbauer S, Kuhn P, Tausch E, Runow S, Kerscher A, Neumann M, Breu M, Lablans M, Serve H. Profile of the multicenter cohort of the German Cancer Consortium's Clinical Communication Platform. Eur J Epidemiol 2023; 38:573-586. [PMID: 37017830 PMCID: PMC10073785 DOI: 10.1007/s10654-023-00990-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/09/2023] [Indexed: 04/06/2023]
Abstract
Treatment concepts in oncology are becoming increasingly personalized and diverse. Successively, changes in standards of care mandate continuous monitoring of patient pathways and clinical outcomes based on large, representative real-world data. The German Cancer Consortium's (DKTK) Clinical Communication Platform (CCP) provides such opportunity. Connecting fourteen university hospital-based cancer centers, the CCP relies on a federated IT-infrastructure sourcing data from facility-based cancer registry units and biobanks. Federated analyses resulted in a cohort of 600,915 patients, out of which 232,991 were incident since 2013 and for which a comprehensive documentation is available. Next to demographic data (i.e., age at diagnosis: 2.0% 0-20 years, 8.3% 21-40 years, 30.9% 41-60 years, 50.1% 61-80 years, 8.8% 81+ years; and gender: 45.2% female, 54.7% male, 0.1% other) and diagnoses (five most frequent tumor origins: 22,523 prostate, 18,409 breast, 15,575 lung, 13,964 skin/malignant melanoma, 9005 brain), the cohort dataset contains information about therapeutic interventions and response assessments and is connected to 287,883 liquid and tissue biosamples. Focusing on diagnoses and therapy-sequences, showcase analyses of diagnosis-specific sub-cohorts (pancreas, larynx, kidney, thyroid gland) demonstrate the analytical opportunities offered by the cohort's data. Due to its data granularity and size, the cohort is a potential catalyst for translational cancer research. It provides rapid access to comprehensive patient groups and may improve the understanding of the clinical course of various (even rare) malignancies. Therefore, the cohort may serve as a decisions-making tool for clinical trial design and contributes to the evaluation of scientific findings under real-world conditions.
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Affiliation(s)
- Daniel Maier
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jörg Janne Vehreschild
- University Hospital Frankfurt, Frankfurt, Germany.
- Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany.
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
| | - Barbara Uhl
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sandra Meyer
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Karin Berger-Thürmel
- University Hospital Munich, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melanie Boerries
- Faculty of Medicine, Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rickmer Braren
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- School of Medicine, Technical University Munich, Munich, Germany
| | - Viktor Grünwald
- West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Boris Hadaschik
- West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan Palm
- West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Susanne Singer
- University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Cancer Consortium (DKTK), Partner Site Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Stuschke
- West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Juárez
- German Cancer Research Center (DKFZ), Federated Information Systems, Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pierre Delpy
- German Cancer Research Center (DKFZ), Federated Information Systems, Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mohamed Lambarki
- German Cancer Research Center (DKFZ), Federated Information Systems, Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hummel
- Charité Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Cäcilia Engels
- Charité Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefanie Andreas
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nicola Gökbuget
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kristina Ihrig
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Susen Burock
- Charité Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dietmar Keune
- Charité Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Angelika Eggert
- Charité Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ulrich Keilholz
- Charité Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hagen Schulz
- University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Büttner
- University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Steffen Löck
- University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mechthild Krause
- University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mirko Esins
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Frank Ressing
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Martin Schuler
- West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Brandts
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel P Brucker
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gabriele Husmann
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Oellerich
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Patrick Metzger
- Faculty of Medicine, Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frederik Voigt
- Faculty of Medicine, Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anna L Illert
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Medicine I, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Matthias Theobald
- University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Cancer Consortium (DKTK), Partner Site Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Kindler
- University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Cancer Consortium (DKTK), Partner Site Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ursula Sudhof
- University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Achim Reckmann
- University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Cancer Consortium (DKTK), Partner Site Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Schwinghammer
- University Hospital Munich, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Nasseh
- University Hospital Munich, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wilko Weichert
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- School of Medicine, Technical University Munich, Munich, Germany
| | - Michael von Bergwelt-Baildon
- University Hospital Munich, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Bitzer
- Center for Personalized Medicine, Eberhard-Karls University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nisar Malek
- Center for Personalized Medicine, Eberhard-Karls University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Öznur Öner
- Center for Personalized Medicine, Eberhard-Karls University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Klaus Schulze-Osthoff
- Center for Personalized Medicine, Eberhard-Karls University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan Bartels
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Haier
- Comprehensive Cancer Center Hannover (Claudia von Schilling-Zentrum), Hannover Medical School, Hannover, Germany
| | - Raimund Ammann
- Comprehensive Cancer Center Hannover (Claudia von Schilling-Zentrum), Hannover Medical School, Hannover, Germany
| | - Anja Franziska Schmidt
- Comprehensive Cancer Center Hannover (Claudia von Schilling-Zentrum), Hannover Medical School, Hannover, Germany
| | - Bernd Guenther
- Comprehensive Cancer Center Hannover (Claudia von Schilling-Zentrum), Hannover Medical School, Hannover, Germany
| | - Melanie Janning
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
- Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
- Department of Personalized Medical Oncology (A420), DKFZ German Cancer Research Center, Heidelberg, Germany
| | - Bernd Kasper
- Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Sonja Loges
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
- Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
- Department of Personalized Medical Oncology (A420), DKFZ German Cancer Research Center, Heidelberg, Germany
| | | | - Peter Kuhn
- Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | | | | | | | | | - Martin Breu
- University Hospital of Würzburg, Würzburg, Germany
| | - Martin Lablans
- German Cancer Research Center (DKFZ), Federated Information Systems, Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hubert Serve
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Frankfurt Cancer Institute, Frankfurt, Germany
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11
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van der Heijden LL, Marang-van de Mheen PJ, Thielman L, Stijnen P, Hamming JF, Fourneau I. Validity of Routinely Reported Rutherford Scores Reported by Clinicians as Part of Daily Clinical Practice. Int J Angiol 2023. [DOI: 10.1055/s-0043-1761280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
AbstractRoutinely reported structured data from the electronic health record (EHR) are frequently used for secondary purposes. However, it is unknown how valid routinely reported data are for reuse.This study aimed to assess the validity of routinely reported Rutherford scores by clinicians as an indicator for the validity of structured data in the EHR.This observational study compared clinician-reported Rutherford scores with medical record review Rutherford scores for all visits at the vascular surgery department between April 1, 2016 and December 31, 2018. Free-text fields with clinical information for all visits were extracted for the assignment of the medical record review Rutherford score, after which the agreement with the clinician-reported Rutherford score was assessed using Fleiss' Kappa.A total of 6,633 visits were included for medical record review. Substantial agreement was shown between clinician-reported Rutherford scores and medical record review Rutherford scores for the left (k = 0.62, confidence interval [CI]: 0.60–0.63) and right leg (k = 0.62, CI: 0.60–0.64). This increased to the almost perfect agreement for left (k = 0.84, CI: 0.82–0.86) and right leg (k = 0.85, CI: 0.83–0.87), when excluding missing clinician-reported Rutherford scores. Expert's judgment was rarely required to be the deciding factor (11 out of 6,633).Substantial agreement between clinician-reported Rutherford scores and medical record review Rutherford scores was found, which could be an indicator for the validity of routinely reported data. Depending on its purpose, the secondary use of routinely collected Rutherford scores is a viable option.
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Affiliation(s)
- Laura L.M. van der Heijden
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
- Department Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Perla J. Marang-van de Mheen
- Department Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Louis Thielman
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Pieter Stijnen
- Management Information and Reporting, University Hospitals Leuven, Leuven, Belgium
| | - Jaap F. Hamming
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
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12
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Debray TPA, Collins GS, Riley RD, Snell KIE, Van Calster B, Reitsma JB, Moons KGM. Transparent reporting of multivariable prediction models developed or validated using clustered data: TRIPOD-Cluster checklist. BMJ 2023; 380:e071018. [PMID: 36750242 PMCID: PMC9903175 DOI: 10.1136/bmj-2022-071018] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 02/09/2023]
Affiliation(s)
- Thomas P A Debray
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Richard D Riley
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Kym I E Snell
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Johannes B Reitsma
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Karel G M Moons
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
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13
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Debray TPA, Collins GS, Riley RD, Snell KIE, Van Calster B, Reitsma JB, Moons KGM. Transparent reporting of multivariable prediction models developed or validated using clustered data (TRIPOD-Cluster): explanation and elaboration. BMJ 2023; 380:e071058. [PMID: 36750236 PMCID: PMC9903176 DOI: 10.1136/bmj-2022-071058] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 02/09/2023]
Affiliation(s)
- Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
- National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Richard D Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - Kym I E Snell
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- EPI-centre, KU Leuven, Leuven, Belgium
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Johannes B Reitsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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14
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Ebbers T, Takes RP, Honings J, Smeele LE, Kool RB, van den Broek GB. Development and validation of automated electronic health record data reuse for a multidisciplinary quality dashboard. Digit Health 2023; 9:20552076231191007. [PMID: 37529541 PMCID: PMC10388626 DOI: 10.1177/20552076231191007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 07/13/2023] [Indexed: 08/03/2023] Open
Abstract
Objective To describe the development and validation of automated electronic health record data reuse for a multidisciplinary quality dashboard. Materials and methods Comparative study analyzing a manually extracted and an automatically extracted dataset with 262 patients treated for HNC cancer in a tertiary oncology center in the Netherlands in 2020. The primary outcome measures were the percentage of agreement on data elements required for calculating quality indicators and the difference between indicators results calculated using manually collected and indicators that used automatically extracted data. Results The results of this study demonstrate high agreement between manual and automatically collected variables, reaching up to 99.0% agreement. However, some variables demonstrate lower levels of agreement, with one variable showing only a 20.0% agreement rate. The indicator results obtained through manual collection and automatic extraction show high agreement in most cases, with discrepancy rates ranging from 0.3% to 3.5%. One indicator is identified as a negative outlier, with a discrepancy rate of nearly 25%. Conclusions This study shows that it is possible to use routinely collected structured data to reliably measure the quality of care in real-time, which could render manual data collection for quality measurement obsolete. To achieve reliable data reuse, it is important that relevant data is recorded as structured data during the care process. Furthermore, the results also imply that data validation is conditional to development of a reliable dashboard.
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Affiliation(s)
- Tom Ebbers
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Rudolf B Kool
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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15
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Van den Bulck S, Crèvecoeur J, Aertgeerts B, Delvaux N, Neyens T, Van Pottelbergh G, Coursier P, Vaes B. The impact of the Covid-19 pandemic on the incidence of diseases and the provision of primary care: A registry-based study. PLoS One 2022; 17:e0271049. [PMID: 35793324 PMCID: PMC9258821 DOI: 10.1371/journal.pone.0271049] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/22/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
The Covid-19 pandemic had a tremendous impact on healthcare but uncertainty remains about the extent to which primary care provision was affected. Therefore, this paper aims to assess the impact on primary care provision and the evolution of the incidence of disease during the first year of the Covid-19 pandemic in Flanders (Belgium).
Methods
Care provision was defined as the number of new entries added to a patient’s medical history. Pre-pandemic care provision (February 1, 2018–January 31, 2020) was compared with care provision during the pandemic (February 1, 2020-January 31, 2021). A large morbidity registry (Intego) was used. Regression models compared the effect of demographic characteristics on care provision and on acute and chronic diagnoses incidence both prior and during the pandemic.
Results
During the first year of the Covid-19 pandemic, overall care provision increased with 9.1% (95%CI 8.5%;9.6%). There was an increase in acute diagnoses of 5.1% (95%CI 4.2%;6.0%) and a decrease in the selected chronic diagnoses of 12.8% (95% CI 7.0%;18.4%). Obesity was an exception with an overall incidence increase. The pandemic led to strong fluctuations in care provision that were not the same for all types of care and all demographic groups in Flanders. Relative to other groups in the population, the pandemic caused a reduction in care provision for children aged 0–17 year and patients from a lower socio-economic situation.
Conclusion
This paper strengthened the claim that Covid-19 should be considered as a syndemic instead of a pandemic. During the first Covid-19 year, overall care provision and the incidence of acute diagnoses increased, whereas chronic diseases’ incidence decreased, except for obesity diagnoses which increased. More granular, care provision and chronic diseases’ incidence decreased during the lockdowns, especially for people with a lower socio-economic status. After the lockdowns they both returned to baseline.
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Affiliation(s)
- Steve Van den Bulck
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
- * E-mail: (SVdB); (JC)
| | - Jonas Crèvecoeur
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
- Department of Public Health and Primary Care, I-BioStat, Faculty of Medicine, KU Leuven, Leuven, Belgium
- * E-mail: (SVdB); (JC)
| | - Bert Aertgeerts
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
| | - Nicolas Delvaux
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
| | - Thomas Neyens
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
- Department of Public Health and Primary Care, I-BioStat, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Gijs Van Pottelbergh
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
| | - Patrick Coursier
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
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16
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Averbuch T, Sullivan K, Sauer A, Mamas MA, Voors AA, Gale CP, Metra M, Ravindra N, Van Spall HGC. Applications of artificial intelligence and machine learning in heart failure. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:311-322. [PMID: 36713018 PMCID: PMC9707916 DOI: 10.1093/ehjdh/ztac025] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/15/2022] [Indexed: 02/01/2023]
Abstract
Machine learning (ML) is a sub-field of artificial intelligence that uses computer algorithms to extract patterns from raw data, acquire knowledge without human input, and apply this knowledge for various tasks. Traditional statistical methods that classify or regress data have limited capacity to handle large datasets that have a low signal-to-noise ratio. In contrast to traditional models, ML relies on fewer assumptions, can handle larger and more complex datasets, and does not require predictors or interactions to be pre-specified, allowing for novel relationships to be detected. In this review, we discuss the rationale for the use and applications of ML in heart failure, including disease classification, early diagnosis, early detection of decompensation, risk stratification, optimal titration of medical therapy, effective patient selection for devices, and clinical trial recruitment. We discuss how ML can be used to expedite implementation and close healthcare gaps in learning healthcare systems. We review the limitations of ML, including opaque logic and unreliable model performance in the setting of data errors or data shift. Whilst ML has great potential to improve clinical care and research in HF, the applications must be externally validated in prospective studies for broad uptake to occur.
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Affiliation(s)
- Tauben Averbuch
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kristen Sullivan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Sauer
- Department of Cardiology, University of Kansas Health System, Kansas City, KS, USA
| | - Mamas A Mamas
- Keele Cardiovascular research group, Keele University, Stoke on Trent, Staffordshire
| | | | - Chris P Gale
- Department of Cardiology, University of Leeds, Leeds, West Yorkshire
| | - Marco Metra
- Azienda Socio Sanitaria Territoriale Spedali Civili and University of Brescia, Brescia, Italy
| | - Neal Ravindra
- Department of Computer Science, Yale University, New Haven, CT, USA
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17
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Ronaldson A, Freestone M, Zhang H, Marsh W, Bhui K. Using Structural Equation Modelling in Routine Clinical Data on Diabetes and Depression: Observational Cohort Study. JMIRX MED 2022; 3:e22912. [PMID: 37725546 PMCID: PMC10414237 DOI: 10.2196/22912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 09/21/2023]
Abstract
BACKGROUND Large data sets comprising routine clinical data are becoming increasingly available for use in health research. These data sets contain many clinical variables that might not lend themselves to use in research. Structural equation modelling (SEM) is a statistical technique that might allow for the creation of "research-friendly" clinical constructs from these routine clinical variables and therefore could be an appropriate analytic method to apply more widely to routine clinical data. OBJECTIVE SEM was applied to a large data set of routine clinical data developed in East London to model well-established clinical associations. Depression is common among patients with type 2 diabetes, and is associated with poor diabetic control, increased diabetic complications, increased health service utilization, and increased health care costs. Evidence from trial data suggests that integrating psychological treatment into diabetes care can improve health status and reduce costs. Attempting to model these known associations using SEM will test the utility of this technique in routine clinical data sets. METHODS Data were cleaned extensively prior to analysis. SEM was used to investigate associations between depression, diabetic control, diabetic care, mental health treatment, and Accident & Emergency (A&E) use in patients with type 2 diabetes. The creation of the latent variables and the direction of association between latent variables in the model was based upon established clinical knowledge. RESULTS The results provided partial support for the application of SEM to routine clinical data. Overall, 19% (3106/16,353) of patients with type 2 diabetes had received a diagnosis of depression. In line with known clinical associations, depression was associated with worse diabetic control (β=.034, P<.001) and increased A&E use (β=.071, P<.001). However, contrary to expectation, worse diabetic control was associated with lower A&E use (β=-.055, P<.001) and receipt of mental health treatment did not impact upon diabetic control (P=.39). Receipt of diabetes care was associated with better diabetic control (β=-.072, P<.001), having depression (β=.018, P=.007), and receiving mental health treatment (β=.046, P<.001), which might suggest that comprehensive integrated care packages are being delivered in East London. CONCLUSIONS Some established clinical associations were successfully modelled in a sample of patients with type 2 diabetes in a way that made clinical sense, providing partial evidence for the utility of SEM in routine clinical data. Several issues relating to data quality emerged. Data improvement would have likely enhanced the utility of SEM in this data set.
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Affiliation(s)
- Amy Ronaldson
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Mark Freestone
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Haoyuan Zhang
- School for Electronic Engineering and Computer Science, Queen Mary University of London, London, United Kingdom
| | - William Marsh
- School for Electronic Engineering and Computer Science, Queen Mary University of London, London, United Kingdom
| | - Kamaldeep Bhui
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- Department of Psychiatry, Nuffield Department of Primary Care Sciences, University of Oxford, Oxford, United Kingdom
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18
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Wong LH, Chrea B, Meeker JE, Yoo JU, Atwater LC. Factors Associated With Nonunion and Infection Following Ankle Arthrodesis Using a Large Claims Database: Who Has Elevated Risk? FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221101617. [PMID: 35662901 PMCID: PMC9158424 DOI: 10.1177/24730114221101617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Complications such as nonunion and infection following ankle arthrodesis can lead to increased patient morbidity and financial burden from repeat operations. Improved knowledge of risk factors can improve patient selection and inform post–ankle arthrodesis surveillance protocols. Methods: This is a large retrospective, database study with structured query of a national insurance claims database (PearlDiver Technologies) for patients treated with ankle arthrodesis from 2015 to 2019 as identified by International Classification of Diseases, Tenth Revision (ICD-10), codes. Patients with any operation 1 year prior to or following ankle arthrodesis were excluded from analysis to prevent attributing complications to another operation. Likelihoods of nonunion and infection within 1 year and 3 years following ankle arthrodesis were analyzed using Kaplan-Meier estimations. Patient characteristics associated with the identified complications following ankle arthrodesis were analyzed using multivariable logistic regression analyses. Results: Our query yielded 2463 patients in the 5-year period who underwent ankle arthrodesis. Nonunion occurred in 11% (95% CI 10-12) of patients within 1 year of ankle arthrodesis and 16% (95% CI 14-17) of patients within 3 years. Infection occurred in 3.9% (95% CI 3.1-4.7) of patients within 1 year of ankle arthrodesis and in 6.2% (95% CI 5.1-7.2) of patients within 3 years. Obese patients increased odds of nonunion on multivariable analysis (OR 1.6, 95% CI 1.3-2.0; P < .001). On multivariable analysis, diabetes (OR 1.7, 95% CI 1.2-2.6; P = .010) and each 1-unit increase in Elixhauser Comorbidity Index scores (OR 1.1, 95% CI 1.1-1.2; P < .001) contributed to increased odds of infection after ankle arthrodesis. Conclusion: Nonunion and infection following ankle arthrodesis have a 3-year probability of 16% and 6%, respectively. More than one-quarter of patients with nonunion following ankle arthrodesis experience a delay in diagnosis beyond 1 year. The risk of post–ankle arthrodesis nonunion is highest in patients with obesity; the risk of post–ankle arthrodesis infection is highest in patients with diabetes or an elevated Elixhauser Comorbidity Index score. Level of Evidence: Level III, prognostic study.
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Affiliation(s)
- Liam H. Wong
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Bopha Chrea
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - James E. Meeker
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Jung U. Yoo
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Lara C. Atwater
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
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Mahmud N, Goldberg DS, Bittermann T. Best Practices in Large Database Clinical Epidemiology Research in Hepatology: Barriers and Opportunities. Liver Transpl 2022; 28:113-122. [PMID: 34265178 PMCID: PMC8688188 DOI: 10.1002/lt.26231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 06/10/2021] [Accepted: 06/27/2021] [Indexed: 01/03/2023]
Abstract
With advances in computing and information technology, large health care research databases are becoming increasingly accessible to investigators across the world. These rich, population-level data sources can serve many purposes, such as to generate "real-world evidence," to enhance disease phenotyping, or to identify unmet clinical needs, among others. This is of particular relevance to the study of patients with end-stage liver disease (ESLD), a socioeconomically and clinically heterogeneous population that is frequently under-represented in clinical trials. This review describes the recommended "best practices" in the execution, reporting, and interpretation of large database clinical epidemiology research in hepatology. The advantages and limitations of selected data sources are reviewed, as well as important concepts on data linkages. The appropriate classification of exposures and outcomes is addressed, and the strategies needed to overcome limitations of the data and minimize bias are explained as they pertain to patients with ESLD and/or liver transplantation (LT) recipients. Lastly, selected statistical concepts are reviewed, from model building to analytic decision making and hypothesis testing. The purpose of this review is to provide the practical insights and knowledge needed to ensure successful and impactful research using large clinical databases in the modern era and advance the study of ESLD and LT.
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Affiliation(s)
- Nadim Mahmud
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David S. Goldberg
- Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, FL
| | - Therese Bittermann
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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20
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OUP accepted manuscript. Br J Surg 2022. [DOI: 10.1093/bjs/znac029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Liu M, Qi Y, Wang W, Sun X. Toward a better understanding about real-world evidence. Eur J Hosp Pharm 2022; 29:8-11. [PMID: 34857642 PMCID: PMC8717805 DOI: 10.1136/ejhpharm-2021-003081] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/03/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There has been an interest in real-world evidence (RWE) in recent years. RWE is usually generated from data derived from routine healthcare, such as electronic healthcare records and disease registries. While RWE has many advantages, it is often open to various biases, which may distort results. Appropriate understanding and interpretation are critical to the best use of RWE in healthcare decisions. METHODS On the basis of a literature review and empirical research experience, we summarised the concept and methodological framework of RWE, and discussed in detail methodological issues specific to routinely collected healthcare data and observational studies using such data. RESULTS RWE is derived from a spectrum of data generated from the real-world setting, using two broad study designs including observational studies and pragmatic clinical trials. Real-world data may usually be collected through routine practice or sometimes actively collected with a research purpose. Observational studies using routinely collected data (RCD) are the most common type of RWE, although they are prone to biases. When planning and implementing RWE studies, coherent working steps are warranted, including definition of a clear and answerable research question, development of a research team, selection of a fit-for-purpose data source, choice of state-of-the-art study design, establishing a database with transparent data processing, performing multiple statistical analysis to control bias, and reporting results in accordance with established guidelines. CONCLUSIONS RWE has been mounting over the years. The appropriate interpretation and use of such evidence often warrant adequate understanding about methodology. Researchers and policymakers should be aware of the methodological pitfalls when generating and interpreting RWE.
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Affiliation(s)
- Mei Liu
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China,NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China,Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Yana Qi
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China,NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China,Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Wen Wang
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China,NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China,Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Xin Sun
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China,NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China,Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
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22
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Verma AA, Pasricha SV, Jung HY, Kushnir V, Mak DYF, Koppula R, Guo Y, Kwan JL, Lapointe-Shaw L, Rawal S, Tang T, Weinerman A, Razak F. Assessing the quality of clinical and administrative data extracted from hospitals: the General Medicine Inpatient Initiative (GEMINI) experience. J Am Med Inform Assoc 2021; 28:578-587. [PMID: 33164061 DOI: 10.1093/jamia/ocaa225] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/27/2020] [Accepted: 09/14/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Large clinical databases are increasingly used for research and quality improvement. We describe an approach to data quality assessment from the General Medicine Inpatient Initiative (GEMINI), which collects and standardizes administrative and clinical data from hospitals. METHODS The GEMINI database contained 245 559 patient admissions at 7 hospitals in Ontario, Canada from 2010 to 2017. We performed 7 computational data quality checks and iteratively re-extracted data from hospitals to correct problems. Thereafter, GEMINI data were compared to data that were manually abstracted from the hospital's electronic medical record for 23 419 selected data points on a sample of 7488 patients. RESULTS Computational checks flagged 103 potential data quality issues, which were either corrected or documented to inform future analysis. For example, we identified the inclusion of canceled radiology tests, a time shift of transfusion data, and mistakenly processing the chemical symbol for sodium ("Na") as a missing value. Manual validation identified 1 important data quality issue that was not detected by computational checks: transfusion dates and times at 1 site were unreliable. Apart from that single issue, across all data tables, GEMINI data had high overall accuracy (ranging from 98%-100%), sensitivity (95%-100%), specificity (99%-100%), positive predictive value (93%-100%), and negative predictive value (99%-100%) compared to the gold standard. DISCUSSION AND CONCLUSION Computational data quality checks with iterative re-extraction facilitated reliable data collection from hospitals but missed 1 critical quality issue. Combining computational and manual approaches may be optimal for assessing the quality of large multisite clinical databases.
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Affiliation(s)
- Amol A Verma
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sachin V Pasricha
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Hae Young Jung
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Vladyslav Kushnir
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Denise Y F Mak
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Radha Koppula
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Yishan Guo
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Janice L Kwan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada.,Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
| | - Shail Rawal
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada
| | - Terence Tang
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute for Better Health, Trillium Health Partners, Toronto, Ontario, Canada
| | - Adina Weinerman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Fahad Razak
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Gonçalves DM, Henriques R, Costa RS. Predicting Postoperative Complications in Cancer Patients: A Survey Bridging Classical and Machine Learning Contributions to Postsurgical Risk Analysis. Cancers (Basel) 2021; 13:cancers13133217. [PMID: 34203189 PMCID: PMC8269422 DOI: 10.3390/cancers13133217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/04/2021] [Accepted: 06/22/2021] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Structured survey on the predictive analysis of postoperative complications in oncology, bridging classic risk scores with machine learning advances, and further establishing principles to guide the design of cohort studies and the predictive modeling of postsurgical risks. Abstract Postoperative complications can impose a significant burden, increasing morbidity, mortality, and the in-hospital length of stay. Today, the number of studies available on the prognostication of postsurgical complications in cancer patients is growing and has already created a considerable set of dispersed contributions. This work provides a comprehensive survey on postoperative risk analysis, integrating principles from classic risk scores and machine-learning approaches within a coherent frame. A qualitative comparison is offered, taking into consideration the available cohort data and the targeted postsurgical outcomes of morbidity (such as the occurrence, nature or severity of postsurgical complications and hospitalization needs) and mortality. This work further establishes a taxonomy to assess the adequacy of cohort studies and guide the development and assessment of new learning approaches for the study and prediction of postoperative complications.
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Affiliation(s)
- Daniel M. Gonçalves
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal; (D.M.G.); (R.S.C.)
- INESC-ID, Lisboa Portugal and Instituto Superior Técnico, Universidade de Lisboa, R. Alves Redol 9, 1000-029 Lisboa, Portugal
| | - Rui Henriques
- INESC-ID, Lisboa Portugal and Instituto Superior Técnico, Universidade de Lisboa, R. Alves Redol 9, 1000-029 Lisboa, Portugal
- Correspondence: ; Tel.: +351-21-310-0300
| | - Rafael S. Costa
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal; (D.M.G.); (R.S.C.)
- LAQV-REQUIMTE, NOVA School of Science and Technology, Campus Caparica, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal
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Power and Challenges of Big Data: Why Clinical Researchers Should Not Be Ignored. J Neurosurg Anesthesiol 2021; 32:3-5. [PMID: 31651547 DOI: 10.1097/ana.0000000000000658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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25
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Mahmood A, Needham K, Shakur-Still H, Harris T, Jamaluddin SF, Davies D, Belli A, Mohamed FL, Leech C, Lotfi HM, Moss P, Lecky F, Hopkins P, Wong D, Boyle A, Wilson M, Darwent M, Roberts I. Effect of tranexamic acid on intracranial haemorrhage and infarction in patients with traumatic brain injury: a pre-planned substudy in a sample of CRASH-3 trial patients. Emerg Med J 2021; 38:270-278. [PMID: 33262252 PMCID: PMC7982942 DOI: 10.1136/emermed-2020-210424] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Early tranexamic acid (TXA) treatment reduces head injury deaths after traumatic brain injury (TBI). We used brain scans that were acquired as part of the routine clinical practice during the CRASH-3 trial (before unblinding) to examine the mechanism of action of TXA in TBI. Specifically, we explored the potential effects of TXA on intracranial haemorrhage and infarction. METHODS This is a prospective substudy nested within the CRASH-3 trial, a randomised placebo-controlled trial of TXA (loading dose 1 g over 10 min, then 1 g infusion over 8 hours) in patients with isolated head injury. CRASH-3 trial patients were recruited between July 2012 and January 2019. Participants in the current substudy were a subset of trial patients enrolled at 10 hospitals in the UK and 4 in Malaysia, who had at least one CT head scan performed as part of the routine clinical practice within 28 days of randomisation. The primary outcome was the volume of intraparenchymal haemorrhage (ie, contusion) measured on a CT scan done after randomisation. Secondary outcomes were progressive intracranial haemorrhage (post-randomisation CT shows >25% of volume seen on pre-randomisation CT), new intracranial haemorrhage (any haemorrhage seen on post-randomisation CT but not on pre-randomisation CT), cerebral infarction (any infarction seen on any type of brain scan done post-randomisation, excluding infarction seen pre-randomisation) and intracranial haemorrhage volume (intraparenchymal + intraventricular + subdural + epidural) in those who underwent neurosurgical haemorrhage evacuation. We planned to conduct sensitivity analyses excluding patients who were severely injured at baseline. Dichotomous outcomes were analysed using relative risks (RR) or hazard ratios (HR), and continuous outcomes using a linear mixed model. RESULTS 1767 patients were included in this substudy. One-third of the patients had a baseline GCS (Glasgow Coma Score) of 3 (n=579) and 24% had unilateral or bilateral unreactive pupils. 46% of patients were scanned pre-randomisation and post-randomisation (n=812/1767), 19% were scanned only pre-randomisation (n=341/1767) and 35% were scanned only post-randomisation (n=614/1767). In all patients, there was no evidence that TXA prevents intraparenchymal haemorrhage expansion (estimate=1.09, 95% CI 0.81 to 1.45) or intracranial haemorrhage expansion in patients who underwent neurosurgical haemorrhage evacuation (n=363) (estimate=0.79, 95% CI 0.57 to 1.11). In patients scanned pre-randomisation and post-randomisation (n=812), there was no evidence that TXA reduces progressive haemorrhage (adjusted RR=0.91, 95% CI 0.74 to 1.13) and new haemorrhage (adjusted RR=0.85, 95% CI 0.72 to 1.01). When patients with unreactive pupils at baseline were excluded, there was evidence that TXA prevents new haemorrhage (adjusted RR=0.80, 95% CI 0.66 to 0.98). In patients scanned post-randomisation (n=1431), there was no evidence of an increase in infarction with TXA (adjusted HR=1.28, 95% CI 0.93 to 1.76). A larger proportion of patients without (vs with) a post-randomisation scan died from head injury (38% vs 19%: RR=1.97, 95% CI 1.66 to 2.34, p<0.0001). CONCLUSION TXA may prevent new haemorrhage in patients with reactive pupils at baseline. This is consistent with the results of the CRASH-3 trial which found that TXA reduced head injury death in patients with at least one reactive pupil at baseline. However, the large number of patients without post-randomisation scans and the possibility that the availability of scan data depends on whether a patient received TXA, challenges the validity of inferences made using routinely collected scan data. This study highlights the limitations of using routinely collected scan data to examine the effects of TBI treatments. TRIAL REGISTRATION NUMBER ISRCTN15088122.
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Affiliation(s)
- Abda Mahmood
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Kelly Needham
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Haleema Shakur-Still
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Tim Harris
- Department of Emergency Medicine, Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - David Davies
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Antonio Belli
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Caroline Leech
- Emergency Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Hamzah Mohd Lotfi
- Emergency Department, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Phil Moss
- Clinical Research Unit, Emergency Department, Saint George's University Hospitals NHS Foundation Trust, London, UK
| | - Fiona Lecky
- Accident & Emergency, Salford Royal NHS Foundation Trust, Salford, UK
| | - Philip Hopkins
- Emergency Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Darin Wong
- Emergency Department, Penang General Hospital, Georgetown, Malaysia
| | - Adrian Boyle
- Emergency Department, Addenbrooke's Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mark Wilson
- Neurosurgeries, Emergencies & Trauma, Division of Medicine, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Melanie Darwent
- Emergency Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ian Roberts
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
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Aljuboori Z. In Reply to the Letter to the Editor Regarding "Early Effects of COVID-19 Pandemic on Neurosurgical Training in the United States: A Case Volume Analysis of Eight Programs". World Neurosurg 2021; 146:414. [PMID: 33607742 PMCID: PMC7884221 DOI: 10.1016/j.wneu.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Zaid Aljuboori
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
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Nimmo A, Steenkamp R, Ravanan R, Taylor D. Do routine hospital data accurately record comorbidity in advanced kidney disease populations? A record linkage cohort study. BMC Nephrol 2021; 22:95. [PMID: 33731041 PMCID: PMC7968235 DOI: 10.1186/s12882-021-02301-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Routine healthcare datasets capturing clinical and administrative information are increasingly being used to examine health outcomes. The accuracy of such data is not clearly defined. We examine the accuracy of diagnosis recording in individuals with advanced chronic kidney disease using a routine healthcare dataset in England with comparison to information collected by trained research nurses. METHODS We linked records from the Access to Transplant and Transplant Outcome Measures study to the Hospital Episode Statistics dataset. International Classification of Diseases (ICD-10) and Office for Population Censuses and Surveys Classification of Interventions and Procedures (OPCS-4) codes were used to identify medical conditions from hospital data. The sensitivity, specificity, positive and negative predictive values were calculated for a range of diagnoses. RESULTS Comorbidity information was available in 96% of individuals prior to starting kidney replacement therapy. There was variation in the accuracy of individual medical conditions identified from the routine healthcare dataset. Sensitivity and positive predictive values ranged from 97.7 and 90.4% for diabetes and 82.6 and 82.9% for ischaemic heart disease to 44.2 and 28.4% for liver disease. CONCLUSIONS Routine healthcare datasets accurately capture certain conditions in an advanced chronic kidney disease population. They have potential for use within clinical and epidemiological research studies but are unlikely to be sufficient as a single resource for identifying a full spectrum of comorbidities.
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Affiliation(s)
- Ailish Nimmo
- Richard Bright Renal Service, Southmead Hospital, Bristol, BS10 5NB, UK.
| | | | - Rommel Ravanan
- Richard Bright Renal Service, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Dominic Taylor
- Richard Bright Renal Service, Southmead Hospital, Bristol, BS10 5NB, UK
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Coombes CE, Abrams ZB, Nakayiza S, Brock G, Coombes KR. Umpire 2.0: Simulating realistic, mixed-type, clinical data for machine learning. F1000Res 2021. [DOI: 10.12688/f1000research.25877.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Umpire 2.0 R-package offers a streamlined, user-friendly workflow to simulate complex, heterogeneous, mixed-type data with known subgroup identities, dichotomous outcomes, and time-to-event data, while providing ample opportunities for fine-tuning and flexibility. Here, we describe how we have expanded the core Umpire 1.0 R-package, developed to simulate gene expression data, to generate clinically realistic, mixed-type data for use in evaluating unsupervised and supervised machine learning (ML) methods. As the availability of large-scale clinical data for ML has increased, clinical data has posed unique challenges, including widely variable size, individual biological heterogeneity, data collection and measurement noise, and mixed data types. Developing and validating ML methods for clinical data requires data sets with known ground truth, generated from simulation. Umpire 2.0 addresses challenges to simulating realistic clinical data by providing the user a series of modules to generate survival parameters and subgroups, apply meaningful additive noise, and discretize to single or mixed data types. Umpire 2.0 provides broad functionality across sample sizes, feature spaces, and data types, allowing the user to simulate correlated, heterogeneous, binary, continuous, categorical, or mixed type data from the scale of a small clinical trial to data on thousands of patients drawn from electronic health records. The user may generate elaborate simulations by varying parameters in order to compare algorithms or interrogate operating characteristics of an algorithm in both supervised and unsupervised ML.
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Takeuchi M, Kawakami K. Association of baloxavir marboxil prescription with subsequent medical resource utilization among school-aged children with influenza. Pharmacoepidemiol Drug Saf 2021; 30:779-786. [PMID: 33608939 DOI: 10.1002/pds.5207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE Baloxavir marboxil is a novel antiviral agent for influenza, introduced into clinical practice in 2018. A concern remains about the variant virus with reduced susceptibility after baloxavir exposure and its clinical consequences such as healthcare-seeking behavior. METHODS Using a healthcare database in Japan, we compared the medical resource use following baloxavir and neuraminidase inhibitors (NAIs) treatment among children aged 7-15 years. The study period was from December 2018 to March 2019. The primary endpoint was the composite of hospitalization, laboratory and radiological tests, and antibiotic use over 1-9 days of antiviral treatment. As exploratory analyses, secondary outcomes being each single component of the primary composite were assessed and subgroup analyses comparing baloxavir with each NAI were done. RESULTS Data from 115 867 prescriptions in 115 238 children were analyzed (median age: 10 years; severe influenza risk in 26%; baloxavir accounting for 43%). Overall, baloxavir use did not increase subsequent medical resource utilization in the composite endpoint (adjusted odds ratio [aOR]: 1.04; 95% confidence interval [CI]: 0.99-1.09; P = 0.14), as were likelihoods of other secondary outcomes. In the subgroup analysis, baloxavir use was associated with higher medical resource use than oseltamivir (aOR: 1.21; 95% CI: 1.13-1.31; P < 0.001) and lower resource use than zanamivir (aOR: 0.93; 95% CI 0.86-1.00; P = 0.040). CONCLUSIONS Based on a single-year experience in Japan, prescribing baloxavir rather than NAIs did not increase medical resource utilization within 9 days of treatment, except in one exploratory comparison with oseltamivir.
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Affiliation(s)
- Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Impact of Recreational Cannabis Legalization on Hospitalizations for Hyperemesis. Am J Gastroenterol 2021; 116:609-612. [PMID: 33657044 DOI: 10.14309/ajg.0000000000001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/08/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Chronic cannabis use had been associated with hyperemesis. We sought to determine whether cannabis liberalization contributed to increased hospitalizations for hyperemesis. METHODS Cannabis use and admissions for hyperemesis in legalized states were compared with those of nonlegalized states, before and after cannabis legalization, using state inpatient databases. RESULTS From 2011 to 2015, cannabis use increased 2.2 times in legalized states and 1.8 times in nonlegalized states. The odds of presentation with hyperemesis were higher in 2015 compared with those of 2011 in all states. DISCUSSION Recreational legalization may be contributing to rising cannabis use. Hospitalizations for hyperemesis have also increased but did not seem to be solely due to cannabis legalization.
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Araujo LH, Baldotto CS, Monteiro MR, Aguiar PN, Andrade MC, Longo CL, Batista M, Lima R, Azevedo D, Carvalho N, Andrade P, Zukin M, Teich N. Patient-centered outcomes in non-small-cell lung cancer: a real-world perspective. Future Oncol 2021; 17:1721-1733. [PMID: 33626916 DOI: 10.2217/fon-2020-0991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aims: To assess non-small-cell lung cancer (NSCLC) patient-centered outcomes in the real world. Methods: This is a prospective study of NSCLC patients treated at a private cancer care institution in Brazil between 2014 and 2019. Results: The report comprises 337 patients. Advanced stage was associated with higher symptom burden - fatigue (p = 0.03), pain (p < 0.001) and arm pain (p = 0.022) - and worse global, social and physical functioning (all p < 0.001). In the first 2 years, most factors evolved to either improvement or stability: cough (p = 0.02), pain (p = 0.002), global functioning (p < 0.001) and emotional functioning (p < 0.001). Staging (p < 0.001), fatigue (p = 0.001) and gender (p = 0.004) were independently associated with overall survival. Conclusions: Our results demonstrate the feasibility of conducting real-world prospective analysis of patient-centered outcomes.
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Affiliation(s)
- Luiz H Araujo
- Instituto COI de Educação e Pesquisa, Avenida das Américas, 6205 Loja F Barra da Tijuca, Rio de Janeiro, 22793-080, Brazil.,Americas Centro de Oncologia Integrado, Av. Jorge Curi, 550 Barra da Tijuca, Rio de Janeiro, 22775-001, Brazil.,Instituto Nacional de Câncer (INCA), Rua André Cavalcanti, 37, Quinto Andar Prédio Anexo, Centro, Rio de Janeiro, 20.230-050, Brazil
| | - Clarissa S Baldotto
- Instituto COI de Educação e Pesquisa, Avenida das Américas, 6205 Loja F Barra da Tijuca, Rio de Janeiro, 22793-080, Brazil.,Americas Centro de Oncologia Integrado, Av. Jorge Curi, 550 Barra da Tijuca, Rio de Janeiro, 22775-001, Brazil
| | - Mariana R Monteiro
- Instituto COI de Educação e Pesquisa, Avenida das Américas, 6205 Loja F Barra da Tijuca, Rio de Janeiro, 22793-080, Brazil.,Americas Centro de Oncologia Integrado, Av. Jorge Curi, 550 Barra da Tijuca, Rio de Janeiro, 22775-001, Brazil
| | - Pedro N Aguiar
- Instituto COI de Educação e Pesquisa, Avenida das Américas, 6205 Loja F Barra da Tijuca, Rio de Janeiro, 22793-080, Brazil.,Americas Centro de Oncologia Integrado, Av. Jorge Curi, 550 Barra da Tijuca, Rio de Janeiro, 22775-001, Brazil
| | - Maria Clara Andrade
- Instituto COI de Educação e Pesquisa, Avenida das Américas, 6205 Loja F Barra da Tijuca, Rio de Janeiro, 22793-080, Brazil.,Americas Centro de Oncologia Integrado, Av. Jorge Curi, 550 Barra da Tijuca, Rio de Janeiro, 22775-001, Brazil
| | - Cecília L Longo
- Instituto COI de Educação e Pesquisa, Avenida das Américas, 6205 Loja F Barra da Tijuca, Rio de Janeiro, 22793-080, Brazil.,Americas Centro de Oncologia Integrado, Av. Jorge Curi, 550 Barra da Tijuca, Rio de Janeiro, 22775-001, Brazil
| | - Mayara Batista
- Instituto COI de Educação e Pesquisa, Avenida das Américas, 6205 Loja F Barra da Tijuca, Rio de Janeiro, 22793-080, Brazil
| | - Raphaela Lima
- Instituto COI de Educação e Pesquisa, Avenida das Américas, 6205 Loja F Barra da Tijuca, Rio de Janeiro, 22793-080, Brazil
| | - Débora Azevedo
- Instituto COI de Educação e Pesquisa, Avenida das Américas, 6205 Loja F Barra da Tijuca, Rio de Janeiro, 22793-080, Brazil
| | - Natalia Carvalho
- Instituto COI de Educação e Pesquisa, Avenida das Américas, 6205 Loja F Barra da Tijuca, Rio de Janeiro, 22793-080, Brazil
| | - Perla Andrade
- Instituto COI de Educação e Pesquisa, Avenida das Américas, 6205 Loja F Barra da Tijuca, Rio de Janeiro, 22793-080, Brazil
| | - Mauro Zukin
- Instituto COI de Educação e Pesquisa, Avenida das Américas, 6205 Loja F Barra da Tijuca, Rio de Janeiro, 22793-080, Brazil.,Americas Centro de Oncologia Integrado, Av. Jorge Curi, 550 Barra da Tijuca, Rio de Janeiro, 22775-001, Brazil
| | - Nelson Teich
- Instituto COI de Educação e Pesquisa, Avenida das Américas, 6205 Loja F Barra da Tijuca, Rio de Janeiro, 22793-080, Brazil.,Americas Centro de Oncologia Integrado, Av. Jorge Curi, 550 Barra da Tijuca, Rio de Janeiro, 22775-001, Brazil
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The Prospective Dutch Colorectal Cancer (PLCRC) cohort: real-world data facilitating research and clinical care. Sci Rep 2021; 11:3923. [PMID: 33594104 PMCID: PMC7887218 DOI: 10.1038/s41598-020-79890-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022] Open
Abstract
Real-world data (RWD) sources are important to advance clinical oncology research and evaluate treatments in daily practice. Since 2013, the Prospective Dutch Colorectal Cancer (PLCRC) cohort, linked to the Netherlands Cancer Registry, serves as an infrastructure for scientific research collecting additional patient-reported outcomes (PRO) and biospecimens. Here we report on cohort developments and investigate to what extent PLCRC reflects the “real-world”. Clinical and demographic characteristics of PLCRC participants were compared with the general Dutch CRC population (n = 74,692, Dutch-ref). To study representativeness, standardized differences between PLCRC and Dutch-ref were calculated, and logistic regression models were evaluated on their ability to distinguish cohort participants from the Dutch-ref (AU-ROC 0.5 = preferred, implying participation independent of patient characteristics). Stratified analyses by stage and time-period (2013–2016 and 2017–Aug 2019) were performed to study the evolution towards RWD. In August 2019, 5744 patients were enrolled. Enrollment increased steeply, from 129 participants (1 hospital) in 2013 to 2136 (50 of 75 Dutch hospitals) in 2018. Low AU-ROC (0.65, 95% CI: 0.64–0.65) indicates limited ability to distinguish cohort participants from the Dutch-ref. Characteristics that remained imbalanced in the period 2017–Aug’19 compared with the Dutch-ref were age (65.0 years in PLCRC, 69.3 in the Dutch-ref) and tumor stage (40% stage-III in PLCRC, 30% in the Dutch-ref). PLCRC approaches to represent the Dutch CRC population and will ultimately meet the current demand for high-quality RWD. Efforts are ongoing to improve multidisciplinary recruitment which will further enhance PLCRC’s representativeness and its contribution to a learning healthcare system.
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Wang TT, Lee KC, Chuang SK. Large Publicly Available Administrative Databases: An Opportunity to Improve Evidence-Based Care in Oral and Maxillofacial Surgery. J Oral Maxillofac Surg 2021; 79:1195-1196. [PMID: 33640329 DOI: 10.1016/j.joms.2021.01.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Tim T Wang
- DMD Candidate, School of Dental Medicine; MPH Candidate, Perelman School of Medicine; and Associate Fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
| | - Kevin C Lee
- Resident, Division of Oral and Maxillofacial Surgery, New York-Presbyterian/Columbia University, Irving Medical Center, New York, NY
| | - Sung-Kiang Chuang
- Clinical Professor, Department of Oral and Maxillofacial Surgery, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA; Private Practice, Brockton Oral and Maxillofacial Surgery Inc.; Attending, Department of Oral and Maxillofacial Surgery, Good Samaritan Medical Center, Brockton, MA; Visiting Professor, Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University, School of Dentistry, Kaohsiung, Taiwan
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Nijman SWJ, Hoogland J, Groenhof TKJ, Brandjes M, Jacobs JJL, Bots ML, Asselbergs FW, Moons KGM, Debray TPA. Real-time imputation of missing predictor values in clinical practice. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2020; 2:154-164. [PMID: 36711167 PMCID: PMC9707891 DOI: 10.1093/ehjdh/ztaa016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/02/2020] [Accepted: 11/30/2020] [Indexed: 02/01/2023]
Abstract
Aims Use of prediction models is widely recommended by clinical guidelines, but usually requires complete information on all predictors, which is not always available in daily practice. We aim to describe two methods for real-time handling of missing predictor values when using prediction models in practice. Methods and results We compare the widely used method of mean imputation (M-imp) to a method that personalizes the imputations by taking advantage of the observed patient characteristics. These characteristics may include both prediction model variables and other characteristics (auxiliary variables). The method was implemented using imputation from a joint multivariate normal model of the patient characteristics (joint modelling imputation; JMI). Data from two different cardiovascular cohorts with cardiovascular predictors and outcome were used to evaluate the real-time imputation methods. We quantified the prediction model's overall performance [mean squared error (MSE) of linear predictor], discrimination (c-index), calibration (intercept and slope), and net benefit (decision curve analysis). When compared with mean imputation, JMI substantially improved the MSE (0.10 vs. 0.13), c-index (0.70 vs. 0.68), and calibration (calibration-in-the-large: 0.04 vs. 0.06; calibration slope: 1.01 vs. 0.92), especially when incorporating auxiliary variables. When the imputation method was based on an external cohort, calibration deteriorated, but discrimination remained similar. Conclusions We recommend JMI with auxiliary variables for real-time imputation of missing values, and to update imputation models when implementing them in new settings or (sub)populations.
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Affiliation(s)
- Steven W J Nijman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands,Corresponding author. Tel: +31 88 75 680 12,
| | - Jeroen Hoogland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - T Katrien J Groenhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Menno Brandjes
- Department of Health, Ortec B.V., Zoetermeer, Houtsingel 5, 2719 EA Zoetermeer, The Netherlands
| | - John J L Jacobs
- Department of Health, Ortec B.V., Zoetermeer, Houtsingel 5, 2719 EA Zoetermeer, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, 62 Huntley St, Fitzrovia, London WC1E 6DD, UK,Health Data Research UK, Institute of Health Informatics, University College London, Gibbs Building, 215 Euston Rd, London NW1 2BE, UK
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands,Health Data Research UK, Institute of Health Informatics, University College London, Gibbs Building, 215 Euston Rd, London NW1 2BE, UK
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Ghanem OM, Badaoui JN. Comment on: High acquisition rate and internal validity in the Scandinavian Obesity Surgery Registry. Surg Obes Relat Dis 2020; 17:615-617. [PMID: 33272855 DOI: 10.1016/j.soard.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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Mintz HP, Dosanjh A, Parsons HM, Hughes A, Jakeman A, Pope AM, Bryan RT, James ND, Patel P. Development and validation of a follow-up methodology for a randomised controlled trial, utilising routine clinical data as an alternative to traditional designs: a pilot study to assess the feasibility of use for the BladderPath trial. Pilot Feasibility Stud 2020; 6:165. [PMID: 33292682 PMCID: PMC7599120 DOI: 10.1186/s40814-020-00713-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/20/2020] [Indexed: 01/19/2023] Open
Abstract
Background Bladder cancer outcomes have not changed significantly in 30 years; the BladderPath trial (Image Directed Redesign of Bladder Cancer Treatment Pathway, ISRCTN35296862) proposes to evaluate a modified pathway for diagnosis and treatment ensuring appropriate pathways are undertaken earlier to improve outcomes. We are piloting a novel data collection technique based on routine National Health Service (NHS) data, with no traditional patient-Health Care Professional contact after recruitment, where trial data are traditionally collected on case report forms. Data will be collected from routine administrative sources and validated via data queries to sites. We report here the feasibility and pre-trial methodological development and validation of the schema proposed for BladderPath. Methods Locally treated patient cohorts were utilised for routine data validation (hospital interactions data (HID) and administrative radiotherapy department data (RTD)). Single site events of interest were algorithmically extracted from the 2008–2018 HID and validated against reference datasets to determine detection sensitivity. Survival analysis was performed using RTD and HID data. Hazard ratios and survival statistics were calculated estimating treatment effects and further validating and assessing the scope of routine data. Results Overall, 829/1042 (sensitivity 0.80) events of interest were identified in the HID, with varying levels of sensitivity; identifying, 202/206 (sensitivity 0.98; PPV 0.96) surgical events but only 391/568 (sensitivity 0.69; PPV 0.95) radiotherapy regimens. An overall temporal quality improvement trend was present: detecting 41/117 events (35%) in 2011 to 104/109 (95%) in 2017 (all event types). Using the RTD, 5-year survival rates were 43% (95% CI 25–59%) in the chemoradiotherapy group and 30% (95% CI 23–36%) in the radiotherapy group; using the HID, the 5-year radical cystectomy survival rate was 57% (95% CI 50–63%). Conclusions Routine data are a feasible method for trial data collection. As long as events of interest are pre-validated, very high sensitivities for trial conduct can be achieved and further improved with targeted data queries. Outcomes can also be produced comparable to clinical trial and national dataset results. Given the real-time, obligatory nature of the HID, which forms the Hospital Episode Statistics (HES) data, alongside other datasets, we believe routine data extraction and validation is a robust way of rapidly collecting datasets for trials. Supplementary Information Supplementary information accompanies this paper at 10.1186/s40814-020-00713-y.
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Affiliation(s)
- Harriet P Mintz
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW, UK
| | - Amandeep Dosanjh
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Helen M Parsons
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Ana Hughes
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Alicia Jakeman
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW, UK
| | - Ann M Pope
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Richard T Bryan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | | | - Nicholas D James
- The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB, UK.,The Royal Marsden NHS foundation Trust, Fulham Road, Chelsea, London, SW3 6JJ, UK
| | - Prashant Patel
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW, UK. .,Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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40% reoperation rate in adolescents with spondylolisthesis. Spine Deform 2020; 8:1059-1067. [PMID: 32378040 DOI: 10.1007/s43390-020-00121-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Multicenter retrospective. OBJECTIVE To determine the long-term complication rate associated with surgical treatment of spondylolisthesis in adolescents. There is limited information on the complication rate associated with posterior spinal fusion (PSF) of spondylolisthesis in the pediatric and adolescent population. METHODS Patients who underwent PSF for spondylolisthesis between 2004 and 2015 at four spine centers, < 21 years of age, were included. Exclusion criteria were < 2 years of follow-up or anterior approach. Charts and radiographs were reviewed. RESULTS 50 patients had PSF for spondylolisthesis, 26 had PSF alone, while 24 had PSF with trans-foraminal lumbar interbody fusion (TLIF). Mean age was 13.9 years (range 9.6-18.4). Mean follow-up was 5.5 years (range 2-15). Mean preoperative slip was 61.2%. 20/50 patients (40%) experienced 23 complications requiring reoperation at a mean of 2.1 years (range 0-9.3) for the following: implant failure (12), persistent radiculopathy (3), infection (3), persistent back pain (2), extension of fusion (2), and hematoma (1). In addition, there were 22 cases of radiculopathy (44%) that were transient. Rate of implant failure was related to preoperative slip angle (p = 0.02). Reoperation rate and rates of implant failure were not associated with preoperative % slip (reoperation: p = 0.42, implant failure: p = 0.15), postoperative % slip (reoperation: p = 0.42, implant failure: p = 0.99), postoperative kyphosis of the lumbosacral angle (reoperation: p = 0.81, implant failure: p = 0.48), change in % slip (reoperation: p = 0.30, implant failure: p = 0.12), change in slip angle (reoperation: p = 0.42, implant failure: p = 0.40), graft used (reoperation: p = 0.22, implant failure: p = 0.81), or addition of a TLIF (reoperation: p = 0.55, implant failure: p = 0.76). CONCLUSION PSF of spondylolisthesis in the adolescent population was associated with a 40% reoperation rate and high rate of post-operative radiculopathy. Addition of a TLIF did not impact reoperation rate or rate of radiculopathy.
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Ronaldson A, Chandakas E, Kang Q, Brennan K, Akande A, Ebyarimpa I, Wyllie E, Howard G, Fradgley R, Freestone M, Bhui K. Cohort profile: he East London Health and Care Partnership Data Repository: using novel integrated data to support commissioning and research. BMJ Open 2020; 10:e037183. [PMID: 32948559 PMCID: PMC7511638 DOI: 10.1136/bmjopen-2020-037183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The East London Health and Care Partnership (ELHCP) Data Repository was established to support commissioning decisions in London. This dataset comprises routine clinical data for the general practitioner (GP)-registered populations of two London boroughs, Tower Hamlets and City and Hackney, and provides a rich source of demographic, clinical and health service use data of relevance to clinicians, commissioners, researchers and policy makers. This paper describes the dataset in its current form, its representativeness and data completeness. PARTICIPANTS There were 351 749 and 344 511 members of the GP-registered population in the two boroughs, respectively, for the financial year 2017/2018. Demographic information and prevalence data were available for 9 mental health and 15 physical health conditions. Prevalence rates from the cohort were compared with local and national data. In order to illustrate the health service use data available in the dataset, emergency department use across mental health conditions was described. Information about data completeness was provided. FINDINGS TO DATE The ELHCP Data Repository provides a rich source of information about a relatively young, urban, ethnically diverse, population within areas of socioeconomic deprivation. Prevalence data were in line with local and national statistics with some exceptions. Physical health conditions were more common in those with mental health conditions, reflecting that comorbidities are the norm rather than the exception. This has implications for integrated care. Data completeness for risk factors (eg, blood pressure, cholesterol) was high in patients with long-term conditions. FUTURE PLANS The data are being further cleaned and evaluated using imputation, Bayesian and economic methods, principally focusing on specific cohorts, including type II diabetes, depression and personality disorder. Data continue to be collected for the foreseeable future to support commissioning decisions, which will also enable more long-term prospective analysis as data become available at the end of each financial year.
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Affiliation(s)
- Amy Ronaldson
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, UK
| | | | - Qiongwen Kang
- NHS Tower Hamlets Clinical Commissioning Group, London, London, UK
| | - Katie Brennan
- NHS Tower Hamlets Clinical Commissioning Group, London, London, UK
| | - Aminat Akande
- NHS Tower Hamlets Clinical Commissioning Group, London, London, UK
| | - Irene Ebyarimpa
- NHS Tower Hamlets Clinical Commissioning Group, London, London, UK
| | | | | | | | - Mark Freestone
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, UK
| | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
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Fuzzy Matchmaking: How Two Records Became One. Pediatr Crit Care Med 2020; 21:848-849. [PMID: 32890090 DOI: 10.1097/pcc.0000000000002392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhao L, Ciallella HL, Aleksunes LM, Zhu H. Advancing computer-aided drug discovery (CADD) by big data and data-driven machine learning modeling. Drug Discov Today 2020; 25:1624-1638. [PMID: 32663517 PMCID: PMC7572559 DOI: 10.1016/j.drudis.2020.07.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/26/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023]
Abstract
Advancing a new drug to market requires substantial investments in time as well as financial resources. Crucial bioactivities for drug candidates, including their efficacy, pharmacokinetics (PK), and adverse effects, need to be investigated during drug development. With advancements in chemical synthesis and biological screening technologies over the past decade, a large amount of biological data points for millions of small molecules have been generated and are stored in various databases. These accumulated data, combined with new machine learning (ML) approaches, such as deep learning, have shown great potential to provide insights into relevant chemical structures to predict in vitro, in vivo, and clinical outcomes, thereby advancing drug discovery and development in the big data era.
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Affiliation(s)
- Linlin Zhao
- The Rutgers Center for Computational and Integrative Biology, Camden, NJ 08102, USA
| | - Heather L Ciallella
- The Rutgers Center for Computational and Integrative Biology, Camden, NJ 08102, USA
| | - Lauren M Aleksunes
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ 08854, USA
| | - Hao Zhu
- The Rutgers Center for Computational and Integrative Biology, Camden, NJ 08102, USA; Department of Chemistry, Rutgers University, Camden, NJ 08102, USA.
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Gokhale KM, Chandan JS, Toulis K, Gkoutos G, Tino P, Nirantharakumar K. Data extraction for epidemiological research (DExtER): a novel tool for automated clinical epidemiology studies. Eur J Epidemiol 2020; 36:165-178. [PMID: 32856160 PMCID: PMC7987616 DOI: 10.1007/s10654-020-00677-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/12/2020] [Indexed: 01/07/2023]
Abstract
The use of primary care electronic health records for research is abundant. The benefits gained from utilising such records lies in their size, longitudinal data collection and data quality. However, the use of such data to undertake high quality epidemiological studies, can lead to significant challenges particularly in dealing with misclassification, variation in coding and the significant effort required to pre-process the data in a meaningful format for statistical analysis. In this paper, we describe a methodology to aid with the extraction and processing of such databases, delivered by a novel software programme; the "Data extraction for epidemiological research" (DExtER). The basis of DExtER relies on principles of extract, transform and load processes. The tool initially provides the ability for the healthcare dataset to be extracted, then transformed in a format whereby data is normalised, converted and reformatted. DExtER has a user interface designed to obtain data extracts specific to each research question and observational study design. There are facilities to input the requirements for; eligible study period, definition of exposed and unexposed groups, outcome measures and important baseline covariates. To date the tool has been utilised and validated in a multitude of settings. There have been over 35 peer-reviewed publications using the tool, and DExtER has been implemented as a validated public health surveillance tool for obtaining accurate statistics on epidemiology of key morbidities. Future direction of this work will be the application of the framework to linked as well as international datasets and the development of standardised methods for conducting electronic pre-processing and extraction from datasets for research purposes.
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Affiliation(s)
- Krishna Margadhamane Gokhale
- School of Computer Science, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, B152TT, UK.
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK.
- Health Data Research UK, Birmingham, UK.
| | - Joht Singh Chandan
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK
| | - Konstantinos Toulis
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK
| | - Georgios Gkoutos
- Chair of Clinical Bioinformatics, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK
- Health Data Research UK, Birmingham, UK
| | - Peter Tino
- School of Computer Science, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, B152TT, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK.
- Health Data Research UK, Birmingham, UK.
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Priestap F, Kao R, Martin CM. External validation of a prognostic model for intensive care unit mortality: a retrospective study using the Ontario Critical Care Information System. Can J Anaesth 2020; 67:981-991. [PMID: 32383124 PMCID: PMC7223438 DOI: 10.1007/s12630-020-01686-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/21/2020] [Accepted: 03/05/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To externally validate an intensive care unit (ICU) mortality prediction model that was created using the Ontario Critical Care Information System (CCIS), which includes the Multiple Organ Dysfunction Score (MODS). METHODS We applied the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) recommendations to a prospective longitudinal cohort of patients discharged between 1 July 2015 and 31 December 31 2016 from 90 adult level-3 critical care units in Ontario. We used multivariable logistic regression with measures of discrimination, calibration-in-the-large, calibration slope, and flexible calibration plots to compare prediction model performance of the entire data set and for each ICU subtype. RESULTS Among 121,201 CCIS records with ICU mortality of 11.3%, the C-statistic for the validation data set was 0.805. The C-statistic ranged from 0.775 to 0.846 among the ICU subtypes. After intercept recalibration to adjust the baseline risk, the mean predicted risk of death matched actual ICU mortality. The calibration slope was close to 1 with all CCIS data and ICU subtypes of cardiovascular and community hospitals with low ventilation rates. Calibration slopes significantly less than 1 were found for ICUs in teaching hospitals and community hospitals with high ventilation rates whereas coronary care units had a calibration slope significantly higher than 1. Calibration plots revealed over-prediction in high risk groups to a varying degree across all cohorts. CONCLUSIONS A risk prediction model primarily based on the MODS shows reproducibility and transportability after intercept recalibration. Risk adjusting models that use existing and feasible data collection can support performance measurement at the individual ICU level.
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Affiliation(s)
- Fran Priestap
- London Health Sciences Centre - Victoria Hospital, 800 Commissioner's Rd E, London, ON, Canada, N6A 5W9.
| | - Raymond Kao
- London Health Sciences Centre - Victoria Hospital, 800 Commissioner's Rd E, London, ON, Canada, N6A 5W9
- Division of Critical Care, Department of Medicine, Schulich School of Dentistry and Medicine, Western University, London, ON, Canada
| | - Claudio M Martin
- London Health Sciences Centre - Victoria Hospital, 800 Commissioner's Rd E, London, ON, Canada, N6A 5W9
- Division of Critical Care, Department of Medicine, Schulich School of Dentistry and Medicine, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
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43
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Coombes CE, Abrams ZB, Li S, Abruzzo LV, Coombes KR. Unsupervised machine learning and prognostic factors of survival in chronic lymphocytic leukemia. J Am Med Inform Assoc 2020; 27:1019-1027. [PMID: 32483590 PMCID: PMC7647286 DOI: 10.1093/jamia/ocaa060] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/08/2020] [Accepted: 04/24/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Unsupervised machine learning approaches hold promise for large-scale clinical data. However, the heterogeneity of clinical data raises new methodological challenges in feature selection, choosing a distance metric that captures biological meaning, and visualization. We hypothesized that clustering could discover prognostic groups from patients with chronic lymphocytic leukemia, a disease that provides biological validation through well-understood outcomes. METHODS To address this challenge, we applied k-medoids clustering with 10 distance metrics to 2 experiments ("A" and "B") with mixed clinical features collapsed to binary vectors and visualized with both multidimensional scaling and t-stochastic neighbor embedding. To assess prognostic utility, we performed survival analysis using a Cox proportional hazard model, log-rank test, and Kaplan-Meier curves. RESULTS In both experiments, survival analysis revealed a statistically significant association between clusters and survival outcomes (A: overall survival, P = .0164; B: time from diagnosis to treatment, P = .0039). Multidimensional scaling separated clusters along a gradient mirroring the order of overall survival. Longer survival was associated with mutated immunoglobulin heavy-chain variable region gene (IGHV) status, absent Zap 70 expression, female sex, and younger age. CONCLUSIONS This approach to mixed-type data handling and selection of distance metric captured well-understood, binary, prognostic markers in chronic lymphocytic leukemia (sex, IGHV mutation status, ZAP70 expression status) with high fidelity.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Female
- Humans
- Immunoglobulin Heavy Chains/genetics
- Kaplan-Meier Estimate
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Male
- Middle Aged
- Mutation
- Prognosis
- Proportional Hazards Models
- Unsupervised Machine Learning
- ZAP-70 Protein-Tyrosine Kinase/metabolism
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Affiliation(s)
- Caitlin E Coombes
- The Ohio State University College of Medicine, Columbus, Ohio, USA
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Zachary B Abrams
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Suli Li
- Department of Statistics and Data Science, Cornell University, Ithaca, New York, USA
| | - Lynne V Abruzzo
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Kevin R Coombes
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
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van Smeden M, Groenwold RHH, Moons KG. A cautionary note on the use of the missing indicator method for handling missing data in prediction research. J Clin Epidemiol 2020; 125:188-190. [PMID: 32565213 DOI: 10.1016/j.jclinepi.2020.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Maarten van Smeden
- Julius Center for Health Science and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands.
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | - Karel Gm Moons
- Julius Center for Health Science and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
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45
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Luz CF, Vollmer M, Decruyenaere J, Nijsten MW, Glasner C, Sinha B. Machine learning in infection management using routine electronic health records: tools, techniques, and reporting of future technologies. Clin Microbiol Infect 2020; 26:1291-1299. [PMID: 32061798 DOI: 10.1016/j.cmi.2020.02.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/01/2020] [Accepted: 02/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Machine learning (ML) is increasingly being used in many areas of health care. Its use in infection management is catching up as identified in a recent review in this journal. We present here a complementary review to this work. OBJECTIVES To support clinicians and researchers in navigating through the methodological aspects of ML approaches in the field of infection management. SOURCES A Medline search was performed with the keywords artificial intelligence, machine learning, infection∗, and infectious disease∗ for the years 2014-2019. Studies using routinely available electronic hospital record data from an inpatient setting with a focus on bacterial and fungal infections were included. CONTENT Fifty-two studies were included and divided into six groups based on their focus. These studies covered detection/prediction of sepsis (n = 19), hospital-acquired infections (n = 11), surgical site infections and other postoperative infections (n = 11), microbiological test results (n = 4), infections in general (n = 2), musculoskeletal infections (n = 2), and other topics (urinary tract infections, deep fungal infections, antimicrobial prescriptions; n = 1 each). In total, 35 different ML techniques were used. Logistic regression was applied in 18 studies followed by random forest, support vector machines, and artificial neural networks in 18, 12, and seven studies, respectively. Overall, the studies were very heterogeneous in their approach and their reporting. Detailed information on data handling and software code was often missing. Validation on new datasets and/or in other institutions was rarely done. Clinical studies on the impact of ML in infection management were lacking. IMPLICATIONS Promising approaches for ML use in infectious diseases were identified. But building trust in these new technologies will require improved reporting. Explainability and interpretability of the models used were rarely addressed and should be further explored. Independent model validation and clinical studies evaluating the added value of ML approaches are needed.
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Affiliation(s)
- C F Luz
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, the Netherlands.
| | - M Vollmer
- Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | - J Decruyenaere
- Ghent University, Ghent University Hospital, Department of Intensive Care, Ghent, Belgium
| | - M W Nijsten
- University of Groningen, University Medical Center Groningen, Department of Critical Care, Groningen, the Netherlands
| | - C Glasner
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, the Netherlands
| | - B Sinha
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, the Netherlands
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Multi-level models for heart failure patients' 30-day mortality and readmission rates: the relation between patient and hospital factors in administrative data. BMC Health Serv Res 2019; 19:1012. [PMID: 31888610 PMCID: PMC6936032 DOI: 10.1186/s12913-019-4818-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/09/2019] [Indexed: 01/16/2023] Open
Abstract
Background This study aims at gathering evidence about the relation between 30-day mortality and 30-day unplanned readmission and patient and hospital factors. By definition, we refer to 30-day mortality and 30-day unplanned readmission as the number of deaths and non-programmed hospitalizations for any cause within 30 days after the incident heart failure (HF). In particular, the focus is on the role played by hospital-level factors. Methods A multi-level logistic model that combines patient- and hospital-level covariates has been developed to better disentangle the role played by the two groups of covariates. Later on, hospital outliers in term of better-than-expected/worst-than-expected performers have been identified by comparing expected cases vs. observed cases. Hospitals performance in terms of 30-day mortality and 30-day unplanned readmission rates have been visualized through the creation of funnel plots. Covariates have been selected coherently to past literature. Data comes from the hospital discharge forms for Heart Failure patients in the Lombardy Region (Northern Italy). Considering incident cases for HF in the timespan 2010–2012, 78,907 records for adult patients from 117 hospitals have been collected after quality checks. Results Our results show that 30-day mortality and 30-day unplanned readmissions are explained by hospital-level covariates, paving the way for the design and implementation of evidence-based improvement strategies. While the percentage of surgical DRG (OR = 1.001; CI (1.000–1.002)) and the hospital type of structure (Research hospitals vs. non-research public hospitals (OR = 0.62; CI (0.48–0.80)) and Non-research private hospitals vs. non-research hospitals OR = 0.75; CI (0.63–0.90)) are significant for mortality, the mean length of stay (OR = 0.96; CI (0.95–0.98)) is significant for unplanned readmission, showing that mortality and readmission rates might be improved through different strategies. Conclusion Our results confirm that hospital-level covariates do affect quality of care, and that 30-day mortality and 30-day unplanned readmission are affected by different managerial choices. This confirms that hospitals should be accountable for their “added value” to quality of care.
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Recalde M, Manzano-Salgado CB, Díaz Y, Puente D, Garcia-Gil MDM, Marcos-Gragera R, Ribes-Puig J, Galceran J, Posso M, Macià F, Duarte-Salles T. Validation Of Cancer Diagnoses In Electronic Health Records: Results From The Information System For Research In Primary Care (SIDIAP) In Northeast Spain. Clin Epidemiol 2019; 11:1015-1024. [PMID: 31819655 PMCID: PMC6899079 DOI: 10.2147/clep.s225568] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/30/2019] [Indexed: 12/12/2022] Open
Abstract
Background Electronic health records are becoming an increasingly valuable resource for epidemiology but their data quality needs to be quantified. We aimed to validate twenty-five types of incident cancer cases in the Information System for Research in Primary Care (SIDIAP) in Catalonia with the population-based cancer registries of Girona and Tarragona as the gold-standard. Methods We calculated the sensitivity, positive predictive values (PPV), and the time-difference between the date of diagnosis entered into the SIDIAP and into the registries. We added hospital discharge cancer diagnoses to the SIDIAP to assess sensitivity changes. Results We identified 27,046 incident cancer diagnoses in the SIDIAP from 2009–2015 among the 949,841 residents of Girona and Tarragona. The cancer types with the highest sensitivity were breast (89%, 95% CI: 88–90%), colorectal (81%, 95% CI: 80–82%), and prostate (81%, 95% CI: 80–83%). Trachea, bronchus and lung cancers had the highest PPV (76%, 95% CI: 74%-78%) followed by stomach (72%, 95% CI: 68–75%) and pancreas (71%, 95% CI: 67–75%). Most cancer diagnoses were reported with less than three months of difference between the SIDIAP and the registries. More cases were registered first in the registries than in the SIDIAP. By adding cancer diagnoses based on hospital discharge data, sensitivity increased for all cancers, especially for gallbladder and biliary tract for which the sensitivity increased by 21%. Conclusion The SIDIAP includes 76% of the cancer diagnoses in the cancer registries but includes a considerable number of cases that are not in the registries. The SIDIAP reports most of the cancer diagnoses within a three-month period difference from the date of diagnosis in the cancer registries. Our results support the use of the SIDIAP cancer diagnoses for epidemiological research when cancer is the outcome of interest. We recommend adding hospital discharge data to the SIDIAP to increase data quality, particularly for less frequent cancer types.
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Affiliation(s)
- Martina Recalde
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGoL), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Cerdanyola del Vallès, Spain
| | - Cyntia B Manzano-Salgado
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGoL), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Cerdanyola del Vallès, Spain
| | - Yesika Díaz
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGoL), Barcelona, Spain
| | - Diana Puente
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGoL), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Cerdanyola del Vallès, Spain
| | - Maria Del Mar Garcia-Gil
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGoL), Barcelona, Spain
| | - Rafael Marcos-Gragera
- Unitat d'Epidemiologia i Registre de Càncer de Girona (UERCG), Pla Director d'Oncologia, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Girona (IdIBGi), Universitat De Girona, Girona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Josefa Ribes-Puig
- Catalan Cancer Plan, Department of Health of Catalonia, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona (UB), Barcelona, Spain
| | - Jaume Galceran
- Registre de Càncer de Tarragona, Fundació per a la Investigació i Prevenció del Càncer (FUNCA), IISPV, Reus, Spain
| | - Margarita Posso
- Cancer Prevention Unit and Cancer Registry, Department of Epidemiology and Evaluation, Hospital del Mar, Barcelona, Spain
| | - Francesc Macià
- Cancer Prevention Unit and Cancer Registry, Department of Epidemiology and Evaluation, Hospital del Mar, Barcelona, Spain
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGoL), Barcelona, Spain
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Cohen JA, Trojano M, Mowry EM, Uitdehaag BM, Reingold SC, Marrie RA. Leveraging real-world data to investigate multiple sclerosis disease behavior, prognosis, and treatment. Mult Scler 2019; 26:23-37. [PMID: 31778094 PMCID: PMC6950891 DOI: 10.1177/1352458519892555] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Randomized controlled clinical trials and real-world observational studies
provide complementary information but with different validity. Some clinical
questions (disease behavior, prognosis, validation of outcome measures,
comparative effectiveness, and long-term safety of therapies) are often better
addressed using real-world data reflecting larger, more representative
populations. Integration of disease history, clinician-reported outcomes,
performance tests, and patient-reported outcome measures during patient
encounters; imaging and biospecimen analyses; and data from wearable devices
increase dataset utility. However, observational studies utilizing these data
are susceptible to many potential sources of bias, creating barriers to
acceptance by regulatory agencies and the medical community. Therefore, data
standardization and validation within datasets, harmonization across datasets,
and application of appropriate analysis methods are important considerations. We
review approaches to improve the scope, quality, and analyses of real-world data
to advance understanding of multiple sclerosis and its treatment, as an example
of opportunities to better support patient care and research.
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Affiliation(s)
- Jeffrey A Cohen
- Department of Neurology, Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Ellen M Mowry
- Department of Neurology, School of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Bernard Mj Uitdehaag
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Ruth Ann Marrie
- Departments of Internal Medicine (Neurology) and Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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49
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Gill S, Page R. From big data to big impact: realizing the potential of clinical registries. ANZ J Surg 2019; 89:1356-1357. [DOI: 10.1111/ans.15503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 08/21/2019] [Accepted: 08/28/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Stephen Gill
- Barwon Centre for Orthopaedic Research and EducationSt John of God Hospital Geelong Victoria Australia
- School of MedicineDeakin University Geelong Victoria Australia
| | - Richard Page
- Barwon Centre for Orthopaedic Research and EducationSt John of God Hospital Geelong Victoria Australia
- School of MedicineDeakin University Geelong Victoria Australia
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50
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Sigmon ER, Kelleman M, Susi A, Nylund CM, Oster ME. Congenital Heart Disease and Autism: A Case-Control Study. Pediatrics 2019; 144:peds.2018-4114. [PMID: 31601611 DOI: 10.1542/peds.2018-4114] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES There has long been an association between congenital heart disease (CHD) and general neurodevelopmental delays. However, the association between CHD and autism spectrum disorders (AuSDs) is less well understood. Using administrative data, we sought to determine the association between CHD and AuSD and identify specific CHD lesions with higher odds of developing AuSD. METHODS We performed a 1:3 case-control study of children enrolled in the US Military Health System from 2001 to 2013. Children with International Classification of Disease, Ninth Revision, Clinical Modification codes for AuSD were identified as cases and matched with controls on the basis of date of birth, sex, and enrollment time frame. Each child's records were reviewed for CHD lesions and associated procedures. Conditional logistic regression determined odds ratios (ORs) and 95% confidence intervals (CIs) for comparative associations. RESULTS There were 8760 cases with AuSD and 26 280 controls included in the study. After adjustment for genetic syndrome, maternal age, gestational diabetes, short gestation, newborn epilepsy, birth asphyxia, and low birth weight, there were increased odds of AuSD in patients with CHD (OR 1.32; 95% CI 1.10-1.59). Specific lesions with significant OR included atrial septal defects (n = 82; OR 1.72; 95% CI 1.07-2.74) and ventricular septal defects (n = 193; OR 1.65; 95% CI 1.21-2.25). CONCLUSIONS Children with CHD have increased odds of developing AuSD. Specific lesions associated with increased risk include atrial septal defects and ventricular septal defects. These findings will be useful for counseling parents of children with CHD.
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Affiliation(s)
- Eric R Sigmon
- Division of Pediatric Cardiology, Children's Healthcare of Atlanta and.,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia; and
| | - Michael Kelleman
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia; and
| | - Apryl Susi
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Cade M Nylund
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Matthew E Oster
- Division of Pediatric Cardiology, Children's Healthcare of Atlanta and .,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia; and
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