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Sampson C, Parkin D, Devlin N. Is anchoring at 'dead' a theoretical requirement for health state valuation? HEALTH ECONOMICS 2024; 33:1929-1935. [PMID: 38831492 DOI: 10.1002/hec.4863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 05/12/2024] [Accepted: 05/26/2024] [Indexed: 06/05/2024]
Abstract
Values that accompany generic health measures are typically anchored at 1 = full health and 0 = dead. Some health states may then be considered 'worse than dead' (WTD) and assigned negative values, which causes fundamental measurement problems. In this paper, we challenge the assumption that anchoring values at 'dead = 0' is necessary for quality-adjusted life year (QALY) estimation. We summarise the role of 'dead' in health state valuation and consider three critical questions: (i) whether the measurement properties of health state values require 'dead'; (ii) whether 'dead' needs to be valued relative to health states; and (iii) whether values for states WTD are meaningful or useful. We conclude that anchoring 0 at dead is not a requirement of health status measurement or cost-effectiveness analysis. This results from reframing QALYs as the relevant unit of measurement and reframing values as being derived from QALYs rather than the reverse.
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Affiliation(s)
| | - David Parkin
- Office of Health Economics, London, UK
- City, University of London, London, UK
| | - Nancy Devlin
- Office of Health Economics, London, UK
- University of Melbourne, Melbourne, Victoria, Australia
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2
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Young CA, Chaouch A, Mcdermott CJ, Al-Chalabi A, Chhetri SK, Talbot K, Harrower T, Orrell RW, Annadale J, Hanemann CO, Scalfari A, Tennant A, Mills R. Dyspnea (breathlessness) in amyotrophic lateral sclerosis/motor neuron disease: prevalence, progression, severity, and correlates. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:475-485. [PMID: 38465877 DOI: 10.1080/21678421.2024.2322545] [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] [Received: 12/12/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Dyspnea, or breathlessness, is an important symptom in amyotrophic lateral sclerosis/motor neuron disease (ALS/MND). We examined the measurement properties of the Dyspnea-12. METHODS Rasch analysis enabled conversion of raw Dyspnea-12 scores to interval level metric equivalents. Converted data were used to perform trajectory modeling; those following different trajectories were compared for demographic, clinical, symptom, and functioning characteristics. Logistic regression examined differences between distinct trajectories. RESULTS In 1022 people, at baseline, mean metric Dyspnea-12 was 7.6 (SD 9.3). 49.8% had dyspnea, severe in 12.6%. Trajectory analysis over 28 months revealed three breathlessness trajectories: group 1 reported none at baseline/follow-up (42.7%); group 2 significantly increased over time (9.4%); group 3 had a much higher level at baseline which rose over follow-up (47.9%). Group 3 had worse outcomes on all symptoms, functioning and quality of life; compared to group 1, their odds of: respiratory onset sixfold greater; King's stage ≥3 2.9 greater; increased odds of being bothered by choking, head drop, fasciculations, and muscle cramps; fatigue and anxiety also elevated (p < .01). CONCLUSION Dyspnea is a cardinal symptom in ALS/MND and can be quickly measured using the Dyspnea-12. Raw scores can easily be converted to interval level measurement, for valid change scores and trajectory modeling. Dyspnea trajectories reveal different patterns, showing that clinical services must provide monitoring which is customized to individual patient need. Almost half of this large population had worsening dyspnea, confirming the importance of respiratory monitoring and interventions being integrated into routine ALS care.
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Affiliation(s)
- Carolyn A Young
- Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Amina Chaouch
- Greater Manchester Centre for Clinical Neurosciences, Salford, UK
| | | | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
- Department of Neurology, King's College Hospital, London, UK
| | | | - Kevin Talbot
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | | | - Joe Annadale
- Hywel Dda University Health Board, Carmarthen, UK
| | - C Oliver Hanemann
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | | | - Alan Tennant
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Roger Mills
- Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
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3
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Minnema J, Polinder-Bos HA, Cesari M, Dockery F, Everink IHJ, Francis BN, Gordon AL, Grund S, Perez Bazan LM, Eruslanova K, Topinková E, Vassallo MA, Faes MC, van Tol LS, Caljouw MAA, Achterberg WP, Haaksma ML. The Impact of Delirium on Recovery in Geriatric Rehabilitation after Acute Infection. J Am Med Dir Assoc 2024; 25:105002. [PMID: 38670170 DOI: 10.1016/j.jamda.2024.03.113] [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] [Received: 12/06/2023] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES Delirium is common during acute infection in older patients and is associated with functional decline. Geriatric rehabilitation (GR) can help older patients to return to their premorbid functional level. It is unknown whether delirium affects GR outcomes in patients with acute infection. We evaluated whether delirium affects trajectories of activities of daily living (ADL) and quality of life (QoL) recovery in GR after COVID-19 infection. DESIGN This study was part of the EU-COGER study, a multicenter cohort study conducted between October 2020 and October 2021. SETTING AND PARTICIPANTS Participants were recruited after COVID-19 infection from 59 GR centers in 10 European countries. METHODS Data were collected at GR admission, discharge, and at the 6-week and 6-month follow-ups. Trajectories of ADL [using the Barthel index (BI)] and QoL [using the EuroQol-5 Dimensions-5 Level (EQ-5D-5L)] recovery were examined using linear mixed models. RESULTS Of the 723 patients included (mean age 75.5 ± 9.9 years; 52.4% male), 28.9% had delirium before or during GR admission. Participants with delirium recovered in ADL at approximately the same rate as those without (linear slope effect = -0.13, SE 0.16, P = .427) up to an estimated BI score of 16.1 at 6 months. Similarly, participants with delirium recovered in QoL at approximately the same rate as those without (linear slope effect = -0.017, SE 0.015, P = .248), up to an estimated EQ-5D-5L score of 0.8 at 6 months. CONCLUSIONS AND IMPLICATIONS Presence of delirium during the acute phase of infection or subsequent GR did not influence the recovery trajectory of ADL functioning and QoL.
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Affiliation(s)
- J Minnema
- Section Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - H A Polinder-Bos
- Section Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M Cesari
- IRCCS Istituti Clinici Maugeri, University of Milan, Milan, Italy
| | - F Dockery
- Department of Geriatric Medicine, Beaumont Hospital, Dublin, Ireland
| | - I H J Everink
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - B N Francis
- Fliman Geriatric Rehabilitation Centre, Haifa, Israel; Geriatric Division, Holy Family Hospital, Bar Ilan University, Safad, Israel
| | - A L Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, United Kingdom
| | - S Grund
- Centre for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Centre at the Heidelberg University, Heidelberg, Germany
| | - L M Perez Bazan
- RE-FiT Barcelona Research Group, Parc Sanitari Pere Virgili Hospital and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - K Eruslanova
- Russian Clinical and Research Centre of Gerontology, Moscow, Russia
| | - E Topinková
- Department of Geriatric Medicine, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic; Faculty of Health and Social Sciences, South Bohemian University, České Budějovice, Czech Republic
| | - M A Vassallo
- Geriatric Medicine Society of Malta & Telghet G'Mangia, Rehabilitation Hospital Karin Grech, Pietà, Malta
| | - M C Faes
- Department of Geriatrics, Amphia Hospital, Breda, the Netherlands
| | - L S van Tol
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - M A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - W P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, the Netherlands
| | - M L Haaksma
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, the Netherlands
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Chang JYA, Hsu CN, Ramos-Goñi JM, Luo N, Lin HW, Lin FJ. Beyond 10-year lead-times in EQ-5D-5L: leveraging alternative lead-times in willingness-to-accept questions to capture preferences for worse-than-dead states and their implication. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:1041-1055. [PMID: 38072877 DOI: 10.1007/s10198-023-01642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 10/18/2023] [Indexed: 07/28/2024]
Abstract
BACKGROUND A fixed 10-year lead-time in composite time-trade-off (C-TTO) tasks might compromise the precision of utility values below - 1. This study explored how alternative lead-times (ALTs) influence EQ-5D-5L value sets and their implications in economic evaluations. METHODS Leveraging data from Taiwan's EQ-5D-5L valuation and capitalizing on its exploratory willingness-to-accept question, we explored participants' quantification of "worse-than-dead (WTD)" health states with ALTs up to 50 years. We then derived alternative value sets incorporating these ALTs through interval regression and compared them against those from conventional models. To evaluate their impact on health change valuation, we simulated utility differences for all possible EQ-5D-5L health-state-pairs using each value set. RESULTS With a salient floor effect observed in the C-TTO values, the model with ALT led to a wider range of predicted utilities ( - 2.3897 ~ 1), compared with those of conventional models (generalized least squares (GLS): - 0.7773 ~ 1; Tobit-GLS: - 0.9583 ~ 1). Compared to the Tobit-GLS model, the model with ALT increased the numerical distance in 80% of health-state-pairs, with 11% decreasing and 9% altering direction (e.g., positive to negative) in utility differences. CONCLUSIONS While ALTs offer insights into patient preferences, their integration into economic evaluations might require rescaling. Future research should prioritize advanced rescaling methods or enhanced elicitation strategies for populations with substantial censoring. This is pivotal for improving the elicitation of extreme WTD states and accurately discerning the relative distances between health states. Countries developing EQ-5D-5L value sets should consider pilot studies and incorporating region-specific questions on social determinants, especially where pronounced floor effects are suspected.
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Grants
- EQ project 2016440 EuroQol Research Foundation
- 10542652 The Center for Drug Evaluation, Taiwan
- NSC102-2320-B-039-007 Ministry of Science and Technology, Taiwan
- MOST 109-2622-8-039-001-TB1; MOST 110-2622-8-039-004 -TB1 Ministry of Science and Technology, Taiwan
- NHRI-EX103-10318PC The National Health Research Institute, Taiwan
- NHRI-EX104-10318PC The National Health Research Institute, Taiwan
- NHRI-EX105-10318PC The National Health Research Institute, Taiwan
- NHRI-EX106-10318PC The National Health Research Institute, Taiwan
- CMU108-N-03 China Medical University, Taiwan
- CMU108-Z-7 China Medical University, Taiwan
- CMU109-Z-07 China Medical University, Taiwan
- CMU110-Z-07 China Medical University, Taiwan
- DMR-110-080 China Medical University Hospital, Taiwan
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Affiliation(s)
- Jen-Yu Amy Chang
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Hsiang-Wen Lin
- School of Pharmacy and Graduate Institute, College of Pharmacy, China Medical University, Taichung, Taiwan.
- Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan.
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, USA.
| | - Fang-Ju Lin
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
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McGuinness MB, Ayton LN, Schofield D, Britten-Jones AC, Chen FK, Grigg JR, Qi Z, Kraindler J, Shrestha R, Mack HG. EQ-5D-5L health utility scores in Australian adults with inherited retinal diseases: A cross-sectional survey. Acta Ophthalmol 2024; 102:e736-e745. [PMID: 38226448 DOI: 10.1111/aos.16634] [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: 07/17/2023] [Revised: 09/21/2023] [Accepted: 01/04/2024] [Indexed: 01/17/2024]
Abstract
PURPOSE Economic evaluations of interventions for ocular disease require utility scores that accurately represent quality of life in the target population. This study aimed to describe the distribution of EQ-5D-5L utility values among Australian adults with symptomatic inherited retinal diseases (IRDs) and to assess the relationship between these scores and vision-related quality of life. METHODS A survey was administered predominantly online in 2021. Participants completed the EQ-5D-5L general health utility instrument, the EQ vertical visual analogue scale (EQ-VAS) and the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25). Self-reported IRD diagnoses were classified as being associated with central or widespread retinal involvement. RESULTS Responses from 647 participants aged 18-93 years were included, 50.1% were men and 77.6% had an IRD associated with widespread retinal involvement. The majority reported no problems with self-care and no pain/discomfort but did report anxiety/depression and problems with work, study, housework, or family/leisure activities. Most people with widespread involvement reported problems with mobility. Median EQ-5D-5L utility was 0.88 and 0.91 among people with widespread and central involvement, respectively (age and sex-adjusted p = 0.029); and median EQ-VAS was 75 and 80, respectively (adjusted p = 0.003). A moderate curvilinear correlation was observed between EQ-5D-5L and NEI-VFQ-25 composite score (Spearman's ρ 0.69), but not all people with poor vision-related quality of life had low EQ-5D-5L utility values. CONCLUSIONS EQ-5D-5L health utility values are correlated with vision-related quality of life among adults with IRDs. However, the EQ-5D-5L may not be sensitive to the full impact of vision impairment on quality of life.
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Affiliation(s)
- Myra B McGuinness
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Lauren N Ayton
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Schofield
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia
| | - Alexis Ceecee Britten-Jones
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Fred K Chen
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia
- Department of Ophthalmology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - John R Grigg
- Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
- Eye Genetics Research Unit, Sydney Children's Hospitals Network, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Ziyi Qi
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Joshua Kraindler
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia
| | - Rupendra Shrestha
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia
| | - Heather G Mack
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Pfeffer PE, Brown T, Chaudhuri R, Faruqi S, Gore R, Heaney LG, Mansur AH, Pantin T, Patel M, Rupani H, Siddiqui S, Vyas A, Busby J. Impact of comorbidities on EQ-5D quality-of-life index in severe asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100286. [PMID: 39071731 PMCID: PMC11277382 DOI: 10.1016/j.jacig.2024.100286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/10/2024] [Accepted: 04/05/2024] [Indexed: 07/30/2024]
Abstract
Background Severe asthma pathology encompasses a wide range of pulmonary and extrapulmonary treatable traits with a high prevalence of comorbidities. Although asthma-specific health-related quality-of-life measures are most sensitive to changes in asthma control, generic measures, such as EQ-5D-5L (EuroQol 5-Dimension 5-Level questionnaire), are potentially better for capturing the impact of comorbidities. Objective We sought to examine the impact of pulmonary and extrapulmonary treatable traits on quality of life at initial severe asthma assessment, and to compare the characteristics of those patients whose quality of life does and does not improve during follow-up at severe asthma centers. Methods Patients' characteristics at baseline assessment within the UK Severe Asthma Registry were compared by EQ-5D-5L utility index quartile. Patients with follow-up review data were stratified by change in EQ-5D-5L utility index from baseline to follow-up, and characteristics similarly examined. Results Patients in the quartiles with worst dysutility at baseline were observed to exhibit more treatable traits and in particular extrapulmonary traits associated with cumulative systemic corticosteroids, including obesity, anxiety/depression, and osteoporosis. In those patients whose quality of life improved over follow-up, a reduction in exacerbations, uncontrolled symptoms, and requirement for maintenance oral corticosteroids were observed. Conclusions Both pulmonary and extrapulmonary treatable traits are important determinants of quality of life in severe asthma. Comorbidities associated with cumulative systemic corticosteroid exposure are particularly associated with worse quality of life, emphasizing the importance of early identification and management of severe asthma before comorbidities develop.
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Affiliation(s)
- Paul E. Pfeffer
- Barts Health NHS Trust, London, United Kingdom
- Queen Mary University of London, London, United Kingdom
| | - Thomas Brown
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Rekha Chaudhuri
- Gartnavel General Hospital and University of Glasgow, Glasgow, United Kingdom
| | - Shoaib Faruqi
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Robin Gore
- Addenbrookes Hospital, Cambridge, United Kingdom
| | | | - Adel H. Mansur
- University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
- University of Birmingham, Birmingham, United Kingdom
| | | | | | - Hitasha Rupani
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Salman Siddiqui
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Aashish Vyas
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - John Busby
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
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Bakker NF, van Weely SFE, Boonen A, Vliet Vlieland TPM, Knoop J. Work-related support for employed and self-employed people with rheumatoid arthritis or axial spondyloarthritis: a cross-sectional online survey of patients. Rheumatol Int 2024; 44:1553-1565. [PMID: 38898306 PMCID: PMC11222234 DOI: 10.1007/s00296-024-05643-z] [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: 04/10/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Little is known about the provision of work-related support for (self-)employed people with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) by healthcare providers (HCPs) or employers. OBJECTIVE This study aims to explore the experiences of (self-)employed people with RA or axSpA regarding work-related support from HCPs and employers in the Netherlands. METHODS This cross-sectional study concerned an online survey for (self-)employed people, aged ≥ 16 years and diagnosed with RA or axSpA. The survey focused on experiences with HCPs and employers' work-related support and included questions on sociodemographic factors, health and work characteristics and work-related problems. RESULTS The survey was completed by 884 participants, 56% with RA and 44% with axSpA, of whom 65% were employed, 8% self-employed and 27% not employed. In total, 95% (589/617) of (self-)employed participants reported work-related problems. Sixty-five percent of employed and 56% of self-employed participants had discussed these work-related problems with rheumatologists and/or other HCPs. Whereas 69% of employees with their employer. Both employed and self-employed participants reported that work-related advices or actions were more often provided by other HCPs (53%) than rheumatologists (29%). Fifty-six percent of employees reported this work-related support by the employer. CONCLUSION This survey among (self-)employed people with RA or axSpA found that the majority reported work-related problems, but only half of them received any work-related support for these problems. Discussion of work-related problems with HCPs was more often reported by employed than self-employed participants. More attention from especially rheumatologists and other HCPs is important to identify and address work-related problems promptly.
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Affiliation(s)
- N F Bakker
- Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, P.O.Box 9600, 2300 RC, Leiden, the Netherlands.
| | - S F E van Weely
- Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, P.O.Box 9600, 2300 RC, Leiden, the Netherlands
- Institute of Allied Health Professions, HU University of Applied Sciences, Utrecht, the Netherlands
| | - A Boonen
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - T P M Vliet Vlieland
- Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, P.O.Box 9600, 2300 RC, Leiden, the Netherlands
| | - J Knoop
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Gongora-Salazar P, Perera R, Rivero-Arias O, Tsiachristas A. Unravelling Elements of Value of Healthcare and Assessing their Importance Using Evidence from Two Discrete-Choice Experiments in England. PHARMACOECONOMICS 2024:10.1007/s40273-024-01416-5. [PMID: 39085565 DOI: 10.1007/s40273-024-01416-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Health systems are moving towards value-based care, implementing new care models that allegedly aim beyond patient outcomes. Therefore, a policy and academic debate is underway regarding the definition of value in healthcare, the inclusion of costs in value metrics, and the importance of each value element. This study aimed to define healthcare value elements and assess their relative importance (RI) to the public in England. METHOD Using data from 26 semi-structured interviews and a literature review, and applying decision-theory axioms, we selected a comprehensive and applicable set of value-based elements. Their RI was determined using two discrete choice experiments (DCEs) based on Bayesian D-efficient DCE designs, with one DCE incorporating healthcare costs expressed as income tax rise. Respondent preferences were analysed using mixed logit models. RESULTS Six value elements were identified: additional life-years, health-related quality of life, patient experience, target population size, equity, and cost. The DCE surveys were completed by 402 participants. All utility coefficients had the expected signs and were statistically significant (p < 0.05). Additional life-years (25.3%; 95% confidence interval [CI] 22.5-28.6%) and patient experience (25.2%; 95% CI 21.6-28.9%) received the highest RI, followed by target population size (22.4%; 95% CI 19.1-25.6%) and quality of life (17.6%; 95% CI 15.0-20.3%). Equity had the lowest RI (9.6%; 95% CI 6.4-12.1%), decreasing by 8.8 percentage points with cost inclusion. A similar reduction was observed in the RI of quality of life when cost was included. CONCLUSION The public prioritizes value elements not captured by conventional metrics, such as quality-adjusted life-years. Although cost inclusion did not alter the preference ranking, its inclusion in the value metric warrants careful consideration.
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Affiliation(s)
- Pamela Gongora-Salazar
- Social Protection and Health Division, Inter-American Development Bank, Washington, DC, USA.
- Nuffield Department of Population Health, Health Economics Research Centre (HERC), University of Oxford, Oxford, UK.
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Oliver Rivero-Arias
- Nuffield Department of Population Health, Health Economics Research Centre (HERC), University of Oxford, Oxford, UK
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, England, UK
| | - Apostolos Tsiachristas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
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Andersson J, Maripuu M, Sjövill M, Lindam A, Laurell K. Depressive symptoms, functional impairment, and health-related quality of life in idiopathic normal pressure hydrocephalus: A population-based study. PLoS One 2024; 19:e0308079. [PMID: 39078825 PMCID: PMC11288432 DOI: 10.1371/journal.pone.0308079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 07/16/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Maximising quality of life is a central goal for all healthcare, especially when dealing with dementing disorders. In this study we aimed to compare health-related quality of life (HRQoL), depressive symptoms and functional impairment between individuals with and without idiopathic normal pressure hydrocephalus (iNPH) from the general population. METHODS A total of 122 individuals, 30 with iNPH (median age 75 years, 67 females) underwent neurological examinations and computed tomography of the brain with standardised rating of imaging findings and clinical symptoms. The participants completed the Geriatric Depression Scale (GDS-15) and the HRQoL instrument EQ5D-5L. In addition, the modified Rankin Scale (mRS) was used to evaluate functional impairment. RESULTS Compared with participants without iNPH, those with iNPH reported a higher score on GDS-15 (median 3 vs 1) and mRS (median 2 vs 1) (p < 0.05). Further, those with iNPH rated lower on EQ5D-5L (index 0.79, VAS 70) than those without iNPH (index 0.86, VAS 80) (p < 0.05). In logistic regression models, low HRQoL was associated with more depressive symptoms, a higher degree of iNPH symptoms, and lower functional status. CONCLUSIONS In this population-based sample, those with iNPH had more depressive symptoms, lower functional status, and worse quality of life compared to those without iNPH. The strongest association with low HRQoL was found for depressive symptoms, functional level, and degree of iNPH symptoms. These results underline the value of shunt surgery because of its potential to reduce symptoms and disability in iNPH and therefore improve HRQoL.
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Affiliation(s)
| | - Martin Maripuu
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | | | - Anna Lindam
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development- Östersund, Umeå University, Umeå, Sweden
| | - Katarina Laurell
- Department of Biomedical and Clinical Sciences, Neurology, Linköping University, Linköping, Sweden
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Lynskey MT, Thurgur H, Athanasiou-Fragkouli A, Schlag AK, Nutt DJ. Suicidal Ideation in Medicinal Cannabis Patients: A 12-Month Prospective Study. Arch Suicide Res 2024:1-15. [PMID: 39045855 DOI: 10.1080/13811118.2024.2356615] [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] [Indexed: 07/25/2024]
Abstract
OBJECTIVE To document the prevalence and correlates of suicidal ideation (SI) among individuals seeking cannabis-based medicinal products (CBMPs); to test whether SI declines or intensifies after three months of CBMP treatment and to document 12-month trajectories of depression in those reporting SI and other patients. METHOD Observational data were available for 3781 patients at entry to treatment, 2112 at three months and 777 for 12 months. Self-reported depressed mood and SI were assessed using items from the PHQ-9. Additional data included sociodemographic characteristics and self-reported well-being. RESULTS 25% of the sample reported SI at treatment entry and those with SI had higher levels of depressed mood (mean = 17.4 vs. 11.3; F(1,3533) = 716.5, p < .001) and disturbed sleep (mean = 13.8 vs. 12.2, F(1,3533) = 125.9, p < .001), poorer general health (mean = 43.6 vs. 52.2, F(1,3533) = 118.3, p < .001) and lower quality of life (mean = 0.44 vs. 0.56 (F(1,3533) = 118.3, p < .001). The prevalence of SI reduced from 23.6% to 17.6% (z = 6.5, p < .001) at 3 months. Twelve-month follow-up indicated a substantial reduction in depressed mood with this reduction being more pronounced in those reporting SI (mean (baseline) = 17.7 vs. mean (12 months) = 10.3) than in other patients (mean (baseline) = 11.1 vs. mean (12 months) = 7.0). CONCLUSIONS SI is common among individuals seeking CBMPs to treat a range of chronic conditions and is associated with higher levels of depressed mood and poorer quality of life. Treatment with CBMPs reduced the prevalence and intensity of suicidal ideation.
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D’Souza AN, Merrett M, Griffin H, Tran-Duy A, Struck C, Fazio TN, Juj G, Granger CL, Peiris CL. Recovering from COVID-19 (ReCOV): Feasibility of an Allied-Health-Led Multidisciplinary Outpatient Rehabilitation Service for People with Long COVID. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:958. [PMID: 39063534 PMCID: PMC11277266 DOI: 10.3390/ijerph21070958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND A multidisciplinary approach is required for the management of long COVID. The aim of this study was to determine the feasibility (demand, implementation, practicality, acceptability, and limited efficacy) of an allied-health-led multidisciplinary symptom management service (ReCOV) for long COVID. METHODS A single-group observational cohort feasibility study was conducted to determine demand (referrals), acceptability (survey), implementation (waitlist times, health professions seen), practicality (adverse events), and limited efficacy (admission and discharge scores from the World Health Organization Disability Assessment Scale, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire, and EuroQol 5D-5L). Data are presented as median [interquartile range] or count (percentage). RESULTS During the study, 143 participants (aged 42.00 [32.00-51.00] years, 68% women) participated in ReCOV. Participants were waitlisted for 3.86 [2.14-9.86] weeks and engaged with 5.00 [3.00-6.00] different health professionals. No adverse events occurred. The thematic analysis revealed that ReCOV was helpful but did not fully meet the needs of all participants. Limited efficacy testing indicated that participants had improved understanding and control (p < 0.001) of symptoms (BIPQ) and a small improvement in EQ VAS score (median difference 5.50 points [0.00-25.00], p = 0.004]). CONCLUSIONS A multidisciplinary service was safe and mostly acceptable to participants for the management of long COVID. Further research should investigate the clinical and cost effectiveness of such a service, including optimal service duration and patient outcomes.
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Affiliation(s)
- Aruska N. D’Souza
- Allied Health, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
| | - Myvanwy Merrett
- Allied Health, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
| | - Hilda Griffin
- Allied Health, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
| | - An Tran-Duy
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
- Methods and Implementation Support for Clinical and Health Research (MISCH) Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Carly Struck
- Allied Health, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
| | - Timothy N. Fazio
- Health Intelligence Unit, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
- Electronic Medical Records, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
- Melbourne Medical School, The University of Melbourne, Parkvillle, VIC 3010, Australia
| | - Genevieve Juj
- Allied Health, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
| | | | - Casey L. Peiris
- Allied Health, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
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Fraser LK, Bedendo A, O'Neill M, Taylor J, Hackett J, Horridge KA, Cade J, Richardson G, Phung H, McCarter A, Hewitt CE. Safety, resource use and nutritional content of home-blended diets in children who are gastrostomy fed: findings from 'YourTube' - a prospective cohort study. Arch Dis Child 2024; 109:628-635. [PMID: 38129118 PMCID: PMC11287525 DOI: 10.1136/archdischild-2023-326393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To assess the risks, benefits and resource implications of using home-blended food in children with gastrostomy tubes compared with currently recommended formula feeds. DESIGN This is a cohort study. Data were collected at months 0, 12 and 18 from parents and clinicians using standardised measures. SETTING 32 sites across England: 28 National Health Service trusts and 4 children's hospices. PATIENTS Children aged 6 months-18 years who were gastrostomy fed. MAIN OUTCOME MEASURE The main outcome measure was the PedsQL Gastrointestinal Symptoms Scales score. Secondary outcomes included quality of life, sleep (child, parent), dietary intake, anthropometry, healthcare usage, safety outcomes and resource use. RESULTS 180 children and families completed the baseline data collection, with 134 (74%) and 105 (58%) providing follow-up data at 12 and 18 months. There were fewer gastrointestinal (GI) symptoms at all time points in the home-blended diet group, but there was no difference in change over time within or between the groups. The nutritional intake of those on a home-blended diet had higher calories per kilogram and fibre, and both home-blended and formula-fed children have values above the dietary reference values for most micronutrients. Safety outcomes were similar between groups and over time. The total costs to the statutory sector were higher among children who were formula fed, but the costs of purchasing special equipment for home-blended food and the total time spent on childcare were higher for families with home-blended diet. CONCLUSIONS Children who are gastrostomy fed a home-blended diet have similar safety profile, adequate nutritional intake and lower burden of GI symptoms than formula-fed children. Trial registration number ISRCTN13977361.
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Affiliation(s)
- Lorna K Fraser
- Cicely Saunders Institute, King's College London, London, UK
- Health Sciences, University of York, York, UK
| | | | | | - Jo Taylor
- Health Sciences, University of York, York, UK
| | | | | | | | | | - Han Phung
- University of York Centre for Health Economics, York, UK
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13
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Griffiths S, Spencer E, Flanagan K, O'Keeffe A, Hunter R, Wiegand M, D'Andrea F, Benjamin L, Poole M, Hagan AJ, Brar M, Wilcock J, Walters KR, Robinson L, Rait G, Burns A, Evans E, King D, Knapp M, Lewins RD, Banerjee S, Manthorpe J, Allen L, Tucker S, Wittenberg R. Evaluating a model of best practice in primary care led post-diagnostic dementia care: feasibility and acceptability findings from the PriDem study. BMJ Open 2024; 14:e083175. [PMID: 39002959 PMCID: PMC11255409 DOI: 10.1136/bmjopen-2023-083175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 06/24/2024] [Indexed: 07/15/2024] Open
Abstract
OBJECTIVES To evaluate the feasibility and acceptability of a primary care-based intervention for improving post-diagnostic dementia care and support (PriDem), and implementation study procedures. DESIGN A non-randomised, mixed methods, feasibility study. SETTING Seven general practices from four primary care networks (PCNs) in the Northeast and Southeast of England. PARTICIPANTS We aimed to recruit 80 people with dementia (PWD) and 66 carers INTERVENTION: Clinical Dementia Leads delivered a 12-month intervention in participating PCNs, to develop care systems, build staff capacity and capability, and deliver tailored care and support to PWD and carers. OUTCOMES Recruitment and retention rates were measured. A mixed methods process evaluation evaluated feasibility and acceptability of the intervention and study procedures. Using electronic care records, researchers extracted service use data and undertook a dementia care plan audit, preintervention and postintervention, assessing feasibility of measuring the primary implementation outcome: adoption of personalised care planning by participating general practices. Participants completed quality of life, and service use measures at baseline, 4 and 9 months. RESULTS 60 PWD (75% of recruitment target) and 51 carers (77% of recruitment target) were recruited from seven general practices across four PCNs. Retention rate at 9 months was 70.0% of PWD and 76.5% of carers. The recruitment approach showed potential for including under-represented groups within dementia. Despite implementation challenges, the intervention was feasible and acceptable, and showed early signs of sustainability. Study procedures were feasible and accessible, although researcher capacity was crucial. Participants needed time and support to engage with the study. Care plan audit procedures were feasible and acceptable. CONCLUSIONS The PriDem model is an acceptable and feasible intervention. A definitive study is warranted to fully inform dementia care policy and personalised dementia care planning guidance. Successful strategies to support inclusion of PWD and their carers in future research were developed. TRIAL REGISTRATION NUMBER ISRCTN11677384.
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Affiliation(s)
- Sarah Griffiths
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
| | - Emily Spencer
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
| | - Katie Flanagan
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
| | - Aidan O'Keeffe
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
| | - Rachael Hunter
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
| | | | - Federica D'Andrea
- School of Biomedical Sciences, University of West London, London, UK
| | - Lewis Benjamin
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
| | - Marie Poole
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Alexander James Hagan
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - M Brar
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Jane Wilcock
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
| | - Kate R Walters
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
| | - Louise Robinson
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Rait
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
| | - on behalf of the PriDem Study Team
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Alistair Burns
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Emily Evans
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Derek King
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Martin Knapp
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Revd Doug Lewins
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Sube Banerjee
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Jill Manthorpe
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Allen
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Sue Tucker
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Raphael Wittenberg
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
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Guo N, Cao J, Duan M, Zhou F, Wang W, Xu L, Wei C, Song X. Effects of ciprofol infusion on hemodynamics during induction and maintenance of anesthesia and on postoperative recovery in patients undergoing thoracoscopic lobectomy: Study protocol for a randomized, controlled trial. PLoS One 2024; 19:e0305478. [PMID: 38985796 PMCID: PMC11236111 DOI: 10.1371/journal.pone.0305478] [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: 10/30/2023] [Accepted: 05/29/2024] [Indexed: 07/12/2024] Open
Abstract
INTRODUCTION Ciprofol, a new candidate drug, is effective and safe for the maintenance of anesthesia in non-cardiothoracic and non-neurological elective surgery. However, few studies have been conducted on general anesthesia using ciprofol in patients undergoing thoracoscopic lobectomy. Therefore, this study aims to observe the effects of ciprofol on hemodynamics and on postoperative recovery in patients undergoing thoracoscopic lobectomy. METHODS AND ANALYSIS This randomized controlled trial will include 136 patients aged 18-65 years undergoing elective thoracoscopic lobectomy between April 2023 and December 2024. The participants will be randomly assigned to the propofol or ciprofol group. The primary outcome to be assessed is the hemodynamic fluctuation during the induction and maintenance of anesthesia. The secondary outcomes involve quality of anesthesia induction and quality of recovery from anesthesia. The former includes TLOC (time to loss of consciousness), the use of vasoactive agents, the incidence of injection pain, body movement, muscle twitching and coughing during induction of anesthesia. The latter includes TROC (time to recovery of consciousness), post anesthesia care unit (PACU) time, incidence of postoperative nausea and vomiting (PONV), postoperative agitation, intraoperative awareness and quality of recovery (QoR) score. DISCUSSION A number of clinical trials have confirmed that ciprofol, as a new sedative-hypnotic agent, has advantages of better tolerance, higher sedation satisfaction score, and lower incidence of adverse reactions, especially in reducing the incidence of injection pain. But considering that ciprofol was recently developed, limited data are available regarding its use for general anesthesia. This study aims to investigate the effects of ciprofol on hemodynamics and on postoperative recovery of patients undergoing thoracoscopic lobectomy. The results of this study may provide evidence for the safe application of ciprofol, a new choice of general anesthetic for thoracic surgery. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT05664386).
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Affiliation(s)
- Na Guo
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji'nan, China
- Shandong Institute of Anesthesia and Respiratory Critical Medicine, Ji'nan, China
- Shandong Provincial Clinical Research Center for Anesthesiology, Ji'nan, China
| | - Jianqiao Cao
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji'nan, China
- Shandong Institute of Anesthesia and Respiratory Critical Medicine, Ji'nan, China
- Shandong Provincial Clinical Research Center for Anesthesiology, Ji'nan, China
| | - Mingjie Duan
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji'nan, China
- Shandong Institute of Anesthesia and Respiratory Critical Medicine, Ji'nan, China
- Shandong Provincial Clinical Research Center for Anesthesiology, Ji'nan, China
| | - Fei Zhou
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji'nan, China
- Shandong Institute of Anesthesia and Respiratory Critical Medicine, Ji'nan, China
- Shandong Provincial Clinical Research Center for Anesthesiology, Ji'nan, China
| | - Wei Wang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji'nan, China
- Shandong Institute of Anesthesia and Respiratory Critical Medicine, Ji'nan, China
- Shandong Provincial Clinical Research Center for Anesthesiology, Ji'nan, China
| | - Lingling Xu
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji'nan, China
| | - Chuansong Wei
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji'nan, China
| | - Xiumei Song
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji'nan, China
- Shandong Institute of Anesthesia and Respiratory Critical Medicine, Ji'nan, China
- Shandong Provincial Clinical Research Center for Anesthesiology, Ji'nan, China
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15
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Simonsen NV, Klassen AF, Rae C, Mundy LR, Poulsen L, Pusic AL, Fan KL, Sørensen JA. The WOUND-Q Function and Symptoms Scales for Chronic Lower Extremity Wounds: A Validation Study. Adv Wound Care (New Rochelle) 2024. [PMID: 38775456 DOI: 10.1089/wound.2024.0035] [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: 07/11/2024] Open
Abstract
Objective: Determine the validity and reliability of the LIMB-Q scales, Function, and Symptoms in patients with chronic lower extremity wounds. Approach: Cognitive debriefing interviews with people with current or previous wounds were conducted to examine content validity. Scales were field-tested in an international sample of people with chronic lower extremity wounds sourced from an online platform (i.e., Prolific). Psychometric properties were examined using the Rasch Measurement Theory analysis. A test-retest reproducibility study was performed, and construct validity was examined. Results: Content validity was established after 10 cognitive interviews. A total of 233 people with lower extremity wounds (age 19-80 years, mean 39.3) participated in the field test. All 25 items tested demonstrated good fit to the Rasch model with ordered thresholds. One item had a fit residual outside ±2.5, but no items had significant χ2 values after Bonferroni adjustment. Reliability was high with the person separation index, Cronbach alpha, and intraclass correlation coefficient values >0.8. Strong correlations were found between the Function and Symptoms scales and EQ-5D dimensions measuring similar constructs as well as the EQ-5D global score. All hypotheses for construct validity were confirmed. Innovation: Patient-reported outcome measures are an important component of patient-centered care, as they capture the patient's perspective in a rigorous and reproducible way. Adding these two scales to the WOUND-Q provides a means to measure function and symptoms associated with lower extremity wounds. Conclusion: These new WOUND-Q scales can be used to measure outcomes important to patients with lower extremity wounds in clinical settings and research studies.
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Affiliation(s)
- Nina Vestergaard Simonsen
- Research Unit for Plastic Surgery, Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Lily R Mundy
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lotte Poulsen
- Research Unit for Plastic Surgery, Odense University Hospital, University of Southern Denmark, Denmark
| | - Andrea L Pusic
- Department of Surgery and Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Maryland, USA
| | - Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar, MedStar Plastic and Reconstructive Surgery, Washington, USA
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Eaton E, Hunt A. Does Willingness to Pay Differ for Mental and Physical Health? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02748-7. [PMID: 38977184 DOI: 10.1016/j.jval.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/22/2024] [Accepted: 06/14/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES The urban environment can have a significant impact on mental and physical health. Health impact appraisal of new developments should address these issues. However, transferable economic valuation evidence for urban planners in the United Kingdom is thin, especially around mental health, making it harder to estimate the cost-efficiency of public health interventions to address these conditions. A further complication is that mental health may be perceived differently from physical health. This study examines willingness to pay (WTP) to avoid depression and lower back pain. METHODS WTP estimates were obtained by applying contingent valuation tasks in an online survey with a representative sample in the United Kingdom (N = 1553). Interval regression models were used to estimate the effects of disease severity, payment frequency, and respondent characteristics on WTP. RESULTS Respondents' WTP to avoid both conditions was relatively high (around 5%-6% of stated income to return to current health state). Depression was rated as being twice as burdensome on quality of life than pain, and bids to avoid depression were 20% to 30% more than pain. Analysis of motivation responses suggests mental health treatment is perceived as less easy to access and less effective than the equivalent for pain, and respondents expect a larger burden on their family and relationships as they try to manage their condition themselves. CONCLUSIONS Results suggest that depression bids may be affected by uncertainty around access to effective treatment in the healthcare system. This has implications for how mental illness may be prioritized in resource allocation toward public health interventions.
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Affiliation(s)
- Eleanor Eaton
- Department of Economics, University of Bath, Bath, England, UK.
| | - Alistair Hunt
- Department of Economics, University of Bath, Bath, England, UK
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17
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Dardenne N, Donneau AF, Bruyère O. Mapping the Lequesne Functional Index Into the EQ-5D-5L Utility Index in Patients With Knee Osteoarthritis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02756-6. [PMID: 38977193 DOI: 10.1016/j.jval.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 06/06/2024] [Accepted: 06/21/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVE This study aimed to map the Lequesne index onto the EuroQol 5 Dimension (EQ-5D-5L) utility index for patients with knee osteoarthritis. METHODS Baseline data from a previous randomized controlled trial were used; 461 patients were involved in the mapping development, and 230 in the validation phase. Various modeling techniques, including generalized linear models, tobit, and beta regression, were used. Factors such as age, sex, and body mass index were considered as covariates. Model selection was based on criteria such as Akaike and Bayesian information criteria, adjusted R2, mean absolute error, and root mean squared error. Validation involved assessing the preselected models using mean absolute error, root mean squared error, and intraclass correlation coefficient. This study follows the Mapping Onto Preference-Based Measures Reporting Standards statement. RESULTS Five models were developed, with 2 incorporating age, sex, with or without body mass index along with the Lequesne index showing the best fit across regressions. Validation results were similar for the 3 regressions, with beta regression models exhibiting wider ranges closer to the validation data set. Intraclass correlation coefficient values were better for beta regression models. Both models tended to overpredict for lower EQ-5D-5L values and underpredict for better health status. CONCLUSION These mapping functions, the first of their kind, effectively translate the Lequesne index to EQ-5D-5L values in patients with knee osteoarthritis. They demonstrate satisfactory fit and precision, providing valuable tools for clinicians and researchers, particularly in situations where generic preference-based health-related quality of life instruments are inaccessible for utility derivation in cost-effectiveness studies.
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Affiliation(s)
- Nadia Dardenne
- Biostatistics Center (B-STAT), University Hospital and University of Liège, Liège, Belgium
| | - Anne-Françoise Donneau
- Biostatistics Center (B-STAT), University Hospital and University of Liège, Liège, Belgium
| | - Olivier Bruyère
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Research Unit in Public Health, Epidemiology and Health Economics, and Department of Sport and Rehabilitation Sciences, University of Liège, Liège, Belgium.
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18
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Simader FA, Rajkumar CA, Foley MJ, Ahmed-Jushuf F, Chotai S, Bual N, Khokhar A, Gohar A, Lampadakis I, Ganesananthan S, Pathimagaraj RH, Nowbar A, Davies JR, Keeble TR, O'Kane PD, Haworth P, Routledge H, Kotecha T, Spratt JC, Williams R, Nijjer SS, Sen S, Curzen N, Sinha M, Howard JP, Cole G, Harrell FE, Francis DP, Shun-Shin MJ, Al-Lamee RK. Symptoms as a Predictor of the Placebo-Controlled Efficacy of PCI in Stable Coronary Artery Disease. J Am Coll Cardiol 2024; 84:13-24. [PMID: 38759906 DOI: 10.1016/j.jacc.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Placebo-controlled evidence from ORBITA-2 (Objective Randomised Blinded Investigation with Optimal Medical Therapy of Angioplasty in Stable Angina-2) found that percutaneous coronary intervention (PCI) in stable coronary artery disease with little or no antianginal medication relieved angina, but residual symptoms persisted in many patients. The reason for this was unclear. OBJECTIVES This ORBITA-2 secondary analysis investigates the relationship between presenting symptoms and disease severity (anatomic, noninvasive, and invasive ischemia) and the ability of symptoms to predict the placebo-controlled efficacy of PCI. METHODS Prerandomization symptom severity and nature were assessed using the ORBITA smartphone application and symptom and quality of life questionnaires including the World Health Organization Rose angina questionnaire (Rose). Disease severity was assessed using quantitative coronary angiography, stress echocardiography, fractional flow reserve, and instantaneous wave-free ratio. Bayesian ordinal regression was used. RESULTS At prerandomization, the median number of daily angina episodes was 0.8 (Q1-Q3: 0.4-1.6), 64% had Rose angina, quantitative coronary angiography diameter stenosis was 61% (Q1-Q3: 49%-74%), stress echocardiography score was 1.0 (Q1-Q3: 0.0-2.7), fractional flow reserve was 0.63 (Q1-Q3: 0.49-0.75), and instantaneous wave-free ratio was 0.78 (Q1-Q3: 0.55-0.87). There was little relationship between symptom severity and nature and disease severity: angina symptom score with quantitative coronary angiography ordinal correlation coefficient: 0.06 (95% credible interval [CrI]: 0.00-0.08); stress echocardiography: 0.09 (95% CrI: 0.02-0.10); fractional flow reserve: 0.04 (95% CrI: -0.03 to 0.07); and instantaneous wave-free ratio: 0.04 (95% CrI: -0.01 to 0.07). However, Rose angina and guideline-based typical angina were strong predictors of placebo-controlled PCI efficacy (angina symptom score: OR: 1.9; 95% CrI: 1.6-2.1; probability of interaction [PrInteraction] = 99.9%; and OR: 1.8; 95% CrI: 1.6-2.1; PrInteraction = 99.9%, respectively). CONCLUSIONS Although symptom severity and nature were poorly associated with disease severity, the nature of symptoms powerfully predicted the placebo-controlled efficacy of PCI.
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Affiliation(s)
- Florentina A Simader
- Imperial College London, London, United Kingdom; Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Christopher A Rajkumar
- Imperial College London, London, United Kingdom; Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Michael J Foley
- Imperial College London, London, United Kingdom; Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Fiyyaz Ahmed-Jushuf
- Imperial College London, London, United Kingdom; Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Shayna Chotai
- Imperial College London, London, United Kingdom; Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Nina Bual
- Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Arif Khokhar
- Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Aisha Gohar
- Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | | | - Sashiananthan Ganesananthan
- Imperial College London, London, United Kingdom; Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Rachel H Pathimagaraj
- Imperial College London, London, United Kingdom; Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Alexandra Nowbar
- Barking Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - John R Davies
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Essex, United Kingdom; Anglia Ruskin University, Chelmsford, United Kingdom
| | - Tom R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Essex, United Kingdom; Anglia Ruskin University, Chelmsford, United Kingdom
| | - Peter D O'Kane
- University Hospitals of Dorset NHS Foundation Trust, Bournemouth, United Kingdom
| | - Peter Haworth
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Helen Routledge
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - Tushar Kotecha
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - James C Spratt
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom; St George's, University of London, London, United Kingdom
| | - Rupert Williams
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sukhjinder S Nijjer
- Imperial College London, London, United Kingdom; Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Sayan Sen
- Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Nick Curzen
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Manas Sinha
- Salisbury NHS Foundation Trust, Salisbury, United Kingdom
| | - James P Howard
- Imperial College London, London, United Kingdom; Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Graham Cole
- Imperial College London, London, United Kingdom; Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Frank E Harrell
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Darrel P Francis
- Imperial College London, London, United Kingdom; Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Matthew J Shun-Shin
- Imperial College London, London, United Kingdom; Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Rasha K Al-Lamee
- Imperial College London, London, United Kingdom; Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom.
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19
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Ball S, Aylward A, Cockcroft E, Corr A, Gordon E, Kerridge A, McAndrew A, Morgan-Trimmer S, Powell R, Price A, Rhodes S, Timperley AJ, van Horik J, Wickins R, Charity J. Clinical effectiveness of a modified muscle sparing posterior technique compared with a standard lateral approach in hip hemiarthroplasty for displaced intracapsular fractures (HemiSPAIRE): a multicenter, parallel-group, randomized controlled trial. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2024; 6:e000251. [PMID: 38895600 PMCID: PMC11184196 DOI: 10.1136/bmjsit-2023-000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/25/2024] [Indexed: 06/21/2024] Open
Abstract
Objectives Assess the effect of a modified muscle sparing posterior approach; SPAIRE (Save Piriformis and Internus, Repairing Externus), in hip hemiarthroplasty for displaced intracapsular fractures on postoperative mobility and function compared with a standard lateral approach. Design Pragmatic, superiority, multicenter, parallel-group, randomized controlled trial (with internal pilot). Participants, ward staff, and research staff conducting postoperative assessments were blinded to allocation. A CTU allocated treatments centrally using computer-generated lists. Setting Six hospitals in Southwest England, recruiting November 25, 2019-April 25, 2022. Participants 244 adults (≥60 years) requiring hip hemiarthroplasty (122 allocated to each approach). 90 and 85 participants allocated to SPAIRE and lateral, respectively, had primary outcome data within the prespecified data collection window. Interventions Surgery using SPAIRE or standard lateral approach. Follow-up 3 days and 120 days postoperation. Main outcome measure Oxford Hip Score (OHS), via telephone at 120 days. Secondary outcomes: function and mobility (3 days), pain (3 days, 120 days), discharge destination, length of hospital stay, complications and mortality (within 120 days), quality of life and place of residence (120 days). Results Participants' mean age was 84.6 years (SD 7.2); 168 (69%) were women. Primary outcome: little evidence of a difference in OHS at 120 days; adjusted mean difference (SPAIRE-lateral) -1.23 (95% CI -3.96 to 1.49, p=0.37). Secondary outcomes: indication of lower participant-reported pain at 3 days in SPAIRE arm; no differences between arms for remaining outcomes. Conclusions Participants' mobility and function are similar in the short term (3 days) and longer term (120 days), whether receiving the SPAIRE or lateral approach. Neither approach confers benefit over the other in terms of length of hospital stay, return to prefracture residence, survival within 120 days, or quality of life at 120 days. Participants receiving SPAIRE approach may experience less pain in the early postoperative period. Modifying the posterior approach in hip hemiarthroplasty to the SPAIRE approach gives equivalent patient outcomes to the lateral approach within 120 days. Trial registration number NCT04095611.
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Affiliation(s)
- Susan Ball
- NIHR Applied Research Collaboration South West Peninsula (PenARC), Department of Health and Community Sciences, University of Exeter Faculty of Health and Life Sciences, Exeter, UK
| | - Alex Aylward
- NIHR Applied Research Collaboration South West Peninsula (PenARC), Patient Engagement Group, University of Exeter Faculty of Health and Life Sciences, Exeter, UK
| | - Emma Cockcroft
- Department of Health and Community Sciences, University of Exeter Faculty of Health and Life Sciences, Exeter, UK
| | - Aisling Corr
- Research & Development Department, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Elizabeth Gordon
- Research & Development Department, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Alison Kerridge
- Research & Development Department, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Amy McAndrew
- Exeter Clinical Trials Unit, University of Exeter, Exeter, UK
| | - Sarah Morgan-Trimmer
- Department of Health and Community Sciences, University of Exeter Faculty of Health and Life Sciences, Exeter, UK
| | - Roy Powell
- Research Design Service - South West, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Anna Price
- Department of Health and Community Sciences, University of Exeter Faculty of Health and Life Sciences, Exeter, UK
| | - Shelley Rhodes
- Exeter Clinical Trials Unit, University of Exeter, Exeter, UK
| | - Andrew John Timperley
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | | | - Robert Wickins
- Physiotherapy, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - John Charity
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
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20
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Shim J, Fleisch E, Barata F. Circadian rhythm analysis using wearable-based accelerometry as a digital biomarker of aging and healthspan. NPJ Digit Med 2024; 7:146. [PMID: 38834756 DOI: 10.1038/s41746-024-01111-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/12/2024] [Indexed: 06/06/2024] Open
Abstract
Recognizing the pivotal role of circadian rhythm in the human aging process and its scalability through wearables, we introduce CosinorAge, a digital biomarker of aging developed from wearable-derived circadian rhythmicity from 80,000 midlife and older adults in the UK and US. A one-year increase in CosinorAge corresponded to 8-12% higher all-cause and cause-specific mortality risks and 3-14% increased prospective incidences of age-related diseases. CosinorAge also captured a non-linear decline in resilience and physical functioning, evidenced by an 8-33% reduction in self-rated health and a 3-23% decline in health-related quality of life score, adjusting for covariates and multiple testing. The associations were robust in sensitivity analyses and external validation using an independent cohort from a disparate geographical region using a different wearable device. Moreover, we illustrated a heterogeneous impact of circadian parameters associated with biological aging, with young (<45 years) and fast agers experiencing a substantially delayed acrophase with a 25-minute difference in peak timing compared to slow agers, diminishing to a 7-minute difference in older adults (>65 years). We demonstrated a significant enhancement in the predictive performance when integrating circadian rhythmicity in the estimation of biological aging over physical activity. Our findings underscore CosinorAge's potential as a scalable, economic, and digital solution for promoting healthy longevity, elucidating the critical and multifaceted circadian rhythmicity in aging processes. Consequently, our research contributes to advancing preventive measures in digital medicine.
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Affiliation(s)
- Jinjoo Shim
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland.
| | - Elgar Fleisch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Filipe Barata
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
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21
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Alzarea AI, Khan YH, Alzarea SI, Alanazi AS, Alsaidan OA, Alrowily MJ, Al-Shammari M, Almalki ZS, Algarni MA, Mallhi TH. Assessment of Health-Related Quality of Life Among Patients with Chronic Diseases and Its Relationship with Multimorbidity: A Cross-Sectional Study from Saudi Arabia. Patient Prefer Adherence 2024; 18:1077-1094. [PMID: 38854480 PMCID: PMC11162240 DOI: 10.2147/ppa.s448915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/21/2024] [Indexed: 06/11/2024] Open
Abstract
Objective Chronic diseases hold the potential to worsen the overall health of patients by limiting their functional status, productivity, and capacity to live well, affecting their overall health-related quality of life (HRQoL). The purpose of the study was to assess the HRQoL of individuals with chronic diseases residing in the Al-Jouf region of Saudi Arabia. Furthermore, the current study also sought to ascertain the impact of multimorbidity and the duration of illness on HRQoL. Material and Methods A cross-sectional study was conducted among the residents of Al-Jouf region for a period of 6 months. A self-administered EuroQoL (EQ-5D-5L) study tool was used. Appropriate statistical analysis was conducted to ascertain the relationship between various variables and HRQoL. Results A total of 500 out of 562 participants completed the study, with a response rate of 88.97%. Participants had a mean age of 46.15 ± 16.79 years, and the majority were female (n = 299; 59.80%). A mean HRQoL score of 0.82 ± 0.20 was reported, poorest in patients with kidney failure (0.65 ± 0.26) and highest in hepatitis. However, nearly half of the participants had diabetes mellitus type II (n = 205, 39.20%). Patients aged <30 years (OR: 0.109; p = 0.002), male participants (OR: 0.053; p < 0.001), no disability (OR: 0.143; p = 0.002), and <2 comorbid diseases (0.84 ± 0.18; p < 0.001) reported better QoL. Additionally, comorbid conditions such as DM, prolong the duration of the overall illness (14.19 ± 7.67 years). Overall, imperfect health (n = 390, 78%) was reported by the study participants. Conclusion The present study provided preliminary data about the current HRQoL status of individuals with imperfect health and lower HRQoL. In the future, large-scale longitudinal studies are required to investigate the most prevalent chronic diseases, their associations, and change in HRQoL, as there is a dearth of information in the Saudi population.
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Affiliation(s)
- Abdulaziz Ibrahim Alzarea
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Sami I Alzarea
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Abdullah Salah Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Omar Awad Alsaidan
- Department of Pharmaceutics, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Maily J Alrowily
- Department of Radiology, Aljouf Health Cluster, Domat Al-Jandal, Al-Jouf, Saudi Arabia
| | - Monefah Al-Shammari
- Domat Al-Jandal General Hospital, Aljouf Health Cluster, Domat Al Jandal, Al-Jouf, Saudi Arabia
| | - Ziyad Saeed Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Majed A Algarni
- Department of Clinical pharmacy, College of pharmacy, Taif university, Taif, Saudi Arabia
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
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22
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Auriemma CL, Butt MI, Bahti M, Silvestri JA, Solomon E, Harhay MO, Klaiman T, Schapira MM, Barg FK, Halpern SD. Measuring Quality-weighted Hospital-Free Days in Acute Respiratory Failure: A Modified Delphi Study. Ann Am Thorac Soc 2024; 21:928-939. [PMID: 38507646 PMCID: PMC11160130 DOI: 10.1513/annalsats.202311-962oc] [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: 11/13/2023] [Accepted: 01/24/2024] [Indexed: 03/22/2024] Open
Abstract
Rationale: Hospital-free days (HFDs), a measure of the number of days alive spent outside the hospital, is increasingly used as an endpoint in studies of patients with acute respiratory failure (ARF) or other critical and serious illnesses. Current approaches to measuring HFDs do not account for decrements in functional status or quality of life that ARF survivors and family members value. Objectives: To develop an acceptable approach to measure quality-weighted HFDs using patient-reported outcomes. Methods: We conducted a four-round modified Delphi process among ARF experts: those with lived or professional experience. Experts rated survivorship domains, instrument and data collection characteristics, and methods to translate responses into quality-weighted HFDs. The consensus threshold was that ⩾70% of respondents rated an item "totally acceptable" or "acceptable" and ⩽15% of respondents rated the item "totally unacceptable," "unacceptable," or "slightly unacceptable." Results: Fifty-seven experts participated in round 1. Response rates were 82-93% for subsequent rounds. Priority survivorship domains were physical function and health-related quality of life. Participants reached a consensus that data collection during ARF recovery should take less than 15 minutes per assessment, allow surrogate completion when patients are unable, and continue for at least 24 months of follow-up. Using the EuroQol-5 Dimensions (EQ-5D) questionnaire to quality weight HFDs met consensus criteria for acceptability. A majority of panelists preferred quality-weighted HFDs to unweighted HFDs or survival for use in future ARF studies. Conclusions: Quality-weighting HFDs using patient and/or surrogate responses to the EQ-5D captured stakeholder priorities and was acceptable to this Delphi panel.
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Affiliation(s)
- Catherine L. Auriemma
- Palliative and Advanced Illness Research Center
- Department of Medicine
- Leonard Davis Institute of Health Economics
| | | | | | | | | | - Michael O. Harhay
- Palliative and Advanced Illness Research Center
- Department of Biostatistics, Epidemiology, and Informatics
| | | | - Marilyn M. Schapira
- Department of Medicine
- Leonard Davis Institute of Health Economics
- Center for Health Equity Research & Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Frances K. Barg
- Department of Family Medicine and Community Health, and
- Department of Anthropology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Scott D. Halpern
- Palliative and Advanced Illness Research Center
- Department of Medicine
- Leonard Davis Institute of Health Economics
- Department of Biostatistics, Epidemiology, and Informatics
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23
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Fraser LK, Bedendo A, O'neill M, Taylor J, Hackett J, Horridge K, Cade J, Richardson G, Phung H, Mccarter A, Hewitt C. 'YourTube' the role of different diets in gastrostomy-fed children: Baseline findings from a prospective cohort study. Dev Med Child Neurol 2024; 66:755-764. [PMID: 37946550 DOI: 10.1111/dmcn.15799] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/02/2023] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
AIM To assess the risks, benefits, and resource implications of home-blended food for children with gastrostomy tubes compared with a formula diet. METHOD This prospective cohort study of children (aged 0-18 years) collected baseline data on gastrointestinal symptoms, nutritional intake, anthropometric outcomes, parent and child quality of life, and resource use. A propensity score-weighted generalized linear mixed model was used to compare children receiving a home-blended versus formula diet. RESULTS Baseline data were obtained for 180 children (2019-2021; 107 males, 73 females; mean age 9 years 7 months [SD 4 years 5 months]). Children receiving a home-blended diet (n = 104) had similar diagnoses and age but more lived in areas of lower deprivation and parental education was higher compared to the parents of children receiving a formula diet (n = 76). Children receiving home-blended diets had significantly better gastrointestinal scores than those receiving formula diets (B = 13.8, p < 0.001). The number of gut infections and tube blockages were similar between the two groups but with fewer stoma site infections in the group receiving home-blended food. Children receiving a home-blended diet had more fibre in their diet compared to children receiving a formula diet. INTERPRETATION Home-blended diets should be seen as a safe option for children who are gastrostomy-fed unless clinically contraindicated. Equality of access to home-blended diets for children with gastrostomy should be assessed by local clinical teams. WHAT THIS PAPER ADDS Children with gastrostomy receiving a home-blended diet had fewer gastrointestinal symptoms compared to children receiving a formula diet. Children with gastrostomy receiving a home-blended diet had no more complications than children receiving a formula diet.
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Affiliation(s)
- Lorna K Fraser
- Department of Health Sciences, University of York, York, UK
- Cicely Saunders Institute, Kings College London, London, UK
- Department of Women and Children's Health, School of Life Sciences and Population Health, King's College London, London, UK
| | - Andre Bedendo
- Department of Health Sciences, University of York, York, UK
| | - Mark O'neill
- Department of Health Sciences, University of York, York, UK
| | - Johanna Taylor
- Department of Health Sciences, University of York, York, UK
| | - Julia Hackett
- Department of Health Sciences, University of York, York, UK
| | | | - Janet Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | | | - Han Phung
- Centre for Health Economics, University of York, York, UK
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24
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Lynskey MT, Thurgur H, Athanasiou-Fragkouli A, Schlag AK, Nutt DJ. Prescribed Medical Cannabis Use Among Older Individuals: Patient Characteristics and Improvements in Well-Being: Findings from T21. Drugs Aging 2024; 41:521-530. [PMID: 38880841 DOI: 10.1007/s40266-024-01123-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Previous research has suggested that the use of cannabis-based medicinal products is increasing most rapidly among older aged individuals (65+ years). Despite this, little is known about the characteristics of older people using cannabis-based medicinal products and their effectiveness. OBJECTIVES We aimed to document the characteristics, outcomes and prescribing patterns of individuals aged 65+ years receiving prescribed cannabis compared to younger individuals receiving prescribed cannabis. METHODS Data from T21, an observational study of patients seeking treatment with medicinal cannabinoids, including self-report ratings of quality of life (assessed via the EQ-5D-5L), general health (assessed via the visual analogue scale of the EQ-5D-5L), mood (assessed via the Patient Health Questionnaire-9) and sleep (assessed using four items derived from the Pittsburgh Sleep Quality Index) were available at treatment entry [n = 4228; 198 (4.7%) 65+ years] and at a 3-month follow-up [n = 2455; 98 (4.2%) = 65+ years]. RESULTS Relative to younger individuals, those aged over 64 years were more likely to be female (52.5% vs 47.0%; p < 0.001), more likely to report pain as their primary condition (76.3% vs 45.6%; p < 0.001) and less likely to report current daily use (20.2% vs 60.3%, p < 0.001). They received fewer cannabis-based medicinal products (mean = 1.4 vs 2.1; F(1,2199) = 32.3, p < 0.001) and were more likely to receive a prescription for a cannabidiol dominant oil (17.5% vs 5.7%; p < 0.001) and less likely to receive a prescription for delta-9-tetrahydrocannabinol dominant flower (32.5% vs 75.2%; p < 0.001). There were significant improvements across all measures of well-being (p < 0.001), but the extent of improvements in sleep were more marked in younger individuals (p < 0.001). CONCLUSIONS There are important differences between individuals aged 65+ years and younger individuals receiving cannabis-based medicinal products. Older aged individuals experience considerable improvement in health and well-being when prescribed cannabis-based medicinal products.
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Affiliation(s)
- Michael T Lynskey
- Drug Science, St. Peters House, 130 Wood Street, London, EC2V 6DL, UK.
| | - Hannah Thurgur
- Drug Science, St. Peters House, 130 Wood Street, London, EC2V 6DL, UK
| | | | - Anne K Schlag
- Drug Science, St. Peters House, 130 Wood Street, London, EC2V 6DL, UK
- Centre for Neuropsychopharmacology, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - David J Nutt
- Drug Science, St. Peters House, 130 Wood Street, London, EC2V 6DL, UK
- Centre for Neuropsychopharmacology, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
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Vieira RJ, Leemann L, Briggs A, Pereira AM, Savouré M, Kuna P, Morais-Almeida M, Bewick M, Azevedo LF, Louis R, Klimek L, Bahbah F, Samolinski B, Anto JM, Zuberbier T, Fonseca JA, Bousquet J, Sousa-Pinto B. Poor Rhinitis and Asthma Control Is Associated With Decreased Health-Related Quality of Life and Utilities: A MASK-air Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1530-1538.e6. [PMID: 38561141 DOI: 10.1016/j.jaip.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Allergic rhinitis (AR) and asthma may affect health-related quality of life. However, national estimates on the quality of life of patients with AR or asthma are lacking. OBJECTIVE To provide estimates for utility scores and EuroQoL five-dimension (EQ-5D) visual analog scale (VAS) for patients with AR or asthma. METHODS We conducted a cross-sectional study using direct patient data from the MASK-air app on European MASK-air users with self-reported AR or asthma. We used a multi-attribute instrument (EQ-5D) to measure quality of life (as utility scores and EQ-5D VAS values). Mean scores were calculated per country and disease control level using multilevel regression models with poststratification, accounting for age and sex biases. RESULTS We assessed data from 7905 MASK-air users reporting a total of up to 82,737 days. For AR, utilities ranged from 0.86 to 0.99 for good control versus 0.72 to 0.85 for poor control; EQ-5D VAS levels ranged from 78.9 to 87.9 for good control versus 55.3 to 64.2 for poor control. For asthma, utilities ranged from 0.84 to 0.97 for good control versus 0.73 to 0.87 for poor control; EQ-5D VAS levels ranged from 68.4 to 81.5 for good control versus 51.4 to 64.2 for poor control. Poor disease control was associated with a mean loss of 0.14 utilities for both AR and asthma. For the same control levels, AR and asthma were associated with similar utilities and EQ-5D VAS levels. However, lower values were observed for asthma plus AR compared with AR alone. CONCLUSIONS Poor AR or asthma control are associated with reduced quality of life. The estimates obtained from mobile health data may provide valuable insights for health technology assessment studies.
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Affiliation(s)
- Rafael José Vieira
- Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lucas Leemann
- Department of Political Science, University of Zurich, Zurich, Switzerland
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ana Margarida Pereira
- Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marine Savouré
- Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France; Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris-Sud, Villejuif, France
| | - Piotr Kuna
- Division of Internal Medicine, Asthma, and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | | | - Michael Bewick
- University of Central Lancashire Medical School, Preston, United Kingdom
| | - Luís Filipe Azevedo
- Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Renaud Louis
- Department of Pulmonary Medicine, CHU Liège, Liège, Belgium; GIGA I3 Research Group, University of Liège, Liège, Belgium
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Josep M Anto
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany
| | - João A Fonseca
- Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jean Bousquet
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany; MASK-air SAS, Montpellier, France.
| | - Bernardo Sousa-Pinto
- Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
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Sørenstua M, Ræder J, Vamnes JS, Leonardsen ACL. Evaluation of the Erector spinae plane block for postoperative analgesia in laparoscopic ventral hernia repair: a randomized placebo controlled trial. BMC Anesthesiol 2024; 24:192. [PMID: 38811911 PMCID: PMC11134963 DOI: 10.1186/s12871-024-02566-x] [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] [Received: 01/24/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND The Erector spinae plane block (ESPB) reduces postoperative pain after several types of abdominal laparoscopic surgeries. There is sparse data on the effect of ESPB in laparoscopic ventral hernia repair. The purpose of this study was to test the postoperative analgesic efficacy of an ESPB for this procedure. METHODS In this prospective, double-blind, randomized controlled study, adult patients undergoing laparoscopic ventral hernia repair were randomly assigned to either bilateral preoperative ESPB with catheters at the level of Th7 (2 × 30 ml of either 2.5 mg/ml ropivacaine or saline), with postoperative catheter top ups every 6 h for 24 h. The primary outcome was rescue opioid consumption during the first hour postoperatively. Secondary outcomes were total opioid consumption at 4 h and 24 h, pain scores, nausea, sedation, as well as Quality of Recovery 15 (QoR-15) and the EuroQol-5 Dimensions (EQ-5D-5L) during the first week. RESULTS In total, 64 patients were included in the primary outcome measure. There was no significant difference in rescue opioid consumption (oral morphine equivalents (OME)) at one hour postoperatively, with the ESPB group 26.9 ± 17.1 mg versus 32.4 ± 24.3 mg (mean ± SD) in the placebo group (p= 0.27). There were no significant differences concerning the secondary outcomes during the seven-day observation period. Seven patients received a rescue block postoperatively, providing analgesia in five patients. CONCLUSION We found no difference in measured outcomes between ESPB and placebo in laparoscopic ventral hernia repair. Future studies may evaluate whether a block performed using higher concentration and/or at a different thoracic level provides more analgesic efficacy. TRIAL REGISTRATION NCT04438369 ; 18/06/2020. .
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Affiliation(s)
- Marie Sørenstua
- Department of Anesthesia, Kalnesveien 300, Grålum, 1714, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Johan Ræder
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Ann-Chatrin Linqvist Leonardsen
- Faculty of Health, Welfare and Organisation, Ostfold University College, Fredrikstad, Norway
- Department of Anesthesia, Ostfold Hospital Trust, Kalnes, Norway
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Mercadal-Orfila G, Seguí-Solanes C, Rudi-Sola N, Escriva-Sancho ME, Taberner-Ferrer R. Patient-reported outcome measures for assessing atopic dermatitis in clinical practice. FARMACIA HOSPITALARIA 2024:S1130-6343(23)00927-3. [PMID: 38806365 DOI: 10.1016/j.farma.2023.11.002] [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: 06/26/2023] [Revised: 10/05/2023] [Accepted: 11/01/2023] [Indexed: 05/30/2024] Open
Abstract
Atopic dermatitis is a chronic skin condition that affects up to 20% of children and 10% of adults worldwide. Due to the high burden of dermatological signs and symptoms, atopic dermatitis has a significant impact on the quality of life of patients and their families. In the absence of objective measures to accurately assess severity and symptom burden, patient-reported outcome measures are essential to monitor the impact and progression of the disease, as well as the efficacy of treatments. Although there are currently no standardised guidelines for their use in clinical practice, there are some initiatives, such as the Harmonise Outcome Measures for Eczema and Vivir con Dermatitis Atópica, that can provide guidance. As healthcare systems move towards value-based healthcare models, patient-reported measures are becoming increasingly important for incorporating the patient perspective and improving the quality of healthcare services. The use of these measures can help monitor disease activity and guide treatment decisions. This article discusses the impact of atopic dermatitis and describes the patient-reported outcome measures commonly used in atopic dermatitis and the recommendations of the initiatives that have selected a core set of measures to best assess atopic dermatitis in clinical practice. Considering the recommendations of these initiatives and based on our experience in clinical practice, we propose the use of the Dermatology Life Quality Index to assess the impact of the disease on quality of life, the Patient-Oriented Eczema Measure to assess symptom severity, and the Numerical Rating Scale or the Visual Analogue Scale to measure itch intensity. To systematize the administration of these measures and to integrate them into hospital information systems and medical records, we emphasise the importance of telemedicine platforms that allow the electronic administration of these instruments.
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Affiliation(s)
- Gabriel Mercadal-Orfila
- Servicio de Farmacia, Hospital Mateu Orfila, Mahón, Menorca, España; Departamento de Bioquímica y Biología Molecular, Universitat de les Illes Balears (UIB), Palma de Mallorca, España.
| | - Carlos Seguí-Solanes
- Servicio de Farmacia, Hospital General de Granollers, Granollers, Barcelona, España
| | - Nuria Rudi-Sola
- Servicio de Farmacia, Hospital General de Granollers, Granollers, Barcelona, España
| | | | - Rosa Taberner-Ferrer
- Servicio de Dermatología, Hospital Universitari Son Llàtzer, Palma de Mallorca, España
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Radford M, Estcourt LJ, Sirotich E, Pitre T, Britto J, Watson M, Brunskill SJ, Fergusson DA, Dorée C, Arnold DM. Restrictive versus liberal red blood cell transfusion strategies for people with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without haematopoietic stem cell support. Cochrane Database Syst Rev 2024; 5:CD011305. [PMID: 38780066 PMCID: PMC11112982 DOI: 10.1002/14651858.cd011305.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND An estimated one-quarter to one-half of people diagnosed with haematological malignancies experience anaemia. There are different strategies for red blood cell (RBC) transfusions to treat anaemia. A restrictive transfusion strategy permits a lower haemoglobin (Hb) level whereas a liberal transfusion strategy aims to maintain a higher Hb. The most effective and safest strategy is unknown. OBJECTIVES To determine the efficacy and safety of restrictive versus liberal RBC transfusion strategies for people diagnosed with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without a haematopoietic stem cell transplant (HSCT). SEARCH METHODS We searched for randomised controlled trials (RCTs) and non-randomised studies (NRS) in MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1982), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2023, Issue 2), and eight other databases (including three trial registries) to 21 March 2023. We also searched grey literature and contacted experts in transfusion for additional trials. There were no language, date or publication status restrictions. SELECTION CRITERIA We included RCTs and prospective NRS that evaluated restrictive versus liberal RBC transfusion strategies in children or adults with malignant haematological disorders receiving intensive chemotherapy or radiotherapy, or both, with or without HSCT. DATA COLLECTION AND ANALYSIS Two authors independently screened references, full-text reports of potentially relevant studies, extracted data from the studies, and assessed the risk of bias. Any disagreement was discussed and resolved with a third review author. Dichotomous outcomes were presented as a risk ratio (RR) with a 95% confidence interval (CI). Narrative syntheses were used for heterogeneous outcome measures. Review Manager Web was used to meta-analyse the data. Main outcomes of interest included: all-cause mortality at 31 to 100 days, quality of life, number of participants with any bleeding, number of participants with clinically significant bleeding, serious infections, length of hospital admission (days) and hospital readmission at 0 to 3 months. The certainty of the evidence was assessed using GRADE. MAIN RESULTS Nine studies met eligibility; eight RCTs and one NRS. Six hundred and forty-four participants were included from six completed RCTs (n = 560) and one completed NRS (n = 84), with two ongoing RCTs consisting of 294 participants (260 adult and 34 paediatric) pending inclusion. Only one completed RCT included children receiving HSCT (n = 6); the other five RCTs only included adults: 239 with acute leukaemia receiving chemotherapy and 315 receiving HSCT (166 allogeneic and 149 autologous). The transfusion threshold ranged from 70 g/L to 80 g/L for restrictive and from 80 g/L to 120 g/L for liberal strategies. Effects were reported in the summary of findings tables only for the trials that included adults to reduce indirectness due to the limited evidence contributed by the prematurely terminated paediatric trial. Evidence from RCTs Overall, there may be little to no difference in the number of participants who die within 31 to 100 days using a restrictive compared to a liberal transfusion strategy, but the evidence is very uncertain (three studies; 451 participants; RR 1.00, 95% CI 0.27 to 3.70, P=0.99; very low-certainty evidence). There may be little to no difference in quality of life at 0 to 3 months using a restrictive compared to a liberal transfusion strategy, but the evidence is very uncertain (three studies; 431 participants; analysis unable to be completed due to heterogeneity; very low-certainty evidence). There may be little to no difference in the number of participants who suffer from any bleeding at 0 to 3 months using a restrictive compared to a liberal transfusion strategy (three studies; 448 participants; RR 0.91, 95% CI 0.78 to 1.06, P = 0.22; low-certainty evidence). There may be little to no difference in the number of participants who suffer from clinically significant bleeding at 0 to 3 months using a restrictive compared to a liberal transfusion strategy (four studies; 511 participants; RR: 0.94, 95% CI 0.74 to 1.19, P = 0.60; low-certainty evidence). There may be little to no difference in the number of participants who experience serious infections at 0 to 3 months using a restrictive compared to a liberal transfusion strategy (three studies, 451 participants; RR: 1.20, 95% CI 0.93 to 1.55, P = 0.17; low-certainty evidence). A restrictive transfusion strategy likely results in little to no difference in the length of hospital admission at 0 to 3 months compared to a liberal strategy (two studies; 388 participants; analysis unable to be completed due to heterogeneity in reporting; moderate-certainty evidence). There may be little to no difference between hospital readmission using a restrictive transfusion strategy compared to a liberal transfusion strategy (one study, 299 participants; RR: 0.89, 95% CI 0.52 to 1.50; P = 0.65; low-certainty evidence). Evidence from NRS The evidence is very uncertain whether a restrictive RBC transfusion strategy: reduces the risk of death within 100 days (one study, 84 participants, restrictive 1 death; liberal 1 death; very low-certainty evidence); or decreases the risk of clinically significant bleeding (one study, 84 participants, restrictive 3; liberal 8; very low-certainty evidence). No NRS reported on the other eligible outcomes. AUTHORS' CONCLUSIONS Findings from this review were based on seven studies and 644 participants. Definite conclusions are challenging given the relatively few included studies, low number of included participants, heterogeneity of intervention and outcome reporting, and overall certainty of evidence. To increase the certainty of the true effect of a restrictive RBC transfusion strategy on clinical outcomes, there is a need for rigorously designed and executed studies. The evidence is largely based on two populations: adults with acute leukaemia receiving intensive chemotherapy and adults with haematologic malignancy requiring HSCT. Despite the addition of 405 participants from three RCTs to the previous review's results, there is still insufficient evidence to answer this review's primary outcome. If we assume a mortality rate of 3% within 100 days, we would need a total of 1492 participants to have an 80% chance of detecting, at a 5% level of significance, an increase in all-cause mortality from 3% to 6%. Further RCTs are needed overall, particularly in children.
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Affiliation(s)
- Michael Radford
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Canada
- Department of Oncology, Hamilton Health Sciences Centre, Hamilton, Canada
| | - Lise J Estcourt
- Haematology/Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Emily Sirotich
- Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Tyler Pitre
- Medicine, University of Toronto, Toronto, Canada
| | - Joanne Britto
- Oncology, Hamilton Health Sciences Centre, Hamilton, Canada
| | - Megan Watson
- Medicine, University of Toronto, Toronto, Canada
| | - Susan J Brunskill
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Carolyn Dorée
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Donald M Arnold
- Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Ontario, Canada
- McMaster University, Hamilton, Canada
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White A, Carding P, Booth V, McGlashan J, Van Stan J, Logan P, Awad R. Pre- and post-operative voice therapy for benign vocal fold lesions: protocol for a non-randomised, multicentre feasibility trial with embedded process evaluation. Pilot Feasibility Stud 2024; 10:84. [PMID: 38783383 PMCID: PMC11112800 DOI: 10.1186/s40814-024-01508-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Management of benign vocal fold lesions (BVFLs) is variable with individuals receiving surgery, voice therapy, or a combination of these approaches. Some evidence suggests that the best outcomes may be achieved when patients are offered pre- and post-operative voice therapy in addition to phonosurgery, but what constitutes pre- and post-operative voice therapy is poorly described. The pre- and post-operative voice therapy (PAPOV) intervention has been developed and described according to the TIDieR checklist and Rehabilitation Treatment Specification System (RTSS) for voice. The PAPOV intervention is delivered by specialist speech and language therapists trained in the intervention and comprises 7 essential and 4 additional components, delivered in voice therapy sessions with patients who are having surgery on their vocal folds for removal of BVFLs. STUDY DESIGN Non-randomised, multicentre feasibility trial with embedded process evaluation. METHOD Forty patients from two sites who are due to undergo phonosurgery will be recruited to receive the PAPOV intervention. Measures of feasibility, including recruitment, retention, and adherence, will be assessed. The feasibility of gathering clinical and cost effectiveness data will be measured pre-treatment, then at 3 and 6 months post-operatively. An embedded process evaluation will be undertaken to explain feasibility findings. DISCUSSION This study will assess the feasibility of delivering a described voice therapy intervention protocol to patients who are undergoing surgery for removal of BVFLs. Findings will be used to inform the development and implementation of a subsequent effectiveness trial, should this be feasible. TRIAL REGISTRATION This trial has been prospectively registered on ISRCTN (date 4th January 2023), registration number 17438192, and can be viewed here: https://www.isrctn.com/ISRCTN17438192 .
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Affiliation(s)
- Anna White
- Centre for Rehabilitation & Ageing Research, Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
- Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Paul Carding
- Oxford Institute of Applied Health Research, Oxford, UK
| | - Vicky Booth
- Centre for Rehabilitation & Ageing Research, Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Pip Logan
- Centre for Rehabilitation & Ageing Research, Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rehab Awad
- University Hospital Lewisham NHS Trust, London, UK
- Kasr Al-Aini Hospital, Cairo University, Cairo, Egypt
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Killingmo RM, Øiestad BE, Risberg MA, Maas E, Grotle M. Cost-effectiveness of strength exercise or aerobic exercise compared with usual care for patients with knee osteoarthritis: secondary results from a multiarm randomised controlled trial in Norway. BMJ Open 2024; 14:e079704. [PMID: 38803266 DOI: 10.1136/bmjopen-2023-079704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES To evaluate the 1-year cost-effectiveness of strength exercise or aerobic exercise compared with usual care for patients with symptomatic knee osteoarthritis (OA), from a societal and healthcare perspective. DESIGN Cost-effectiveness analysis embedded in a three-arm randomised controlled trial. PARTICIPANTS AND SETTING A total of 161 people with symptomatic knee OA seeking Norwegian primary or secondary care were included in the analyses. INTERVENTIONS Participants were randomised to either 12 weeks of strength exercise (n=54), 12 weeks of aerobic exercise (n=53) or usual care (n=54). OUTCOME MEASURES Quality-adjusted life-years (QALYs) estimated by the EuroQol-5 Dimensions-5 Levels, and costs related to healthcare utilisation and productivity loss estimated in euros (€), aggregated for 1 year of follow-up. Cost-effectiveness was expressed with mean incremental cost-effectiveness ratios (ICERs). Bootstrapping was used to estimate ICER uncertainty. RESULTS From a 1-year societal perspective, the mean cost per patient was €7954, €8101 and €17 398 in the strength exercise, aerobic exercise and usual care group, respectively. From a 1-year healthcare perspective, the mean cost per patient was €848, €2003 and €1654 in the strength exercise, aerobic exercise and usual care group, respectively. Mean differences in costs significantly favoured strength exercise and aerobic exercise from a 1-year societal perspective and strength exercise from a 1-year healthcare perspective. There were no significant differences in mean QALYs between groups. From a 1-year societal perspective, at a willingness-to-pay threshold of €27 500, the probability of strength exercise or aerobic exercise being cost-effective was ≥98%. From a 1-year healthcare perspective, the probability of strength exercise or aerobic exercise being cost-effective was ≥97% and ≥76%, respectively. CONCLUSION From a 1-year societal and healthcare perspective, a 12-week strength exercise or aerobic exercise programme is cost-effective compared with usual care in patients with symptomatic knee OA. TRIAL REGISTRATION NUMBER NCT01682980.
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Affiliation(s)
- Rikke Munk Killingmo
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Division of Orthopaedic Surgery, Oslo Universitetssykehus, Oslo, Norway
| | - Britt Elin Øiestad
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - May-Arna Risberg
- Division of Orthopaedic Surgery, Oslo Universitetssykehus, Oslo, Norway
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Esther Maas
- Department of Health Sciences, Vrije University Amsterdam, Amsterdam, The Netherlands
- The Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| | - Margreth Grotle
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health, Oslo universitetssykehus Ulleval, Oslo, Norway
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31
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McDool E, Mukuria C, Peasgood T. Psychometric Performance of the EQ Health and Wellbeing Short in a United Kingdom Population Sample. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02367-2. [PMID: 38795959 DOI: 10.1016/j.jval.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 04/22/2024] [Accepted: 05/13/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES This study assessed the psychometric performance and construct validity of the EQ Health and Wellbeing Short (EQ-HWB-S), using a validated measure, the EQ-5D-5L, as a comparator. METHODS The experimental version of the EQ-HWB-S was compared with the EQ-5D-5L to assess the psychometric performance of the measures. Data were drawn from the valuation stages of the Extending the Quality-Adjusted Life-Year project (UK general population, n = 429) and the EQ-5D-5L UK valuation pilot study (UK general population, n = 248). Construct validity was assessed based on convergent validity, using Spearman correlations and Pearson correlations. Known-group validity was assessed by estimating effect sizes to assess the ability of the EQ-HWB-S and EQ-5D-5L to discriminate between known groups based on "healthy" status, presence of a long-term condition, health and life satisfaction, age, and employment status. The degree of agreement in utility values across instruments was also evaluated using Bland-Altman plots. RESULTS Strong associations (rs ≥ 0.5, P < .001) were found between conceptually overlapping dimensions and the utility scores of the EQ-HWB-S and EQ-5D-5L. The instruments performed comparably in discriminating between known groups including healthy versus unhealthy groups (based on the visual analog scale ≥ 80), long-term condition (vs no long-term condition), and above versus below average health and life satisfaction and employed (vs unemployed and long-term sick). CONCLUSIONS The EQ-HWB-S performs favorably with utility values successfully discriminating between groups in which differences are expected. Convergence between the EQ-HWB-S and EQ-5D-5L is evident, especially between conceptually overlapping dimensions.
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Affiliation(s)
- Emily McDool
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, England, UK
| | - Clara Mukuria
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, England, UK.
| | - Tessa Peasgood
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, England, UK
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Nørmark LP, McAuliffe F, Maindal HT, O'Reilly S, Davies A, Burden C, Skinner TC, Vrangbæk K, Callander E. Protocol for cost-effectiveness analysis of a randomised trial of mHealth coaching (Bump2Baby and Me) compared with usual care for healthy gestational weight gain and postnatal outcomes in at-risk women and their offspring in the UK, Australia, Ireland and Spain. BMJ Open 2024; 14:e080823. [PMID: 38772891 PMCID: PMC11110546 DOI: 10.1136/bmjopen-2023-080823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 05/03/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION Gestational diabetes mellitus and overweight are associated with an increased likelihood of complications during birth and for the newborn baby. These complications lead to increased immediate and long-term healthcare costs as well as reduced health and well-being in women and infants. This protocol presents the health economic evaluation to investigate the cost-effectiveness of Bump2Baby and Me (B2B&Me), which is a health coaching intervention delivered via smartphone to women at risk of gestational diabetes. METHODS AND ANALYSIS Using data from the B2B&Me randomised controlled trial, this economic evaluation compares costs and health effects between the intervention and control group as an incremental cost-effectiveness ratio. Direct healthcare costs, costs of pharmaceuticals and intervention costs will be included in the analysis, body weight and quality-adjusted life-years for the mother will serve as the effect outcomes. To investigate the long-term cost-effectiveness of the trial, a Markov model will be employed. Deterministic and probabilistic sensitivity analysis will be employed. ETHICS AND DISSEMINATION The National Maternity Hospital Human Research and Ethics Committee was the primary approval site (EC18.2020) with approvals from University College Dublin HREC-Sciences (LS-E-20-150-OReilly), Junta de Andalucia CEIM/CEI Provincial de Granada (2087-M1-22), Monash Health HREC (RES-20-0000-892A) and National Health Service Health Research Authority and Health and Care Research Wales (HCRW) (21/WA/0022). The results from the analysis will be disseminated in scientific papers, through conference presentations and through different channels for communication within the project. TRIAL REGISTRATION NUMBER ACTRN12620001240932.
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Affiliation(s)
- Laura Pirhonen Nørmark
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark
| | - Fionnuala McAuliffe
- UCD Perinatal Research Centre, University College Dublin, Dublin, Ireland
- Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland
| | | | - Sharleen O'Reilly
- Institute of Food and Health, University College Dublin, Dublin, Ireland
| | - Anna Davies
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Christy Burden
- University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Timothy C Skinner
- Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Karsten Vrangbæk
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark
| | - Emily Callander
- School of Public Health, University of Technology Sydney, Sydney, UK
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Barman-Aksözen J, Hentschel N, Pettersson M, Schupp E, Granata F, Dechant C, Aksözen MH, Falchetto R. Fair Funding Decisions: Consistency of the Time Horizons Used in the Calculation of Quality-Adjusted Life Years for Therapies for Very Rare Diseases by the National Institute for Health and Care Excellence in England. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:616. [PMID: 38791830 PMCID: PMC11121024 DOI: 10.3390/ijerph21050616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
The National Institute for Health and Care Excellence (NICE) in England uses quality-adjusted life years (QALYs) to assess the cost-effectiveness of treatments. A QALY is a measure that combines the size of the clinical benefit of a treatment with the time the patient benefits from it, i.e., the time horizon. We wanted to know how consistently QALY gains are calculated at NICE. Therefore, we have analysed information on the time horizons used for the QALY calculations of the concluded evaluations conducted under the Highly Specialised Technologies programme for treatments of very rare diseases at NICE. For treatments with final guidance published by December 2023 (n = 29), a time horizon of median 97.5 years (range: 35 to 125 years) was used to calculate the QALY gains. For most QALY calculations, the accepted time horizon was longer than either the expected treatment duration or the estimated life expectancy. In contrast, for the only technology with a final negative funding decision, i.e., afamelanotide for treating the lifelong chronic disease erythropoietic protoporphyria, a time horizon that was shorter than the expected treatment duration was used. The fairness and consistency of the evaluation process of treatments for very rare diseases at NICE should be reviewed.
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Affiliation(s)
- Jasmin Barman-Aksözen
- International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
| | - Nicole Hentschel
- Independent Researcher, Hegarstrasse 3, 8032 Zurich, Switzerland
| | - Mårten Pettersson
- International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
| | - Eva Schupp
- International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
| | - Francesca Granata
- International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, S.C Medicina ad Indirizzo Metabolico, 20122 Milano, Italy
| | - Cornelia Dechant
- International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
| | - Mehmet Hakan Aksözen
- International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
| | - Rocco Falchetto
- International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
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Van Niekerk L, Pugh S, Mikocka-Walus A, Ng C, O’Hara R, Armour M, Leonardi M, Evans S. An evaluation of sexual function and health-related quality of life following laparoscopic surgery in individuals living with endometriosis. Hum Reprod 2024; 39:992-1002. [PMID: 38563055 PMCID: PMC11063542 DOI: 10.1093/humrep/deae063] [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] [Received: 10/16/2023] [Revised: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
STUDY QUESTION What is the relationship between sexual function, health-related quality of life (HRQoL), and laparoscopic surgery in individuals living with endometriosis? SUMMARY ANSWER A higher number of laparoscopic surgeries is significantly associated with poorer HRQoL and greater levels of sexual dysfunction in individuals with endometriosis. WHAT IS KNOWN ALREADY Prior research indicates that endometriosis is associated with lowered HRQoL and sexual function and that these outcomes are influenced by endometriosis-related symptom profiles, medical, and surgical management. A limited number of studies have examined changes in sexual function in individuals with endometriosis following laparoscopic surgery or following repeated surgeries. STUDY DESIGN, SIZE, DURATION A cross-sectional community-based online survey was used to examine the relationships between sexual function, HRQoL, and laparoscopic surgery (n = 210). PARTICIPANTS/MATERIALS, SETTING, METHODS Individuals with a self-reported diagnosis of endometriosis were recruited via online advertising through social media and gynaecology clinics. Endometriosis-specific data (e.g. diagnostic delay, symptom experience) was collected in addition to engagement with laparoscopic surgery, level of HRQoL (EuroQol-5 Dimension: EQ-5D-5L), and sexual function (Female Sexual Function Index: FSFI). Bivariate correlational analyses and hierarchical multiple regression were used to determine the associations between the variables of interest. MAIN RESULTS AND THE ROLE OF CHANCE Individuals with endometriosis have substantially poorer HRQoL in comparison to Australian normative samples, with greater levels of endometriosis-related symptom burden, distress, and pain significantly associated with lower levels of HRQoL. The mean FSFI score was suggestive of clinically significant female sexual dysfunction, with the lowest level of function noted in the domain of sexual pain and the highest level of function noted in the sexual satisfaction domain. A greater number of laparoscopic surgeries was significantly associated with poorer overall HRQoL and greater levels of sexual dysfunction. LIMITATIONS, REASONS FOR CAUTION The cross-sectional nature of the data precludes direct findings of causality and further longitudinal research is recommended. The information pertaining to engagement in laparoscopic surgery was self-report in nature and was not medically verified. WIDER IMPLICATIONS OF THE FINDINGS The study's findings highlight the pervasive impact of endometriosis on all domains of living, emphasizing the need to extend treatment planning beyond that of physical pain management alone. Early referral for assessment and management of sexual wellbeing is recommended prior to, and post-surgical intervention, with a focus on maintaining post-surgical changes, potentially reducing the need for multiple surgeries. STUDY FUNDING, COMPETING INTEREST(S) The study was not associated with research funding. Author CN reports grant funding from the Australian Government and Medical Research Future Fund (MRFF) and was a previous employee of CSL Vifor (formerly Vifor Pharma Pty Ltd). TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Leesa Van Niekerk
- School of Psychological Sciences, College of Health & Medicine, University of Tasmania, Hobart, TAS, Australia
- National Endometriosis Clinical and Scientific Trials (NECST) Network, UNSW, Sydney, Australia
| | - Shaunagh Pugh
- School of Psychological Sciences, College of Health & Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Antonina Mikocka-Walus
- National Endometriosis Clinical and Scientific Trials (NECST) Network, UNSW, Sydney, Australia
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Cecilia Ng
- National Endometriosis Clinical and Scientific Trials (NECST) Network, UNSW, Sydney, Australia
- Division of Obstetrics and Gynaecology, School of Clinical Medicine, Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Rebecca O’Hara
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, North Adelaide, SA, Australia
| | - Mike Armour
- National Endometriosis Clinical and Scientific Trials (NECST) Network, UNSW, Sydney, Australia
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Mathew Leonardi
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, North Adelaide, SA, Australia
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Subhadra Evans
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
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Tsui TCO, Chan KKW, Xie F, Pullenayegum EM. Creating a Multiply Imputed Value Set for the EQ-5D-5L in Canada: State-Level Misspecification Terms Are Needed to Characterize Parameter Uncertainty Correctly. Med Decis Making 2024; 44:405-414. [PMID: 38591189 PMCID: PMC11102641 DOI: 10.1177/0272989x241241328] [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: 10/06/2023] [Accepted: 02/27/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Parameter uncertainty in EQ-5D-5L value sets often exceeds the instrument's minimum important difference, yet this is routinely ignored. Multiple imputation (MI) accounts for parameter uncertainty in the value set; however, no valuation study has implemented this methodology. Our objective was to create a Canadian MI value set for the EQ-5D-5L, thus enabling users to account for parameter uncertainty in the value set. METHODS Using the Canadian EQ-5D-5L valuation study (N = 1,073), we first refit the original model followed by models with state-level misspecification. Models were compared based on the adequacy of 95% credible interval (CrI) coverage for out-of-sample predictions. Using the best-fitting model, we took 100 draws from the posterior distribution to create 100 imputed value sets. We examined how much the standard error of the estimated mean health utilities increased after accounting for parameter uncertainty in the value set by using the MI and original value sets to score 2 data sets: 1) a sample of 1,208 individuals from the Canadian general public and 2) a sample of 401 women with breast cancer. RESULTS The selected model with state-level misspecification outperformed the original model (95% CrI coverage: 94.2% v. 11.6%). We observed wider standard errors for the estimated mean utilities on using the MI value set for both the Canadian general public (MI: 0.0091; original: 0.0035) and patients with breast cancer (MI: 0.0169; original: 0.0066). DISCUSSION AND CONCLUSIONS We provide 1) the first MI value sets for the EQ-5D-5L and 2) code to construct MI value sets while accounting for state-level model misspecification. Our study suggests that ignoring parameter uncertainty in value sets leads to falsely narrow SEs. HIGHLIGHTS Value sets for health state utility instruments are estimated subject to parameter uncertainty; this parameter uncertainty may exceed the minimum important difference of the instrument, yet it is not fully captured using current methods.This study creates the first multiply imputed value set for a multiattribute utility instrument, the EQ-5D-5L, to fully capture this parameter uncertainty.We apply the multiply imputed value set to 2 data sets from 1) the Canadian general public and 2) women with invasive breast cancer.Scoring the EQ-5D-5L using a multiply imputed value set led to wider standard error estimates, suggesting that the current practice of ignoring parameter uncertainty in the value set leads to falsely low standard errors.Our work will be of interest to methodologists and developers of the EQ-5D-5L and users of the EQ-5D-5L, such as health economists, researchers, and policy makers.
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Affiliation(s)
- Teresa C. O. Tsui
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Canadian Centre for Applied Research in Cancer Control, Canada
| | - Kelvin K. W. Chan
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Canadian Centre for Applied Research in Cancer Control, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Eleanor M. Pullenayegum
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
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Varriale C, Andrulli G, Meregaglia M, Rencz F, Finch AP. Behind the Scenes: A Qualitative Investigation of Interviewers' Performance in EQ-5D Valuation Studies. PHARMACOECONOMICS - OPEN 2024; 8:389-401. [PMID: 38592657 PMCID: PMC11058132 DOI: 10.1007/s41669-024-00486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The EuroQol Valuation Technology (EQ-VT) protocol is currently employed by the valuation studies of the EQ family of instruments worldwide. To date, all the evidence in support of the quality control (QC) originates from quantitative indicators. OBJECTIVE We aimed to explore interviewers' conversational patterns in EQ-VT interviews, beyond quantitative QC indicators, and to provide a preliminary exploration of how the interaction between interviewer and respondent impacts data quality. METHODS Two researchers transcribed and independently coded 24 video-recorded interviews from the Italian EQ-5D-5L valuation study, adopting the conversational analysis framework. The analysis identified positive and negative 'patterns' of conversational practice. These were categorized into themes and sub-themes and were used to score a random sample of 42 video-recorded interviews conducted at different time points by seven interviewers. RESULTS The conversational analysis identified 20 positive and 14 negative interview patterns, which were grouped into two main themes (i.e., task execution and communication skills). Positive items included appending questions that stimulated respondents' engagement, providing different explanations for an unclear aspect, supporting the participant with useful information for completing the tasks, and increasing the interview's coherence by confirming the respondent answers. Negative patterns included moving forward in the exercise without making sure that the respondent understood, trying to force an answer from the respondent, speaking too fast, and providing incomplete or incorrect explanations of the task. Most interviewers exhibited a moderate increase in positive patterns or a decrease in negative patterns over time. A certain degree of consistency between the quantitative QC results and the qualitative scoring deriving from the interviewer-respondent interaction was observed, with the best and worst performers of the qualitative scoring showing good and bad scores on key QC items, respectively. CONCLUSIONS The identified positive and negative patterns may be useful to inform the training material of EQ-VT studies worldwide and complement the existing QC process.
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Affiliation(s)
| | | | | | - Fanni Rencz
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
| | - Aureliano Paolo Finch
- EuroQol Office, EuroQol Research Foundation, Rotterdam, The Netherlands
- Health Values Research and Consultancy, Amsterdam, The Netherlands
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Schneider P, Devlin N, van Hout B, Brazier J. Exploring health preference heterogeneity in the UK: Using the online elicitation of personal utility functions approach to construct EQ-5D-5L value functions on societal, group and individual level. HEALTH ECONOMICS 2024; 33:894-910. [PMID: 38243895 DOI: 10.1002/hec.4805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/07/2023] [Accepted: 12/06/2023] [Indexed: 01/22/2024]
Abstract
A new method has recently been developed for valuing health states, called 'Online elicitation of Personal Utility Functions' (OPUF). In contrast to established methods, such as time trade-off or discrete choice experiments, OPUF does not require hundreds of respondents, but allows estimating utility functions for small groups and even at the individual level. In this study, we used OPUF to elicit EQ-5D-5L health state preferences from a (not representative) sample of the UK general population, and then compared utility functions on the societal-, group-, and individual level. A demo version of the survey is available at: https://eq5d5l.me. Data from 874 respondents were included in the analysis. For each respondent, we constructed a personal EQ-5D-5L value set. These personal value sets predicted respondents' choices in three hold-out discrete choice tasks with an accuracy of 78%. Overall, preferences varied greatly between individuals. However, PERMANOVA analysis showed that demographic characteristics explained only a small proportion of the variability between subgroups. While OPUF is still under development, it has important strengths: it can be used to construct value sets for patient reported outcome instruments such as EQ-5D-5L, while also allowing examination of underlying preferences in an unprecedented level of detail. In the future, OPUF could be used to complement existing methods, allowing valuation studies in smaller samples, and providing more detailed insights into the heterogeneity of preferences across subgroups.
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Affiliation(s)
- Paul Schneider
- ScHARR, The University of Sheffield, Sheffield, UK
- Valorem Health, Bochum, Germany
| | - Nancy Devlin
- University of Melbourne, Melbourne, Victoria, Australia
| | - Ben van Hout
- ScHARR, The University of Sheffield, Sheffield, UK
- Open Health, York, UK
| | - John Brazier
- ScHARR, The University of Sheffield, Sheffield, UK
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Marsh K, Collacott H, Thomson J, Mauer J, Watt S, Shah K, Hauber B, Garrison L, Dzingina M. Using Patient Preferences in Health Technology Assessment: Evaluating Quality-Adjusted Survival Equivalents (QASE) for the Quantification of Non-health Benefits. THE PATIENT 2024; 17:229-237. [PMID: 38421583 DOI: 10.1007/s40271-024-00676-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
Interest in using patient preference (PP) data alongside traditional economic models in health technology assessment (HTA) is growing, including using PP data to quantify non-health benefits. However, this is limited by a lack of standardised methods. In this article, we describe a method for using discrete choice experiment (DCE) data to estimate the value of non-health benefits in terms of quality-adjusted survival equivalence (QASE), which is consistent with the concept of value prevalent among HTA agencies. We describe how PP data can be used to estimate QASE, assess the ability to test the face-validity of QASE estimates of changes in mode of administration calculated from five published DCE oncology studies and review the methodological and normative considerations associated with using QASE to support HTA. We conclude that QASE may have some methodological advantages over alternative methods, but this requires DCEs to estimate second-order effects between length and quality of life. In addition, empirical work has yet to be undertaken to substantiate this advantage and demonstrate the validity of QASE. Further work is also required to align QASE with normative objectives of HTA agencies. Estimating QASE would also have implications for the conduct of DCEs, including standardising and defining more clear attribute definitions.
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Affiliation(s)
- Kevin Marsh
- Evidera, 201 Talgarth Rd, London, W6 8BJ, UK.
| | | | | | | | | | - Koonal Shah
- National Institute for Health and Care Excellence, London, UK
| | - Brett Hauber
- Pfizer, New York, NY, USA
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Louis Garrison
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA
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Ouwerkerk M, Rietberg MB, van der Linden MMW, Uitdehaag BMJ, van Wegen EEH, de Groot V. Mood Associated With Health- and Social Care-Related Quality of Life in Patients With Advanced Multiple Sclerosis. Int J MS Care 2024; 26:199-206. [PMID: 39091383 PMCID: PMC11293463 DOI: 10.7224/1537-2073.2023-060] [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: 08/04/2024]
Abstract
BACKGROUND Individuals with advanced multiple sclerosis (MS) have complex care requirements and are more likely to use long-term facilities. This study determined the associations between mood and social care-related quality of life (SCRQOL), and health-related quality of life (HRQOL) and examined the association between HRQOL and SCRQOL. METHODS Baseline data from a cohort study were used. Patients completed questionnaires, including the Hospital Anxiety and Depression Scale (HADS), Adult Social Care Outcomes Toolkit (ASCOT), and EuroQOL 5D-5L (EQ-5D-5L) and EQ-Visual Analogue Scale (EQ-VAS). Linear regression analyses were employed to assess the relationships between mood and both outcomes of QOL while controlling for relevant confounding factors (βs; 95% CI). The cross-sectional association between SCRQOL and HRQOL was examined using Pearson correlation coefficients (r). RESULTS A total of 75 patients, with a mean age of 56.1 years and a disease duration of 17.3 years, were enrolled from a long-term care facility in the Netherlands. Results showed that after controlling for confounders, HADS is an independent determinant of ASCOT (βs = -.368; 95% CI, -.581 to -.154) and EQ-5D-5L (βs = -.297; 95% CI, -.507 to -.087). Also, there are significant but weak correlations between ASCOT and EQ-5D-5L (r = 0.242; 95% CI, .015-.468), between ASCOT and EQ-VAS (r = 0.230; 95% CI, .003-.457) and between EQ-5D-5L and EQ-VAS (r = 0.227; 95% CI, .000-.454). CONCLUSIONS Mood, especially the depression component, is an important determinant of both HRQOL and SCRQOL in advanced MS. Focusing on mood in health care and social care may contribute to the improvement of QOL in a broader sense.
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Affiliation(s)
- Maaike Ouwerkerk
- Department of Rehabilitation Medicine, Neurosciences, MS Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Nieuw Unicum, Zandvoort, the Netherlands
| | - Marc B. Rietberg
- From the Department of Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Meike M. W. van der Linden
- Department of Rehabilitation Medicine, Neurosciences, MS Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Nieuw Unicum, Zandvoort, the Netherlands
| | - Bernard M. J. Uitdehaag
- Department of Neurology, Neurosciences, MS Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Erwin E. H. van Wegen
- From the Department of Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Vincent de Groot
- From the Department of Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Young CA, Rog DJ, Sharrack B, Tanasescu R, Kalra S, Harrower T, Tennant A, Mills RJ. Correlates and trajectories of relapses in relapsing-remitting multiple sclerosis. Neurol Sci 2024; 45:2181-2189. [PMID: 37976012 PMCID: PMC11021238 DOI: 10.1007/s10072-023-07155-3] [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: 02/02/2023] [Accepted: 10/21/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND AIMS In people with relapsing-remitting multiple sclerosis (pwRRMS), data from studies on non-pharmacological factors which may influence relapse risk, other than age, are inconsistent. There is a reduced risk of relapses with increasing age, but little is known about other trajectories in real-world MS care. METHODS We studied longitudinal questionnaire data from 3885 pwRRMS, covering smoking, comorbidities, disease-modifying therapy (DMT), and patient-reported outcome measures, as well as relapses during the past year. We undertook Rasch analysis, group-based trajectory modelling, and multilevel negative binomial regression. RESULTS The regression cohort of 6285 data sets from pwRRMS over time showed that being a current smoker was associated with 43.9% greater relapse risk; having 3 or more comorbidities increased risk and increasing age reduced risk. Those diagnosed within the last 2 years showed two distinct trajectories, both reducing in relapse frequency but 25.8% started with a higher rate and took 4 years to reduce to the rate of the second group. In the cohort with at least three data points completed, there were three groups: 73.7% followed a low stable relapse rate, 21.6% started from a higher rate and decreased, and 4.7% had an increasing then decreasing pattern. These different trajectory groups showed significant differences in fatigue, neuropathic pain, disability, health status, quality of life, self-efficacy, and DMT use. CONCLUSIONS These results provide additional evidence for supporting pwRRMS to stop smoking and underline the importance of timely DMT decisions and treatment initiation soon after diagnosis with RRMS.
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Affiliation(s)
- Carolyn A Young
- Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool L9 7LJ, UK, University of Liverpool, Liverpool, UK.
| | - David J Rog
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Basil Sharrack
- Academic Department of Neurology, University of Sheffield, Sheffield, UK
| | | | - Seema Kalra
- University Hospital of North Midlands NHS Trust, Stoke-On-Trent, UK
| | | | - Alan Tennant
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Roger J Mills
- Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool L9 7LJ, UK, University of Liverpool, Liverpool, UK
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Stenson K, Fecteau TE, O'Callaghan L, Bryden P, Mellor J, Wright J, Earl L, Thomas O, Iqbal H, Barlow S, Parvanta S. Health-related quality of life across disease stages in patients with amyotrophic lateral sclerosis: results from a real-world survey. J Neurol 2024; 271:2390-2404. [PMID: 38200398 PMCID: PMC11055770 DOI: 10.1007/s00415-023-12141-y] [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: 08/24/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is characterized by a rapid disease course, with disease severity being associated with declining health-related quality of life (HRQoL) in persons living with ALS (pALS). The main objective of this study was to assess the impact of disease progression on HRQoL across King's, Milano-Torino Staging (MiToS), and physician-judgement clinical staging. Additionally, we evaluated the impact of the disease on the HRQoL of care partners (cALS). METHODS Data were sourced from the Adelphi ALS Disease Specific Programme (DSP)™, a cross-sectional survey of neurologists, pALS and cALS presenting in a real-world clinical setting between July 2020 and March 2021 in Europe and the United States. RESULTS Neurologists (n = 142) provided data for 880 pALS. There were significant negative correlations between all three clinical staging systems and EuroQol (European Quality of Life) Five Dimension Five Level Scale (EQ-5D-5L) utility scores and visual analogue scale (VAS) ratings. Although not all differences were significant, 5-item Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-5) scores showed a stepwise increase in HRQoL impairment at each stage of the disease regardless of the staging system. At later stages, high levels of fatigue and substantial activity impairment were reported. As pALS disease states progressed, cALS also experienced a decline in HRQoL and increased burden. CONCLUSIONS Across outcomes, pALS and cALS generally reported worse outcomes at later stages of the disease, highlighting an unmet need in this population for strategies to maximise QoL despite disease progression. Recognition and treatment of symptoms such as pain and fatigue may lead to improved outcomes for pALS and cALS.
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Affiliation(s)
| | | | - L O'Callaghan
- Biogen, Cambridge, MA, USA
- Sage Therapeutics, Boston, MA, USA
| | | | - J Mellor
- Adelphi Real World, Bollington, UK
| | - J Wright
- Adelphi Real World, Bollington, UK
| | - L Earl
- Adelphi Real World, Bollington, UK
| | - O Thomas
- Adelphi Real World, Bollington, UK
| | - H Iqbal
- Adelphi Real World, Bollington, UK
| | - S Barlow
- Adelphi Real World, Bollington, UK
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van Tol LS, Haaksma ML, Cesari M, Dockery F, Everink IHJ, Francis BN, Gordon AL, Grund S, Matchekhina L, Bazan LMP, Schols JMGA, Topinková E, Vassallo MA, Caljouw MAA, Achterberg WP. Post-COVID-19 patients in geriatric rehabilitation substantially recover in daily functioning and quality of life. Age Ageing 2024; 53:afae084. [PMID: 38725361 PMCID: PMC11082471 DOI: 10.1093/ageing/afae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND After an acute infection, older persons may benefit from geriatric rehabilitation (GR). OBJECTIVES This study describes the recovery trajectories of post-COVID-19 patients undergoing GR and explores whether frailty is associated with recovery. DESIGN Multicentre prospective cohort study. SETTING 59 GR facilities in 10 European countries. PARTICIPANTS Post-COVID-19 patients admitted to GR between October 2020 and October 2021. METHODS Patients' characteristics, daily functioning (Barthel index; BI), quality of life (QoL; EQ-5D-5L) and frailty (Clinical Frailty Scale; CFS) were collected at admission, discharge, 6 weeks and 6 months after discharge. We used linear mixed models to examine the trajectories of daily functioning and QoL. RESULTS 723 participants were included with a mean age of 75 (SD: 9.91) years. Most participants were pre-frail to frail (median [interquartile range] CFS 6.0 [5.0-7.0]) at admission. After admission, the BI first steeply increased from 11.31 with 2.51 (SE 0.15, P < 0.001) points per month and stabilised around 17.0 (quadratic slope: -0.26, SE 0.02, P < 0.001). Similarly, EQ-5D-5L first steeply increased from 0.569 with 0.126 points per month (SE 0.008, P < 0.001) and stabilised around 0.8 (quadratic slope: -0.014, SE 0.001, P < 0.001). Functional recovery rates were independent of frailty level at admission. QoL was lower at admission for frailer participants, but increased faster, stabilising at almost equal QoL values for frail, pre-frail and fit patients. CONCLUSIONS Post-COVID-19 patients admitted to GR showed substantial recovery in daily functioning and QoL. Frailty at GR admission was not associated with recovery and should not be a reason to exclude patients from GR.
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Affiliation(s)
- Lisa S van Tol
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
- University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Miriam L Haaksma
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
- University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Matteo Cesari
- IRCCS Istituti Clinici Maugeri, University of Milan, Milan, Italy
| | - Frances Dockery
- Beaumont Hospital & Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Irma H J Everink
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Bahaa N Francis
- Fliman Geriatric Rehabilitation Hospital, Zalman Shneur Street, Haifa, 31021, Israel
- Geriatric Division, Holy Family Hospital, Bar Ilan University, Safad, Israel
| | - Adam L Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Medical School, Nottingham, NG7 2UH, UK
| | - Stefan Grund
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Heidelberg, Germany
| | - Luba Matchekhina
- Russian Gerontology Research and Clinical Centre, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Laura Monica Perez Bazan
- RE-FiT Barcelona Research Group, Parc Sanitari Pere Virgili Hospital and Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Eva Topinková
- Department of Geriatrics, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | | | - Monique A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
- University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
- University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, The Netherlands
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43
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Foley MJ, Rajkumar CA, Ahmed-Jushuf F, Simader FA, Chotai S, Pathimagaraj RH, Mohsin M, Salih A, Wang D, Dixit P, Davies JR, Keeble TR, Cosgrove C, Spratt JC, O'Kane PD, De Silva R, Hill JM, Nijjer SS, Sen S, Petraco R, Mikhail GW, Khamis R, Kotecha T, Harrell FE, Kellman P, Francis DP, Howard JP, Cole GD, Shun-Shin MJ, Al-Lamee RK. Coronary sinus reducer for the treatment of refractory angina (ORBITA-COSMIC): a randomised, placebo-controlled trial. Lancet 2024; 403:1543-1553. [PMID: 38604209 DOI: 10.1016/s0140-6736(24)00256-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND The coronary sinus reducer (CSR) is proposed to reduce angina in patients with stable coronary artery disease by improving myocardial perfusion. We aimed to measure its efficacy, compared with placebo, on myocardial ischaemia reduction and symptom improvement. METHODS ORBITA-COSMIC was a double-blind, randomised, placebo-controlled trial conducted at six UK hospitals. Patients aged 18 years or older with angina, stable coronary artery disease, ischaemia, and no further options for treatment were eligible. All patients completed a quantitative adenosine-stress perfusion cardiac magnetic resonance scan, symptom and quality-of-life questionnaires, and a treadmill exercise test before entering a 2-week symptom assessment phase, in which patients reported their angina symptoms using a smartphone application (ORBITA-app). Patients were randomly assigned (1:1) to receive either CSR or placebo. Both participants and investigators were masked to study assignment. After the CSR implantation or placebo procedure, patients entered a 6-month blinded follow-up phase in which they reported their daily symptoms in the ORBITA-app. At 6 months, all assessments were repeated. The primary outcome was myocardial blood flow in segments designated ischaemic at enrolment during the adenosine-stress perfusion cardiac magnetic resonance scan. The primary symptom outcome was the number of daily angina episodes. Analysis was done by intention-to-treat and followed Bayesian methodology. The study is registered with ClinicalTrials.gov, NCT04892537, and completed. FINDINGS Between May 26, 2021, and June 28, 2023, 61 patients were enrolled, of whom 51 (44 [86%] male; seven [14%] female) were randomly assigned to either the CSR group (n=25) or the placebo group (n=26). Of these, 50 patients were included in the intention-to-treat analysis (24 in the CSR group and 26 in the placebo group). 454 (57%) of 800 imaged cardiac segments were ischaemic at enrolment, with a median stress myocardial blood flow of 1·08 mL/min per g (IQR 0·77-1·41). Myocardial blood flow in ischaemic segments did not improve with CSR compared with placebo (difference 0·06 mL/min per g [95% CrI -0·09 to 0·20]; Pr(Benefit)=78·8%). The number of daily angina episodes was reduced with CSR compared with placebo (OR 1·40 [95% CrI 1·08 to 1·83]; Pr(Benefit)=99·4%). There were two CSR embolisation events in the CSR group, and no acute coronary syndrome events or deaths in either group. INTERPRETATION ORBITA-COSMIC found no evidence that the CSR improved transmural myocardial perfusion, but the CSR did improve angina compared with placebo. These findings provide evidence for the use of CSR as a further antianginal option for patients with stable coronary artery disease. FUNDING Medical Research Council, Imperial College Healthcare Charity, National Institute for Health and Care Research Imperial Biomedical Research Centre, St Mary's Coronary Flow Trust, British Heart Foundation.
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Affiliation(s)
- Michael J Foley
- National Heart and Lung Institute, Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Christopher A Rajkumar
- National Heart and Lung Institute, Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Shayna Chotai
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Rachel H Pathimagaraj
- National Heart and Lung Institute, Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Muhammad Mohsin
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ahmed Salih
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Danqi Wang
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Prithvi Dixit
- National Heart and Lung Institute, Imperial College London, London, UK
| | - John R Davies
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK; Medical Technology Research Centre, Anglia Ruskin University School of Medicine, Chelmsford, UK
| | - Tom R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK; Medical Technology Research Centre, Anglia Ruskin University School of Medicine, Chelmsford, UK
| | - Claudia Cosgrove
- St George's University Hospitals NHS Foundation Trust, London, UK; St George's, University of London, London, UK
| | - James C Spratt
- St George's University Hospitals NHS Foundation Trust, London, UK; St George's, University of London, London, UK
| | - Peter D O'Kane
- University Hospitals of Dorset NHS Foundation Trust, Bournemouth, UK
| | - Ranil De Silva
- The Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jonathan M Hill
- The Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Sayan Sen
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Ramzi Khamis
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Frank E Harrell
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Peter Kellman
- Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Darrel P Francis
- National Heart and Lung Institute, Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Graham D Cole
- National Heart and Lung Institute, Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Matthew J Shun-Shin
- National Heart and Lung Institute, Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Rasha K Al-Lamee
- National Heart and Lung Institute, Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK.
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Phetsouphanh C, Jacka B, Ballouz S, Jackson KJL, Wilson DB, Manandhar B, Klemm V, Tan HX, Wheatley A, Aggarwal A, Akerman A, Milogiannakis V, Starr M, Cunningham P, Turville SG, Kent SJ, Byrne A, Brew BJ, Darley DR, Dore GJ, Kelleher AD, Matthews GV. Improvement of immune dysregulation in individuals with long COVID at 24-months following SARS-CoV-2 infection. Nat Commun 2024; 15:3315. [PMID: 38632311 PMCID: PMC11024141 DOI: 10.1038/s41467-024-47720-8] [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] [Received: 10/09/2023] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
This study investigates the humoral and cellular immune responses and health-related quality of life measures in individuals with mild to moderate long COVID (LC) compared to age and gender matched recovered COVID-19 controls (MC) over 24 months. LC participants show elevated nucleocapsid IgG levels at 3 months, and higher neutralizing capacity up to 8 months post-infection. Increased spike-specific and nucleocapsid-specific CD4+ T cells, PD-1, and TIM-3 expression on CD4+ and CD8+ T cells were observed at 3 and 8 months, but these differences do not persist at 24 months. Some LC participants had detectable IFN-γ and IFN-β, that was attributed to reinfection and antigen re-exposure. Single-cell RNA sequencing at the 24 month timepoint shows similar immune cell proportions and reconstitution of naïve T and B cell subsets in LC and MC. No significant differences in exhaustion scores or antigen-specific T cell clones are observed. These findings suggest resolution of immune activation in LC and return to comparable immune responses between LC and MC over time. Improvement in self-reported health-related quality of life at 24 months was also evident in the majority of LC (62%). PTX3, CRP levels and platelet count are associated with improvements in health-related quality of life.
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Affiliation(s)
| | - Brendan Jacka
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Sara Ballouz
- Garvan Institute for Medical research, Sydney, NSW, Australia
- School of Computer Science and Engineering, Faculty of Engineering, University of New South Wales, Sydney, NSW, Australia
| | | | - Daniel B Wilson
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Bikash Manandhar
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Vera Klemm
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Hyon-Xhi Tan
- Department of Microbiology and Immunology, Peter Doherty Institute, University of Melbourne, Victoria, VIC, Australia
| | - Adam Wheatley
- Department of Microbiology and Immunology, Peter Doherty Institute, University of Melbourne, Victoria, VIC, Australia
| | - Anupriya Aggarwal
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Anouschka Akerman
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Mitchell Starr
- NSW State Reference Laboratory for HIV, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | - Phillip Cunningham
- NSW State Reference Laboratory for HIV, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | - Stuart G Turville
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Stephen J Kent
- Department of Microbiology and Immunology, Peter Doherty Institute, University of Melbourne, Victoria, VIC, Australia
| | - Anthony Byrne
- Heart Lung Clinic, St. Vincent's Hospital Sydney and Faculty of Medicine and Health (UNSW), Sydney, NSW, Australia
| | - Bruce J Brew
- Peter Duncan Neurosciences Unit- St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | | | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
- St. Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Anthony D Kelleher
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
- St. Vincent's Hospital, Darlinghurst, NSW, Australia.
| | - Gail V Matthews
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
- St. Vincent's Hospital, Darlinghurst, NSW, Australia.
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45
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Patel VC, McPhail MJ, Uddin R, Jafari H, Lawrence V, Le Boutillier C, Shearer J, Yaziji N, Cape A, Ahmed H, Ward C, Walsh P, Besly K, Zamalloa A, Kelly J, Carter B. Beta-blockers or Placebo for Primary Prophylaxis (BOPPP) of oesophageal varices: study protocol for a randomised controlled trial. Trials 2024; 25:265. [PMID: 38627804 PMCID: PMC11022376 DOI: 10.1186/s13063-024-08063-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Liver disease is within the top five causes of premature death in adults. Deaths caused by complications of cirrhosis continue to rise, whilst deaths related to other non-liver disease areas are declining. Portal hypertension is the primary sequelae of cirrhosis and is associated with the development of variceal haemorrhage, ascites, hepatic encephalopathy and infection, collectively termed hepatic decompensation, which leads to hospitalisation and mortality. It remains uncertain whether administering a non-selective beta-blocker (NSBB), specifically carvedilol, at an earlier stage, i.e. when oesophageal varices are small, can prevent VH and reduce all-cause decompensation (ACD). METHODS/DESIGN The BOPPP trial is a pragmatic, multicentre, placebo-controlled, triple-blinded, randomised controlled trial (RCT) in England, Scotland, Wales and Northern Ireland. Patients aged 18 years or older with cirrhosis and small oesophageal varices that have never bled will be recruited, subject to exclusion criteria. The trial aims to enrol 740 patients across 55 hospitals in the UK. Patients are allocated randomly on a 1:1 ratio to receive either carvedilol 6.25 mg (a NSBB) or a matched placebo, once or twice daily, for 36 months, to attain adequate power to determine the effectiveness of carvedilol in preventing or reducing ACD. The primary outcome is the time to first decompensating event. It is a composite primary outcome made up of variceal haemorrhage (VH, new or worsening ascites, new or worsening hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP), hepatorenal syndrome, an increase in Child-Pugh grade by 1 grade or MELD score by 5 points, and liver-related mortality. Secondary outcomes include progression to medium or large oesophageal varices, development of gastric, duodenal, or ectopic varices, participant quality of life, healthcare costs and transplant-free survival. DISCUSSION The BOPPP trial aims to investigate the clinical and cost-effectiveness of carvedilol in patients with cirrhosis and small oesophageal varices to determine whether this non-selective beta-blocker can prevent or reduce hepatic decompensation. There is clinical equipoise on whether intervening in cirrhosis, at an earlier stage of portal hypertension, with NSBB therapy is beneficial. Should the trial yield a positive result, we anticipate that the administration and use of carvedilol will become widespread with pathways developed to standardise the administration of the medication in primary care. ETHICS AND DISSEMINATION The trial has been approved by the National Health Service (NHS) Research Ethics Committee (REC) (reference number: 19/YH/0015). The results of the trial will be submitted for publication in a peer-reviewed scientific journal. Participants will be informed of the results via the BOPPP website ( www.boppp-trial.org ) and partners in the British Liver Trust (BLT) organisation. TRIAL REGISTRATION EUDRACT reference number: 2018-002509-78. ISRCTN reference number: ISRCTN10324656. Registered on April 24 2019.
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Affiliation(s)
- Vishal C Patel
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK.
- Institute of Liver Studies, Faculty of Life Sciences and Medicine, School of Immunology and Microbial Sciences, King's College London, London, UK.
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, 111 Coldharbour Lane, London, SE5 9NT, UK.
| | - Mark J McPhail
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
- Institute of Liver Studies, Faculty of Life Sciences and Medicine, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Ruhama Uddin
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Hassan Jafari
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- King's Clinical Trials Unit, Institute of Psychiatry, Psychology & Neuroscience,, King's College London, London, UK
| | - Vanessa Lawrence
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Clair Le Boutillier
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Division of Methodologies, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - James Shearer
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nahel Yaziji
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Angela Cape
- King's Clinical Trials Unit, Institute of Psychiatry, Psychology & Neuroscience,, King's College London, London, UK
| | - Haroon Ahmed
- Cardiff University, Division of Population Medicine, Cardiff, UK
| | | | - Peter Walsh
- British Liver Trust, Venta Court, Winchester, UK
| | - Kevin Besly
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Ane Zamalloa
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Joanna Kelly
- King's Clinical Trials Unit, Institute of Psychiatry, Psychology & Neuroscience,, King's College London, London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- King's Clinical Trials Unit, Institute of Psychiatry, Psychology & Neuroscience,, King's College London, London, UK
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Cole S, Noble S, Gooberman-Hill R, Pinedo-Villanueva R. Modelled cost-effectiveness analysis of the Support and Treatment After Replacement (STAR) care pathway for chronic pain after total knee replacement compared with usual care. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:28. [PMID: 38605347 PMCID: PMC11010279 DOI: 10.1186/s12962-024-00532-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/20/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The aim of the study was to estimate the long-term cost-effectiveness of the Support and Treatment After Replacement (STAR) care pathway for chronic pain after total knee replacement compared with usual postoperative care. METHODS Study design: A decision-analytic (cohort Markov) model was used for the simulation with time dependent annual transition probabilities and a time horizon of five years. SETTING Patients treated by National Health Service (NHS) hospitals in England and Wales. STUDY POPULATION Adults classified as having chronic pain three months after undergoing a total knee replacement. INTERVENTION The STAR care pathway following a total knee replacement. COMPARATOR Usual postoperative care following a total knee replacement. PERSPECTIVE The study was undertaken from the perspective of the NHS. OUTCOME MEASURES Quality-adjusted life years and healthcare costs. Discounting: A rate of 3.5% for both costs and health utility. RESULTS Model results indicate that the STAR intervention would dominate current practice by providing a gain in quality-adjusted life years (QALYs) of 0.086 and a reduction of £375 (per person) in costs over the first five years. The incremental net monetary benefit of the STAR intervention was estimated at £2,086 (at a threshold of £20,000 per QALY). Probabilistic sensitivity analysis suggests the STAR intervention is likely to be cost-effective with a probability of 0.62. The results remain robust to changes in model assumptions on comparator utility and the timing of the start of the intervention. If hospital admission costs are assumed not to be reduced by the STAR intervention, it would no longer be cost saving, but it would likely be cost-effective based on probabilistic sensitivity analysis (0.59). CONCLUSION Evidence from the economic model suggests that the STAR care pathway is likely to be cost-effective and potentially dominant from an NHS perspective. TRIAL REGISTRATION The STAR trial is registered with ISRCTN, ISRCTN92545361.
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Affiliation(s)
- Sophie Cole
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, OX3 7LD, Oxford, UK
| | - Sian Noble
- Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, BS8 1NU, Bristol, UK
| | - Rachael Gooberman-Hill
- Bristol Medical School, University of Bristol, Royal Fort House, BS8 1UH, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Rafael Pinedo-Villanueva
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, OX3 7LD, Oxford, UK.
- National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
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47
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Randell E, Nollett C, Henley J, Smallman K, Johnson S, Meister L, McNamara R, Wilkins D, Segrott J, Casbard A, Wakelyn J, McKay K, Bordea E, Totsika V, Kennedy E. Watch Me Play!: protocol for a feasibility study of a remotely delivered intervention to promote mental health resilience for children (ages 0-8) across UK early years and children's services. Pilot Feasibility Stud 2024; 10:55. [PMID: 38576026 PMCID: PMC10993464 DOI: 10.1186/s40814-024-01491-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/26/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Half of mental health problems are established by the age of 14 years and 75% by 24 years. Early intervention and prevention of mental ill health are therefore vitally important. However, increased demand over recent years has meant that access to child mental health services is often restricted to those in severest need. Watch Me Play! (WMP) is an early intervention designed to support caregiver attunement and attention to the child to promote social-emotional well-being and thereby mental health resilience. Originally developed in the context of a local authority mental health service for children in care, it is now also delivered online as a low intensity, scalable, preventative intervention. Although WMP shows promise and is already used in some services, we do not yet know whether it is effective. METHODS A non-randomised single group feasibility study with embedded process evaluation. We propose to recruit up to 40 parents/carers of children aged 0-8 years who have been referred to early years and children's services in the UK. WMP involves a parent watching the child play and talking to their child about their play (or for babies, observing and following signals) for up to 20 min per session. Some sessions are facilitated by a trained practitioner who provides prompts where necessary, gives feedback, and discusses the child's play with the caregiver. Services will offer five facilitated sessions, and parents will be asked to do at least 10 additional sessions on their own with their child in a 5-week period. Feasibility outcomes examined are as follows: (i) recruitment, (ii) retention, (iii) adherence, (iv) fidelity of delivery, (v) barriers and facilitators of participation, (vi) intervention acceptability, (vii) description of usual care, and (viii) data collection procedures. Intervention mechanisms will be examined through qualitative interview data. Economic evaluation will be conducted estimating cost of the intervention and cost of service use for child and parents/carers quality-adjusted life years. DISCUSSION This study will address feasibility questions associated with progression to a future randomised trial of WMP. TRIAL REGISTRATION ISRCTN13644899 . Registered on 14th April 2023.
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Affiliation(s)
| | - Claire Nollett
- Centre for Trials Research, Cardiff University, Cardiff, Wales
| | - Josie Henley
- School of Social Sciences, Cardiff University, Cardiff, Wales
| | - Kim Smallman
- Centre for Trials Research, Cardiff University, Cardiff, Wales
| | - Sean Johnson
- Centre for Trials Research, Cardiff University, Cardiff, Wales
| | - Lena Meister
- Centre for Trials Research, Cardiff University, Cardiff, Wales
| | - Rachel McNamara
- Centre for Trials Research, Cardiff University, Cardiff, Wales
| | - David Wilkins
- School of Social Sciences, Cardiff University, Cardiff, Wales
| | - Jeremy Segrott
- Centre for Trials Research, DECIPHer Centre, Cardiff University, Cardiff, Wales
| | - Angela Casbard
- Centre for Trials Research, Cardiff University, Cardiff, Wales
| | | | - Kathy McKay
- Tavistock and Portman NHS Foundation Trust, London, England
| | | | | | - Eilis Kennedy
- Tavistock and Portman NHS Foundation Trust, London, England
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Geoghegan L, Carolina M, French J, Harrison CJ, Rodrigues JN. Health-related quality of life in patients with conditions affecting the hand: meta-analysis. Br J Surg 2024; 111:znae067. [PMID: 38593043 PMCID: PMC11003527 DOI: 10.1093/bjs/znae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/23/2023] [Accepted: 02/24/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Health state utility values provide the quality component of quality-adjusted life years and are essential for health economic analyses, such as the National Institute for Health and Care Excellence Technology Appraisal. The aims of this systematic review were to: catalogue utility values for health states experienced by patients with hand conditions; provide pooled utility estimates for common hand conditions; and determine how utilities have been estimated. METHODS A PRISMA-compliant systematic review and meta-analysis was conducted (registered in PROSPERO, the international prospective register of systematic reviews (CRD42021226098)). Five databases were searched from inception until April 2023 (Embase, MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Central Register of Controlled Trials (CENTRAL)). All studies that reported primary utility values for hand health states in adult patients were eligible for inclusion. Pooled utility estimates were determined across conditions and intervention status using random-effects meta-analysis. RESULTS A total of 10 254 articles were identified; 57 studies met the full inclusion criteria and reported 363 distinct health state utility values. Health state utility values were estimated using a range of methods; the most common measure was the EQ-5D. Pooled utility estimates for carpal tunnel syndrome and hand osteoarthritis before surgical intervention were 0.69 (95% c.i. 0.66 to 0.73) and 0.63 (95% c.i. 0.60 to 0.67) respectively. CONCLUSION Pooled utility estimates for patients with untreated carpal tunnel syndrome and hand osteoarthritis are 11% and 18% lower than age-matched population norms respectively. Hand conditions have a significant detrimental impact on health-related quality of life and this study provides catalogued utility values for use in future economic analyses to support the delivery of value-based hand surgery.
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Affiliation(s)
- Luke Geoghegan
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Maria Carolina
- Department of Orthopaedic Surgery, University of Verona, Verona, Italy
| | - James French
- University of Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Conrad J Harrison
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jeremy N Rodrigues
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
- Department of Plastic, Reconstructive and Hand Surgery, Stoke Mandeville Hospital, Aylesbury, UK
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Lee P, Engel L, Lubetkin E, Gao L. Exploring the Comparability Between EQ-5D and the EQ Health and Wellbeing in the General Australian Population. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:508-517. [PMID: 38286249 DOI: 10.1016/j.jval.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 12/12/2023] [Accepted: 01/15/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVES The EQ Health and Wellbeing (EQ-HWB) is a novel measure that conceptually overlaps with the 5-level EQ-5D (EQ-5D-5L) while capturing broader dimensions of health and well-being. This study aimed to explore the extent to which the EQ-HWB and EQ-5D-5L capture overlapping or complementary constructs and to explore the discriminative ability of the EQ-HWB Short version (EQ-HWB-S) as a multiattribute utility instrument in the Australian setting. METHODS A secondary analysis of data from a nationally representative cross-sectional survey of 2002 Australian adults was performed. The survey included socioeconomic questions and health characteristics and the EQ-HWB and EQ-5D-5L instruments. Convergent and known-group validity were evaluated through Spearman rank correlation and multivariable regression analyses, respectively. An exploratory factor analysis was also performed to explore the underlying constructs of the 2 measures. RESULTS Correlation coefficients varied from moderate to strong (rs ≥ 0.40) between the EQ-5D-5L and the corresponding EQ-HWB dimensions (all P < .001). Based on the exploratory factor analysis, both instruments measure similar underlying constructs, with the EQ-HWB capturing broader aspects of well-being. The known-group analysis demonstrated the relative discriminative ability of the EQ-HWB-S in capturing broader aspects of health and well-being. CONCLUSIONS The EQ-HWB was at least moderately correlated with the EQ-5D-5L in overlapping domains/dimensions and demonstrated greater sensitivity in participants with mental health problems versus the EQ-5D-5L. Our findings support future research exploring the value of the EQ-HWB-S as a multiattribute utility instrument for the general Australian population.
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Affiliation(s)
- Peter Lee
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia.
| | - Lidia Engel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Erica Lubetkin
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY, USA
| | - Lan Gao
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
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Siriwardana AN, Hoffman AT, Morton RL, Smyth B, Brown MA. Estimating a Minimal Important Difference for the EQ-5D-5L Utility Index in Dialysis Patients. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:469-477. [PMID: 38307389 DOI: 10.1016/j.jval.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/27/2023] [Accepted: 01/08/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVES The EQ-5D-5L is a commonly used health-related quality of life instrument for evaluating interventions in patients receiving dialysis; however, the minimal important difference (MID) that constitutes a meaningful treatment effect for this population has not been established. This study aims to estimate the MID for the EQ-5D-5L utility index in dialysis patients. METHODS 6-monthly EQ-5D-5L measurements were collected from adult dialysis patients between April 2017 and November 2020 at a renal network in Sydney, Australia. EQ-VAS and Integrated Palliative care Outcome Scale Renal symptom burden scores were collected simultaneously and used as anchors. MID estimates for the EQ-5D-5L utility index were derived using anchor-based and distribution-based methods. RESULTS A total of 352 patients with ≥1 EQ-5D-5L observation were included, constituting 1127 observations. Mean EQ-5D-5L utility index at baseline was 0.719 (SD ± 0.267), and mean EQ-5D-5L utility decreased over time by -0.017 per year (95% CI -0.029 to -0.006, P = .004). Using cross-sectional anchor-based methods, MID estimates ranged from 0.073 to 0.107. Using longitudinal anchor-based methods, MID for improvement and deterioration ranged from 0.046 to 0.079 and -0.111 to -0.048, respectively. Using receiver operating characteristic curves, MID for improvement and deterioration ranged from 0.037 to 0.122 and -0.074 to -0.063, respectively. MID estimates from distribution-based methods were consistent with anchor-based estimates. CONCLUSIONS Anchor-based and distribution-based approaches provided EQ-5D-5L utility index MID estimates ranging from 0.034 to 0.134. These estimates can inform the target difference or "effect size" for clinical trial design among dialysis populations.
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Affiliation(s)
- Amanda N Siriwardana
- Renal and Metabolic Division, The George Institute for Global Health, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Anna T Hoffman
- Department of Renal Medicine, St George Hospital, Sydney, NSW, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Brendan Smyth
- Department of Renal Medicine, St George Hospital, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Mark A Brown
- Department of Renal Medicine, St George Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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