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de Boer IH, Prince DK, Williams K, Allen NB, Burke GL, Hoofnagle AN, Hsu S, Li X, Liu KJ, McClelland RL, Michos ED, Psaty BM, Shea SJ, Rice KM, Rotter JI, Siscovick DS, Tracy RP, Watson KE, Kestenbaum BR. The Multi-Ethnic Study of Atherosclerosis individual response to vitamin D trial: Building a randomized clinical trial into an observational cohort study. Contemp Clin Trials 2021; 103:106318. [PMID: 33588078 PMCID: PMC8089051 DOI: 10.1016/j.cct.2021.106318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 11/21/2022]
Abstract
The INdividual response to VITamin D (INVITe) trial was a randomized, placebo-controlled, parallel group trial of vitamin D3 supplementation (2000 IU daily) designed to determine clinical and genetic characteristics that modify the response to vitamin D supplementation. To enhance internal and external validity and reduce cost, the INVITe trial was nested within the Multi-Ethnic Study of Atherosclerosis (MESA), an ongoing prospective observational cohort study. The INVITe trial enrolled a community-based population of 666 racially and ethnically diverse participants from January 2017 to April 2019. This represents 30% of 2210 MESA participants approached for screening, and 96% of those found to be eligible. Barriers to enrollment included delayed initiation of the trial relative to scheduled MESA study visits, a lower number of available MESA participants than expected, and a high prevalence (18%) of high-dose vitamin D supplementation (>1000 IU daily, an exclusion criterion). The final study visit was attended by 611 participants (92%), and median adherence was 98%. Our experience suggests that integration of a randomized trial into an existing observational cohort study may leverage strengths of the source population and enhance enrollment, retention, and adherence, although with limited enrollment capacity. The INVITe trial will use rigorously-collected data to advance understanding of individual determinants of vitamin D response.
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Affiliation(s)
- Ian H de Boer
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA, United States of America.
| | - David K Prince
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Kayleen Williams
- Department of Biostatistics, University of Washington, Seattle, WA, United States of America
| | - Norrina B Allen
- Department of Internal Medicine, Northwestern University, Chicago, IL, United States of America
| | - Gregory L Burke
- Division of Public Health Sciences Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Andrew N Hoofnagle
- Department of Laboratory Medicine, University of Washington, Seattle, WA, United States of America
| | - Simon Hsu
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Xiaohui Li
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kiang J Liu
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States of America
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, WA, United States of America
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States of America; Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, WA, United States of America; Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Steven J Shea
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States of America; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Kenneth M Rice
- Department of Biostatistics, University of Washington, Seattle, WA, United States of America
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - David S Siscovick
- New York Academy of Medicine, New York, NY, United States of America
| | - Russell P Tracy
- Departments of Pathology & Laboratory Medicine, and Biochemistry, University of Vermont Larner College of Medicine, Burlington, VT, United States of America
| | - Karol E Watson
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Bryan R Kestenbaum
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA, United States of America
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Natural or Urban Campus Walks and Vitality in University Students: Exploratory Qualitative Findings from a Pilot Randomised Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042003. [PMID: 33669552 PMCID: PMC7923099 DOI: 10.3390/ijerph18042003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 11/17/2022]
Abstract
Despite extensive evidence of the restorative effects of nature, the potential vitalizing effects of connecting with nature are yet understudied, particularly in higher education settings. University students face high levels of stress and anxiety, and may benefit from nature-based interventions that enhance positive states such as vitality. Using preliminary data from a pilot randomized controlled study with qualitative interviews, we explored the psychological experiences associated with a brief walk either in nature or an urban environment in a sample of 13 university students. The qualitative thematic analysis revealed that walking in nature was a more energizing and vitalizing experience than the urban walk. The nature walk was also found to have both affective and cognitive enhancing effects on participants. Our study highlights the usefulness of exploring subjective psychological experiences of interacting with nature, as well as supporting its restorative potential. Implications for further research and interventions are discussed.
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Stockler‐Ipsiroglu S, Potter BK, Yuskiv N, Tingley K, Patterson M, van Karnebeek C. Developments in evidence creation for treatments of inborn errors of metabolism. J Inherit Metab Dis 2021; 44:88-98. [PMID: 32944978 PMCID: PMC7891579 DOI: 10.1002/jimd.12315] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022]
Abstract
Inborn errors of metabolism (IEM) represent the first group of genetic disorders, amenable to causal therapies. In addition to traditional medical diet and cofactor treatments, new treatment strategies such as enzyme replacement and small molecule therapies, solid organ transplantation, and cell-and gene-based therapies have become available. Inherent to the rare nature of the single conditions, generating high-quality evidence for these treatments in clinical trials and under real-world conditions has been challenging. Guidelines developed with standardized methodologies have contributed to improve the practice of care and long-term clinical outcomes. Adaptive trial designs allow for changes in sample size, group allocation and trial duration as the trial proceeds. n-of-1 studies may be used in small sample sized when participants are clinically heterogeneous. Multicenter observational and registry-based clinical trials are promoted via international research networks. Core outcome and standard data element sets will enhance comparative analysis of clinical trials and observational studies. Patient-centered outcome-research as well as patient-led research initiatives will further accelerate the development of therapies for IEM.
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Affiliation(s)
- Sylvia Stockler‐Ipsiroglu
- Division of Biochemical Genetics, Department of Pediatrics, and BC Children's Hospital Research InstituteUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Beth K. Potter
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Nataliya Yuskiv
- Division of Biochemical Genetics, Department of Pediatrics, and BC Children's Hospital Research InstituteUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Kylie Tingley
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Marc Patterson
- Division of Child and Adolescent Neurology, Departments of Neurology Pediatrics and Medical GeneticsMayo Clinic Children's CenterRochesterMinnesotaUSA
| | - Clara van Karnebeek
- Departments of Pediatrics and Clinical GeneticsAmsterdam University Medical CentresAmsterdamThe Netherlands
- Department of PediatricsRadboud University Medical CentreNijmegenThe Netherlands
- Department of PediatricsBC Children's Hospital Research Institute, Centre for Molecular Medicine and TherapeuticsVancouverBritish ColumbiaCanada
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Okhomina VI, Seals SR, Marshall GD. Recruitment and enrollment of African Americans into health promoting programs: the effects of health promoting programs on cardiovascular disease risk study. ETHNICITY & HEALTH 2020; 25:825-834. [PMID: 29611712 DOI: 10.1080/13557858.2018.1458074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 03/06/2018] [Indexed: 06/08/2023]
Abstract
Objectives: Randomized controlled trials (RCT) often employ multiple recruitment methods to attract participants, however, special care must be taken to be inclusive of under-represented populations. We examine how recruiting from an existing observational study affected the recruitment of African Americans into a RCT that included yoga-based interventions. In particular, we report the recruitment success of The Effects of Health Promoting Programs (HPP) on Cardiovascular Disease Risk (NCT02019953), the first yoga-based clinical trial to focus only on African Americans. Design: To recruit participants, a multifaceted recruitment strategy was implemented exclusively in the Jackson Heart Study (JHS) cohort. The HPP recruited from the JHS cohort using direct mailings, signs and flyers placed around JHS study facilities, and through JHS annual follow-up interviews. Results: Enrollment into HPP was open to all active JHS participants that were eligible to return for the third clinic exam (n = 4644). The target sample size was 375 JHS participants over a 24 month recruitment and enrollment period. From the active members of the JHS cohort, 503 were pre-screened for eligibility in HPP. More than 90% of those pre-screened were provisionally eligible for the study. The enrollment goal of 375 was completed after a 16-month enrollment period with over 25% (n = 97) of the required sample size enrolling during the second month of recruitment. Conclusions: The findings show that participants in observational studies can be successfully recruited into RCT. Observational studies provide researchers with a well-defined population that may be of interest when designing clinical trials. This is particularly useful in the recruitment of a high-risk, traditionally underrepresented populations for non-pharmacological clinical trials where traditional recruitment methods may prolong enrollment periods and extend study budgets.
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Affiliation(s)
- Victoria I Okhomina
- Department of Data Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Samantha R Seals
- Department of Mathematics and Statistics, Hal Marcus College of Science and Engineering, University of West Florida, Pensacola, FL, USA
| | - Gailen D Marshall
- Division of Clinical Immunology and Allergy, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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Ragni MV, George LA. The national blueprint for future factor VIII inhibitor clinical trials: NHLBI State of the Science (SOS) Workshop on factor VIII inhibitors. Haemophilia 2019; 25:581-589. [PMID: 31329364 PMCID: PMC9883697 DOI: 10.1111/hae.13717] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 12/29/2018] [Accepted: 01/31/2019] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Inhibitor formation is a major complication of haemophilia for which clinical trials are planned. Despite emerging novel haemostatic agents, challenges of rare disease trials are limited subjects and lack of an organized research organization with strategic resources and partnerships. AIM The charge to Working Group 1 was to establish scientific priorities and innovative implementation strategies to conduct inhibitor prevention and eradication trials. To determine feasibility of trial design and strategic resources and partnerships to be leveraged, two clinical trial concepts were considered. RESULTS For the Inhibitor Prevention Trial, we considered adaptive design with early stopping rules, dynamic randomization and Master Protocol models to reduce sample size; and registries to provide concurrent controls and natural history data. For the Inhibitor Eradication Trial using gene therapy, an adaptive design was considered in a small number of subjects, and, if safe and meeting regulatory requirements, enrolment would be expanded. A Haemophilia Clinical Trials Group (HCTG) infrastructure was envisioned, with uniform procedures and standardized outcomes, data collection and assays, within which trial concepts would be developed, vetted and prioritized by a Steering Committee, and submitted to NIH and other research sponsors for review and funding. Mechanistic studies would be embedded within the trials, early stage investigators trained and mentored, and the research infrastructure established within the haemophilia centre (HTC) network and supported by partnerships with foundations, community, federal partners and industry. CONCLUSION The success of inhibitor trials will depend on innovative trial design and an organized HCTG research infrastructure, leveraged through community partnerships.
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Ayurvedic research for direct public benefit. J Ayurveda Integr Med 2019; 10:1-3. [PMID: 30948190 PMCID: PMC6470298 DOI: 10.1016/j.jaim.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/30/2019] [Accepted: 02/02/2019] [Indexed: 11/23/2022] Open
Abstract
Currently, interest in Ayurveda research from a public health perspective, is increasing globally due to its ability of improving quality of life and assist individuals to stay healthy. However, there is a dearth of evidence which can substantiate the credibility of this ancient traditional medicine system. Ayurveda today, has to face numerous challenges in collecting evidence and documenting it. The way forward may be understanding these challenges and developing policies which can make Ayurveda research beneficial for the public.
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Viecelli AK, Tong A, O'Lone E, Ju A, Hanson CS, Sautenet B, Craig JC, Manns B, Howell M, Chemla E, Hooi LS, Johnson DW, Lee T, Lok CE, Polkinghorne KR, Quinn RR, Vachharajani T, Vanholder R, Zuo L, Hawley CM. Report of the Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Consensus Workshop on Establishing a Core Outcome Measure for Hemodialysis Vascular Access. Am J Kidney Dis 2018; 71:690-700. [PMID: 29478866 DOI: 10.1053/j.ajkd.2017.12.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/07/2017] [Indexed: 02/08/2023]
Abstract
Vascular access outcomes in hemodialysis are critically important for patients and clinicians, but frequently are neither patient relevant nor measured consistently in randomized trials. A Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) consensus workshop was convened to discuss the development of a core outcome measure for vascular access. 13 patients/caregivers and 46 professionals (clinicians, policy makers, industry representatives, and researchers) attended. Participants advocated for vascular access function to be a core outcome based on the broad applicability of function regardless of access type, involvement of a multidisciplinary team in achieving a functioning access, and the impact of access function on quality of life, survival, and other access-related outcomes. A core outcome measure for vascular access required demonstrable feasibility for implementation across different clinical and trial settings. Participants advocated for a practical and flexible outcome measure with a simple actionable definition. Integrating patients' values and preferences was warranted to enhance the relevance of the measure. Proposed outcome measures for function included "uninterrupted use of the access without the need for interventions" and "ability to receive prescribed dialysis," but not "access blood flow," which was deemed too expensive and unreliable. These recommendations will inform the definition and implementation of a core outcome measure for vascular access function in hemodialysis trials.
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Affiliation(s)
- Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia.
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Emma O'Lone
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Angela Ju
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Benedicte Sautenet
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia; University Francois Rabelais, Tours, France; Department of Nephrology and Clinical Immunology, Tours Hospital, Tours, France; INSERM, U1246, Tours, France
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Braden Manns
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute and O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Eric Chemla
- St George's University NHS Foundation Trust, London, United Kingdom
| | - Lai-Seong Hooi
- Department of Medicine and Haemodialysis Unit, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| | - Timmy Lee
- Division of Nephrology, Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL
| | - Charmaine E Lok
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Medical Centre, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robert R Quinn
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Tushar Vachharajani
- Division of Nephrology, W.G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, NC
| | - Raymond Vanholder
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Li Zuo
- Peking University People's Hospital, Beijing, China
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
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Treviño RP, Piña C, Fuentes JC, Nuñez M. Evaluation of Medicare's Intensive Behavioral Therapy for Obesity: the BieneStar Experience. Am J Prev Med 2018; 54:497-502. [PMID: 29449133 DOI: 10.1016/j.amepre.2018.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 01/03/2018] [Accepted: 01/15/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In 2011, the Centers for Medicare and Medicaid Services began to reimburse primary care providers for intensive behavior therapy for obesity. This study evaluated a Centers for Medicare and Medicaid Services intensive behavior therapy for obesity program as implemented in primary care clinics. METHODS Data for this retrospective cohort study were obtained between May 2012 and February 2015 and statistical analysis was performed in 2017. The sample included 643 participants who attended at least one BieneStar intensive behavior therapy for obesity program session. The primary outcome was weight, and covariates were number of sessions, age, race/ethnicity, diagnosis of hypertension and diabetes, and type of health insurance. RESULTS Of 643 participants that initiated the BieneStar program, 641 had complete data. The median reduction in weight of participants was as follows: those who attended fewer than four sessions, 0 kg (95% CI=0, 0.11 kg); between four and eight sessions, 1.1 kg (95% CI=0.86, 1.59 kg); and more than eight sessions 3.7 kg (95% CI=3.36, 4.55 kg). Medians of weight were significantly different between each classification of session numbers (p<0.01). Participants lost on average 0.102 kg of weight per session attended. CONCLUSIONS The BieneStar program showed that the weight of participants decreased as they attended more sessions. Further studies are needed to determine if these results can be reproduced in other office-based primary care clinics and the program's impact on chronic disease.
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Affiliation(s)
- Roberto P Treviño
- Department of Health and Human Performance, University of Texas Rio Grande Valley, Edinburg, Texas.
| | - Christina Piña
- BieneStar Healthy Lifestyle Advocacy Program, Social and Health Research Center, San Antonio, Texas
| | | | - Melissa Nuñez
- Health Informatics, South Alamo Medical Group, San Antonio, Texas
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Potter BK, Hutton B, Clifford TJ, Pallone N, Smith M, Stockler S, Chakraborty P, Barbeau P, Garritty CM, Pugliese M, Rahman A, Skidmore B, Tessier L, Tingley K, Coyle D, Greenberg CR, Korngut L, MacKenzie A, Mitchell JJ, Nicholls S, Offringa M, Schulze A, Taljaard M. Establishing core outcome sets for phenylketonuria (PKU) and medium-chain Acyl-CoA dehydrogenase (MCAD) deficiency in children: study protocol for systematic reviews and Delphi surveys. Trials 2017; 18:603. [PMID: 29258568 PMCID: PMC5735866 DOI: 10.1186/s13063-017-2327-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/13/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Inherited metabolic diseases (IMD) are a large group of rare single-gene disorders that are typically diagnosed early in life. There are important evidence gaps related to the comparative effectiveness of therapies for IMD, which are in part due to challenges in conducting randomized controlled trials (RCTs) for rare diseases. Registry-based RCTs present a unique opportunity to address these challenges provided the registries implement standardized collection of outcomes that are important to patients and their caregivers and to clinical providers and healthcare systems. Currently there is no core outcome set (COS) for studies evaluating interventions for paediatric IMD. This protocol outlines a study that will establish COS for each of two relatively common IMD in children, phenylketonuria (PKU) and medium-chain acyl-CoA dehydrogenase (MCAD) deficiency. METHODS This two-part study is registered with the Core Outcome Measures in Effectiveness Trials (COMET) initiative. Part 1 includes a rapid review and development of an evidence map to identify a comprehensive listing of outcomes reported in past studies of PKU and MCAD deficiency. The review follows established methods for knowledge synthesis, including a comprehensive search strategy, two stages of screening citations against inclusion/exclusion criteria by two reviewers working independently, and extraction of important data elements from eligible studies, including details of the outcomes collected and outcome measurement instruments. The review findings will inform part 2 of our study, a set of Delphi surveys to establish consensus on the highest priority outcomes for each condition. Healthcare providers, families of children with PKU or MCAD deficiency, and health system decision-makers will be invited to participate in two to three rounds of Delphi surveys. The design of the surveys will involve parents of children with IMD who are part of a family advisory forum. DISCUSSION This protocol is a crucial step in developing the capacity to launch RCTs with meaningful outcomes that address comparative effectiveness questions in the field of paediatric IMD. Such trials will contribute high-quality evidence to inform decision-making by patients and their family members, clinicians, and policy-makers.
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Affiliation(s)
- Beth K. Potter
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Drive, Ottawa, ON K1G 5Z3 Canada
| | - Brian Hutton
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Drive, Ottawa, ON K1G 5Z3 Canada
- Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Tammy J. Clifford
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Drive, Ottawa, ON K1G 5Z3 Canada
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON Canada
| | - Nicole Pallone
- Patient/family partner and Canadian PKU & Allied Disorders Inc, Sparwood, BC Canada
| | - Maureen Smith
- Patient/family partner and Canadian Organization for Rare Disorders, Ottawa, ON Canada
| | - Sylvia Stockler
- BC Children’s Hospital and University of British Columbia, Vancouver, BC Canada
| | - Pranesh Chakraborty
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada
| | | | | | - Michael Pugliese
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Drive, Ottawa, ON K1G 5Z3 Canada
| | - Alvi Rahman
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Drive, Ottawa, ON K1G 5Z3 Canada
| | | | - Laure Tessier
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada
| | - Kylie Tingley
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Drive, Ottawa, ON K1G 5Z3 Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Drive, Ottawa, ON K1G 5Z3 Canada
| | | | - Lawrence Korngut
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
| | - Alex MacKenzie
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada
| | | | - Stuart Nicholls
- Clinical Research Unit, Children’s Hospital of Eastern Ontario, Ottawa, ON Canada
- Ontario Child Health SUPPORT Unit (OCHSU), Ottawa, ON Canada
| | - Martin Offringa
- Hospital for Sick Children and University of Toronto, Toronto, ON Canada
| | - Andreas Schulze
- Hospital for Sick Children and University of Toronto, Toronto, ON Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Drive, Ottawa, ON K1G 5Z3 Canada
- Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - In collaboration with the Canadian Inherited Metabolic Diseases Research Network
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Drive, Ottawa, ON K1G 5Z3 Canada
- Ottawa Hospital Research Institute, Ottawa, ON Canada
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON Canada
- Patient/family partner and Canadian PKU & Allied Disorders Inc, Sparwood, BC Canada
- Patient/family partner and Canadian Organization for Rare Disorders, Ottawa, ON Canada
- BC Children’s Hospital and University of British Columbia, Vancouver, BC Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada
- University of Manitoba, Winnipeg, MB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
- McGill University Health Centre, Montreal, QC Canada
- Clinical Research Unit, Children’s Hospital of Eastern Ontario, Ottawa, ON Canada
- Ontario Child Health SUPPORT Unit (OCHSU), Ottawa, ON Canada
- Hospital for Sick Children and University of Toronto, Toronto, ON Canada
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Toward Establishing Core Outcome Domains For Trials in Kidney Transplantation: Report of the Standardized Outcomes in Nephrology-Kidney Transplantation Consensus Workshops. Transplantation 2017; 101:1887-1896. [PMID: 28737661 DOI: 10.1097/tp.0000000000001774] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment decisions in kidney transplantation requires patients and clinicians to weigh the benefits and harms of a broad range of medical and surgical interventions, but the heterogeneity and lack of patient-relevant outcomes across trials in transplantation makes these trade-offs uncertain, thus, the need for a core outcome set that reflects stakeholder priorities. METHODS We convened 2 international Standardized Outcomes in Nephrology-Kidney Transplantation stakeholder consensus workshops in Boston (17 patients/caregivers; 52 health professionals) and Hong Kong (10 patients/caregivers; 45 health professionals). In facilitated breakout groups, participants discussed the development and implementation of core outcome domains for trials in kidney transplantation. RESULTS Seven themes were identified. Reinforcing the paramount importance of graft outcomes encompassed the prevailing dread of dialysis, distilling the meaning of graft function, and acknowledging the terrifying and ambiguous terminology of rejection. Reflecting critical trade-offs between graft health and medical comorbidities was fundamental. Contextualizing mortality explained discrepancies in the prioritization of death among stakeholders-inevitability of death (patients), preventing premature death (clinicians), and ensuring safety (regulators). Imperative to capture patient-reported outcomes was driven by making explicit patient priorities, fulfilling regulatory requirements, and addressing life participation. Specificity to transplant; feasibility and pragmatism (long-term impacts and responsiveness to interventions); and recognizing gradients of severity within outcome domains were raised as considerations. CONCLUSIONS Stakeholders support the inclusion of graft health, mortality, cardiovascular disease, infection, cancer, and patient-reported outcomes (ie, life participation) in a core outcomes set. Addressing ambiguous terminology and feasibility is needed in establishing these core outcome domains for trials in kidney transplantation.
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Stevens J, Pratt C, Boyington J, Nelson C, Truesdale KP, Ward DS, Lytle L, Sherwood NE, Robinson TN, Moore S, Barkin S, Cheung YK, Murray DM. Multilevel Interventions Targeting Obesity: Research Recommendations for Vulnerable Populations. Am J Prev Med 2017; 52:115-124. [PMID: 28340973 PMCID: PMC5571824 DOI: 10.1016/j.amepre.2016.09.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/18/2016] [Accepted: 09/06/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The origins of obesity are complex and multifaceted. To be successful, an intervention aiming to prevent or treat obesity may need to address multiple layers of biological, social, and environmental influences. METHODS NIH recognizes the importance of identifying effective strategies to combat obesity, particularly in high-risk and disadvantaged populations with heightened susceptibility to obesity and subsequent metabolic sequelae. To move this work forward, the National Heart, Lung, and Blood Institute, in collaboration with the NIH Office of Behavioral and Social Science Research and NIH Office of Disease Prevention convened a working group to inform research on multilevel obesity interventions in vulnerable populations. The working group reviewed relevant aspects of intervention planning, recruitment, retention, implementation, evaluation, and analysis, and then made recommendations. RESULTS Recruitment and retention techniques used in multilevel research must be culturally appropriate and suited to both individuals and organizations. Adequate time and resources for preliminary work are essential. Collaborative projects can benefit from complementary areas of expertise and shared investigations rigorously pretesting specific aspects of approaches. Study designs need to accommodate the social and environmental levels under study, and include appropriate attention given to statistical power. Projects should monitor implementation in the multiple venues and include a priori estimation of the magnitude of change expected within and across levels. CONCLUSIONS The complexity and challenges of delivering interventions at several levels of the social-ecologic model require careful planning and implementation, but hold promise for successful reduction of obesity in vulnerable populations.
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Affiliation(s)
- June Stevens
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Charlotte Pratt
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Josephine Boyington
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Cheryl Nelson
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Kimberly P Truesdale
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Leslie Lytle
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nancy E Sherwood
- HealthPartners Institute for Education and Research, Bloomington, Minnesota
| | - Thomas N Robinson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Shirley Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Shari Barkin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ying Kuen Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - David M Murray
- Division of Program Coordination, Planning, and Strategic Initiatives, NIH, Bethesda, Maryland
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