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El Chami C, Meunier-Beillard N, Binquet C, Lepage C, Lejeune C. [Targeted therapies and immunotherapy: Positioning in the field of innovation and challenges for the therapeutic decision-making process]. Bull Cancer 2024:S0007-4551(24)00259-5. [PMID: 39209672 DOI: 10.1016/j.bulcan.2024.06.001] [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: 01/29/2024] [Revised: 04/29/2024] [Accepted: 06/01/2024] [Indexed: 09/04/2024]
Abstract
The better understanding of the molecular, cellular, and immunological mechanisms of cancer has led to the development of targeted therapies, then immunotherapy, which have changed the approach to cancer treatment. While these treatments differ from chemotherapy in their mechanisms of action, they also allow for increased personalization of cancer care through the development of technologies that target patients more precisely. However, they are associated with several challenges: the management of uncertainty associated with their risk-benefit balance due to the lack of long-term data and sometimes scientific evidence on their effects; the complexity of integrating molecular and immunological data into the therapeutic decision; the challenge of inequalities in access to these treatments often considered revolutionary due to the required molecular characterization and/or inclusion criteria for early-phase trials; and the challenge of their appropriation and adoption by physicians and patients. This narrative review explores each of these challenges in the context of shared decision-making, the promotion of which is a guarantee of quality and safety of care for cancer patients.
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Affiliation(s)
- Carole El Chami
- Inserm, CTM UMR1231, université de Bourgogne, 21000 Dijon, France; Labex LipSTIC, ANR-11-LABX-0021, université Bourgogne Franche-Comté, 21000 Dijon, France.
| | - Nicolas Meunier-Beillard
- CIC 1432, module épidémiologie clinique, Inserm, CHU de Dijon, université de Bourgogne, 21000 Dijon, France; Direction de la recherche clinique et de l'innovation, CHU de Dijon, 21000 Dijon, France
| | - Christine Binquet
- Inserm, CTM UMR1231, université de Bourgogne, 21000 Dijon, France; Labex LipSTIC, ANR-11-LABX-0021, université Bourgogne Franche-Comté, 21000 Dijon, France; CIC 1432, module épidémiologie clinique, Inserm, CHU de Dijon, université de Bourgogne, 21000 Dijon, France
| | - Côme Lepage
- Inserm, CTM UMR1231, université de Bourgogne, 21000 Dijon, France; Service d'hépato-gastro-entérologie et cancérologie digestive, CHU de Dijon, 21000 Dijon, France
| | - Catherine Lejeune
- Inserm, CTM UMR1231, université de Bourgogne, 21000 Dijon, France; Labex LipSTIC, ANR-11-LABX-0021, université Bourgogne Franche-Comté, 21000 Dijon, France; CIC 1432, module épidémiologie clinique, Inserm, CHU de Dijon, université de Bourgogne, 21000 Dijon, France
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Carvalho D. Access from healthcare professionals to evidence-based pharmacotherapy in allergy management. Curr Opin Allergy Clin Immunol 2024; 24:274-279. [PMID: 38640143 DOI: 10.1097/aci.0000000000000989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
PURPOSE OF REVIEW Access to evidence-based pharmacotherapy (EBP) is crucial in effectively managing allergies. Allergy conditions, including rhinitis, asthma, and dermatitis, require treatment guided by scientific evidence. However, healthcare professionals face challenges in accessing relevant information. RECENT FINDINGS The dynamic nature of allergy research, coupled with limited resources and variability in practice guidelines, complicates decision-making. SUMMARY To enhance access, healthcare institutions should invest in comprehensive online resources tailored to allergy management, such as databases and platforms. Advances in algorithm development have shown that artificial intelligence and machine learning can enhance clinical decision-making. Integrating allergy-specific Clinical Decision Support Systems (CDSS) into electronic health records can assist professionals in making EBP decisions at the point of care. Continuing education and training programs focused on allergy management can keep healthcare providers updated on the latest research and guidelines. Multidisciplinary teams facilitate knowledge exchange and standardize practice approaches. Social media outlets can be a great route to publicize work carried out or in progress to a target audience of interest. By bridging the gap between evidence and practice in allergy management, healthcare systems can ensure optimal care for patients, alleviating the burden of allergic diseases on individuals and society.
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Affiliation(s)
- Daniela Carvalho
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
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Keyes O, Dietz EA. Values and Evidence in Gender-Affirming Care. Hastings Cent Rep 2024; 54:51-53. [PMID: 38842883 DOI: 10.1002/hast.1592] [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] [Indexed: 06/07/2024]
Abstract
This commentary responds to the article "What Is the Aim of Pediatric 'Gender-Affirming' Care?," by Moti Gorin, in the same issue of the journal. Gender-affirming care is often treated as exceptional and subject to heightened scrutiny. This exceptionalization results in its being held to stricter evidentiary standards than other forms of medical interventions are. But values and value judgments are inextricable from the practice of evidence-based medicine. For gender-affirming care, values shape what counts as "strong" evidence, whether the legitimacy of transgender identity is assumed versus treated as something to be investigated, how to characterize the testimonial accounts of trans and gender-nonconforming patients, and more. We argue that these kinds of questions are part of the practice of medicine, not exceptional to transgender people and gender-affirming care. However, litigation of evidence for gender-affirming care in state and national policy underscores the moral urgency of thinking carefully about what values ought to guide evidence.
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Gonzalez-Del-Hoyo M, Mas-Llado C, Siquier-Padilla J, Blaya-Peña L, Coughlan JJ, Peral V, Rossello X. A systematic assessment of the characteristics of randomized controlled trials cited by acute coronary syndrome clinical practice guidelines. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:176-188. [PMID: 37296213 DOI: 10.1093/ehjqcco/qcad034] [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: 03/22/2023] [Revised: 05/23/2023] [Accepted: 06/08/2023] [Indexed: 06/12/2023]
Abstract
AIMS The aim of this study was to describe the methodological features of the randomized controlled trials (RCTs) cited in American and European clinical practice guidelines (CPGs) for ST elevation myocardial infarction (STEMI) and non-ST elevation acute coronary syndrome (NSTE-ACS). METHODS AND RESULTS Out of 2128 non-duplicated references cited in the 2013 and 2014 American College of Cardiology/American Heart Association and 2017 and 2020 European Society of Cardiology CPGs for STEMI and NSTE-ACS, we extracted data for 407 RCTs (19.1% of total references). The majority were multicenter studies (81.8%), evaluated pharmacological interventions (63.1%), had a 2-arm (82.6%), and superiority (90.4%) design. Most RCTs (60.2%) had an active comparator, and 46.2% were funded by industry. The median observed sample size was 1001 patients (84.2% of RCTs achieved ≥80% of the intended sample size). Most RCTs had a single primary outcome (90.9%), which was a composite in just over half (51.9%). Among the RCTs testing for superiority, 44.0% reported a P-value of ≥0.05 for the primary outcome and 61.9% observed a risk reduction of >15%. The observed treatment effect was lower-than-expected in 67.6% of RCTs, with 34.4% having at least a 20% lower-than-expected treatment effect. The calculated post hoc statistical power was ≥80% for 33.9% of cited RCTs. CONCLUSIONS This analysis demonstrates that RCTs cited by CPGs can still have significant methodological issues and limitations, highlighting that a better understanding of the methodological aspects of RCTs is crucial in order to formulate recommendations relevant to clinical practice.
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Affiliation(s)
- Maribel Gonzalez-Del-Hoyo
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, 07120 Palma, Spain
- Cardiology Department, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120 Palma, Spain
| | - Caterina Mas-Llado
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, 07120 Palma, Spain
- Cardiology Department, Hospital de Manacor, Carretera Manacor-Alcudia, 07500 Manacor, Spain
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Carretera de Valldemossa, 79, 07120 Palma, Spain
| | - Joan Siquier-Padilla
- Cardiology Department, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120 Palma, Spain
| | - Laura Blaya-Peña
- Cardiology Department, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120 Palma, Spain
| | - J J Coughlan
- Cardiovascular Research Institute, Universtiy of Medicine and Health Sciences, Mater Private Network, D07 KWR1 Dublin, Ireland
| | - Vicente Peral
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, 07120 Palma, Spain
- Cardiology Department, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120 Palma, Spain
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Carretera de Valldemossa, 79, 07120 Palma, Spain
| | - Xavier Rossello
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, 07120 Palma, Spain
- Cardiology Department, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120 Palma, Spain
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Carretera de Valldemossa, 79, 07120 Palma, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Calle Melchor Fernández Almagro, 3, 28029 Madrid, Spain
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Safi AG, Kalaji M, Avery R, Niederdeppe J, Mathios A, Dorf M, Byrne S. Examining Perceptions of Uncertain Language in Potential E-Cigarette Warning Labels: Results from 16 Focus Groups with Adult Tobacco Users and Youth. HEALTH COMMUNICATION 2024; 39:460-481. [PMID: 36717390 PMCID: PMC10387126 DOI: 10.1080/10410236.2023.2170092] [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] [Indexed: 06/18/2023]
Abstract
E-cigarette use among youth presents a public health risk. Yet, cigarette smokers who substantially reduce their smoking or switch completely from traditional combustible cigarettes could benefit. As science about e-cigarettes is continually emerging, any potential warnings are likely to contain uncertain language. Hedged verbiage may impact decision making. To assess reactions, we conducted 16 online focus groups; 8 with youth (n = 32, grouped by gender and by vaping experience) and 8 with adult tobacco users (n = 37, grouped by smokers, dual users of e-cigarettes and cigarettes, and former smokers who switched to e-cigarettes). Each focus group viewed and discussed 8 potential warnings messages. We conducted an inductive thematic analysis of the reactions to warning messages that contain uncertain language. Respondents' reactions were often negative, but varied based on specific usages of uncertainty, existing beliefs about uncertainty in law and science, and smoking/vaping use patterns that supported the use of uncertainty related to e-cigarettes. Many youth (and some adults) believed that uncertain language enabled audiences to minimize the likelihood of harm or interpreted it as meaning there are both healthy and unhealthy e-cigarettes. This qualitative study provides evidence that the use of types of uncertain language, the frequency of that use, and/or the selection of particular words in warnings, might not achieve the intended public health aims of increasing understanding of risk, deterring youth uptake, and/or facilitating a substantial switch from cigarettes. The use of certain types of uncertain language appears to have significant potential to bring unintended consequences. Suggestions for research and policy are included.
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Affiliation(s)
- Amelia Greiner Safi
- Department of Public and Ecosystem Health, Cornell University, USA
- Department of Communication, Cornell University, USA
| | - Motasem Kalaji
- Department of Communication Studies, California State University Northridge, USA
| | - Rosemary Avery
- Jeb E. Brooks School of Public Policy, Cornell University, USA
| | - Jeff Niederdeppe
- Department of Communication, Cornell University, USA
- Jeb E. Brooks School of Public Policy, Cornell University, USA
| | - Alan Mathios
- Jeb E. Brooks School of Public Policy, Cornell University, USA
| | | | - Sahara Byrne
- Department of Communication, Cornell University, USA
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Mas-Llado C, Rossello X, González-Del-Hoyo M, Pocock S, de Werf FV, Chin CT, Danchin N, Lee SWL, Medina J, Huo Y, Bueno H. Secondary Prevention Therapies in Real-World Patients with Myocardial Infarction: Eligibility Based on Randomized Trials Supporting European and American Guidelines. Am J Med 2024; 137:137-146.e10. [PMID: 37838236 DOI: 10.1016/j.amjmed.2023.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE We aimed to evaluate the applicability of the eligibility criteria of randomized controlled trials (RCTs) cited in guideline recommendations in a real-world cohort of patients receiving secondary prevention after acute myocardial infarction from the EPICOR registries. METHODS Recommendations provided by American and European guidelines for acute myocardial infarction were classified into general (applying to all patients) and specific (applying to patients with left ventricular dysfunction or heart failure). Randomized controlled trials cited in these recommendations were selected, and their entry criteria were applied to our international cohort of 18,117 patients. RESULTS There were 91.5% patients eligible for beta blockers (84.6% for general, and 5.9% for specific recommendations), 97.7% eligible for renin-angiotensin system inhibitor (angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers [ACEI/ARB]) recommendations (69.9% for general, 27.9% for specific) and 4.1% eligible for mineralocorticoid receptor antagonists (only specific recommendations). The percentages of patients with eligibility criteria who were discharged with a prescription of the recommended therapies were 80%-85% for beta blockers, 70%-75% for ACEI/ARB, and 29% for mineralocorticoid receptor antagonists. There were large regional variations in the percentage of eligible patients and in those receiving the medications (eg, 95% in Northern Europe and 57% in Southeast Asia for beta blockers). CONCLUSION Most real-world acute myocardial infarction patients are eligible for secondary prevention therapy in both general and specific guideline recommendations, and the percentage of those on beta blockers and ACEI/ARB at hospital discharge is high. There are large regional variations in the proportion of patients receiving recommended therapies. Local targeted interventions are needed for quality improvement.
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Affiliation(s)
- Caterina Mas-Llado
- Cardiology Department, Hospital de Manacor, Spain; Health Research Institute of the Balearic Islands, Palma, Spain; Facultad de Medicina, Universitat de les Illes Balears, Palma, Spain
| | - Xavier Rossello
- Health Research Institute of the Balearic Islands, Palma, Spain; Facultad de Medicina, Universitat de les Illes Balears, Palma, Spain; Cardiology Department, Health Research Institute of the Balearic Islands, Hospital Universitari Son Espases, Palma, Spain; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
| | | | | | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Belgium
| | | | - Nicolas Danchin
- Hôpital Européen Georges Pompidou & René Descartes University, France
| | | | | | - Yong Huo
- Beijing University First Hospital, China
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación i+12, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain.
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Yu X, Wu S, Sun Y, Wang P, Wang L, Su R, Zhao J, Fadlallah R, Boeira L, Oliver S, Abraha YG, Sewankambo NK, El-Jardali F, Norris SL, Chen Y. Exploring the diverse definitions of 'evidence': a scoping review. BMJ Evid Based Med 2024; 29:37-43. [PMID: 37940419 PMCID: PMC10850639 DOI: 10.1136/bmjebm-2023-112355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To systematically collect and analyse diverse definitions of 'evidence' in both health and social sciences, and help users to correctly use the term 'evidence' and rethink what is the definition of 'evidence' in scientific research. DESIGN Scoping review. METHODS Definitions of evidence in the health sciences and social sciences were included. We have excluded the definition of evidence applied in the legal field, abstracts without full text, documents not published in either Chinese or English and so on. We established a multidisciplinary working group and systematically searched five electronic databases including Medline, Web of Science, EBSCO, the Chinese Social Sciences Citation Index and the Chinese Science Citation Database from their inception to 26 February 2022. We also searched websites and reviewed the reference lists of the identified studies. Six reviewers working in pairs, independently, selected studies according to the inclusion and exclusion criteria, and extracted information. Any differences were discussed in pairs, and if there was disagreement, it was resolved via discussion or with the help of a third reviewer. Reviewers extracted document characteristics, the original content for the definitions of 'evidence', assessed definitions as either intensional or extensional, and any citations for the given definition. RESULTS Forty-nine documents were finally included after screening, and 68 definitions were obtained. After excluding duplicates, a total of 54 different definitions of 'evidence' were identified. There were 42 intensional definitions and 12 extensional definitions. The top three definiens were 'information', 'fact' and 'research/study'. The definition of 'evidence' differed between health and social sciences. The term 'research' appeared most frequently in the definitions. CONCLUSIONS The definition of 'evidence' has gradually attracted the attention of many scholars and decision-makers in health and social sciences. Nevertheless, there is no widely recognised and accepted definition in scientific research. Given the wide use of the term, we need to think about whether, or under what circumstances, a standardised, clear, meaningful and widely applicable definition of 'evidence' might be helpful.
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Affiliation(s)
- Xuan Yu
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Shouyuan Wu
- Department of Epidemiology and Biostatistics, Lanzhou University School of Public Health, Lanzhou, Gansu, China
| | - Yajia Sun
- Department of Epidemiology and Biostatistics, Lanzhou University School of Public Health, Lanzhou, Gansu, China
| | - Ping Wang
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Ling Wang
- Department of Epidemiology and Biostatistics, Lanzhou University School of Public Health, Lanzhou, Gansu, China
| | - Renfeng Su
- Department of Epidemiology and Biostatistics, Lanzhou University School of Public Health, Lanzhou, Gansu, China
| | - Junxian Zhao
- Department of Social Medicine and Health Management, Lanzhou University School of Public Health, Lanzhou, Gansu, China
| | - Racha Fadlallah
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
| | | | - Sandy Oliver
- EPPI-Centre, Social Science Research Unit, UCL Social Research Institute, University College London, London, UK
- Africa Centre for Evidence, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Yoseph G Abraha
- Knowledge Translation Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Fadi El-Jardali
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
| | - Susan L Norris
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Yaolong Chen
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), Lanzhou University School of Basic Medical Sciences, Lanzhou, Gansu, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, Gansu, China
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Mas-Llado C, Gonzalez-Del-Hoyo M, Siquier-Padilla J, Blaya-Peña L, Coughlan JJ, García de la Villa B, Peral V, Rossello X. Representativeness in randomised clinical trials supporting acute coronary syndrome guidelines. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:796-805. [PMID: 36702530 PMCID: PMC10745262 DOI: 10.1093/ehjqcco/qcad007] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/12/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023]
Abstract
AIMS Clinical practice guidelines (CPGs) are published to guide the management of acute coronary syndrome (ACS). We aimed to critically appraise the representativeness and standard of care of randomised clinical trials (RCTs) supporting CPGs for ACS. METHODS AND RESULTS American and European CPGs for ST- and non-ST-elevation ACS were screened to extract all references (n = 2128) and recommendations (n = 600). Among the 407 primary publications of RCTs (19.1%), there were 52.6 and 73.2% recruiting patients in North America and Europe, respectively, whereas other regions were largely under-represented (e.g. 25.3% RCTs recruited in Asia). There was 68.6% RCTs enrolling patient with ACS, whereas the remaining 31.4% did not enrol any patient with ACS. There was under-representation of some important subgroups, including elderly, female (29.9%), and non-white patients (<20%). The incidence and type of reperfusion reported in these RCTs were not reflective of current clinical practice (the percentage of patients who underwent percutaneous coronary intervention (PCI) among all RCTs was 42.7%; whereas for ST-Elevation Myocardial Infarction patients, the number of participants who underwent fibrinolysis was 3.3-fold higher than those who underwent primary PCI). All-cause mortality in these RCTs was 11.9% in RCTs with a follow-up ≤ 1 year. CONCLUSION Randomised clinical trials supporting CPGs for ACS are not fully representative of the diversity of the ACS population and their current standard of care. While some of these issues with representativeness may be explained by how evidence has been accrued over time, efforts should be made by trialists to ensure that the evidence supporting CPGs is representative of the wider ACS population.
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Affiliation(s)
- Caterina Mas-Llado
- Cardiology Department, Hospital de Manacor, 07500 Manacor, Spain
- Fisiopatología y Terapéutica Cardiovascular, Health Research Institute of the Balearic Islands (IdISBa), 07122 Palma, Spain
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Spain
| | - Maribel Gonzalez-Del-Hoyo
- Fisiopatología y Terapéutica Cardiovascular, Health Research Institute of the Balearic Islands (IdISBa), 07122 Palma, Spain
- Cardiology Department, Hospital Universitari Son Espases, Health Research Institute of the Balearic Islands (IdISBa), 07122 Palma, Spain
| | - Joan Siquier-Padilla
- Cardiology Department, Hospital Universitari Son Espases, Health Research Institute of the Balearic Islands (IdISBa), 07122 Palma, Spain
| | - Laura Blaya-Peña
- Cardiology Department, Hospital Universitari Son Espases, Health Research Institute of the Balearic Islands (IdISBa), 07122 Palma, Spain
| | - J J Coughlan
- Cardiology Department, Deutsches Herzzentrum München und Technische Universität München, 80636 Munich, Germany
- Cardiology Department, Cardiovascular Research Institute, Mater Private Network, D07 KWR1 Dublin, Ireland
| | - Bernardo García de la Villa
- Cardiology Department, Hospital de Manacor, 07500 Manacor, Spain
- Fisiopatología y Terapéutica Cardiovascular, Health Research Institute of the Balearic Islands (IdISBa), 07122 Palma, Spain
| | - Vicente Peral
- Fisiopatología y Terapéutica Cardiovascular, Health Research Institute of the Balearic Islands (IdISBa), 07122 Palma, Spain
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Spain
- Cardiology Department, Hospital Universitari Son Espases, Health Research Institute of the Balearic Islands (IdISBa), 07122 Palma, Spain
| | - Xavier Rossello
- Fisiopatología y Terapéutica Cardiovascular, Health Research Institute of the Balearic Islands (IdISBa), 07122 Palma, Spain
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Spain
- Cardiology Department, Hospital Universitari Son Espases, Health Research Institute of the Balearic Islands (IdISBa), 07122 Palma, Spain
- Translational Laboratory for Cardiovascular Imaging and Therapy, Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
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Gambó Ruberte E, Chabbar Boudet MC, Albarrán Martín C, Untoria Agustín C, Murlanch Dosset E, Peiró Aventín B, Garza Benito F. [Prognostic effects of cardiac rehabilitation in patients with acute coronary syndrome]. J Healthc Qual Res 2023; 38:206-213. [PMID: 36804861 DOI: 10.1016/j.jhqr.2023.01.001] [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: 07/07/2022] [Revised: 12/03/2022] [Accepted: 01/10/2023] [Indexed: 02/17/2023]
Abstract
AIM Reduction of major adverse cardiovascular events (MACE) at 5 years in patients with acute coronary syndrome (ACS) and percutaneous coronary intervention who completed a cardiac rehabilitation program. METHODS We included 230 consecutive men with a diagnosis of ACS and percutaneous coronary intervention in the first half of 2015 according to the inclusion criteria. Two cohorts of 115 patients each were compared, one of them (rehabilitated group) with patients who completed the cardiac rehabilitation program and the other (control group) who received conventional outpatient care. Base-line characteristics and MACE at 5-years follow-up were compared and analyzed. MACE included re-infarction, heart failure, cerebrovascular accident and all-cause mortality. RESULTS At 5 years of follow-up, a statistically significant reduction in MACE (27.19% vs 7.83%; OR 0.23 [IC 0.10-0.50]; P=.0001), all-cause mortality (OR 0.12 [IC 0.01-0.94]; P=0.01), re-infarction rate (OR 0.29 [IC 0.11-0.77]; P=.007) and cerebrovascular accident (P=.014) was found in the rehabilitated group (RG). MACE-free survival was significantly longer in the RG, regardless of risk (HR 0.25 [IC 0.12-0.53]; P=.000). CONCLUSION In our sample, cardiac rehabilitation programs showed a prognostic benefit in patients with ACS and percutaneous coronary intervention, with a statistically significant reduction in MACE, re-infarction rate and CVA at five-year follow-up.
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Affiliation(s)
- E Gambó Ruberte
- Departamento de Cardiología, Hospital Arnau de Vilanova, Lleida, España.
| | - M C Chabbar Boudet
- Unidad de Prevención Cardiovascular y Rehabilitación Cardiaca, Hospital Nuestra Señora de Gracia, Zaragoza, España
| | - C Albarrán Martín
- Unidad de Prevención Cardiovascular y Rehabilitación Cardiaca, Hospital Nuestra Señora de Gracia, Zaragoza, España
| | - C Untoria Agustín
- Unidad de Prevención Cardiovascular y Rehabilitación Cardiaca, Hospital Nuestra Señora de Gracia, Zaragoza, España
| | - E Murlanch Dosset
- Departamento de Cardiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - B Peiró Aventín
- Departmento de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - F Garza Benito
- Unidad de Prevención Cardiovascular y Rehabilitación Cardiaca, Hospital Nuestra Señora de Gracia, Zaragoza, España
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Fernandez-Guzman D, Caira-Chuquineyra B, Baca-Rondan F, Yucra-Sosa MC, Ccami-Bernal F, Soriano-Moreno DR, Nieto-Gutierrez W, Benites-Zapata VA. Association between self-reported evidence-based medicine competencies and prescribing of drugs without scientific evidence against mild COVID-19 among recently graduated physicians in Peru. Heliyon 2023; 9:e15366. [PMID: 37064449 PMCID: PMC10082469 DOI: 10.1016/j.heliyon.2023.e15366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/20/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023] Open
Abstract
Objective To evaluate the association between self-rated evidence-based medicine (EBM) competencies and the prescription of drugs without scientific evidence against mild COVID-19 (present with any of the signs and symptoms of COVID-19 but who do not have shortness of breath, dyspnea, or abnormal chest imaging) among recently graduated physicians in Peru. Methods We conducted an analytical cross-sectional study where we evaluated a non-probability sample of recently graduated physicians during June and July 2021 (end of second wave of COVID-19 in Peru). Self-rated EBM competencies were assessed by four domains (formulation of a clinical question, search, analysis, and application) using a Likert scale with scores from zero to four ("Very inadequate" = 0, to "Very Adequate" = 4), it was considered as "Adequate" if the score was three or four. In addition, the variable "General competence on EBM" was rated as "Adequate" if in all domains evaluated it presented an adequate self-rating. For the outcome, drug prescription, we considered the use of ivermectin, azithromycin, other antibiotics, hydroxychloroquine, dexamethasone, and anticoagulants (drugs with no efficacy demonstrated for patients with mild COVID-19). To assess the association, we used Poisson regression models with robust variances and obtaining crude (cPR) and adjusted (aPR) prevalence ratios with their 95% confidence intervals (95%CI). Results Of a total of 239 physicians included 70.7% prescribed at least one drug without scientific evidence. A total of 51.1% reported adequate ratings in all evaluated domains of EBM. Self-rating the "Clinical Question Formulation" competency as adequate was associated with a lower frequency of prescribing medications for mild COVID-19 (aPR: 0.93; 95% CI: 0.91-0.95). While self-rating as adequate the competency of "Identify possible implications of investigations" was associated with an increase in the prescription of such drugs (aPR: 1.14; 95% CI: 1.09-1.20). Additionally, self-rating all domains as adequate were associated with less prescription (aPR: 0.93; 95% CI: 0.90-0.96). Conclusion Seven out of ten recently graduated physicians prescribed some type of medication without scientific evidence to treat patients with mild COVID-19. Having adequate self-perceived EBM competencies was associated with a lower frequency of prescribing medications without scientific evidence to manage patients with mild COVID-19.
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Affiliation(s)
| | | | - Fiorella Baca-Rondan
- Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru
| | - Maria Cristina Yucra-Sosa
- Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru
| | - Fabricio Ccami-Bernal
- Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa, Arequipa, Peru
| | - David R Soriano-Moreno
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, Peru
| | | | - Vicente A Benites-Zapata
- Unidad para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
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11
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Torreggiani M, Wang AYM, Fois A, Piccoli GB. Personalized Low-Protein Diet Prescription in CKD Population: Merging Evidence From Randomized Trials With Observational Data. Semin Nephrol 2023; 43:151402. [PMID: 37536057 DOI: 10.1016/j.semnephrol.2023.151402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Nutritional therapy is a cornerstone of the clinical management of chronic kidney disease (CKD). Nevertheless, randomized controlled trials often have failed to show a relevant benefit of low-protein diets in nonselected CKD populations in terms of slowing the progression of kidney disease and need for dialysis. The more the target population is selected, the less the results can be generalizable to implement in clinical practice. On the contrary, observational studies, especially if performed with patient-centered, flexible approaches, point toward an extensive implementation of dietary protein restriction in different and unselected CKD populations. The observational evidence cannot be disregarded anymore. The most recent guidelines advise implementing low-protein diets or even very-low-protein diets in all CKD patients as early as stage 3. However, the lack of data from large randomized controlled trials on unselected CKD populations as well as on specific subpopulations, such as diabetic or obese patients, which nowadays comprise the majority of CKD subjects, reduces the generalizability of the recommendations. For some patient populations, such as those encompassing very old, nephrotic, or pregnant patients, the literature is even more limited because of the lower prevalence of these conditions and diffused prejudices against reducing protein intake. This pragmatic review discusses the need for integrating information derived from randomized trials with evidence derived from observational studies to guide feasible strategies for more successful implementation of low-protein diets in the treatment of all segments of the CKD population.
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Affiliation(s)
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Antioco Fois
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France
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12
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Management of Multisystem Inflammatory Syndrome in Children: Decision-Making Regarding a New Condition in the Absence of Clinical Trial Data. Can J Cardiol 2022:S0828-282X(22)01048-0. [PMID: 36455760 PMCID: PMC9705008 DOI: 10.1016/j.cjca.2022.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a new illness that evolved during the COVID-19 pandemic with initial reports of severe disease including use of extracorporeal membrane oxygenation and death. Institutions rapidly assembled task forces to develop treatment algorithms. At the national/international levels, collaboratives and associations assembled consensus writing groups to draft guidelines. These guidelines and algorithms were initially on the basis of expert opinion and small case series. Some groups used the Delphi approach, and the resultant guidelines often mimicked those for other conditions that resembled MIS-C, like Kawasaki disease (KD). For instance, intravenous immunoglobulin (IVIG), a known effective treatment for KD, was recommended for MIS-C. Early in the pandemic many favoured IVIG over steroids as first-line therapy. As evidence evolved so did some guidelines, which now endorse the dual use of IVIG with steroids as first-line therapy. In contrast, withholding immunotherapy became an option for some MIS-C patients with mild symptoms. Herein, we review guidelines and discuss the evidence informing early recommendations, how this has evolved, the role and limitations of expert opinion and observational data, and the importance of leveraging existing research infrastructures, such as the intensive care unit collaborative (Overcoming COVID-19 surveillance registry), and the International Kawasaki Disease Registry. Finally, we discuss strategies to rapidly develop, deploy, and adapt clinical trials evaluating the treatment of such rare conditions in children, which might include alternatives to conventional clinical trial design. The emergence of MIS-C during the COVID-19 pandemic has highlighted unmet needs regarding research of a new condition.
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13
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Rossello X, Massó-van Roessel A, Chioncel O, Tavazzi L, Ferrari R, Vahanian A, Gale CP, Popescu BA, Maggioni AP. EURObservational Research Programme: a bibliometric assessment of its scientific output. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:804-811. [PMID: 35881480 DOI: 10.1093/ehjqcco/qcac041] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 12/29/2022]
Abstract
AIMS Given the lack of reliable observational data, a network of volunteer centres, and standardized methodological procedures, the European Society of Cardiology EURObservational Research Programme (EORP) was set up to provide a better understanding of real-world cardiovascular care and outcomes. We aimed to evaluate the scientific impact of EORP using a bibliometric approach. METHODS AND RESULTS We collected data for each individual publication and for each individual journal with at least one EORP publication. Bibliometric indicators evaluating research performance were categorized into those evaluating EORP publications (publication-based indicators) and those assessing the journals where those papers were published (journal-based indicators). During the first ∼11 years since its inception, we found that EORP produced 189 publications, with most published in journals in the first quartile (60.9%) or the second quartile (33.5%) of the Web of Science Journal Citation Report. The total number of citations to EORP publications was 9630 (average citation per publication of 51, h-index of 54, and 29 EORP publications with ≥100 citations). Of EORP publications, 20 had an Altmetric Attention Score >50 and 9 had a score >100. A total of 52 EORP papers have been cited 65 times in ESC Clinical Practice Guidelines between 2013 and 2021. CONCLUSION EORP registries have contributed to impactful scientific knowledge. The high-quality metrics highlight the relevance of the EORP international cardiovascular registries to the academic community. Efforts are needed to support this, and other programmes aimed at delivering real-world evidence from independent patient data of cardiovascular care and outcomes across multiple geographies.
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Affiliation(s)
- Xavier Rossello
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Carretera de Valldemossa, 07122 Palma, Spain.,Cardiology Department, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, 07120 Palma, Spain.,Translational Laboratory for Cardiovascular Imaging and Therapy, Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain.,Medical Statistics Department, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Albert Massó-van Roessel
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Carretera de Valldemossa, 07122 Palma, Spain
| | - Ovidiu Chioncel
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila', Bucharest 050474, Romania.,Department of Cardiology, Emergency Institute for Cardiovascular Diseases 'Prof. Dr C. C. Iliescu', 022328 Bucharest, Romania
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy
| | | | - Alec Vahanian
- UFR Médecine, Université de Paris, 75006 Paris, France.,LVTS INSERM U1148, GH Bichat, 75018 Paris, France
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds LS2 9NL, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila', Bucharest 050474, Romania.,Department of Cardiology, Emergency Institute for Cardiovascular Diseases 'Prof. Dr C. C. Iliescu', 022328 Bucharest, Romania
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, 50014 Firenze, Italy
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14
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Martini A, Mottet N, Montorsi F, Necchi A, Ribal MJ, Malavaud B. A Plea for Economically Sustainable Evidence-based Guidelines. Eur Urol 2022; 82:449-451. [PMID: 35999118 DOI: 10.1016/j.eururo.2022.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 11/04/2022]
Abstract
The rising costs of cancer care with the introduction of new agents are a challenge. The impact of these costs differs among countries. We compare costs for metastatic prostate cancer, with prices normalized to international dollars, as an example that highlights the need for cost-effectiveness analyses in trials and treatment guidelines.
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Affiliation(s)
- Alberto Martini
- Department of Urology, Institut Universitaire du Cancer Toulouse-Oncopôle, Toulouse, France
| | - Nicolas Mottet
- Department of Urology, University Jean Monnet, St. Etienne, France
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Necchi
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria J Ribal
- Department of Urology, Uro-Oncology Unit, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Bernard Malavaud
- Department of Urology, Institut Universitaire du Cancer Toulouse-Oncopôle, Toulouse, France.
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15
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Davids JR, Shilt J, Kay R, Dreher T, Shore BJ, McCarthy J, Shrader W, Graham K, Veerkamp M, Narayanan U, Chambers H, Novacheck T, Rhodes J, Van Campenhout A, Pierz K, Theologis T, Rutz E. Assessment of foot alignment and function for ambulatory children with cerebral palsy: Results of a modified Delphi technique consensus study. J Child Orthop 2022; 16:111-120. [PMID: 35620124 PMCID: PMC9127886 DOI: 10.1177/18632521221084183] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/01/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study was to establish consensus for the assessment of foot alignment and function in ambulatory children with cerebral palsy, using expert surgeon's opinion through a modified Delphi technique. METHODS The panel used a five-level Likert-type scale to record agreement or disagreement with 33 statements regarding the assessment of foot alignment and function. Consensus was defined as at least 80% of responses being in the highest or lowest of two of the five Likert-type ratings. General agreement was defined as 60%-79% falling into the highest or lowest two ratings. There was no agreement if neither threshold was reached. RESULTS Consensus was achieved for 25 (76%) statements, general agreement for 4 (12%) statements, and lack of consensus for 4 (12%) of the statements. There was consensus that the functional anatomy of the foot is best understood by dividing the foot into three segments and two columns. Consensus was achieved concerning descriptors of foot segmental alignment for both static and dynamic assessment. There was consensus that radiographs of the foot should be weight-bearing. There was general agreement that foot deformity in children with cerebral palsy can be classified into three levels based on soft tissue imbalance and skeletal malalignment. CONCLUSION The practices identified in this study can be used to establish best care guidelines, and the format used will be a template for future Delphi technique studies on clinical decision-making for the management of specific foot segmental malalignment patterns commonly seen in children with cerebral palsy. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Jon R Davids
- Shriners Children’s Northern California, Sacramento, CA, USA,Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA,Jon R Davids, Shriners Children’s Northern California, 2425 Stockton Blvd., Sacramento, CA 95817, USA.
| | - Jeff Shilt
- Texas Children’s Hospital, Houston, TX, USA,Baylor College of Medicine, Houston, TX, USA
| | - Robert Kay
- Children’s Hospital Los Angeles, Los Angeles, CA, USA,Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Benjamin J Shore
- Boston Children’s Hospital, Boston, MA, USA,Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - James McCarthy
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Wade Shrader
- Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Kerr Graham
- The Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Matthew Veerkamp
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Tom Novacheck
- Gillette Children’s Specialty Healthcare, Saint Paul, MN, USA
| | | | | | - Kristan Pierz
- Connecticut Children’s Medical Center, Hartford, CT, USA
| | - Tim Theologis
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Erich Rutz
- The Royal Children’s Hospital, Melbourne, VIC, Australia
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16
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Fu C, Shuang Q, Liu Y, Zeng L, Su W. Baihe Extracts Reduce the Activation and Apoptosis of Microglia in the Hippocampus of Mice with Depression-like Behaviors by Downregulating MYC. ACS Chem Neurosci 2022; 13:587-598. [PMID: 35139304 DOI: 10.1021/acschemneuro.1c00439] [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: 12/09/2022] Open
Abstract
The purpose of our investigation is to identify the potential effects and key molecular targets of Baihe extracts in depression treatment. Network meta-analysis was applied for the synthesis of efficacy outcomes of fluoxetine and three traditional Chinese medicine Baihe prescriptions in depression. Depression-related target genes were screened using "GeneCards" database and "Comparative Toxicogenomics Database (CTD)". The major active components and targets of Baihe were screened using the Traditional Chinese Medicine Systems Pharmacology (TCMSP) database. The identified depression-related genes and the target genes of Baihe were intersected, an interaction network was constructed using the "String" database, and key target genes were determined based on their degree value. Functional enrichment analysis of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) profiles was performed using the "ClusterProfiler" R package. A mouse model with depression-like behaviors was constructed to verify the putative roles of the in silico identified key genes. Microglia were isolated from the mouse hippocampus, and the effects of Baihe extract-containing serum on microglia activation and apoptosis by targeting the key genes were examined in vitro. The meta-analysis results revealed no obvious differences in depression treatment efficacy between fluoxetine and the three Baihe prescriptions, suggesting Baihe extracts as a safe and effective alternative treatment for depression. Using network pharmacology and bioinformatics analysis, Baihe extracts were found to modulate depression by regulating 15 key genes, with MYC as the key gene. Subsequent animal experiments demonstrated that Baihe extracts reduced depression-related behavior, microglial activation, and inflammatory mediator release in mice by inhibiting MYC. Serum containing Baihe extracts could inhibit the activation of microglia and the release of inflammatory mediators by downregulating MYC. In summary, Baihe extracts were found to diminish MYC expression to reduce microglial activation and inflammatory factor release, thereby exerting antidepressant effects.
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Affiliation(s)
- Chunyan Fu
- College of Pharmacy, Shaoyang University, Shaoyang 422000, P. R. China
- The First Affiliated Hospital of Shaoyang University, Shaoyang 422000, P. R. China
- Hunan Engineering Research Center for Development and Utilization of Traditional Chinese Medicine in Southwest Hunan, Shaoyang University, Shaoyang 422000, P. R. China
| | - Qincui Shuang
- The First Affiliated Hospital of Shaoyang University, Shaoyang 422000, P. R. China
| | - Yonghui Liu
- The Second Affiliated Hospital of Shaoyang University, Shaoyang 422000, P. R. China
| | - Li Zeng
- College of Pharmacy, Shaoyang University, Shaoyang 422000, P. R. China
| | - Wen Su
- College of Pharmacy, Shaoyang University, Shaoyang 422000, P. R. China
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17
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Lozada-Martínez ID, Acevedo-Aguilar LM, Mass-Hernández LM, Matta-Rodríguez D, Jiménez-Filigrana JA, Garzón-Gutiérrez KE, Barahona-Botache SA, Vásquez-Castañeda DL, Caicedo-Giraldo SDR, Rahman S. Practical guide for the use of medical evidence in scientific publication: Recommendations for the medical student: Narrative review. Ann Med Surg (Lond) 2021; 71:102932. [PMID: 34659747 PMCID: PMC8503847 DOI: 10.1016/j.amsu.2021.102932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 11/25/2022] Open
Abstract
Currently, the adaptation of scientific evidence in clinical problem solving is based on the evidence-based medicine method. Medical students and health professionals should have an adequate knowledge of this method and thus provide adequate health care and increasingly provide high quality scientific publications that can be subsequently integrated in different clinical scenarios. Several scales and tools have been proposed as guides to recognize the different levels of quality of the available evidence, their degrees of recommendation and the biases and fallacies that may occur both in the clinical and research areas, with the aim of identifying the best available evidence. However, few students and professionals are aware of them and make proper use of them. Therefore, it is necessary to synthesize these tools in an understandable and practical way.
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Affiliation(s)
| | | | | | - Duván Matta-Rodríguez
- School of Medicine, Universidad de Ciencias Aplicadas y Ambientales, Bogotá, Colombia
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18
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Walsh J, Cave J, Griffiths F. Spontaneously Generated Online Patient Experience of Modafinil: A Qualitative and NLP Analysis. Front Digit Health 2021; 3:598431. [PMID: 34713085 PMCID: PMC8521895 DOI: 10.3389/fdgth.2021.598431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/27/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To compare the findings from a qualitative and a natural language processing (NLP) based analysis of online patient experience posts on patient experience of the effectiveness and impact of the drug Modafinil. Methods: Posts (n = 260) from 5 online social media platforms where posts were publicly available formed the dataset/corpus. Three platforms asked posters to give a numerical rating of Modafinil. Thematic analysis: data was coded and themes generated. Data were categorized into PreModafinil, Acquisition, Dosage, and PostModafinil and compared to identify each poster's own view of whether taking Modafinil was linked to an identifiable outcome. We classified this as positive, mixed, negative, or neutral and compared this with numerical ratings. NLP: Corpus text was speech tagged and keywords and key terms extracted. We identified the following entities: drug names, condition names, symptoms, actions, and side-effects. We searched for simple relationships, collocations, and co-occurrences of entities. To identify causal text, we split the corpus into PreModafinil and PostModafinil and used n-gram analysis. To evaluate sentiment, we calculated the polarity of each post between −1 (negative) and +1 (positive). NLP results were mapped to qualitative results. Results: Posters had used Modafinil for 33 different primary conditions. Eight themes were identified: the reason for taking (condition or symptom), impact of symptoms, acquisition, dosage, side effects, other interventions tried or compared to, effectiveness of Modafinil, and quality of life outcomes. Posters reported perceived effectiveness as follows: 68% positive, 12% mixed, 18% negative. Our classification was consistent with poster ratings. Of the most frequent 100 keywords/keyterms identified by term extraction 88/100 keywords and 84/100 keyterms mapped directly to the eight themes. Seven keyterms indicated negation and temporal states. Sentiment was as follows 72% positive sentiment 4% neutral 24% negative. Matching of sentiment between the qualitative and NLP methods was accurate in 64.2% of posts. If we allow for one category difference matching was accurate in 85% of posts. Conclusions: User generated patient experience is a rich resource for evaluating real world effectiveness, understanding patient perspectives, and identifying research gaps. Both methods successfully identified the entities and topics contained in the posts. In contrast to current evidence, posters with a wide range of other conditions found Modafinil effective. Perceived causality and effectiveness were identified by both methods demonstrating the potential to augment existing knowledge.
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Affiliation(s)
- Julia Walsh
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jonathan Cave
- Department of Economics, University of Warwick, Coventry, United Kingdom
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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19
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Vaz JM, Alves BM, Duarte DB, Marques LA, Santana RS. Quality appraisal of existing guidelines for the management of headache disorders by the AGREE II's method. Cephalalgia 2021; 42:239-249. [PMID: 34404264 DOI: 10.1177/03331024211037297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the quality of existing clinical practice guidelines for headache management and their main recommendations. BACKGROUND Evidence-based clinical practice guidelines have been developed to support the clinical decision-making. However, to achieve this goal, the quality of these guidelines must be ensured. METHODS A systematic search for clinical practice guidelines for headache management was conducted in the PubMed database, in websites of known guideline developers and in websites of known headache associations. The quality appraisal was performed through the Appraisal of Guidelines for Research and Evaluation II method. RESULTS Twelve guidelines were evaluated. The domains of rigor of development, applicability, and editorial independence, which most influence the overall quality of guidelines, had the lowest average scores and the highest standard deviation rates (61% ± 23; 37% ± 20; 53% ± 31). The main recommendations regarding medication use for acute treatment of episodic tension-type headache and migraine in adult patients consisted of paracetamol, acetylsalicylic acid, and other nonsteroidal anti-inflammatory drugs in all guidelines. CONCLUSIONS The statistical results indicate that the appraised guidelines have room for both individual and collective improvement. In addition, there is a well-established medication recommendation pattern among all guidelines evaluated.
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20
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Latoo J, Mistry M, Alabdulla M, Wadoo O, Jan F, Munshi T, Iqbal Y, Haddad P. Mental health stigma: the role of dualism, uncertainty, causation and treatability. Gen Psychiatr 2021; 34:e100498. [PMID: 34308151 PMCID: PMC8258661 DOI: 10.1136/gpsych-2021-100498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/15/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Javed Latoo
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
| | - Minal Mistry
- Fredericton Addiction and Mental Health Services, Fredericton, New Brunswick, Canada
| | - Majid Alabdulla
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
| | - Ovais Wadoo
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | - Farida Jan
- Department of Psychiatry, Northamptonshire Healthcare NHS Foundation Trust, Northampton, UK
| | - Tariq Munshi
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yousaf Iqbal
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | - Peter Haddad
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
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21
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Sex differences in Cardiac electronic device implantation: Outcomes from an Australian multi-centre clinical quality registry. IJC HEART & VASCULATURE 2021; 35:100828. [PMID: 34235244 PMCID: PMC8246382 DOI: 10.1016/j.ijcha.2021.100828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/30/2021] [Accepted: 06/12/2021] [Indexed: 12/11/2022]
Abstract
Background There is uncertainty regarding whether outcomes after Cardiac Implantable Electronic Devices (CIED) differ between women and men. There are no prospectively collected data regarding Australian CIED outcomes. This study aimed to determine whether the characteristics and outcomes of Australian patients undergoing CIED implantation differ by sex. Methods We prospectively followed 5,360 patients undergoing CIED implantation between 2015 and 2019 in a large multi-centre Australian registry. Patient characteristics, procedural data, medications and clinical outcomes to 1 year were analysed. Results The mean age was 76.2 + 11.2 years, and 2022 (37.7%) were female. Women were older than men at device implantation (77.0 ± 11.6 years vs. 75.5 ± 10.9 years, p < 0.001). Most implants were de novo (79.7%). Pacing was more commonly for sick sinus syndrome in women than men (54.4% vs. 47.2%, p < 0.001) and less often for A-V block (28.3% vs. 35.1%, p < 0.001). Adverse events at 30 days were low compared to international cohorts, for mortality (0.06%) and major complications (0.6%). There were no significant sex differences (women vs. men) for death (HR 1.33, 95% CI 0.58–3.13, p = 0.49) or major complications (HR 1.41, 95% 95% CI 0.65–3.03, p = 0.39). At 1-year, there was no difference in major complications or risk-adjusted all-cause mortality (HR 1.05, 95% CI 0.70–1.29, p = 0.77) between women and men. Conclusions Clinical practice and 30-day outcomes after CIED implantation in Australia are consistent with international reports. There were no differences in procedural complication rates or clinical outcomes at 1-year between women and men, regardless of age or CIED system implanted.
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Key Words
- A-V, Atrio-ventricular
- AF, Atrial fibrillation
- CABG, Coronary artery bypass graft
- CIED, Cardiac implantable electronic device
- CRT-P, Cardiac Resynchronisation therapy pacemaker
- Cardiac Implantable Electronic Device
- DDD, Dual chamber sensing and pacing
- EPS, Electrophysiological study
- GCOR, GenesisCare Cardiovascular Outcomes Registry
- HF, Heart failure
- ICD, Implantable cardioverter-defibrillator
- ILR, Implantable loop recorder
- MI, Myocardial infarction
- NCDR, National Cardiovascular data registry
- NOAC, Non-Vitamin K-dependent Oral Anticoagulant
- OR, Odds ratio
- Outcomes
- PCI, Percutaneous coronary intervention
- PM, Pacemaker
- Quality
- Registry
- Sex
- VDD, Ventricular sensing dual chamber pacing
- VT/VF, Ventricular tachycardia/fibrillation
- VVI, Ventricular sensing and pacing
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Bhagavathula AS, Vidyasagar K, Chhabra M, Rashid M, Sharma R, Bandari DK, Fialova D. Prevalence of Polypharmacy, Hyperpolypharmacy and Potentially Inappropriate Medication Use in Older Adults in India: A Systematic Review and Meta-Analysis. Front Pharmacol 2021; 12:685518. [PMID: 34093207 PMCID: PMC8173298 DOI: 10.3389/fphar.2021.685518] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/26/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Older people often receive multiple medications for chronic conditions, which often result in polypharmacy (concomitant use of 5‒9 medicines) and hyperpolypharmacy (concomitant use of ≥10 medicines). A limited number of studies have been performed to evaluate the prevalence of polypharmacy, hyperpolypharmacy, and potentially inappropriate medication (PIM) use in older people of developing countries. The present study aimed to investigate regional variations in the prevalence of polypharmacy, hyperpolypharmacy, and PIM use in older people (60 + years) in India. Methods: Studies were identified using Medline/PubMed, Scopus, and Google Scholar databases published from inception (2002) to September 31, 2020. Out of the total 1890 articles, 27 were included in the study. Results: Overall, the pooled prevalence of polypharmacy was 49% (95% confidence interval: 42–56; p < 0.01), hyperpolypharmacy was 31% (21–40; p < 0.01), and PIM use was 28% (24–32; p < 0.01) among older Indian adults. Polypharmacy was more prevalent in North-east India (65%, 50–79), whereas hyperpolypharmacy was prevalent in south India (33%, 17–48). Region-wize estimates for the pooled prevalence of PIM use in India were as follows: 23% (21–25) in East, 33% in West (24–42), 17.8% in North (11–23), and 32% (26–38) in South India. The prevalence of PIM use in adults aged ≥70°years was 35% (28–42), in those taking more medications (≥5.5/day) was 27% (22–31), and in adults using a high number of PIMs (≥3) was 29% (22–36). Subgroup analysis showed that cross-sectional studies had a higher pooled prevalence of polypharmacy 55% (44–65) than cohorts 45% (37–54). Hyperpolypharmacy in inpatient care settings was 37% (26–47), whereas PIM use was higher in private hospitals 31% (24–38) than government hospitals 25% (19–31). Conclusion: Polypharmacy and hyperpolypharmacy are widely prevalent in India. About 28% of older Indian adults are affected by PIM use. Thus, appropriate steps are needed to promote rational geriatric prescribing in India. Systematic Review Registration: https://clinicaltrials.gov, identifier [CRD42019141037].
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Affiliation(s)
- Akshaya S Bhagavathula
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czechia
| | - Kota Vidyasagar
- University College of Pharmaceutical Sciences, Kakatiya University, Warangal, India
| | - Manik Chhabra
- Indo-Soviet Friendship College of Pharmacy, Moga, India
| | - Muhammed Rashid
- Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Mandya, India
| | | | - Deepak K Bandari
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czechia
| | - Daniela Fialova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czechia.,Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czechia
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Seventy-Fifth Anniversary of Plastic and Reconstructive Surgery: How Evidence-Based Medicine Has Transformed Plastic Surgery. Plast Reconstr Surg 2021; 147:1235-1241. [PMID: 33890912 DOI: 10.1097/prs.0000000000007913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Validity and reliability of the Noor Evidence-Based Medicine Questionnaire: A cross-sectional study. PLoS One 2021; 16:e0249660. [PMID: 33886615 PMCID: PMC8061909 DOI: 10.1371/journal.pone.0249660] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 02/28/2021] [Indexed: 11/19/2022] Open
Abstract
Background Evidence-based medicine (EBM) is a widely accepted scientific advancement in clinical settings that helps achieve better, safer, and more cost-effective healthcare. However, presently, validated instruments to evaluate healthcare professionals’ attitude and practices toward implementing EBM are not widely available. Therefore, the present study aimed to determine the validity and reliability of a newly developed knowledge, attitude, and practice (KAP) questionnaire on EBM for use among healthcare professionals. Methods The Noor Evidence-Based Medicine Questionnaire was tested among physicians in a government hospital between July and August 2018. Exploratory factor analysis and internal consistency reliability-based Cronbach’s alpha statistic were conducted. Results The questionnaire was distributed among 94 physicians, and 90 responded (response rate of 95.7%). The initial number of items in the KAP domains of the Noor Evidence-Based Medicine Questionnaire were 15, 17, and 13, respectively; however, two items in the practice domain with communalities <0.25 and factor loadings <0.4 were removed. The factor structure accounted for 52.33%, 66.29%, and 55.39% of data variance in the KAP domains, respectively. Cronbach’s alpha values were 0.81, 0.81, and 0.84 for KAP domains, respectively, indicating high reliability. Conclusions This questionnaire can be used to evaluate the knowledge, attitudes, and behaviour of healthcare professionals toward EBM. Future testing of this questionnaire among other medical personnel groups will help expand the scope of this tool.
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Lamy JB. A data science approach to drug safety: Semantic and visual mining of adverse drug events from clinical trials of pain treatments. Artif Intell Med 2021; 115:102074. [PMID: 34001324 DOI: 10.1016/j.artmed.2021.102074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 01/21/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
Clinical trials are the basis of Evidence-Based Medicine. Trial results are reviewed by experts and consensus panels for producing meta-analyses and clinical practice guidelines. However, reviewing these results is a long and tedious task, hence the meta-analyses and guidelines are not updated each time a new trial is published. Moreover, the independence of experts may be difficult to appraise. On the contrary, in many other domains, including medical risk analysis, the advent of data science, big data and visual analytics allowed moving from expert-based to fact-based knowledge. Since 12 years, many trial results are publicly available online in trial registries. Nevertheless, data science methods have not yet been applied widely to trial data. In this paper, we present a platform for analyzing the safety events reported during clinical trials and published in trial registries. This platform is based on an ontological model including 582 trials on pain treatments, and uses semantic web technologies for querying this dataset at various levels of granularity. It also relies on a 26-dimensional flower glyph for the visualization of the Adverse Drug Events (ADE) rates in 13 categories and 2 levels of seriousness. We illustrate the interest of this platform through several use cases and we were able to find back conclusions that were initially found during meta-analyses. The platform was presented to four experts in drug safety, and is publicly available online, with the ontology of pain treatment ADE.
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Affiliation(s)
- Jean-Baptiste Lamy
- Université Sorbonne Paris Nord, LIMICS, Sorbonne Université, INSERM, UMR 1142, F-93000 Bobigny, France; Laboratoire de Recherche en Informatique, CNRS/Université Paris-Sud/Université Paris-Saclay, Orsay, France.
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Coronary Revascularization and Long-Term Survivorship in Chronic Coronary Syndrome. J Clin Med 2021; 10:jcm10040610. [PMID: 33562869 PMCID: PMC7914537 DOI: 10.3390/jcm10040610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 01/09/2023] Open
Abstract
Ischemic heart disease (IHD) persists as the leading cause of death in the Western world. In recent decades, great headway has been made in reducing mortality due to IHD, based around secondary prevention. The advent of coronary revascularization techniques, first coronary artery bypass grafting (CABG) surgery in the 1960s and then percutaneous coronary intervention (PCI) in the 1970s, has represented one of the major breakthroughs in medicine during the last century. The benefit provided by these techniques, especially PCI, has been crucial in lowering mortality rates in acute coronary syndrome (ACS). However, in the setting where IHD is most prevalent, namely chronic coronary syndrome (CCS), the increase in life expectancy provided by coronary revascularization is controversial. Over more than 40 years, several clinical trials have been carried out comparing optimal medical treatment (OMT) alone with a strategy of routine coronary revascularization on top of OMT. Beyond a certain degree of symptomatic improvement and lower incidence of minor events, routine invasive management has not demonstrated a convincing effect in terms of reducing mortality in CCS. Based on the accumulated evidence more than half a century after the first revascularization procedures were used, invasive management should be considered in those patients with uncontrolled symptoms despite OMT or high-risk features related to left ventricular function, coronary anatomy, or functional assessment, taking into account the patient expectations and preferences.
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Perna G, Cuniberti F, Daccò S, Grassi M, Caldirola D. 'Precision' or 'personalized' psychiatry: different terms - same content? FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2020; 88:759-766. [PMID: 32838431 DOI: 10.1055/a-1211-2722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Due to the increased lifetime prevalence and personal, social, and economic burden of mental disorders, psychiatry is in need of a significant change in several aspects of its clinical and research approaches. Over the last few decades, the development of personalized / precision medicine in psychiatry focusing on tailored therapies that fit each patient's unique individual, physiological, and genetic profile has not achieved the same results as those obtained in other branches, such as oncology. The long-awaited revolution has not yet surfaced. There are various explanations for this including imprecise diagnostic criteria, incomplete understanding of the molecular pathology involved, absence of available clinical tools and, finally, the characteristics of the patient. Since then, the co-existence of the two terms has sparked a great deal of discussion around the definition and differentiation between the two types of psychiatry, as they often seem similar or even superimposable. Generally, the two terminologies are used indiscriminately, alternatively, and / or separately, within the same scientific works. In this paper, an overview is provided on the overlap between the application and meaning of the terms 'precision psychiatry' and 'personalized psychiatry'.
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Affiliation(s)
- Giampaolo Perna
- Department of Biomedical Sciences, Humanitas University, San Benedetto Menni Hospital, Department of Clinical Neurosciences; Maastricht University Faculty of Health Medicine and Life Sciences, Department of Psychiatry and Neuropsychology; Leonard M Miller School of Medicine, Department of Psychiatry and Behavioral Sciences
| | - Francesco Cuniberti
- Humanitas University, Department of Biomedical Sciences; San Benedetto Menni Hospital, Department of Clinical Neurosciences
| | - Silvia Daccò
- Humanitas University, Department of Biomedical Sciences; San Benedetto Menni Hospital, Department of Clinical Neurosciences
| | - Massimiliano Grassi
- Humanitas University, Department of Biomedical Sciences; San Benedetto Menni Hospital, Department of Clinical Neurosciences
| | - Daniela Caldirola
- Humanitas University, Department of Biomedical Sciences; San Benedetto Menni Hospital, Department of Clinical Neurosciences
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Bardin T, Richette P. Can gout management guidelines be solely evidence based? Nat Rev Rheumatol 2020; 16:479-480. [DOI: 10.1038/s41584-020-0471-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Marsh K, van Til JA, Molsen-David E, Juhnke C, Hawken N, Oehrlein EM, Choi YC, Duenas A, Greiner W, Haas K, Hiligsmann M, Hockley KS, Ivlev I, Liu F, Ostermann J, Poder T, Poon JL, Muehlbacher A. Health Preference Research in Europe: A Review of Its Use in Marketing Authorization, Reimbursement, and Pricing Decisions-Report of the ISPOR Stated Preference Research Special Interest Group. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:831-841. [PMID: 32762984 DOI: 10.1016/j.jval.2019.11.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 11/07/2019] [Accepted: 11/27/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study examines European decision makers' consideration and use of quantitative preference data. METHODS The study reviewed quantitative preference data usage in 31 European countries to support marketing authorization, reimbursement, or pricing decisions. Use was defined as: agency guidance on preference data use, sponsor submission of preference data, or decision-maker collection of preference data. The data could be collected from any stakeholder using any method that generated quantitative estimates of preferences. Data were collected through: (1) documentary evidence identified through a literature and regulatory websites review, and via key opinion leader outreach; and (2) a survey of staff working for agencies that support or make healthcare technology decisions. RESULTS Preference data utilization was identified in 22 countries and at a European level. The most prevalent use (19 countries) was citizen preferences, collected using time-trade off or standard gamble methods to inform health state utility estimation. Preference data was also used to: (1) value other impact on patients, (2) incorporate non-health factors into reimbursement decisions, and (3) estimate opportunity cost. Pilot projects were identified (6 countries and at a European level), with a focus on multi-criteria decision analysis methods and choice-based methods to elicit patient preferences. CONCLUSION While quantitative preference data support reimbursement and pricing decisions in most European countries, there was no utilization evidence in European-level marketing authorization decisions. While there are commonalities, a diversity of usage was identified between jurisdictions. Pilots suggest the potential for greater use of preference data, and for alignment between decision makers.
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Affiliation(s)
| | - Janine A van Til
- Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | | | | | | | | | - Y Christy Choi
- University of Minnesota College of Pharmacy, Minneapolis, Minnesota
| | | | - Wolfgang Greiner
- Department of Health Economics, Bielefeld University, Bielefeld, Germany
| | | | - Mickael Hiligsmann
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | | | - Ilya Ivlev
- Center for Health Research, Kaiser Permanente, Portland, OR, USA
| | | | - Jan Ostermann
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, USA
| | | | - Jiat L Poon
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Axel Muehlbacher
- Hochschule Neubrandenburg, Neubrandenburg, Germany; Department of Population Health Sciences, Duke University, Durham, NC, USA
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Braschi E, Stacey D, Légaré F, Grad R, Archibald D. Evidence-based medicine, shared decision making and the hidden curriculum: a qualitative content analysis. PERSPECTIVES ON MEDICAL EDUCATION 2020; 9:173-180. [PMID: 32323113 PMCID: PMC7283448 DOI: 10.1007/s40037-020-00578-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Medical education should portray evidence-based medicine (EBM) and shared decision making (SDM) as central to patient care. However, misconceptions regarding EBM and SDM are common in clinical practice, and these biases might unintentionally be transmitted to medical trainees through a hidden curriculum. The current study explores how assumptions of EBM and SDM can be hidden in formal curriculum material such as PowerPoint slides. METHODS We conducted a qualitative content analysis using a purposive sample of 18 PowerPoints on the management of upper respiratory tract infections. We identified concepts pertaining to decision making using theory-driven codes taken from the fields of EBM and SDM. We then re-analyzed the coded text using a constructivist latent thematic approach to develop a rich description of conceptualizations of decision making in relation to EBM and SDM frameworks. RESULTS PowerPoint slides can relay a hidden curriculum, which can normalize: pathophysiological reasoning, unexplained variations in clinical care, the use of EBM mimics, defensive medicine, an unrealistic portrayal of benefits, and paternalism. DISCUSSION Addressing the hidden curriculum in formal curricular material should be explored as a novel strategy to foster a positive attitude towards EBM and SDM and to improve patient outcomes by encouraging the use of these skills.
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Affiliation(s)
- Emélie Braschi
- Lamont Primary Health Care Research Centre, Ottawa, ON, Canada.
| | - Dawn Stacey
- Faculty of Health Sciences, Ottawa Hospital Research Institute, Ontario, ON, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Roland Grad
- Herzl Family Practice Centre, Montreal, Canada
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Huynh KA, Chung KC. Using Evidence for Hand Surgery: How to Practice Evidence-Based Hand Surgery Care. Hand Clin 2020; 36:137-144. [PMID: 32307043 DOI: 10.1016/j.hcl.2019.12.001] [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: 02/02/2023]
Abstract
Each step of the evidence-based practice process is critical and requires clear understanding for accurate application. To practice evidence-based care, providers must acquire a specific skillset that facilitates translation of a patient problem into an answerable research question. Additional requirements are understanding of electronic databases, critical appraisal of the available evidence, and integration of the findings to generate a specific, individualized treatment plan. Although this process is demanding, evidence-based practice is essential in the delivery of optimal patient care.
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Affiliation(s)
- Kristine A Huynh
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Michigan Medicine Comprehensive Hand Center, University of Michigan, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA.
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Lam C, van Velthoven MH, Chaudhury H, Meinert E. Teaching Real-World Evidence: Protocol for a Systematic Review. JMIR Res Protoc 2020; 9:e16941. [PMID: 32012110 PMCID: PMC7055761 DOI: 10.2196/16941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 11/17/2022] Open
Abstract
Background Real-world evidence (RWE) refers to observational health care data beyond clinical trial data. It holds the promise of transforming health care as a new form of evidence to support decision makers in making decisions when developing and regulating medicines. As the importance of RWE is recognized by industry and regulatory bodies, teaching RWE becomes an important matter to evaluate and refine in order to develop future researchers and stakeholders who can better integrate RWE into the routine development of medicine. Objective The aim of this review is to understand how RWE is currently being taught. From this landscape study, the insufficiencies of the current education of RWE can be identified and subsequently inform future education policies around RWE and its subfacets. Methods We will search MEDLINE, EMBASE, PsycINFO, Healthcare Management Information Consortium, Cochrane, and Web of Science for published studies using a combination of keywords and subject headings related to RWE and education. In addition, a Google search to identify grey literature will be conducted. Two authors will independently screen the titles and abstracts identified from the search and accept or reject the studies according to the study inclusion criteria; any discrepancies will be discussed and resolved. The quality of the included literature will be assessed using the Critical Appraisal Skills Programme systematic review checklist. Results Data from eligible publications will be abstracted into a predesigned form in order to better understand the current state of education of RWE and inform future RWE education directions and policies. Conclusions The subsequent systematic review will be published in a peer-reviewed journal. International Registered Report Identifier (IRRID) PRR1-10.2196/16941
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Affiliation(s)
- Ching Lam
- Digitally Enabled Preventative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Michelle Helena van Velthoven
- Digitally Enabled Preventative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Hassan Chaudhury
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Edward Meinert
- Digitally Enabled Preventative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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Hestevik CH, Molin M, Debesay J, Bergland A, Bye A. Healthcare professionals' experiences of providing individualized nutritional care for Older People in hospital and home care: a qualitative study. BMC Geriatr 2019; 19:317. [PMID: 31747884 PMCID: PMC6865038 DOI: 10.1186/s12877-019-1339-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/31/2019] [Indexed: 01/04/2023] Open
Abstract
Background Recent studies indicate inadequate nutritional care practices in healthcare institutions and identify several barriers to perform individualized nutritional care to older persons. Organisation of care can become rigid and standardised, thus failing to be respectful of and responsive to each person’s needs and preferences. There is limited research exploring health professionals’ views on how structure of care allows them to individualize nutritional care to older persons. In this study we aim to explore how healthcare professionals’ experience providing individualised nutritional care within the organisational frames of acute geriatric hospital care and home care. Methods Semi-structured interviews with 23 healthcare professionals from hospital acute geriatric care and home care. Interviews were analyzed using thematic analysis. Results Two main themes and six sub-themes emerged from the material. Theme 1: ‘Meeting patients with complex nutritional problems’ with the sub-themes: ‘It is much more complex than just not eating’ and ‘seeing nutrition as a part of the whole’. Theme 2: ‘The structure of the nutritional care’, with the sub-themes: ‘Nutritional routines: Much ado, but for what?’, ‘lack of time to individualize nutritional care’, ‘lack of interdisciplinary collaboration in nutritional care’ and ‘meeting challenging situations with limited resources in home care’. Conclusions The healthcare professionals described having a high focus on and priority of nutritional care when caring for older persons. They did however find it challenging to practice individualized nutritional care due to the complexity of the patients’ nutritional problems and constraints in the way nutritional care was organised. By describing the challenges the healthcare professionals face when trying to individualize the nutritional care, this study may provide important knowledge to health professionals and policy makers on how to decrease the gap between older patients’ preferences for care and nutritional care practice.
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Affiliation(s)
| | - Marianne Molin
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,Bjorknes University College, Lovisenberggata 13, 0456, Oslo, Norway
| | - Jonas Debesay
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Asta Bye
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
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Lam C, van Velthoven MH, Chaudhury H, Meinert E. Teaching Real-World Evidence: Protocol for a Systematic Review (Preprint).. [DOI: 10.2196/preprints.16941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
Abstract
BACKGROUND
Real-world evidence (RWE) refers to observational health care data beyond clinical trial data. It holds the promise of transforming health care as a new form of evidence to support decision makers in making decisions when developing and regulating medicines. As the importance of RWE is recognized by industry and regulatory bodies, teaching RWE becomes an important matter to evaluate and refine in order to develop future researchers and stakeholders who can better integrate RWE into the routine development of medicine.
OBJECTIVE
The aim of this review is to understand how RWE is currently being taught. From this landscape study, the insufficiencies of the current education of RWE can be identified and subsequently inform future education policies around RWE and its subfacets.
METHODS
We will search MEDLINE, EMBASE, PsycINFO, Healthcare Management Information Consortium, Cochrane, and Web of Science for published studies using a combination of keywords and subject headings related to RWE and education. In addition, a Google search to identify grey literature will be conducted. Two authors will independently screen the titles and abstracts identified from the search and accept or reject the studies according to the study inclusion criteria; any discrepancies will be discussed and resolved. The quality of the included literature will be assessed using the Critical Appraisal Skills Programme systematic review checklist.
RESULTS
Data from eligible publications will be abstracted into a predesigned form in order to better understand the current state of education of RWE and inform future RWE education directions and policies.
CONCLUSIONS
The subsequent systematic review will be published in a peer-reviewed journal.
INTERNATIONAL REGISTERED REPORT
PRR1-10.2196/16941
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The Efficacy of Exercise-Based Cardiac Rehabilitation: The Changing Face of Usual Care. J Am Coll Cardiol 2019; 69:1207-1208. [PMID: 28254186 DOI: 10.1016/j.jacc.2016.10.084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/26/2016] [Indexed: 11/21/2022]
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Barry A, Bottasso OA, Vicco MH. The importance of being scientifically cautious when criticizing the administration of vaccines: ‘retracted’ post truth. Immunotherapy 2019; 11:7-9. [DOI: 10.2217/imt-2018-0062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Amadou Barry
- Malaria Research & Training Center, Faculty of Medicine, Pharmacy & Dentistry, University of Sciences Techniques & Technologies of Bamako, Bamako, Mali
| | - Oscar A Bottasso
- lnstituto de Inmunología Clínica y Experimental de Rosario, Universidad Nacional de Rosario, Consejo Nacional de Investigaciones Científicas y Técnicas, Rosario, Argentina
| | - Miguel H Vicco
- Facultad de Ciencias Médicas, Universidad Nacional del Litoral, Santa Fe, Argentina
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Chow N, Gallo L, Busse JW. Evidence-based medicine and precision medicine: Complementary approaches to clinical decision-making. PRECISION CLINICAL MEDICINE 2018; 1:60-64. [PMID: 35693200 PMCID: PMC8985809 DOI: 10.1093/pcmedi/pby009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/11/2018] [Accepted: 07/19/2018] [Indexed: 12/21/2022] Open
Abstract
Evidence-based medicine is widely promoted for decision-making in health care and is associated with improved patient outcomes. Critics have suggested that evidence-based medicine focuses primarily on groups of patients rather than individuals, but often fail to consider subgroup analyses, N-of-1 trials, and the incorporation of patient values and preferences. Precision medicine has been promoted as an approach to individualize diagnosis and treatment of diseases through genetic, biomarker, phenotypic, and psychosocial characteristics. However, there are often high costs associated with personalized medicine, and high-quality evidence is lacking for effectiveness in many applications. For the potential of personalized medicine to be realized, it must adhere to the principles of evidence-based medicine: (1) evidence in isolation is not sufficient to make clinical decisions—patient’s values and preferences as well as resource implications must be considered, and (2) there is a hierarchy of evidence to guide clinical decision-making and studies at lower risk of bias are likely to provide more trustworthy findings.
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Affiliation(s)
- Ngai Chow
- Department of Health Research Methods, Evidence and Impact, McMaster University, HSC-2C, 1280 Main St. West, Hamilton, Ontario, Canada
- The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, MDCL-2101, 1280 Main St. West, Hamilton, Ontario, Canada
| | - Lucas Gallo
- Department of Medicine, McMaster University, 4V33, 1280 Main St. West, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, HSC-2C, 1280 Main St. West, Hamilton, Ontario, Canada
- The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, MDCL-2101, 1280 Main St. West, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, HSC-2V9, 1280 Main St. West, Hamilton, Ontario, Canada
- The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, 1280 Main St. West, Hamilton, Ontario, Canada
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A Baby in the Bathwater: Preserving Evidence-Based Medicine. J Am Coll Cardiol 2018; 68:214-6. [PMID: 27386776 DOI: 10.1016/j.jacc.2016.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 05/18/2016] [Indexed: 11/23/2022]
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Affiliation(s)
- Andrea Damiani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy.
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
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Petrie TD, Schulman-Marcus J. Editorial commentary: Beta blockers and the inertia of evidence-based medicine. Trends Cardiovasc Med 2018; 28:390-391. [PMID: 29395782 DOI: 10.1016/j.tcm.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 11/19/2022]
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Lamy JB. Owlready: Ontology-oriented programming in Python with automatic classification and high level constructs for biomedical ontologies. Artif Intell Med 2017; 80:11-28. [DOI: 10.1016/j.artmed.2017.07.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/04/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
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Varma N, Mittal S, Prillinger JB, Snell J, Dalal N, Piccini JP. Survival in Women Versus Men Following Implantation of Pacemakers, Defibrillators, and Cardiac Resynchronization Therapy Devices in a Large, Nationwide Cohort. J Am Heart Assoc 2017; 6:JAHA.116.005031. [PMID: 28490521 PMCID: PMC5524072 DOI: 10.1161/jaha.116.005031] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Whether outcomes differ between sexes following treatment with pacemakers (PM), implantable cardioverter defibrillators, and cardiac resynchronization therapy (CRT) devices is unclear. Methods and Results Consecutive US patients with newly implanted PM, implantable cardioverter defibrillators, and CRT devices from a large remote monitoring database between 2008 and 2011 were included in this observational cohort study. Sex‐specific all‐cause survival postimplant was compared within each device type using a multivariable Cox proportional hazards model, stratified on age and adjusted for remote monitoring utilization and ZIP‐based socioeconomic variables. A total of 269 471 patients were assessed over a median 2.9 [interquartile range, 2.2, 3.6] years. Unadjusted mortality rates (MR; deaths/100 000 patient‐years) were similar between women versus men receiving PMs (n=115 076, 55% male; MR 4193 versus MR 4256, respectively; adjusted hazard ratio, 0.87; 95% CI, 0.84–0.90; P<0.001) and implantable cardioverter defibrillators (n=85 014, 74% male; MR 4417 versus MR 4479, respectively; adjusted hazard ratio, 0.98; 95% CI, 0.93–1.02; P=0.244). In contrast, survival was superior in women receiving CRT defibrillators (n=61 475, 72% male; MR 5270 versus male MR 7175; adjusted hazard ratio, 0.73; 95% CI, 0.70–0.76; P<0.001) and also CRT pacemakers (n=7906, 57% male; MR 5383 versus male MR 7625, adjusted hazard ratio, 0.69; 95% CI, 0.61–0.78; P<0.001). This relative difference increased with time. These results were unaffected by age or remote monitoring utilization. Conclusions Women accounted for less than 30% of high‐voltage implants and fewer than half of low‐voltage implants in a large, nation‐wide cohort. Survival for women and men receiving implantable cardioverter defibrillators and PMs was similar, but dramatically greater for women receiving both defibrillator‐ and PM‐based CRT.
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Bae JM. An opposing view on including high school students in a latent tuberculosis infection control program in Korea. Epidemiol Health 2017; 39:e2017015. [PMID: 28395400 PMCID: PMC5434224 DOI: 10.4178/epih.e2017015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 03/31/2017] [Indexed: 11/13/2022] Open
Abstract
The Korea Centers for Diseases Control and Prevention (KCDC) has announced a control program against latent Mycobacterium tuberculosis infection (LTBI), for a “TB-safe country” this year with the goal of a “TB-free Korea” by 2025. The program includes high school students as one target group; however, some school health teachers and parents have expressed their opposition to this. The 2015 World Health Organization guidelines do not recommend inclusion of asymptomatic high school students in LTBI control programs. Based on this guideline, the KCDC should consider excluding this population from the program.
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Affiliation(s)
- Jong-Myon Bae
- Department of Preventive Medicine, Jeju National University Scool of Medicine, Jeju, Korea
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Harrington L. Closing the Science-Practice Gap With Technology: From Evidence-Based Practice to Practice-Based Evidence. AACN Adv Crit Care 2017; 28:12-15. [DOI: 10.4037/aacnacc2017331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Linda Harrington
- Linda Harrington is an Independent Consultant, Health Informatics and Digital Strategy, and Professor, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030
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Reply. J Am Coll Cardiol 2017; 69:1208-1209. [DOI: 10.1016/j.jacc.2016.11.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 11/18/2016] [Indexed: 11/20/2022]
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Stehlik J, Bavaria JE, Bax J, Cronenwett JL, Edwards LB, Fairman RM, Ferrari R, Jacobs JP, Johnson MR, Kraiss LW, Masoudi FA, Mehra MR, Vahanian A, Walsh MN, Lund LH. Heart, lung, and vascular registries: Evolving goals, successful approaches, and ongoing innovation. J Heart Lung Transplant 2016; 35:1149-1157. [DOI: 10.1016/j.healun.2016.08.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 08/24/2016] [Indexed: 10/21/2022] Open
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Blease CR, Lilienfeld SO, Kelley JM. Evidence-Based Practice and Psychological Treatments: The Imperatives of Informed Consent. Front Psychol 2016; 7:1170. [PMID: 27559322 PMCID: PMC4979245 DOI: 10.3389/fpsyg.2016.01170] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 07/22/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charlotte R. Blease
- Centre for Medical Humanities, University of LeedsLeeds, UK
- Program in Placebo Studies, Harvard Medical SchoolBoston, MA, USA
| | | | - John M. Kelley
- Program in Placebo Studies, Harvard Medical SchoolBoston, MA, USA
- Psychology, Endicott CollegeBeverly, MA, USA
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