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Saggaf MM, Liu K, Ho G, Anastakis EE, Baltzer H. Sex Difference in the Treatment of Dupuytren's Disease: A Systematic Review and Meta-Analysis of Clinical Trials. Plast Surg (Oakv) 2024; 32:374-383. [PMID: 39104932 PMCID: PMC11298125 DOI: 10.1177/22925503221141707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 08/07/2024] Open
Abstract
Purpose: The aim of this study was to assess the sex differences in enrollment into clinical trials for Dupuytren's disease (DD), treatment efficacy, and complications. Methods: Three databases were searched; Ovid MEDLINE, Ovid EMBASE, and EBSCO CINAHL. Included studies were clinical trials on adult patients with DD. Exclusion criteria were non-English studies and other study designs. Two independent reviewers completed abstract screening, full-text review, and data extraction. The number and percentage of studies that reported ad hoc analyses for sex differences in treatment efficacy, tolerability, and complications were reported. A meta-analysis was performed on the proportion of female participants enrolled in clinical trials for DD. Results: A total of 3172 references were screened, and 59 studies were identified for full-text review. We identified 28 clinical trials for DD of which none reported secondary analyses for sex differences. Only 2 trials discussed sex differences in complications, and one trial reported sex differences in tolerability. The proportion of female participants in the meta-analysis was 19.5% [95% CI: 16.1-23.0%]. Conclusion: Sex differences in the clinical trials for DD are not widely considered in clinical trials despite their critical role. Males and females do not have equal representation in clinical trials for DD. Future studies should account for sex differences in the design and the analysis of clinical trials.
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Affiliation(s)
- Moaath M. Saggaf
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Hand Program, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kathy Liu
- Hand Program, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - George Ho
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Hand Program, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Emily E. Anastakis
- Hand Program, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Heather Baltzer
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Hand Program, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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Meirmanova A, Omarova G, Kurmanova A, Begniyazova Z, Yuldasheva A. Surgical management of genital prolapse and combined gynecological pathologies in women: A meta-analysis. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
<b>Introduction:</b> Prolapse can be fixed using a variety of surgical procedures. The goal of the present study was to examine the current literature on various surgical techniques for treating female genital organ prolapse.<br />
<b>Methods:</b> The PubMed and Medline databases were explored for pertinent literature up through August 2022 for this meta-analysis. The terms [surgery] AND [management] AND [genital prolapse OR gynaecological diseases] AND [randomised control studies OR randomised control trials] were used as search criteria. The studies that met the inclusion criteria were considered qualified using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Cochrane handbook of “Systematic reviews of interventions” was used for risk of bias assessment.<br />
<b>Results:</b> The investigations found significant difference in the heterogeneity between the groups with a 76% I<sup>2</sup> value (p<0.00001). There was little variability among the six trials that examined robotic and laparoscopic therapy of prolapse (I<sup>2</sup>=0%, p=0.94). In six investigations, the odd ratio revealed no statistically significant difference between groups (1.05; 95% CI, 0.52, 2.12). However, generally there were no appreciable differences between robotic and laparoscopic treatment of female prolapse. There was a low-risk bias among the selected studies.<br />
<b>Conclusion:</b> According to this meta-analysis study, laparoscopic surgery performed better job of managing prolapse than abdominal surgery.
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Affiliation(s)
- Aliya Meirmanova
- Department Obstetrics and Gynecology, Kazakh National Medical University, Almaty, KAZAKHSTAN
| | - Gulzhakhan Omarova
- Department Obstetrics and Gynecology, Kazakh National Medical University, Almaty, KAZAKHSTAN
| | - Almagul Kurmanova
- Department of Health Policy and Organization, Al-Farabi Kazakh National University, Almaty, KAZAKHSTAN
| | - Zhanara Begniyazova
- Department Obstetrics and Gynecology, Kazakh National Medical University, Almaty, KAZAKHSTAN
| | - Ainura Yuldasheva
- Department Obstetrics and Gynecology, Kazakh National Medical University, Almaty, KAZAKHSTAN
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Zhang Y, Wang W, Lu Y, Shen W, Niu K. Mid-term efficacy of surgical treatments for post-hysterectomy vaginal vault prolapse: a retrospective study. Gland Surg 2022; 11:992-1002. [PMID: 35800747 PMCID: PMC9253193 DOI: 10.21037/gs-22-261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/01/2022] [Indexed: 07/20/2023]
Abstract
BACKGROUND The surgical treatment of post-hysterectomy vaginal vault prolapse (PHVP) has been reported in several clinical studies, but mostly are short-term studies. This study aims to explore the mid-term efficacy of surgical treatments for PHVP. METHODS A total of 138 PHVP patients underwent surgery from January 2005 to January 2020 at the Fourth Medical Center of PLA General Hospital, Beijing. The clinical data of 119 patients who completed follow-up were retrospectively analyzed. Both groups of patients are diagnosed Pelvic Organ Prolapse Quantification system (POP-Q) III-IV stage of prolapse, with obvious prolapse-related symptoms and requiring surgical treatment. Among them, pelvic floor reconstruction surgery (RPS) was performed in patients who wanted to retain vaginal function and colpocleisis were used for frail patients who cannot tolerate RPS. We used the POP-Q scores for the objective efficacy evaluation, and use the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7) to evaluate the subjective symptom during follow up. Among them, 61 patients underwent pelvic floor RPS (Group R), and 58 received colpocleisis (Group C). RESULTS The surgeries in both groups were successfully completed, the median follow-up time after surgery was 4.3 years (0.25-13 years) and 5.3 years (0.33-15 years), respectively; the overall surgical success rate was 86.9% (53/61) and 100% (58/58), respectively; the subjective satisfaction rate was 90.2% (55/61) and 91.4% (53/58), respectively; and the PFDI-20 and PFIQ-7 scores in both groups were significantly improved compared with the preoperative levels (P<0.05). In Group R, 6 cases (9.8%, 6/61) were dissatisfied after surgery; in Group C, 5 cases (8.6%, 5/58) were dissatisfied after surgery. CONCLUSIONS Reconstructive surgery and colpocleisis have a good mid-term effect on PHVP, with good outcome and few complications. The surgeon is expected to ascertain an appropriate surgical procedure based on the characteristics of the patient, the degree and the location of prolapse, in order to achieve the best surgical efficacy and minimize the damage.
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Affiliation(s)
- Yinghui Zhang
- The Fourth Medical Center, Senior Department of Obstetrics & Gynecology, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Wenying Wang
- The Fourth Medical Center, Senior Department of Obstetrics & Gynecology, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Yongxian Lu
- The Fourth Medical Center, Senior Department of Obstetrics & Gynecology, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Wenjie Shen
- The Fourth Medical Center, Senior Department of Obstetrics & Gynecology, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Ke Niu
- The Fourth Medical Center, Senior Department of Obstetrics & Gynecology, the Seventh Medical Center of PLA General Hospital, Beijing, China
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Pearson S, Temple L, Bishop T, Ukaegbu A, Alden J, Kwagyan J, Sanses TVD. Community-based Versus Traditional Research Among Older Minority Women With Urinary Incontinence. Female Pelvic Med Reconstr Surg 2022; 28:201-206. [PMID: 34387261 PMCID: PMC8831655 DOI: 10.1097/spv.0000000000001089] [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: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate research retention of older minority women with urinary incontinence (UI) using a community-based participatory research (CBPR) versus a traditional research approach. METHODS An ancillary prospective study was conducted within an ongoing pilot randomized clinical trial to treat UI. Participants were recruited using CBPR in collaboration with a local community versus a traditional research approach at an academic center. Inclusion criteria were women 65 years and older and symptomatic UI. The primary outcome was the randomization rate defined as the proportion of women randomized into the randomized clinical trial out of screened participants. Screening and consent rates were also evaluated. Pearson χ2, Fisher exact, and t tests were used. The effect of CBPR on research retention rates was expressed as odds ratio (OR) with 95% confidence intervals (CI). RESULTS There were 10 and 88 women screened in the CBPR and traditional research groups, respectively. The CBPR participants were Hispanic (n = 10, 100%) and older (78.4 ± 8.3 years; P < 0.01). Most of the traditional research participants were non-Hispanic Black (n = 55, 62.5%) and younger (71.0 ± 4.9 years). The CBPR group had higher rates of screening (76.9% vs 40.6%; P = 0.01), consent (80% vs 44.3%; P = 0.045), and randomization (50.0% vs 14.8%; P < 0.01) compared with the traditional research group. Community-based participatory research increased the odds of research retention during screening (OR, 4.9; 95% CI, 1.3-18.2), consent (OR, 5.0; 95% CI, 1.0-25.0), and randomization (OR, 5.8; 95% CI, 1.5-22.7). CONCLUSION Compared with traditional research, CBPR yielded higher research retention among older minority women with UI in a clinical study.
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Affiliation(s)
- Sharee Pearson
- From the Department of Obstetrics and Gynecology, Howard University College of Medicine, Washington, DC
| | - Luisa Temple
- From the Department of Obstetrics and Gynecology, Howard University College of Medicine, Washington, DC
| | | | | | | | | | - Tatiana V D Sanses
- From the Department of Obstetrics and Gynecology, Howard University College of Medicine, Washington, DC
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Han JK, Russo AM. Underrepresentation of women in implantable cardioverter defibrillator trials. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 14:100120. [PMID: 38560561 PMCID: PMC10978341 DOI: 10.1016/j.ahjo.2022.100120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/13/2022] [Accepted: 03/09/2022] [Indexed: 04/04/2024]
Abstract
There are sex differences in the epidemiology and presentation of ventricular arrhythmias. Sudden cardiac death (SCD) is less common in women than in men. Women have been under-represented in implantable cardioverter defibrillator (ICD) trials evaluating the benefit of ICD therapy for primary and secondary prevention of SCD. Following ICD implantation, women are less likely to experience appropriate ICD therapy for ventricular arrhythmias, consistent with epidemiological findings of a lower rate of SCD in women. Sex differences in ICD implantation rates have also been noted for primary and secondary prevention of SCD in registries and large observational cohort studies. Reasons for these differences are unclear. Age and comorbidities at the time of presentation may be partially responsible, although sex bias, patient preference, or contribution of social determinants of health cannot be excluded. There are many unanswered questions regarding reasons for sex differences in ICD usage and under-representation of women in clinical device trials. Additional investigation is needed to better understand these differences to improve outcome of all patients who are at risk for sudden cardiac arrest.
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Affiliation(s)
- Janet K. Han
- Division of Cardiology, VA Greater Los Angeles Healthcare and David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States of America
| | - Andrea M. Russo
- Division of Cardiology, Cooper Medical School of Rowan University, Camden, NJ, United States of America
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Dobra RA, Boeri M, Elborn S, Kee F, Madge S, Davies JC. Discrete choice experiment (DCE) to quantify the influence of trial features on the decision to participate in cystic fibrosis (CF) clinical trials. BMJ Open 2021; 11:e045803. [PMID: 33653764 PMCID: PMC7929793 DOI: 10.1136/bmjopen-2020-045803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/21/2021] [Accepted: 02/04/2021] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Engaging people with cystic fibrosis (CF) in clinical trials is critical to improving outcomes for this fatal disease. Following extensive exploration of engagement in CF trials we believe six key concepts require a quantitative understanding of their influence in the current CF trials landscape including how controversial issues like placebos, washouts, stipend provision and location of trial visits are viewed by the CF community and how these might be modified depending on the type of medicine being investigated and the mechanism of access to the drug on trial completion. METHODS AND ANALYSIS We have designed and will administer an online discrete choice experiment to elicit and quantify preferences of people with CF for these trials' attributes and estimate the relative importance of an attribute when choosing to participate in a trial. The cross-sectional data generated will be explored using conditional multinomial logit model. Mixed logit models such as the random-parameters logit and a latent class models will be used to explore preference heterogeneity. To determine the relative importance of an attribute, the difference between the attribute level with the highest preference weight and the level with the lowest preference weight will be calculated. ETHICS AND DISSEMINATION Imperial College London Joint Research Compliance Office has granted ethical approval for this study. Patient consent will be sought following full explanation. No identifying information will be collected. Dissemination will be via international conferences, peer-review publication and patient accessible forums. Major CF trials networks have agreed to incorporate our findings into their review process, meaning our results can realistically influence and optimise CF trial delivery. PROSPERO REGISTRATION NUMBER CRD42020184886.
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Affiliation(s)
- Rebecca Anne Dobra
- National Heart Lung institute, Imperial College London, London, UK
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Marco Boeri
- Health Preference Assessments, RTI Health Solutions, Belfast, UK
| | - Stuart Elborn
- School of Medicine, Dentistry and Biomedical Sciences, Queens University of Belfast, Belfast, UK
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health (NI), Queen's University Belfast, Belfast, UK
| | - Susan Madge
- Department of Adult Cystic Fibrosis, Royal Brompton Hospital, London, UK
| | - Jane C Davies
- National Heart Lung institute, Imperial College London, London, UK
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
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Arora A, Manohar N, Bedros D, Hua APD, You SYH, Blight V, Ajwani S, Eastwood J, Bhole S. Lessons learnt in recruiting disadvantaged families to a birth cohort study. BMC Nurs 2018; 17:7. [PMID: 29491745 PMCID: PMC5828325 DOI: 10.1186/s12912-018-0276-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 02/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dental decay in early childhood can be prevented by a model based on shared care utilising members of primary care team such as Child and Family Health Nurses (CFHNs) in health promotion and early intervention. The aims of this study were to identify the facilitators and barriers faced by CFHNs in recruiting research participants from disadvantaged backgrounds to a birth cohort study in South Western Sydney, Australia. METHODS Child and Family Health Nurses recruited mothers-infants dyads (n = 1036) at the first post-natal home visit as part of Healthy Smiles Healthy Kids Study, an ongoing birth cohort study in South Western Sydney. The nurses (n = 19) were purposively selected and approached for a phone based in-depth semi-structured interview to identify the challenges faced by them during the recruitment process. Interviews were audio-recorded, subsequently transcribed verbatim and analysed by thematic analysis. RESULTS The nurses found the early phase of parenting was an overwhelming stage for parents as they are pre-occupied with more immediate issues such as settling and feeding a newborn. They highlighted some key time-points such as during pregnancy and/or around the time of infant teething may be more appropriate for recruiting families to dental research projects. However, they found it easier to secure the family's attention by offering incentives, gifts and invitations for free oral health services. The use of web-based approaches and maintaining regular contact with the participants was deemed crucial for long-term research. Cultural and linguistic barriers were seen as an obstacle in recruiting ethnic minority populations and the need for cultural insiders in the research team was deemed important to resolve the challenges associated with conducting research with diverse cultures. Finally, nurses identified the importance of inter-professional collaboration to provide easier access to recruiting research participants. CONCLUSIONS This study highlighted the need for multiple time-points and incentives to facilitate recruitment and retention of disadvantaged communities in longitudinal research. The need for cultural insiders and inter-professional collaboration in research team are important to improve research participation.
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Affiliation(s)
- Amit Arora
- School of Science and Health, Western Sydney University, 24.2.97 Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751 Australia
- Sydney Dental Hospital and Oral Health Services, Sydney Local Health District, Surry Hills, NSW Australia
- Discipline of Paediatrics and Child Health, Sydney Medical School, Westmead, NSW Australia
- Collaboration for Oral Health Outcomes Research, Translation, and Evaluation (COHORTE) Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW Australia
| | - Narendar Manohar
- School of Science and Health, Western Sydney University, 24.2.97 Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Dina Bedros
- Faculty of Dentistry, The University of Sydney, Surry Hills, NSW Australia
| | | | | | - Victoria Blight
- Child and Family Health Nursing, Primary & Community Health, South Western Sydney Local Health District, Narellan, NSW Australia
| | - Shilpi Ajwani
- Sydney Dental Hospital and Oral Health Services, Sydney Local Health District, Surry Hills, NSW Australia
- Faculty of Dentistry, The University of Sydney, Surry Hills, NSW Australia
| | - John Eastwood
- Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, Croydon, NSW Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW Australia
- School of Women’s and Children’s Health, UNSW Australia, Kensington, NSW Australia
- School of Medicine, Griffith University, Gold Coast, QLD Australia
| | - Sameer Bhole
- Sydney Dental Hospital and Oral Health Services, Sydney Local Health District, Surry Hills, NSW Australia
- Faculty of Dentistry, The University of Sydney, Surry Hills, NSW Australia
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Factors affecting patient participation in clinical trials in Ireland: A narrative review. Contemp Clin Trials Commun 2016; 3:23-31. [PMID: 29736453 PMCID: PMC5935836 DOI: 10.1016/j.conctc.2016.01.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 01/11/2016] [Accepted: 01/20/2016] [Indexed: 11/24/2022] Open
Abstract
Objective Clinical trials have long been considered the ‘gold standard’ of research generated evidence in health care. Patient recruitment is an important determinant in the success of the trials, yet little focus is placed on the decision making process of patients towards recruitment. Our objective was to identify the key factors pertaining to patient participation in clinical trials, to better understand the identified low participation rate of patients in one clinical research facility within Ireland. Design Narrative literature review of studies focussing on factors which may act to facilitate or deter patient participation in clinical trials. Studies were identified from Medline, PubMed, Cochrane Library and CINAHL. Results Sixty-one studies were included in the narrative review: Forty-eight of these papers focused specifically on the patient's perspective of participating in clinical trials. The remaining thirteen related to carers, family and health care professional perspectives of participation. The primary factor influencing participation in clinical trials amongst patients was related to personal factors and these were collectively associated with obtaining a form of personal gain through participation. Cancer was identified as the leading disease entity included in clinical trials followed by HIV and cardiovascular disease. Conclusion The vast majority of literature relating to participation in clinical trials emanates predominantly from high income countries, with 63% originating from the USA. No studies for inclusion in this review were identified from low income or developing countries and therefore limits the generalizability of the influencing factors.
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Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL, Howard VJ, Lichtman JH, Lisabeth LD, Piña IL, Reeves MJ, Rexrode KM, Saposnik G, Singh V, Towfighi A, Vaccarino V, Walters MR. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:1545-88. [PMID: 24503673 PMCID: PMC10152977 DOI: 10.1161/01.str.0000442009.06663.48] [Citation(s) in RCA: 627] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this statement is to summarize data on stroke risk factors that are unique to and more common in women than men and to expand on the data provided in prior stroke guidelines and cardiovascular prevention guidelines for women. This guideline focuses on the risk factors unique to women, such as reproductive factors, and those that are more common in women, including migraine with aura, obesity, metabolic syndrome, and atrial fibrillation. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through May 15, 2013. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA Stroke Council methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS We provide current evidence, research gaps, and recommendations on risk of stroke related to preeclampsia, oral contraceptives, menopause, and hormone replacement, as well as those risk factors more common in women, such as obesity/metabolic syndrome, atrial fibrillation, and migraine with aura. CONCLUSIONS To more accurately reflect the risk of stroke in women across the lifespan, as well as the clear gaps in current risk scores, we believe a female-specific stroke risk score is warranted.
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Konrat C, Boutron I, Trinquart L, Auleley GR, Ricordeau P, Ravaud P. Underrepresentation of elderly people in randomised controlled trials. The example of trials of 4 widely prescribed drugs. PLoS One 2012; 7:e33559. [PMID: 22479411 PMCID: PMC3316581 DOI: 10.1371/journal.pone.0033559] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 02/13/2012] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We aimed to determine the representation of elderly people in published reports of randomized controlled trials (RCTs). We focused on trials of 4 medications--pioglitazone, rosuvastatin, risedronate, and valsartan-frequently used by elderly patients with chronic medical conditions. METHODS AND FINDINGS We selected all reports of RCTs indexed in PubMed from 1966 to April 2008 evaluating one of the 4 medications of interest. Estimates of the community-based "on-treatment" population were from a national health insurance database (SNIIR-AM) covering approximately 86% of the population in France. From this database, we evaluated data claims from January 2006 to December 2007 for 1,958,716 patients who received one of the medications of interest for more than 6 months. Of the 155 RCT reports selected, only 3 studies were exclusively of elderly patients (2 assessing valsartan; 1 risedronate). In only 4 of 37 reports (10.8%) for pioglitazone, 4 of 22 (18.2%) for risedronate, 3 of 29 (10.3%) for rosuvastatine and 9 of 67 (13.4%) for valsartan, the proportion of patients aged 65 or older was within or above that treated in clinical practice. In 62.2% of the reports for pioglitazone, 40.9% for risedronate, 37.9% for rosuvastatine, and 70.2% for valsartan, the proportion of patients aged 65 or older was lower than half that in the treated population. The representation of elderly people did not differ by publication date or sample size. CONCLUSIONS Elderly patients are poorly represented in RCTs of drugs they are likely to receive.
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Affiliation(s)
| | - Isabelle Boutron
- INSERM U738, Paris, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Centre d'Epidémiologie Clinique, Paris, France
- Université Paris Descartes, Faculté de Médecine, Paris, France
- French Cochrane Center, Paris, France
| | - Ludovic Trinquart
- INSERM U738, Paris, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Centre d'Epidémiologie Clinique, Paris, France
- French Cochrane Center, Paris, France
| | - Guy-Robert Auleley
- Département de la Recherche Clinique, Institut National du Cancer (INCa), Paris, France
| | - Philippe Ricordeau
- Caisse nationale d'assurance maladie des travailleurs salariés (CNAMTS), Paris, France
| | - Philippe Ravaud
- INSERM U738, Paris, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Centre d'Epidémiologie Clinique, Paris, France
- Université Paris Descartes, Faculté de Médecine, Paris, France
- French Cochrane Center, Paris, France
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Carroll R, Antigua J, Taichman D, Palevsky H, Forfia P, Kawut S, Halpern SD. Motivations of patients with pulmonary arterial hypertension to participate in randomized clinical trials. Clin Trials 2012; 9:348-57. [PMID: 22388077 DOI: 10.1177/1740774512438981] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is substantial need to rigorously evaluate existing and new therapies for pulmonary arterial hypertension (PAH) and other severe and relatively rare conditions affecting younger patients. However, the ability to conduct meaningful randomized clinical trials (RCTs) in such contexts often is limited by difficulties obtaining adequate patient enrollment. PURPOSE To understand the motivations of patients with PAH for participating in RCTs so as to facilitate enrollment in future trials among patients with similar diseases. METHODS We conducted semistructured interviews of a diverse sample of patients with World Health Organization (WHO) Group I PAH. We purposefully recruited a diverse sample of participants until theoretical saturation was reached. We randomly assigned patients to review hypothetical RCTs that did or did not allow continuation of background PAH therapies and elicited their reasons for or against enrolling. Interviews were transcribed and analyzed using constant comparison techniques to code and sort data into discrete themes. RESULTS The 26 PAH patients enrolled before theoretical saturation was reached identified 24 factors that would influence their RCT enrollment decisions. These factors grouped naturally into four themes: (1) personal medical benefits, (2) personal medical risks/harms, (3) nonmedical benefits, and (4) nonmedical burdens. Personal benefits were cited as commonly as altruistic motives. One third of the patients (9/26) suggested that they would defer enrollment decisions to their treating clinicians. Seventy-nine percent of patients (11/14) assigned to consider trials without background therapies expressed concerns about clinical deterioration (vs. 17% (2/12) among patients assigned to consider trials allowing background therapies). LIMITATIONS The sample was recruited from a single academic center. Furthermore, the use of hypothetical trials may not elicit identical decision-making processes as may be used among patients contemplating actual trial participation. CONCLUSION For PAH patients considering RCT enrollment, the potentials for personal benefit and risk are at least as important as altruistic motives. Minimizing the time demands of participating, financial remuneration, and allowing participants to continue current therapies are factors, which might enhance enrollment to trials in similar disease areas.
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Affiliation(s)
- Ricki Carroll
- Department of Medicine, University of Pennsylvania, Philadelphia, 19104-6021, USA
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Jefferson AL, Lambe S, Chaisson C, Palmisano J, Horvath KJ, Karlawish J. Clinical research participation among aging adults enrolled in an Alzheimer's Disease Center research registry. J Alzheimers Dis 2011; 23:443-52. [PMID: 21116048 DOI: 10.3233/jad-2010-101536] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In light of our limited understanding of what motivates older adults to participate in clinical studies of Alzheimer's disease (AD), the current study examines incentives and barriers to participating in AD clinical research among older adults. 235 participants enrolled in the Boston University Alzheimer's Disease Center research registry (75 ± 8 years, range 58-99 years, 60% female), a longitudinal registry from which individuals are recruited into other clinical studies, completed a survey assessing registry participation satisfaction, religiousness, trust in healthcare institutions, and medical research attitudes. Most participants reported initially enrolling in the registry for societal benefit. Insufficient time was a commonly endorsed barrier to enrolling in other Center-approved studies, particularly among younger participants. Driving and a lack of transportation to the medical facility were also barriers, particularly for older participants. Transportation was the most popular incentive, followed by home-based visits (particularly for older participants and participants with less formal education) and compensation (particularly among respondents from racial/ethnic minority groups). Participation interest in other studies was associated with favorable medical research attitudes (r = 0.34, p = 0.00003) but not religiousness (r = -0.09, p = 0.21), or trust in healthcare institutions (r = 0.09, p = 0.17). Among older adults, societal benefit is a motivating factor for registry enrollment; however, participation in additional studies is hindered by insufficient time among younger participants and transportation barriers among older participants. Providing transportation, home-based visits, and modest compensation may improve participation rates. Furthermore, favorable attitudes toward medical research are strongly associated with interest in enrolling in additional studies and may serve as a beneficial outreach triage technique.
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Affiliation(s)
- Angela L Jefferson
- Alzheimer's Disease Center, Boston University School of Medicine, Boston, MA 02118, USA.
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Patient Participation in Research Among Solid Organ Transplant Recipients in the United States. Transplantation 2011; 91:1424-35. [DOI: 10.1097/tp.0b013e31821a20ee] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Surgical treatment for pelvic floor disorders in women 75 years or older: a single-center experience. Menopause 2011; 18:314-8. [PMID: 20861753 DOI: 10.1097/gme.0b013e3181f2e629] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Older patients are usually regarded as suboptimal candidates for surgical operations, particularly in cases of reparative, non-life-saving procedures. The aim of this study was to analyze the feasibility and safety of surgical treatment for pelvic floor dysfunction in advanced-age women. METHODS A single-center descriptive study was performed through a retrospective medical records review. Women 75 years or older who underwent a surgical operation for urogynecological dysfunction (pelvic organ prolapse, urinary incontinence, or both) between January 2000 and December 2009 were considered. RESULTS Overall, 138 women were included. Median age was 77 years (range, 75-95 y). Women underwent different types of surgical correction. The following procedures (alone or in combination) were performed: 102 (73.9%) vaginal hysterectomies, 106 (76.8%) anterior repairs, 36 (26%) posterior repairs, 9 (6.5%) colpocleisis, 4 vaginal vault ileococcygeus suspensions (2.9%), and 22 (15.9%) tension-free vaginal tape procedures. One (0.7%) intraoperative and five (3.6%) postoperative complications occurred. Urinary retention rate after surgical operation was 5.8%. Only one (0.7%) woman was discharged with a Foley catheter because of voiding difficulty. Clinical follow-up showed 87.6% anatomical success in women with genital prolapse and a subjective success rate of 86.4% in women undergoing anti-incontinence procedures. CONCLUSIONS Our study shows that reconstructive surgical operation is a viable treatment option for pelvic floor dysfunction in older patients.
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Jefferson AL, Lambe S, Chaisson C, Palmisano J, Horvath KJ, Karlawish J. Clinical research participation among aging adults enrolled in an Alzheimer's Disease Center research registry. JOURNAL OF ALZHEIMER'S DISEASE : JAD 2010. [PMID: 21116048 DOI: 10.3233/jad‐2010‐101536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In light of our limited understanding of what motivates older adults to participate in clinical studies of Alzheimer's disease (AD), the current study examines incentives and barriers to participating in AD clinical research among older adults. 235 participants enrolled in the Boston University Alzheimer's Disease Center research registry (75 ± 8 years, range 58-99 years, 60% female), a longitudinal registry from which individuals are recruited into other clinical studies, completed a survey assessing registry participation satisfaction, religiousness, trust in healthcare institutions, and medical research attitudes. Most participants reported initially enrolling in the registry for societal benefit. Insufficient time was a commonly endorsed barrier to enrolling in other Center-approved studies, particularly among younger participants. Driving and a lack of transportation to the medical facility were also barriers, particularly for older participants. Transportation was the most popular incentive, followed by home-based visits (particularly for older participants and participants with less formal education) and compensation (particularly among respondents from racial/ethnic minority groups). Participation interest in other studies was associated with favorable medical research attitudes (r = 0.34, p = 0.00003) but not religiousness (r = -0.09, p = 0.21), or trust in healthcare institutions (r = 0.09, p = 0.17). Among older adults, societal benefit is a motivating factor for registry enrollment; however, participation in additional studies is hindered by insufficient time among younger participants and transportation barriers among older participants. Providing transportation, home-based visits, and modest compensation may improve participation rates. Furthermore, favorable attitudes toward medical research are strongly associated with interest in enrolling in additional studies and may serve as a beneficial outreach triage technique.
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Affiliation(s)
- Angela L Jefferson
- Alzheimer's Disease Center, Boston University School of Medicine, Boston, MA 02118, USA.
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Patient-reported outcomes after combined surgery for pelvic floor disorders in older compared to younger women. Am J Obstet Gynecol 2009; 201:534.e1-5. [PMID: 19729141 DOI: 10.1016/j.ajog.2009.07.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 05/26/2009] [Accepted: 07/07/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this study was to compare patient-reported outcomes after combined surgery for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) between older and younger women. STUDY DESIGN This was a retrospective cohort study including 122 younger (<65 years) and 70 older women (>/=65 years old) who underwent combined POP and SUI surgery. SUI and POP treatment failure were based on validated measures. Logistic regression was used to calculate adjusted odds ratios and 95% confidence interval [CI]. RESULTS Mean follow-up was 10 +/- 1.2 months. Women in both age groups reported significant improvement in symptoms and life impact postoperatively. In multivariable analyses, older women had an increased odds of SUI treatment failure (adjusted odds ratio [AOR], 1.10; 95% CI, 1.05-2.5), but not POP treatment failure (AOR, 0.90; 95% CI, 0.29-2.8). CONCLUSION Women 65 years and older undergoing combined surgery for POP and SUI are at risk for recurrent SUI, but still experience significant improvements in symptoms and life impact.
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McSweeney JC, Pettey CM, Fischer EP, Spellman A. Going the distance: overcoming challenges in recruitment and retention of Black and White women in multisite, longitudinal study of predictors of coronary heart disease. Res Gerontol Nurs 2009; 2:256-64. [PMID: 20077981 DOI: 10.3928/19404921-20090803-01] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 06/23/2009] [Indexed: 11/20/2022]
Abstract
High recruitment and retention rates are hallmarks of scientifically rigorous longitudinal research. However, recruitment and retention are challenging, especially with older adults and minorities. In this article, we discuss strategies that have enabled us to retain more than 80% of both Black and White women in a 5-year observational study. To overcome challenges such as staff turnover and introduction of computerized record systems, we developed a time-saving handout, streamlined procedures for documenting contact information, and motivated site staff through weekly personal contact. We responded to problems with mailed privacy consent forms by garnering approval for verbal consent that allowed immediate response to participants' questions. In addition to standard steps to minimize attrition, we encouraged ongoing participation with personal letters following interviews, "refrigerator reminders" of the next interview date, and "missing you" letters following missed appointments. We believe these and other strategies described in this article were responsible for our high retention rate.
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Affiliation(s)
- Jean C McSweeney
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Puts MTE, Monette J, Girre V, Wolfson C, Monette M, Batist G, Bergman H. Participation of older newly-diagnosed cancer patients in an observational prospective pilot study: an example of recruitment and retention. BMC Cancer 2009; 9:277. [PMID: 19664289 PMCID: PMC3087334 DOI: 10.1186/1471-2407-9-277] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 08/10/2009] [Indexed: 01/16/2023] Open
Abstract
Background There have been few prospective observational studies which recruited older newly-diagnosed cancer patients, and of these only some have reported information on the number needed to screen to recruit their study sample, and the number and reasons for refusal and drop-out. This paper reports on strategies to recruit older newly-diagnosed cancer patients prior to treatment into an observational prospective pilot study and to retain them during a six-month period. Methods Medical charts of all patients in the Segal Cancer Centre aged 65 and over were screened and evaluated for inclusion. Several strategies to facilitate recruitment and retention were implemented. Reasons for exclusion, refusal and loss to follow-up were recorded. Descriptive statistics were used to report the reasons for refusal and loss to follow-up. A non-response analysis using chi-square tests and t-tests was conducted to compare respondents to those who refused to participate and to compare those who completed the study to those who were lost to follow-up. A feedback form with open-ended questions was administered following the last interview to obtain patient's opinions on the length of the interviews and conduct of this pilot study. Results 3060 medical charts were screened and 156 eligible patients were identified. Of these 112 patients participated for a response rate of 72%. Reasons for refusal were: feeling too anxious (40%), not interested (25%), no time (12.5%), too sick (5%) or too healthy (5%) or other reasons (5%). Ninety-one patients participated in the six-month follow-up (retention 81.3%), seven patients refused follow-up (6.2%) and fourteen patients died (12.5%) during the course of the study. The median time to conduct the baseline interview was 45 minutes and 57% of baseline interviews were conducted at home. Most patients enjoyed participation and only five felt that the interviews were too long. Conclusion It was feasible to recruit newly-diagnosed cancer patients prior to treatment although it required considerable time and effort. Once patients were included, the retention rate was high despite the fact that most were undergoing active cancer treatment.
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Affiliation(s)
- Martine T E Puts
- Solidage Research Group, Université de Montréal/McGill University Research Group on Frailty and Aging, Montreal, Canada.
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