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Kortbeek S, Johara FT, Kwan K, John T, Ng VL. Determining the minimally clinically important difference for the pediatric liver transplant quality of life questionnaire. J Pediatr Gastroenterol Nutr 2024; 79:119-125. [PMID: 38801021 DOI: 10.1002/jpn3.12256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/16/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE The Pediatric Liver Transplant Quality of Life (PeLTQL) questionnaire is a disease-specific patient reported outcome measure for pediatric liver transplant (LT) recipients. To-date, threshold values above which a change in PeLTQL score is considered meaningful to patients are unavailable. This study proposes the first values for the minimally clinically important difference (MCID) for the PeLTQL. METHODS In this retrospective cohort study, anchor and distribution-based methods were used to estimate the MCID for the PeLTQL. Questionnaires completed between March 2013, and July 2022 were included if data from two sequential visits were available. An internal anchor question was used for anchor-based determination of the MCID. A final MCID estimate was ascertained from triangulation of all methods. RESULTS PeLTQL data from 65 LT recipients (26 [40%] male, 17 [42%] biliary atresia, median age at LT 3.08 years [interquartile range 0.99-7.30]), and their caregivers were included for analysis. Median patient age at time of baseline PeLTQL completion was 13.84 (10.90-15.86) years. The MCID for self-PeLTQL total scores ranged from 4.53 to 8.46, and from 4.47 to 8.85 for proxy responses. By triangulation, the MCID of the PeLTQL total score was 6.45 and 6.78 for self and proxy responses respectively. CONCLUSION A change in PeLTQL score of 6.5 or more points suggests a change in health status that is meaningful to the patient, providing the clinical team an opportunity to engage the patient's voice in reassessing current health status and management strategies.
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Affiliation(s)
- Simone Kortbeek
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Fatema T Johara
- Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karina Kwan
- Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tomisin John
- Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vicky L Ng
- Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
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Ruf W, Juvan L, van Poppel M, Hiebler-Ragger M, Anhaus S, Sattler MC. Self-determined motivational health coaching ('SAMI') during outpatient treatment to promote physical activity of people with serious mental illness: a pilot controlled trial. J Ment Health 2024:1-10. [PMID: 38949040 DOI: 10.1080/09638237.2024.2361230] [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: 11/28/2023] [Accepted: 04/17/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Brief motivational coaching, integrated into health care; seems promising to address physical inactivity of people with serious mental illness (SMI). AIMS To test the impact of a self-determined health coaching approach (the "SAMI" intervention) during outpatient mental health treatment on moderate-to-vigorous physical activity (MVPA) of people with SMI. METHODS Adults (mean age = 41.9, SD = 10.9) with an ICD-10 diagnosis of mental illness were semi-randomized to the SAMI-intervention group (IG) or control group (CG). The IG received 30 minutes of health coaching based on the self-determination theory (SDT). MVPA and sedentary time (ST) were measured with the International Physical Activity Questionnaire - short form (IPAQ-SF) and symptoms of mental illness with the Brief Symptom Inventory (BSI-18), each at baseline and follow-up (3-4 months). Differences in primary (MVPA) and secondary (ST, BSI-18) outcomes were evaluated using negative binomial regressions and general linear models. RESULTS In the IG (n = 30), MVPA increased from 278 (interquartile range [IQR] = 175-551) to 435 (IQR = 161-675) min/week compared to a decrease from 250 (IQR = 180-518) to 155 (IQR = 0-383) min/week in the CG (n = 26; adjusted relative difference at follow-up: Incidence Rate Ratio [IRR] = 2.14, 95% CI: 1.17-3.93, p = 0.014). There were no statistically significant differences in ST and BSI-18. CONCLUSIONS Brief self-determined health coaching during outpatient treatment could increase post-treatment MVPA in people with SMI, potentially up to a clinically relevant level. However, great uncertainty (for all outcomes) weakens the assessment of clinical relevance.
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Affiliation(s)
- Wolfgang Ruf
- Institute of Sport Science, German University of Health and Sport, Berlin, Germany
| | - Lukas Juvan
- Ambulante Psychosoziale Rehabilitation Graz, ProMente-Reha, Graz, Austria
| | - Mireille van Poppel
- Institute of Human Movement Science, Sport and Health, University of Graz, Austria
| | | | - Susanne Anhaus
- Ambulante Psychosoziale Rehabilitation Graz, ProMente-Reha, Graz, Austria
| | - Matteo C Sattler
- Institute of Human Movement Science, Sport and Health, University of Graz, Austria
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Rodrigues DC, de Oliveira da Cunha CN, Mattos GT, Martins LHR, Nogueira TCM, de Souza MVN, da Costa de Avila LF, Ramos DF, Scaini CJ. Larvicidal activity of coumarin derivatives on Toxocara canis larvae, cytotoxicity analysis, and in silico bioavailability studies. Parasitol Res 2024; 123:246. [PMID: 38896311 DOI: 10.1007/s00436-024-08272-4] [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: 04/06/2024] [Accepted: 06/13/2024] [Indexed: 06/21/2024]
Abstract
Human toxocariasis is a neglected anthropozoonosis with global distribution. Treatment is based on the administration of anthelmintics; however, their effectiveness at the tissue level is low to moderate, necessitating the discovery of new drug candidates. Several groups of synthetic compounds, including coumarin derivatives, have demonstrated bioactivity against fungi, bacteria, and even parasites, such as Dactylogyrus intermedius, Leishmania major, and Plasmodium falciparum. The aim of this study was to evaluate the effect of ten coumarin-derived compounds against Toxocara canis larvae using in vitro, cytotoxicity, and in silico tests for selecting new drug candidates for preclinical tests aimed at evaluating the treatment of visceral toxocariasis. The compounds were tested in vitro in duplicate at a concentration of 1 mg/mL, and compounds with larvicidal activity were serially diluted to obtain concentrations of 0.5 mg/mL; 0.25 mg/mL; 0.125 mg/mL; and 0.05 mg/mL. The tests were performed in a microculture plate containing 100 T. canis larvae in RPMI-1640 medium. One compound (COU 9) was selected for cytotoxicity analysis using J774.A1 murine macrophages and it was found to be non-cytotoxic at any concentration tested. The in silico analysis was performed using computational models; the compound presented adequate results of oral bioavailability. To confirm the non-viability of the larvae, the contents of the microplate wells of COU 9 were inoculated intraperitoneally (IP) into female Swiss mice at 7-8 weeks of age. This confirmed the larvicidal activity of this compound. These results show that COU 9 exhibited larvicidal activity against T. canis larvae, which, after exposure to the compound, were non-viable, and that COU 9 inhibited infection in a murine model. In addition, COU 9 did not exhibit cytotoxicity and presented adequate bioavailability in silico, similar to albendazole, an anthelmintic, which is the first choice for treatment of human toxocariasis, supporting the potential for future investigations and preclinical tests on COU 9.
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Affiliation(s)
| | | | - Gabriela Torres Mattos
- Parasitology Laboratory, Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil
| | | | | | | | | | - Daniela Fernandes Ramos
- New Drug Development Laboratory, Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil
| | - Carlos James Scaini
- Parasitology Laboratory, Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil
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Cortés-Pérez I, Moreno-Montilla L, Ibáñez-Vera AJ, Díaz-Fernández Á, Obrero-Gaitán E, Lomas-Vega R. Efficacy of extracorporeal shockwave therapy, compared to corticosteroid injections, on pain, plantar fascia thickness and foot function in patients with plantar fasciitis: A systematic review and meta-analysis. Clin Rehabil 2024:2692155241253779. [PMID: 38738305 DOI: 10.1177/02692155241253779] [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: 05/14/2024]
Abstract
OBJECTIVE To compare the efficacy of extracorporeal shock waves versus corticosteroids injections on pain, thickness of plantar fascia and foot function in patients with plantar fasciitis. Secondarily, to assess the efficacy of radial and focused extracorporeal shock waves and the most appropriated intensity (high, medium or low). DATA SOURCES PubMed, SCOPUS, CINAHL and PEDro, until April 2024, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. REVIEW METHODS Randomized controlled trials comparing the efficacy of extracorporeal shock waves versus corticosteroids injections on pain intensity and sensitivity, thickness of plantar fascia and foot function in patients with plantar fasciitis. Methodological quality and risk of bias were assessed using PEDro Scale and Cochrane Risk of Bias Tool. Pooled effect was calculated using the standardized mean difference (SMD) and its 95% confidence interval (95%CI). RESULTS Sixteen studies involving 1121 patients, showing a mean of 6 points in PEDro scale, were included. At three months, extracorporeal shock waves were better than corticosteroids injections in reducing pain (SMD -0.6; 95%CI -1.1 to -0.11) and thickness of the plantar fascia (SMD -0.4; 95%CI -0.8 to -0.01) and increasing foot function (SMD 0.27; 95%CI 0.12-0.44). At six months, extracorporeal shock waves are more effective in reducing pain (SMD -0.81; 95%CI -1.6 to -0.06) and increasing foot function (SMD 0.67; 95%CI 0.45-0.89). Local pain and slight erythema were the most frequent adverse events. CONCLUSIONS Extracorporeal shock waves are a safe therapy, presenting more efficacy than corticosteroids injections in improving pain, thickness of plantar fascia and foot function at mid-term.
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Affiliation(s)
- Irene Cortés-Pérez
- Physiotherapy Area, Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Laura Moreno-Montilla
- Physiotherapy Area, Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Alfonso Javier Ibáñez-Vera
- Physiotherapy Area, Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Ángeles Díaz-Fernández
- Physiotherapy Area, Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Esteban Obrero-Gaitán
- Physiotherapy Area, Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Rafael Lomas-Vega
- Physiotherapy Area, Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
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Mukadam AA, Nayak S, Willems J, Pandey V. Estimating the minimal clinically important difference of shoulder functional scores after arthroscopic rotator cuff repair: a prospective study. Arch Orthop Trauma Surg 2024; 144:1693-1701. [PMID: 38386062 PMCID: PMC10965714 DOI: 10.1007/s00402-024-05222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 02/10/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION The minimal clinically important difference (MCID) is a valuable tool for patient-based outcome analysis, for which limited data is available in the literature, especially after arthroscopic rotator cuff repair (ARCR). Although several studies have reported MCID after ARCR, few have studied the impact of various clinical factors such as Diabetes, pseudoparalysis, type of cuff repair, and retear over MCID. This study attempts to determine the MCID in shoulder functional scores after ARCR and the impact of various factors on MCID. METHODS 144 patients undergoing ARCR were prospectively evaluated at six and 12 months by ASES and UCLA scores. MCID for American Shoulder and Elbow Surgeons (ASES) and the University of California and Los Angeles (UCLA) scores were calculated using an anchor-based and distribution-based approach. MCID was also calculated for diabetic and non-diabetic patients, smokers vs. non-smokers, presence or absence of pseudoparalysis, type of cuff repair (single row vs. suture bridge), and presence of retears. Uni- and multivariate analysis was performed to identify factors affecting the MCID of both scores. RESULTS Mean MCID for ASES score was 13.3 and 16.6 using an anchor-based and distribution-based approach, respectively. For the UCLA score, the mean MCID was 10.0 and 12.6 by anchor-based and 12.6 by distribution-based approach, respectively. Patients with higher pre-operative ASES scores demonstrated lower MCID values. No significant difference was observed in MCID scores of diabetic vs. non-diabetic patients, smoker vs. non-smoker, patients with or without pseudoparalysis, and type of cuff repair. The age, gender, and presence of retear did not affect MCID values. CONCLUSION This study establishes the MCID values of ASES and UCLA scores for rotator cuff repair by anchor and distribution methods. No patient or surgical factors appear to affect the MCID except pre-operative ASES scores. STUDY DESIGN Prospective cohort, Level II.
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Affiliation(s)
- Aditya A Mukadam
- Department of Orthopedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, 576104, India
| | - Shalini Nayak
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Udupi, Karnataka, 576104, India
| | - Jaap Willems
- International Knee and Joint Centre, Abu Dhabi, UAE
| | - Vivek Pandey
- Department of Orthopedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, 576104, India.
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Longhini J, Marzaro C, Bargeri S, Palese A, Dell'Isola A, Turolla A, Pillastrini P, Battista S, Castellini G, Cook C, Gianola S, Rossettini G. Wearable Devices to Improve Physical Activity and Reduce Sedentary Behaviour: An Umbrella Review. SPORTS MEDICINE - OPEN 2024; 10:9. [PMID: 38219269 PMCID: PMC10788327 DOI: 10.1186/s40798-024-00678-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Several systematic reviews (SRs), with and without meta-analyses, have investigated the use of wearable devices to improve physical activity, and there is a need for frequent and updated syntheses on the topic. OBJECTIVE We aimed to evaluate whether using wearable devices increased physical activity and reduced sedentary behaviour in adults. METHODS We conducted an umbrella review searching PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, MedRxiv, Rxiv and bioRxiv databases up to February 5th, 2023. We included all SRs that evaluated the efficacy of interventions when wearable devices were used to measure physical activity in adults aged over 18 years. The primary outcomes were physical activity and sedentary behaviour measured as the number of steps per day, minutes of moderate to vigorous physical activity (MVPA) per week, and minutes of sedentary behaviour (SB) per day. We assessed the methodological quality of each SR using the Assessment of Multiple Systematic Reviews, version 2 (AMSTAR 2) and the certainty of evidence of each outcome measure using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). We interpreted the results using a decision-making framework examining the clinical relevance and the concordances or discordances of the SR effect size. RESULTS Fifty-one SRs were included, of which 38 included meta-analyses (302 unique primary studies). Of the included SRs, 72.5% were rated as 'critically low methodological quality'. Overall, with a slight overlap of primary studies (corrected cover area: 3.87% for steps per day, 3.12% for MVPA, 4.06% for SB) and low-to-moderate certainty of the evidence, the use of WDs may increase PA by a median of 1,312.23 (IQR 627-1854) steps per day and 57.8 (IQR 37.7 to 107.3) minutes per week of MVPA. Uncertainty is present for PA in pathologies and older adults subgroups and for SB in mixed and older adults subgroups (large confidence intervals). CONCLUSIONS Our findings suggest that the use of WDs may increase physical activity in middle-aged adults. Further studies are needed to investigate the effects of using WDs on specific subgroups (such as pathologies and older adults) in different follow-up lengths, and the role of other intervention components.
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Affiliation(s)
- Jessica Longhini
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Silvia Bargeri
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Alvisa Palese
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Andrea Dell'Isola
- Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Orthopedics, Lund University, Lund, Sweden
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum Università di Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum Università di Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Simone Battista
- Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Orthopedics, Lund University, Lund, Sweden
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Campus of Savona, Savona, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Chad Cook
- Department of Orthopaedics, Division of Physical Therapy, Duke University, Durham, NC, USA
| | - Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Giacomo Rossettini
- School of Physiotherapy, University of Verona, Verona, Italy
- Department of Human Neurosciences, University of Roma "Sapienza Roma", Rome, Italy
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón 28670, Spain
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Joshi S, Parmar S, Kalavant A, Shah L, Parmar D. Effectiveness of structured physiotherapy in constipation in children with neurodevelopmental disorders-a randomized trial. Physiother Theory Pract 2024; 40:2-10. [PMID: 35848580 DOI: 10.1080/09593985.2022.2100299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Constipation is one of the major issues faced by children with neuro-developmental disorder (NDD). The aims of the study were to: 1) examine the effectiveness of a structured physiotherapy program on constipation in children with NDD; and 2) compare if conventional physiotherapy along with structured physiotherapy intervention has any combined effect on constipation in children with NDD. METHOD Thirty-five children with neurodevelopmental disorder were assessed and randomly allotted into two groups. Twenty-two completed the intervention for 2 weeks and were statistically analyzed at baseline and post 4 weeks at a single tertiary center. The outcome measures used were Pediatric quality of life inventory (PedsQL), Peds QL Gastrointestinal symptoms scale, Bristol stool form scale, and defecation frequency. Group A received the conventional treatment, whereas group B received structured physiotherapy along with the conventional treatment. RESULTS Group A had no significant outcomes, whereas in group B there were statistically significant differences for all outcome measures. Comparatively, a statistically significant change was noted for PedsQL GI symptoms scale (p = .045) and its constipation sub-scale (p = .002) in group B along with change in the Bristol stool form. CONCLUSION Combined effect of structured along with conventional physiotherapy was better in terms of form of stool, constipation, and its associated quality of life factors as compared to conventional physiotherapy alone.
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Affiliation(s)
- Sayali Joshi
- SDM College of Physiotherapy, SDM University, Dharwad, India
| | - Sanjay Parmar
- SDM College of Physiotherapy, SDM University, Dharwad, India
| | - Akshay Kalavant
- Department of Pediatric Surgery, SDM College of Medical Sciences and Hospital, Dharwad, India
| | - Lakshita Shah
- SDM College of Physiotherapy, SDM University, Dharwad, India
| | - Disha Parmar
- SDM College of Physiotherapy, SDM University, Dharwad, India
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Patel YS, Baste JM, Shargall Y, Waddell TK, Yasufuku K, Machuca TN, Xie F, Thabane L, Hanna WC. Robotic Lobectomy Is Cost-effective and Provides Comparable Health Utility Scores to Video-assisted Lobectomy: Early Results of the RAVAL Trial. Ann Surg 2023; 278:841-849. [PMID: 37551615 DOI: 10.1097/sla.0000000000006073] [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: 08/09/2023]
Abstract
OBJECTIVE The aim of this study was to determine if robotic-assisted lobectomy (RPL-4) is cost-effective and offers improved patient-reported health utility for patients with early-stage non-small cell lung cancer when compared with video-assisted thoracic surgery lobectomy (VATS-lobectomy). BACKGROUND Barriers against the adoption of RPL-4 in publicly funded health care include the paucity of high-quality prospective trials and the perceived high cost of robotic surgery. METHODS Patients were enrolled in a blinded, multicentered, randomized controlled trial in Canada, the United States, and France, and were randomized 1:1 to either RPL-4 or VATS-lobectomy. EuroQol 5 Dimension 5 Level (EQ-5D-5L) was administered at baseline and postoperative day 1; weeks 3, 7, 12; and months 6 and 12. Direct and indirect costs were tracked using standard methods. Seemingly Unrelated Regression was applied to estimate the cost effect, adjusting for baseline health utility. The incremental cost-effectiveness ratio was generated by 10,000 bootstrap samples with multivariate imputation by chained equations. RESULTS Of 406 patients screened, 186 were randomized, and 164 analyzed after the final eligibility review (RPL-4: n=81; VATS-lobectomy: n=83). Twelve-month follow-up was completed by 94.51% (155/164) of participants. The median age was 68 (60-74). There were no significant differences in body mass index, comorbidity, pulmonary function, smoking status, baseline health utility, or tumor characteristics between arms. The mean 12-week health utility score was 0.85 (0.10) for RPL-4 and 0.80 (0.19) for VATS-lobectomy ( P =0.02). Significantly more lymph nodes were sampled [10 (8-13) vs 8 (5-10); P =0.003] in the RPL-4 arm. The incremental cost/quality-adjusted life year of RPL-4 was $14,925.62 (95% CI: $6843.69, $23,007.56) at 12 months. CONCLUSION Early results of the RAVAL trial suggest that RPL-4 is cost-effective and associated with comparable short-term patient-reported health utility scores when compared with VATS-lobectomy.
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Affiliation(s)
- Yogita S Patel
- Department of Surgery, Division of Thoracic Surgery, McMaster University, Hamilton, ON, Canada
| | - Jean-Marc Baste
- Department of Surgery, Division of Thoracic Surgery, Rouen Normandy University, Rouen Cedex, France
| | - Yaron Shargall
- Department of Surgery, Division of Thoracic Surgery, McMaster University, Hamilton, ON, Canada
| | - Thomas K Waddell
- Department of Surgery, Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada
| | - Kazuhiro Yasufuku
- Department of Surgery, Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada
| | - Tiago N Machuca
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, FL
| | - Feng Xie
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Waël C Hanna
- Department of Surgery, Division of Thoracic Surgery, McMaster University, Hamilton, ON, Canada
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Kunze KN. Clinically Meaningful Achievement in Outcomes After Subacromial Balloon Spacer Implantation: Response. Am J Sports Med 2023; 51:NP44-NP45. [PMID: 37777863 DOI: 10.1177/03635465231184393] [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] [Indexed: 10/02/2023]
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10
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Bargeri S, Scalea S, Agosta F, Banfi G, Corbetta D, Filippi M, Sarasso E, Turolla A, Castellini G, Gianola S. Effectiveness and safety of virtual reality rehabilitation after stroke: an overview of systematic reviews. EClinicalMedicine 2023; 64:102220. [PMID: 37745019 PMCID: PMC10514431 DOI: 10.1016/j.eclinm.2023.102220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023] Open
Abstract
Background Virtual reality (VR) is an innovative neurorehabilitation modality that has been variously examined in systematic reviews. We assessed VR effectiveness and safety after cerebral stroke. Methods In this overview of systematic reviews, we searched eleven databases (Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, SCOPUS, ISI Web of Science, CINAHL, PsycINFO, Pedro, Otseeker, Healthevidence.org, Epistemonikos) and grey literature from inception to January 17, 2023. Studies eligible for inclusion were systematic reviews published in English that included adult patients with a clinical diagnosis of stroke (acute to chronic phase) undergoing any kind of immersive, semi-immersive or non-immersive VR intervention with or without conventional therapy versus conventional therapy alone. The primary outcome was motor upper limb function and activity. The secondary outcomes were gait and balance, cognitive and mental function, limitation of activities, participation, and adverse events. We calculated the degree of overlap between reviews based on the corrected covered area (CCA). Methodological quality was assessed using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) and the Certainty of Evidence (CoE) using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Discordances between results were examined using a conceptual framework based on the Jadad algorithm. This overview is registered with PROSPERO, CRD42022329263. Findings Of the 58 reviews included (n = 345 unique primary studies), 42 (72.4%) had conducted meta-analysis. More than half of the reviews (58.6%) were published between 2020 and 2022 and many (77.6%) were judged critically low in quality by AMSTAR 2. Most reported the Fugl Meyer Assessment scale (FMA-UE) to measure upper limb function and activity. For the primary outcome, there was a moderate overlap of primary studies (CCA 9.0%) with discordant findings. Focusing on upper limb function (FMA-UE), VR with or without conventional therapy seems to be more effective than conventional therapy alone, with low to moderate CoE and probable to definite clinical relevance. For secondary outcomes there was uncertainty about the superiority or no difference between groups due to substantial heterogeneity of measurement scales (eg, methodological choices). A few reviews (n = 6) reported the occurrence of mild adverse events. Interpretation Current evidence suggests that multiple meta-analyses agreed on the superiority of VR with or without conventional therapy over conventional therapy on FME-UE for upper limb. Clinicians may consider embedding VR technologies into their practice as appropriate with patient's goals, abilities, and preferences. However, caution is needed given the poor methodological quality of reviews. Funding Italian Ministry of Health.
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Affiliation(s)
- Silvia Bargeri
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | | | - Federica Agosta
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Banfi
- Vita-Salute San Raffaele University, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Davide Corbetta
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Massimo Filippi
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Sarasso
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences – DIBINEM, Alma Mater Università di Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Greta Castellini
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Silvia Gianola
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
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Mishra B, Sudheer P, Agarwal A, Srivastava MVP, Nilima, Vishnu VY. Minimal Clinically Important Difference (MCID) in Patient-Reported Outcome Measures for Neurological Conditions: Review of Concept and Methods. Ann Indian Acad Neurol 2023; 26:334-343. [PMID: 37970301 PMCID: PMC10645230 DOI: 10.4103/aian.aian_207_23] [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: 03/10/2023] [Revised: 04/29/2023] [Accepted: 05/10/2023] [Indexed: 11/17/2023] Open
Abstract
The concept of the minimal clinically important difference (MCID) emerged from the recognition that statistical significance alone is not enough to determine the clinical relevance of treatment effects in clinical research. In many cases, statistically significant changes in outcomes may not be meaningful to patients or may not result in any tangible improvements in their health. This has led to a growing emphasis on the importance of measuring patient-reported outcome measures (PROMs) in clinical trials and other research studies, in order to capture the patient perspective on treatment effectiveness. MCID is defined as the smallest change in scores that is considered meaningful or important to patients. MCID is particularly important in fields such as neurology, where many of the outcomes of interest are subjective or based on patient-reported symptoms. This review discusses the challenges associated with interpreting outcomes of clinical trials based solely on statistical significance, highlighting the importance of considering clinical relevance and patient perception of change. There are two main approaches to estimating MCID: anchor-based and distribution-based. Anchor-based approaches compare change scores using an external anchor, while distribution-based approaches estimate MCID values based on statistical characteristics of scores within a sample. MCID is dynamic and context-specific, and there is no single 'gold standard' method for estimating it. A range of MCID thresholds should be defined using multiple methods for a disease under targeted intervention, rather than relying on a single absolute value. The use of MCID thresholds can be an important tool for researchers, neurophysicians and patients in evaluating the effectiveness of treatments and interventions, and in making informed decisions about care.
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Affiliation(s)
- Biswamohan Mishra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pachipala Sudheer
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Nilima
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Linnerooth S, Penley B, Sauvageau G, Ha J, Beal A, Craven J, Feeney E, Taddei-Allen P, Thomas N, Watkins J, Hydery T. Methodology for conducting a comprehensive product review in managed care. J Manag Care Spec Pharm 2023; 29:237-243. [PMID: 36840955 PMCID: PMC10388012 DOI: 10.18553/jmcp.2023.29.3.237] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The high degree of complexity of the product-review process and differences in procedures between organizations have resulted in a need for best practices and an overall product-review process to create efficiencies for health care decision makers. In an effort to streamline product-review concepts, this article outlines the different components of the review process, including clinical and economic review, formulary placement determination, and evaluation of alternatives within a drug class. The article also details opportunities for the near future, as technology continues to advance and alignment between medical and pharmacy benefits is desired. DISCLOSURES: Drs Linnerooth, Penley, Ha, and Craven report employment with Xcenda, which provided funding for the manuscript. Drs Sauvageau and Hydery report employment Xcenda, which provided funding for the manuscript, and stock holdings with AmerisourceBergen. Dr Feeney reports support for attending meetings and/or travel provided by Highmark, Inc. Dr Thomas reports receipt of consulting fees from ActiveRADAR, board member roles with ActiveRADAR and RoundtableRx, an adjunct professor role with the University of Minnesota, and stock options and pensions with Eli Lilly and Aetna/CVS. Dr Watkins reports payment or honoraria from ISPOR and for articles written for Value and Outcomes Spotlight, and support for attending meetings and/or travel by AMCP.
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Affiliation(s)
| | | | | | | | | | - Jennifer Craven
- MedImpact, San Diego, CA, now with UC Davis Health, Sacramento
| | | | - Patty Taddei-Allen
- WellDyneRx, Lakeland, FL, now with School of Pharmacy, Lake Erie College of Osteopathic Medicine, Bradenton, FL
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13
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Ménager L, Ruperto M, Fricain JC, Catros S, Fénelon M. Does surgical removal of mandibular third molar influence the periodontal status of the adjacent second molars? A systematic review. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2023. [DOI: 10.1051/mbcb/2022032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objective: This study aimed to assess the influence of mandibular third molar surgical removal on the periodontal status of adjacent second molars and to investigate the potential impact of the flap design. Methods: A systematic review of the literature, registered in PROSPERO, has been carried out from Pubmed and Scopus databases following PRISMA guidelines from January 2010 to January 2022. PICO method was used to select the relevant articles. Studies comparing the periodontal status of the second molar before and after mandibular third molar removal were considered. Results: Twenty-three studies involving 1067 patients were included. The two main parameters studied were periodontal pocket depth and clinical attachment level. The envelope flap and the triangular flap were the most commonly used flap techniques. Periodontal health of adjacent second molar was maintained or improved in most of the included studies. The flap design did not seem to have a significant influence either. Conclusion: Avulsion of impacted third molar in healthy young adults does not impair the periodontal health of adjacent second molars. Further studies, with higher levels of evidence, are needed to confirm these results and to identify possible risk factors (such as age, impaction depth or periodontal disease) responsible for poorer healing.
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Bingol H, Kerem Gunel M, Alkan H. The Efficacy of Two Models of Intensive Upper Limb Training on Health-Related Quality of Life in Children with Hemiplegic Cerebral Palsy Mainstreamed in Regular Schools: A Double-Blinded, Randomized Controlled Trial. Physiother Theory Pract 2023; 39:10-25. [PMID: 34743663 DOI: 10.1080/09593985.2021.1999355] [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: 12/16/2022]
Abstract
BACKGROUND Children with hemiplegic cerebral palsy (CP) are at risk of reduced upper limb function and poorer quality of life than their typically developing peers. Although upper limb impairments have potential negative impact on the health-related quality of life (HRQOL) in children with hemiplegic CP, the efficacy of upper limb rehabilitation approaches aiming to improve upper limb impairments on HRQOL has not been adequately investigated. OBJECTIVE This study compares the efficacy of two modes of activity-based upper limb rehabilitation (modified constraint-induced movement therapy [mCIMT] and bimanual training [BIM]) on HRQOL outcomes in children with hemiplegic CP mainstreamed in regular schools. METHODS Thirty children with hemiplegic CP aged between 7 and 11 years (mean age 8.53 ± 1.54 years) who had functional ability levels of I-III according to the Manual Ability Classification System (MACS), Gross Motor Classification System (GMFCS), and Communication Function Classification System (CFCS) were randomly assigned to receive mCIMT or BIM training. Result: Both mCIMT and BIM yielded statistically significant improvements in all HRQOL domains immediately after the 10-week interventions (P < .001), which were retained at 16 weeks. CONCLUSION While there were some differences in the intervention effects, both of these upper limb rehabilitation approaches based on intensive unimanual or bimanual activity may be beneficial for improving perceived life satisfaction related to physical activity, general mood, family, friends, and school among children with hemiplegic CP mainstreamed in regular schools.
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Affiliation(s)
- Hasan Bingol
- Department of Therapy and Rehabilitation, Vocational School of Health Services, Mus Alparslan University, 49250-Güzeltepe/Mus, Turkey.,Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Hacettepe University, 06100-Samanpazarı/Ankara, Turkey
| | - Mintaze Kerem Gunel
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Hacettepe University, 06100-Samanpazarı/Ankara, Turkey
| | - Halil Alkan
- Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, 06100-Samanpazarı/Ankara, Turkey.,Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Mus Alparslan University, 49250-Güzeltepe/Mus, Turkey
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15
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Griese M, Schwerk N, Carlens J, Wetzke M, Emiralioğlu N, Kiper N, Lange J, Krenke K, Seidl E. Minimal important difference in childhood interstitial lung diseases. Thorax 2022; 78:476-483. [PMID: 36572533 PMCID: PMC10176404 DOI: 10.1136/thorax-2022-219206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/25/2022] [Indexed: 12/27/2022]
Abstract
BackgroundMonitoring disease progression in childhood interstitial lung diseases (chILD) is essential. No information for the minimal important difference (MID), which is defined as the smallest change in a parameter that is perceived as important prompting a clinician to change the treatment, is available. We calculated MIDs for vital signs (respiratory rate, peripheral oxygen saturation in room air, Fan severity score) and health-related quality of life (HrQoL) scores.MethodsThis study used data from the Kids Lung Register, which is a web-based management platform that collects data of rare paediatric lung disorders with a focus on chILD. Data of vital signs and HrQoL scores (Health Status Questionnaire, chILD-specific questionnaire and PedsQL V.4.0) were collected. MIDs were calculated according to distribution-based (one-third SD) and anchor-based methods (using forced expiratory volume in 1 s and forced vital capacity) as anchors.ResultsBaseline data of 774 children were used to calculate the following MIDs: respiratory rate 1.3 (z-score), O2saturation in room air 3.0%, Fan severity score 0.2–0.4, Health Status Questionnaire 0.4–0.8, chILD-specific questionnaire 4.4%–8.2%, physical health summary score 7.8%–8.9%, psychosocial health summary score 3.4%–6.9% and total score 5.1%–7.4%. Results of the responsiveness analysis generally agreed with the MIDs calculated.ConclusionsFor the first time, we provide estimates of MIDs for vital signs and HrQoL scores in a large cohort of chILD using different methods.
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Affiliation(s)
- Matthias Griese
- Munich University Hospital, Dr von Hauner Children's Hospital, German Center for Lung Research (DZL), Munchen, Germany
| | - Nicolaus Schwerk
- Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, German Center for Lung Research (DZL), Hannover, Germany
| | - Julia Carlens
- Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, German Center for Lung Research (DZL), Hannover, Germany
| | - Martin Wetzke
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | | | - Nural Kiper
- Pediatric Pulmonology, Hacettepe University, Ankara, Turkey
| | - Joanna Lange
- Department of Pediatric Pneumology and Allergy, Warszawski Uniwersytet Medyczny, Warszawa, Poland
| | - Katarzyna Krenke
- Department of Pediatric Pneumology and Allergy, Warszawski Uniwersytet Medyczny, Warszawa, Poland
| | - Elias Seidl
- Munich University Hospital, Dr von Hauner Children's Hospital, German Center for Lung Research (DZL), Munchen, Germany
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Castellini G, Pillastrini P, Vanti C, Bargeri S, Giagio S, Bordignon E, Fasciani F, Marzioni F, Innocenti T, Chiarotto A, Gianola S, Bertozzi L. Some conservative interventions are more effective than others for people with chronic non-specific neck pain: a systematic review and network meta-analysis. J Physiother 2022; 68:244-254. [PMID: 36266185 DOI: 10.1016/j.jphys.2022.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/08/2022] [Accepted: 09/26/2022] [Indexed: 01/11/2023] Open
Abstract
QUESTION Which is the most effective conservative intervention for patients with non-specific chronic neck pain (CNSNP)? DESIGN A systematic review and network meta-analysis of randomised clinical trials. PARTICIPANTS Adults with CNSNP of at least 3 months duration. INTERVENTIONS All available pharmacological and non-pharmacological interventions. OUTCOME MEASURES The primary outcomes were pain intensity and disability. The secondary outcome was adverse events. RESULTS Overall, 119 RCTs (12,496 patients; 32 interventions) were included. Risk of bias was low in 50.4% of trials, unclear in 22.7% and high in 26.9%. Compared with inert treatment, a combination of active and/or passive multimodal non-pharmacological inventions (eg, exercise and manual therapy) were effective for pain on a 0-to-10 scale at 1 month (MD range 0.84 to 3.74) and at 3 to 6 months (MD range 1.06 to 1.49), and effective on disability on a 0-to-100 scale at 1 month (MD range 10.26 to 14.09) and 3 to 6 months (MD range 5.60 to 16.46). These effects ranged from possible to definite clinical relevance. Compared with inert treatment, anti-inflammatory drugs alone or in combination with another non-pharmacological treatment did not reduce pain at 1 month or 3 to 6 months. At 12 months, no superiority was found over inert treatment on both outcomes. Most mild adverse events were experienced following acupuncture/dry needling intervention. On average, the evidence varied from low to very low certainty. CONCLUSIONS While multimodal non-pharmacological interventions may reduce pain and disability for up to 3 to 6 months of follow-up when compared with inert treatment, the evidence was very uncertain about their effects. Better quality and larger trials are needed to improve the certainty of evidence. REGISTRATION PROSPERO CRD42019124501.
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Affiliation(s)
- Greta Castellini
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences (DIBINEM) - University of Bologna, Italy
| | - Carla Vanti
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Silvia Bargeri
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Silvia Giagio
- Department of Biomedical and Neuromotor Sciences (DIBINEM) - University of Bologna, Italy
| | | | - Francesco Fasciani
- Department of Biomedical and Neuromotor Sciences (DIBINEM) - University of Bologna, Italy
| | - Francesco Marzioni
- Department of Biomedical and Neuromotor Sciences (DIBINEM) - University of Bologna, Italy
| | - Tiziano Innocenti
- Department of Health Science - Faculty of Science - Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands; GIMBE Foundation, Bologna, Italy
| | - Alessandro Chiarotto
- Department of Health Science - Faculty of Science - Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands; Department of General Practice - Erasmus MC - University Medical Center Rotterdam, The Netherlands
| | - Silvia Gianola
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Lucia Bertozzi
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
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Fedkov D, Berghofen A, Weiss C, Peine C, Lang F, Knitza J, Kuhn S, Krämer BK, Leipe J. Efficacy and safety of a mobile app intervention in patients with inflammatory arthritis: a prospective pilot study. Rheumatol Int 2022; 42:2177-2190. [PMID: 36112186 PMCID: PMC9483251 DOI: 10.1007/s00296-022-05175-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
AbstractEULAR highlighted the essential role of digital health in increasing self-management and improving clinical outcomes in patients with arthritis. The objective of this study was to evaluate the efficacy and safety of the digital health application (DHA) in patients with inflammatory arthritis. We assessed demographic parameters, treatment regimen, disease activity, and other patient-reported outcomes at baseline and after 4 weeks of DHA use added to standard care treatment. Of 17 patients, who completed the study, 7 (41.2%) patients were male, ranging from 19 to 63 (40.5 ± 12.2) years. No significant change in antirheumatic treatment was observed during the study. Statistically significant improvements (p < 0.05) were noted for health-related quality of life (increase in Physical Component Summary of Short Form-36 (SF-36) by 23.6%) and disease activity (decrease of Clinical Disease Activity Index and Simple Disease Activity Index by 38.4% and 39.9%, respectively). Clinically significant improvement was demonstrated for SF-36 Total Score (+ 14.4%), disease activity (Rheumatoid Arthritis Disease Activity Index− 5 to 15.9%), and depression (Patient Health Questionnaire− 9 to 13.5%). None of the efficacy parameters showed negative trends. No adverse events were reported throughout the study. The usability level was high i.e., the mean mHealth Application Usability Questionnaire Score of 5.96 (max.: 7.0) demonstrated a high level of application usability. This suggests that using a personalized disease management program based on DHA significantly improves several measures of patient-reported outcomes and disease activity in patients with inflammatory arthritis in a timely manner. These findings highlight the potential of complementary digital therapy in patients with inflammatory arthritis.
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Affiliation(s)
- Dmytro Fedkov
- Department of Internal Medicine #3, Bogomolets National Medical University, Kiev, Ukraine
| | - Andrea Berghofen
- Medical Clinic, Medical Faculty Mannheim of the University Heidelberg, Mannheim, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer, Mannheim, Germany
| | | | | | - Johannes Knitza
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg, Erlangen, Germany
- Deutsches Zentrum Für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Université Grenoble Alpes, AGEIS, Grenoble, France
| | - Sebastian Kuhn
- Department of Digital Medicine, Bielefeld University—Medical Faculty OWL, Bielefeld, Germany
- Department of Orthopaedic and Trauma Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Bernhard K. Krämer
- Department of Medicine (Nephrology, Rheumatology, Pneumology), University Hospital Mannheim, University of Heidelberg, HypertensiologyMannheim, Endocrinology Germany
| | - Jan Leipe
- Medical Clinic, Medical Faculty Mannheim of the University Heidelberg, Mannheim, Germany
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Hary V, Schitter S, Martinez V. Efficacy and safety of botulinum A toxin for the treatment of chronic peripheral neuropathic pain: A systematic review of randomized controlled trials and meta-analysis. Eur J Pain 2022; 26:980-990. [PMID: 35293078 DOI: 10.1002/ejp.1941] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Botulinum toxin type A (BTX-A) is a recently developed treatment for the management of peripheral neuropathic pain. The objective of this study was to provide a synthesis of the evidence concerning the efficacy and safety of subcutaneous botulinum toxin type A injections. DATABASES AND DATA TREATMENT We searched the MEDLINE, EMBASE, LILACS, Cochrane, and Clinical Trial Register databases for randomized controlled trials comparing subcutaneous BTX-A to placebo injections for treating chronic peripheral neuropathic pain. The primary endpoint was the assessment of pain 1 month after the injection. The secondary outcomes were the assessment of pain at 3 months, neuropathic pain intensity and quality of life at 1 and 3 months, and adverse effects. A random-effect meta-analysis was performed on the combined data. Evidence quality was rated by the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) method. RESULTS Ten randomized controlled trials including 505 patients were included in this review (registration number CRD42021239108). At 1 and 3 months after injection, the BTX-A groups had a lower mean difference (MD) in pain score (MD -1.87 (confidence intervals [CIs] -2.91; -0.83) and -1.38 (CI -1.95; -0.81), respectively). Subgroup analysis showed greater efficacy for diabetic polyneuropathy (MD -2.48, [-3.22; -1.74]). We found no impact of BTX-A on quality of life and no difference in adverse effect between BTX-A and placebo. The evidence was considered of moderate quality. CONCLUSION The pooled data suggest that subcutaneous BTX-A injections have a clinically significant effect, decreasing pain for three months after the injection, but no benefit in terms of quality of life has yet been demonstrated. SIGNIFICANCE We found that botulinum toxin is efficient and safe for the treatment of neuropathic pain, especially for diabetic polyneuropathy. Botulinum toxin type A, used for years in neurology, rehabilitation and physical medicine, has proved innocuous and effective, and should be considered as a serious alternative for pain treatment.
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Affiliation(s)
- Vincent Hary
- Faculty of medecine, Université de Paris, Paris, France
- Pain Unit, Hôpital Raymond Poincaré, APHP, Garches, France
| | - Sebastien Schitter
- Pain Unit, Hôpital Raymond Poincaré, APHP, Garches, France
- Faculty de medecine, Université Versailles Saint Quentin, Versailles, France
| | - Valeria Martinez
- Pain Unit, Hôpital Raymond Poincaré, APHP, Garches, France
- Faculty de medecine, Université Versailles Saint Quentin, Versailles, France
- INSERM U 987, CETD, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France
- Department of Anesthesiology, Hôpital Raymond Poincaré, APHP, Garches, France
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Hengartner MP, Plöderl M. Estimates of the minimal important difference to evaluate the clinical significance of antidepressants in the acute treatment of moderate-to-severe depression. BMJ Evid Based Med 2022; 27:69-73. [PMID: 33593736 DOI: 10.1136/bmjebm-2020-111600] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 12/27/2022]
Abstract
The efficacy of antidepressants in the acute treatment of moderate-to-severe depression remains a controversial issue. The minimal important difference (MID) is relevant to judge the clinical significance of treatment effects. In this analysis paper, we discuss estimates of the MID for common depression outcome measures.For the Hamilton Depression Rating Scale 17-item Version (HDRS-17), according to both anchor-based and distribution-based approaches, MID estimates range from 3 to 8 points, and the most accurate values are likely between 3 and 5 points. For the 6-item version (HDRS-6), MID estimates range between 2 and 4 points. For both the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Beck Depression Inventory II (BDI-II), MID estimates range between 3 and 9 points, with estimates of 3-6 points likely being the most accurate. Quality of life appears to be more important to patients than core depression symptoms. We thus also evaluated the Short-Form 36 (SF-36) mental component score, a popular mental-health-related quality of life measure. Its MID estimate is likely about 5 points. By contrast, the average treatment effects of antidepressants on the HDRS-17, HDRS-6, MADRS, BDI-II and SF-36 are 2 points, 1.5 points, 3 points, 2 points and 3-5 points, respectively.In conclusion, the efficacy of antidepressants in the acute treatment of moderate-to-severe depression consistently fails to exceed the lower bound of the MID estimates for common depression outcome measures. The clinical significance of antidepressants thus remains uncertain and we call for more research on quality of life measures, which are the patients' most valued outcome domains.
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Affiliation(s)
- Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Martin Plöderl
- Department of Crisis Intervention and Suicide Prevention, Paracelsus Medical University Salzburg, Salzburg, Salzburg, Austria
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Tan JY, Molassiotis A, Suen LKP, Liu J, Wang T, Huang HR. Effects of auricular acupressure on chemotherapy-induced nausea and vomiting in breast cancer patients: a preliminary randomized controlled trial. BMC Complement Med Ther 2022; 22:87. [PMID: 35331208 PMCID: PMC8953362 DOI: 10.1186/s12906-022-03543-y] [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: 05/13/2020] [Accepted: 02/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Auricular acupressure (AA) has been viewed as a promising approach to managing chemotherapy-induced nausea and vomiting (CINV) but relevant research evidence has been inconclusive. This study aimed to examine the effects of AA on CINV in breast cancer (BC) patients undergoing chemotherapy. METHODS A preliminary randomized controlled trial was conducted in 114 BC patients. Participants were randomly allocated to a true AA group (n = 38), a sham AA group (n = 38), and a standard care group (n = 38). All the participants were provided with standard antiemetic treatment and care, while the true AA group and the sham AA group received an additional 5-day true AA and a 5-day sham AA, respectively. Acute and delayed CINV were assessed by using the MASCC Antiemesis Tool (MAT), anticipatory nausea and vomiting were measured by the Index of Nausea, Vomiting, and Retching (INVR), and patients' quality of life (QoL) was evaluated by the Functional Assessment of Cancer Therapy-Breast (FACT-B). RESULTS Both the true and sham AA groups reported improved CINV outcomes than the standard care group, with the true AA demonstrating larger effects than the sham comparison. The true and sham AA groups had higher complete response (CR) rates of CINV when compared with the standard care group, with the difference in the CR of acute CINV achieving statistical significance (p = 0.03). Both the true and sham AA groups demonstrated lower incidence and severity of acute CINV compared with the standard care group with the among-group difference reaching statistical significance for the occurrence (p = 0.04) and severity (p = 0.001) of acute nausea. No significant differences in anticipatory CINV and QoL were found among the groups. CONCLUSION The use of AA plus standard antiemetic treatment and care was superior to the use of standard antiemetic treatment and care alone in managing CINV among BC patients receiving chemotherapy. The antiemetic effects of AA were identified to be more profound in improving acute CINV, particularly acute nausea. The antiemetic effects of AA were deemed to be a mixture of specific treatment effects and placebo effects, and the placebo effects were very large and even reached clinical significance. TRIAL REGISTRATION ClinicalTrials.gov; NCT02403037 ; Registered March 31, 2015.
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Affiliation(s)
- Jing-Yu Tan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR. .,College of Nursing and Midwifery, Charles Darwin University, Casuarina Campus, Ellengowan Drive, Brinkin, NT, 0810, Australia.
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | - Lorna K P Suen
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR.,School of Nursing, Tung Wah College, Homantin, Kowloon, Hong Kong SAR
| | - Jian Liu
- Department of Breast Oncology, Fujian Provincial Cancer Hospital, Fuma Road, Jinan District, Fuzhou, 340014, Fujian, China
| | - Tao Wang
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR.,College of Nursing and Midwifery, Charles Darwin University, Casuarina Campus, Ellengowan Drive, Brinkin, NT, 0810, Australia.,The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Wusi Road, Gulou District, Fuzhou, 350003, Fujian, China
| | - Hui-Rong Huang
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, 817 Mid Road, Taijiang District, Fuzhou, 350004, Fujian, China
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21
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Leichsenring F, Steinert C, Rabung S, Ioannidis JP. The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta-analytic evaluation of recent meta-analyses. World Psychiatry 2022; 21:133-145. [PMID: 35015359 PMCID: PMC8751557 DOI: 10.1002/wps.20941] [Citation(s) in RCA: 137] [Impact Index Per Article: 68.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mental disorders represent a worldwide public health concern. Psychotherapies and pharmacotherapies are recommended as first line treatments. However, evidence has emerged that their efficacy may be overestimated, due to a variety of shortcomings in clinical trials (e.g., publication bias, weak control conditions such as waiting list). We performed an umbrella review of recent meta-analyses of randomized controlled trials (RCTs) of psychotherapies and pharmacotherapies for the main mental disorders in adults. We selected meta-analyses that formally assessed risk of bias or quality of studies, excluded weak comparators, and used effect sizes for target symptoms as primary outcome. We searched PubMed and PsycINFO and individual records of the Cochrane Library for meta-analyses published between January 2014 and March 2021 comparing psychotherapies or pharmacotherapies with placebo or treatment-as-usual (TAU), or psychotherapies vs. pharmacotherapies head-to-head, or the combination of psychotherapy with pharmacotherapy to either monotherapy. One hundred and two meta-analyses, encompassing 3,782 RCTs and 650,514 patients, were included, covering depressive disorders, anxiety disorders, post-traumatic stress disorder, obsessive-compulsive disorder, somatoform disorders, eating disorders, attention-deficit/hyperactivity disorder, substance use disorders, insomnia, schizophrenia spectrum disorders, and bipolar disorder. Across disorders and treatments, the majority of effect sizes for target symptoms were small. A random effect meta-analytic evaluation of the effect sizes reported by the largest meta-analyses per disorder yielded a standardized mean difference (SMD) of 0.34 (95% CI: 0.26-0.42) for psychotherapies and 0.36 (95% CI: 0.32-0.41) for pharmacotherapies compared with placebo or TAU. The SMD for head-to-head comparisons of psychotherapies vs. pharmacotherapies was 0.11 (95% CI: -0.05 to 0.26). The SMD for the combined treatment compared with either monotherapy was 0.31 (95% CI: 0.19-0.44). Risk of bias was often high. After more than half a century of research, thousands of RCTs and millions of invested funds, the effect sizes of psychotherapies and pharmacotherapies for mental disorders are limited, suggesting a ceiling effect for treatment research as presently conducted. A paradigm shift in research seems to be required to achieve further progress.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and PsychotherapyUniversity of GiessenGiessenGermany,Department of Psychosomatics and PsychotherapyUniversity of RostockRostockGermany
| | - Christiane Steinert
- Department of Psychosomatics and PsychotherapyUniversity of GiessenGiessenGermany,International Psychoanalytic UniversityBerlinGermany
| | - Sven Rabung
- Department of PsychologyUniversity of KlagenfurtKlagenfurtAustria
| | - John P.A. Ioannidis
- Department of MedicineStanford University School of MedicineStanfordCAUSA,Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCAUSA,Department of Biomedical Data ScienceStanford University School of MedicineStanfordCAUSA
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22
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Comment on "Long-term Outcome of Surgery Versus Conservative Management for Recurrent and Ongoing Complaints After an Episode of Diverticulitis": Statistically Significant Results Are Not Necessarily Clinically Important. Ann Surg 2021; 274:e680-e681. [PMID: 32282376 DOI: 10.1097/sla.0000000000003809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Sharma H. Statistical significance or clinical significance? A researcher's dilemma for appropriate interpretation of research results. Saudi J Anaesth 2021; 15:431-434. [PMID: 34658732 PMCID: PMC8477766 DOI: 10.4103/sja.sja_158_21] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 11/05/2022] Open
Abstract
It is incredibly essential that the current clinicians and researchers remain updated with findings of current biomedical literature for evidence-based medicine. However, they come across many types of research that are nonreproducible and are even difficult to interpret clinically. Statistical and clinical significance is one such difficulty that clinicians and researchers face across many instances. In simpler terms, the P value tests all hypothesis about how the data were produced (model as whole), and not just the targeted hypothesis that it is intended to test (such as a null hypothesis) keeping in mind how reliable are the of the research results. Most of the times it is misinterpreted and misunderstood as a measure to judge the results as clinically significant. Hence this review aims to impart knowledge about “P” value and its importance in biostatistics, also highlights the importance of difference between statistical and clinical significance for appropriate interpretation of research results.
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Affiliation(s)
- Hunny Sharma
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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24
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Mat Said Z, Musa KI, Tengku Ismail TA, Abdul Hamid A, Sahathevan R, Abdul Aziz Z, Feigin V. The Effectiveness of Stroke Riskometer™ in Improving Stroke Risk Awareness in Malaysia: A Study Protocol of a Cluster-Randomized Controlled Trial. Neuroepidemiology 2021; 55:436-446. [PMID: 34535608 DOI: 10.1159/000518853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 08/03/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Stroke is considered the second leading cause of mortality and disability worldwide. The increasing burden of stroke is strong evidence that currently used primary prevention strategies are not sufficiently effective. The Stroke Riskometer™ application (app) represents a new stroke prevention strategy distinctly different from the conventional high-cardiovascular disease risk approach. OBJECTIVE This proposed study aims to evaluate the effectiveness of the Stroke Riskometer™ app in improving stroke awareness and stroke risk probability amongst the adult population in Malaysia. METHODS A non-blinded, parallel-group cluster-randomized controlled trial with a 1:1 allocation ratio will be implemented in Kelantan, Malaysia. Two groups with a sample size of 66 in each group will be recruited. The intervention group will be equipped with the Stroke Riskometer™ app and informational leaflets, while the control group will be provided with standard management, including information leaflets only. The Stroke Riskometer™ app was developed according to the self-management model of chronic diseases based on self-regulation and social cognitive theories. Data collection will be conducted at baseline and on the third week, sixth week, and sixth month follow-up via telephone interview or online questionnaire survey. The primary outcome measure is stroke risk awareness, including the domains of knowledge, perception, and intention to change. The secondary outcome measure is stroke risk probability within 5 and 10 years adjusted to each participant's socio-demographic and/or socio-economic status. An intention-to-treat approach will be used to evaluate these measures. Pearson's χ2 or independent t test will be used to examine differences between the intervention and control groups. The generalized estimating equation and the linear mixed-effects model will be employed to test the overall effectiveness of the intervention. CONCLUSION This study will evaluate the effect of Stroke Riskometer™ app on stroke awareness and stroke probability and briefly evaluate participant engagement to a pre-specified trial protocol. The findings from this will inform physicians and public health professionals of the benefit of mobile technology intervention and encourage more active mobile phone-based disease prevention apps. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT04529681.
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Affiliation(s)
- Zarudin Mat Said
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Malaysia,
| | - Kamarul Imran Musa
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Malaysia
| | - Tengku Alina Tengku Ismail
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Malaysia
| | - Anees Abdul Hamid
- Primary Care Unit, Kelantan State Health Department, Kota Bharu, Malaysia
| | - Ramesh Sahathevan
- Department of Medicine and Neurology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Zariah Abdul Aziz
- Department of Medicine, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology (AUT), Auckland City, New Zealand
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25
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Abstract
Reperfusion therapy with intravenous alteplase and endovascular therapy are effective treatments for selected patients with acute ischemic stroke. Guidelines for treatment are based upon randomized trials demonstrating substantial treatment effects for highly selected patients based on time from stroke onset and imaging features. However, patients beyond the current established guidelines might benefit with lesser but still clinically significant treatment effects. The STAIR (Stroke Treatment Academic Industry Roundtable) XI meeting convened a workgroup to consider the "outer limits" of reperfusion therapy by defining the current boundaries, and exploring optimal parameters and methodology for determining the outer limits. In addition to statistical significance, the minimum clinically important difference should be considered in exploring the limits of reperfusion therapy. Societal factors and quality of life considerations should be incorporated into assessment of treatment efficacy. The threshold for perception of benefit in the medical community may differ from that necessary for the Food and Drug Administration approval. Data from alternative sources such as platform trials, registries and large pragmatic trials should supplement randomized controlled trials to improve generalizability to routine clinical practice. Further interactions between industry and academic centers should be encouraged.
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Affiliation(s)
- Lawrence R Wechsler
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (L.R.W.)
| | - Ashutosh P Jadhav
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ (A.P.J.)
| | - Tudor G Jovin
- Department of Neurology, Cooper Medical School of Rowan University, Camden, NJ (T.G.J.)
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26
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Leichsenring F, Jaeger U, Masuhr O, Dally A, Dümpelmann M, Fricke-Neef C, Spitzer C, Steinert C. To Be or Not to Be Improved: Patients' Perception of Symptom Improvement - Linking the SCL-90-R to Patient-Rated Global Improvement in a Large Real-World Treatment Sample. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:357-362. [PMID: 32731248 DOI: 10.1159/000509213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/27/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION From both a clinical and research perspective, it is important to determine what constitutes a perceivable change in commonly used outcome measures. OBJECTIVE We aimed to do so for the Symptom Checklist-90-Revised (SCL-90-R). METHODS Patients from a large real-world sample treated with inpatient psychotherapy (n = 4,791) rated improvements in symptoms on a global 5-point Likert scale at discharge. These ratings were related to pre-post changes in the Global Severity Index (GSI) of the SCL-90-R by use of equipercentile linking. RESULTS A patient rating of 5 ("clearly improved") was found to be equivalent to an absolute pre-post difference in the GSI of 0.67 or to a percentage improvement of 54%, with the latter corresponding to the common definition of response as a 50% reduction in symptoms. A rating of 1 ("clearly worse") was equivalent to an increase in the GSI >0.50 and to a percentage worsening >55%. "Slightly improved" or "slightly worse" (ratings of 4 or 2) corresponded to pre-post changes in the GSI of 0.07 and 0.50. For severely disordered patients, larger changes were required for ratings of improvement, and for less severely disordered patients, larger changes were required for ratings of worsening. Results for depressive, anxiety, and personality disorders were widely consistent with those of the total sample. CONCLUSIONS This study is the first to link patient ratings of improvement or worsening to changes in the SCL-90-R. Results are relevant to both the interpretation of changes in individual patients and of effect sizes in outcome research. Results require replication.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany, .,Department of Psychosomatics and Psychotherapeutic Medicine, University of Rostock, Rostock, Germany,
| | | | | | | | | | | | - Carsten Spitzer
- Asklepios Clinic Tiefenbrunn, Tiefenbrunn, Germany.,Department of Psychosomatics and Psychotherapeutic Medicine, University of Rostock, Rostock, Germany
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany.,International Psychoanalytic University, Berlin, Germany
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27
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Yusri S, Elfana A, Elbattawy W, Fawzy El-Sayed KM. Effect of locally delivered adjunctive antibiotics during surgical periodontal therapy: a systematic review and meta-analysis. Clin Oral Investig 2021; 25:5127-5138. [PMID: 34283285 PMCID: PMC8370941 DOI: 10.1007/s00784-021-04056-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 06/27/2021] [Indexed: 01/08/2023]
Abstract
Aim The present study aimed to systematically assess current evidence on effects of locally delivered antibiotics during periodontal surgery compared to periodontal surgery alone on clinical attachment level (CAL) gain, probing pocket depth (PPD) reduction, recession depth (RD) changes, gingival index (GI), bleeding on probing (BOP), and plaque index (PI). Methodology MEDLINE-PubMed, Cochrane-CENTRAL and Scopus databases were searched up to April 2021 for randomized clinical trials (RCT), evaluating effects of locally delivered antibiotics during periodontal surgery. CAL gain served as primary, while PPD reduction, RD changes, GI and PI as secondary outcomes. The Cochrane Risk of Bias Tool was used to assess possible bias. Data were extracted, and meta-analysis was performed where appropriate. Result Screening of 2314 papers resulted in nine eligible studies. No adverse events were reported. Data on outcome variables were pooled and analyzed using generic inverse variance model and presented as weighted mean difference (WMD) and 95% confidence interval (95% CI). Statistically significant improvements in favor of antibiotics’ delivery were observed in studies with follow-up of ≤6 months for CAL gain (WMD = 0.61 mm (95% CI [0.07, 1.14]; p = 0.03), PPD reduction (WMD = 0.41 mm (95% CI [0.02, 0.80]; p = 0.04)) and BOP (WMD = −28.47% (95% CI [−33.00, −23.94]); p < 0.001), while for GI improvements were notable for >6 to 12 months (WMD = −0.27 (95% CI [−0.49, −0.06]; p = 0.01)). Conclusion Within the current review’s limitations, locally delivered antibiotics during surgical periodontal therapy results in post-surgical improvements for CAL, PPD, and BOP (≤6 months) with a longer-lasting GI improvement. Further randomized controlled trials are needed with true periodontal end-points to assess the ideal antibiotic agent, dosage, and delivery methods. Clinical relevance Local delivery of antibiotics during periodontal surgery improved clinical parameters for up to 6-month follow-up, with beneficial longer effects on gingival inflammation. Within the current study’s limitation, the presented evidence could support the elective usage of locally delivered antibiotics during surgical periodontal therapy. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-021-04056-7.
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Affiliation(s)
- Sarah Yusri
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Al Saraya Str. 11, Manial, Cairo, Egypt
| | - Ahmed Elfana
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Al Saraya Str. 11, Manial, Cairo, Egypt
| | - Weam Elbattawy
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Al Saraya Str. 11, Manial, Cairo, Egypt
| | - Karim M Fawzy El-Sayed
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Al Saraya Str. 11, Manial, Cairo, Egypt.
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian Albrechts University, Kiel, Germany.
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28
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Ren D, Wu T, Wan C, Li G, Qi Y, Fang Y, Zhong J. Exploration of the methods of establishing the minimum clinical important difference based on anchor and its application in the quality of life measurement scale QLICP-ES (V2.0) for esophageal cancer. Health Qual Life Outcomes 2021; 19:173. [PMID: 34215267 PMCID: PMC8254221 DOI: 10.1186/s12955-021-01808-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 06/18/2021] [Indexed: 11/12/2022] Open
Abstract
Background The development of the minimum clinical important difference (MCID) can make it easier for researchers or doctors to judge the significance of research results and the effect of intervention measures, and improve the evaluation system of efficacy. This paper is aimed to calculate the MCID based on anchor and to develop MCID for esophageal cancer scale (QLICP-ES). Methods The item Q29 (How do you evaluate your overall health in the past week with 7 grades answers from 1 very poor to 7 excellent)of EORTC QLQ-C30 was used as the subjective anchor to calculate the score difference between each domain at discharge and admission. MCID was established according to two standards, "one grade difference"(A) and "at least one grade difference"(B), and developed by three methods: anchor-based method, ROC curve method and multiple linear regression models. In terms of anchor-based method, the mean of the absolute value of the difference before and after treatments is MCID. The point with the best sensitivity and specificity-Yorden index at the ROC curve is MCID for ROC curve method. In contrast, the predicted mean value based on a multiple linear regression model and the parameters of each factor is MCID. Results Most of the correlation coefficients of Q29 and various domains of the QLICP-ES were higher than 0.30. The rank of MCID values determined by different methods and standards were as follows: standard B > standard A, anchor-based method > ROC curve method > multiple linear regression models. The recommended MCID values of physical domain, psychological domain, social domain, common symptom and side-effects domain, the specific domain and the overall of the QLICP-ES were 7.8, 9.7, 4.7, 3.6, 4.3, 2.3 and 2.9, respectively. Conclusion Different methods have their own advantages and disadvantages, and also different definitions and standards can be adopted according to research purposes and methods. A lot of different MCID values were presented in this paper so that it can be easy and convenient to select by users.
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Affiliation(s)
- Dandan Ren
- School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Guangdong Medical University, Dongguan, 523808, China
| | - Ting Wu
- School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Guangdong Medical University, Dongguan, 523808, China
| | - Chonghua Wan
- School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Guangdong Medical University, Dongguan, 523808, China.
| | - Gaofeng Li
- The Third Affiliated Hospital, Kunming Medical University (Yunnan Tumor Hospital), Kunming, 650106, China
| | - Yanbo Qi
- The Center for Response and Management of Emergence Public Health Event, the Center for Disease Control and Prevention of Yunnan Province, Kunming, 650022, China
| | - Yujing Fang
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, China
| | - Jiudi Zhong
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, China
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29
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Peripheral Nerve Blocks and Potentially Attributable Adverse Events in Older People with Hip Fracture: A Retrospective Population-based Cohort Study. Anesthesiology 2021; 135:454-462. [PMID: 34237127 DOI: 10.1097/aln.0000000000003863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Peripheral nerve blocks are being used with increasing frequency for management of hip fracture-related pain. Despite converging evidence that nerve blocks may be beneficial, safety data are lacking. This study hypothesized that peripheral nerve block receipt would not be associated with adverse events potentially attributable to nerve blocks, as well as overall patient safety incidents while in hospital. METHODS This was a preregistered, retrospective population-based cohort study using linked administrative data. This study identified all hip fracture admissions in people 50 yr of age or older and identified all nerve blocks (although we were unable to ascertain the specific anatomic location or type of block), potentially attributable adverse events (composite of seizures, fall- related injuries, cardiac arrest, nerve injury), and any patient safety events using validated codes. The study also estimated the unadjusted and adjusted association of nerve blocks with adverse events; adjusted absolute risk differences were also calculated. RESULTS In total, 91,563 hip fracture patients from 2009 to 2017 were identified; 15,631 (17.1%) received a nerve block, and 5,321 (5.8%; 95% CI, 5.7 to 6.0%) patients experienced a potentially nerve block-attributable adverse event: 866 (5.5%) in patients with a block and 4,455 (5.9%) without a block. Before and after adjustment, nerve blocks were not associated with potentially attributable adverse events (adjusted odds ratio, 1.05; 95% CI, 0.97 to 1.15; and adjusted risk difference, 0.3%, 95% CI, -0.1 to 0.8). CONCLUSIONS The data suggest that nerve blocks in hip fracture patients are not associated with higher rates of potentially nerve block-attributable adverse events, although these findings may be influenced by limitations in routinely collected administrative data. EDITOR’S PERSPECTIVE
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30
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Acuna SA, Dossa F, Chesney TR. Comments and Concerns on the LASER Trial. JAMA Surg 2021; 156:985-986. [PMID: 34106228 DOI: 10.1001/jamasurg.2021.2250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sergio A Acuna
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Fahima Dossa
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tyler R Chesney
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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31
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Dankers M, Nelissen-Vrancken MHJMG, Hart BH, Lambooij AC, van Dijk L, Mantel-Teeuwisse AK. Alignment between outcomes and minimal clinically important differences in the Dutch type 2 diabetes mellitus guideline and healthcare professionals' preferences. Pharmacol Res Perspect 2021; 9:e00750. [PMID: 33934550 PMCID: PMC8244004 DOI: 10.1002/prp2.750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
To evaluate the clinical benefit of new medicines for type 2 diabetes mellitus (T2DM), the Dutch guideline committee T2DM in primary care established the importance of outcomes and minimal clinically important differences (MCIDs). The present study used an online questionnaire to investigate healthcare professionals' opinions about the importance of outcomes and preferences for MCIDs. A total of 211 physicians, pharmacists, practice nurses, diabetes nurses, nurse practitioners and physician assistants evaluated the importance of mortality, macro- and microvascular morbidity, HbA1c, body weight, quality of life, (overall) hospital admissions and severe and other hypoglycemia on a 9-point scale. All outcomes were considered critical (mean scores 7-9), except for body weight and other hypoglycemia (mean scores 4-6). Only HbA1c and hospital admissions were valued differently by the guideline committee (not critical). Other relevant outcomes according to the respondents were adverse events, ease of use and costs. Median MCIDs were 4 mmol/mol for HbA1c (guideline: 5 mmol/mol) and 3 kg for body weight (guideline: 5 kg weight gain and 2,5 kg weight loss). Healthcare professionals preferred relative risk reductions of 20% for mortality (guideline: 10%) and macrovascular morbidity (guideline: 25%) and 50% for other hypoglycaemia (guideline: 25%). The MCID of 25% for microvascular morbidity, hospital admissions and severe hypoglycaemia corresponded to the guideline-MCID. Healthcare professionals' preferences were thus comparable to the views of the guideline committee. However, healthcare professionals had a stricter view on the importance of HbA1c and hospital admissions and the MCIDs for mortality and other hypoglycemia.
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Affiliation(s)
- Marloes Dankers
- Dutch Institute for Rational Use of Medicine, Utrecht, the Netherlands.,Department of PharmacoTherapy, -Epidemiology and -Economics (PTEE, Groningen Research Institute of Pharmacy, Faculty of Science and Engineering, University of Groningen, Groningen, the Netherlands
| | | | - Bertien H Hart
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Leidsche Rijn Julius Healthcare Centers, Utrecht, the Netherlands
| | - Anke C Lambooij
- Dutch Institute for Rational Use of Medicine, Utrecht, the Netherlands
| | - Liset van Dijk
- Department of PharmacoTherapy, -Epidemiology and -Economics (PTEE, Groningen Research Institute of Pharmacy, Faculty of Science and Engineering, University of Groningen, Groningen, the Netherlands.,Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS, Utrecht University, Utrecht, the Netherlands
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32
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Yang XC, Shao LL, Mi YJ, Zhang WH, Liu NY, Liu RB, Zhou XX, Zhang WH, Tian QB. Effect of renin-angiotensin-aldosterone system inhibitors on all-cause mortality and major cardiovascular events in patients with diabetes: A meta-analysis focusing on the number needed to treat and minimal clinical effect. J Diabetes Complications 2021; 35:107830. [PMID: 33446411 DOI: 10.1016/j.jdiacomp.2020.107830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/22/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
AIMS To assess the effectiveness of renin-angiotensin-aldosterone system (RAAS) inhibitors, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) separately to prevent all-cause mortality, myocardial infarction (MI), stroke and heart failure (HF) in patients with diabetes considering the number needed to treat (NNT) and minimal clinical effect (MCE). METHODS Data from 17 morbidity-mortality trials in patients with diabetes were used to calculate NNTs and evaluate MCE to prevent all-cause mortality, myocardial infarction, stroke, and heart failure. RESULTS A total of 17 trials involving 42,037 patients were included in this meta-analysis. Mean follow-up was 3.7 years. ACEIs significantly reduced the risk of all-cause mortality, MI and HF; the corresponding mean NNTBs were 48, 62 and 78, respectively, but ARBs were only associated with a reduction in heart failure. The clinical significance assessment of the included trials indicated that most of the statistically significant trial results had no definitive clinical significance, and only some of them had possible clinical significance. CONCLUSIONS Among patients with diabetes, ACEIs reduced all-cause mortality, MI and HF, whereas ARBs could only prevent HF. However, none of the results of these trials had clear clinical significance, and most had only possible clinical significance.
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Affiliation(s)
- Xiao-Chun Yang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang 050017, China; Hebei Province Key Laboratory of Environment and Human Health, 361 East Zhongshan Road, Shijiazhuang 050017, China
| | - Li-Li Shao
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang 050017, China; Hebei Province Key Laboratory of Environment and Human Health, 361 East Zhongshan Road, Shijiazhuang 050017, China
| | - Ying-Jun Mi
- Hebei Province Key Laboratory of Environment and Human Health, 361 East Zhongshan Road, Shijiazhuang 050017, China; Department of Social Medicine and Health Care Management, School of Public Health, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang 050017, China
| | - Wen-Hao Zhang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang 050017, China; Hebei Province Key Laboratory of Environment and Human Health, 361 East Zhongshan Road, Shijiazhuang 050017, China
| | - Nuo-Ya Liu
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang 050017, China; Hebei Province Key Laboratory of Environment and Human Health, 361 East Zhongshan Road, Shijiazhuang 050017, China
| | - Ruo-Bin Liu
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang 050017, China; Hebei Province Key Laboratory of Environment and Human Health, 361 East Zhongshan Road, Shijiazhuang 050017, China
| | - Xiao-Xi Zhou
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang 050017, China; Hebei Province Key Laboratory of Environment and Human Health, 361 East Zhongshan Road, Shijiazhuang 050017, China
| | - Wei-Hong Zhang
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University of Ghent. Belgium C. Heymanslaan 10, Entrance 75/ICRH, 9000 Gent, Belgium
| | - Qing-Bao Tian
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang 050017, China; Hebei Province Key Laboratory of Environment and Human Health, 361 East Zhongshan Road, Shijiazhuang 050017, China.
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The effects of mobile apps on stress, anxiety, and depression: overview of systematic reviews. Int J Technol Assess Health Care 2020; 37:e4. [PMID: 33314997 DOI: 10.1017/s0266462320002093] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Despite a large number of mobile apps in the field of mental health, it is difficult to find a useful and reliable one, mainly due to the fact that the effectiveness of many apps has not been assessed scientifically. The present study aimed to assess the effects of mental health apps on managing the symptoms of stress, anxiety, and depression. METHODS A comprehensive literature search was conducted in PubMed, Scopus, EMBASE, Cochrane, and Web of Science databases for the papers published from 2000 to 2019. Studies were included if they reviewed articles or mobile apps for their effectiveness in stress, anxiety, and depression. The reviews that had considered mobile apps or web-based mobile applications as an intervention or part of intervention were included, as well. RESULTS A total of 4,999 peer-reviewed articles were identified, out of which nine systematic reviews met the inclusion criteria. Seven systematic reviews measured depression outcomes, three measured stress, and five systematic reviews measured anxiety symptoms. The applications that used behavior change strategies, such as Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, and Behavioral Activation, reported significant effects on depression, anxiety, and stress. CONCLUSION It seems that mental health apps can be promising media for reducing depressive symptoms. This field is an emerging area of mobile health, and further research should be done in future in order to reach conclusive evidence.
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Tan OL, Safii SH, Razali M. Clinical Efficacy of Single Application Local Drug Delivery and Adjunctive Agents in Nonsurgical Periodontal Therapy: A Systematic Review and Network Meta-Analysis. Pharmaceutics 2020; 12:pharmaceutics12111086. [PMID: 33198248 PMCID: PMC7698182 DOI: 10.3390/pharmaceutics12111086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/29/2022] Open
Abstract
This review aimed to rank the clinical efficacy of commercially available single-application local drug delivery and adjunctive agents (LDAs) compared with subgingival mechanical debridement (SMD) in nonsurgical periodontal therapy (NSPT). Randomized controlled clinical trials that compared LDAs against SMD alone or with placebo in adults (aged at least 18 years) diagnosed with periodontitis with a minimum of 6 months follow-up were included. A frequentist approach to random-effects network meta-analysis was implemented. The efficacies of the LDAs measured by probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain were reported as mean difference (MD) with 95% confidence intervals (CIs). The treatments were ranked according to their P-score. Four network meta-analyses suggested that sulfonic/sulfuric acid gel (PPD MD −1.13 mm, 95% CI −1.74 to −0.53, P-score 0.91; CAL MD −1.09 mm, 95% CI −1.58 to −0.61, P-score 0.95) and doxycycline hyclate gel (PPD MD −0.90 mm, 95% CI −1.50 to −0.30, P-score 0.93; CAL MD −0.84 mm, 95% CI −1.40 to −0.28, P-score 0.92) were the most effective in reducing PPD and gaining CAL in split-mouth and parallel studies, respectively (moderate certainty of evidence). LDAs have differing efficacies, but they present with possible clinical significance over SMD alone in NSPT.
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Affiliation(s)
- Oi Leng Tan
- Centre for Restorative Dentistry, Unit of Periodontology, Faculty of Dentistry, National University of Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Syarida Hasnur Safii
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | - Masfueh Razali
- Centre for Restorative Dentistry, Unit of Periodontology, Faculty of Dentistry, National University of Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
- Correspondence:
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Slullitel PA, Dobransky JS, Bali K, Poitras S, Bhullar RS, Kim PR. Response to Letter to the Editor on "Is There a Role for Pre-closure Dilute Betadine Irrigation in the Prevention of Postoperative Infection Following TJA?". J Arthroplasty 2020; 35:1751-1752. [PMID: 32063414 DOI: 10.1016/j.arth.2020.01.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/17/2020] [Indexed: 02/01/2023] Open
Affiliation(s)
- Pablo A Slullitel
- The Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, Ottawa ON
| | - Johanna S Dobransky
- The Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, Ottawa ON
| | - Kamal Bali
- The Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, Ottawa ON
| | - Stéphane Poitras
- The Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, Ottawa ON
| | - Ramandeep S Bhullar
- The Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, Ottawa ON
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- The Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, Ottawa ON
| | - Paul R Kim
- The Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, Ottawa ON
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Khan MS, Shaikh A, Ochani RK, Akhtar T, Fatima K, Khan SU, Mookadam F, Murad MH, Figueredo VM, Doukky R, Krasuski RA. Assessing the Quality of Abstracts in Randomized Controlled Trials Published in High Impact Cardiovascular Journals. Circ Cardiovasc Qual Outcomes 2020; 12:e005260. [PMID: 31030545 DOI: 10.1161/circoutcomes.118.005260] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND In the busy world of cardiovascular medicine, abstracts may be the only part of a publication that clinicians read. Therefore, it is critical for abstracts to accurately reflect article content. The extended CONSORT (Consolidated Standards of Reporting Trials) Statement for Abstracts was developed to ensure high abstract quality. However, it is unknown how often adherence to CONSORT guidelines occurs among cardiovascular journals. METHODS AND RESULTS We searched MEDLINE for randomized controlled trials published in 3 major cardiovascular journals ( Circulation, Journal of the American College of Cardiology, and European Heart Journal) from 2011 to 2017. Post hoc, interim, and cost-effective analyses of randomized controlled trials were excluded. Two independent investigators extracted the data using a prespecified data collection form and a third investigator adjudicated the data. The primary outcome was frequency of subcategory adherence to CONSORT guidelines. A total of 478 abstracts were included in the analysis. Approximately half of the abstracts (53%; 255/478; 95% CI, 49%-57%) identified the article as randomized in the title. All abstracts detailed the interventions for both study groups (100%) and 81% (95% CI, 78%-85%) reported trial registration. Methodological quality reporting was relatively low: 9% (45/478; 95% CI, 6%-12%) described participant eligibility criteria with settings for data collection, 43% (204/478; 95% CI, 39%-47%) reported details of blinding, and <1% (4/478; 95% CI, 0%-2%) reported allocation concealment. Approximately 60% (301/478; 95% CI, 59%-67%) of the included abstracts provided primary outcome results while 55% (262/478; 95% CI, 51%-60%) reported harms or adverse effects. CONCLUSIONS There is a high prevalence of nonadherence to CONSORT guidelines among leading cardiovascular journals. Efforts by editors, authors, and reviewers should be made to increase adherence and promote transparent and unbiased presentation of study results.
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Affiliation(s)
- Muhammad Shahzeb Khan
- Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL (M.S.K., T.A., R.D.)
| | - Asim Shaikh
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (A.S., R.K.O., K.F.)
| | - Rohan Kumar Ochani
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (A.S., R.K.O., K.F.)
| | - Tauseef Akhtar
- Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL (M.S.K., T.A., R.D.)
| | - Kaneez Fatima
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (A.S., R.K.O., K.F.)
| | - Safi U Khan
- Department of Internal Medicine, Robert Packer Hospital, Sayre, PA (S.U.K.)
| | - Farouk Mookadam
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ (F.M.)
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN (M.H.M.)
| | - Vincent M Figueredo
- Einstein Medical Center and Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (V.M.F.)
| | - Rami Doukky
- Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL (M.S.K., T.A., R.D.)
| | - Richard A Krasuski
- Department of Cardiovascular Medicine, Duke University Health System, Durham, NC (R.A.K.)
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Slullitel PA, Dobransky JS, Bali K, Poitras S, Bhullar RS, Kim PR. Is There a Role for Preclosure Dilute Betadine Irrigation in the Prevention of Postoperative Infection Following Total Joint Arthroplasty? J Arthroplasty 2020; 35:1374-1378. [PMID: 31926778 DOI: 10.1016/j.arth.2019.12.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Conflicting evidence exists surrounding the use of preclosure irrigation solutions in primary total joint arthroplasty (TJA). We aimed to determine the role of dilute betadine lavage in preventing early infection after primary TJA. METHODS We retrospectively reviewed primary TJAs between 2010 and 2018. Dilute betadine lavage was introduced to our practice in November 2014. We included 3513 total hip arthroplasties, 3932 total knee arthroplasties, and 1033 hip resurfacings (HRs). In group 1 (n = 5588), surgical wounds were irrigated with saline; group 2 used dilute betadine solution (n = 2890). Subanalyses using propensity matching based on known risk factors of infection-age, body mass index, American Society of Anesthesiologists grade, diabetes, and procedure-were completed. RESULTS There were 48 acute infections in group 1 (0.9%) and 23 in group 2 (0.8%) (P = .762). HR without betadine had the highest acute infection prevalence (P = .028). When groups in the whole cohort were propensity score-matched, group 1 had more acute infections than group 2 (P = .033). The effect of betadine was isolated to HR patients. After excluding HR cases, betadine continued to reduce the acute infection rate when compared with the no betadine group, but this was not statistically significant (0.4% vs 0.8%; P = .101). Likewise, we did not find a significant difference in total hip arthroplasty and total knee arthroplasty patients (P = .796). CONCLUSION There was a decreased infection rate in the betadine group overall when groups were propensity-matched. Because the reduction in the acute infection rate was clinically significant, we feel this practice is an effective means to prevent infections.
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Affiliation(s)
- Pablo A Slullitel
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
| | - Johanna S Dobransky
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
| | - Kamal Bali
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
| | - Stéphane Poitras
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
| | - Raman S Bhullar
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
| | -
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
| | - Paul R Kim
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
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Abdel-Kader K, Jhamb M. EHR-Based Clinical Trials: The Next Generation of Evidence. Clin J Am Soc Nephrol 2020; 15:1050-1052. [PMID: 32094245 PMCID: PMC7341790 DOI: 10.2215/cjn.11860919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Khaled Abdel-Kader
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Manisha Jhamb
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Affiliation(s)
- Vivian W Sung
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Marie G Gantz
- Social, Statistical, & Environmental Sciences, RTI International, Research Triangle Park, North Carolina
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Lynggaard V, Zwisler AD, Taylor RS, May O, Nielsen CV. Effects of the patient education strategy 'Learning and Coping' in cardiac rehabilitation on readmissions and mortality: a randomized controlled trial (LC-REHAB). HEALTH EDUCATION RESEARCH 2020; 35:cyz034. [PMID: 31999315 DOI: 10.1093/her/cyz034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/06/2019] [Indexed: 06/10/2023]
Abstract
We assessed the effects of the patient education strategy 'Learning and Coping' (LC) in cardiac rehabilitation (CR) on mortality and readmissions by exploring results from the LC-REHAB trial. In all, 825 patients with ischaemic heart disease or heart failure were randomized to the intervention arm (LC-CR) or the control arm (standard CR) at three hospitals in Denmark. LC-CR was situational and inductive, with experienced patients as co-educators supplemented with two individual interviews. Group-based training and education hours were the same in both arms. Outcomes were time to death or readmission, length of stay and absolute number of deaths or readmissions. No between-arm differences were found in time to death, first readmission, or length of stay. Within 30 days after completion of CR, the absolute number of all-cause readmissions was 117 in the LC arm and 146 in the control arm, adjusted odds ratio 78 (95% CI: 0.61-1.01), P = 0.06. This trend diminished over time. Adding LC strategies to standard CR showed a short term but no significant long-term effect on mortality or readmissions. However, the study was not powered to detect differences in mortality and morbidity. Thus, a risk of overseeing a true effect was present.
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Affiliation(s)
- V Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, 61 Gammel Landevej, 7400 Herning, Denmark
| | - A D Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and Institute of Clinical Medicine, University of Southern Denmark, 17 Vestergade, 5800 Nyborg, Denmark
| | - R S Taylor
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and Institute of Clinical Medicine, University of Southern Denmark, 17 Vestergade, 5800 Nyborg, Denmark
- Institute of Health Research, University of Exeter Medical School, St. Luke's Campus, Heavitree Road, EX1 2LU Exeter, UK
| | - O May
- Department of Cardiology, Regional Hospital West Jutland, 61 Gammel Landevej, Herning 7400, Denmark
| | - C V Nielsen
- Department of Public Health, Section of Social Medicine and Rehabilitation, Aarhus University, 2 Bartholins Allé, 8000 Aarhus C, Denmark
- MarselisborgCentret, DEFACTUM, Central Denmark Region, 11 P.P. Ørums Gade, 8000 Aarhus C, Denmark
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Functional recovery after knee arthroplasty with regional analgesia: A systematic review and meta-analysis of randomised controlled trials. Eur J Anaesthesiol 2019; 36:418-426. [PMID: 30950899 DOI: 10.1097/eja.0000000000000983] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Regional analgesia (RA) has been widely evaluated for pain relief after total knee arthroplasty (TKA). Its impact on functional recovery is less well known. OBJECTIVES To evaluate the functional benefits of RA after TKA. DESIGN Systematic review with a random-effects meta-analysis of randomised controlled trials comparing LRA with systemic analgesia on function in adults undergoing TKA for osteoarthritis. DATABASE SOURCES MEDLINE, EMBASE, LILAC, Cochrane, CTRD databases. OUTCOMES Length of stay (LOS) in hospital and early knee flexion range of motion (ROM), early and long-term knee function, serious adverse effects. RESULTS Twenty-three studies (1246 patients) were included. LOS was significantly shorter for RA than for systemic analgesia (0.90 days, 95% confidence interval 0.3 to 1.4). Subgroup analyses found that only infiltration analgesia decreased the LOS. ROM during the first week was significantly higher for all techniques of RA than for systemic analgesia (9.23°, 95% confidence interval 4.6 to 13.9). No impact of regional analgesia techniques on global function in the longer term was demonstrated. No difference in serious adverse effects was found between RA and systemic analgesia. CONCLUSION RA techniques compared with systemic analgesia have a beneficial impact on the LOS and the ROM achieved in the early postoperative period. Global function in the longer term after surgery seems unaffected by peri-operative RA. TRIAL REGISTRATION CRD42014013995.
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Iliescu AM, McIntyre A, Wiener J, Iruthayarajah J, Lee A, Caughlin S, Teasell R. Evaluating the effectiveness of aquatic therapy on mobility, balance, and level of functional independence in stroke rehabilitation: a systematic review and meta-analysis. Clin Rehabil 2019; 34:56-68. [DOI: 10.1177/0269215519880955] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To meta-analyze and systematically review the effectiveness of aquatic therapy in improving mobility, balance, and functional independence after stroke. Data Sources: Articles published in Medline, Embase, CINAHL, PsycINFO, and Scopus up to 20 August 2019. Study Selection: Studies met the following inclusion criteria: (1) English, (2) adult stroke population, (3) randomized or non-randomized prospectively controlled trial (RCT or PCT, respectively) study design, (4) the experimental group received >1 session of aquatic therapy, and (5) included a clinical outcome measure of mobility, balance, or functional independence. Data Extraction: Participant characteristics, treatment protocols, between-group outcomes, point measures, and measures of variability were extracted. Methodological quality was assessed using Physiotherapy Evidence Database (PEDro) tool, and pooled mean differences (MD) ± standard error and 95% confidence intervals (CI) were calculated for Functional Reach Test (FRT), Timed Up and Go Test (TUG), gait speed, and Berg Balance Scale (BBS). Data Synthesis: Nineteen studies (17 RCTs and 2 PCTs) with a mean sample size of 36 participants and mean PEDro score of 5.6 (range 4–8) were included. Aquatic therapy demonstrated statistically significant improvements over land therapy on FRT (MD = 3.511 ± 1.597; 95% CI: 0.381–6.642; P = 0.028), TUG (MD = 2.229 ± 0.513; 95% CI: 1.224–3.234; P < 0.001), gait speed (MD = 0.049 ± 0.023; 95% CI: 0.005–0.094; P = 0.030), and BBS (MD = 2.252 ± 0.552; 95% CI: 1.171–3.334; P < 0.001). Conclusions: While the effect of aquatic therapy on mobility and balance is statistically significant compared to land-based therapy, the clinical significance is less clear, highly variable, and outcome measure dependent.
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Affiliation(s)
- Alice Mary Iliescu
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Amanda McIntyre
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Joshua Wiener
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Jerome Iruthayarajah
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Andrea Lee
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Sarah Caughlin
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Robert Teasell
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
- Parkwood Institute, St. Joseph’s Health Care London, London, ON, Canada
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Hasan H, Goddard K, Howard AF. Utility of the number needed to treat in paediatric haematological cancer randomised controlled treatment trials: a systematic review. BMJ Open 2019; 9:e022839. [PMID: 30787076 PMCID: PMC6398916 DOI: 10.1136/bmjopen-2018-022839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES The primary objective was to assess the utility of the number needed to treat (NNT) to inform decision-making in the context of paediatric oncology and to calculate the NNT in all superiority, parallel, paediatric haematological cancer, randomised controlled trials (RCTs), with a comparison to the threshold NNT as a measure of clinical significance. DESIGN Systematic review DATA SOURCES: MEDLINE, EMBASE and the Cochrane Childhood Cancer Group Specialized Register through CENTRAL from inception to August 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Superiority, parallel RCTs of haematological malignancy treatments in paediatric patients that assessed an outcome related to survival, relapse or remission; reported a sample size calculation with a delta value to allow for calculation of the threshold NNT, and that included parameters required to calculate the NNT and associated CI. RESULTS A total of 43 RCTs were included, representing 45 randomised questions, of which none reported the NNT. Among acute lymphoblastic leukaemia (ALL) RCTs, 29.2% (7/24) of randomised questions were found to have a NNT corresponding to benefit, in comparison to acute myeloid leukaemia (ALM) RCTs with 50% (3/6), and none in lymphoma RCTs (0/13). Only 28.6% (2/7) and 33.3% (1/3) had a NNT that was less than the threshold NNT for ALL and AML, respectively. Of these, 100% (2/2 ALL and 1/1 AML) were determined to be possibly clinically significant. CONCLUSIONS We recommend that decision-makers in paediatric oncology use the NNT and associated confidence limits as a supportive tool to evaluate evidence from RCTs while placing careful attention to the inherent limitations of this measure.
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Affiliation(s)
- Haroon Hasan
- Epi Methods Consulting, Toronto, Ontario, Canada
| | - Karen Goddard
- Department of Radiation Oncology, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - A Fuchsia Howard
- School Of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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Hung M, Baumhauer JF, Licari FW, Voss MW, Bounsanga J, Saltzman CL. PROMIS and FAAM Minimal Clinically Important Differences in Foot and Ankle Orthopedics. Foot Ankle Int 2019; 40:65-73. [PMID: 30282469 PMCID: PMC6698160 DOI: 10.1177/1071100718800304] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: Establishing score points that reflect meaningful change from the patient perspective is important for interpreting patient-reported outcomes. This study estimated the minimum clinically important difference (MCID) values of 2 Patient-Reported Outcomes Measurement Information System (PROMIS) instruments and the Foot and Ankle Ability Measure (FAAM) Sports subscale within a foot and ankle orthopedic population. METHODS: Patients seen for foot and ankle conditions at an orthopedic clinic were administered the PROMIS Physical Function (PF) v1.2, the PROMIS Pain Interference (PI) v1.1, and the FAAM Sports at baseline and all follow-up visits. MCID estimation was conducted using anchor-based and distribution-based methods. RESULTS: A total of 3069 patients, mean age of 51 years (range = 18-94), were included. The MCIDs for the PROMIS PF ranged from approximately 3 to 30 points (median = 11.3) depending on the methods being used. The MCIDs ranged from 3 to 25 points (median = 8.9) for the PROMIS PI, and from 9 to 77 points (median = 32.5) for the FAAM Sports. CONCLUSIONS: This study established a range of MCIDs in the PROMIS PF, PROMIS PI, and FAAM Sports indicating meaningful change in patient condition. MCID values were consistent across follow-up periods, but were different across methods. Values below the 25th percentile of MCIDs may be useful for low-risk clinical decisions. Midrange values (eg, near the median) should be used for high stakes decisions in clinical practice (ie, surgery referrals). The MCID values within the interquartile range should be utilized for most decision making. LEVEL OF EVIDENCE: Level I, diagnostic study, testing of previously developed diagnostic measure on consecutive patients with reference standard applied.
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Affiliation(s)
- Man Hung
- Department of Orthopaedic Surgery Operations, University of Utah, Salt Lake City, UT, USA,Department of Family & Preventive Medicine, University of Utah, Salt Lake City, UT, USA,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Judith F. Baumhauer
- Department of Orthopaedic Surgery, University of Rochester, Rochester, NY, USA
| | - Frank W. Licari
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, USA
| | - Maren W. Voss
- Department of Orthopaedic Surgery Operations, University of Utah, Salt Lake City, UT, USA
| | - Jerry Bounsanga
- Department of Orthopaedic Surgery Operations, University of Utah, Salt Lake City, UT, USA
| | - Charles L. Saltzman
- Department of Orthopaedic Surgery Operations, University of Utah, Salt Lake City, UT, USA
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Stringer W, Marciniuk D. The Role of Cardiopulmonary Exercise Testing (CPET) in Pulmonary Rehabilitation (PR) of Chronic Obstructive Pulmonary Disease (COPD) Patients. COPD 2018; 15:621-631. [PMID: 30595047 DOI: 10.1080/15412555.2018.1550476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common multisystem inflammatory disease with ramifications involving essentially all organ systems. Pulmonary rehabilitation is a comprehensive program designed to prevent and mitigate these disparate systemic effects and improve patient quality of life, functional status, and social functioning. Although initial patient assessment is a prominent component of any pulmonary rehabilitation (PR) program, cardiopulmonary exercise testing (CPET) is not regularly performed as a screening physiologic test prior to PR in COPD patients. Further, CPET is not often used to assess or document the improvement in exercise capacity related to completion of PR. In this review we will describe the classic physiologic abnormalities related to COPD on CPET parameters, the role of CPET in Risk Stratification/Safety prior to PR, the physiologic changes that occur in CPET parameters with PR, and the literature regarding the use of CPET to assess PR results. Finally, we will compare CPET to 6MW in COPD PR, the common minimal clinically important difference (MCID) is associated with CPET, and the potential future roles of CPET in PR and Research.
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Affiliation(s)
- William Stringer
- a Chronic Diseases Clinical Research Center (CDCRC), Los Angeles Biomedical Institute at Harbor-UCLA Medical Center , David Geffen School of Medicine at UCLA , Torrance , CA , USA
| | - Darcy Marciniuk
- b Respiratory Research Center, Royal University Hospital , University of Saskatchewan , Saskatoon , Canada
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Zill J, Christalle E, Tillenburg N, Mrowietz U, Augustin M, Härter M, Dirmaier J. Effects of psychosocial interventions on patient‐reported outcomes in patients with psoriasis: a systematic review and meta‐analysis. Br J Dermatol 2018; 181:939-945. [DOI: 10.1111/bjd.17272] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2018] [Indexed: 12/27/2022]
Affiliation(s)
- J.M. Zill
- Department of Medical Psychology University Medical Center Hamburg‐Eppendorf Martinistraße 52 20246 HamburgGermany
| | - E. Christalle
- Department of Medical Psychology University Medical Center Hamburg‐Eppendorf Martinistraße 52 20246 HamburgGermany
| | - N. Tillenburg
- Department of Medical Psychology University Medical Center Hamburg‐Eppendorf Martinistraße 52 20246 HamburgGermany
| | - U. Mrowietz
- Psoriasis Center at the Department of Dermatology University Medical Center Schleswig‐Holstein Campus Kiel Kiel Germany
| | - M. Augustin
- Institute for Health Services Research in Dermatology and Nursing University Medical Center Hamburg‐Eppendorf Martinistraße 52 20246 Hamburg Germany
| | - M. Härter
- Department of Medical Psychology University Medical Center Hamburg‐Eppendorf Martinistraße 52 20246 HamburgGermany
| | - J. Dirmaier
- Department of Medical Psychology University Medical Center Hamburg‐Eppendorf Martinistraße 52 20246 HamburgGermany
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Henderson EJ, Morgan GS, Amin J, Gaunt DM, Ben-Shlomo Y. The minimum clinically important difference (MCID) for a falls intervention in Parkinson's: A delphi study. Parkinsonism Relat Disord 2018; 61:106-110. [PMID: 30455158 DOI: 10.1016/j.parkreldis.2018.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/19/2018] [Accepted: 11/05/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Falls are common in Parkinson's disease so any intervention that reduced falls risk would be of value. One potential intervention is the use of cholinesterase inhibitor (ChEi) drugs. OBJECTIVE To establish the minimum clinically important difference (MCID) for fall rates to inform the effect estimate for sample size calculations of future clinical trials. METHODS We performed a Delphi study assembling a panel of experts in Parkinson's disease from academic and clinical medicine in order to reach a consensus of opinion. Responses from a panel were summarised and resent to the group, until consensus was reached. RESULTS 780 clinicians, who had been caring for people with Parkinson's for an average of 14 years, were contacted via three routes. The median (Interquartile range (IQR)) MCID after round 1 was 25% (IQR 20-30%) which equates to the prevention of 5 (IQR 4-6) falls per year. Increasing consensus after round two confirmed the MCID of 25%, narrowing the (IQ) range to 20%-25%. This was unchanged when the panel were shown the number of participants that would need to be recruited to a clinical trial in order to achieve this difference. CONCLUSIONS We have established that an expert panel of PD specialists consider that an intervention that demonstrated a 25% (IQR 20-25%) relative reduction in falls rate would be clinically meaningful. This estimate can be used to help determine the sample size for any future clinical trial.
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Affiliation(s)
- Emily J Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom; Royal United Hospitals NHS Foundation Trust Bath, BA1 3NG, United Kingdom.
| | - Gemma S Morgan
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom
| | - Jigisha Amin
- Faculty of Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, United Kingdom
| | - Daisy M Gaunt
- Bristol Randomised Trials Collaboration (BRTC), Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom
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Karkouti K, Wijeysundera DN. The clinical dilemma of managing patients who are on dual antiplatelet therapy and require major non-cardiac surgery. Br J Anaesth 2018; 122:162-164. [PMID: 30686300 DOI: 10.1016/j.bja.2018.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 09/28/2018] [Accepted: 10/03/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- K Karkouti
- Department of Anesthesia and Pain Management, and the Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Anesthesia, University of Toronto, Toronto, ON, Canada.
| | - D N Wijeysundera
- Department of Anesthesia and Pain Management, and the Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Anesthesia, University of Toronto, Toronto, ON, Canada
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Brigden A, Parslow RM, Gaunt D, Collin SM, Jones A, Crawley E. Defining the minimally clinically important difference of the SF-36 physical function subscale for paediatric CFS/ME: triangulation using three different methods. Health Qual Life Outcomes 2018; 16:202. [PMID: 30340599 PMCID: PMC6194701 DOI: 10.1186/s12955-018-1028-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Defining the minimally clinically important difference (MCID) is important for the design and analysis of clinical trials and ensures that findings are clinically meaningful. Studies in adult populations have investigated the MCID of The Short Form 36 physical function sub-scale (SF-36-PFS). However, to our knowledge no studies have defined the MCID of the SF-36-PFS in a paediatric population. We aimed to triangulate findings from distribution, anchor and qualitative methods to identify the MCID of the SF-36-PFS for children and adolescents with CFS/ME. METHODS Quantitative methods: We analysed routinely-collected data from a specialist paediatric CFS/ME service in South-West England using: 1) the anchor method, based on Clinical Global Impression (CGI) outcomes at 6 months' follow-up; 2) the distribution method, based on the standard deviation of baseline SF-36-PFS scores. Qualitative methods: Young people (aged 12-17 years) and parents were asked to complete the SF-36-PFS, marking each question twice: once for where they would currently rate themselves/their child and a second time to show what they felt would be the smallest amount of change for them/their child to feel treatment had made a difference. Semi-structured interviews were designed to explore what factors were deemed important to patients and to what extent an improvement was considered satisfactory. We thematically analysed qualitative interviews from 21 children and their parents. RESULTS Quantitative results: Six-month follow-up data were available for 198 children with a mean age of 14 years. Most were female (74%, 146/198) and 95% gave their ethnicity as "White British". Half the standard deviation of the baseline SF-36-PFS scores was 11.0. "A little better" on the CGI equated to a mean difference on the SF-36-PFS from baseline to 6-month follow-up of 9.0. Qualitative results: Twenty-one children with CFS/ME participated: 16 females (76.2%) with a mean age of 14.4 years. Twenty mothers and two fathers were also interviewed. The median minimal improvement in the SF-36-PFS was 10. Participants indicated that small changes in physical function can lead to important improvements in valued social and family function. Patients and parents were positive about improvement even in the presence of persisting symptoms. Triangulation: The MCID based on the mean score from the three methods was 10. CONCLUSIONS Converging evidence indicates future studies in paediatric CFS/ME should use an MCID of 10 on the SF-36-PFS.
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Affiliation(s)
- Amberly Brigden
- Population Health Sciences, Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK.
| | - Roxanne M Parslow
- 0000 0004 1936 7603grid.5337.2Population Health Sciences, Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU UK
| | - Daisy Gaunt
- 0000 0004 1936 7603grid.5337.2Population Health Sciences, Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU UK ,0000 0004 1936 7603grid.5337.2Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS UK
| | - Simon M Collin
- 0000 0004 1936 7603grid.5337.2Population Health Sciences, Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU UK
| | - Andy Jones
- 0000 0004 1936 7603grid.5337.2Population Health Sciences, Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU UK
| | - Esther Crawley
- 0000 0004 1936 7603grid.5337.2Population Health Sciences, Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU UK
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Howard AF, Goddard K, Rassekh SR, Samargandi OA, Hasan H. Clinical significance in pediatric oncology randomized controlled treatment trials: a systematic review. Trials 2018; 19:539. [PMID: 30290839 PMCID: PMC6173909 DOI: 10.1186/s13063-018-2925-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/19/2018] [Indexed: 12/16/2022] Open
Abstract
Background Clinical significance in a randomized controlled trial (RCT) can be determined using the minimal clinically important difference (MCID), which should inform the delta value used to determine sample size. The primary objective was to assess clinical significance in the pediatric oncology randomized controlled trial (RCT) treatment literature by evaluating: (1) the relationship between the treatment effect and the delta value as reported in the sample size calculation, and (2) the concordance between statistical and clinical significance. The secondary objective was to evaluate the reporting of methodological attributes related to clinical significance. Methods RCTs of pediatric cancer treatments, where a sample size calculation with a delta value was reported or could be calculated, were systematically reviewed. MEDLINE, EMBASE, and the Cochrane Childhood Cancer Group Specialized Register through CENTRAL were searched from inception to July 2016. Results RCTs (77 overall; 11 and 66), representing 95 (13 and 82) randomized questions were included for non-inferiority and superiority RCTs (herein, respectively). The minority (22.1% overall; 76.9 and 13.4%) of randomized questions reported conclusions based on clinical significance, and only 4.2% (15.4 and 2.4%) explicitly based the delta value on the MCID. Over half (67.4% overall; 92.3 and 63.4%) reported a confidence interval or standard error for the primary outcome experimental and control values and 12.6% (46.2 and 7.3%) reported the treatment effect, respectively. Of the 47 randomized questions in superiority trials that reported statistically non-significant findings, 25.5% were possibly clinically significant. Of the 24 randomized questions in superiority trials that were statistically significant, only 8.3% were definitely clinically significant. Conclusions A minority of RCTs in the pediatric oncology literature reported methodological attributes related to clinical significance and a notable portion of statistically insignificant studies were possibly clinically significance. Electronic supplementary material The online version of this article (10.1186/s13063-018-2925-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Fuchsia Howard
- School of Nursing, The University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Karen Goddard
- Department of Radiation Oncology, BC Cancer, Vancouver, BC, V5Z 4E6, Canada
| | - Shahrad Rod Rassekh
- Division of Hematology/Oncology, BC Children's Hospital, Vancouver, BC, V6H 3N1, Canada
| | - Osama A Samargandi
- Division of Plastic Surgery, QEII Health Sciences Centre, Halifax, NS, B3H 3A7, Canada
| | - Haroon Hasan
- Department of Radiation Oncology, BC Cancer, Vancouver, BC, V5Z 4E6, Canada.,Epi Methods Consulting, Toronto, ON, M5V 0C4, Canada
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