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Athar F, Ehsan M, Farooq M, Lo KB, Cheema HA, Ahmad S, Naveed A, Amir U. Adverse Fetal and Neonatal Outcomes following in-utero exposure to Oxcarbazepine: A Systematic Review and Meta-Analysis. Br J Clin Pharmacol 2022; 88:3600-3609. [PMID: 35591806 DOI: 10.1111/bcp.15413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/08/2022] [Accepted: 05/15/2022] [Indexed: 11/27/2022] Open
Abstract
AIM This systematic review aims to assess the safety profile of oxcarbazepine during pregnancy. METHODS Observational studies that included women who took oxcarbazepine anytime during pregnancy were included in our systematic review. The review did not include non-English articles, reviews, meta-analyses, case reports, and animal studies. Different online sources such as MEDLINE, Cochrane library, Virtual Health Library, etc. were searched for published and unpublished literature. Assessment of the risk of bias in observational studies was done using the Newcastle-Ottawa Scale. The meta-analyses were performed using a random-effect model. GRADE was used for the evaluation of the quality of evidence for the primary outcomes. RESULTS We included 19 cohort studies with a total number of 5,071,137 patients, of which 2,450 were exposed to oxcarbazepine either as monotherapy or polytherapy. The summary odds ratio (OR) was 1.69 (95% CI, 0.95-2.98) for congenital malformations following in-utero exposure to oxcarbazepine as compared to the control group of unexposed patients [seven studies (n=625)], and was 1.19 (95% CI, 0.67-2.12) when compared to those following lamotrigine (LTG) exposure during pregnancy [3 studies (n=591)]. In total, three studies (n=770) reported the association between in-utero oxcarbazepine exposure and fetal/perinatal deaths. The meta-analysis yielded a summary OR of 3.33 (95% CI, 1.70-6.51). SIGNIFICANCE Our systematic review will help healthcare providers and guideline developers regarding the treatment of epilepsy and other neurological disorders during pregnancy. More cohort studies with a higher sample size concerning oxcarbazepine use in pregnant patients are required to truly assess the in-utero safety profile of the drug.
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Affiliation(s)
- Farwa Athar
- Department of Pathology, King Edward Medical University, Lahore, Pakistan
| | - Muhammad Ehsan
- Department of Pathology, King Edward Medical University, Lahore, Pakistan
| | - Minaam Farooq
- Department of Pathology, King Edward Medical University, Lahore, Pakistan
| | - Kevin B Lo
- Department of Medicine, Einstein Medical Center, Philadelphia
| | - Huzaifa A Cheema
- Department of Pathology, King Edward Medical University, Lahore, Pakistan
| | - Shahzaib Ahmad
- Department of Pathology, King Edward Medical University, Lahore, Pakistan
| | - Aiman Naveed
- Department of Pathology, King Edward Medical University, Lahore, Pakistan
| | - Umer Amir
- Department of Pathology, King Edward Medical University, Lahore, Pakistan
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Alnakhi WK, Segal JB, Frick KD, Hussin A, Ahmed S, Morlock L. Treatment destinations and visit frequencies for patients seeking medical treatment overseas from the United Arab Emirates: results from Dubai Health Authority reporting during 2009-2016. Trop Dis Travel Med Vaccines 2019; 5:10. [PMID: 31308954 PMCID: PMC6604140 DOI: 10.1186/s40794-019-0086-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 06/04/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Each year, the Dubai Health Authority (DHA) spends millions of dollars to cover the costs of United Arab Emirates (UAE) nationals seeking healthcare overseas. Patients may travel overseas to seek an array of treatments. It is important to analyze the number of trips and treatment destinations for patients travelling overseas to provide baseline information for the DHA to improve polices and strategies related to overseas treatment for UAE nationals. METHODS Administrative data were obtained from the DHA for UAE nationals who sought medical treatment overseas during 2009-2016. We examined the number of trips and treatment destinations by medical specialty, age, gender, years of travel and travel seasons. Multinomial logistic and negative binomial regression models were used to assess the relationships of the treatment destinations and number of trips, respectively, with the key variables of interest. RESULTS The study included data from 6557 UAE nationals. The top three treatment destinations were Germany (46%), the UK (19%) and Thailand (14%). The most common medical specialties were orthopedic surgery (13%), oncology (13%) and neurosurgery (10%). Oncology had the highest expected number of trips adjusted for a number of covariates (IRR 1.34, 95% CI: 1.24-1.44). Regarding destination variation, patients had a lower relative risk ratio of seeking healthcare in Germany in the winter (RRR 0.68, 95% CI: 0.57-0.80). Endocrinology was the most common medical specialty sought in the UK (RRR 3.36, 95% CI: 2.01-5.60). CONCLUSIONS This is the first study to systematically examine the current practice of medical treatment overseas among UAE nationals. The results demonstrate that treatment destinations, medical specialties for which treatment was sought, age, gender and travel season are significant factors in understanding overseas travel for medical care. The study can guide the DHA in collecting more data for further research that may lead to policy-relevant information about sending patients to the best-quality treatment choices at an optimal cost.
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Affiliation(s)
- Wafa K. Alnakhi
- Department of Health Policy and Management Bloomberg School of Public Health, Baltimore, USA
| | - Jodi B. Segal
- School of Medicine Johns Hopkins University, Baltimore, USA
| | - Kevin D. Frick
- Carey Business School Johns Hopkins University, Baltimore, USA
| | | | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health Bloomberg School of Public Health, Baltimore, USA
| | - Laura Morlock
- Department of Health Policy and Management Bloomberg School of Public Health, Baltimore, USA
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Henderson NC, Varadhan R, Weiss CO. Cross-design synthesis for extending the applicability of trial evidence when treatment effect is heterogenous: Part II. Application and external validation. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23737484.2017.1398056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nicholas C. Henderson
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ravi Varadhan
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Biostatistics, School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Carlos O. Weiss
- Department of Family Medicine, Michigan State University, Grand Rapids, Michigan, USA
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Varadhan R, Henderson NC, Weiss CO. Cross-design synthesis for extending the applicability of trial evidence when treatment effect is heterogeneous: Part I. Methodology. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/23737484.2017.1392265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ravi Varadhan
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Biostatistics, School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nicholas C. Henderson
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Carlos O. Weiss
- Department of Family Medicine, Michigan State University, Grand Rapids, Michigan, USA
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Maragh-Bass AC, Appelson JR, Changoor NR, Davis WA, Haider AH, Morris MA. Prioritizing qualitative research in surgery: A synthesis and analysis of publication trends. Surgery 2016; 160:1447-1455. [PMID: 27499145 DOI: 10.1016/j.surg.2016.06.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 06/10/2016] [Accepted: 06/17/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Over the past 2 decades, researchers have recognized the value of qualitative research. Little has been done to characterize its application to surgery. We describe characteristics and overall prevalence of qualitative surgical research. METHODS We searched PubMed and CINAHL using "surgery" and 7 qualitative methodology terms. Four researchers extracted information; a fifth researcher reviewed 10% of abstracts for inter-rater reliability. RESULTS A total of 3,112 articles were reviewed. Removing duplicates, 28% were relevant (N = 878; κ = 0.70). Common qualitative methodologies included phenomenology (34.3%) and grounded theory (30.2%). Interviews were the most common data collection method (81.9%) of patients (64%) within surgical oncology (15.4%). Postdischarge was the most commonly studied topic (30.8%). Overall, 41% of studies were published in nursing journals, while 8% were published in surgical journals. More than half of studies were published since 2011. CONCLUSION Results suggest qualitative surgical research is gaining popularity. Most is published in nonsurgical journals, however, utilizing only 2 methodologies (phenomenology, grounded theory). The surgical journals that have published qualitative research had study topics restricted to a handful of surgical specialties. Additional surgical qualitative research should take advantage of a greater variety of approaches to provide insight into rare phenomena and social context.
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Affiliation(s)
- Allysha C Maragh-Bass
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Schools of Medicine and Public Health, Boston, MA.
| | - Jessica R Appelson
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Schools of Medicine and Public Health, Boston, MA
| | - Navin R Changoor
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Schools of Medicine and Public Health, Boston, MA
| | - W Austin Davis
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Schools of Medicine and Public Health, Boston, MA
| | - Adil H Haider
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Schools of Medicine and Public Health, Boston, MA
| | - Megan A Morris
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Schools of Medicine and Public Health, Boston, MA
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Johnson JR, Rivard RL, Griffin KH, Kolste AK, Joswiak D, Kinney ME, Dusek JA. The effectiveness of nurse-delivered aromatherapy in an acute care setting. Complement Ther Med 2016; 25:164-9. [DOI: 10.1016/j.ctim.2016.03.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 03/01/2016] [Accepted: 03/05/2016] [Indexed: 10/22/2022] Open
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Anderson JE, Rhinehart AS, Reid TS, Cuddihy RM, Vlajnic A, Dalal MR, Gemmen E, Johnstone B, Abbaszadeh B, Reed J, Sheller J, Stewart J, Mozaffari E. A Practice-Based Research Network Focused on Comparative Effectiveness Research in Type 2 Diabetes Management. Postgrad Med 2015; 125:172-80. [DOI: 10.3810/pgm.2013.05.2658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Johnson JR, Crespin DJ, Griffin KH, Finch MD, Rivard RL, Baechler CJ, Dusek JA. The effectiveness of integrative medicine interventions on pain and anxiety in cardiovascular inpatients: a practice-based research evaluation. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 14:486. [PMID: 25494710 PMCID: PMC4301797 DOI: 10.1186/1472-6882-14-486] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 12/10/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pain and anxiety occurring from cardiovascular disease are associated with long-term health risks. Integrative medicine (IM) therapies reduce pain and anxiety in small samples of hospitalized cardiovascular patients within randomized controlled trials; however, practice-based effectiveness research has been limited. The goal of the study is to evaluate the effectiveness of IM interventions (i.e., bodywork, mind-body and energy therapies, and traditional Chinese medicine) on pain and anxiety measures across a cardiovascular population. METHODS Retrospective data obtained from medical records identified patients with a cardiovascular ICD-9 code admitted to a large Midwestern hospital between 7/1/2009 and 12/31/2012. Outcomes were changes in patient-reported pain and anxiety, rated before and after IM treatments based on a numeric scale (0-10). RESULTS Of 57,295 hospital cardiovascular admissions, 6,589 (11.5%) included IM. After receiving IM therapy, patients averaged a 46.5% (p-value < 0.001) decrease in pain and a 54.8% (p-value < 0.001) decrease in anxiety. There was no difference between treatment modalities on pain reduction; however, mind-body and energy therapies (p-value < 0.01), traditional Chinese medicine (p-value < 0.05), and combination therapies (p-value < 0.01) were more effective at reducing anxiety than bodywork therapies. Each additional year of age reduced the odds of receiving any IM therapy by two percent (OR: 0.98, p-value < 0.01) and females had 96% (OR: 1.96, p-value < 0.01) higher odds of receiving any IM therapy compared to males. CONCLUSIONS Cardiovascular inpatients reported statistically significant decreases in pain and anxiety following care with adjunctive IM interventions. This study underscores the potential for future practice-based research to investigate the best approach for incorporating these therapies into an acute care setting such that IM therapies are most appropriately provided to patient populations.
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Bae JM. The clinical decision analysis using decision tree. Epidemiol Health 2014; 36:e2014025. [PMID: 25358466 PMCID: PMC4251295 DOI: 10.4178/epih/e2014025] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/29/2014] [Indexed: 11/09/2022] Open
Abstract
The clinical decision analysis (CDA) has used to overcome complexity and uncertainty in medical problems. The CDA is a tool allowing decision-makers to apply evidence-based medicine to make objective clinical decisions when faced with complex situations. The usefulness and limitation including six steps in conducting CDA were reviewed. The application of CDA results should be done under shared decision with patients' value.
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Affiliation(s)
- Jong-Myon Bae
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea
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Chain ASY, Dieleman JP, van Noord C, Hofman A, Stricker BHC, Danhof M, Sturkenboom MCJM, Della Pasqua O. Not-in-trial simulation I: Bridging cardiovascular risk from clinical trials to real-life conditions. Br J Clin Pharmacol 2014; 76:964-72. [PMID: 23617533 DOI: 10.1111/bcp.12151] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 04/04/2013] [Indexed: 01/08/2023] Open
Abstract
AIMS The assessment of heart rate-corrected QT (QTc) interval prolongation relies on the evidence of drug effects in healthy subjects. This study demonstrates the relevance of pharmacokinetic-pharmacodynamic (PKPD) relationships to characterize drug-induced QTc interval prolongation and explore the discrepancies between clinical trials and real-life conditions. METHODS d,l-Sotalol data from healthy subjects and from the Rotterdam Study cohort were used to assess treatment response in a phase I setting and in a real-life conditions, respectively. Using modelling and simulation, drug effects at therapeutic doses were predicted in both populations. RESULTS Inclusion criteria were shown to restrict the representativeness of the trial population in comparison to real-life conditions. A significant part of the typical patient population was excluded from trials due to weight and baseline QTc interval criteria. Relative risk was significantly different between sotalol users with and without heart failure, hypertension, diabetes and myocardial infarction (P < 0.01). Although drug effects do cause an increase in the relative risk of QTc interval prolongation, the presence of diabetes represented an increase from 4.0 [95% confidence interval (CI) 2.7-5.8] to 6.5 (95% CI 1.6-27.1), whilst for myocardial infarction it increased from 3.4 (95% CI 2.3-5.13) to 15.5 (95% CI 4.9-49.3). CONCLUSIONS Our findings show that drug effects on QTc interval do not explain the observed QTc values in the population. The prevalence of high QTc values in the real-life population can be assigned to co-morbidities and concomitant medications. These findings substantiate the need to account for these factors when evaluating the cardiovascular risk of medicinal products.
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Affiliation(s)
- Anne S Y Chain
- Leiden/Amsterdam Center for Drug Research, Division of Pharmacology, Leiden University, 2300 RA, Leiden, The Netherlands; Department of Medical Informatics, Erasmus Medical Centre, 3015 GE, Rotterdam, The Netherlands
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Tricco AC, Cogo E, Angeliki VA, Soobiah C, Hutton B, Hemmelgarn BR, Moher D, Finkelstein Y, Straus SE. Comparative safety of anti-epileptic drugs among infants and children exposed in utero or during breastfeeding: protocol for a systematic review and network meta-analysis. Syst Rev 2014; 3:68. [PMID: 24964932 PMCID: PMC4086277 DOI: 10.1186/2046-4053-3-68] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epilepsy affects about 1% of the general population. Anti-epileptic drugs (AEDs) prevent or terminate seizures in individuals with epilepsy. Pregnant women with epilepsy may continue taking AEDs. Many of these agents cross the placenta and increase the risk of major congenital malformations, early cognitive and developmental delays, and infant mortality. We aim to evaluate the comparative safety of AEDs approved for chronic use in Canada when administered to pregnant and breastfeeding women and the effects on their infants and children through a systematic review and network meta-analysis. METHODS Studies examining the effects of AEDs administered to pregnant and breastfeeding women regardless of indication (e.g., epilepsy, migraine, pain, psychiatric disorders) on their infants and children will be included. We will include randomized clinical trials (RCTs), quasi-RCTs, non-RCTs, controlled before-after, interrupted time series, cohort, registry, and case-control studies. The main literature search will be executed in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. We will seek unpublished literature through searches of trial protocol registries and conference abstracts. The literature search results screening, data abstraction, and risk of bias appraisal will be performed by two individuals, independently. Conflicts will be resolved through discussion. The risk of bias of experimental and quasi-experimental studies will be appraised using the Cochrane Effective Practice and Organization of Care Risk-of-Bias tool, methodological quality of observational studies will be appraised using the Newcastle-Ottawa Scale, and quality of reporting of safety outcomes will be conducted using the McMaster Quality Assessment Scale of Harms (McHarm) tool. If feasible and appropriate, we will conduct random effects meta-analysis. Network meta-analysis will be considered for outcomes that fulfill network meta-analysis assumptions.The primary outcome is major congenital malformations (overall and by specific types), while secondary outcomes include fetal loss/miscarriage, minor congenital malformations (overall and by specific types), cognitive development, psychomotor development, small for gestational age, preterm delivery, and neonatal seizures. DISCUSSION Our systematic review will address safety concerns regarding the use of AEDs during pregnancy and breastfeeding. Our results will be useful to healthcare providers, policy-makers, and women of childbearing age who are taking anti-epileptic medications. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014008925.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St, Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario M5B 1 T8, Canada.
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Peinemann F, Tushabe DA, Kleijnen J. Using multiple types of studies in systematic reviews of health care interventions--a systematic review. PLoS One 2013; 8:e85035. [PMID: 24416098 PMCID: PMC3887134 DOI: 10.1371/journal.pone.0085035] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 11/23/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A systematic review may evaluate different aspects of a health care intervention. To accommodate the evaluation of various research questions, the inclusion of more than one study design may be necessary. One aim of this study is to find and describe articles on methodological issues concerning the incorporation of multiple types of study designs in systematic reviews on health care interventions. Another aim is to evaluate methods studies that have assessed whether reported effects differ by study types. METHODS AND FINDINGS We searched PubMed, the Cochrane Database of Systematic Reviews, and the Cochrane Methodology Register on 31 March 2012 and identified 42 articles that reported on the integration of single or multiple study designs in systematic reviews. We summarized the contents of the articles qualitatively and assessed theoretical and empirical evidence. We found that many examples of reviews incorporating multiple types of studies exist and that every study design can serve a specific purpose. The clinical questions of a systematic review determine the types of design that are necessary or sufficient to provide the best possible answers. In a second independent search, we identified 49 studies, 31 systematic reviews and 18 trials that compared the effect sizes between randomized and nonrandomized controlled trials, which were statistically different in 35%, and not different in 53%. Twelve percent of studies reported both, different and non-different effect sizes. CONCLUSIONS Different study designs addressing the same question yielded varying results, with differences in about half of all examples. The risk of presenting uncertain results without knowing for sure the direction and magnitude of the effect holds true for both nonrandomized and randomized controlled trials. The integration of multiple study designs in systematic reviews is required if patients should be informed on the many facets of patient relevant issues of health care interventions.
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Affiliation(s)
- Frank Peinemann
- University of Maastricht, School for Public Health and Primary Care, Maastricht, The Netherlands
- Children's Hospital, University of Cologne, Cologne, Germany
- * E-mail:
| | - Doreen Allen Tushabe
- University of Birmingham, Department of Public Health, Epidemiology & Biostatistics, Birmingham, United Kingdom
| | - Jos Kleijnen
- University of Maastricht, School for Public Health and Primary Care, Maastricht, The Netherlands
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
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Faggion CM, Tu YK, Giannakopoulos NN. Reporting adverse events in randomized controlled trials in periodontology: a systematic review. J Clin Periodontol 2013; 40:889-95. [PMID: 23869905 DOI: 10.1111/jcpe.12140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIMS Reporting of adverse events is of paramount importance in randomized controlled trials (RCTs) to guide the implementation of new therapeutic approaches in clinical practice. The aim of this study was to assess the quality of adverse events reporting in RCTs published in the periodontal literature. MATERIALS AND METHODS Two authors (CMF and NNG) searched the PubMed and LILACS electronic databases independently and in duplicate to identify RCTs published in periodontology from 2002 to 2003 and from 2011 to 2012. Reporting quality in RCTs was assessed with reference to the 2004 CONSORT Extension for Harms checklist. Differences in adverse events reporting between industry- and non-industry-funded RCTs were also determined. Cohen's kappa statistic was used to determine the extent of inter-reviewer agreement. Fischer's exact test was used to assess differences in reporting between the two samples. RESULTS The analysis included 246 publications. One hundred twenty-four of 990 (13%) items and 223 of 1460 (15%) items were adequately reported in publications from 2002 to 2003 and from 2011 to 2012 respectively. Three checklist topics were significantly better reported in the 2011-2012 sample; two recommendations were better reported in non-industry-funded trials in publications from both periods. CONCLUSION Improvement and standardization of adverse events reporting in periodontology are needed.
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Affiliation(s)
- Clovis M Faggion
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin 9054, New Zealand.
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Goddard KAB, Knaus WA, Whitlock E, Lyman GH, Feigelson HS, Schully SD, Ramsey S, Tunis S, Freedman AN, Khoury MJ, Veenstra DL. Building the evidence base for decision making in cancer genomic medicine using comparative effectiveness research. Genet Med 2012; 14:633-42. [PMID: 22516979 PMCID: PMC3632438 DOI: 10.1038/gim.2012.16] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The clinical utility is uncertain for many cancer genomic applications. Comparative effectiveness research (CER) can provide evidence to clarify this uncertainty. The aim of this study was to identify approaches to help stakeholders make evidence-based decisions and to describe potential challenges and opportunities in using CER to produce evidence-based guidance. We identified general CER approaches for genomic applications through literature review, the authors' experiences, and lessons learned from a recent, seven-site CER initiative in cancer genomic medicine. Case studies illustrate the use of CER approaches. Evidence generation and synthesis approaches used in CER include comparative observational and randomized trials, patient-reported outcomes, decision modeling, and economic analysis. Significant challenges to conducting CER in cancer genomics include the rapid pace of innovation, lack of regulation, and variable definitions and evidence thresholds for clinical and personal utility. Opportunities to capitalize on CER methods in cancer genomics include improvements in the conduct of evidence synthesis, stakeholder engagement, increasing the number of comparative studies, and developing approaches to inform clinical guidelines and research prioritization. CER offers a variety of methodological approaches that can address stakeholders' needs and help ensure an effective translation of genomic discoveries.
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Segal JB, Kapoor W, Carey T, Mitchell PH, Murray MD, Saag KG, Schumock G, Jonas D, Steinman M, Filart R, Weinberger M, Selker H. Preliminary competencies for comparative effectiveness research. Clin Transl Sci 2012; 5:476-9. [PMID: 23253670 DOI: 10.1111/j.1752-8062.2012.00420.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The Clinical and Translational Science Award (CTSA) Workgroup for Comparative Effectiveness Research (CER) Education, Training, and Workforce Development identified a need to delineate the competencies that practitioners and users of CER for patient-centered outcomes research, should acquire. With input from CTSA representatives and collaborators, we began by describing the workforce. We recognize the workforce that conducts CER and the end users who use CER to improve the health of individuals and communities. We generated a preliminary set of competencies and solicited feedback from the CER representatives at each member site of the CTSA consortium. We distinguished applied competencies (i.e., skills needed by individuals who conduct CER) from foundational competencies that are needed by the entire CER workforce, including end users of CER. Key competency categories of relevance to both practitioners and users of CER were: (1) asking relevant research questions; (2) recognizing or designing ideal CER studies; (3) executing or using CER studies; (4) using appropriate statistical analyses for CER; and (5) communicating and disseminating CER study results to improve health. Although CER is particularly broad concept, we anticipate that these preliminary, relatively generic competencies will be used in tailoring curricula to individual learners from a variety of programmatic perspectives.
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Affiliation(s)
- Jodi B Segal
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
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Affiliation(s)
- Sally C. Morton
- Sally C. Morton is Vice President for Statistics and Epidemiology, RTI International, Research Triangle Park, NC 27709 . This article is her presidential address delivered to the American Statistical Association in Washington, DC, on August 4, 2009
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Tony M, Wagner M, Khoury H, Rindress D, Papastavros T, Oh P, Goetghebeur MM. Bridging health technology assessment (HTA) with multicriteria decision analyses (MCDA): field testing of the EVIDEM framework for coverage decisions by a public payer in Canada. BMC Health Serv Res 2011; 11:329. [PMID: 22129247 PMCID: PMC3248909 DOI: 10.1186/1472-6963-11-329] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 11/30/2011] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Consistent healthcare decision making requires systematic consideration of decision criteria and evidence available to inform them. This can be tackled by combining multicriteria decision analysis (MCDA) and Health Technology Assessment (HTA). The objective of this study was to field-test a decision support framework (EVIDEM), explore its utility to a drug advisory committee and test its reliability over time. METHODS Tramadol for chronic non-cancer pain was selected by the health plan as a case study relevant to their context. Based on extensive literature review, a by-criterion HTA report was developed to provide synthesized evidence for each criterion of the framework (14 criteria for the MCDA Core Model and 6 qualitative criteria for the Contextual Tool). During workshop sessions, committee members tested the framework in three steps by assigning: 1) weights to each criterion of the MCDA Core Model representing individual perspective; 2) scores for tramadol for each criterion of the MCDA Core Model using synthesized data; and 3) qualitative impacts of criteria of the Contextual Tool on the appraisal. Utility and reliability of the approach were explored through discussion, survey and test-retest. Agreement between test and retest data was analyzed by calculating intra-rater correlation coefficients (ICCs) for weights, scores and MCDA value estimates. RESULTS The framework was found useful by the drug advisory committee in supporting systematic consideration of a broad range of criteria to promote a consistent approach to appraising healthcare interventions. Directly integrated in the framework as a "by-criterion" HTA report, synthesized evidence for each criterion facilitated its consideration, although this was sometimes limited by lack of relevant data. Test-retest analysis showed fair to good consistency of weights, scores and MCDA value estimates at the individual level (ICC ranging from 0.676 to 0.698), thus lending some support for the reliability of the approach. Overall, committee members endorsed the inclusion of most framework criteria and revealed important areas of discussion, clarification and adaptation of the framework to the needs of the committee. CONCLUSIONS By promoting systematic consideration of all decision criteria and the underlying evidence, the framework allows a consistent approach to appraising healthcare interventions. Further testing and validation are needed to advance MCDA approaches in healthcare decisionmaking.
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Affiliation(s)
- Michèle Tony
- BioMedCom Consultants inc, Montréal, Québec Canada
| | | | | | | | - Tina Papastavros
- Workplace Safety Insurance Board of Ontario, Toronto, Ontario, Canada
| | - Paul Oh
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Mireille M Goetghebeur
- BioMedCom Consultants inc, Montréal, Québec Canada
- Centre Hospitalier Universitaire Ste Justine, Montréal Québec, Canada
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Atkins D, Chang SM, Gartlehner G, Buckley DI, Whitlock EP, Berliner E, Matchar D. Assessing applicability when comparing medical interventions: AHRQ and the Effective Health Care Program. J Clin Epidemiol 2011; 64:1198-207. [DOI: 10.1016/j.jclinepi.2010.11.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 08/05/2010] [Accepted: 11/05/2010] [Indexed: 11/28/2022]
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Gagliardi AR, Dobrow MJ. Paucity of qualitative research in general medical and health services and policy research journals: analysis of publication rates. BMC Health Serv Res 2011; 11:268. [PMID: 21992238 PMCID: PMC3214160 DOI: 10.1186/1472-6963-11-268] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 10/12/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Qualitative research has the potential to inform and improve health care decisions but a study based on one year of publications suggests that it is not published in prominent health care journals. A more detailed, longitudinal analysis of its availability is needed. The purpose of this study was to identify, count and compare the number of qualitative and non-qualitative research studies published in high impact health care journals, and explore trends in these data over the last decade. METHODS A bibliometric approach was used to identify and quantify qualitative articles published in 20 top general medical and health services and policy research journals from 1999 to 2008. Eligible journals were selected based on performance in four different ranking systems reported in the 2008 ISI Journal Citation Reports. Qualitative and non-qualitative research published in these journals were identified by searching MEDLINE, and validated by hand-searching tables of contents for four journals. RESULTS The total number of qualitative research articles published during 1999 to 2008 in ten general medical journals ranged from 0 to 41, and in ten health services and policy research journals from 0 to 39. Over this period the percentage of empirical research articles that were qualitative ranged from 0% to 0.6% for the general medical journals, and 0% to 6.4% for the health services and policy research journals. CONCLUSIONS This analysis suggests that qualitative research it is rarely published in high impact general medical and health services and policy research journals. The factors that contribute to this persistent marginalization need to be better understood.
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Affiliation(s)
- Anna R Gagliardi
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Khoury MJ, Clauser SB, Freedman AN, Gillanders EM, Glasgow RE, Klein WMP, Schully SD. Population sciences, translational research, and the opportunities and challenges for genomics to reduce the burden of cancer in the 21st century. Cancer Epidemiol Biomarkers Prev 2011; 20:2105-14. [PMID: 21795499 PMCID: PMC3189274 DOI: 10.1158/1055-9965.epi-11-0481] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Advances in genomics and related fields are promising tools for risk assessment, early detection, and targeted therapies across the entire cancer care continuum. In this commentary, we submit that this promise cannot be fulfilled without an enhanced translational genomics research agenda firmly rooted in the population sciences. Population sciences include multiple disciplines that are needed throughout the translational research continuum. For example, epidemiologic studies are needed not only to accelerate genomic discoveries and new biological insights into cancer etiology and pathogenesis, but to characterize and critically evaluate these discoveries in well-defined populations for their potential for cancer prediction, prevention and response to treatment. Behavioral, social, and communication sciences are needed to explore genomic-modulated responses to old and new behavioral interventions, adherence to therapies, decision making across the continuum, and effective use in health care. Implementation science, health services, outcomes research, comparative effectiveness research, and regulatory science are needed for moving validated genomic applications into practice and for measuring their effectiveness, cost-effectiveness, and unintended consequences. Knowledge synthesis, evidence reviews, and economic modeling of the effects of promising genomic applications will facilitate policy decisions and evidence-based recommendations. Several independent and multidisciplinary panels have recently made specific recommendations for enhanced research and policy infrastructure to inform clinical and population research for moving genomic innovations into the cancer care continuum. An enhanced translational genomics and population sciences agenda is urgently needed to fulfill the promise of genomics in reducing the burden of cancer.
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Affiliation(s)
- Muin J Khoury
- Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Kangwana BP, Kedenge SV, Noor AM, Alegana VA, Nyandigisi AJ, Pandit J, Fegan GW, Todd JE, Brooker S, Snow RW, Goodman CA. The impact of retail-sector delivery of artemether-lumefantrine on malaria treatment of children under five in Kenya: a cluster randomized controlled trial. PLoS Med 2011; 8:e1000437. [PMID: 21655317 PMCID: PMC3104978 DOI: 10.1371/journal.pmed.1000437] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 04/18/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It has been proposed that artemisinin-based combination therapy (ACT) be subsidised in the private sector in order to improve affordability and access. This study in western Kenya aimed to evaluate the impact of providing subsidized artemether-lumefantrine (AL) through retail providers on the coverage of prompt, effective antimalarial treatment for febrile children aged 3-59 months. METHODS AND FINDINGS We used a cluster-randomized, controlled design with nine control and nine intervention sublocations, equally distributed across three districts in western Kenya. Cross-sectional household surveys were conducted before and after the delivery of the intervention. The intervention comprised provision of subsidized packs of paediatric ACT to retail outlets, training of retail outlet staff, and community awareness activities. The primary outcome was defined as the proportion of children aged 3-59 months reporting fever in the past 2 weeks who started treatment with AL on the same day or following day of fever onset. Data were collected using structured questionnaires and analyzed based on cluster-level summaries, comparing control to intervention arms, while adjusting for other covariates. Data were collected on 2,749 children in the target age group at baseline and 2,662 at follow-up. 29% of children experienced fever within 2 weeks before the interview. At follow-up, the percentage of children receiving AL on the day of fever or the following day had risen by 14.6% points in the control arm (from 5.3% [standard deviation (SD): 3.2%] to 19.9% [SD: 10.0%]) and 40.2% points in the intervention arm (from 4.7% [SD: 3.4%] to 44.9% [SD: 11.7%]). The percentage of children receiving AL was significantly greater in the intervention arm at follow-up, with a difference between the arms of 25.0% points (95% confidence interval [CI]: 14.1%, 35.9%; unadjusted p = 0.0002, adjusted p = 0.0001). No significant differences were observed between arms in the proportion of caregivers who sought treatment for their child's fever by source, or in the child's adherence to AL. CONCLUSIONS Subsidizing ACT in the retail sector can significantly increase ACT coverage for reported fevers in rural areas. Further research is needed on the impact and cost-effectiveness of such subsidy programmes at a national scale. TRIAL REGISTRATION Current Controlled Trials ISRCTN59275137 and Kenya Pharmacy and Poisons Board Ethical Committee for Clinical Trials PPB/ECCT/08/07.
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Affiliation(s)
- Beth P Kangwana
- Malaria Public Health & Epidemiology Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kenya.
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Pilcher J, Bedford LA. Hierarchies of evidence in education. J Contin Educ Nurs 2011; 42:371-7. [PMID: 21485980 DOI: 10.3928/00220124-20110401-03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Accepted: 03/17/2011] [Indexed: 11/20/2022]
Abstract
The trend toward providing evidence-based education has emerged in part from the precedent set by the evidence-based practice movement in medicine. Historically, the medical model specified that evidence should be informed by experimental research. However, more contemporary models draw on a variety of evidence to determine best practices. Quantitative, qualitative, and mixed-methods designs, as well as the incorporation of professional expertise, are recognized as acceptable approaches to interpreting evidence in the educational arena. This article describes an integrated level of evidence model to assist educators in identifying the best evidence to inform teaching and learning practices.
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Affiliation(s)
- Jobeth Pilcher
- Baylor University Medical Center, Dallas, Texas 75246, USA.
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Kalogeropoulos A, Savoye LP, Georgiopoulou V, Raj L, Lloyd MS, Chiladakis J, Lerakis S, Alexopoulos D, Butler J. Long-term response of the left ventricle to cardiac resynchronization therapy: insights from standard and strain echocardiography. CONGESTIVE HEART FAILURE (GREENWICH, CONN.) 2011; 17:71-79. [PMID: 21449995 DOI: 10.1111/j.1751-7133.2011.00212.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Left ventricular (LV) response to cardiac resynchronization therapy (CRT) has typically been studied over 3- to 12-month periods. Longer-term data are unclear and response of strain parameters has not been reported. The authors evaluated long-term response with standard and strain echocardiography in 57 patients (52±15 years; 40 male; 30 white; 15 with ischemic etiology) who received a CRT-defibrillator between January 2004 and December 2005. Median ejection fraction (EF) at baseline was 22% (17%-25%). Global longitudinal, radial, and circumferential strain were -6.5% (-5.0% to -8.4%), 10.4% (6.9%-15.1%), and -7.6% (-5.5% to -10.8%), respectively. After a median of 42 months, EF increased by 5% (-1% to 15%; P<.001), with improvements in circumferential (-3.2% [-5.2% to 1.5%]; P=.001), longitudinal (-0.5% [-3.4% to 1.2%]; P=.035), and radial (1.4% [-1.1% to 9.2%]; P=.035) strain. Changes in volumes were nonsignificant. EF improvement ≥5% was observed in 29 patients (50.9%). Relative improvement ≥15% in longitudinal, radial, and circumferential strain was observed in 26 (45.6%), 29 (50.9%), and 37 (64.9%) patients, respectively. Improvement in longitudinal strain and EF was strongly associated with lower rates of heart failure-related and all-cause readmissions. A wide range of long-term LV responses to CRT was observed, with approximately 50% of patients showing favorable responses.
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Affiliation(s)
- Andreas Kalogeropoulos
- Emory Clinical Cardiovascular Research Institute, 1462 Clifton Road NE, Atlanta, GA 30322, USA.
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Krobot KJ, Wagner A, Siebert U. Risk factor levels, risk factor combinations, and residual coronary risk: population-based estimates for secondary prevention patients using statins. Eur J Prev Cardiol 2011; 19:109-17. [PMID: 21450620 DOI: 10.1177/1741826710392668] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Population-based risk factor combinations and residual risks for coronary heart disease (CHD) patients on statins were assessed in order to bridge the gap between knowledge on relative effects from clinical trials and absolute risk from real-world practice. DESIGN Population-based, retrospective 1-year cross-sectional primary care study in CHD patients (ICD-10 I20-I25) on ongoing statin monotherapy in Germany in 2007 (MediPlus database, IMS Health). METHODS Prevalence charts for 384 risk factor combinations were constructed. Population-averaged residual risks were estimated using the Framingham secondary prevention algorithm and generalized estimating equations accounting for repeated measurements within patients. RESULTS 13,256 CHD patients in 332 practices were eligible for the study (7791 men, 5465 women, 32.6% with diabetes mellitus, 82.5% on simvastatin at a mean effective dose of 26.7 mg/d). The overall residual 10-year coronary risk was projected at 35.1% (robust 95% CI 34.8-35.4). In 83.6% of patients this risk was ≥20% and in 36.5% of patients the risk was ≥40%. An increase in tablet strength to 40 mg (fluvastatin 80 mg) and in exposure to 40 mg/d (fluvastatin 80 mg/d) would be expected to reduce the predicted residual 10-year coronary risk to 34.1% and 33.8%, respectively. CONCLUSION Even when receiving high-dose statin monotherapy, the typical CHD patient in Germany is projected to be exposed to a residual coronary risk that is substantially above the generally recognized intervention threshold of 20% over 10 years. The question of how to further reduce residual coronary risk without compromising patient safety in patients on optimal statin therapy remains an important clinical challenge.
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Affiliation(s)
- Karl J Krobot
- MSD Sharp & Dohme, Lindenplatz 1, 85540 Haar, Germany.
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Tunis SR, Benner J, McClellan M. Comparative effectiveness research: Policy context, methods development and research infrastructure. Stat Med 2010; 29:1963-76. [PMID: 20564311 DOI: 10.1002/sim.3818] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Comparative effectiveness research (CER) has received substantial attention as a potential approach for improving health outcomes while lowering costs of care, and for improving the relevance and quality of clinical and health services research. The Institute of Medicine defines CER as 'the conduct and synthesis of systematic research comparing different interventions and strategies to prevent, diagnose, treat, and monitor health conditions. The purpose of this research is to inform patients, providers, and decision-makers, responding to their expressed needs, about which interventions are most effective for which patients under specific circumstances.' Improving the methods and infrastructure for CER will require sustained attention to the following issues: (1) Meaningful involvement of patients, consumers, clinicians, payers, and policymakers in key phases of CER study design and implementation; (2) Development of methodological 'best practices' for the design of CER studies that reflect decision-maker needs and balance internal validity with relevance, feasibility and timeliness; and (3) Improvements in research infrastructure to enhance the validity and efficiency with which CER studies are implemented. The approach to addressing each of these issues should be informed by the understanding that the primary purpose of CER is to help health care decision makers make informed clinical and health policy decisions.
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Affiliation(s)
- Sean R Tunis
- Center for Medical Technology Policy, World Trade Center Baltimore, 401 E. Pratt St., Suite 631, Baltimore, MD 21201, USA.
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Berdaï D, Hotton JM, Lechat P. Comparators (medicinal and non medicinal) for marketing authorization, for public health, for payers and at the European level. Therapie 2010; 65:329-34. [PMID: 20854755 DOI: 10.2515/therapie/2010035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 06/08/2010] [Indexed: 11/20/2022]
Abstract
Drug evaluation is based on comparison. Thus, the choice of the comparator for any new treatment becomes a key issue, especially when there are great differences in medical practice and of use conditions of the comparators depending on the geographical zones and their evolution with time. The choice of the comparators must satisfy sometimes different expectations from the registration authorities and for insurance coverage. The universal comparator that allows answering all the clinical assessment questions does not exist. Placebo, when it can be used, remains a reference for the MA (marketing authorisation) application, but does not exclude the use of the reference drug available on the market and prescribed under optimal efficacy conditions. The reference treatment is sometimes a difficult choice due to the absence of validated therapeutic recommendations or if the recommendations vary depending on the countries. The expansion and international harmonization of prescription guidelines (clinical practice guidelines) would reinforce the robustness and efficiency of clinical research efforts with respect to the relevance of the comparison to reference treatments. This principle also applies to the use of a non-drug comparator when it has been recognized as the reference comparator in the treatment of the pathology in question. In as much as possible, the search for a consensus must also aim at defining in the clinical development recommendations significant thresholds for the size of evaluated effects. Optimization of the information made available after clinical trials could also be helped by the development of use of methodologies that allow assessing superiority on secondary criteria during a non-inferiority study on the main criterion. Finally, the development of early scientific consultations by the Haute Autorité de Santé (HAS, French Health Authority) would contribute to adapt phase III clinical trials better to questions concerning the assessment of the clinical added value of the medicinal products evaluated.
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Berdaï D, Hotton JM, Lechat P, Barna A, Becquemont L, Bergman JF, Bernaud C, Boucot I, Cheiney I, Cucherat M, d’Andon A, d’Enfert J, Francillon A, Frauger E, Girault D, Harlin JM, Joseph A, Lassale C, Mahlberg-Gaudin F, Moreau-Defarges T, Pavlovic M, Ravoire S, Rochaix L, Vicaut E. Les comparateurs (médicamenteux et non médicamenteux) pour l’autorisation de mise sur le marché, pour la santé publique, pour les payeurs et au niveau européen. Therapie 2010; 65:323-8. [DOI: 10.2515/therapie/2010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 06/08/2010] [Indexed: 11/20/2022]
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Janszky J, Kovacs N, Gyimesi C, Fogarasi A, Doczi T, Wiebe S. Epilepsy surgery, antiepileptic drug trials, and the role of evidence. Epilepsia 2010; 51:1004-9. [DOI: 10.1111/j.1528-1167.2010.02566.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Allen RT, Rihn JA, Glassman SD, Currier B, Albert TJ, Phillips FM. An evidence-based approach to spine surgery. Am J Med Qual 2010; 24:15S-24S. [PMID: 19890181 DOI: 10.1177/1062860609348743] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Health care reform will emphasize evidence-based medicine to provide the highest quality care. Recent literature has emerged in spinal surgery that has profoundly increased the evidence base for several spinal procedures. There is now good evidence from randomized controlled trials that surgical treatment of symptomatic lumbar disc herniation, decompression for spinal stenosis, and decompression and fusion for degenerative spondylolisthesis all offer significant clinical benefit in the face of serious back and radicular pain when compared with nonsurgical care. Studies of nonsurgical and surgical treatments for chronic low back pain are inconclusive, limited by study design/methodology. Continuing to increase study quality in the field of spine surgery is more important now than ever before. Optimizing diagnostic specificity, surgical indications, and measuring outcomes with validated instruments should help the spine care community acquire essential data to provide the highest quality evidence-based care, while simultaneously eliminating procedures that lack evidence of efficacy or value.
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Affiliation(s)
- R Todd Allen
- Department of Orthopedic Surgery, University of California San Diego Medical Center, San Diego, CA 92103-8894, USA.
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Spinal cord stimulation for failed back surgery syndrome: Outcomes in a workers’ compensation setting. Pain 2010; 148:14-25. [DOI: 10.1016/j.pain.2009.08.014] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 08/03/2009] [Accepted: 08/17/2009] [Indexed: 11/21/2022]
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Berger ML, Mamdani M, Atkins D, Johnson ML. Good research practices for comparative effectiveness research: defining, reporting and interpreting nonrandomized studies of treatment effects using secondary data sources: the ISPOR Good Research Practices for Retrospective Database Analysis Task Force Report--Part I. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12:1044-1052. [PMID: 19793072 DOI: 10.1111/j.1524-4733.2009.00600.x] [Citation(s) in RCA: 236] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Health insurers, physicians, and patients worldwide need information on the comparative effectiveness and safety of prescription drugs in routine care. Nonrandomized studies of treatment effects using secondary databases may supplement the evidence based from randomized clinical trials and prospective observational studies. Recognizing the challenges to conducting valid retrospective epidemiologic and health services research studies, a Task Force was formed to develop a guidance document on state of the art approaches to frame research questions and report findings for these studies. METHODS The Task Force was commissioned and a Chair was selected by the International Society for Pharmacoeconomics and Outcomes Research Board of Directors in October 2007. This Report, the first of three reported in this issue of the journal, addressed issues of framing the research question and reporting and interpreting findings. RESULTS The Task Force Report proposes four primary characteristics-relevance, specificity, novelty, and feasibility while defining the research question. Recommendations included: the practice of a priori specification of the research question; transparency of prespecified analytical plans, provision of justifications for any subsequent changes in analytical plan, and reporting the results of prespecified plans as well as results from significant modifications, structured abstracts to report findings with scientific neutrality; and reasoned interpretations of findings to help inform policy decisions. CONCLUSIONS Comparative effectiveness research in the form of nonrandomized studies using secondary databases can be designed with rigorous elements and conducted with sophisticated statistical methods to improve causal inference of treatment effects. Standardized reporting and careful interpretation of results can aid policy and decision-making.
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Affiliation(s)
- Marc L Berger
- Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA
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Meadows-Oliver M. Does qualitative research have a place in evidence-based nursing practice? J Pediatr Health Care 2009; 23:352-4. [PMID: 19720273 DOI: 10.1016/j.pedhc.2009.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 05/19/2009] [Accepted: 05/20/2009] [Indexed: 11/26/2022]
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Inadequate reporting of trials compromises the applicability of systematic reviews. Int J Technol Assess Health Care 2009; 25:323-30. [DOI: 10.1017/s0266462309990122] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background:Uncertainty about the applicability of controlled trial findings is an increasing concern for clinicians and policy decision makers. This study aimed to determine whether information reported in studies included in systematic reviews was adequate enough to assess their applicability.Methods:We used the databases of four recently conducted systematic reviews on the comparative efficacy and safety of second-generation antidepressants, inhaled corticosteroids, Alzheimer's drugs, and targeted immune modulators. We developed and pilot-tested a questionnaire to assess the adequacy of reporting with respect to seven previously validated criteria of study design that distinguish explanatory from pragmatic studies. For each of the 137 included studies, two reviewers independently assessed the adequacy of reporting.Results:Overall, only 12 percent of the included studies provided sufficient information to reliably distinguish explanatory from pragmatic studies. The areas with the greatest lack of reporting were the setting of the study, methods of adverse event assessment, and sample size considerations to determine a minimally important difference from a patient perspective.Conclusions:Substantial shortcomings in reporting exist in aspects of study design important to determine whether a study is applicable to specific populations of interest.
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Rich EC. The policy debate over public investment in comparative effectiveness research. J Gen Intern Med 2009; 24:752-7. [PMID: 19381731 PMCID: PMC2686765 DOI: 10.1007/s11606-009-0958-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 02/20/2009] [Accepted: 03/09/2009] [Indexed: 11/01/2022]
Abstract
BACKGROUND Policy makers across the political spectrum, as well as many clinicians and physician professional associations, have proposed that better information on comparative clinical effectiveness should be a key element of any solution to the US health-care cost crisis. This superficial consensus hides intense disagreements over critical issues essential to any new public effort to promote more comparative effectiveness research (CER). METHODS AND RESULTS This article reviews the background for these disputes, summarizes the different perspectives represented by policy makers and advocates, and offers a framework to aid both practicing and academic internists in understanding the key elements of the emerging debate. Regarding the fundamental question of "what is CER," disagreements rage over whether value or cost effectiveness should be a consideration, and how specific patient perspectives should be reflected in the development and the use of such research. The question of how to pay for CER invokes controversies over the role of the market in producing such information and the private (e.g., insurers and employers) versus public responsibility for its production. The financing debate further highlights the high stakes of comparative effectiveness research, and the risks of stakeholder interests subverting any public process. Accordingly there are a range of proposals for the federal government's role in prioritization, development, and dissemination of CER. CONCLUSION The internal medicine community, with its long history of commitment to scientific medical practice and its leadership in evidence-based medicine, should have a strong interest and play an active role in this debate.
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Affiliation(s)
- Eugene C Rich
- Professor of Medicine, Creighton University School of Medicine, 601 North 30th ST, Omaha, NE, 68131, USA .
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Gross Cohn E, Haomiao Jia, Larson E. Evaluation of Statistical Approaches in Quantitative Nursing Research. Clin Nurs Res 2009; 18:223-41. [DOI: 10.1177/1054773809336096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purposes of this study were to (a) develop a tool to assess statistical methods and (b) use the tool to evaluate recently published quantitative research. We rated the statistical approaches used in 152 studies published in the 5 top impact-factor nursing research journals from September 2005 to August 2007. Studies were generally of high quality; 45% scored between 80% and 100%, and 22% achieved a score of 100%. Predictors of high scores were interdisciplinary authorship, a statistician coauthor, and the number of aims. The authors conclude that studies published in high impact-factor nursing journals are statistically sound and provide a solid foundation for evidence-based practice.
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Hoppe DJ, Schemitsch EH, Morshed S, Tornetta P, Bhandari M. Hierarchy of evidence: where observational studies fit in and why we need them. J Bone Joint Surg Am 2009; 91 Suppl 3:2-9. [PMID: 19411493 DOI: 10.2106/jbjs.h.01571] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Although randomized controlled designs are considered the so-called gold standard in medical trials and sit atop the hierarchy of evidence in evidence-based medicine, there are situations in which they are impractical or unethical to undertake, especially in surgical trials. Then, observational studies often provide the best source of information. In this paper, we use examples from the literature to explain the importance of observational studies in furthering the boundaries of orthopaedic surgery and knowledge of musculoskeletal disorders.
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Affiliation(s)
- Daniel J Hoppe
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON L8L 2X2, Canada
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Abstract
BACKGROUND Interest in new methods for comparative effectiveness, drug and patient safety, and related studies is burgeoning. The advent of Medicare Part D for outpatient prescription drugs has drawn significant attention to the need for efficient ways to monitor the potential benefits and harms of pharmaceuticals. These trends prompted the Effective Health Care program at the Agency for Healthcare Research and Quality and its DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) network to examine innovative approaches for such investigations through an invitational symposium in June 2006. RESULTS Conference papers covered numerous points about ways to structure both interventional and database-oriented studies, particularly those concerned with adverse drug events, to avoid bias in those studies, and to apply advanced statistical tools to exploit the information from these studies to their fullest. Of particular importance are: (1) using new types of experimental designs, including cluster randomization, delayed designs, pragmatic trials, and practice-based investigations that incorporate the natural variation of data from routine clinical practice; (2) finding efficient ways to use different types of databases-eg, Department of Veterans Affairs files, Centers for Disease Control and Prevention surveillance files, Medicaid claims data, and state hospital data-for examining initiation, persistence, and adherence, and the benefits and adverse events of pharmaceutical use; and (3) inventing or refining ways to decrease the threats to validity of analyses relying on administrative or other observational data, particularly through propensity scoring, inverse probability weighting, risk adjustment, and direct or indirect methods for synthesizing comparative effectiveness information.
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Affiliation(s)
- Kathleen N Lohr
- RTI International, Research Triangle Park, North Carolina, USA.
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