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Riccioni A, Radua J, Ashaye FO, Solmi M, Cortese S. Systematic Review and Meta-Analysis: Reporting and Representation of Race/Ethnicity in 310 Randomized Controlled Trials of Attention-Deficit/Hyperactivity Disorder Medications. J Am Acad Child Adolesc Psychiatry 2024; 63:698-707. [PMID: 37890665 DOI: 10.1016/j.jaac.2023.09.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/21/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To evaluate the reporting of race/ethnicity data in randomized controlled trials (RCTs) of attention-deficit/hyperactivity disorder (ADHD) medications. Secondary objectives were to estimate temporal trends in the reporting, and to compare the pooled prevalence of racial/ethnic groups in RCTs conducted in the US to national estimates. METHOD We drew on, adapted, and updated the search of a network meta-analysis by Cortese et al. (2018) up to March 2022. We calculated the percentage of RCTs reporting data on race/ethnicity of participants in the published article or in related unpublished material. Temporal trends were estimated with logistic regression. The pooled prevalence of each racial/ethnic group across US RCTs was calculated using random-effects model meta-analyses. RESULTS We retained 310 RCTs (including 44,447 participants), of which 231 were conducted in children/adolescents, 78 in adults, and 1 in both. Data on race/ethnicity were reported in 59.3% of the RCTs (75% of which were conducted in children/adolescents and 25% in adults) in the published article, and in unpublished material in an additional 8.7% of the RCTs. Reporting improved over time. In the US RCTs, Asian and White individuals were under- and overrepresented, respectively, compared to national estimates in the most recent time period considered. CONCLUSION More than 30% of the RCTs of ADHD medications retained in this review did not include data on race/ethnicity in their published or unpublished reports, and more than 40% in their published articles, even though reporting improved over time. Results should inform investigators, authors, editors, regulators, and study participants in relation to efforts to tackle inequalities in ADHD research. PLAIN LANGUAGE SUMMARY A systematic review of 310 randomized controlled trials for attention-deficit/hyperactivity disorder (ADHD) medications found that race/ethnicity were reported in only 30% of trials. Compared to national estimates, Asian individuals were underrepresented and non-Hispanic Whites individuals were overrepresented, drawing attention to the inequities in participation in ADHD research. DIVERSITY & INCLUSION STATEMENT One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. STUDY PREREGISTRATION INFORMATION Reporting and representation of race/ethnicity in double blind randomised controlled trials of medications for ADHD; https://osf.io/; hfgz8.
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Affiliation(s)
| | - Joaquim Radua
- DIBAPS, Barcelona, Catalunya, Spain, Karolinska Institute Stockholm, Sweden and King's College London, United Kingdom
| | - Florence O Ashaye
- University of Southampton School of Medicine, South Hampton, United Kingdom
| | - Marco Solmi
- University of Ottawa and the Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program Ontario, Canada; Charité Universitätsmedizin, Berlin, Germany; Centre for Innovation in Mental Health, University of Southampton, United Kingdom
| | - Samuele Cortese
- Centre for Innovation in Mental Health, Academic Unit of Psychology, Faculty of Environmental and Life Sciences; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK, Solent National Health System Trust (NHS), Southampton, United Kingdom, Hassenfeld Children's Hospital at NYU Langone; the New York University Child Study Center, New York City, New York; and the Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
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Whittaker HR, Torkpour A, Quint J. Eligibility of patients with chronic obstructive pulmonary disease for inclusion in randomised control trials investigating triple therapy: a study using routinely collected data. Respir Res 2024; 25:43. [PMID: 38238769 PMCID: PMC10797743 DOI: 10.1186/s12931-024-02672-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Randomised control trials (RCTs) with strict eligibility criteria can lead to trial populations not commonly seen in clinical practice. We described the proportion of people with chronic obstructive pulmonary disease (COPD) in England eligible for RCTs investigating treatment with triple therapy. METHODS MEDLINE and Clinicaltrials.gov were searched for RCTs investigating triple therapy and eligibility criteria for each trial were extracted. Using routinely collected primary care data from Clinical Practice Research Datalink Aurum linked with Hospital Episode Statistics, we defined a population of COPD patients registered at a general practice in England, who were ≥ 40 years old, and had a history of smoking. Inclusion date was January 1, 2020. Patients who died earlier or left the general practice were excluded. Eligibility criteria for each RCT was applied to the population of COPD patients and the proportion of patients meeting each trial eligibility criteria were described. RESULTS 26 RCTs investigating triple therapy were identified from the literature. The most common eligibility criteria were post-bronchodilator FEV1% predicted 30-80%, ≥ 2 moderate/≥ 1 severe exacerbations 12-months prior, no moderate exacerbations one-month prior and no severe exacerbations three-months prior, and the use of maintenance therapy or ICS use prior to inclusion. After applying each RCT eligibility criteria to our population of 79,810 COPD patients, a median of 11.2% [interquartile range (IQR) 1.8-17.4] of patients met eligibility criteria. The most discriminatory criteria included the presence exacerbations of COPD and previous COPD related medication use with a median of 67.6% (IQR 8.5-73.4) and 63% (IQR 69.3-38.4) of COPD patients not meeting these criteria, respectively. CONCLUSION Data from these RCTs may not be generalisable to the wider population of people with COPD seen in everyday clinical practice and real-world evidence studies are needed to supplement trials to understand effectiveness in all people with COPD.
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Affiliation(s)
| | - Aria Torkpour
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Jennifer Quint
- School of Public Health, Imperial College London, London, UK
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Abel KM, Radojčić MR, Rayner A, Butt R, Whelan P, Parr I, Gledhill LF, Minchin A, Bower P, Hope H. Representativeness in health research studies: an audit of Greater Manchester Clinical Research Network studies between 2016 and 2021. BMC Med 2023; 21:471. [PMID: 38031070 PMCID: PMC10687774 DOI: 10.1186/s12916-023-03170-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND There are increasing concerns that participants in health research in the UK are not representative of the UK population, risking widening health inequities. However, detailed information on the magnitude of the problem is limited. Therefore, we evaluated if the health research conducted in the Greater Manchester region was broadly representative of its diverse population. METHODS We conducted an audit of all health research studies conducted exclusively in Greater Manchester, using data from a national research network. Two researchers selected studies that were (1) an interventional or observational study of a health outcome; (2) 'closed' for recruitment between May 2016 and May 2021 and (3) human research. They extracted study information (dates, contacts, sample recruited, clinical speciality). Participant characteristics were sourced from published and unpublished manuscripts and requested directly from principal investigators and named study contacts. Data were extracted, summarised and compared to the Greater Manchester population for the following metrics: ethnicity, sex, age, deprivation and smoking status. A weighted mean age estimate was calculated to account for variation in age reporting. Too few studies provided patient-level deprivation data so, using the area code of the recruitment site, the area level multiple deprivation, health deprivation and disability index and decile was derived. These data were geo-mapped using QGIS 3.26. RESULTS Overall, 145/153 (95%) studies met inclusion criteria and participant information was sourced for 85/145 (59%) studies, representing 21,797 participants. Participant information was incomplete for all metrics. Where ethnicity (N = 10,259) data were available and compared to Greater Manchester estimates there was evidence that ethnic minorities were under-represented (6% versus 16%). Most of the recruitment occurred in central Manchester (50%) and with NHS hospital settings (74%). CONCLUSIONS Greater Manchester health research in 2016-2021 was centralised and under-represented ethnic minorities. We could not report which ethnic minority group was least represented because sourcing detailed participant information was challenging. Recommendations to improve the reporting of key participant characteristics with which to monitor representativeness in health research are discussed.
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Affiliation(s)
- Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Maja R Radojčić
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Archie Rayner
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rabia Butt
- National Institute for Health and Care Research Greater Manchester Clinical Research Network, Manchester, UK
| | - Pauline Whelan
- Centre for Health Informatics, Division of Imaging, Informatics and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- GM.Digital Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Isaac Parr
- National Institute for Health and Care Research Greater Manchester Clinical Research Network, Manchester, UK
| | - Lauren F Gledhill
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, UK
| | - Ashley Minchin
- National Institute for Health and Care Research Greater Manchester Clinical Research Network, Manchester, UK
| | - Peter Bower
- National Institute for Health and Care Research Greater Manchester Clinical Research Network, Manchester, UK
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, UK
| | - Holly Hope
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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Ridgeon E, Shadwell R, Wilkinson A, Odor PM. Mismatch of populations between randomised controlled trials of perioperative interventions in major abdominal surgery and current clinical practice. Perioper Med (Lond) 2023; 12:60. [PMID: 37974283 PMCID: PMC10655289 DOI: 10.1186/s13741-023-00344-w] [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: 07/27/2023] [Accepted: 10/14/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Demographics of patients undergoing major abdominal surgery are changing. External validity of relevant RCTs may be limited by participants not resembling patients encountered in clinical practice. We aimed to characterise differences in age, weight, BMI, and ASA grade between participants in perioperative trials in major abdominal surgery and patients in a reference real-world clinical practice sample. The secondary aim was to investigate whether time since trial publication was associated with increasing mismatch between these groups. METHODS MEDLINE and Embase were searched for multicentre RCTs from inception to September 2022. Studies of perioperative interventions in adults were included. Studies that limited enrolment based on age, weight, BMI, or ASA status were excluded. We compared trial cohort age, weight, BMI, and ASA distribution to those of patients undergoing major abdominal surgery at our tertiary referral hospital during September 2021 to September 2022. We used a local, single-institution reference sample to reflect the reality of clinical practice (i.e. patients treated by a clinician in their own hospital, rather than averaged nationally). Mismatch was defined using comparison of summary characteristics and ad hoc criteria based on differences relevant to predicted mortality risk after surgery. RESULTS One-hundred and six trials (44,499 participants) were compared to a reference cohort of 2792 clinical practice patients. Trials were published a median (IQR [range]) 13.4 (5-20 [0-35]) years ago. A total of 94.3% of trials were mismatched on at least one characteristic (age, weight, BMI, ASA). Recruitment of ASA 3 + participants in trials increased over time, and recruitment of ASA 1 participants decreased over time (Spearman's Rho 0.58 and - 0.44, respectively). CONCLUSIONS Patients encountered in our current local clinical practice are significantly different from those in our defined set of perioperative RCTs. Older trials recruit more low-risk than high-risk participants-trials may thus 'expire' over time. These trials may not be generalisable to current patients undergoing major abdominal surgery, and meta-analyses or guidelines incorporating these trials may therefore be similarly non-applicable. Comparison to local, rather than national cohorts, is important for meaningful on-the-ground evidence-based decision-making.
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Affiliation(s)
- Elliott Ridgeon
- Department of Anaesthetics and Perioperative Medicine, Wexham Park Hospital, Slough, UK.
- Department of Anaesthetics and Perioperative Medicine, University College London Hospitals, London, UK.
- Perioperative Medicine MSc, University College London, London, UK.
| | - Rory Shadwell
- Department of Critical Care, University College London Hospitals, London, UK
| | - Alice Wilkinson
- Department of Anaesthetics, University College London Hospitals, London, UK
| | - Peter M Odor
- Department of Anaesthetics and Perioperative Medicine, University College London Hospitals, London, UK
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Upadya M, Durga P, Rao ST, Kurdi MS. Ethnicity in Anaesthesia research: Time to search our own backyards! Indian J Anaesth 2022; 66:S239-S242. [PMID: 36262732 PMCID: PMC9575926 DOI: 10.4103/ija.ija_642_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Madhusudan Upadya
- Department of Anaesthesiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Padmaja Durga
- Department of Anaesthesiology and Intensive Care, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sumesh T. Rao
- Department of Anaesthesiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Madhuri S. Kurdi
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences (KIMS), Hubli, Karnataka, India
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Inclusion, characteristics, and outcomes of male and female participants in large international perioperative studies. Br J Anaesth 2022; 129:336-345. [PMID: 35753807 DOI: 10.1016/j.bja.2022.05.019] [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: 04/19/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND We compared baseline characteristics and outcomes and evaluated the subgroup effects of randomised interventions by sex in males and females in large international perioperative trials. METHODS Nine randomised trials and two cohort studies recruiting adult patients, conducted between 1995 and 2020, were included. Baseline characteristics and outcomes common to six or more studies were evaluated. Regression models included terms for sex, study, and an interaction between the two. Comparing outcomes without adjustment for baseline characteristics represents the 'total effect' of sex on the outcome. RESULTS Of 54 626 participants, 58% were male and 42% were female. Females were less likely to have ASA physical status ≥3 (56% vs 64%), to smoke (15% vs 23%), have coronary artery disease (21% vs 32%), or undergo vascular surgery (10% vs 23%). The pooled incidence of death was 1.6% in females and 1.8% in males (risk ratio [RR] 0.92; 95% confidence interval [CI]: 0.81-1.05; P=0.20), of myocardial infarction was 4.2% vs 4.5% (RR 0.92; 95% CI: 0.81-1.03; P=0.10), of stroke was 0.5% vs 0.6% (RR 1.03; 95% CI: 0.79-1.35; P=0.81), and of surgical site infection was 8.6% vs 8.3% (RR 1.03; 95% CI: 0.79-1.35; P=0.70). Treatment effects of three interventions demonstrated statistically significant effect modification by sex. CONCLUSIONS Females were in the minority in all included studies. They were healthier than males, but outcomes were comparable. Further research is needed to understand the reasons for this discrepancy. CLINICAL TRIAL REGISTRATION International Registry of Meta-Research (UID: IRMR_000011; 5 January 2021).
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Hsu S, Rosen KJ, Cupertino A, Temple L, Fleming F. Generalizability of Randomized Controlled Trials in Rectal Cancer. J Gastrointest Surg 2022; 26:453-465. [PMID: 34755313 DOI: 10.1007/s11605-021-05192-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/26/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The generalizability of outcomes from randomized controlled trials (RCTs) in oncology is a frequent concern. Given the prevalence and multidisciplinary management of rectal cancer, understanding the generalizability of rectal cancer RCTs is critical to surgical oncologists. METHODS An exhaustive literature review identified 100 non-metastatic rectal cancer RCTs published in English over the past 10 years investigating surgery, chemotherapy, or radiotherapy. In order to evaluate the representativeness of these RCTs compared to the USA and each continent's rectal cancer populations, demographic characteristics were stratified by surgical versus chemoradiotherapy (CRT) trial and by continent then compared with the National Cancer Database and CANCER TODAY using chi-squared and Welch's t-tests. RESULTS Of the 100 trials identified, 65% enrolled significantly younger patients, and 38% enrolled a significantly greater proportion of males than the US rectal cancer population. These demographic differences were more prominent among CRT trials than surgical trials. Half of all trials enrolled patients who were on average more than 7 years younger and enrolled a 5% greater proportion of males than their respective continental rectal cancer populations. Patients enrolled in trials had more advanced cancers than their corresponding continental populations. Sociodemographic data was rarely reported. CONCLUSION Patients enrolled in trials were younger, predominantly male, and had advanced stage cancer when compared to the rectal cancer population. Sociodemographic variables are underreported, further limiting equal participation in clinical trials. Future rectal cancer RCTs should strive to recruit representative samples. To enhance recruitment of women and underrepresented minorities, tailored recruitment strategies must be implemented.
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Affiliation(s)
- Shawn Hsu
- Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Katherine J Rosen
- Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - AnaPaula Cupertino
- Community Outreach & Engagement, Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Larissa Temple
- Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Fergal Fleming
- Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
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Fritel X, de Tayrac R, de Keizer J, Campagne-Loiseau S, Cosson M, Ferry P, Deffieux X, Lucot JP, Wagner L, Debodinance P, Saussine C, Pizzoferrato AC, Carlier-Guérin C, Thubert T, Panel L, Bosset PO, Nkounkou E, Ramanah R, Boisramé T, Charles T, Raiffort C, Charvériat A, Ragot S, Fauconnier A. Serious complications and recurrences after pelvic organ prolapse surgery for 2309 women in the VIGI-MESH registry. BJOG 2021; 129:656-663. [PMID: 34541781 DOI: 10.1111/1471-0528.16892] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the incidence of serious complications and reoperations for recurrence after surgery for pelvic organ prolapse (POP) and compare the three most common types of repair. DESIGN Prospective cohort study using a registry. SETTING Nineteen French surgical centres. POPULATION A total of 2309 women participated between 2017 and 2019. METHODS A multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. MAIN OUTCOME MEASURES Serious complications and subsequent reoperations for POP recurrence. RESULTS The median follow-up time was 17.6 months. Surgeries were native tissue vaginal repairs (n = 504), transvaginal mesh placements (n = 692) and laparoscopic sacropexies with mesh (n = 1113). Serious complications occurred among 52 women (2.3%), and reoperation for POP recurrence was required for 32 women (1.4%). At 1 year the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair, 3.9% for transvaginal mesh and 2.2% for sacropexy, and the rates for reoperation for recurrence of POP were 1.5, 0.7 and 1.1%, respectively. Compared with native tissue vaginal repair, the risk of serious complications was higher in the transvaginal mesh group (weighted hazard ratio, wHR 3.84, 95% CI 2.43-6.08) and the sacropexy group (wHR 2.48, 95% CI 1.45-4.23), whereas the risk of reoperation for prolapse recurrence was lower in both the transvaginal mesh (wHR 0.22, 95% CI 0.13-0.39) and sacropexy (wHR 0.29, 95% CI 0.18-0.47) groups. CONCLUSIONS Our results suggest that native tissue vaginal repairs have the lowest risk of serious complications but the highest risk of reoperation for recurrence. These results are useful for informing women and for shared decision making. TWEETABLE ABSTRACT Laparoscopic sacropexy had fewer serious complications than transvaginal mesh and fewer reoperations for recurrence than vaginal repair.
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Affiliation(s)
- X Fritel
- Service de Gynécologie, CHU de Poitiers, Poitiers, France.,Université de Poitiers, INSERM CIC 1402, Poitiers, France
| | - R de Tayrac
- Service de Gynécologie, CHU Carémeau, Nîmes, France
| | - J de Keizer
- Université de Poitiers, INSERM CIC 1402, Poitiers, France
| | | | - M Cosson
- Service de Gynécologie, CHU de Lille, Lille, France
| | - P Ferry
- Service de Gynécologie, CH de La Rochelle, La Rochelle, France
| | - X Deffieux
- Service de Gynécologie, APHP Antoine-Béclère, Clamart, France
| | - J-P Lucot
- Service de Gynécologie, Hôpital Saint-Vincent-de-Paul, Lille, France
| | - L Wagner
- Service d'Urologie, CHU Carémeau, Nîmes, France
| | - P Debodinance
- Service de Gynécologie, CH de Dunkerque, Dunkerque, France
| | - C Saussine
- Service d'Urologie, CHU de Strasbourg, Strasbourg, France
| | | | - C Carlier-Guérin
- Service de Gynécologie, CH de Châtellerault, Châtellerault, France
| | - T Thubert
- Service de Gynécologie, CHU de Nantes, Nantes, France
| | - L Panel
- Service de Gynécologie, Clinique Beau-Soleil, Montpellier, France
| | - P-O Bosset
- Service d'Urologie, Hôpital Foch, Suresnes, France
| | - E Nkounkou
- Service de Gynécologie, CH de Béthune, Béthune, France
| | - R Ramanah
- Université de Franche-Comté, CHU de Besançon, Besançon, France
| | - T Boisramé
- Service de Gynécologie, CHU de Strasbourg, Strasbourg, France
| | - T Charles
- Service d'Urologie, CHU de Poitiers, Poitiers, France
| | - C Raiffort
- Service de Gynécologie, Groupe Hospitalier Diaconesses-Croix-Saint-Simon, Paris, France
| | - A Charvériat
- Service de Gynécologie, CHU de Poitiers, Poitiers, France
| | - S Ragot
- Université de Poitiers, INSERM CIC 1402, Poitiers, France
| | - A Fauconnier
- Service de Gynécologie, CHI Poissy-Saint-Germain, Poissy, France
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Nerenberg KA, Roeters van Lennep JE. Advancing Sex and Gender Considerations in Perioperative Cardiovascular-Risk Assessment. Can J Cardiol 2021; 37:1912-1914. [PMID: 34461231 DOI: 10.1016/j.cjca.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Kara A Nerenberg
- Department of Medicine, Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
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Iudici M, Jarlborg M, Lauper K, Müller-Ladner U, Smith V, Allanore Y, Balbir-Gurman A, Doria A, Airò P, Walker UA, Riccieri V, Vonk MC, Gabrielli A, Hoffmann-Vold AM, Szücs G, Martin T, Distler O, Courvoisier DS. Representativeness of Systemic Sclerosis Patients in Interventional Randomized Trials: an analysis of the EUSTAR database. Rheumatology (Oxford) 2021; 61:743-755. [PMID: 33989387 DOI: 10.1093/rheumatology/keab437] [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: 03/09/2021] [Revised: 05/10/2021] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To estimate the extent of and the reasons for ineligibility in randomized controlled trials (RCTs) of systemic sclerosis (SSc) patients included in the EUSTAR database, and to determine the association between patient's features and generalizability of study results. METHODS We searched Clinicaltrials.gov for all records on interventional SSc-RCTs registered from January 2013 to January 2018. Two reviewers selected studies, and information on the main trial features were retrieved. Data from 8046 patients having a visit in the EUSTAR database since 2013 were used to check patient's eligibility. The proportion of potentially eligible patients per trial, and the risk factors for ineligibility were analyzed. Complete-, worst- and best-case analyses were performed. RESULTS Of the 37 RCTs included, 43% were conducted in Europe, 35% were industry-funded, and 87% investigated pharmacological treatments. Ninety-one percent of 8046 patients included could have participated in at least one RCT. In complete-case analysis, the median [range] proportion of eligible patients having the main organ complication targeted by each study was 60% [10-100] in the overall sample of trials, ranging from 50% [32-79] for trials on skin fibrosis to 90% [34-77] for those targeting Raynaud's phenomenon. Among the criteria checked, treatment- and safety-related but not demographic were the main barriers to patient's recruitment. Older age, absence of Raynaud's phenomenon, and lower mRSS were independently associated with the failure to fulfill criteria for any of the included studies. CONCLUSIONS Patient's representativeness in SSc-RCTs is highly variable and is driven more by treatment- and safety-related rather than demographic criteria.
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Affiliation(s)
- Michele Iudici
- Rheumatology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Matthias Jarlborg
- Rheumatology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Kim Lauper
- Rheumatology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Ulf Müller-Ladner
- Justus-Liebig-University of Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Yannick Allanore
- Service de Rhumatologie, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | | | - Andrea Doria
- Department of Rheumatology, University of Padova, Padova, Italy
| | - Paolo Airò
- Rheumatology and Clinical Immunology, Spedali Civili, Brescia, Italy
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Valeria Riccieri
- Dipartimento di Scienze Cliniche Internistiche Anestesiologiche e Cardiovascolari, Sapienza University of Rome, Rome, Italy
| | - Madelon C Vonk
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Gabriella Szücs
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Thierry Martin
- Clinical immunology department, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest (RESO), Strasbourg, France
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Delphine S Courvoisier
- Rheumatology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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11
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Brenna CT. Limits of mice and men: Underrepresenting female and intersex patients in anaesthesia research. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.1016/j.tacc.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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12
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Shepherd V. Advances and challenges in conducting ethical trials involving populations lacking capacity to consent: A decade in review. Contemp Clin Trials 2020; 95:106054. [PMID: 32526281 PMCID: PMC7832147 DOI: 10.1016/j.cct.2020.106054] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/21/2020] [Accepted: 06/03/2020] [Indexed: 01/28/2023]
Abstract
Informed consent is an essential requirement prior to clinical trial participation, however some 'vulnerable' groups, such as people with cognitive impairments and those in medical emergency situations, may lack decisional capacity to consent. This raises ethical and practical challenges when designing and conducting clinical trials involving these populations, who are frequently excluded as a result. Despite recent advances in improving informed consent processes, there has been far less attention paid to the enrolment of adults lacking capacity. Exclusion criteria are an important determinant of the external validity of clinical trial results. The exclusion of these populations, and consent-based recruitment biases which arise from the challenges of identifying and involving surrogate decision-makers, leads to trials which are not representative of the clinical population. This article discusses the involvement of adults who lack decisional capacity to consent in clinical trials and presents the advances over the previous decade and the remaining ethical challenges for the inclusion of this under-represented population in research.
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Affiliation(s)
- Victoria Shepherd
- Centre for Trials Research, 4th floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
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Mohamed TY, Patel J, El-Badawi S. Is ethnicity associated with recruitment into perioperative care studies? Br J Anaesth 2020; 125:e396-e398. [PMID: 32703546 DOI: 10.1016/j.bja.2020.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Jamie Patel
- Anaesthetics, Birmingham Heartlands Hospital, Birmingham, UK
| | - Sarra El-Badawi
- Department of Medical Education, Luton and Dunstable University Hospital, Luton, UK
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14
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Shepherd V. An under-represented and underserved population in trials: methodological, structural, and systemic barriers to the inclusion of adults lacking capacity to consent. Trials 2020; 21:445. [PMID: 32471488 PMCID: PMC7257506 DOI: 10.1186/s13063-020-04406-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/11/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There is increasing international recognition that populations included in trials should adequately represent the population treated in clinical practice; however, adults who lack the capacity to provide informed consent are frequently excluded from trials. Addressing the under-representation of groups such as those with impaired capacity to consent is essential to develop effective interventions and provide these groups with the opportunity to benefit from evidence-based care. While the spotlight has been on ensuring only appropriate and justifiable exclusion criteria are used in trials, barriers to the inclusion of adults lacking capacity are multifactorial and complex, and addressing their under-representation will require more than merely widening eligibility criteria. This commentary draws on the literature exploring the inclusion of adults lacking the capacity to consent in research and a number of recent studies to describe the methodological, structural, and systemic factors that have been identified. MAIN TEXT A number of potentially modifiable factors contributing to the under-representation of adults lacking the capacity to consent in trials have been identified. In addition to restrictive eligibility criteria, methodological issues include developing appropriate interventions and outcome measures for populations with impaired capacity. Structurally determined factors include the resource-intensive nature of these trials, the requirement for more appropriate research infrastructure, and a lack of interventions to inform and support proxy decision-makers. Systemic factors include the complexities of the legal frameworks, the challenges of ethical review processes, and paternalistic attitudes towards protecting adults with incapacity from the perceived harms of research. CONCLUSIONS Measures needed to address under-representation include greater scrutiny of exclusion criteria by those reviewing study proposals, providing education and training for personnel who design, conduct, and review research, ensuring greater consistency in the reviews undertaken by research ethics committees, and extending processes for advance planning to include prospectively appointing a proxy for research and documenting preferences about research participation. Negative societal and professional attitudes towards the inclusion of adults with impaired capacity in research should also be addressed, and the development of trials that are more person-centred should be encouraged. Further work to conceptualise under-representation in trials for such populations may also be helpful.
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Scrimshire AB, Fairhurst C, McDaid C, Torgerson DJ. Effectiveness of pre-operative anaemia screening and increased Tranexamic acid dose policies on outcomes following unilateral primary, elective total hip or knee replacement: a statistical analysis plan for an interrupted time series and regression discontinuity study. F1000Res 2020; 9:224. [PMID: 33163156 PMCID: PMC7607480 DOI: 10.12688/f1000research.22962.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/20/2022] Open
Abstract
Perioperative blood transfusion is associated with poorer postoperative outcomes following hip and knee replacement surgery. Evidence for the effectiveness of some measures aimed at reducing blood transfusions in this setting are limited and often rely on weak pre-post study designs. Quasi-experimental study designs such as interrupted time series (ITS) and regression discontinuity design (RDD) address many of the weaknesses of the pre-post study design. In addition,
a priori publication of statistical analysis plans for such studies increases their transparency and likely validity, as readers are able to distinguish between pre-planned and exploratory analyses. As such, this article, written prospective of any analysis, provides the statistical analysis plan for an ITS and RDD study based on a data set of 20,772 primary elective hip and knee replacement patients in a single English NHS Trust. The primary aim is to evaluate the impact of a preoperative anaemia optimisation service on perioperative blood transfusion (within 7 days of surgery) using both ITS and RDD methods. A secondary aim is to evaluate the impact of a policy of increased tranexamic acid dose given at the time of surgery, using ITS methods.
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Affiliation(s)
- Ashley B Scrimshire
- Department of Health Sciences, University of York, York, UK.,Northumbria Healthcare NHS Trust, Wansbeck, UK
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