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Benzon HT, Joshi GP, Gan TJ, Vetter TR. Development, Reporting, and Evaluation of Clinical Practice Guidelines. Anesth Analg 2019; 129:1771-1777. [PMID: 31743200 DOI: 10.1213/ane.0000000000004441] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Clinical practice parameters have been published with greater frequency by professional societies and groups of experts. These publications run the gamut of practice standards, practice guidelines, consensus statements or practice advisories, position statements, and practice alerts. The definitions of these terms have been clarified in an accompanying article. In this article, we present the criteria for high-quality clinical practice parameters and outline a process for developing them, specifically the Delphi method, which is increasingly being used to build consensus among content experts and stakeholders. Several tools for grading the level of evidence and strength of recommendation are offered and compared. The speciousness of categorizing guidelines as evidence-based or consensus-based will be explained. We examine the recommended checklist for reporting and appraise the tools for evaluating a practice guideline. This article is geared toward developers and reviewers of clinical practice guidelines and consensus statements.
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Affiliation(s)
- Honorio T Benzon
- From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Girish P Joshi
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University, Stony Brook, New York
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, University of Texas, Austin, Texas
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Gambichler T, Schmitz L. Ultraviolet A1 Phototherapy for Fibrosing Conditions. Front Med (Lausanne) 2018; 5:237. [PMID: 30211165 PMCID: PMC6119689 DOI: 10.3389/fmed.2018.00237] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/03/2018] [Indexed: 01/27/2023] Open
Abstract
In this article we describe efficacy and safety aspects of ultraviolet A1 (UV-A1) phototherapy in fibrosing conditions. UV-A1 is a specific phototherapeutic modality that is defined by a selective spectral range (340–400 nm). UV-A1 includes distinct modes of action qualifying this method for therapy of a variety of conditions, in particular fibrosing skin diseases. Concerning efficacy of UV-A1 phototherapy in fibrosing conditions, the best evidence obtained from randomized controlled trials exists for localized scleroderma. Moreover, fibrosing disorders such as lichen sclerosus and graft-vs.-host disease can be treated successfully by means of UV- A1. Regarding the optimal dosage regimen medium-dose UV-A1 seems to be linked to the best benefit/risk ratio. Possible acute adverse events of UV-A1 phototherapy include erythema and provocation of photodermatoses. Skin ageing and skin cancer formation belong to the chronic adverse events that may occur after long-term UV-A1 phototherapy.
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Affiliation(s)
- Thilo Gambichler
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Lutz Schmitz
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
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PANLAR Consensus Recommendations for the Management in Osteoarthritis of Hand, Hip, and Knee. J Clin Rheumatol 2017; 22:345-54. [PMID: 27660931 DOI: 10.1097/rhu.0000000000000449] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The objective of this consensus is to update the recommendations for the treatment of hand, hip, and knee osteoarthritis (OA) by agreeing on key propositions relating to the management of hand, hip, and knee OA, by identifying and critically appraising research evidence for the effectiveness of the treatments and by generating recommendations based on a combination of the available evidence and expert opinion of 18 countries of America. METHODS Recommendations were developed by a group of 48 specialists of rheumatologists, members of other medical disciplines (orthopedics and physiatrists), and three patients, one for each location of OA. A systematic review of existing articles, meta-analyses, and guidelines for the management of hand, hip, and knee OA published between 2008 and January 2014 was undertaken. The scores for Level of Evidence and Grade of Recommendation were proposed and fully consented within the committee based on The American Heart Association Evidence-Based Scoring System. The level of agreement was established through a variation of Delphi technique. RESULTS Both "strong" and "conditional" recommendations are given for management of hand, hip, and knee OA and nonpharmacological, pharmacological, and surgical modalities of treatment are presented according to the different levels of agreement. CONCLUSIONS These recommendations are based on the consensus of clinical experts from a wide range of disciplines taking available evidence into account while balancing the benefits and risks of nonpharmacological, pharmacological, and surgical treatment modalities, and incorporating their preferences and values. Different backgrounds in terms of patient education or drug availability in different countries were not evaluated but will be important.
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Silber S. [Secondary prevention after myocardial infarction with prolonged dual anti-platelet therapy (DAPT). A new therapeutic concept]. MMW Fortschr Med 2017; 159:49-52. [PMID: 28321726 DOI: 10.1007/s15006-017-9389-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Zhang YQ, Zhu D, Zhou XY, Liu YY, Qin B, Ren GP, Xie P. Bilateral repetitive transcranial magnetic stimulation for treatment-resistant depression: a systematic review and meta-analysis of randomized controlled trials. ACTA ACUST UNITED AC 2015; 48:198-206. [PMID: 25590350 PMCID: PMC4381939 DOI: 10.1590/1414-431x20144270] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 09/09/2014] [Indexed: 01/30/2023]
Abstract
There has been concern regarding the use of controversial paradigms for repetitive
transcranial magnetic stimulation (rTMS) to manage treatment-resistant depression
(TRD). This meta-analysis assessed the efficacy of bilateral rTMS compared with
unilateral and sham rTMS in patients with TRD. PubMed, Embase, CENTRAL, PsycINFO, Web
of Science, EAGLE and NTIS databases were searched to identify relevant studies, and
randomized controlled trials (RCTs) on bilateral rTMS for TRD patients were included.
The response was defined as the primary outcome, and remission was the secondary
outcome. Ten RCTs that included 634 patients met the eligibility criteria. The risk
ratio (RRs) of both the primary and secondary outcomes of bilateral rTMS showed
non-significant increases compared to unilateral rTMS (RR=1.01, P=0.93; odds ratio
[OR]=0.77, P=0.22). Notably, the RR of the primary bilateral rTMS outcome was
significantly increased compared to that for sham rTMS (RR=3.43, P=0.0004). The
results of our analysis demonstrated that bilateral rTMS was significantly more
effective than sham rTMS but not unilateral rTMS in patients with TRD. Thus,
bilateral rTMS may not be a useful paradigm for patients with TRD.
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Affiliation(s)
- Y Q Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - D Zhu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - X Y Zhou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Y Y Liu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - B Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - G P Ren
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - P Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Abstract
Nutritional epidemiology has recently been criticized on several fronts, including the inability to measure diet accurately, and for its reliance on observational studies to address etiologic questions. In addition, several recent meta-analyses with serious methodologic flaws have arrived at erroneous or misleading conclusions, reigniting controversy over formerly settled debates. All of this has raised questions regarding the ability of nutritional epidemiologic studies to inform policy. These criticisms, to a large degree, stem from a misunderstanding of the methodologic issues of the field and the inappropriate use of the drug trial paradigm in nutrition research. The exposure of interest in nutritional epidemiology is human diet, which is a complex system of interacting components that cumulatively affect health. Consequently, nutritional epidemiology constantly faces a unique set of challenges and continually develops specific methodologies to address these. Misunderstanding these issues can lead to the nonconstructive and sometimes naive criticisms we see today. This article aims to clarify common misunderstandings of nutritional epidemiology, address challenges to the field, and discuss the utility of nutritional science in guiding policy by focusing on 5 broad questions commonly asked of the field.
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Affiliation(s)
- Ambika Satija
- Department of Nutrition and Department of Epidemiology, Harvard School of Public Health, Boston, MA; and
| | | | - Walter C Willett
- Department of Nutrition and Department of Epidemiology, Harvard School of Public Health, Boston, MA; and Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - Frank B Hu
- Department of Nutrition and Department of Epidemiology, Harvard School of Public Health, Boston, MA; and Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
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Wang C, Chi C, Guo L, Wang X, Guo L, Sun J, Sun B, Liu S, Chang X, Li E. Heparin therapy reduces 28-day mortality in adult severe sepsis patients: a systematic review and meta-analysis. Crit Care 2014; 18:563. [PMID: 25318353 PMCID: PMC4213495 DOI: 10.1186/s13054-014-0563-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 10/01/2014] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION There are approximately 19 million new cases of sepsis worldwide each year. Among them, more than one quarter of patients die. We aimed to assess the effects of heparin on short-term mortality in adult patients with sepsis and severe sepsis. METHODS We searched electronic databases (Medline, Embase, and Cochrane Library databases; the Cochrane Controlled Trials Register) and conference proceedings (Web of Knowledge (Conference Proceedings Citation Index - Science, Conference Proceedings Citation Index - Social Sciences & Humanities)) from inception to July 2014, expert contacts and relevant websites. Controlled trials of heparin versus placebo in sepsis or severe sepsis were identified. In total two reviewers independently assessed eligibility, and four authors independently extracted data; consensus was reached by conference. We used the chi-square test and I2 to assess statistical heterogeneity (P <0.05). The primary analysis was based on the fixed-effect model to produce pooled odds ratios with 95% confidence intervals. RESULTS A total of nine publications were included in the meta-analysis. Heparin decreased 28-day mortality (n = 3,482, OR = 0.656, 95% CI = 0.562 to 0.765, P <0.0001). According to the meta-analysis of 28-day mortality, heterogeneity was not found among the eight randomized clinical trials (RCTs) (I2 = 0.0%). Heparin had no effect on bleeding events in sepsis (seven RCTs, n = 2,726; OR = 1.063; 95% CI = 0.834 to 1.355; P = 0.623; and I2 = 20.9%). Subgroup analysis demonstrated that the sample size may be a source of heterogeneity, but experimental design was not. CONCLUSIONS Heparin may reduce 28-day mortality in patients with severe sepsis, at the same time, there was no increase in the risk of bleeding in the heparin group. We recommend the use of heparin for sepsis and severe sepsis.
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Affiliation(s)
- Changsong Wang
- />Department of Anesthesiology, First Affiliated Hospital of Harbin Medical University, No 23 Youzheng Street, Nangang District, Harbin, Heilongjiang 150001 China
| | - Chunjie Chi
- />Department of Anesthesiology, First Affiliated Hospital of Harbin Medical University, No 23 Youzheng Street, Nangang District, Harbin, Heilongjiang 150001 China
| | - Lei Guo
- />Department of Anesthesiology, First Affiliated Hospital of Harbin Medical University, No 23 Youzheng Street, Nangang District, Harbin, Heilongjiang 150001 China
| | - Xiaoyang Wang
- />Department of Anesthesiology, First Affiliated Hospital of Harbin Medical University, No 23 Youzheng Street, Nangang District, Harbin, Heilongjiang 150001 China
| | - Libo Guo
- />Department of Anesthesiology, First Affiliated Hospital of Harbin Medical University, No 23 Youzheng Street, Nangang District, Harbin, Heilongjiang 150001 China
| | - Jiaxiao Sun
- />Department of Anesthesiology, First Affiliated Hospital of Quan Zhou, No. 151 Yanjiang West Road, Yuexiu, Quan Zhou, Guangdong China
| | - Bo Sun
- />Department of Anesthesiology, First Affiliated Hospital of Harbin Medical University, No 23 Youzheng Street, Nangang District, Harbin, Heilongjiang 150001 China
| | - Shanshan Liu
- />Department of Anesthesiology, First Affiliated Hospital of Harbin Medical University, No 23 Youzheng Street, Nangang District, Harbin, Heilongjiang 150001 China
| | - Xuenan Chang
- />Department of Anesthesiology, Tianjin Huanhu Hospital, No. 122 Qixiangtai Road, Hexi, Tian Jin 300060 China
| | - Enyou Li
- />Department of Anesthesiology, First Affiliated Hospital of Harbin Medical University, No 23 Youzheng Street, Nangang District, Harbin, Heilongjiang 150001 China
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Prescripciones potencialmente inapropiadas en el tratamiento ambulatorio de pacientes ancianos. ACTA ACUST UNITED AC 2014; 29:22-8. [DOI: 10.1016/j.cali.2013.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/15/2013] [Accepted: 08/26/2013] [Indexed: 11/19/2022]
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Treatment regimens, protocols, dosage, and indications for UVA1 phototherapy: Facts and controversies. Clin Dermatol 2013; 31:438-454. [DOI: 10.1016/j.clindermatol.2013.01.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Van de Werf F, Ardissino D, Bueno H, Collet JP, Gershlick A, Kolh P, Kristensen SD, Silber S, Verheugt F, Wojakowski W. Acute coronary syndromes: considerations for improved acceptance and implementation of management guidelines. Expert Rev Cardiovasc Ther 2012; 10:489-503. [PMID: 22458581 DOI: 10.1586/erc.12.20] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The management of acute coronary syndrome in Europe is covered by various European Society of Cardiology guidelines, which although valuable, are complex and may not always provide clear guidance in everyday clinical practice. Consequently, implementation of the guideline recommendations is frequently suboptimal. To complicate matters further, a wealth of new data from large trials examining novel anti-thrombotic agents will become or are already available, necessitating guideline updates. This article summarizes the gaps between current guideline-recommended treatment of acute coronary syndrome and daily practice as dictated by the evidence base, including recent trials. Reasons for the suboptimal implementation of the current European Society of Cardiology guidelines and possible solutions to making these more practice oriented are presented.
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Affiliation(s)
- Frans Van de Werf
- Department of Cardiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
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Fan J, Du H, Yin Y, Ling Z, Wu J, Xiao P, Zrenner B. Efficacy and safety of zotarolimus-eluting stents compared with sirolimus-eluting stents in patients undergoing percutaneous coronary interventions--a meta-analysis of randomized controlled trials. Int J Cardiol 2012; 167:2126-33. [PMID: 22703941 DOI: 10.1016/j.ijcard.2012.05.105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 04/29/2012] [Accepted: 05/27/2012] [Indexed: 01/26/2023]
Abstract
BACKGROUND Whether ZES can further improve angiographic and clinical outcomes compared to SES still remains uncertain. OBJECTIVES The aim of this study was to assess the efficacy and safety of zotarolimus-eluting stents (ZES) compared with sirolimus-eluting stents (SES) in patients undergoing percutaneous coronary interventions (PCI). METHODS Major electronic information sources were explored for randomized controlled trials comparing ZES with SES among patients undergoing PCI during at least 9 months follow-up. The primary efficacy outcomes were target lesion revascularization (TLR), target vessel revascularization (TVR), and major adverse cardiac events (MACE); safety outcomes were stent thrombosis (ST), myocardial infarction (MI), and cardiac death. RESULTS Seven comparative studies were identified (a total of 5983 patients). When compared with ZES at 12-month follow-up, SES significantly reduced risk of MACE (relative risk [RR]: 0.74, 95% confidence interval [CI]: 0.61 to 0.89, p=0.002), and TLR (RR:0.39; 95% CI: 0.29 to 0.52; p<0.00001), without significant differences in terms of TVR (RR:0.68, 95% CI: 0.38 to 1.20; p=0.18), ST (RR:0.71; 95% CI: 0.39 to 1.31; p=0.28), cardiac death (RR:0.83; 95% CI: 0.49-1.42, p=0.50) or MI (RR:1.08; 95%CI: 0.80 to 1.45; p=0.62). CONCLUSIONS At 12-month follow-up, SES are superior to ZES in reducing the incidences of TLR and MACE in patients undergoing PCI, without significant differences in terms of TVR, ST, cardiac death, and MI.
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Affiliation(s)
- Jinqi Fan
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, The Chongqing Cardiac Arrhythmias Service Center, Chongqing 400010, China
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Aradi D, Komócsi A, Price MJ, Cuisset T, Ari H, Hazarbasanov D, Trenk D, Sibbing D, Valgimigli M, Bonello L. Efficacy and safety of intensified antiplatelet therapy on the basis of platelet reactivity testing in patients after percutaneous coronary intervention: systematic review and meta-analysis. Int J Cardiol 2012; 167:2140-8. [PMID: 22704866 DOI: 10.1016/j.ijcard.2012.05.100] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 04/14/2012] [Accepted: 05/27/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND ADP-specific platelet function assays were shown to predict thrombotic events, and might be helpful to select candidates for more potent antiplatelet therapy. We aimed to determine the efficacy and safety of giving intensified antiplatelet therapy on the basis of platelet reactivity testing for patients undergoing percutaneous coronary intervention (PCI). METHODS Electronic databases were searched to find prospective, randomized trials that reported the clinical impact of using an intensified antiplatelet protocol (repeated loading or elevated maintenance doses of clopidogrel, prasugrel or glycoprotein IIb/IIIa inhibitor) on the basis of ADP-specific platelet reactivity testing (VerifyNow, Multiplate, VASP or light transmission aggregometry) compared to standard-dose clopidogrel. Evaluated efficacy measures included cardiovascular death, non-fatal myocardial infarction and definite/probable stent thrombosis (ST), while major bleeding events were recorded as safety endpoint. RESULTS Between 2008 and 2011, 10 clinical trials comprising 4213 randomized patients were identified. Compared to standard antiplatelet therapy, the intensified protocol was associated with a significant reduction in cardiovascular mortality, ST and myocardial infarction (p<0.01 for all). There was no difference in the rate of major bleeding events between intensified and standard groups (p=0.44). Although the observed effects regarding mortality, ST and bleeding were not heterogeneous, meta-regression analysis revealed that the net clinical benefit of the intensified treatment significantly depended on the risk of ST with standard-dose clopidogrel (p=0.023). CONCLUSION Intensifying antiplatelet therapy on the basis of platelet reactivity testing reduces cardiovascular mortality and ST after PCI; however, the net benefit of this approach depends on the risk of ST with standard-dose clopidogrel.
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Affiliation(s)
- Dániel Aradi
- University of Pécs, Heart Institute, Pécs, Hungary.
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Basalus M, Tandjung K, van Houwelingen K, Stoel M, de Man F, Louwerenburg J, Saïd S, Linssen G, Kleijne M, van der Palen J, Huisman J, Verhorst P, von Birgelen C. TWENTE Study: The Real-World Endeavor Resolute Versus Xience V Drug-Eluting Stent Study in Twente: study design, rationale and objectives. Neth Heart J 2010; 18:360-4. [PMID: 20730003 PMCID: PMC2922782 DOI: 10.1007/bf03091792] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background. New-generation drug-eluting stents (DES) may solve several problems encountered with first-generation DES, but there is a lack of prospective head-to-head comparisons between new-generation DES. In addition, the outcome of regulatory trials may not perfectly reflect the outcome in 'real world' patients.Objectives. To compare the efficacy and safety of two new-generation DES in a 'real world' patient population.Methods. A prospective, randomised, single-blinded clinical trial to evaluate clinical outcome after Endeavor Resolute vs. Xience V stent implantation. The primary endpoint is target vessel failure at one-year follow-up. In addition, the study comprises a two-year and an open-label five-year follow-up. (Neth Heart J 2010;18:360-4.).
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Affiliation(s)
- M.W.Z. Basalus
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - K. Tandjung
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - K.G. van Houwelingen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - M.G. Stoel
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - F.H.A.F. de Man
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - J.W. Louwerenburg
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - S.A.M. Saïd
- Department of Cardiology, Hospital Group Twente, Hengelo, the Netherlands
| | - G.C.M. Linssen
- Department of Cardiology, Hospital Group Twente, Almelo, the Netherlands
| | - M.A.W.J. Kleijne
- Department of Cardiology, Streekziekenhuis Koningin Beatrix, Winterswijk, the Netherlands
| | - J. van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, Enschede and Department of Research Methodology, Measurement & Data Analysis, University of Twente, Enschede, the Netherlands
| | - J. Huisman
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - P.M.J. Verhorst
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - C. von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, and MIRA, Institute for Biomedical Technology & Technical Medicine, University of Twente, Enschede; the Netherlands
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Goetghebeur MM, Wagner M, Khoury H, Levitt RJ, Erickson LJ, Rindress D. Evidence and Value: Impact on DEcisionMaking--the EVIDEM framework and potential applications. BMC Health Serv Res 2008; 8:270. [PMID: 19102752 PMCID: PMC2673218 DOI: 10.1186/1472-6963-8-270] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 12/22/2008] [Indexed: 11/25/2022] Open
Abstract
Background Healthcare decisionmaking is a complex process relying on disparate types of evidence and value judgments. Our objectives for this study were to develop a practical framework to facilitate decisionmaking in terms of supporting the deliberative process, providing access to evidence, and enhancing the communication of decisions. Methods Extensive analyses of the literature and of documented decisionmaking processes around the globe were performed to explore what steps are currently used to make decisions with respect to context (from evidence generation to communication of decision) and thought process (conceptual components of decisions). Needs and methodologies available to support decisionmaking were identified to lay the groundwork for the EVIDEM framework. Results A framework was developed consisting of seven modules that can evolve over the life cycle of a healthcare intervention. Components of decision that could be quantified, i.e., intrinsic value of a healthcare intervention and quality of evidence available, were organized into matrices. A multicriteria decision analysis (MCDA) Value Matrix (VM) was developed to include the 15 quantifiable components that are currently considered in decisionmaking. A methodology to synthesize the evidence needed for each component of the VM was developed including electronic access to full text source documents. A Quality Matrix was designed to quantify three criteria of quality for the 12 types of evidence usually required by decisionmakers. An integrated system was developed to optimize data analysis, synthesis and validation by experts, compatible with a collaborative structure. Conclusion The EVIDEM framework promotes transparent and efficient healthcare decisionmaking through systematic assessment and dissemination of the evidence and values on which decisions are based. It provides a collaborative framework that could connect all stakeholders and serve the healthcare community at local, national and international levels by allowing sharing of data, resources and values. Validation and further development is needed to explore the full potential of this approach.
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Affiliation(s)
- Mireille M Goetghebeur
- BioMedCom Consultants Inc, 1405 Transcanada Highway, Suite 310, Dorval, Québec H9P 2V9, Canada.
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Mahmud E, Bromberg-Marin G, Palakodeti V, Ang L, Creanga D, DeMaria AN. Clinical Efficacy of Drug-Eluting Stents in Diabetic Patients. J Am Coll Cardiol 2008; 51:2385-95. [DOI: 10.1016/j.jacc.2008.03.028] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Revised: 02/21/2008] [Accepted: 03/07/2008] [Indexed: 01/21/2023]
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17
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Kereiakes DJ. The Emperor’s New Clothes. J Am Coll Cardiol 2007; 50:1381-5. [PMID: 17903639 DOI: 10.1016/j.jacc.2007.07.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 07/20/2007] [Accepted: 07/24/2007] [Indexed: 11/21/2022]
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Silber S, Borggrefe M, Böhm M, Hoffmeister H, Dietz R, Ertl G, Heusch G. Positionspapier der DGK zur Wirksamkeit und Sicherheit von Medikamente freisetzenden Koronarstents (DES). KARDIOLOGE 2007. [DOI: 10.1007/s12181-007-0012-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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