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Guo Q, Jiang G, Zhao Q, Long Y, Feng K, Gu X, Xu Y, Li Z, Huang J, Du L. Rapid review: A review of methods and recommendations based on current evidence. J Evid Based Med 2024; 17:434-453. [PMID: 38512942 DOI: 10.1111/jebm.12594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
Rapid review (RR) could accelerate the traditional systematic review (SR) process by simplifying or omitting steps using various shortcuts. With the increasing popularity of RR, numerous shortcuts had emerged, but there was no consensus on how to choose the most appropriate ones. This study conducted a literature search in PubMed from inception to December 21, 2023, using terms such as "rapid review" "rapid assessment" "rapid systematic review" and "rapid evaluation". We also scanned the reference lists and performed citation tracking of included impact studies to obtain more included studies. We conducted a narrative synthesis of all RR approaches, shortcuts and studies assessing their effectiveness at each stage of RRs. Based on the current evidence, we provided recommendations on utilizing certain shortcuts in RRs. Ultimately, we identified 185 studies focusing on summarizing RR approaches and shortcuts, or evaluating their impact. There was relatively sufficient evidence to support the use of the following shortcuts in RRs: limiting studies to those published in English-language; conducting abbreviated database searches (e.g., only searching PubMed/MEDLINE, Embase, and CENTRAL); omitting retrieval of grey literature; restricting the search timeframe to the recent 20 years for medical intervention and the recent 15 years for reviewing diagnostic test accuracy; conducting a single screening by an experienced screener. To some extent, the above shortcuts were also applicable to SRs. This study provided a reference for future RR researchers in selecting shortcuts, and it also presented a potential research topic for methodologists.
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Affiliation(s)
- Qiong Guo
- Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, P. R. China
- West China Medical Publishers, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Guiyu Jiang
- West China School of Public Health, Sichuan University, Chengdu, P. R. China
| | - Qingwen Zhao
- West China School of Public Health, Sichuan University, Chengdu, P. R. China
| | - Youlin Long
- Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, P. R. China
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Kun Feng
- Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, P. R. China
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Xianlin Gu
- Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, P. R. China
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Yihan Xu
- Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, P. R. China
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Center for education of medical humanities, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Zhengchi Li
- Center for education of medical humanities, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Jin Huang
- Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Liang Du
- Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, P. R. China
- West China Medical Publishers, West China Hospital, Sichuan University, Chengdu, P. R. China
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
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Nemeth B, Smeets MJ, Cannegieter SC, van Smeden M. Tutorial: dos and don'ts in clinical prediction research for venous thromboembolism. Res Pract Thromb Haemost 2024; 8:102480. [PMID: 39099799 PMCID: PMC11295571 DOI: 10.1016/j.rpth.2024.102480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/27/2024] [Accepted: 06/11/2024] [Indexed: 08/06/2024] Open
Abstract
Clinical prediction modeling has become an increasingly popular domain of venous thromboembolism research in recent years. Prediction models can help healthcare providers make decisions regarding starting or withholding therapeutic interventions, or referrals for further diagnostic workup, and can form a basis for risk stratification in clinical trials. The aim of the current guide is to assist in the practical application of complicated methodological requirements for well-performed prediction research by presenting key dos and don'ts while expanding the understanding of predictive research in general for (clinical) researchers who are not specifically trained in the topic; throughout we will use prognostic venous thromboembolism scores as an exemplar.
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Affiliation(s)
- Banne Nemeth
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mark J.R. Smeets
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Suzanne C. Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Toews I, Anglemyer A, Nyirenda JL, Alsaid D, Balduzzi S, Grummich K, Schwingshackl L, Bero L. Healthcare outcomes assessed with observational study designs compared with those assessed in randomized trials: a meta-epidemiological study. Cochrane Database Syst Rev 2024; 1:MR000034. [PMID: 38174786 PMCID: PMC10765475 DOI: 10.1002/14651858.mr000034.pub3] [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] [Indexed: 01/05/2024]
Abstract
BACKGROUND Researchers and decision-makers often use evidence from randomised controlled trials (RCTs) to determine the efficacy or effectiveness of a treatment or intervention. Studies with observational designs are often used to measure the effectiveness of an intervention in 'real world' scenarios. Numerous study designs and their modifications (including both randomised and observational designs) are used for comparative effectiveness research in an attempt to give an unbiased estimate of whether one treatment is more effective or safer than another for a particular population. An up-to-date systematic analysis is needed to identify differences in effect estimates from RCTs and observational studies. This updated review summarises the results of methodological reviews that compared the effect estimates of observational studies with RCTs from evidence syntheses that addressed the same health research question. OBJECTIVES To assess and compare synthesised effect estimates by study type, contrasting RCTs with observational studies. To explore factors that might explain differences in synthesised effect estimates from RCTs versus observational studies (e.g. heterogeneity, type of observational study design, type of intervention, and use of propensity score adjustment). To identify gaps in the existing research comparing effect estimates across different study types. SEARCH METHODS We searched MEDLINE, the Cochrane Database of Systematic Reviews, Web of Science databases, and Epistemonikos to May 2022. We checked references, conducted citation searches, and contacted review authors to identify additional reviews. SELECTION CRITERIA We included systematic methodological reviews that compared quantitative effect estimates measuring the efficacy or effectiveness of interventions tested in RCTs versus in observational studies. The included reviews compared RCTs to observational studies (including retrospective and prospective cohort, case-control and cross-sectional designs). Reviews were not eligible if they compared RCTs with studies that had used some form of concurrent allocation. DATA COLLECTION AND ANALYSIS Using results from observational studies as the reference group, we examined the relative summary effect estimates (risk ratios (RRs), odds ratios (ORs), hazard ratios (HRs), mean differences (MDs), and standardised mean differences (SMDs)) to evaluate whether there was a relatively larger or smaller effect in the ratio of odds ratios (ROR) or ratio of risk ratios (RRR), ratio of hazard ratios (RHR), and difference in (standardised) mean differences (D(S)MD). If an included review did not provide an estimate comparing results from RCTs with observational studies, we generated one by pooling the estimates for observational studies and RCTs, respectively. Across all reviews, we synthesised these ratios to produce a pooled ratio of ratios comparing effect estimates from RCTs with those from observational studies. In overviews of reviews, we estimated the ROR or RRR for each overview using observational studies as the reference category. We appraised the risk of bias in the included reviews (using nine criteria in total). To receive an overall low risk of bias rating, an included review needed: explicit criteria for study selection, a complete sample of studies, and to have controlled for study methodological differences and study heterogeneity. We assessed reviews/overviews not meeting these four criteria as having an overall high risk of bias. We assessed the certainty of the evidence, consisting of multiple evidence syntheses, with the GRADE approach. MAIN RESULTS We included 39 systematic reviews and eight overviews of reviews, for a total of 47. Thirty-four of these contributed data to our primary analysis. Based on the available data, we found that the reviews/overviews included 2869 RCTs involving 3,882,115 participants, and 3924 observational studies with 19,499,970 participants. We rated 11 reviews/overviews as having an overall low risk of bias, and 36 as having an unclear or high risk of bias. Our main concerns with the included reviews/overviews were that some did not assess the quality of their included studies, and some failed to account appropriately for differences between study designs - for example, they conducted aggregate analyses of all observational studies rather than separate analyses of cohort and case-control studies. When pooling RORs and RRRs, the ratio of ratios indicated no difference or a very small difference between the effect estimates from RCTs versus from observational studies (ratio of ratios 1.08, 95% confidence interval (CI) 1.01 to 1.15). We rated the certainty of the evidence as low. Twenty-three of 34 reviews reported effect estimates of RCTs and observational studies that were on average in agreement. In a number of subgroup analyses, small differences in the effect estimates were detected: - pharmaceutical interventions only (ratio of ratios 1.12, 95% CI 1.04 to 1.21); - RCTs and observational studies with substantial or high heterogeneity; that is, I2 ≥ 50% (ratio of ratios 1.11, 95% CI 1.04 to 1.18); - no use (ratio of ratios 1.07, 95% CI 1.03 to 1.11) or unclear use (ratio of ratios 1.13, 95% CI 1.03 to 1.25) of propensity score adjustment in observational studies; and - observational studies without further specification of the study design (ratio of ratios 1.06, 95% CI 0.96 to 1.18). We detected no clear difference in other subgroup analyses. AUTHORS' CONCLUSIONS We found no difference or a very small difference between effect estimates from RCTs and observational studies. These findings are largely consistent with findings from recently published research. Factors other than study design need to be considered when exploring reasons for a lack of agreement between results of RCTs and observational studies, such as differences in the population, intervention, comparator, and outcomes investigated in the respective studies. Our results underscore that it is important for review authors to consider not only study design, but the level of heterogeneity in meta-analyses of RCTs or observational studies. A better understanding is needed of how these factors might yield estimates reflective of true effectiveness.
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Affiliation(s)
- Ingrid Toews
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, Freiburg, Germany
| | - Andrew Anglemyer
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - John Lz Nyirenda
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, Freiburg, Germany
| | - Dima Alsaid
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, Freiburg, Germany
| | - Sara Balduzzi
- Biometrics Department, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Kathrin Grummich
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, Freiburg, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, Freiburg, Germany
| | - Lisa Bero
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, Australia
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Huang Y, Parakati I, Patil DH, Sanda MG. Interval estimation for operating characteristic of continuous biomarkers with controlled sensitivity or specificity. Stat Sin 2023; 33:193-214. [PMID: 37193541 PMCID: PMC10181819 DOI: 10.5705/ss.202021.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The receiver operating characteristic (ROC) curve provides a comprehensive performance assessment of a continuous biomarker over the full threshold spectrum. Nevertheless, a medical test often dictates to operate at a certain high level of sensitivity or specificity. A diagnostic accuracy metric directly targeting the clinical utility is specificity at the controlled sensitivity level, or vice versa. While the empirical point estimation is readily adopted in practice, the nonparametric interval estimation is challenged by the fact that the variance involves density functions due to estimated threshold. In addition, even with a fixed threshold, many standard confidence intervals including the Wald interval for binomial proportion could have erratic behaviors. In this article, we are motivated by the superior performance of the score interval for binomial proportion and propose a novel extension for the biomarker problem. Meanwhile, we develop exact bootstrap and establish consistency of the bootstrap variance estimator. Both single-biomarker evaluation and two-biomarker comparison are investigated. Extensive simulation studies were conducted, demonstrating competitive performance of our proposals. An illustration with aggressive prostate cancer diagnosis is provided.
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Affiliation(s)
- Yijian Huang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Isaac Parakati
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Dattatraya H. Patil
- Department of Urology, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Martin G. Sanda
- Department of Urology, School of Medicine, Emory University, Atlanta, GA 30322, USA
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Legume Intake Is Associated with Potential Savings in Coronary Heart Disease-Related Health Care Costs in Australia. Nutrients 2022; 14:nu14142912. [PMID: 35889870 PMCID: PMC9319708 DOI: 10.3390/nu14142912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 02/04/2023] Open
Abstract
Legume intake has been associated with lower risk for a number of chronic disorders of high financial burden, and is advocated by dietary guidelines as an important part of healthy dietary patterns. Still, the intake of legumes generally falls short of the recommended levels in most countries around the world despite their role as an alternative protein source. The aim of this study was to assess the potential savings in costs of health care services that would follow the reduction in incidences of coronary heart disease (CHD) when adult consumers achieve a targeted level of 50 g/day of legumes intake in Australia. A cost-of-illness analysis was developed using estimates of current and targeted legumes intake in adults (age 25+ y), the estimated percent reduction in relative risk (95% CI) of CHD following legumes intake, and recent data on health care costs related to CHD in Australia. A sensitivity analysis of ‘very pessimistic’ through to ‘universal’ scenarios suggested savings in CHD-related health care costs equal to AUD 4.3 (95% CI 1.2–7.4) to AUD 85.5 (95% CI 23.3–147.7) million annually. Findings of the study suggest an economic value of incorporating attainable levels of legumes within the dietary behaviors of Australians. Greater prominence of legumes in dietary guidelines could assist with achieving broader sustainability measures in relation to diet, helping to bring together the environment and health as an important pillar in relation to sustainability.
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Wang H, Song J, Lin Y, Dai W, Gao Y, Qin L, Chen Y, Tam W, Wu IX, Chung VC. Trial-level characteristics associate with treatment effect estimates: a systematic review of meta-epidemiological studies. BMC Med Res Methodol 2022; 22:171. [PMID: 35705904 PMCID: PMC9202161 DOI: 10.1186/s12874-022-01650-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To summarize the up-to-date empirical evidence on trial-level characteristics of randomized controlled trials associated with treatment effect estimates. METHODS A systematic review searched three databases up to August 2020. Meta-epidemiological (ME) studies of randomized controlled trials on intervention effect were eligible. We assessed the methodological quality of ME studies using a self-developed criterion. Associations between treatment effect estimates and trial-level characteristics were presented using forest plots. RESULTS Eighty ME studies were included, with 25/80 (31%) being published after 2015. Less than one-third ME studies critically appraised the included studies (26/80, 33%), published a protocol (23/80, 29%), and provided a list of excluded studies with justifications (12/80, 15%). Trials with high or unclear (versus low) risk of bias on sequence generation (3/14 for binary outcome and 1/6 for continuous outcome), allocation concealment (11/18 and 1/6), double blinding (5/15 and 2/4) and smaller sample size (4/5 and 2/2) significantly associated with larger treatment effect estimates. Associations between high or unclear risk of bias on allocation concealment (5/6 for binary outcome and 1/3 for continuous outcome), double blinding (4/5 and 1/3) and larger treatment effect estimates were more frequently observed for subjective outcomes. The associations between treatment effect estimates and non-blinding of outcome assessors were removed in trials using multiple observers to reach consensus for both binary and continuous outcomes. Some trial characteristics in the Cochrane risk-of-bias (RoB2) tool have not been covered by the included ME studies, including using validated method for outcome measures and selection of the reported results from multiple outcome measures or multiple analysis based on results (e.g., significance of the results). CONCLUSIONS Consistently significant associations between larger treatment effect estimates and high or unclear risk of bias on sequence generation, allocation concealment, double blinding and smaller sample size were found. The impact of allocation concealment and double blinding were more consistent for subjective outcomes. The methodological and reporting quality of included ME studies were dissatisfactory. Future ME studies should follow the corresponding reporting guideline. Specific guidelines for conducting and critically appraising ME studies are needed.
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Affiliation(s)
- Huan Wang
- 5/F, Xiangya School of Public Health, No. 238, Shang-ma-yuan-ling Alley, Kaifu district, Changsha, China
| | - Jinlu Song
- 5/F, Xiangya School of Public Health, No. 238, Shang-ma-yuan-ling Alley, Kaifu district, Changsha, China
| | - Yali Lin
- 5/F, Xiangya School of Public Health, No. 238, Shang-ma-yuan-ling Alley, Kaifu district, Changsha, China
| | - Wenjie Dai
- 5/F, Xiangya School of Public Health, No. 238, Shang-ma-yuan-ling Alley, Kaifu district, Changsha, China
| | - Yinyan Gao
- 5/F, Xiangya School of Public Health, No. 238, Shang-ma-yuan-ling Alley, Kaifu district, Changsha, China
| | - Lang Qin
- 5/F, Xiangya School of Public Health, No. 238, Shang-ma-yuan-ling Alley, Kaifu district, Changsha, China
| | - Yancong Chen
- 5/F, Xiangya School of Public Health, No. 238, Shang-ma-yuan-ling Alley, Kaifu district, Changsha, China
| | - Wilson Tam
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Irene Xy Wu
- 5/F, Xiangya School of Public Health, No. 238, Shang-ma-yuan-ling Alley, Kaifu district, Changsha, China. .,Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China.
| | - Vincent Ch Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.,School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Zhou K, Arslanturk S, Craig DB, Heath E, Draghici S. Discovery of primary prostate cancer biomarkers using cross cancer learning. Sci Rep 2021; 11:10433. [PMID: 34001952 PMCID: PMC8128891 DOI: 10.1038/s41598-021-89789-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/30/2021] [Indexed: 02/03/2023] Open
Abstract
Prostate cancer (PCa), the second leading cause of cancer death in American men, is a relatively slow-growing malignancy with multiple early treatment options. Yet, a significant number of low-risk PCa patients are over-diagnosed and over-treated with significant and long-term quality of life effects. Further, there is ever increasing evidence of metastasis and higher mortality when hormone-sensitive or castration-resistant PCa tumors are treated indistinctively. Hence, the critical need is to discover clinically-relevant and actionable PCa biomarkers by better understanding the biology of PCa. In this paper, we have discovered novel biomarkers of PCa tumors through cross-cancer learning by leveraging the pathological and molecular similarities in the DNA repair pathways of ovarian, prostate, and breast cancer tumors. Cross-cancer disease learning enriches the study population and identifies genetic/phenotypic commonalities that are important across diseases with pathological and molecular similarities. Our results show that ADIRF, SLC2A5, C3orf86, HSPA1B are among the most significant PCa biomarkers, while MTRNR2L1, EEPD1, TEPP and VN1R2 are jointly important biomarkers across prostate, breast and ovarian cancers. Our validation results have further shown that the discovered biomarkers can predict the disease state better than any randomly selected subset of differentially expressed prostate cancer genes.
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Affiliation(s)
- Kaiyue Zhou
- Department of Computer Science, Wayne State University, Detroit, 48201, USA
| | - Suzan Arslanturk
- Department of Computer Science, Wayne State University, Detroit, 48201, USA.
| | - Douglas B Craig
- Department of Oncology, Wayne State University, Detroit, 48201, USA
- Bioinformatics and Biostatistics Core, Barbara Ann Karmanos Cancer Institute, Detroit, 48201, USA
| | - Elisabeth Heath
- Department of Oncology, Wayne State University, Detroit, 48201, USA
- Molecular Therapeutics Program, Barbara Ann Karmanos Cancer Institute, Detroit, 48201, USA
| | - Sorin Draghici
- Department of Computer Science, Wayne State University, Detroit, 48201, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, 48201, USA
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Kimachi M, Onishi A, Tajika A, Kimachi K, Furukawa TA. Systematic differences in effect estimates between observational studies and randomized control trials in meta-analyses in nephrology. Sci Rep 2021; 11:6088. [PMID: 33731727 PMCID: PMC7971062 DOI: 10.1038/s41598-021-85519-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/23/2021] [Indexed: 01/02/2023] Open
Abstract
The limited availability of randomized controlled trials (RCTs) in nephrology undermines causal inferences in meta-analyses. Systematic reviews of observational studies have grown more common under such circumstances. We conducted systematic reviews of all comparative observational studies in nephrology from 2006 to 2016 to assess the trends in the past decade. We then focused on the meta-analyses combining observational studies and RCTs to evaluate the systematic differences in effect estimates between study designs using two statistical methods: by estimating the ratio of odds ratios (ROR) of the pooled OR obtained from observational studies versus those from RCTs and by examining the discrepancies in their statistical significance. The number of systematic reviews of observational studies in nephrology had grown by 11.7-fold in the past decade. Among 56 records combining observational studies and RCTs, ROR suggested that the estimates between study designs agreed well (ROR 1.05, 95% confidence interval 0.90-1.23). However, almost half of the reviews led to discrepant interpretations in terms of statistical significance. In conclusion, the findings based on ROR might encourage researchers to justify the inclusion of observational studies in meta-analyses. However, caution is needed, as the interpretations based on statistical significance were less concordant than those based on ROR.
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Affiliation(s)
- Miho Kimachi
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Akira Onishi
- Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Hyōgo, Japan
| | - Aran Tajika
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
| | - Kimihiko Kimachi
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Markozannes G, Koutsioumpa C, Cividini S, Monori G, Tsilidis KK, Kretsavos N, Theodoratou E, Gill D, Ioannidis JP, Tzoulaki I. Global assessment of C-reactive protein and health-related outcomes: an umbrella review of evidence from observational studies and Mendelian randomization studies. Eur J Epidemiol 2021; 36:11-36. [PMID: 32978716 PMCID: PMC7847446 DOI: 10.1007/s10654-020-00681-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 08/25/2020] [Indexed: 02/07/2023]
Abstract
C-reactive protein (CRP) has been studied extensively for association with a large number of non-infectious diseases and outcomes. We aimed to evaluate the breadth and validity of associations between CRP and non-infectious, chronic health outcomes and biomarkers. We conducted an umbrella review of systematic reviews and meta-analyses and a systematic review of Mendelian randomization (MR) studies. PubMed, Scopus, and Cochrane Database of Systematic Reviews were systematically searched from inception up to March 2019. Meta-analyses of observational studies and MR studies examining associations between CRP and health outcomes were identified, excluding studies on the diagnostic value of CRP for infections. We found 113 meta-analytic comparisons of observational studies and 196 MR analyses, covering a wide range of outcomes. The overwhelming majority of the meta-analyses of observational studies reported a nominally statistically significant result (95/113, 84.1%); however, the majority of the meta-analyses displayed substantial heterogeneity (47.8%), small study effects (39.8%) or excess significance (41.6%). Only two outcomes, cardiovascular mortality and venous thromboembolism, showed convincing evidence of association with CRP levels. When examining the MR literature, we found MR studies for 53/113 outcomes examined in the observational study meta-analyses but substantial support for a causal association with CRP was not observed for any phenotype. Despite the striking amount of research on CRP, convincing evidence for associations and causal effects is remarkably limited.
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Affiliation(s)
- Georgios Markozannes
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, 45110, Ioannina, Greece
| | - Charalampia Koutsioumpa
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, 45110, Ioannina, Greece
- Department of Neurobiology, Harvard Medical School, Boston, MA, USA
- BBS Program, Harvard Medical School, 220 Longwood Avenue, Boston, MA, 02115, USA
| | - Sofia Cividini
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Grace Monori
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Konstantinos K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, 45110, Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Nikolaos Kretsavos
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, 45110, Ioannina, Greece
| | - Evropi Theodoratou
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - John Pa Ioannidis
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Biomedical Data Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, 94305, USA
- Meta-Research Innovation Center at Stanford (METRICS), Stanford, CA, 94305, USA
| | - Ioanna Tzoulaki
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, 45110, Ioannina, Greece.
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
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10
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Silajdžić E, Björkqvist M. A Critical Evaluation of Wet Biomarkers for Huntington's Disease: Current Status and Ways Forward. J Huntingtons Dis 2019; 7:109-135. [PMID: 29614689 PMCID: PMC6004896 DOI: 10.3233/jhd-170273] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
There is an unmet clinical need for objective biomarkers to monitor disease progression and treatment response in Huntington's disease (HD). The aim of this review is, therefore, to provide practical advice for biomarker discovery and to summarise studies on biofluid markers for HD. A PubMed search was performed to review literature with regard to candidate saliva, urine, blood and cerebrospinal fluid biomarkers for HD. Information has been organised into tables to allow a pragmatic approach to the discussion of the evidence and generation of practical recommendations for future studies. Many of the markers published converge on metabolic and inflammatory pathways, although changes in other analytes representing antioxidant and growth factor pathways have also been found. The most promising markers reflect neuronal and glial degeneration, particularly neurofilament light chain. International collaboration to standardise assays and study protocols, as well as to recruit sufficiently large cohorts, will facilitate future biomarker discovery and development.
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Affiliation(s)
- Edina Silajdžić
- Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Maria Björkqvist
- Department of Experimental Medical Science, Brain Disease Biomarker Unit, Wallenberg Neuroscience Center, Lund University, Lund, Sweden
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Simes J, Robledo KP, White HD, Espinoza D, Stewart RA, Sullivan DR, Zeller T, Hague W, Nestel PJ, Glasziou PP, Keech AC, Elliott J, Blankenberg S, Tonkin AM. D-Dimer Predicts Long-Term Cause-Specific Mortality, Cardiovascular Events, and Cancer in Patients With Stable Coronary Heart Disease: LIPID Study. Circulation 2019; 138:712-723. [PMID: 29367425 DOI: 10.1161/circulationaha.117.029901] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND D-dimer, a degradation product of cross-linked fibrin, is a marker for hypercoagulability and thrombotic events. Moderately elevated levels of D-dimer are associated with the risk of venous and arterial events in patients with vascular disease. We assessed the role of D-dimer levels in predicting long-term vascular outcomes, cause-specific mortality, and new cancers in the LIPID trial (Long-Term Intervention with Pravastatin in Ischaemic Disease) in the context of other risk factors. METHODS LIPID randomized patients to placebo or pravastatin 40 mg/d 5 to 38 months after myocardial infarction or unstable angina. D-dimer levels were measured at baseline and at 1 year. Median follow-up was 6.0 years during the trial and 16 years in total. RESULTS Baseline D-dimer levels for 7863 patients were grouped by quartile (≤112, 112-173, 173-273, >273 ng/mL). Higher levels were associated with older age, female sex, history of hypertension, poor renal function, and elevated levels of B-natriuretic peptide, high-sensitivity C-reactive protein, and sensitive troponin I (each P<0.001). During the first 6 years, after adjustment for up to 30 additional risk factors, higher D-dimer was associated with a significantly increased risk of a major coronary event (quartile 4 versus 1: hazard ratio [HR], 1.45; 95% confidence interval, 1.21-1.74), major cardiovascular disease (CVD) event (HR, 1.45; 95% confidence interval, 1.23-1.71) and venous thromboembolism (HR, 4.03; 95% confidence interval, 2.31-7.03; each P<0.001). During the 16 years overall, higher D-dimer was an independent predictor of all-cause mortality (HR, 1.59), CVD mortality (HR, 1.61), cancer mortality (HR, 1.54), and non-CVD noncancer mortality (HR, 1.57; each P<0.001), remaining significant for deaths resulting from each cause occurring beyond 10 years of follow-up (each P≤0.01). Higher D-dimer also independently predicted an increase in cancer incidence (HR, 1.16; P=0.02).The D-dimer level increased the net reclassification index for all-cause mortality by 4.0 and venous thromboembolism by 13.6. CONCLUSIONS D-dimer levels predict long-term risk of arterial and venous events, CVD mortality, and non-CVD noncancer mortality independent of other risk factors. D-dimer is also a significant predictor of cancer incidence and mortality. These results support an association of D-dimer with fatal events across multiple diseases and demonstrate that this link extends beyond 10 years' follow-up.
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Affiliation(s)
- John Simes
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (J.S., K.P.R., D.E., W.H., A.C.K.)
| | - Kristy P Robledo
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (J.S., K.P.R., D.E., W.H., A.C.K.)
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.)
| | - David Espinoza
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (J.S., K.P.R., D.E., W.H., A.C.K.)
| | - Ralph A Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.)
| | | | - Tanja Zeller
- University Heart Centre Hamburg, Germany (T.Z., S.B.)
| | - Wendy Hague
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (J.S., K.P.R., D.E., W.H., A.C.K.)
| | - Paul J Nestel
- Baker Heart and Diabetes Institute, Melbourne, Australia (P.J.N.)
| | - Paul P Glasziou
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia (P.P.G.)
| | - Anthony C Keech
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (J.S., K.P.R., D.E., W.H., A.C.K.)
| | - John Elliott
- Department of Medicine, University of Otago, Christchurch, New Zealand (J.E.)
| | | | - Andrew M Tonkin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (A.M.T.)
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Piovani D, Danese S, Peyrin-Biroulet L, Nikolopoulos GK, Lytras T, Bonovas S. Environmental Risk Factors for Inflammatory Bowel Diseases: An Umbrella Review of Meta-analyses. Gastroenterology 2019; 157:647-659.e4. [PMID: 31014995 DOI: 10.1053/j.gastro.2019.04.016] [Citation(s) in RCA: 398] [Impact Index Per Article: 79.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Multiple environmental factors have been associated with the development of inflammatory bowel diseases (IBDs). We performed an umbrella review of meta-analyses to summarize available epidemiologic evidence and assess its credibility. METHODS We systematically identified and appraised meta-analyses of observational studies examining environmental factors and risk of IBD (Crohn's disease [CD] or ulcerative colitis [UC]). For each meta-analysis, we considered the random effects estimate, its 95% confidence interval, the estimates of heterogeneity, and small-study effects, and we graded the evidence according to prespecified criteria. Methodologic quality was assessed with AMSTAR (ie, A Measurement Tool to Assess Systematic Reviews) 2. RESULTS We examined 183 estimates in 53 meta-analyses of 71 environmental factors related to lifestyles and hygiene, surgeries, drug exposures, diet, microorganisms, and vaccinations. We identified 9 factors that increase risk of IBD: smoking (CD), urban living (CD and IBD), appendectomy (CD), tonsillectomy (CD), antibiotic exposure (IBD), oral contraceptive use (IBD), consumption of soft drinks (UC), vitamin D deficiency (IBD), and non-Helicobacter pylori-like enterohepatic Helicobacter species (IBD). We identified 7 factors that reduce risk of IBD: physical activity (CD), breastfeeding (IBD), bed sharing (CD), tea consumption (UC), high levels of folate (IBD), high levels of vitamin D (CD), and H pylori infection (CD, UC, and IBD). Epidemiologic evidence for all of these associations was of high to moderate strength; we identified another 11 factors associated with increased risk and 16 factors associated with reduced risk with weak credibility. Methodologic quality varied considerably among meta-analyses. Several associations were based on findings from retrospective studies, so it is not possible to determine if these are effects of IBD or the results of recall bias. CONCLUSIONS In an umbrella review of meta-analyses, we found varying levels of evidence for associations of different environmental factors with risk of IBD. High-quality prospective studies with analyses of samples from patients with recent diagnoses of IBD are needed to determine whether these factors cause or are results of IBD and their pathogenic mechanisms.
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Affiliation(s)
- Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Inflammatory Bowel Disease Center, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Inflammatory Bowel Disease Center, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Hepato-Gastroenterology and INSERM U954, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | | | - Theodore Lytras
- Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Inflammatory Bowel Disease Center, Humanitas Clinical and Research Center-IRCCS, Milan, Italy.
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Unbiased data analytic strategies to improve biomarker discovery in precision medicine. Drug Discov Today 2019; 24:1735-1748. [PMID: 31158511 DOI: 10.1016/j.drudis.2019.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/23/2019] [Accepted: 05/28/2019] [Indexed: 12/25/2022]
Abstract
Omics technologies promised improved biomarker discovery for precision medicine. The foremost problem of discovered biomarkers is irreproducibility between patient cohorts. From a data analytics perspective, the main reason for these failures is bias in statistical approaches and overfitting resulting from batch effects and confounding factors. The keys to reproducible biomarker discovery are: proper study design, unbiased data preprocessing and quality control analyses, and a knowledgeable application of statistics and machine learning algorithms. In this review, we discuss study design and analysis considerations and suggest standards from an expert point-of-view to promote unbiased decision-making in biomarker discovery in precision medicine.
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Quint JK, Minelli C. Can't see the wood for the trees: confounders, colliders and causal inference - a clinician's approach. Thorax 2019; 74:321-322. [PMID: 30733329 DOI: 10.1136/thoraxjnl-2018-212488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2019] [Indexed: 01/22/2023]
Affiliation(s)
| | - Cosetta Minelli
- National Heart and Lung Institute, Imperial College, London, UK
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Giannakou K, Evangelou E, Papatheodorou SI. Genetic and non-genetic risk factors for pre-eclampsia: umbrella review of systematic reviews and meta-analyses of observational studies. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:720-730. [PMID: 29143991 DOI: 10.1002/uog.18959] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/09/2017] [Accepted: 10/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To summarize evidence from the literature on genetic and non-genetic risk factors associated with pre-eclampsia (PE), assess the presence of statistical bias in the studies and identify risk factors for which there is robust evidence supporting their association with PE. METHODS PubMed and ISI Web of Science were searched from inception to October 2016, to identify systematic reviews and meta-analyses of observational studies examining associations between genetic or non-genetic risk factors and PE. For each meta-analysis, the summary-effect size was estimated using random-effects and fixed-effects models, along with 95% CIs and the 95% prediction interval. Between-study heterogeneity was expressed using the I2 statistic, and evidence of small-study effects (large studies had significantly more conservative results than smaller studies) and evidence of excess significance bias (too many studies with statistically significant results) were estimated. RESULTS Fifty-eight eligible meta-analyses were identified, which included 1466 primary studies and provided data on 130 comparisons of risk factors associated with PE, covering a wide range of comorbid diseases, genetic factors, exposure to environmental agents and biomarkers. Sixty-five (50%) associations had nominally statistically significant findings at P < 0.05, while 16 (12%) were significant at P < 10-6 . Sixty-five (50%) associations had large or very large heterogeneity. Evidence for small-study effects and excess significance bias was found in 10 (8%) and 26 (20%) associations, respectively. The only non-genetic risk factor with convincing evidence for an association with PE was oocyte donation vs spontaneous conception, which had a summary odds ratio of 4.33 (95% CI, 3.11-6.03), was supported by 2712 cases with small heterogeneity (I2 = 26%) and 95% prediction intervals excluding the null value, and without hints of small-study effects (P for Egger's test > 0.10) or excess of significance (P > 0.05). Of the statistically significant (P < 0.05) genetic risk factors for PE, only PAI-1 4G/5G (recessive model) polymorphism was supported by strong evidence for a contribution to the pathogenesis of PE. Eleven factors (serum iron level, pregnancy-associated plasma protein-A, chronic kidney disease, polycystic ovary syndrome, mental stress, bacterial and viral infections, cigarette smoking, oocyte donation vs assisted reproductive technology, obesity vs normal weight, severe obesity vs normal weight and primiparity) presented highly suggestive evidence for an association with PE. CONCLUSIONS A large proportion of meta-analyses of genetic and non-genetic risk factors for PE have caveats that threaten their validity. Oocyte donation vs spontaneous conception and PAI-1 4G/5G polymorphism (recessive model) showed the strongest consistent evidence for an association with risk for PE. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- K Giannakou
- Cyprus International Institute for Environmental & Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - E Evangelou
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - S I Papatheodorou
- Cyprus International Institute for Environmental & Public Health, Cyprus University of Technology, Limassol, Cyprus
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Affiliation(s)
- Bill Matney
- Division of Music Education and Music Therapy, University of Kansas, Lawrence, KS, USA
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17
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Ramirez FD, Motazedian P, Jung RG, Di Santo P, MacDonald ZD, Moreland R, Simard T, Clancy AA, Russo JJ, Welch VA, Wells GA, Hibbert B. Methodological Rigor in Preclinical Cardiovascular Studies: Targets to Enhance Reproducibility and Promote Research Translation. Circ Res 2017; 120:1916-1926. [PMID: 28373349 PMCID: PMC5466021 DOI: 10.1161/circresaha.117.310628] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/11/2017] [Accepted: 03/31/2017] [Indexed: 01/13/2023]
Abstract
RATIONALE Methodological sources of bias and suboptimal reporting contribute to irreproducibility in preclinical science and may negatively affect research translation. Randomization, blinding, sample size estimation, and considering sex as a biological variable are deemed crucial study design elements to maximize the quality and predictive value of preclinical experiments. OBJECTIVE To examine the prevalence and temporal patterns of recommended study design element implementation in preclinical cardiovascular research. METHODS AND RESULTS All articles published over a 10-year period in 5 leading cardiovascular journals were reviewed. Reports of in vivo experiments in nonhuman mammals describing pathophysiology, genetics, or therapeutic interventions relevant to specific cardiovascular disorders were identified. Data on study design and animal model use were collected. Citations at 60 months were additionally examined as a surrogate measure of research impact in a prespecified subset of studies, stratified by individual and cumulative study design elements. Of 28 636 articles screened, 3396 met inclusion criteria. Randomization was reported in 21.8%, blinding in 32.7%, and sample size estimation in 2.3%. Temporal and disease-specific analyses show that the implementation of these study design elements has overall not appreciably increased over the past decade, except in preclinical stroke research, which has uniquely demonstrated significant improvements in methodological rigor. In a subset of 1681 preclinical studies, randomization, blinding, sample size estimation, and inclusion of both sexes were not associated with increased citations at 60 months. CONCLUSIONS Methodological shortcomings are prevalent in preclinical cardiovascular research, have not substantially improved over the past 10 years, and may be overlooked when basing subsequent studies. Resultant risks of bias and threats to study validity have the potential to hinder progress in cardiovascular medicine as preclinical research often precedes and informs clinical trials. Stroke research quality has uniquely improved in recent years, warranting a closer examination for interventions to model in other cardiovascular fields.
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Affiliation(s)
- F Daniel Ramirez
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Pouya Motazedian
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Richard G Jung
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Pietro Di Santo
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Zachary D MacDonald
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Robert Moreland
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Trevor Simard
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Aisling A Clancy
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Juan J Russo
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Vivian A Welch
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - George A Wells
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada.
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Lambin P, Zindler J, Vanneste BGL, De Voorde LV, Eekers D, Compter I, Panth KM, Peerlings J, Larue RTHM, Deist TM, Jochems A, Lustberg T, van Soest J, de Jong EEC, Even AJG, Reymen B, Rekers N, van Gisbergen M, Roelofs E, Carvalho S, Leijenaar RTH, Zegers CML, Jacobs M, van Timmeren J, Brouwers P, Lal JA, Dubois L, Yaromina A, Van Limbergen EJ, Berbee M, van Elmpt W, Oberije C, Ramaekers B, Dekker A, Boersma LJ, Hoebers F, Smits KM, Berlanga AJ, Walsh S. Decision support systems for personalized and participative radiation oncology. Adv Drug Deliv Rev 2017; 109:131-153. [PMID: 26774327 DOI: 10.1016/j.addr.2016.01.006] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/08/2015] [Accepted: 01/06/2016] [Indexed: 12/12/2022]
Abstract
A paradigm shift from current population based medicine to personalized and participative medicine is underway. This transition is being supported by the development of clinical decision support systems based on prediction models of treatment outcome. In radiation oncology, these models 'learn' using advanced and innovative information technologies (ideally in a distributed fashion - please watch the animation: http://youtu.be/ZDJFOxpwqEA) from all available/appropriate medical data (clinical, treatment, imaging, biological/genetic, etc.) to achieve the highest possible accuracy with respect to prediction of tumor response and normal tissue toxicity. In this position paper, we deliver an overview of the factors that are associated with outcome in radiation oncology and discuss the methodology behind the development of accurate prediction models, which is a multi-faceted process. Subsequent to initial development/validation and clinical introduction, decision support systems should be constantly re-evaluated (through quality assurance procedures) in different patient datasets in order to refine and re-optimize the models, ensuring the continuous utility of the models. In the reasonably near future, decision support systems will be fully integrated within the clinic, with data and knowledge being shared in a standardized, dynamic, and potentially global manner enabling truly personalized and participative medicine.
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Affiliation(s)
- Philippe Lambin
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - Jaap Zindler
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ben G L Vanneste
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Lien Van De Voorde
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Daniëlle Eekers
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Inge Compter
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Kranthi Marella Panth
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jurgen Peerlings
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ruben T H M Larue
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Timo M Deist
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Arthur Jochems
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Tim Lustberg
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Johan van Soest
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Evelyn E C de Jong
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Aniek J G Even
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Bart Reymen
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Nicolle Rekers
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marike van Gisbergen
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Erik Roelofs
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sara Carvalho
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ralph T H Leijenaar
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Catharina M L Zegers
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maria Jacobs
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Janita van Timmeren
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Patricia Brouwers
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jonathan A Lal
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ludwig Dubois
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ala Yaromina
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Evert Jan Van Limbergen
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maaike Berbee
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Cary Oberije
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Bram Ramaekers
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Liesbeth J Boersma
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Frank Hoebers
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Kim M Smits
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Adriana J Berlanga
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sean Walsh
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Ojerholm E, Smith A, Hwang WT, Baumann BC, Tucker KN, Lerner SP, Mamtani R, Boursi B, Christodouleas JP. Neutrophil-to-lymphocyte ratio as a bladder cancer biomarker: Assessing prognostic and predictive value in SWOG 8710. Cancer 2016; 123:794-801. [PMID: 27787873 DOI: 10.1002/cncr.30422] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/12/2016] [Accepted: 10/03/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Risk stratification is a major challenge in bladder cancer (BC), and a biomarker is needed. Multiple studies have reported the neutrophil-to-lymphocyte ratio (NLR) as a promising candidate; however, these analyses have methodological limitations. Therefore, the authors performed a category B biomarker study to test whether NLR is prognostic for overall survival (OS) after curative treatment or is predictive for the survival benefit from neoadjuvant chemotherapy (NAC). METHODS This study is an unplanned secondary analysis of SWOG 8710, a randomized phase 3 trial that assessed cystectomy with or without NAC in 317 patients with muscle-invasive BC. NLR was calculated from prospectively collected complete blood counts. For the prognostic analysis, 230 patients were identified; for the predictive analysis, 263 were identified. NLR was evaluated with proportional hazards models including prespecified factors (age, sex, T-stage, lymphovascular invasion, and treatment arm). RESULTS With a median follow-up of 18.6 years, there were 172 and 205 deaths in the prognostic and predictive cohorts, respectively. In a multivariable analysis, NLR was not prognostic for OS (hazard ratio [HR], 1.04; 95% confidence interval [CI], 0.98-1.11; P = .24). Furthermore, NLR did not predict for the OS benefit from NAC (HR, 1.01; 95% CI, 0.90-1.14; P = .86). Factors associated with worse OS were older age (HR, 1.05; 95% CI, 1.04-1.07; P < .001) and surgery without NAC (HR, 1.39; 95% CI, 1.03-1.88; P = .03). CONCLUSIONS This is the first analysis of NLR in BC to use prospectively collected clinical trial data. In contrast to previous studies, it suggests that NLR is neither a prognostic nor predictive biomarker for OS in muscle-invasive BC. Cancer 2017;123:794-801. © 2016 American Cancer Society.
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Affiliation(s)
- Eric Ojerholm
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew Smith
- Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wei-Ting Hwang
- Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian C Baumann
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kai N Tucker
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Ronac Mamtani
- Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ben Boursi
- Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John P Christodouleas
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
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20
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Wierzbicki AS. Mind the gap - surviving in the modern world. Int J Clin Pract 2016; 70:517-9. [PMID: 27354169 DOI: 10.1111/ijcp.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- A S Wierzbicki
- Department of Metabolic Medicine/Chemical Pathology, Guy's and St Thomas' Hospitals, London, UK.
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21
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Espinoza M, Hsieh A, Hsiehchen D. Systematic characterization of gastrointestinal clinical trials. Dig Liver Dis 2016; 48:480-488. [PMID: 26847963 DOI: 10.1016/j.dld.2016.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/15/2015] [Accepted: 01/05/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Clinical guidelines are commonly based on inadequate evidence, suggesting deficiencies in the present portfolio of clinical research. AIMS To investigate characteristics of clinical trials examining gastrointestinal (GI) diseases registered in ClinicalTrials.gov. METHODS A cross-sectional analysis of 13,647 GI trials and 111,535 non-GI trials initiated between January 1997 and September 2013 was performed. Entries were sorted by operational status, purpose, interventions, trial design, and epochs to identify trends and interactions in trial properties. RESULTS The global production of GI trials has remained static in recent years and a majority of research efforts are focused on a few diseases. While GI trials are generally produced by highly populated US states and countries, they are also seldom larger than 500 patients. The likelihood of using data monitoring committees, randomization, and double blinding in GI trials has increased over time, though a substantial fraction of GI trials still do not employ rigorous trial designs. While levels of GI trials correlate with disease burden, the explained variance of GI trials by disease burden worldwide is poor. CONCLUSION GI trials are chiefly concentrated in few diseases and highly populated regions, exhibit heterogeneous trends and methodologies, and are sensitive to disease burdens, though more so within North America than worldwide.
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Affiliation(s)
| | - Antony Hsieh
- Northwestern Memorial Hospital, Northwestern University, Chicago, IL, USA
| | - David Hsiehchen
- Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA.
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22
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Sodium-Glucose Cotransporter 2 Inhibition and Cardiovascular Risk. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0503-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Brignardello-Petersen R, Carrasco-Labra A, Jadad AR, Johnston BC, Tomlinson G. Diverse criteria and methods are used to compare treatment effect estimates: a scoping review. J Clin Epidemiol 2016; 75:29-39. [PMID: 26891950 DOI: 10.1016/j.jclinepi.2016.02.001] [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: 07/16/2015] [Revised: 01/16/2016] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To determine what criteria researchers use to assess whether the estimates of effect of an intervention on a dichotomous outcome are different when obtained using different study designs. STUDY DESIGN AND SETTING Scoping review of the literature. We included studies of dichotomous outcomes in which authors compared the estimates of effects from different study designs. We performed searches in electronic databases and in the list of references of relevant studies. Two reviewers independently selected studies and abstracted data. We created a list of the criteria used to compare estimates of effects between study designs, described their main features, and classified them using a clinical perspective. RESULTS We included 26 studies, from which we identified 24 criteria. Most of the studies focused on comparing estimates from observational studies and randomized controlled trials (n = 19). The most common criteria aimed to determine whether there was a difference or not (n = 18), provided guidance for such a judgment (n = 16), and were based on the point estimates (n = 11). We judged 14 criteria to be appropriate and classified them as either statistically related or clinically related. CONCLUSION We found that diverse criteria are used to compare effect estimates between study designs. Familiarity with these would aid in the interpretation of results from different studies regarding the same question.
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Affiliation(s)
- Romina Brignardello-Petersen
- Evidence-Based Dentistry Unit, Faculty of Dentistry, University of Chile, Sergio Livingstone 943, Independencia, Santiago 8380492, Chile; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6, Canada.
| | - Alonso Carrasco-Labra
- Evidence-Based Dentistry Unit, Faculty of Dentistry, University of Chile, Sergio Livingstone 943, Independencia, Santiago 8380492, Chile
| | - Alejandro R Jadad
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6, Canada; Institute for Global Health Equity and Innovation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6, Canada; Centre for Global eHealth Innovation, R Fraser Elliot Building, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Bradley C Johnston
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6, Canada; Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Room 11.9859, West Toronto, Ontario M5G 0A4, Canada; Department of Anesthesia and Pain Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| | - George Tomlinson
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6, Canada; Department of Medicine, University Health Network and Mt Sinai Hospital, Toronto, Eaton North, 13th Floor, Room 238, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
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24
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Basic study design influences the results of orthodontic clinical investigations. J Clin Epidemiol 2015; 68:1512-22. [DOI: 10.1016/j.jclinepi.2015.03.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 03/05/2015] [Accepted: 03/18/2015] [Indexed: 11/24/2022]
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Abstract
With the emergence of genomic profiling technologies and selective molecular targeted therapies, biomarkers play an increasingly important role in the clinical management of cancer patients. Single gene/protein or multi-gene "signature"-based assays have been introduced to measure specific molecular pathway deregulations that guide therapeutic decision-making as predictive biomarkers. Genome-based prognostic biomarkers are also available for several cancer types for potential incorporation into clinical prognostic staging systems or practice guidelines. However, there is still a large gap between initial biomarker discovery studies and their clinical translation due to the challenges in the process of cancer biomarker development. In this review we summarize the steps of biomarker development, highlight key issues in successful validation and implementation, and overview representative examples in the oncology field. We also discuss regulatory issues and future perspectives in the era of big data analysis and precision medicine.
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Affiliation(s)
- Nicolas Goossens
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
- Division of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland
| | - Shigeki Nakagawa
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Xiaochen Sun
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Yujin Hoshida
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
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Belbasis L, Bellou V, Evangelou E, Ioannidis JPA, Tzoulaki I. Environmental risk factors and multiple sclerosis: an umbrella review of systematic reviews and meta-analyses. Lancet Neurol 2015; 14:263-73. [DOI: 10.1016/s1474-4422(14)70267-4] [Citation(s) in RCA: 412] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Moons KGM, Altman DG, Reitsma JB, Ioannidis JPA, Macaskill P, Steyerberg EW, Vickers AJ, Ransohoff DF, Collins GS. Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): explanation and elaboration. Ann Intern Med 2015; 162:W1-73. [PMID: 25560730 DOI: 10.7326/m14-0698] [Citation(s) in RCA: 2875] [Impact Index Per Article: 319.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) Statement includes a 22-item checklist, which aims to improve the reporting of studies developing, validating, or updating a prediction model, whether for diagnostic or prognostic purposes. The TRIPOD Statement aims to improve the transparency of the reporting of a prediction model study regardless of the study methods used. This explanation and elaboration document describes the rationale; clarifies the meaning of each item; and discusses why transparent reporting is important, with a view to assessing risk of bias and clinical usefulness of the prediction model. Each checklist item of the TRIPOD Statement is explained in detail and accompanied by published examples of good reporting. The document also provides a valuable reference of issues to consider when designing, conducting, and analyzing prediction model studies. To aid the editorial process and help peer reviewers and, ultimately, readers and systematic reviewers of prediction model studies, it is recommended that authors include a completed checklist in their submission. The TRIPOD checklist can also be downloaded from www.tripod-statement.org.
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Defagó MD, Elorriaga N, Irazola VE, Rubinstein AL. Influence of food patterns on endothelial biomarkers: a systematic review. J Clin Hypertens (Greenwich) 2014; 16:907-13. [PMID: 25376124 PMCID: PMC4270900 DOI: 10.1111/jch.12431] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/04/2014] [Accepted: 09/04/2014] [Indexed: 01/19/2023]
Abstract
The purpose of this study was to conduct a systematic review on the association of food patterns (FPs) and endothelial biomarkers. An electronic literature search from 1990 to 2012 was conducted and reference lists and experts were consulted. Studies without dietary intervention and without language restrictions were considered. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were employed. Methodological quality was assessed by Strengthening the Reporting of Observational Studies in Epidemiology guidelines. A total of 546 references were identified, of which 8 were finally included. Several FPs were identified. Healthy FPs (abundant in fruits and vegetables) had a beneficial impact on endothelial function as estimated by circulating levels of biomarkers such as C-reactive protein, soluble intercellular adhesion molecule 1, soluble vascular adhesion molecule 1, and E-selectin molecules. Westernized patterns (higher intakes of processed meats, sweets, fried foods, and refined grains) were positively associated with inflammation molecules and atherogenic promoters. The study of FPs in relation to endothelial function contributes to the development of dietary recommendations for improved cardiovascular health and therefore a better lifestyle.
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Affiliation(s)
- María Daniela Defagó
- Centro de Excelencia en Salud Cardiovascular para el Cono Sur (CESCAS/SACECH)Instituto de Efectividad Clínica y SanitariaBuenos AiresArgentina
- Facultad de Ciencias MédicasEscuela de NutriciónUniversidad Nacional de CórdobaCórdobaArgentina
| | - Natalia Elorriaga
- Centro de Excelencia en Salud Cardiovascular para el Cono Sur (CESCAS/SACECH)Instituto de Efectividad Clínica y SanitariaBuenos AiresArgentina
| | - Vilma Edith Irazola
- Centro de Excelencia en Salud Cardiovascular para el Cono Sur (CESCAS/SACECH)Instituto de Efectividad Clínica y SanitariaBuenos AiresArgentina
| | - Adolfo Luis Rubinstein
- Centro de Excelencia en Salud Cardiovascular para el Cono Sur (CESCAS/SACECH)Instituto de Efectividad Clínica y SanitariaBuenos AiresArgentina
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29
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Guo R, Li Y, Wen J, Li W, Xu Y. Elevated Plasma Level of Pentraxin-3 Predicts In-Hospital and 30-Day Clinical Outcomes in Patients with Non-ST-Segment Elevation Myocardial Infarction Who Have Undergone Percutaneous Coronary Intervention. Cardiology 2014; 129:178-88. [DOI: 10.1159/000364996] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 06/02/2014] [Indexed: 11/19/2022]
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30
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Abstract
The concept of meta-epidemiology has been introduced with considering the methodological limitations of systematic review for intervention trials. The paradigm of meta-epidemiology has shifted from a statistical method into a new methodology to close gaps between evidence and practice. Main interest of meta-epidemiology is to control potential biases in previous quantitative systematic reviews and draw appropriate evidences for establishing evidence-base guidelines. Nowadays, the network meta-epidemiology was suggested in order to overcome some limitations of meta-epidemiology. To activate meta-epidemiologic studies, implementation of tools for risk of bias and reporting guidelines such as the Consolidated Standards for Reporting Trials (CONSORT) should be done.
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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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31
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Haring R, Baumeister SE, Lieb W, von Sarnowski B, Völzke H, Felix SB, Nauck M, Wallaschofski H. Glycated hemoglobin as a marker of subclinical atherosclerosis and cardiac remodeling among non-diabetic adults from the general population. Diabetes Res Clin Pract 2014; 105:416-23. [PMID: 24972524 DOI: 10.1016/j.diabres.2014.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 02/04/2014] [Accepted: 05/16/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Elevated glycated hemoglobin (HbA1c) is associated with increased risk of cardiovascular disease (CVD) and mortality but little is known about potential mechanisms underlying the reported associations. METHODS We used data from 1798 non-diabetic participants from the population-based cohort Study of Health in Pomerania (SHIP) to investigate cross-sectional and longitudinal associations of HbA1c with subclinical atherosclerosis (common carotid artery intima-media thickness [CCA-IMT]), cardiac structure (left ventricular mass [LVM]), and cardiac function (fractional shortening). RESULTS Cross-sectional analyses revealed a positive association between HbA1c and mean CCA-IMT with a 0.02 mm (95% confidence interval: 0.01-0.04) increase in CCA-IMT per 1% increase in HbA1c, and a similar positive trend across HbA1c quartiles (overall p-value <0.01). We also observed a graded association between HbA1c and high CCA-IMT (>75th percentile) with an odds ratio of 1.42 (95% CI: 1.11-1.81) per 1% increase in HbA1c. Longitudinal analyses showed no consistent associations of baseline HbA1c with mean follow-up CCA-IMT. There were no consistent associations of HbA1c with cardiac remodeling in cross-sectional and longitudinal analyses, respectively. CONCLUSIONS The association between HbA1c and CCA-IMT in non-diabetic adults may be a crucial link between high-normal HbA1c levels and an increased risk of CVD and mortality.
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Affiliation(s)
- Robin Haring
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Germany.
| | | | - Wolfgang Lieb
- Institute for Community Medicine, University Medicine Greifswald, Germany; Institute of Epidemiology, Christian Albrechts University Kiel, Germany
| | | | - Henry Völzke
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Germany; Institute for Community Medicine, University Medicine Greifswald, Germany
| | - Stephan B Felix
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Germany; Department of Cardiology, University Medicine Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Germany
| | - Henri Wallaschofski
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Germany
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Bias and small-study effects influence treatment effect estimates: a meta-epidemiological study in oral medicine. J Clin Epidemiol 2014; 67:984-92. [DOI: 10.1016/j.jclinepi.2014.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 04/01/2014] [Accepted: 04/04/2014] [Indexed: 12/17/2022]
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Artus M, van der Windt D, Jordan KP, Croft PR. The clinical course of low back pain: a meta-analysis comparing outcomes in randomised clinical trials (RCTs) and observational studies. BMC Musculoskelet Disord 2014; 15:68. [PMID: 24607083 PMCID: PMC4007531 DOI: 10.1186/1471-2474-15-68] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 02/25/2014] [Indexed: 02/07/2024] Open
Abstract
Background Evidence suggests that the course of low back pain (LBP) symptoms in randomised clinical trials (RCTs) follows a pattern of large improvement regardless of the type of treatment. A similar pattern was independently observed in observational studies. However, there is an assumption that the clinical course of symptoms is particularly influenced in RCTs by mere participation in the trials. To test this assumption, the aim of our study was to compare the course of LBP in RCTs and observational studies. Methods Source of studies CENTRAL database for RCTs and MEDLINE, CINAHL, EMBASE and hand search of systematic reviews for cohort studies. Studies include individuals aged 18 or over, and concern non-specific LBP. Trials had to concern primary care treatments. Data were extracted on pain intensity. Meta-regression analysis was used to compare the pooled within-group change in pain in RCTs with that in cohort studies calculated as the standardised mean change (SMC). Results 70 RCTs and 19 cohort studies were included, out of 1134 and 653 identified respectively. LBP symptoms followed a similar course in RCTs and cohort studies: a rapid improvement in the first 6 weeks followed by a smaller further improvement until 52 weeks. There was no statistically significant difference in pooled SMC between RCTs and cohort studies at any time point:- 6 weeks: RCTs: SMC 1.0 (95% CI 0.9 to 1.0) and cohorts 1.2 (0.7to 1.7); 13 weeks: RCTs 1.2 (1.1 to 1.3) and cohorts 1.0 (0.8 to 1.3); 27 weeks: RCTs 1.1 (1.0 to 1.2) and cohorts 1.2 (0.8 to 1.7); 52 weeks: RCTs 0.9 (0.8 to 1.0) and cohorts 1.1 (0.8 to 1.6). Conclusions The clinical course of LBP symptoms followed a pattern that was similar in RCTs and cohort observational studies. In addition to a shared ‘natural history’, enrolment of LBP patients in clinical studies is likely to provoke responses that reflect the nonspecific effects of seeking and receiving care, independent of the study design.
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Affiliation(s)
- Majid Artus
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK.
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Ioannidis JPA, Greenland S, Hlatky MA, Khoury MJ, Macleod MR, Moher D, Schulz KF, Tibshirani R. Increasing value and reducing waste in research design, conduct, and analysis. Lancet 2014; 383:166-75. [PMID: 24411645 PMCID: PMC4697939 DOI: 10.1016/s0140-6736(13)62227-8] [Citation(s) in RCA: 937] [Impact Index Per Article: 93.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Correctable weaknesses in the design, conduct, and analysis of biomedical and public health research studies can produce misleading results and waste valuable resources. Small effects can be difficult to distinguish from bias introduced by study design and analyses. An absence of detailed written protocols and poor documentation of research is common. Information obtained might not be useful or important, and statistical precision or power is often too low or used in a misleading way. Insufficient consideration might be given to both previous and continuing studies. Arbitrary choice of analyses and an overemphasis on random extremes might affect the reported findings. Several problems relate to the research workforce, including failure to involve experienced statisticians and methodologists, failure to train clinical researchers and laboratory scientists in research methods and design, and the involvement of stakeholders with conflicts of interest. Inadequate emphasis is placed on recording of research decisions and on reproducibility of research. Finally, reward systems incentivise quantity more than quality, and novelty more than reliability. We propose potential solutions for these problems, including improvements in protocols and documentation, consideration of evidence from studies in progress, standardisation of research efforts, optimisation and training of an experienced and non-conflicted scientific workforce, and reconsideration of scientific reward systems.
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Affiliation(s)
- John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA; Division of Epidemiology, School of Medicine, Stanford University, Stanford, CA, USA; Department of Statistics, School of Humanities and Sciences, Stanford University, Stanford, CA, USA; Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA.
| | - Sander Greenland
- Department of Epidemiology and Department of Statistics, UCLA School of Public Health, Los Angeles, CA, USA
| | - Mark A Hlatky
- Division of Cardiovascular Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA; Division of Health Services Research, Stanford University, Stanford, CA, USA
| | - Muin J Khoury
- Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemiology and Genomics Research Program, National Cancer Institute, Rockville, MD, USA
| | - Malcolm R Macleod
- Department of Clinical Neurosciences, University of Edinburgh School of Medicine, Edinburgh, UK
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kenneth F Schulz
- FHI 360, Durham, NC, USA; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Robert Tibshirani
- Department of Health Research and Policy, Stanford University, Stanford, CA, USA; Department of Statistics, School of Humanities and Sciences, Stanford University, Stanford, CA, USA
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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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Ben-Shlomo Y, Spears M, Boustred C, May M, Anderson SG, Benjamin EJ, Boutouyrie P, Cameron J, Chen CH, Cruickshank JK, Hwang SJ, Lakatta EG, Laurent S, Maldonado J, Mitchell GF, Najjar SS, Newman AB, Ohishi M, Pannier B, Pereira T, Vasan RS, Shokawa T, Sutton-Tyrell K, Verbeke F, Wang KL, Webb DJ, Willum Hansen T, Zoungas S, McEniery CM, Cockcroft JR, Wilkinson IB. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol 2013; 63:636-646. [PMID: 24239664 DOI: 10.1016/j.jacc.2013.09.063] [Citation(s) in RCA: 1238] [Impact Index Per Article: 112.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/13/2013] [Accepted: 09/22/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The goal of this study was to determine whether aortic pulse wave velocity (aPWV) improves prediction of cardiovascular disease (CVD) events beyond conventional risk factors. BACKGROUND Several studies have shown that aPWV may be a useful risk factor for predicting CVD, but they have been underpowered to examine whether this is true for different subgroups. METHODS We undertook a systematic review and obtained individual participant data from 16 studies. Study-specific associations of aPWV with CVD outcomes were determined using Cox proportional hazard models and random effect models to estimate pooled effects. RESULTS Of 17,635 participants, a total of 1,785 (10%) had a CVD event. The pooled age- and sex-adjusted hazard ratios (HRs) per 1-SD change in loge aPWV were 1.35 (95% confidence interval [CI]: 1.22 to 1.50; p < 0.001) for coronary heart disease, 1.54 (95% CI: 1.34 to 1.78; p < 0.001) for stroke, and 1.45 (95% CI: 1.30 to 1.61; p < 0.001) for CVD. Associations stratified according to sex, diabetes, and hypertension were similar but decreased with age (1.89, 1.77, 1.36, and 1.23 for age ≤50, 51 to 60, 61 to 70, and >70 years, respectively; pinteraction <0.001). After adjusting for conventional risk factors, aPWV remained a predictor of coronary heart disease (HR: 1.23 [95% CI: 1.11 to 1.35]; p < 0.001), stroke (HR: 1.28 [95% CI: 1.16 to 1.42]; p < 0.001), and CVD events (HR: 1.30 [95% CI: 1.18 to 1.43]; p < 0.001). Reclassification indices showed that the addition of aPWV improved risk prediction (13% for 10-year CVD risk for intermediate risk) for some subgroups. CONCLUSIONS Consideration of aPWV improves model fit and reclassifies risk for future CVD events in models that include standard risk factors. aPWV may enable better identification of high-risk populations that might benefit from more aggressive CVD risk factor management.
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Affiliation(s)
- Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
| | - Melissa Spears
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Chris Boustred
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Margaret May
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Simon G Anderson
- Institute of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Emelia J Benjamin
- National Heart Lung and Blood Institute and Boston University's Framingham Heart Study, Cardiology Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Pierre Boutouyrie
- INSERM U 970, Paris-Descartes University, Hopital Europeen Georges Pompidou, Assistance Publique Hopitaux de Paris, Paris, France
| | - James Cameron
- Monash Cardiovascular Research Centre, MonashHEART and Monash University Department of Medicine (MMC), Melbourne, Australia
| | - Chen-Huan Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - J Kennedy Cruickshank
- King's College & King's Health Partners, St. Thomas' & Guy's Hospital, London, United Kingdom
| | - Shih-Jen Hwang
- Branch of Population Sciences, Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Edward G Lakatta
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Stephane Laurent
- INSERM U 970, Paris-Descartes University, Hopital Europeen Georges Pompidou, Assistance Publique Hopitaux de Paris, Paris, France
| | - João Maldonado
- Instituto de Investigação e Formação Cardiovascular, Penacova, Portugal
| | | | - Samer S Najjar
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland; MedStar Heart Research Institute, Washington, DC
| | - Anne B Newman
- Center for Aging and Population Health, Pittsburgh, Pennsylvania
| | - Mitsuru Ohishi
- Department of Geriatric Medicine, Osaka University, Osaka, Japan
| | - Bruno Pannier
- Centre d'Investigations Preventives et Cliniques, Paris, France
| | - Telmo Pereira
- Escola Superior de Tecnologia da Saúde de Coimbra, Coimbra, Portugal
| | - Ramachandran S Vasan
- National Heart Lung and Blood Institute and Boston University's Framingham Heart Study, Department of Medicine, Boston University, Boston, Massachusetts
| | - Tomoki Shokawa
- Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Francis Verbeke
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Kang-Ling Wang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - David J Webb
- University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Tine Willum Hansen
- Research Center for Prevention and Health, Glostrup Hospital, Glostrup and Steno Diabetes Center, Glostrup, Denmark
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Carmel M McEniery
- Clinical Pharmacology Unit, University of Cambridge, Cambridge, United Kingdom
| | | | - Ian B Wilkinson
- Clinical Pharmacology Unit, University of Cambridge, Cambridge, United Kingdom
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Schillaci G, Battista F, Pucci G. Are Observational Studies More Informative Than Randomized Controlled Trials in Hypertension? Hypertension 2013; 62:470-6. [DOI: 10.1161/hypertensionaha.113.01501] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Giuseppe Schillaci
- From the Dipartimento di Medicina, Terni University Hospital, Università di Perugia, Terni, Italy
| | - Francesca Battista
- From the Dipartimento di Medicina, Terni University Hospital, Università di Perugia, Terni, Italy
| | - Giacomo Pucci
- From the Dipartimento di Medicina, Terni University Hospital, Università di Perugia, Terni, Italy
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Doyle TJ, Pinto-Plata V, Morse D, Celli BR, Rosas IO. The expanding role of biomarkers in the assessment of smoking-related parenchymal lung diseases. Chest 2013; 142:1027-1034. [PMID: 23032451 DOI: 10.1378/chest.12-1540] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Recent advances in the field of clinical biomarkers suggest that quantification of serum proteins could play an important role in the diagnosis, classification, prognosis, and treatment response of smoking-related parenchymal lung diseases. COPD and idiopathic pulmonary fibrosis (IPF), two common chronic progressive parenchymal lung diseases, share cigarette smoke exposure as a common dominant risk factor for their development. We have recently shown that COPD and interstitial lung disease may represent distinct outcomes of chronic tobacco use, whereas others have demonstrated that both diseases coexist in some individuals. In this perspective, we examine the potential role of peripheral blood biomarkers in predicting which individuals will develop COPD or IPF, as well as their usefulness in tracking disease progression and exacerbations. Additionally, given the current lack of sensitive and effective metrics to determine an individual's response to treatment, we evaluate the potential role of biomarkers as surrogate markers of clinical outcomes. Finally, we examine the possibility that changes in levels of select protein biomarkers can provide mechanistic insight into the common origins and unique individual susceptibilities that lead to the development of smoking-related parenchymal lung diseases. This discussion is framed by a consideration of the properties of ideal biomarkers for different clinical and research purposes and the best uses for those biomarkers that have already been proposed and investigated.
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Affiliation(s)
- Tracy J Doyle
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston MA
| | - Victor Pinto-Plata
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston MA
| | - Danielle Morse
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston MA
| | - Bartolome R Celli
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston MA
| | - Ivan O Rosas
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston MA; Lovelace Respiratory Research Institute, Albuquerque NM.
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Shun-Shin MJ, Francis DP. Why even more clinical research studies may be false: effect of asymmetrical handling of clinically unexpected values. PLoS One 2013; 8:e65323. [PMID: 23825524 PMCID: PMC3692492 DOI: 10.1371/journal.pone.0065323] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/23/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In medical practice, clinically unexpected measurements might be quite properly handled by the remeasurement, removal, or reclassification of patients. If these habits are not prevented during clinical research, how much of each is needed to sway an entire study? METHODS AND RESULTS Believing there is a difference between groups, a well-intentioned clinician researcher addresses unexpected values. We tested how much removal, remeasurement, or reclassification of patients would be needed in most cases to turn an otherwise-neutral study positive. Remeasurement of 19 patients out of 200 per group was required to make most studies positive. Removal was more powerful: just 9 out of 200 was enough. Reclassification was most powerful, with 5 out of 200 enough. The larger the study, the smaller the proportion of patients needing to be manipulated to make the study positive: the percentages needed to be remeasured, removed, or reclassified fell from 45%, 20%, and 10% respectively for a 20 patient-per-group study, to 4%, 2%, and 1% for an 800 patient-per-group study. Dot-plots, but not bar-charts, make the perhaps-inadvertent manipulations visible. Detection is possible using statistical methods such as the Tadpole test. CONCLUSIONS Behaviours necessary for clinical practice are destructive to clinical research. Even small amounts of selective remeasurement, removal, or reclassification can produce false positive results. Size matters: larger studies are proportionately more vulnerable. If observational studies permit selective unblinded enrolment, malleable classification, or selective remeasurement, then results are not credible. Clinical research is very vulnerable to "remeasurement, removal, and reclassification", the 3 evil R's.
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Affiliation(s)
- Matthew James Shun-Shin
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College, London, United Kingdom.
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Wierzbicki AS, Reynolds TM. Secondary tests for stratification of risk for atherosclerosis. Curr Med Res Opin 2013; 29:597-9. [PMID: 23574149 DOI: 10.1185/03007995.2013.794133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Predicting outcomes in radiation oncology--multifactorial decision support systems. Nat Rev Clin Oncol 2012; 10:27-40. [PMID: 23165123 DOI: 10.1038/nrclinonc.2012.196] [Citation(s) in RCA: 276] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With the emergence of individualized medicine and the increasing amount and complexity of available medical data, a growing need exists for the development of clinical decision-support systems based on prediction models of treatment outcome. In radiation oncology, these models combine both predictive and prognostic data factors from clinical, imaging, molecular and other sources to achieve the highest accuracy to predict tumour response and follow-up event rates. In this Review, we provide an overview of the factors that are correlated with outcome-including survival, recurrence patterns and toxicity-in radiation oncology and discuss the methodology behind the development of prediction models, which is a multistage process. Even after initial development and clinical introduction, a truly useful predictive model will be continuously re-evaluated on different patient datasets from different regions to ensure its population-specific strength. In the future, validated decision-support systems will be fully integrated in the clinic, with data and knowledge being shared in a standardized, instant and global manner.
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Inflammatory cardiovascular risk biomarkers: update on novelties and limitations. Mediators Inflamm 2012; 2012:515692. [PMID: 22701275 PMCID: PMC3373150 DOI: 10.1155/2012/515692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 04/01/2012] [Indexed: 12/15/2022] Open
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Reviews: 2030: The Future of Medicine: Avoiding A Medical Meltdown. Br J Gen Pract 2012. [DOI: 10.3399/bjgp12x641555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Ioannidis JP, Tzoulaki I. Minimal and Null Predictive Effects for the Most Popular Blood Biomarkers of Cardiovascular Disease. Circ Res 2012; 110:658-62. [DOI: 10.1161/res.0b013e31824da8ad] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- John P.A. Ioannidis
- From the Stanford Prevention Research Center, Department of Medicine and Department of Health Research and Policy, Stanford University School of Medicine, and Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA (J.P.A.I.), Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK (I.T.)
| | - Ioanna Tzoulaki
- From the Stanford Prevention Research Center, Department of Medicine and Department of Health Research and Policy, Stanford University School of Medicine, and Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA (J.P.A.I.), Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK (I.T.)
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