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Sharif F, Shahzad L, Batool M. The association between climatic factors and waterborne infectious outbreaks with a focus on vulnerability in Pakistan: integrative review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:3299-3316. [PMID: 38195067 DOI: 10.1080/09603123.2024.2302040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/31/2023] [Indexed: 01/11/2024]
Abstract
Climate change affects the spread of waterborne infectious diseases, yet research on vulnerability to outbreaks remains limited. This integrative review examines how climate variables (temperature and precipitation) relate to human vulnerability factors in Pakistan. By 2060, mean temperatures are projected to rise from 21.68°C (2021) to 30°C, with relatively stable precipitation. The epidemiological investigation in Pakistan identified Diarrhea (119,000 cases/year), Malaria (2.6 million cases/year), and Hepatitis (A and E) as the most prevalent infections. This research highlighted vulnerability factors, including poverty (52% of the population), illiteracy (59% of the population), limited healthcare accessibility (55% of the population), malnutrition (38% of the population), dietary challenges (48% of the population), as well as exposure to water pollution (80% of the population) and air pollution (55% of the population). The findings suggest that the coordinated strategies are vital across health, environmental, meteorological, and social sectors, considering climatic variability patterns and population vulnerability determinants.
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Affiliation(s)
- Faiza Sharif
- Sustainable development study center (SDSC), Government College University, Lahore, Pakistan
| | - Laila Shahzad
- Sustainable development study center (SDSC), Government College University, Lahore, Pakistan
| | - Masooma Batool
- Sustainable development study center (SDSC), Government College University, Lahore, Pakistan
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2
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Ghozy S, Kobeissi H, Amoukhteh M, Kadirvel R, Brinjikji W, Rabinstein AA, Carpenter CR, Kallmes DF. The Utilization of Systematic Reviews and Meta-Analyses in Stroke Guidelines. Brain Sci 2024; 14:728. [PMID: 39061468 PMCID: PMC11274449 DOI: 10.3390/brainsci14070728] [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: 05/18/2024] [Revised: 06/13/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Stroke guideline statements are important references for clinicians due to the rapidly evolving nature of treatments. Guideline statements should be informed by up-to-date systematic reviews (SRs) and meta-analyses (MAs) because they provide the highest level of evidence. To investigate the utilization of SRs/MAs in stroke management guidelines, we conducted a literature review of guidelines and extracted relevant information regarding SRs/MAs. METHODS A literature review was conducted in PubMed with supplementation using the Trip medical database with the term "stroke" as the target population, followed by using the filter "guidelines". We extracted the number of included SRs/MAs, the years of publication, the country of origin, and other characteristics of interest. Descriptive statistics were generated using the R software version 4.2.1. RESULTS We included 27 guideline statements. The median number of overall SRs or MAs within the guidelines was 4.0 (interquartile range [IQR] = 2-9). For MAs only, the median number included in the guidelines was 3.0 (IQR = 2.0-5.5). Canadian guidelines had the oldest citations, with a median gap of 12.0 (IQR = 5.2-18.0) years for the oldest citation, followed by European (median = 12; IQR = 9.5-13.5) and US (median = 10.0; IQR = 5.2-16) guidelines. CONCLUSIONS Stroke guideline writing groups and issuing bodies should devote greater effort to the inclusion of up-to-date SRs/MAs in their guideline statements so that clinicians can reference recent data with the highest level of evidence.
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Affiliation(s)
- Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; (H.K.); (M.A.); (R.K.); (W.B.); (D.F.K.)
| | - Hassan Kobeissi
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; (H.K.); (M.A.); (R.K.); (W.B.); (D.F.K.)
| | - Melika Amoukhteh
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; (H.K.); (M.A.); (R.K.); (W.B.); (D.F.K.)
| | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; (H.K.); (M.A.); (R.K.); (W.B.); (D.F.K.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; (H.K.); (M.A.); (R.K.); (W.B.); (D.F.K.)
| | | | | | - David F. Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; (H.K.); (M.A.); (R.K.); (W.B.); (D.F.K.)
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3
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Grygorieva N, Tronko M, Kovalenko V, Komisarenko S, Tatarchuk T, Dedukh N, Veliky M, Strafun S, Komisarenko Y, Kalashnikov A, Orlenko V, Pankiv V, Shvets O, Gogunska I, Regeda S. Ukrainian Consensus on Diagnosis and Management of Vitamin D Deficiency in Adults. Nutrients 2024; 16:270. [PMID: 38257163 PMCID: PMC10820145 DOI: 10.3390/nu16020270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Vitamin D deficiency (VDD) is a global problem, however, there were no Ukrainian guidelines devoted to its screening, prevention, and treatment, which became the reason for the Consensus creation. This article aimed to present the Consensus of Ukrainian experts devoted to VDD management. Following the creation of the multidisciplinary Consensus group, consent on the formation process, drafting and fine-tuning of key recommendations, and two rounds of voting, 14 final recommendations were successfully voted upon. Despite a recent decrease in VDD prevalence in Ukraine, we recommend raising awareness regarding VDD's importance and improving the strategies for its decline. We recommend screening the serum 25-hydroxyvitamin D (25(OH)D) level in risk groups while maintaining a target concentration of 75-125 nmol/L (30-50 ng/mL). We recommend prophylactic cholecalciferol supplementation (800-2000 IU/d for youthful healthy subjects, and 3000-5000 IU/d for subjects from the risk groups). For a VDD treatment, we recommend a short-term administration of increased doses of cholecalciferol (4000-10,000 IU/d) with 25(OH)D levels monitored after 4-12 weeks of treatment, followed by the use of maintenance doses. Additionally, we recommend assessing serum 25(OH)D levels before antiosteoporotic treatment and providing vitamin D and calcium supplementation throughout the full course of the antiosteoporotic therapy.
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Affiliation(s)
- Nataliia Grygorieva
- D.F. Chebotarev Institute of Gerontology, The National Academy of Medical Sciences of Ukraine, 04114 Kyiv, Ukraine
| | - Mykola Tronko
- V.P. Komisarenko Institute of Endocrinology and Metabolism, The National Academy of Medical Sciences of Ukraine, 04114 Kyiv, Ukraine
| | - Volodymir Kovalenko
- National Scientific Center «The M.D. Strazhesko Institute of Cardiology», Clinical and Regenerative Medicine, The National Academy of Medical Sciences of Ukraine, 03151 Kyiv, Ukraine
| | - Serhiy Komisarenko
- Palladin Institute of Biochemistry, The National Academy of Sciences of Ukraine, 02000 Kyiv, Ukraine
| | - Tetiana Tatarchuk
- Institute of Pediatrics, Obstetrics and Gynecology Named after Academician O.M. Lukyanova, The National Academy of Medical Sciences of Ukraine, 04050 Kyiv, Ukraine
| | - Ninel Dedukh
- D.F. Chebotarev Institute of Gerontology, The National Academy of Medical Sciences of Ukraine, 04114 Kyiv, Ukraine
| | - Mykola Veliky
- Palladin Institute of Biochemistry, The National Academy of Sciences of Ukraine, 02000 Kyiv, Ukraine
| | - Serhiy Strafun
- Institute of Traumatology and Orthopedics, The National Academy of Medical Sciences of Ukraine, 01601 Kyiv, Ukraine
| | - Yulia Komisarenko
- Department of Endocrinology, O.O. Bogomolets National Medical University, 01601 Kyiv, Ukraine
| | - Andrii Kalashnikov
- Institute of Traumatology and Orthopedics, The National Academy of Medical Sciences of Ukraine, 01601 Kyiv, Ukraine
| | - Valeria Orlenko
- V.P. Komisarenko Institute of Endocrinology and Metabolism, The National Academy of Medical Sciences of Ukraine, 04114 Kyiv, Ukraine
| | - Volodymyr Pankiv
- Ukrainian Scientific and Practical Centre for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues, Health Ministry of Ukraine, 01021 Kyiv, Ukraine
| | - Oleg Shvets
- Department of Public Health and Nutrition, National University of Life and Environmental Sciences of Ukraine, 03041 Kyiv, Ukraine
| | - Inna Gogunska
- O.S. Kolomiychenko Institute of Otolaryngology, The National Academy of Medical Sciences of Ukraine, 03057 Kyiv, Ukraine
| | - Svitlana Regeda
- Center of Innovative Medical Technologies, The National Academy of Sciences of Ukraine, 04053 Kyiv, Ukraine
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4
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Zhao FY, Xu P, Zheng Z, Conduit R, Xu Y, Yue LP, Wang HR, Wang YM, Li YX, Li CY, Zhang WJ, Fu QQ, Kennedy GA. Managing depression with complementary and alternative medicine therapies: a scientometric analysis and visualization of research activities. Front Psychiatry 2023; 14:1288346. [PMID: 38034915 PMCID: PMC10684695 DOI: 10.3389/fpsyt.2023.1288346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
Background Complementary and Alternative Medicine (CAM) interventions may prove to be an attractive option for the treatment of depression. The aim of this scientometric analysis is to determine the global scientific output of research regarding managing depression with CAM and identify the hotspots and frontiers within this theme. Methods Publications regarding the utilization of CAM for treating depression were collected from the Web of Science Core Collection from 1993 to 2022, and analyzed and visualized by Bibliometrix R-package, VOSviewer, and CiteSpace. Results A total of 1,710 publications were acquired. The number of annual publications showed an overall rapid upward trend, with the figure peaking at 179 in 2021. The USA was the leading research center. Totally 2,323 distinct institutions involving 7,638 scholars contributed to the research theme. However, most of the cooperation was limited to within the same country, institution or research team. The Journal of Alternative and Complementary Medicine was the most productive periodical. The CAM therapies of most interest to researchers were acupuncture and body-mind techniques, such as yoga, meditation and mindfulness. Systematic review and meta-analysis are commonly used methods. "Inflammation," "rating scale" and "psychological stress" were identified as the most studied trend topics recently. Conclusion Managing depression with evidence-based CAM treatment is gaining attention globally. Body-mind techniques and acupuncture are growing research hotspots or emerging trending topics. Future studies are predicted to potentially investigate the possible mechanisms of action underlying CAM treatments in reducing depression in terms of modulation of psychological stress and inflammation levels. Cross-countries/institutes/team research collaborations should be encouraged and further enhanced.
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Affiliation(s)
- Fei-Yi Zhao
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Peijie Xu
- School of Computing Technologies, RMIT University, Melbourne, VIC, Australia
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Yan Xu
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China
| | - Li-Ping Yue
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China
| | - Hui-Ru Wang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan-Mei Wang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuan-Xin Li
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chun-Yan Li
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen-Jing Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qiang-Qiang Fu
- Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Gerard A. Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Institute of Health and Wellbeing, Federation University, Mount Helen, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
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Scholten W, Seldenrijk A, Hoogendoorn A, Bosman R, Muntingh A, Karyotaki E, Andersson G, Berger T, Carlbring P, Furmark T, Bouchard S, Goldin P, Kampmann I, Morina N, Kocovski N, Leibing E, Leichsenring F, Stolz T, van Balkom A, Batelaan N. Baseline Severity as a Moderator of the Waiting List-Controlled Association of Cognitive Behavioral Therapy With Symptom Change in Social Anxiety Disorder: A Systematic Review and Individual Patient Data Meta-analysis. JAMA Psychiatry 2023; 80:822-831. [PMID: 37256597 PMCID: PMC10233456 DOI: 10.1001/jamapsychiatry.2023.1291] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/16/2023] [Indexed: 06/01/2023]
Abstract
Importance Social anxiety disorder (SAD) can be adequately treated with cognitive behavioral therapy (CBT). However, there is a large gap in knowledge on factors associated with prognosis, and it is unclear whether symptom severity predicts response to CBT for SAD. Objective To examine baseline SAD symptom severity as a moderator of the association between CBT and symptom change in patients with SAD. Data Sources For this systematic review and individual patient data meta-analysis (IPDMA), PubMed, PsycInfo, Embase, and the Cochrane Library were searched from January 1, 1990, to January 13, 2023. Primary search topics were social anxiety disorder, cognitive behavior therapy, and randomized controlled trial. Study Selection Inclusion criteria were randomized clinical trials comparing CBT with being on a waiting list and using the Liebowitz Social Anxiety Scale (LSAS) in adults with a primary clinical diagnosis of SAD. Data Extraction and Synthesis Authors of included studies were approached to provide individual-level data. Data were extracted by pairs of authors following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline, and risk of bias was assessed using the Cochrane tool. An IPDMA was conducted using a 2-stage approach for the association of CBT with change in LSAS scores from baseline to posttreatment and for the interaction effect of baseline LSAS score by condition using random-effects models. Main Outcomes and Measures The main outcome was the baseline to posttreatment change in symptom severity measured by the LSAS. Results A total of 12 studies including 1246 patients with SAD (mean [SD] age, 35.3 [10.9] years; 738 [59.2%] female) were included in the meta-analysis. A waiting list-controlled association between CBT and pretreatment to posttreatment LSAS change was found (b = -20.3; 95% CI, -24.9 to -15.6; P < .001; Cohen d = -0.95; 95% CI, -1.16 to -0.73). Baseline LSAS scores moderated the differences between CBT and waiting list with respect to pretreatment to posttreatment symptom reductions (b = -0.22; 95% CI, -0.39 to -0.06; P = .009), indicating that individuals with severe symptoms had larger waiting list-controlled symptom reductions after CBT (Cohen d = -1.13 [95% CI, -1.39 to -0.88] for patients with very severe SAD; Cohen d = -0.54 [95% CI, -0.80 to -0.29] for patients with mild SAD). Conclusions and Relevance In this systematic review and IPDMA, higher baseline SAD symptom severity was associated with greater (absolute but not relative) symptom reductions after CBT in patients with SAD. The findings contribute to personalized care by suggesting that clinicians can confidently offer CBT to individuals with severe SAD symptoms.
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Affiliation(s)
- Willemijn Scholten
- GGZ inGeest, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Adrie Seldenrijk
- GGZ inGeest, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Adriaan Hoogendoorn
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Renske Bosman
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Anna Muntingh
- GGZ inGeest, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Eirini Karyotaki
- Faculty of Behavioural and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, VU Amsterdam, Amsterdam, the Netherlands
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Tomas Furmark
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Stéphane Bouchard
- Departement de Psychoéducation et Psychologie, Université du Québec en Outaouais, Gatineau, Quebec, Canada
- Centre de Recherche, Centre Intégré de Santé et des Services Sociaux de l’Outaouais, Gatineau, Quebec, Canada
| | - Philippe Goldin
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento
| | - Isabel Kampmann
- Institute of Psychology, University of Münster, Münster, Germany
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
| | - Nancy Kocovski
- Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Eric Leibing
- Clinic of Psychosomatic Medicine and Psychotherapy, University Medicine Goettingen, Georg-August-Universität Goettingen, Goettingen, Germany
| | - Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Timo Stolz
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Anton van Balkom
- GGZ inGeest, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Neeltje Batelaan
- GGZ inGeest, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
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Liu M, Gao Y, Yang K, Cai Y, Xu J, Dai D, Wu S, Zhang J, Tian J. Reporting quality and risk of bias of Cochrane individual participant data meta-analyses: A cross-sectional study. J Evid Based Med 2023. [PMID: 37020358 DOI: 10.1111/jebm.12521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 02/28/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVES This study aimed to assess the reporting quality and risk of bias of Cochrane individual participant data meta-analyses (IPD-MAs). METHODS We searched the Cochrane Library and identified the Cochrane IPD-MAs. We used the Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data (PRISMA-IPD) assessed the reporting quality of included Cochrane IPD- MAs, and the Risk Of Bias In Systematic reviews (ROBIS) tool was used to assess the risk of bias. We performed stratified and correlation analyses to explore factors affecting the quality. RESULTS Forty-six Cochrane IPD-MAs were included in our study. Twenty-six Cochrane IPD-MAs (56.5%) had statistical or epidemiological authors involved, and 31 (67.4%) contained only IPD data. Thirty-five studies (76.1%) did not report whether they used 1-stage or 2-stage methods, and forty (87.0%) did not report the statistical techniques used for missing participant data. We found that the entire compliance reported PRISMA-IPD items of Cochrane IPD-MAs published after 2015 (n = 18; Mean ± SD: 26.61 ± 2.75) was higher than those studies published in 2015 and before (n = 28; Mean ± SD: 22.61 ± 4.73), the difference was statistically significant (p = 0.002). A strong positive correlation was found between the fully reported PRISMA-IPD items and fully accordance ROBIS items (Spearman's: ρ = 0.653, p < 0.001). CONCLUSIONS The quality of Cochrane IPD-MAs is not high, especially in the reporting of statistical methods. There was room for further improvement in IPD retrieval, IPD integrity and statistical analyses.
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Affiliation(s)
- Ming Liu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kelu Yang
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven-University of Leuven, Leuven, Belgium
| | - Yitong Cai
- Nursing Psychology Research Center, Xiangya School of Nursing, Central South University, Changsha, China
| | - Jianguo Xu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Dingmei Dai
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Shuilin Wu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Junhua Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
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7
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Stevelink R, Al-Toma D, Jansen FE, Lamberink HJ, Asadi-Pooya AA, Farazdaghi M, Cação G, Jayalakshmi S, Patil A, Özkara Ç, Aydın Ş, Gesche J, Beier CP, Stephen LJ, Brodie MJ, Unnithan G, Radhakrishnan A, Höfler J, Trinka E, Krause R, Irelli EC, Di Bonaventura C, Szaflarski JP, Hernández-Vanegas LE, Moya-Alfaro ML, Zhang Y, Zhou D, Pietrafusa N, Specchio N, Japaridze G, Beniczky S, Janmohamed M, Kwan P, Syvertsen M, Selmer KK, Vorderwülbecke BJ, Holtkamp M, Viswanathan LG, Sinha S, Baykan B, Altindag E, von Podewils F, Schulz J, Seneviratne U, Viloria-Alebesque A, Karakis I, D'Souza WJ, Sander JW, Koeleman BP, Otte WM, Braun KP. Individualised prediction of drug resistance and seizure recurrence after medication withdrawal in people with juvenile myoclonic epilepsy: A systematic review and individual participant data meta-analysis. EClinicalMedicine 2022; 53:101732. [PMID: 36467455 PMCID: PMC9716332 DOI: 10.1016/j.eclinm.2022.101732] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background A third of people with juvenile myoclonic epilepsy (JME) are drug-resistant. Three-quarters have a seizure relapse when attempting to withdraw anti-seizure medication (ASM) after achieving seizure-freedom. It is currently impossible to predict who is likely to become drug-resistant and safely withdraw treatment. We aimed to identify predictors of drug resistance and seizure recurrence to allow for individualised prediction of treatment outcomes in people with JME. Methods We performed an individual participant data (IPD) meta-analysis based on a systematic search in EMBASE and PubMed - last updated on March 11, 2021 - including prospective and retrospective observational studies reporting on treatment outcomes of people diagnosed with JME and available seizure outcome data after a minimum one-year follow-up. We invited authors to share standardised IPD to identify predictors of drug resistance using multivariable logistic regression. We excluded pseudo-resistant individuals. A subset who attempted to withdraw ASM was included in a multivariable proportional hazards analysis on seizure recurrence after ASM withdrawal. The study was registered at the Open Science Framework (OSF; https://osf.io/b9zjc/). Findings Our search yielded 1641 articles; 53 were eligible, of which the authors of 24 studies agreed to collaborate by sharing IPD. Using data from 2518 people with JME, we found nine independent predictors of drug resistance: three seizure types, psychiatric comorbidities, catamenial epilepsy, epileptiform focality, ethnicity, history of CAE, family history of epilepsy, status epilepticus, and febrile seizures. Internal-external cross-validation of our multivariable model showed an area under the receiver operating characteristic curve of 0·70 (95%CI 0·68-0·72). Recurrence of seizures after ASM withdrawal (n = 368) was predicted by an earlier age at the start of withdrawal, shorter seizure-free interval and more currently used ASMs, resulting in an average internal-external cross-validation concordance-statistic of 0·70 (95%CI 0·68-0·73). Interpretation We were able to predict and validate clinically relevant personalised treatment outcomes for people with JME. Individualised predictions are accessible as nomograms and web-based tools. Funding MING fonds.
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Affiliation(s)
- Remi Stevelink
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Dania Al-Toma
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Floor E. Jansen
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Herm J. Lamberink
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Ali A. Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Zand, Shiraz, Iran
- Department of Neurology, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA, 19107, USA
| | - Mohsen Farazdaghi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Zand, Shiraz, Iran
| | - Gonçalo Cação
- Department of Neurology, Unidade Local de Saude do Alto Minho, Estrada de Santa Luzia, Viana do Castelo, 4904-858, Portugal
| | - Sita Jayalakshmi
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad, 500003, India
| | - Anuja Patil
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad, 500003, India
| | - Çiğdem Özkara
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Kocamustafapaşa caddesi, Istanbul, 34098, Turkey
| | - Şenay Aydın
- Department of Neurology, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, University of Health Sciences, Belgrat Kapı yolu, Istanbul, 34020, Turkey
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, J.B. Winsløws Vej 4, Odense, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 4, Odense, 5000, Denmark
| | - Christoph P. Beier
- Department of Neurology, Odense University Hospital, J.B. Winsløws Vej 4, Odense, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 4, Odense, 5000, Denmark
| | - Linda J. Stephen
- Epilepsy Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - Martin J. Brodie
- Epilepsy Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - Gopeekrishnan Unnithan
- Department of Neurology, R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Chalakkuzhi, Medical College Road, Trivandrum, 695011, India
| | - Ashalatha Radhakrishnan
- Department of Neurology, R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Chalakkuzhi, Medical College Road, Trivandrum, 695011, India
| | - Julia Höfler
- Department of Neurology and Neuroscience Institute, Christian Doppler Medical Centre, Paracelsus Medical University and Centre for Cognitive Neuroscience, European Reference Network EpiCARE, Ignaz-Harrer Straße 79, Salzburg, 5020, Austria
| | - Eugen Trinka
- Department of Neurology and Neuroscience Institute, Christian Doppler Medical Centre, Paracelsus Medical University and Centre for Cognitive Neuroscience, European Reference Network EpiCARE, Ignaz-Harrer Straße 79, Salzburg, 5020, Austria
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Hellbrunner Straße 34, Salzburg, 3100, Austria
- Department of Public Health, University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnöfer-Zentrum 1, Hall in Tirol, 6060, Austria
| | - Roland Krause
- Bioinformatics Core Facility, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, 6 Ave du Swing, Belvaux, 4367, Luxembourg
| | | | - Emanuele Cerulli Irelli
- Department of Human Neurosciences, Epilepsy Unit, Sapienza, University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Epilepsy Unit, Sapienza, University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Jerzy P. Szaflarski
- Departments of Neurology, Neurosurgery, and Neurobiology, UAB Epilepsy Center, University of Alabama at Birmingham Heersink School of Medicine, 1670 University Blvd, Birmingham, AL, 35294, USA
| | - Laura E. Hernández-Vanegas
- Department of Clinical Research, Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, Mexico, 14269, Mexico
| | - Monica L. Moya-Alfaro
- Department of Clinical Research, Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, Mexico, 14269, Mexico
| | - Yingying Zhang
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
| | - Nicola Pietrafusa
- Department of Neuroscience, Division of Neurology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome, 00165, Italy
| | - Nicola Specchio
- Department of Neuroscience, Division of Neurology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome, 00165, Italy
| | - Giorgi Japaridze
- Department of Clinical Neurophysiology, Institute of Neurology and Neuropsychology, 83/11 Vazha-Pshavela Ave., Tbilisi, 186, Georgia
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Filadelfia, Visby Allé 5, Dianalund, 4293, Denmark
- Department of Clinical Neurophysiology, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Blvd. 99, Aarhus, 8200, Denmark
| | - Mubeen Janmohamed
- Department of Neurosciences, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Patrick Kwan
- Department of Neurosciences, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
- Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, Victoria, Australia
| | - Marte Syvertsen
- Department of Neurology, Vestre Viken Hospital Trust, Dronninggata 28, Drammen, 3004, Norway
| | - Kaja K. Selmer
- National Centre for Epilepsy & Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, G. F. Henriksens vei 29, Sandvika, 1337, Norway
| | - Bernd J. Vorderwülbecke
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Martin Holtkamp
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | | | - Sanjib Sinha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, 560029, India
| | - Betül Baykan
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, Istanbul, 34390, Turkey
| | - Ebru Altindag
- Department of Neurology, Istanbul Florence Nightingale Hospital, Abide-i Hürriyet Cad, Istanbul, 34381, Turkey
| | - Felix von Podewils
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Sauerbruchstraße, Greifswald, 17489, Germany
| | - Juliane Schulz
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Sauerbruchstraße, Greifswald, 17489, Germany
| | - Udaya Seneviratne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 55 Victoria Parade, Melbourne, Victoria, 3065, Australia
- Department of Medicine, The School of Clinical Sciences at Monash Health, Monash University, Clayton Road, Melbourne, Victoria, 3168, Australia
| | - Alejandro Viloria-Alebesque
- Department of Neurology, Hospital General de la Defensa, Vía Ibérica 1, Zaragoza, 50009, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Avda. San Juan Bosco 13, Zaragoza, 50009, Spain
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE, Office 335, Atlanta, GA, 30303, USA
| | - Wendyl J. D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 55 Victoria Parade, Melbourne, Victoria, 3065, Australia
| | - Josemir W. Sander
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
- Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 7, Heemstede, Netherlands
- UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Bobby P.C. Koeleman
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Willem M. Otte
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Kees P.J. Braun
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
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Fundaun J, Thomas ET, Schmid AB, Baskozos G. The power of integrating data: advancing pain research using meta-analysis. Pain Rep 2022; 7:e1038. [PMID: 36213594 PMCID: PMC9534369 DOI: 10.1097/pr9.0000000000001038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/21/2022] [Accepted: 07/30/2022] [Indexed: 12/03/2022] Open
Abstract
Publications related to pain research have increased significantly in recent years. The abundance of new evidence creates challenges staying up to date with the latest information. A comprehensive understanding of the literature is important for both clinicians and investigators involved in pain research. One commonly used method to combine and analyse data in health care research is meta-analysis. The primary aim of a meta-analysis is to quantitatively synthesise the results of multiple studies focused on the same research question. Meta-analysis is a powerful tool that can be used to advance pain research. However, there are inherent challenges when combining data from multiple sources. There are also numerous models and statistical considerations when undertaking a meta-analysis. This review aims to discuss the planning and preparation for completing a meta-analysis, review commonly used meta-analysis models, and evaluate the clinical implications of meta-analysis in pain research.
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Affiliation(s)
- Joel Fundaun
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Elizabeth T. Thomas
- Nuffield Department of Primary Care Health Sciences, Centre for Evidence-Based Medicine, University of Oxford, Oxford, United Kingdom
| | - Annina B. Schmid
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Georgios Baskozos
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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9
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Hunter KE, Webster AC, Clarke M, Page MJ, Libesman S, Godolphin PJ, Aberoumand M, Rydzewska LHM, Wang R, Tan AC, Li W, Mol BW, Willson M, Brown V, Palacios T, Seidler AL. Development of a checklist of standard items for processing individual participant data from randomised trials for meta-analyses: Protocol for a modified e-Delphi study. PLoS One 2022; 17:e0275893. [PMID: 36219622 PMCID: PMC9553056 DOI: 10.1371/journal.pone.0275893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022] Open
Abstract
Individual participant data meta-analyses enable detailed checking of data quality and more complex analyses than standard study-level synthesis of summary data based on publications. However, there is limited existing guidance on the specific systematic checks that should be undertaken to confirm and enhance data quality for individual participant data meta-analyses and how to conduct these checks. We aim to address this gap by developing a checklist of items for data quality checking and cleaning to be applied to individual participant data meta-analyses of randomised trials. This study will comprise three phases: 1) a scoping review to identify potential checklist items; 2) two e-Delphi survey rounds among an invited panel of experts followed by a consensus meeting; and 3) pilot testing and refinement of the checklist, including development of an accompanying R-markdown program to facilitate its uptake.
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Affiliation(s)
- Kylie E. Hunter
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
- * E-mail:
| | - Angela C. Webster
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Mike Clarke
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Matthew J. Page
- Methods in Evidence Synthesis Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sol Libesman
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Peter J. Godolphin
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Mason Aberoumand
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Aidan C. Tan
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Wentao Li
- Department of Obstetrics and Gynaecology, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Ben W. Mol
- Department of Obstetrics and Gynaecology, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Melina Willson
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Talia Palacios
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Anna Lene Seidler
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
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10
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Chen C, Liu J, Liu B, Cao X, Liu Z, Zhao T, Lv X, Guo S, Li Y, He L, Ai Y. Efficacy of acupuncture in subpopulations with functional constipation: A protocol for a systematic review and individual patient data meta-analysis. PLoS One 2022; 17:e0266075. [PMID: 35413064 PMCID: PMC9004736 DOI: 10.1371/journal.pone.0266075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Several systematic reviews have suggested that acupuncture is effective against functional constipation, but it is unknown whether variations in treatment effect across subgroups remain consistent. Our purpose of this study is to explore the heterogeneity of treatment effect of acupuncture on functional constipation across subgroups.
Methods
We will search eleven English and Chinese electronic databases and three clinical trial registries from inception to December 2021. Randomized controlled trials that evaluate acupuncture compared with sham acupuncture or no treatment for functional constipation will be eligible if they report at least one primary outcome. The primary outcomes will include the change in weekly complete spontaneous bowel movements or spontaneous bowel movements from baseline. Two authors will independently identify the relevant studies, assess the risk of bias using the Cochrane RoB 2 tool and contact the primary researchers of the eligible trials for individual patient data. Individual patient data obtained from the original trial author will be standardized and all trial data will be combined into a single database. Generalized linear mixed effects model will be used to determine possible subgroup effects by adding an interaction term for predefined subgroup and treatment.
Systematic review registration
International Prospective Register of Systematic Reviews (Number: CRD42020188366).
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Affiliation(s)
- Chao Chen
- Institute of Basic Research for Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
- China Astronaut Research and Training Center, Beijing, China
| | - Jia Liu
- Institute of Basic Research for Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Baoyan Liu
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Xue Cao
- Institute of Basic Research for Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhishun Liu
- Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tianyi Zhao
- Institute of Basic Research for Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaoying Lv
- Institute of Basic Research for Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shengnan Guo
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yang Li
- Beijing Fengtai Youanmen Hospital, Beijing, China
| | - Liyun He
- Institute of Basic Research for Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
- * E-mail: (YA); (LH)
| | - Yanke Ai
- Institute of Basic Research for Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
- * E-mail: (YA); (LH)
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11
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Hernaez R, Thimme R. End of the story: direct-acting antiviral agents are not associated with recurrence of hepatocellular carcinoma. Gut 2022; 71:454-456. [PMID: 33785552 DOI: 10.1136/gutjnl-2021-324288] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/11/2021] [Accepted: 03/18/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Ruben Hernaez
- Gastroenterology and Hepatology, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA .,Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Robert Thimme
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center, University of Freiburg, Freiburg, Germany
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12
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Cashman KD, Kiely ME, Andersen R, Grønborg IM, Tetens I, Tripkovic L, Lanham-New SA, Lamberg-Allardt C, Adebayo FA, Gallagher JC, Smith LM, Sacheck JM, Huang Q, Ng K, Yuan C, Giovannucci EL, Rajakumar K, Patterson CG, Öhlund I, Lind T, Åkeson PK, Ritz C. Individual participant data (IPD)-level meta-analysis of randomised controlled trials to estimate the vitamin D dietary requirements in dark-skinned individuals resident at high latitude. Eur J Nutr 2022; 61:1015-1034. [PMID: 34705075 PMCID: PMC8857035 DOI: 10.1007/s00394-021-02699-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/01/2021] [Indexed: 02/07/2023]
Abstract
CONTEXT AND PURPOSE There is an urgent need to develop vitamin D dietary recommendations for dark-skinned populations resident at high latitude. Using data from randomised controlled trials (RCTs) with vitamin D3-supplements/fortified foods, we undertook an individual participant data-level meta-regression (IPD) analysis of the response of wintertime serum 25-hydroxyvitamin (25(OH)D) to total vitamin D intake among dark-skinned children and adults residing at ≥ 40° N and derived dietary requirement values for vitamin D. METHODS IPD analysis using data from 677 dark-skinned participants (of Black or South Asian descent; ages 5-86 years) in 10 RCTs with vitamin D supplements/fortified foods identified via a systematic review and predefined eligibility criteria. Outcome measures were vitamin D intake estimates across a range of 25(OH)D thresholds. RESULTS To maintain serum 25(OH)D concentrations ≥ 25 and 30 nmol/L in 97.5% of individuals, 23.9 and 27.3 µg/day of vitamin D, respectively, were required among South Asian and 24.1 and 33.2 µg/day, respectively, among Black participants. Overall, our age-stratified intake estimates did not exceed age-specific Tolerable Upper Intake Levels for vitamin D. The vitamin D intake required by dark-skinned individuals to maintain 97.5% of winter 25(OH)D concentrations ≥ 50 nmol/L was 66.8 µg/day. This intake predicted that the upper 2.5% of individuals could potentially achieve serum 25(OH)D concentrations ≥ 158 nmol/L, which has been linked to potential adverse effects in older adults in supplementation studies. CONCLUSIONS Our IPD-derived vitamin D intakes required to maintain 97.5% of winter 25(OH)D concentrations ≥ 25, 30 and 50 nmol/L are substantially higher than the equivalent estimates for White individuals. These requirement estimates are also higher than those currently recommended internationally by several agencies, which are based predominantly on data from Whites and derived from standard meta-regression based on aggregate data. Much more work is needed in dark-skinned populations both in the dose-response relationship and risk characterisation for health outcomes. TRAIL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews (Registration Number: CRD42018097260).
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Affiliation(s)
- Kevin D Cashman
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland.
| | - Mairead E Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Rikke Andersen
- Research Group for Risk-Benefit, Division for Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Ida M Grønborg
- Research Group for Risk-Benefit, Division for Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Inge Tetens
- Research Group for Risk-Benefit, Division for Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg C, Denmark
| | - Laura Tripkovic
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Susan A Lanham-New
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Christel Lamberg-Allardt
- Calcium Research Unit, Department of Food and Nutrition, University of Helsinki, PO Box 66, 00014, Helsinki, Finland
| | - Folasade A Adebayo
- Calcium Research Unit, Department of Food and Nutrition, University of Helsinki, PO Box 66, 00014, Helsinki, Finland
| | | | - Lynette M Smith
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jennifer M Sacheck
- Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA
| | - Qiushi Huang
- Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA
| | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Chen Yuan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Edward L Giovannucci
- The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kumaravel Rajakumar
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Charity G Patterson
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, 15219, USA
| | - Inger Öhlund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Torbjörn Lind
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Pia Karlsland Åkeson
- Department of Clinical Sciences, Pediatrics, Lund University, Malmö/Lund, Sweden
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg C, Denmark
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13
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Dewidar O, Riddle A, Ghogomu E, Hossain A, Arora P, Bhutta ZA, Black RE, Cousens S, Gaffey MF, Mathew C, Trawin J, Tugwell P, Welch V, Wells GA. PRIME-IPD SERIES Part 1. The PRIME-IPD tool promoted verification and standardization of study datasets retrieved for IPD meta-analysis. J Clin Epidemiol 2021; 136:227-234. [PMID: 34044099 PMCID: PMC8442853 DOI: 10.1016/j.jclinepi.2021.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/19/2021] [Accepted: 05/05/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We describe a systematic approach to preparing data in the conduct of Individual Participant Data (IPD) analysis. STUDY DESIGN AND SETTING A guidance paper proposing methods for preparing individual participant data for meta-analysis from multiple study sources, developed by consultation of relevant guidance and experts in IPD. We present an example of how these steps were applied in checking data for our own IPD meta analysis (IPD-MA). RESULTS We propose five steps of Processing, Replication, Imputation, Merging, and Evaluation to prepare individual participant data for meta-analysis (PRIME-IPD). Using our own IPD-MA as an exemplar, we found that this approach identified missing variables and potential inconsistencies in the data, facilitated the standardization of indicators across studies, confirmed that the correct data were received from investigators, and resulted in a single, verified dataset for IPD-MA. CONCLUSION The PRIME-IPD approach can assist researchers to systematically prepare, manage and conduct important quality checks on IPD from multiple studies for meta-analyses. Further testing of this framework in IPD-MA would be useful to refine these steps.
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Affiliation(s)
- Omar Dewidar
- Bruyère Research Institute, University of Ottawa, 85 Primrose Ave, Ottawa, Ontario, K1R 6M1, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Alison Riddle
- Bruyère Research Institute, University of Ottawa, 85 Primrose Ave, Ottawa, Ontario, K1R 6M1, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Elizabeth Ghogomu
- Bruyère Research Institute, University of Ottawa, 85 Primrose Ave, Ottawa, Ontario, K1R 6M1, Canada
| | - Alomgir Hossain
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada; Department of Medicine (Cardiology), The University of Ottawa Heart Institute and University of Ottawa, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Paul Arora
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, Ontario M5T 3M7, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada; Institute for Global Health & Development, Aga Khan University, South-Central Asia, East Africa & United Kingdom, Karachi, Pakistan
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St Suite E8545, Baltimore, MD, 21205, USA
| | - Simon Cousens
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - Michelle F Gaffey
- Centre for Global Child Health, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada
| | - Christine Mathew
- Bruyère Research Institute, University of Ottawa, 85 Primrose Ave, Ottawa, Ontario, K1R 6M1, Canada
| | - Jessica Trawin
- Bruyère Research Institute, University of Ottawa, 85 Primrose Ave, Ottawa, Ontario, K1R 6M1, Canada
| | - Peter Tugwell
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, Ontario K1H 8L6, Canada; Department of Medicine, University of Ottawa Faculty of Medicine, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, Ontario, K1H 8M5, Canada; WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, 85 Primrose Ave, Ottawa, Ontario, K1R 6M1, Canada; Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, Ontario, K1Y 4W7, Canada
| | - Vivian Welch
- Bruyère Research Institute, University of Ottawa, 85 Primrose Ave, Ottawa, Ontario, K1R 6M1, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada; WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, 85 Primrose Ave, Ottawa, Ontario, K1R 6M1, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada; WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, 85 Primrose Ave, Ottawa, Ontario, K1R 6M1, Canada; Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, Ontario, K1Y 4W7, Canada
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14
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Wang H, Chen Y, Lin Y, Abesig J, Wu IX, Tam W. The methodological quality of individual participant data meta-analysis on intervention effects: systematic review. BMJ 2021; 373:n736. [PMID: 33875446 PMCID: PMC8054226 DOI: 10.1136/bmj.n736] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the methodological quality of individual participant data (IPD) meta-analysis and to identify areas for improvement. DESIGN Systematic review. DATA SOURCES Medline, Embase, and Cochrane Database of Systematic Reviews. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Systematic reviews with IPD meta-analyses of randomised controlled trials on intervention effects published in English. RESULTS 323 IPD meta-analyses covering 21 clinical areas and published between 1991 and 2019 were included: 270 (84%) were non-Cochrane reviews and 269 (84%) were published in journals with a high impact factor (top quarter). The IPD meta-analyses showed low compliance in using a satisfactory technique to assess the risk of bias of the included randomised controlled trials (43%, 95% confidence interval 38% to 48%), accounting for risk of bias when interpreting results (40%, 34% to 45%), providing a list of excluded studies with justifications (32%, 27% to 37%), establishing an a priori protocol (31%, 26% to 36%), prespecifying methods for assessing both the overall effects (44%, 39% to 50%) and the participant-intervention interactions (31%, 26% to 36%), assessing and considering the potential of publication bias (31%, 26% to 36%), and conducting a comprehensive literature search (19%, 15% to 23%). Up to 126 (39%) IPD meta-analyses failed to obtain IPD from 90% or more of eligible participants or trials, among which only 60 (48%) provided reasons and 21 (17%) undertook certain strategies to account for the unavailable IPD. CONCLUSIONS The methodological quality of IPD meta-analyses is unsatisfactory. Future IPD meta-analyses need to establish an a priori protocol with prespecified data syntheses plan, comprehensively search the literature, critically appraise included randomised controlled trials with appropriate technique, account for risk of bias during data analyses and interpretation, and account for unavailable IPD.
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Affiliation(s)
- Huan Wang
- Xiangya School of Public Health, Central South University, 5/F, Xiangya School of Public Health, No. 238, Shang ma Yuan ling Alley, Kaifu district, Changsha, Hunan, China
| | - Yancong Chen
- Xiangya School of Public Health, Central South University, 5/F, Xiangya School of Public Health, No. 238, Shang ma Yuan ling Alley, Kaifu district, Changsha, Hunan, China
| | - Yali Lin
- Xiangya School of Public Health, Central South University, 5/F, Xiangya School of Public Health, No. 238, Shang ma Yuan ling Alley, Kaifu district, Changsha, Hunan, China
| | - Julius Abesig
- Xiangya School of Public Health, Central South University, 5/F, Xiangya School of Public Health, No. 238, Shang ma Yuan ling Alley, Kaifu district, Changsha, Hunan, China
| | - Irene Xy Wu
- Xiangya School of Public Health, Central South University, 5/F, Xiangya School of Public Health, No. 238, Shang ma Yuan ling Alley, Kaifu district, Changsha, Hunan, China
| | - Wilson Tam
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
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Annane D, Pirracchio R, Billot L, Waschka A, Chevret S, Cohen J, Finfer S, Gordon A, Hammond N, Myburgh J, Venkatesh B, Delaney A. Effects of low-dose hydrocortisone and hydrocortisone plus fludrocortisone in adults with septic shock: a protocol for a systematic review and meta-analysis of individual participant data. BMJ Open 2020; 10:e040931. [PMID: 33268422 PMCID: PMC7713227 DOI: 10.1136/bmjopen-2020-040931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The benefits and risks of low-dose hydrocortisone in patients with septic shock have been investigated in numerous randomised controlled trials and trial-level meta-analyses. Yet, the routine use of this treatment remains controversial. To overcome the limitations of previous meta-analyses inherent to the use of aggregate data, we will perform an individual patient data meta-analysis (IPDMA) on the effect of hydrocortisone with or without fludrocortisone compared with placebo or usual care on 90-day mortality and other outcomes in patients with septic shock. METHODS AND ANALYSIS To assess the benefits and risks of hydrocortisone, with or without fludrocortisone for adults with septic shock, we will search major electronic databases from inception to September 2020 (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and Latin American Caribbean Health Sciences Literature), complimented by a search for unpublished trials. The primary analysis will compare hydrocortisone with or without fludrocortisone to placebo or no treatment in adult patients with septic shock. Secondary analyses will compare hydrocortisone to placebo (or usual care), hydrocortisone plus fludrocortisone to placebo (or usual care), and hydrocortisone versus hydrocortisone plus fludrocortisone. The primary outcome will be all cause mortality at 90 days. We will conduct both one-stage IPDMA using mixed-effect models and machine learning with targeted maximum likelihood analyses. We will assess the risk of bias related to unshared data and related to the quality of individual trial. ETHICS AND DISSEMINATION This IPDMA will use existing data from completed randomised clinical trials and will comply with the ethical and regulatory requirements regarding data sharing for each of the component trials. The findings of this study will be submitted for publication in a peer-review journal with straightforward policy for open access. PROSPERO REGISTRATION NUMBER CRD42017062198.
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Affiliation(s)
- Djillali Annane
- School of Medicine, Versailles Saint-Quentin-en-Yvelines University, Versailles, Île-de-France, France
- Universite Paris-Saclay, Saint-Aubin, Île-de-France, France
| | - Romain Pirracchio
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Laurent Billot
- Statistics Division, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Andre Waschka
- University of California Berkeley, Berkeley, California, USA
| | | | - Jeremy Cohen
- University of Queensland, Brisbane, Queensland, Australia
| | - Simon Finfer
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Anthony Gordon
- Section of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK
| | - Naomi Hammond
- George Institute for Global Health, Camperdown, New South Wales, Australia
| | - John Myburgh
- St George Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Anthony Delaney
- The George Institute for Global Health, Newtown, New South Wales, Australia
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16
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Wu IXY, Xiao F, Wang H, Chen Y, Zhang Z, Lin Y, Tam W. Trials number, funding support, and intervention type associated with IPDMA data retrieval: a cross-sectional study. J Clin Epidemiol 2020; 130:59-68. [PMID: 33098991 DOI: 10.1016/j.jclinepi.2020.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/17/2020] [Accepted: 10/15/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study aimed to investigate the predictors for high data retrieval and the reporting of individual participant data meta-analyses (IPDMAs). STUDY DESIGN AND SETTING We searched EMBASE, MEDLINE, and the Cochrane Library for articles pertaining to IPDMA from 2011 to 2019. Only IPDMA assessing treatment effects, including randomized controlled trials (RCTs), were included. Adherence to the PRISMA-IPD guideline was checked. RESULTS A total of 210 IPDMA covering 18 diseases were sampled; 80 (38.1%) and 123 (58.6%) of the IPDMA retrieved IPD from all and ≥80% RCTs, respectively. Non-Cochrane reviews, IPDMA on nonpharmacological interventions, analyses of smaller numbers of RCTs, and having funding supports were predictors of complete IPD retrieval. Owners of RCTs had an increased probability of obtaining IPD. Only 4.3% described the eligibility criteria covering all the PICO components, 11.0% reported the methods for assessing risk of bias across studies, 11.4% mentioned the IPD integrity, and 9.0% presented detailed results of syntheses. CONCLUSION IPD retrieval and reporting was not satisfactory among the published IPDMA. Encouraging RCT owners to conduct or join in the IPDMA is a potential strategy to maximize the IPD retrieval. IPDMA are suggested to adhere to the PRISMA-IPD guideline during reporting.
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Affiliation(s)
- Irene X Y Wu
- Xiangya School of Public Health, Central South University, Changsha, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Fang Xiao
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Huan Wang
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Yancong Chen
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Zixuan Zhang
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Yali Lin
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Wilson Tam
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore.
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Horsley T, Steinert Y, Leslie K, Oswald A, Friesen F, Ellaway RH. The use of BEME reviews in the medical education literature. MEDICAL TEACHER 2020; 42:1171-1178. [PMID: 32772602 DOI: 10.1080/0142159x.2020.1798909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Knowledge syntheses in medical education are intended to promote the translation to, and mobilization of, research knowledge into practice. Despite the effort invested in conducting them, how these knowledge syntheses are used is unclear. This study aimed to explore how knowledge syntheses published by the Best Evidence Medical Education Collaboration (BEME) have been used in a cross-section of published literature. METHODS Citation patterns for BEME reviews were explored using data drawn from Web of Science and Scopus, and a sub-sample of citing papers. RESULTS Bibliometric data on 3419 papers citing 29 BEME reviews were analysed. More detailed data were extracted from a random sample of 629 full-text papers. DISCUSSION BEME reviews were most often positioned to consolidate and summarize the current state of knowledge on a particular topic and to identify gaps in the literature; they were also used to justify current research, and less frequently to contextualize and explain results, or direct future areas of research. Their use to identify instruments or methodological approaches was relatively absent. CONCLUSION While BEME reviews are primarily used to justify and support other studies, the current literature does not demonstrate their translation to educational practice.
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Affiliation(s)
- Tanya Horsley
- Research Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Yvonne Steinert
- Institute of Health Sciences Education and Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Canada
| | - Karen Leslie
- Centre for Faculty Development and Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Anna Oswald
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Farah Friesen
- Centre for Faculty Development, Faculty of Medicine, University of Toronto at St. Michael's Hospital, Toronto, Canada
| | - Rachel H Ellaway
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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18
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Lhatoo SD, Bernasconi N, Blumcke I, Braun K, Buchhalter J, Denaxas S, Galanopoulou A, Josephson C, Kobow K, Lowenstein D, Ryvlin P, Schulze-Bonhage A, Sahoo SS, Thom M, Thurman D, Worrell G, Zhang GQ, Wiebe S. Big data in epilepsy: Clinical and research considerations. Report from the Epilepsy Big Data Task Force of the International League Against Epilepsy. Epilepsia 2020; 61:1869-1883. [PMID: 32767763 DOI: 10.1111/epi.16633] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/25/2022]
Abstract
Epilepsy is a heterogeneous condition with disparate etiologies and phenotypic and genotypic characteristics. Clinical and research aspects are accordingly varied, ranging from epidemiological to molecular, spanning clinical trials and outcomes, gene and drug discovery, imaging, electroencephalography, pathology, epilepsy surgery, digital technologies, and numerous others. Epilepsy data are collected in the terabytes and petabytes, pushing the limits of current capabilities. Modern computing firepower and advances in machine and deep learning, pioneered in other diseases, open up exciting possibilities for epilepsy too. However, without carefully designed approaches to acquiring, standardizing, curating, and making available such data, there is a risk of failure. Thus, careful construction of relevant ontologies, with intimate stakeholder inputs, provides the requisite scaffolding for more ambitious big data undertakings, such as an epilepsy data commons. In this review, we assess the clinical and research epilepsy landscapes in the big data arena, current challenges, and future directions, and make the case for a systematic approach to epilepsy big data.
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Affiliation(s)
- Samden D Lhatoo
- University of Texas Health Sciences Center at Houston, Houston, Texas
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Ingmar Blumcke
- Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Kees Braun
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeffrey Buchhalter
- Department of Neurology, St Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
| | - Aristea Galanopoulou
- Saul Korey Department of Neurology, Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York
| | - Colin Josephson
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Katja Kobow
- Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Daniel Lowenstein
- Department of Neurology, University of California, San Francisco, San Francisco, California
| | - Philippe Ryvlin
- Department of Neurosciences, University of Lausanne, Lausanne, Switzerland
| | | | - Satya S Sahoo
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Maria Thom
- Institute of Neurology, University College London, London, UK
| | | | - Greg Worrell
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Guo-Qiang Zhang
- University of Texas Health Sciences Center at Houston, Houston, Texas
| | - Samuel Wiebe
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
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Cashman KD, Kiely ME, Andersen R, Grønborg IM, Madsen KH, Nissen J, Tetens I, Tripkovic L, Lanham-New SA, Toxqui L, Vaquero MP, Trautvetter U, Jahreis G, Mistry VV, Specker BL, Hower J, Knoll A, Wagner D, Vieth R, Öhlund I, Karlsland Åkeson P, Brett NR, Weiler HA, Ritz C. Individual participant data (IPD)-level meta-analysis of randomised controlled trials with vitamin D-fortified foods to estimate Dietary Reference Values for vitamin D. Eur J Nutr 2020; 60:939-959. [DOI: 10.1007/s00394-020-02298-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022]
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20
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Ventresca M, Schünemann HJ, Macbeth F, Clarke M, Thabane L, Griffiths G, Noble S, Garcia D, Marcucci M, Iorio A, Zhou Q, Crowther M, Akl EA, Lyman GH, Gloy V, DiNisio M, Briel M. Obtaining and managing data sets for individual participant data meta-analysis: scoping review and practical guide. BMC Med Res Methodol 2020; 20:113. [PMID: 32398016 PMCID: PMC7218569 DOI: 10.1186/s12874-020-00964-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/30/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Shifts in data sharing policy have increased researchers' access to individual participant data (IPD) from clinical studies. Simultaneously the number of IPD meta-analyses (IPDMAs) is increasing. However, rates of data retrieval have not improved. Our goal was to describe the challenges of retrieving IPD for an IPDMA and provide practical guidance on obtaining and managing datasets based on a review of the literature and practical examples and observations. METHODS We systematically searched MEDLINE, Embase, and the Cochrane Library, until January 2019, to identify publications focused on strategies to obtain IPD. In addition, we searched pharmaceutical websites and contacted industry organizations for supplemental information pertaining to recent advances in industry policy and practice. Finally, we documented setbacks and solutions encountered while completing a comprehensive IPDMA and drew on previous experiences related to seeking and using IPD. RESULTS Our scoping review identified 16 articles directly relevant for the conduct of IPDMAs. We present short descriptions of these articles alongside overviews of IPD sharing policies and procedures of pharmaceutical companies which display certification of Principles for Responsible Clinical Trial Data Sharing via Pharmaceutical Research and Manufacturers of America or European Federation of Pharmaceutical Industries and Associations websites. Advances in data sharing policy and practice affected the way in which data is requested, obtained, stored and analyzed. For our IPDMA it took 6.5 years to collect and analyze relevant IPD and navigate additional administrative barriers. Delays in obtaining data were largely due to challenges in communication with study sponsors, frequent changes in data sharing policies of study sponsors, and the requirement for a diverse skillset related to research, administrative, statistical and legal issues. CONCLUSIONS Knowledge of current data sharing practices and platforms as well as anticipation of necessary tasks and potential obstacles may reduce time and resources required for obtaining and managing data for an IPDMA. Sufficient project funding and timeline flexibility are pre-requisites for successful collection and analysis of IPD. IPDMA researchers must acknowledge the additional and unexpected responsibility they are placing on corresponding study authors or data sharing administrators and should offer assistance in readying data for sharing.
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Affiliation(s)
- Matthew Ventresca
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Fergus Macbeth
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Mike Clarke
- Northern Ireland Hub for Trials Methodology Research and Cochrane Individual Participant Data Meta-analysis Methods Group, Queen’s University Belfast, Belfast, UK
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Gareth Griffiths
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Wales, UK; Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, Wales, UK
| | - David Garcia
- Department of Medicine, University of Washington School of Medicine, Seattle, WA USA
| | - Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Qi Zhou
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Elie A. Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Gary H. Lyman
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington USA
| | - Viktoria Gloy
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Marcello DiNisio
- Department of Medicine and Ageing Sciences, University G. D’Annunzio, Chieti-Pescara, Italy
| | - Matthias Briel
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
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Schuit E, Li AH, Ioannidis JPA. How often can meta-analyses of individual-level data individualize treatment? A meta-epidemiologic study. Int J Epidemiol 2020; 48:596-608. [PMID: 30445577 DOI: 10.1093/ije/dyy239] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND One of the claimed main advantages of individual participant data meta-analysis (IPDMA) is that it allows assessment of subgroup effects based on individual-level participant characteristics, and eventually stratified medicine. In this study, we evaluated the conduct and results of subgroup analyses in IPDMA. METHODS We searched PubMed, EMBASE and the Cochrane Library from inception to 31 December 2014. We included papers if they described an IPDMA based on randomized clinical trials that investigated a therapeutic intervention on human subjects and in which the meta-analysis was preceded by a systematic literature search. We extracted data items related to subgroup analysis and subgroup differences (subgroup-treatment interaction p < 0.05). RESULTS Overall, 327 IPDMAs were eligible. A statistically significant subgroup-treatment interaction for the primary outcome was reported in 102 (36.6%) of 279 IPDMAs that reported at least one subgroup analysis. This corresponded to 187 different statistically significant subgroup-treatment interactions: 124 for an individual-level subgrouping variable (in 76 IPDMAs) and 63 for a group-level subgrouping variable (in 36 IPDMAs). Of the 187, only 7 (3.7%; 6 individual and 1 group-level subgrouping variables) had a large difference between strata (standardized effect difference d ≥ 0.8). Among the 124 individual-level statistically significant subgroup differences, the IPDMA authors claimed that 42 (in 21 IPDMAs) should lead to treating the subgroups differently. None of these 42 had d ≥ 0.8. CONCLUSIONS Availability of individual-level data provides statistically significant interactions for relative treatment effects in about a third of IPDMAs. A modest number of these interactions may offer opportunities for stratified medicine decisions.
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Affiliation(s)
- Ewoud Schuit
- Departments of Medicine, of Health Research and Policy, of Biomedical Data Science and of Statistics, Stanford University, Stanford, CA, USA.,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alvin H Li
- Departments of Medicine, of Health Research and Policy, of Biomedical Data Science and of Statistics, Stanford University, Stanford, CA, USA.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - John P A Ioannidis
- Departments of Medicine, of Health Research and Policy, of Biomedical Data Science and of Statistics, Stanford University, Stanford, CA, USA.,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
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Pieper D, Ober P, Dressler C, Schmidt S, Mathes T, Becker M. [Increasing the efficiency of guideline production: a narrative review]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2019; 146:1-6. [PMID: 31563415 DOI: 10.1016/j.zefq.2019.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND The development of high-quality clinical practice guidelines is laborious and time-consuming. New methods have become available to streamline this process. However, the awareness of these methods should be improved. METHODS Selective literature search in PubMed/MEDLINE und Embase. RESULTS Simple tools such as surveys or voting systems can facilitate the organization, planning and communication. Adequate methods should be used to prioritize all potential questions that should be addressed in the guideline. Published or ongoing international guidelines and systematic reviews can be used meaningfully for the planned guideline. In the case of guideline updates, it should be determined whether all parts of the guideline require an update of the evidence. The need for an update should be investigated. The concept of living guidelines has the biggest potential to provide gains in efficiency. Living guidelines are continuously updated based on new evidence instead of being regularly updated at a predefined time. CONCLUSIONS New methods allowing for more efficient guideline production have been developed and, in part, already been introduced. Before starting with the production of a guideline (or its update), the potential advantages and disadvantages/risks of the corresponding methods should be balanced.
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Affiliation(s)
- Dawid Pieper
- Institut für Forschung in der Operativen Medizin, Abteilung Evidenzbasierte Versorgungsforschung, Universität Witten/Herdecke, Köln, Deutschland.
| | - Peggy Ober
- Institut für Forschung in der Operativen Medizin, Abteilung Evidenzbasierte Versorgungsforschung, Universität Witten/Herdecke, Köln, Deutschland
| | - Corinna Dressler
- Division of Evidence Based Medicine, Klinik für Dermatologie, Charite -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - Stefanie Schmidt
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Deutschland
| | - Tim Mathes
- Institut für Forschung in der Operativen Medizin, Abteilung Evidenzbasierte Versorgungsforschung, Universität Witten/Herdecke, Köln, Deutschland
| | - Monika Becker
- Institut für Forschung in der Operativen Medizin, Abteilung Evidenzbasierte Versorgungsforschung, Universität Witten/Herdecke, Köln, Deutschland
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Blanchard P, Aupérin A, Pignon JP. Are Individual patient data meta-analyses still needed today in oncology? A discussion focused on Head and Neck oncology. Acta Oncol 2019; 58:1333-1336. [PMID: 31478777 DOI: 10.1080/0284186x.2019.1649458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Pierre Blanchard
- Radiation Oncology Department, Gustave-Roussy, Paris-Saclay University, Villejuif, France
- INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
- Biostatistics and Epidemiology Department, Gustave-Roussy, Paris-Saclay University, Ligue Nationale Contre le Cancer meta-analysis platform, Villejuif, France
| | - Anne Aupérin
- INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
- Biostatistics and Epidemiology Department, Gustave-Roussy, Paris-Saclay University, Ligue Nationale Contre le Cancer meta-analysis platform, Villejuif, France
| | - Jean-Pierre Pignon
- INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
- Biostatistics and Epidemiology Department, Gustave-Roussy, Paris-Saclay University, Ligue Nationale Contre le Cancer meta-analysis platform, Villejuif, France
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Assessing evidence quality in research reporting neurocognitive outcomes following paediatric temporal lobe surgery for epilepsy. Epilepsy Res 2019; 154:116-123. [DOI: 10.1016/j.eplepsyres.2019.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/17/2018] [Accepted: 03/21/2019] [Indexed: 11/24/2022]
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Amer YS, Al-Joudi HF, Varnham JL, Bashiri FA, Hamad MH, Al Salehi SM, Daghash HF, Albatti TH. Appraisal of clinical practice guidelines for the management of attention deficit hyperactivity disorder (ADHD) using the AGREE II Instrument: A systematic review. PLoS One 2019; 14:e0219239. [PMID: 31276528 PMCID: PMC6611626 DOI: 10.1371/journal.pone.0219239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 06/19/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE High quality evidence-based clinical practice guidelines (CPGs) have a major impact on the appropriate diagnosis and management and positive outcomes. The evidence-based healthcare for patients with attention deficit hyperactive disorder (ADHD) is challenging. The objective of this study was to appraise the quality of published CPGs for ADHD. METHODS A systematic review was conducted for ADHD CPGs using CPG databases, DynaMed, PubMed, and Google Scholar. The quality of each included CPG was appraised by three independent appraisers using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. RESULTS Six CPGs were critically reviewed. The AGREE II standardized domain scores revealed variation between the quality of these CPGs with the National Institute of Health and Care Excellence (NICE), University of Michigan Health System, and American Academy of Pediatrics CPGs as the top three. Overall, the recommendations for management of ADHD were similar in these CPGs. CONCLUSIONS Reporting of CPG development is often poorly documented. Guideline development groups should aim to follow the AGREE II criteria to improve the standards and quality of CPGs. The NICE CPG showed the best quality. Embedding the AGREE II appraisal of CPGs in the training and education of healthcare providers is recommended. The protocol for this study was published in PROSPERO (International prospective register of systematic reviews). Link: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017078712 and is additionally available from protocols.io. Link: https://dx.doi.org/10.17504/protocols.io.q27dyhn.
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Affiliation(s)
- Yasser Sami Amer
- CPG Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
- Pediatrics Department, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
| | - Haya Faisal Al-Joudi
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Jeremy L. Varnham
- Saudi ADHD Society, Riyadh, Saudi Arabia
- School of Psychology, University of East London, London, United Kingdom
| | - Fahad A. Bashiri
- Division of Neurology, Department of Pediatrics, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Muddathir Hamad Hamad
- Division of Neurology, Department of Pediatrics, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Saleh M. Al Salehi
- Child Development Center, King Abdullah Bin Abdulaziz University Hospital, Princess Noura Bint AbdulRahman University, Riyadh, Saudi Arabia
| | - Hadeel Fakhri Daghash
- Ada’a Program, Assistant Deputyship for Hospital Services, Ministry of Health, Riyadh, Saudi Arabia
| | - Turki Homod Albatti
- Saudi ADHD Society, Riyadh, Saudi Arabia
- Department of Psychiatry, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Tobacco smoking and gastric cancer: meta-analyses of published data versus pooled analyses of individual participant data (StoP Project). Eur J Cancer Prev 2019; 27:197-204. [PMID: 29595756 DOI: 10.1097/cej.0000000000000401] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Tobacco smoking is one of the main risk factors for gastric cancer, but the magnitude of the association estimated by conventional systematic reviews and meta-analyses might be inaccurate, due to heterogeneous reporting of data and publication bias. We aimed to quantify the combined impact of publication-related biases, and heterogeneity in data analysis or presentation, in the summary estimates obtained from conventional meta-analyses. We compared results from individual participant data pooled-analyses, including the studies in the Stomach Cancer Pooling (StoP) Project, with conventional meta-analyses carried out using only data available in previously published reports from the same studies. From the 23 studies in the StoP Project, 20 had published reports with information on smoking and gastric cancer, but only six had specific data for gastric cardia cancer and seven had data on the daily number of cigarettes smoked. Compared to the results obtained with the StoP database, conventional meta-analyses overvalued the relation between ever smoking (summary odds ratios ranging from 7% higher for all studies to 22% higher for the risk of gastric cardia cancer) and yielded less precise summary estimates (SE ≤2.4 times higher). Additionally, funnel plot asymmetry and corresponding hypotheses tests were suggestive of publication bias. Conventional meta-analyses and individual participant data pooled-analyses reached similar conclusions on the direction of the association between smoking and gastric cancer. However, published data tended to overestimate the magnitude of the effects, possibly due to publication biases and limited the analyses by different levels of exposure or cancer subtypes.
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27
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Best practices for MRI systematic reviews and meta‐analyses. J Magn Reson Imaging 2018; 49:e51-e64. [DOI: 10.1002/jmri.26198] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/01/2018] [Indexed: 12/12/2022] Open
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Cashman KD. Vitamin D Requirements for the Future-Lessons Learned and Charting a Path Forward. Nutrients 2018; 10:E533. [PMID: 29693631 PMCID: PMC5986413 DOI: 10.3390/nu10050533] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/19/2018] [Accepted: 04/23/2018] [Indexed: 12/21/2022] Open
Abstract
Estimates of dietary requirements for vitamin D or Dietary Reference Values (DRV) are crucial from a public health perspective in providing a framework for prevention of vitamin D deficiency and optimizing vitamin D status of individuals. While these important public health policy instruments were developed with the evidence-base and data available at the time, there are some issues that need to be clarified or considered in future iterations of DRV for vitamin D. This is important as it will allow for more fine-tuned and truer estimates of the dietary requirements for vitamin D and thus provide for more population protection. The present review will overview some of the confusion that has arisen in relation to the application and/or interpretation of the definitions of the Estimated Average Requirement (EAR) and Recommended Dietary Allowance (RDA). It will also highlight some of the clarifications needed and, in particular, how utilization of a new approach in terms of using individual participant-level data (IPD), over and beyond aggregated data, from randomised controlled trials with vitamin D may have a key role in generating these more fine-tuned and truer estimates, which is of importance as we move towards the next iteration of vitamin D DRVs.
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Affiliation(s)
- Kevin D Cashman
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, T12 Y337 Cork, Ireland.
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29
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Shaghaghi M, Soleyman-Jahi S, Abolhassani H, Yazdani R, Azizi G, Rezaei N, Barbouche MR, McKinlay MA, Aghamohammadi A. New insights into physiopathology of immunodeficiency-associated vaccine-derived poliovirus infection; systematic review of over 5 decades of data. Vaccine 2018; 36:1711-1719. [PMID: 29478755 DOI: 10.1016/j.vaccine.2018.02.059] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/26/2018] [Accepted: 02/15/2018] [Indexed: 12/25/2022]
Abstract
Widespread administration of oral poliovirus vaccine (OPV) has decreased global incidence of poliomyelitis by ≈99.9%. However, the emergence of vaccine-derived polioviruses (VDPVs) is threatening polio-eradication program. Primary immunodeficiency (PID) patients are at higher risks of vaccine-associated paralytic poliomyelitis (VAPP) and prolonged excretion of immunodeficiency-associated VDPV (iVDPV). We searched Embase, Medline, Science direct, Scopus, Web of Science, and CDC and WHO databases by 30 September 2016, for all reports of iVDPV cases. Patient-level data were extracted form eligible studies. Data on immunization coverage and income-level of countries were extracted from WHO/UNICEF and the WORLD BANK databases, respectively. We assessed bivariate associations between immunological, clinical, and virological parameters, and exploited multivariable modeling to identify independent determinants of poliovirus evolution and patients' outcomes. Study protocol was registered with PROSPERO (CRD42016052931). 4329 duplicate-removed titles were screened. A total of 107 iVDPV cases were identified from 68 eligible articles. The majority of cases were from higher income countries with high polio-immunization coverage. 74 (69.81%) patients developed VAPP. Combined immunodeficiency patients showed lower rates of VAPP (p < .001) and infection clearance (p = .02), compared to humoral immunodeficiency patients. The rate of poliovirus genomic evolution was higher at early stages of replication, decreasing over time until reaching a steady state. Independent of replication duration, higher extent (p = .04) and rates (p = .03) of genome divergence contributed to a less likelihood of virus clearance. PID type (p < .001), VAPP occurrence (p = .008), and income-level of country (p = .04) independently influenced patients' survival. With the use of OPV, new iVDPVs will emerge independent of the rate of immunization coverage. Inherent features of PIDs contribute to the clinical course of iVDPV infection and virus evolution. This finding could shed further light on poliomyelitis pathogenesis and iVDPV evolution pattern. It also has implications for public health, the polio eradication effort and the development of effective antiviral interventions.
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Affiliation(s)
- Mohammadreza Shaghaghi
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran; Network of Immunology in Infections, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Saeed Soleyman-Jahi
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran; Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Hassan Abolhassani
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran; Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Reza Yazdani
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Gholamreza Azizi
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran; Network of Immunology in Infections, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamed-Ridha Barbouche
- Department of Immunology, Institut Pasteur de Tunis and University Tunis El-Manar, Tunis, Tunisia
| | - Mark A McKinlay
- Center for Vaccine Equity, Task Force for Global Health, Atlanta, GA, United States
| | - Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran.
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Haile SR, Guerra B, Soriano JB, Puhan MA. Multiple Score Comparison: a network meta-analysis approach to comparison and external validation of prognostic scores. BMC Med Res Methodol 2017; 17:172. [PMID: 29268701 PMCID: PMC5740913 DOI: 10.1186/s12874-017-0433-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/20/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Prediction models and prognostic scores have been increasingly popular in both clinical practice and clinical research settings, for example to aid in risk-based decision making or control for confounding. In many medical fields, a large number of prognostic scores are available, but practitioners may find it difficult to choose between them due to lack of external validation as well as lack of comparisons between them. METHODS Borrowing methodology from network meta-analysis, we describe an approach to Multiple Score Comparison meta-analysis (MSC) which permits concurrent external validation and comparisons of prognostic scores using individual patient data (IPD) arising from a large-scale international collaboration. We describe the challenges in adapting network meta-analysis to the MSC setting, for instance the need to explicitly include correlations between the scores on a cohort level, and how to deal with many multi-score studies. We propose first using IPD to make cohort-level aggregate discrimination or calibration scores, comparing all to a common comparator. Then, standard network meta-analysis techniques can be applied, taking care to consider correlation structures in cohorts with multiple scores. Transitivity, consistency and heterogeneity are also examined. RESULTS We provide a clinical application, comparing prognostic scores for 3-year mortality in patients with chronic obstructive pulmonary disease using data from a large-scale collaborative initiative. We focus on the discriminative properties of the prognostic scores. Our results show clear differences in performance, with ADO and eBODE showing higher discrimination with respect to mortality than other considered scores. The assumptions of transitivity and local and global consistency were not violated. Heterogeneity was small. CONCLUSIONS We applied a network meta-analytic methodology to externally validate and concurrently compare the prognostic properties of clinical scores. Our large-scale external validation indicates that the scores with the best discriminative properties to predict 3 year mortality in patients with COPD are ADO and eBODE.
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Affiliation(s)
- Sarah R. Haile
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Beniamino Guerra
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Joan B. Soriano
- Servicio de Neumología, Instituto de Investigación del Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Epidemiology & Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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31
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Vitamin D in adolescence: evidence-based dietary requirements and implications for public health policy. Proc Nutr Soc 2017; 77:292-301. [PMID: 29198201 DOI: 10.1017/s0029665117004104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Vitamin D is a unique nutrient. First, it acts as a pro-hormone and secondly, the requirement for vitamin D can be met by both endogenous synthesis from sunlight and by dietary sources. This complicates the determination of dietary requirements for vitamin D, which along with the definition of optimal vitamin D status, have been highly controversial and much debated over recent years. Adolescents are a population group at high risk of low vitamin D status, which is concerning given the important role of vitamin D, and calcium, in promoting normal bone mineralisation and attainment of peak bone mass during this rapid growth phase. Dietary vitamin D recommendations are important from a public health perspective in helping to avoid deficiency and optimise vitamin D status for health. However limited experimental data from winter-based dose-response randomised trials in adolescents has hindered the development of evidence-based dietary requirements for vitamin D in this population group. This review will highlight how specifically designed randomised trials and the approach adopted for estimating such requirements can lead to improved recommendations. Such data indicate that vitamin D intakes of between 10 and about 30 µg/d may be required to avoid deficiency and ensure adequacy in adolescents, considerably greater than the current recommendations of 10-15 µg/d. Finally this review will consider the implications of this on public health policy, in terms of future refinements of vitamin D requirement recommendations and prioritisation of public health strategies to help prevent vitamin D deficiency.
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32
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Midia M, Odedra D, Haider E, Shuster A, Muir J. Choosing Wisely Canada and Diagnostic Imaging: What Level of Evidence Supports the Recommendations? Can Assoc Radiol J 2017; 68:359-367. [DOI: 10.1016/j.carj.2017.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 06/14/2017] [Accepted: 06/15/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Mehran Midia
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
- Joseph Brant Hospital, Burlington, Ontario, Canada
| | - Devang Odedra
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Ehsan Haider
- St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Anatoly Shuster
- Department of Radiology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Jeff Muir
- Motion Research, Ancaster, Ontario, Canada
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33
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Xing D, Wang B, Zhang W, Yang Z, Hou Y, Chen Y, Lin J. Intra-articular hyaluronic acid injection in treating knee osteoarthritis: assessing risk of bias in systematic reviews with ROBIS tool. Int J Rheum Dis 2017; 20:1658-1673. [PMID: 29044993 DOI: 10.1111/1756-185x.13192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Intra-articular injection of hyaluronic acid (HA) is a common, yet controversial therapeutic option in treating knee osteoarthritis (OA). The purpose of the present study was to assess the risk of bias (RoB) of systematic reviews (SRs) and to summarize available evidence of HA in treating knee OA. METHODS A systematic search of SRs published through to December 2016 was conducted using the MEDLINE, EMBASE and Cochrane Library. The RoB of included SRs was assessed by ROBIS tool. In addition, the methodological quality of primary studies in SRs with low RoB was evaluated according to the Cochrane Handbook. The evidence quality of each primary outcome of SRs with low RoB was determined by the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system. RESULTS Thirty-one SRs were eligible for inclusion. According to the ROBIS tool, there were 13 SRs with low RoB, 16 with high RoB and two with unclear RoB. The methodological quality of a total of 135 primary studies was evaluated and summarized. Forty-two outcomes from these 13 SRs were classified into the four following quality levels based on the GRADE approach: three outcomes with high quality, eight with moderate quality, 12 with low quality and 19 with very low quality. CONCLUSIONS This study evaluated RoB in SRs for managing knee OA with HA and assessed the evidence quality of each primary outcome in SRs with low RoB. These results can help users of SRs to improve the process of SR assessment in developing overviews or guidelines, leading to more reliable recommendations for improvements in treating knee OA. Registration: PROSPERO ((http://www.crd.york.ac.uk/PROSPERO) [CRD42017057384].
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Affiliation(s)
- Dan Xing
- Arthritis Clinic & Research Center, Peking University People's Hospital, Beijing, China.,Arthritis Institute, Peking University, Beijing, China
| | - Bin Wang
- Arthritis Clinic & Research Center, Peking University People's Hospital, Beijing, China.,Arthritis Institute, Peking University, Beijing, China
| | - Wei Zhang
- Arthritis Clinic & Research Center, Peking University People's Hospital, Beijing, China.,Arthritis Institute, Peking University, Beijing, China
| | - Ziyi Yang
- Arthritis Clinic & Research Center, Peking University People's Hospital, Beijing, China.,Arthritis Institute, Peking University, Beijing, China
| | - Yunfei Hou
- Arthritis Clinic & Research Center, Peking University People's Hospital, Beijing, China.,Arthritis Institute, Peking University, Beijing, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Chinese GRADE Center, Gansu, China
| | - Jianhao Lin
- Arthritis Clinic & Research Center, Peking University People's Hospital, Beijing, China.,Arthritis Institute, Peking University, Beijing, China
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Arabi YM, Preiser JC. A critical view on primary and secondary outcome measures in nutrition trials. Intensive Care Med 2017; 43:1875-1877. [PMID: 28756470 DOI: 10.1007/s00134-017-4894-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Yaseen M Arabi
- Intensive Care Department, MC 1425, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) and King Abdullah International Medical Research Center (KAIMRC), P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.
| | - Jean-Charles Preiser
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Anand V, Cahan A, Ghosh S. Clinical Trials.Gov: A Topical Analyses. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2017; 2017:37-47. [PMID: 28815102 PMCID: PMC5543348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
ClinicalTrials.gov was established as a web-based registry for clinical trials of human participants in 2000. Mandatory registration started in 2008. Given more than a decade of registered trials, it's important to understand the "topic" areas and their evolution over time from this resource. This information may help in identifying current knowledge gaps. We use dynamic topic model (DTM) methods to discover topics and their evolution over last 17 years. Our model suggests that there are disease or organ specific trials such as 'Cardiovascular disorders', Heart & Brain conditions', or 'Breast & Prostate cancer' as well as trials registered for general health. General health trials are less likely to be FDA regulated, but both health and pain management, as well as surgical, heart, and brain trials have upward trend in recent years while advanced cancer trials have downward trended. Our model derives unique insights from metadata associated with each topic area.
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Affiliation(s)
- Vibha Anand
- IBM T.J. Watson Research Center, Cambridge, MA
| | - Amos Cahan
- IBM T.J. Watson Research Center, Cambridge, MA
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36
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Cashman KD, Ritz C, Kiely M, Odin Collaborators. Improved Dietary Guidelines for Vitamin D: Application of Individual Participant Data (IPD)-Level Meta-Regression Analyses. Nutrients 2017; 9:E469. [PMID: 28481259 PMCID: PMC5452199 DOI: 10.3390/nu9050469] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/27/2017] [Accepted: 05/02/2017] [Indexed: 12/27/2022] Open
Abstract
Dietary Reference Values (DRVs) for vitamin D have a key role in the prevention of vitamin D deficiency. However, despite adopting similar risk assessment protocols, estimates from authoritative agencies over the last 6 years have been diverse. This may have arisen from diverse approaches to data analysis. Modelling strategies for pooling of individual subject data from cognate vitamin D randomized controlled trials (RCTs) are likely to provide the most appropriate DRV estimates. Thus, the objective of the present work was to undertake the first-ever individual participant data (IPD)-level meta-regression, which is increasingly recognized as best practice, from seven winter-based RCTs (with 882 participants ranging in age from 4 to 90 years) of the vitamin D intake-serum 25-hydroxyvitamin D (25(OH)D) dose-response. Our IPD-derived estimates of vitamin D intakes required to maintain 97.5% of 25(OH)D concentrations >25, 30, and 50 nmol/L across the population are 10, 13, and 26 µg/day, respectively. In contrast, standard meta-regression analyses with aggregate data (as used by several agencies in recent years) from the same RCTs estimated that a vitamin D intake requirement of 14 µg/day would maintain 97.5% of 25(OH)D >50 nmol/L. These first IPD-derived estimates offer improved dietary recommendations for vitamin D because the underpinning modeling captures the between-person variability in response of serum 25(OH)D to vitamin D intake.
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Affiliation(s)
- Kevin D Cashman
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork T12 Y337, Ireland.
- Department of Medicine, University College Cork, Cork T12 DFK4, Ireland.
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg C DK-1958, Denmark.
| | - Mairead Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork T12 Y337, Ireland.
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork T12 DFK4, Ireland.
| | - Odin Collaborators
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork T12 Y337, Ireland
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37
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Nevitt SJ, Marson AG, Davie B, Reynolds S, Williams L, Smith CT. Exploring changes over time and characteristics associated with data retrieval across individual participant data meta-analyses: systematic review. BMJ 2017; 357:j1390. [PMID: 28381561 PMCID: PMC5733815 DOI: 10.1136/bmj.j1390] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective To investigate whether the success rate of retrieving individual participant data (IPD) for use in IPD meta-analyses has increased over time, and to explore the characteristics associated with IPD retrieval.Design Systematic review of published IPD meta-analyses, supplemented by a reflection of the Cochrane Epilepsy Group's 20 years' experience of requesting IPD.Data sources Medline, CENTRAL, Scopus, Web of Science, CINAHL Plus, and PsycINFO.Eligibility criteria for study selection IPD meta-analyses of studies of all designs and all clinical areas published in English.Results 760 IPD meta-analyses which identified studies by systematic methods that had been published between 1987 and 2015 were included. Only 188 (25%) of these IPD meta-analyses retrieved 100% of the eligible IPD for analysis, with 324 (43%) of these IPD meta-analyses retrieving 80% or more of relevant IPD. There is insufficient evidence to suggest that IPD retrieval rates have improved over time. IPD meta-analyses that included only randomised trials, had an authorship policy, included fewer eligible participants, and were conducted outside of the Cochrane Database of Systematic Reviews were associated with a high or complete IPD retrieval rate. There was no association between the source of funding of the IPD meta-analyses and IPD retrieval rate. The IPD retrieval rate of the Cochrane Epilepsy Group has declined from 83% (up to 2005) to 65% (between 2012 and 2015) and the reported reasons for lack of data availability have changed in recent years.Conclusions IPD meta-analyses are considered to be the "gold standard" for the synthesis of data from clinical research studies; however, only 25% of published IPD meta-analyses have had access to all IPD.
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Affiliation(s)
- Sarah J Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool L69 3GL, UK
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Becky Davie
- Department of Biostatistics, University of Liverpool, Liverpool L69 3GL, UK
| | - Sally Reynolds
- Department of Biostatistics, University of Liverpool, Liverpool L69 3GL, UK
| | - Lisa Williams
- Department of Biostatistics, University of Liverpool, Liverpool L69 3GL, UK
| | - Catrin Tudur Smith
- Department of Biostatistics, University of Liverpool, Liverpool L69 3GL, UK
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Dodd JM, Grivell RM, Louise J, Deussen AR, Giles L, Mol BW, Vinter C, Tanvig M, Jensen DM, Bogaerts A, Devlieger R, Luoto R, McAuliffe F, Renault K, Carlsen E, Geiker N, Poston L, Briley A, Thangaratinam S, Rogozinska E, Owens JA. The effects of dietary and lifestyle interventions among pregnant women who are overweight or obese on longer-term maternal and early childhood outcomes: protocol for an individual participant data (IPD) meta-analysis. Syst Rev 2017; 6:51. [PMID: 28274270 PMCID: PMC5343397 DOI: 10.1186/s13643-017-0442-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/22/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this individual participant data meta-analysis (IPDMA) is to evaluate the effects of dietary and lifestyle interventions among pregnant women who are overweight or obese on later maternal and early childhood outcomes at ages 3-5 years. METHODS/DESIGN We will build on the established International Weight Management in Pregnancy (i-WIP) IPD Collaborative Network, having identified researchers who have conducted randomised dietary and lifestyle interventions among pregnant women who are overweight or obese, and where ongoing childhood follow-up of participants has been or is being undertaken. The primary maternal outcome is a diagnosis of maternal metabolic syndrome. The primary childhood outcome is BMI above 90%. We have identified 7 relevant trials, involving 5425 women who were overweight or obese during pregnancy, with approximately 3544 women and children with follow-up assessments available for inclusion in the meta-analysis. DISCUSSION The proposed IPDMA provides an opportunity to evaluate the effect of dietary and lifestyle interventions among pregnant women who are overweight or obese on later maternal and early childhood health outcomes, including risk of obesity. This knowledge is essential to effectively translate research findings into clinical practice and public health policy. SYSTEMATIC REVIEW REGISTRATION This IPD has been prospectively registered (PROSPERO), ID number CRD42016047165 .
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Affiliation(s)
- Jodie M Dodd
- The University of Adelaide, Discipline of Obstetrics & Gynaecology, and Robinson Research Institute, Adelaide, South Australia, Australia. .,Department of Perinatal Medicine, Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006, Australia.
| | - Rosalie M Grivell
- The University of Adelaide, Discipline of Obstetrics & Gynaecology, and Robinson Research Institute, Adelaide, South Australia, Australia.,Department of Perinatal Medicine, Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006, Australia
| | - Jennie Louise
- The University of Adelaide, Discipline of Obstetrics & Gynaecology, and Robinson Research Institute, Adelaide, South Australia, Australia
| | - Andrea R Deussen
- The University of Adelaide, Discipline of Obstetrics & Gynaecology, and Robinson Research Institute, Adelaide, South Australia, Australia
| | - Lynne Giles
- The University of Adelaide, School of Public Health, Adelaide, South Australia, Australia
| | - Ben W Mol
- The University of Adelaide, Discipline of Obstetrics & Gynaecology, and Robinson Research Institute, Adelaide, South Australia, Australia
| | - Christina Vinter
- Institute of Clinical Research, University of Southern Denmark, 5230, Odense M, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Mette Tanvig
- Institute of Clinical Research, University of Southern Denmark, 5230, Odense M, Denmark.,Department of Endocrinology, Odense University Hospital, 5000, Odense C, Denmark
| | - Dorte Moller Jensen
- Department of Endocrinology, Odense University Hospital, 5000, Odense C, Denmark
| | - Annick Bogaerts
- Department of Healthcare Research, PHL University College, Limburg Catholic University College, Hasselt, Belgium
| | - Roland Devlieger
- Division of Mother and Child, Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium
| | - Riitta Luoto
- UKK Institute for Health Promotion, Tampere, Finland
| | - Fionnuala McAuliffe
- School of Medicine and Medical Science, UCD Institute of Food and Health, Dublin, Ireland
| | - Kristina Renault
- Department of Obstetrics and Gynaecology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Emma Carlsen
- Department of Obstetrics and Gynaecology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Nina Geiker
- Herlev and Gentofte Hospital Clinical Nutrition Research Unit, Copenhagen University Herlev, Herlev, Denmark
| | - Lucilla Poston
- Division of Women's Health, Women's Health Academic Centre, King's College London, St. Thomas' Hospital, London, UK
| | - Annette Briley
- Division of Women's Health, Women's Health Academic Centre, King's College London, St. Thomas' Hospital, London, UK
| | - Shakila Thangaratinam
- Multidisciplinary Evidence Synthesis Hub (mEsh), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ewelina Rogozinska
- Multidisciplinary Evidence Synthesis Hub (mEsh), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Julie A Owens
- The University of Adelaide, Discipline of Obstetrics & Gynaecology, and Robinson Research Institute, Adelaide, South Australia, Australia
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Dal-Ré R. The International Committee of Medical Journal Editors trial data sharing requirement and participants' consent. Eur J Clin Invest 2016; 46:971-975. [PMID: 27782296 DOI: 10.1111/eci.12694] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/24/2016] [Indexed: 12/18/2022]
Abstract
The International Committee of Medical Journal Editors (ICMJE) has published a draft proposal on de-identified individual clinical trial participant data (IPD) sharing, stating that sharing trial data requires planning to ensure appropriate research ethics committee approval and participants' informed consent. This is why its implementation will be deferred for 1 year after the publication of the final version of the policy. When conducting research with anonymous data, it is not feasible to obtain the informed consent from research participants. De-identified IPD are anonymous to the investigator who is performing the secondary analysis. De-identified IPD meta-analyses have been conducted for decades. Public funders, industry and foundations have recently implemented new IPD sharing procedures; almost all trials used for secondary analyses so far were conducted without participant's consent to de-identified IPD. As stated by the ICMJE, de-identified IPD protects participant's confidentiality. It follows that publishing secondary analyses from completed trials without participant's consent is ethically acceptable. From the ethical perspective, the ICMJE requirement on de-identified IPD sharing should be implemented from the day the policy is published.
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Affiliation(s)
- Rafael Dal-Ré
- Clinical Research, BUC (Biosciences UAM+CSIC) Program, International Campus of Excellence, Universidad Autónoma de Madrid, Madrid, Spain
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Riley RD, Ensor J, Snell KIE, Debray TPA, Altman DG, Moons KGM, Collins GS. External validation of clinical prediction models using big datasets from e-health records or IPD meta-analysis: opportunities and challenges. BMJ 2016; 353:i3140. [PMID: 27334381 PMCID: PMC4916924 DOI: 10.1136/bmj.i3140] [Citation(s) in RCA: 287] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Richard D Riley
- Research Institute for Primary Care and Health Sciences, Keele University, Keele ST5 5BG, Staffordshire, UK
| | - Joie Ensor
- Research Institute for Primary Care and Health Sciences, Keele University, Keele ST5 5BG, Staffordshire, UK
| | - Kym I E Snell
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Thomas P A Debray
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands Cochrane Netherlands, University Medical Center Utrecht, Utrecht, Netherlands
| | - Doug G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Karel G M Moons
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands Cochrane Netherlands, University Medical Center Utrecht, Utrecht, Netherlands
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Veroniki AA, Straus SE, Soobiah C, Elliott MJ, Tricco AC. A scoping review of indirect comparison methods and applications using individual patient data. BMC Med Res Methodol 2016; 16:47. [PMID: 27116943 PMCID: PMC4847203 DOI: 10.1186/s12874-016-0146-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 04/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several indirect comparison methods, including network meta-analyses (NMAs), using individual patient data (IPD) have been developed to synthesize evidence from a network of trials. Although IPD indirect comparisons are published with increasing frequency in health care literature, there is no guidance on selecting the appropriate methodology and on reporting the methods and results. METHODS In this paper we examine the methods and reporting of indirect comparison methods using IPD. We searched MEDLINE, Embase, the Cochrane Library, and CINAHL from inception until October 2014. We included published and unpublished studies reporting a method, application, or review of indirect comparisons using IPD and at least three interventions. RESULTS We identified 37 papers, including a total of 33 empirical networks. Of these, only 9 (27 %) IPD-NMAs reported the existence of a study protocol, whereas 3 (9 %) studies mentioned that protocols existed without providing a reference. The 33 empirical networks included 24 (73 %) IPD-NMAs and 9 (27 %) matching adjusted indirect comparisons (MAICs). Of the 21 (64 %) networks with at least one closed loop, 19 (90 %) were IPD-NMAs, 13 (68 %) of which evaluated the prerequisite consistency assumption, and only 5 (38 %) of the 13 IPD-NMAs used statistical approaches. The median number of trials included per network was 10 (IQR 4-19) (IPD-NMA: 15 [IQR 8-20]; MAIC: 2 [IQR 3-5]), and the median number of IPD trials included in a network was 3 (IQR 1-9) (IPD-NMA: 6 [IQR 2-11]; MAIC: 2 [IQR 1-2]). Half of the networks (17; 52 %) applied Bayesian hierarchical models (14 one-stage, 1 two-stage, 1 used IPD as an informative prior, 1 unclear-stage), including either IPD alone or with aggregated data (AD). Models for dichotomous and continuous outcomes were available (IPD alone or combined with AD), as were models for time-to-event data (IPD combined with AD). CONCLUSIONS One in three indirect comparison methods modeling IPD adjusted results from different trials to estimate effects as if they had come from the same, randomized, population. Key methodological and reporting elements (e.g., evaluation of consistency, existence of study protocol) were often missing from an indirect comparison paper.
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Affiliation(s)
- Areti Angeliki Veroniki
- />Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Sharon E. Straus
- />Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- />Department of Geriatric Medicine, Faculty of Medicine, University of Toronto, 27 King’s College Circle, Toronto, ON M5S 1A1 Canada
| | - Charlene Soobiah
- />Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- />Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, 4th floor, Toronto, ON M5T 3M6 Canada
| | - Meghan J. Elliott
- />Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Andrea C. Tricco
- />Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- />Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
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Abstract
BACKGROUND AND OBJECTIVE There has been increasing emphasis on the role of the pediatrician with respect to behavioral, learning, and mental health (MH) issues, and developmental behavioral rotations are now required in pediatric residency programs. We sought to examine whether this newer emphasis on MH is reflected in pediatricians' reports of their current practices. METHODS Data from 2 periodic surveys conducted in 2004 and 2013 by the American Academy of Pediatrics were examined to see whether there were differences in self-reported behaviors of usually inquiring/screening, treating/managing/comanaging, or referring patients for attention-deficit/hyperactivity disorder (ADHD), anxiety, depression, behavioral problems, or learning problems. We examined patterns for all practicing members and for those who practiced general pediatrics exclusively. RESULTS There were few changes over the decade in the percentage who inquired or screened among all clinicians; among those exclusively practicing general pediatrics, the percentage who inquired or screened increased about 10% for ADHD and depression. ADHD remained the only condition for which the majority of respondents treated/managed/comanaged (57%). While there was some increase in the percentages who treated other conditions, the other conditions were usually treated by <30% of respondents. A similar pattern of results was observed in analyses adjusted for physician, practice, and patient characteristics. CONCLUSIONS Despite the changing nature of pediatric practice and increased efforts to emphasize the importance of behavior, learning, and MH, the pediatric community appears to be making little progress toward providing for the long-term behavioral, learning, and MH needs of children and adolescents in its care.
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Abstract
Jayne Tierney and colleagues offer guidance on how to spot a well-designed and well-conducted individual participant data meta-analysis.
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