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Hu J, Mei X, Pepper S, Wang Y, Zhang B, Cernik C, Gajewski B. PROpwr: a Shiny R application to analyze patient-reported outcomes data and estimate power. J Biopharm Stat 2024:1-12. [PMID: 38869267 DOI: 10.1080/10543406.2024.2365966] [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: 12/28/2022] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
Patient Reported Outcomes (PROs) are widely used in quality of life (QOL) studies, health outcomes research, and clinical trials. The importance of PRO has been advocated by health authorities. We propose this R shiny web application, PROpwr, that estimates power for two-arm clinical trials with PRO measures as endpoints using Item Response Theory (GRM: Graded Response Model) and simulations. PROpwr also supports the analysis of PRO data for convenience of estimating the effect size. There are seven function tabs in PROpwr: Frequentist Analysis, Bayesian Analysis, GRM power, T-test Power Given Sample Size, T-test Sample Size Given Power, Download, and References. PROpwr is user-friendly with point-and-click functions. PROpwr can assist researchers to analyze and calculate power and sample size for PRO endpoints in clinical trials without prior programming knowledge.
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Affiliation(s)
- Jinxiang Hu
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Xiaohang Mei
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sam Pepper
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Yu Wang
- Biometrics, Bristol Myers Squibb, USA
| | - Bo Zhang
- Food & Drug Administration, Division of Biometrics III, USA
| | - Colin Cernik
- Department of Data Science, Dana-Farber Cancer Institute, USA
| | - Byron Gajewski
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
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Li Y, Zhu L, Zhu C, Chen Y, Yu H, Zhu H, Yin P, Liu M, Li Y, Li H, Gong Z, Hanzi Xu, Han J. Circulating micrornas as potential diagnostic biomarkers for cervical intraepithelial neoplasia and cervical cancer: a systematic review and meta-analysis. Discov Oncol 2024; 15:189. [PMID: 38801504 PMCID: PMC11130102 DOI: 10.1007/s12672-024-01028-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Cervical cancer is a prevalent malignancy of the female reproductive system. Cervical intraepithelial neoplasia (CIN) is a precursor lesion for CC. Various studies have examined circulating microRNAs (miRNAs) as potential early diagnostic markers for CC and CIN. However, the findings have been inconclusive. Therefore, it is necessary to evaluate the diagnostic accuracy and identify potential sources of variability among these studies. METHODS The PubMed, Cochrane Library, Embase, and Web of Science databases were searched to identify relevant literature. Then, Stata 14.0 was utilized to calculate summary estimates for diagnostic parameters, including sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic (ROC). To scrutinize the heterogeneity, the Cochran-Q test and I2 statistic were utilized. As significant heterogeneity was observed, the random effects model was chosen. To explore potential sources of the heterogeneity, subgroup and regression analyses were conducted. RESULTS We analysed 12 articles reporting on 24 studies involving 1817 patients and 1731 healthy controls. The pooled sensitivity was 0.77 (95% CI 0.73-0.81), the specificity was 0.81 (95% CI 0.73-0.86), the PLR was 3.99 (95% CI 2.81-5.65), the NLR was 0.28 (95% CI 0.23-0.35), the DOR was 14.18 (95% CI 8.47-23.73), and the area under the curve (AUC) was 0.85 (95% CI 0.81-0.87). Subgroup analysis revealed that multiple miRNAs can improve diagnostic performance; the pooled sensitivity of multiple miRNAs was 0.78 (95% CI 0.68-0.86), the specificity was 0.85 (95% CI 0.78-0.90), and the AUC was 0.89 (95% CI 0.86-0.91). CONCLUSION This study suggested that circulating microRNAs may be biomarkers for early CC diagnosis.
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Affiliation(s)
- Yue Li
- Jiangsu Cancer Centre, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The AffiliatedCancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Longbiao Zhu
- Department of The Sixth Dental Division, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- State Key Laboratory Cultivation Base of Research, Prevention and Treatment for Oral Diseases, Nanjing Medical University, Nanjing, Jiangsu, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, Jiangsu, China
| | - Chenjing Zhu
- Jiangsu Cancer Centre, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The AffiliatedCancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yan Chen
- Jiangsu Cancer Centre, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The AffiliatedCancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hui Yu
- Jiangsu Cancer Centre, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The AffiliatedCancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hangju Zhu
- Jiangsu Cancer Centre, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The AffiliatedCancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ping Yin
- Jiangsu Cancer Centre, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The AffiliatedCancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Mengyu Liu
- Jiangsu Cancer Centre, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The AffiliatedCancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yang Li
- Jiangsu Cancer Centre, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The AffiliatedCancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Huixin Li
- Department of Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Woman and Children's HealthCare Hospital, Nanjing, Jiangsu, China
| | - Zhen Gong
- Department of Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Woman and Children's HealthCare Hospital, Nanjing, Jiangsu, China.
| | - Hanzi Xu
- Jiangsu Cancer Centre, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The AffiliatedCancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Jing Han
- Jiangsu Cancer Centre, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The AffiliatedCancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Yu X, Zoh RS, Fluharty DA, Mestre LM, Valdez D, Tekwe CD, Vorland CJ, Jamshidi-Naeini Y, Chiou SH, Lartey ST, Allison DB. Misstatements, misperceptions, and mistakes in controlling for covariates in observational research. eLife 2024; 13:e82268. [PMID: 38752987 PMCID: PMC11098558 DOI: 10.7554/elife.82268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 04/02/2024] [Indexed: 05/18/2024] Open
Abstract
We discuss 12 misperceptions, misstatements, or mistakes concerning the use of covariates in observational or nonrandomized research. Additionally, we offer advice to help investigators, editors, reviewers, and readers make more informed decisions about conducting and interpreting research where the influence of covariates may be at issue. We primarily address misperceptions in the context of statistical management of the covariates through various forms of modeling, although we also emphasize design and model or variable selection. Other approaches to addressing the effects of covariates, including matching, have logical extensions from what we discuss here but are not dwelled upon heavily. The misperceptions, misstatements, or mistakes we discuss include accurate representation of covariates, effects of measurement error, overreliance on covariate categorization, underestimation of power loss when controlling for covariates, misinterpretation of significance in statistical models, and misconceptions about confounding variables, selecting on a collider, and p value interpretations in covariate-inclusive analyses. This condensed overview serves to correct common errors and improve research quality in general and in nutrition research specifically.
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Affiliation(s)
- Xiaoxin Yu
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-BloomingtonBloomingtonUnited States
| | - Roger S Zoh
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-BloomingtonBloomingtonUnited States
| | - David A Fluharty
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-BloomingtonBloomingtonUnited States
| | - Luis M Mestre
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-BloomingtonBloomingtonUnited States
| | - Danny Valdez
- Department of Applied Health Science, Indiana University School of Public Health-BloomingtonBloomingtonUnited States
| | - Carmen D Tekwe
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-BloomingtonBloomingtonUnited States
| | - Colby J Vorland
- Department of Applied Health Science, Indiana University School of Public Health-BloomingtonBloomingtonUnited States
| | - Yasaman Jamshidi-Naeini
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-BloomingtonBloomingtonUnited States
| | - Sy Han Chiou
- Department of Statistics and Data Science, Southern Methodist UniversityDallasUnited States
| | - Stella T Lartey
- University of Memphis, School of Public HealthMemphisUnited Kingdom
| | - David B Allison
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-BloomingtonBloomingtonUnited States
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Troeung L, Sarunga Raja TL, Mann G, Wagland J, MacLeod C, Martini A. IMproving psYchosocial adjustment to Traumatic Brain Injury from acute to chronic injury through development and evaluation of the myTBI online psychoeducation platform: protocol for a mixed-methods study. BMJ Open 2024; 14:e080030. [PMID: 38508623 PMCID: PMC10953309 DOI: 10.1136/bmjopen-2023-080030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION This protocol describes the myTBI study which aims to: (1) develop an online psychoeducation platform for people with traumatic brain injury (TBI), their family members/caregivers, and healthcare staff to improve psychosocial adjustment to TBI across different phases of injury (acute, postacute, and chronic), and (2) undertake an evaluation of efficacy, acceptability, and feasibility. METHODS AND ANALYSIS A three-stage mixed-methods research design will be used. The study will be undertaken across four postacute community-based neurorehabilitation and disability support services in Western Australia. Stage 1 (interviews and surveys) will use consumer-driven qualitative methodology to: (1) understand the recovery experiences and psychosocial challenges of people with TBI over key stages (acute, postacute, and chronic), and (2) identify required areas of psychosocial support to inform the psychoeducation platform development. Stage 2 (development) will use a Delphi expert consensus method to: (1) determine the final psychoeducation modules, and (2) perform acceptance testing of the myTBI platform. Finally, stage 3 (evaluation) will be a randomised stepped-wedge trial to evaluate efficacy, acceptability, and feasibility. Outcomes will be measured at baseline, postintervention, follow-up, and at final discharge from services. Change in outcomes will be analysed using multilevel mixed-effects modelling. Follow-up surveys will be conducted to evaluate acceptability and feasibility. ETHICS AND DISSEMINATION Ethics approval was granted by North Metropolitan Health Service Mental Health Research Ethics and Governance Office (RGS0000005877). Study findings will be relevant to clinicians, researchers, and organisations who are seeking a cost-effective solution to deliver ongoing psychoeducation and support to individuals with TBI across the recovery journey. TRIAL REGISTRATION NUMBER ACTRN12623000990628.
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Affiliation(s)
- Lakkhina Troeung
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Western Australia, Australia
| | - Thilaga L Sarunga Raja
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Western Australia, Australia
- Oats Street Rehabilitation Centre, Brightwater Care Group, East Victoria Park, Western Australia, Australia
| | - Georgina Mann
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Western Australia, Australia
- School of Psychological Science, The University of Western Australia, Crawley, Western Australia, Australia
| | - Janet Wagland
- Disability Services, Brightwater Care Group, Inglewood, Western Australia, Australia
| | - Colin MacLeod
- School of Psychological Science, The University of Western Australia, Crawley, Western Australia, Australia
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
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McKevitt S, White M, Petticrew M, Summerbell C, Vasiljevic M, Boyland E, Cummins S, Laverty AA, Junghans C, Millett C, De Vocht F, Hrobonova E, Vamos EP. Typology of how 'harmful commodity industries' interact with local governments in England: a critical interpretive synthesis. BMJ Glob Health 2023; 8:e010216. [PMID: 36690378 PMCID: PMC9872461 DOI: 10.1136/bmjgh-2022-010216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/20/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Industries that produce and market potentially harmful commodities or services (eg, tobacco, alcohol, gambling, less healthy foods and beverages) are a major influence on the drivers of behavioural risk factors for non-communicable diseases. The nature and impact of interactions between public bodies and 'harmful commodity industries' (HCIs) has been widely recognised and discussed at national and international levels, but to date little is known about such interactions at local or regional government levels. This study aimed to identify and characterise actual and potential interactions and proposes a typology of interactions between HCIs and English local authorities (LAs). METHODS Five electronic databases covering international literature (PubMed, EBSCO, OVID, Scopus and Web of Science) were searched up to June 2021. We also performed online searches for publicly available, web-based grey literature and documented examples of interactions in an English LA context. We conducted a critical interpretive synthesis of the published and grey literature to integrate and conceptualise the data in the context of English LAs. RESULTS We included 47 published papers to provide the frame for the typology, which was refined and contextualised for English LAs through the available grey literature. Three categories were developed, describing the medium through which interactions occur: (1) direct involvement with LAs, (2) involvement through intermediaries and (3) involvement through the local knowledge space. Within these, we grouped interactions into 10 themes defining their nature and identified illustrative examples. CONCLUSION Our typology identifies complex inter-relationships and characterises interactions between HCIs and LAs, with illustrative examples from English LAs. Drawn from well-established theories and frameworks in combination with contextual information on English LAs, this typology explores the LA perspective and could help local decision-makers to maximise population health while minimising negative impacts of HCIs. PROSPERO REGISTRATION NUMBER CRD42021257311.
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Affiliation(s)
- Sarah McKevitt
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Mark Petticrew
- PHP, London School of Hygiene and Tropical Medicine, London, UK
| | - Carolyn Summerbell
- Fuse - Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Milica Vasiljevic
- Fuse - Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK
- Department of Psychology, Durham University, Durham, UK
| | - Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Cornelia Junghans
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Frank De Vocht
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West, Bristol, UK
| | | | - Eszter P Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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Naughton M, Scott T, Weaving D, Solomon C, McLean S. Defining and quantifying fatigue in the rugby codes. PLoS One 2023; 18:e0282390. [PMID: 36897849 PMCID: PMC10004502 DOI: 10.1371/journal.pone.0282390] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
The rugby codes (i.e., rugby union, rugby league, rugby sevens [termed 'rugby']) are team-sports that impose multiple complex physical, perceptual, and technical demands on players which leads to substantial player fatigue post-match. In the post-match period, fatigue manifests through multiple domains and negatively influences recovery. There is, however, currently no definition of fatigue contextualised to the unique characteristics of rugby (e.g., locomotor and collision loads). Similarly, the methods and metrics which practitioners consider when quantifying the components of post-match fatigue and subsequent recovery are not known. The aims of this study were to develop a definition of fatigue in rugby, to determine agreement with this common definition of fatigue, and to outline which methods and metrics are considered important and feasible to implement to quantify post-match fatigue. Subject matter experts (SME) undertook a two-round online Delphi questionnaire (round one; n = 42, round two; n = 23). SME responses in round one were analysed to derive a definition of fatigue, which after discussion and agreement by the investigators, obtained 96% agreement in round two. The SME agreed that fatigue in rugby refers to a reduction in performance-related task ability which is underpinned by time-dependent negative changes within and between cognitive, neuromuscular, perceptual, physiological, emotional, and technical/tactical domains. Further, there were 33 items in the neuromuscular performance, cardio-autonomic, or self-report domains achieved consensus for importance and/or feasibility to implement. Highly rated methods and metrics included countermovement jump force/power (neuromuscular performance), heart rate variability (cardio-autonomic measures), and soreness, mood, stress, and sleep quality (self-reported assessments). A monitoring system including highly-rated fatigue monitoring objective and subjective methods and metrics in rugby is presented. Practical recommendations of objective and subjective measures, and broader considerations for testing and analysing the resulting data in relation to monitoring fatigue are provided.
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Affiliation(s)
- Mitchell Naughton
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Applied Sports Science and Exercise Testing Laboratory, University of Newcastle, Ourimbah, New South Wales, Australia
| | - Tannath Scott
- Carnegie Applied Rugby Research Centre, Leeds Beckett University, Leeds, West Yorkshire, United Kingdom
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Dan Weaving
- Carnegie Applied Rugby Research Centre, Leeds Beckett University, Leeds, West Yorkshire, United Kingdom
- * E-mail:
| | - Colin Solomon
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Scott McLean
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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Ibrahim N, Da Silva RB. Profile of health facilities and determinants of the family planning services supply to unmarried adolescents in Burkina Faso, Ghana, and Niger. Ghana Med J 2022; 56:115-126. [PMID: 38322740 PMCID: PMC10630035 DOI: 10.4314/gmj.v56i3s.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Objectives Despite numerous interventions to facilitate adolescents' access to family planning (FP) services in West Africa, studies reveal that unmarried adolescents have difficulties accessing these services. This study analyses the supply of the FP services package to unmarried adolescents as well as the profiles of the facilities that provide this package in Burkina Faso, Ghana, and Niger. Also, it examines the determinants of the supply of this package. Design The study adopted a spatiotemporal descriptive analysis and a binary logistic Generalized Estimating Equation (GEE) model. The data come from surveys conducted in the three countries between 2013 and 2019 as part of the Performance Monitoring and Accountability 2020 program. Participants The target population consists of health facilities that provide health services. Results The study indicates that more than 80% of FP services are provided by basic health facilities in Burkina Faso and Niger, while in Ghana, the profile is more diversified, including hospitals, polyclinics, and public and private primary health centres. The econometric analysis indicates that regional ownership, examination of client opinion data, ownership of a functioning computer, and knowledge of the served population are the main determinants of the supply of the FP services package to unmarried adolescents. Conclusion By identifying facility profiles and determinants of FP services supply, this study provides a pathway for action to ensure that adolescents have access to these services regardless of their marital status in West Africa. Funding This work was carried out with the support of the COMCAHPSS project funded by IDRC and the Adolescent Health in West Africa (Adowa) project funded by MRC.
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Koohi Rostamkalaee Z, Jafari M, Gorji HA. Demand-side Interventions to Control Moral Hazard in Health Systems, Beneficial or Detrimental: A Systematic Review Study. Med J Islam Repub Iran 2022; 36:69. [PMID: 36128264 PMCID: PMC9448464 DOI: 10.47176/mjiri.36.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/27/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Moral hazard is one of the main reasons for health market failure where supply-side and demand-side interventions are used for its control and prevention. This study aimed to identify the effects of demand-side interventions on moral hazards in health systems. Methods: For this systematic review, electronic databases, including Scopus, PubMed, Web of Science, Embase, ProQuest, Google Scholar's search engine, and Iranian databases such as SID and Magiran, were investigated. No time limitation was considered in the search process. The narrative synthesis approach was used for data analysis. Results: Out of 7484 retrieved papers, 61 papers were included in the study. The Identified effects were divided into 2 categories: health services consumption effects and financial effects, which were summarized in the form of advantages and disadvantages. The most important advantages included a decrease in the utilization of different services and a reduction in health expenditures. Also, the most important disadvantages included lower quality of care, shifting financing burden to the consumers, and limited access to necessary care. Conclusion: The results showed that the most benefits of interventions, especially in cost-sharing and waiting list interventions, are for insurance organizations, where the disadvantages also affect consumers more. Therefore, it is necessary to pay more attention to these effects and their management because a lack of attention in this regard may impair the performance of insurance financial protection and health provision as one of the major goals of the health system.
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Affiliation(s)
- Zohreh Koohi Rostamkalaee
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Jafari
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran,Corresponding author: Dr Mehdi Jafari,
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Appleton R, Loew J, Mughal F. Young people who have fallen through the mental health transition gap: a qualitative study on primary care support. Br J Gen Pract 2022; 72:e413-e420. [PMID: 35504728 PMCID: PMC9090175 DOI: 10.3399/bjgp.2021.0678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/17/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Owing to poor continuity of care between child and adult mental health services, young people are often discharged to their GP when they reach the upper boundary of child and adolescent mental health services (CAMHS). This handover is poorly managed, and GPs can struggle to support young people without input from specialist services. Little is known about young people's experiences of accessing mental health support from their GP after leaving CAMHS. AIM To explore the experiences and perspectives of young people and the parents/carers of young people receiving primary care support after CAMHS and to identify barriers and facilitators to accessing primary care. DESIGN AND SETTING Qualitative study with young people and parents in two English counties: London and West Midlands. METHOD Narrative interviews were conducted with 14 young people and 13 parents who had experienced poor continuity of care after reaching CAMHS transition boundary. Data were analysed using reflexive thematic analysis. RESULTS Three themes were identified: unmet mental health needs, disjointed care, and taking responsibility for the young person's mental health care. Barriers included the perception that GPs couldn't prescribe certain medication, anxiety caused by the general practice environment, and having to move to a new practice at university. Young people's positive experiences were more likely to include having a long-term relationship with their GP and finding that their GP made time to understand their needs and experiences. CONCLUSION GPs could help to meet the unmet needs of young people unable to access specialist mental health services after leaving CAMHS. There is a need for comprehensive handover of care from CAMHS to GPs, which could include a joint meeting with the young person and a member of the CAMHS team. Future research should focus on interventions which improve continuity of care for young people after leaving CAMHS, and collaborative working across community mental health services.
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Affiliation(s)
- Rebecca Appleton
- National Institute for Health Research (NIHR) Mental Health Policy Research Unit, Division of Psychiatry, UCL, London
| | - Joelle Loew
- Department of Languages and Literatures, University of Basel, Switzerland; lecturer in English business communication, Lucerne University of Applied Sciences and Arts, Switzerland
| | - Faraz Mughal
- School of Medicine, Keele University, Keele; honorary clinical research fellow, Unit of Academic Primary Care, University of Warwick, Coventry; affiliate, NIHR Greater Manchester Patient Safety Translational Research Centre, Keele University, Keele
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Remote primary care during the COVID-19 pandemic for people experiencing homelessness: a qualitative study. Br J Gen Pract 2022; 72:e492-e500. [PMID: 35379604 PMCID: PMC8999705 DOI: 10.3399/bjgp.2021.0596] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background The COVID-19 pandemic has caused unprecedented disruption and change to the organisation of primary care, including for people experiencing homelessness who may not have access to a phone. Little is known about whether the recent changes required to deliver services to people experiencing homelessness will help to address or compound inequality in accessing care. Aim To explore the experience and impact of organisational and technology changes in response to COVID-19 on access to health care for people experiencing homelessness. Design and setting An action-led and participatory research methodology was employed in three case study sites made up of primary care services delivering care for people experiencing homelessness. Method Individual semi-structured interviews were conducted with 21 people experiencing homelessness and 22 clinicians and support workers. Interviews were analysed using a framework approach. Results The move to remote telephone consultations highlighted the difficulties experienced by participants in accessing health care. These barriers included problems at the practice level associated with remote triage as participants did not always have access to a phone or the means to pay for a phone call. This fostered increased reliance on support workers and clinicians working in the community to provide or facilitate a primary care appointment. Conclusion The findings have emphasised the importance of addressing practical and technology barriers as well as supporting communication and choice for mode of consultation. The authors argue that consultations should not be remote ‘by default’ and instead take into consideration both the clinical and social factors underpinning health.
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Pereira MF, Buchanan T, Höglinger GU, Bogdanovic M, Tofaris G, Prangnell S, Sarangmat N, FitzGerald JJ, Antoniades CA. Longitudinal changes of early motor and cognitive symptoms in progressive supranuclear palsy: the OxQUIP study. BMJ Neurol Open 2022; 4:e000214. [PMID: 35128403 PMCID: PMC8785161 DOI: 10.1136/bmjno-2021-000214] [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: 08/31/2021] [Accepted: 12/19/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is a rare neurodegenerative condition characterised by a range of motor and cognitive symptoms. Very little is known about the longitudinal change in these symptoms over time. Moreover, the effectiveness of clinical scales to detect early changes in PSP is still a matter of debate. OBJECTIVE We aimed to determine longitudinal changes in PSP features using multiple closely spaced follow-up time points over a period of 2 years. Methods 28 healthy control and 28 PSP participants, with average time since onset of symptoms of 1.9 years, were prospectively studied every 3 months for up to 24 months. Changes from baseline scores were calculated at each follow-up time point using multiple clinical scales to identify longitudinal progression of motor and cognitive symptoms. RESULTS The Montreal Cognitive Assessment, but not the Mini-Mental State Examination, detected cognitive decline at baseline. Both scales revealed poor longitudinal sensitivity to clinical change in global cognitive symptoms. Conversely, the Movement Disorders Society Unified Parkinson's disease Rating Scale - part III and the PSP Rating Scale (PSPRS) reliably detected motor decline less than 2 years after disease onset. The 'Gait/Midline' PSPRS subscore consistently declined over time, with the earliest change being observed 6 months after baseline assessment. CONCLUSION While better cognitive screening tools are still needed to monitor cognitive decline in PSP, motor decline is consistently captured by clinical rating scales. These results support the inclusion of multiple follow-up time points in longitudinal studies in the early stages of PSP.
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Affiliation(s)
- Marta F Pereira
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Günter U Höglinger
- Department of Neurology, Technische Universität München & Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Munich, Germany
| | - Marko Bogdanovic
- Department of Neurology, Oxford University Hospitals, Oxford, UK
| | - George Tofaris
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Simon Prangnell
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - James J FitzGerald
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Breuer E, Remond M, Lighton S, Passalaqua J, Galouzis J, Stewart KA, Sullivan E. The needs and experiences of mothers while in prison and post-release: a rapid review and thematic synthesis. HEALTH & JUSTICE 2021; 9:31. [PMID: 34773158 PMCID: PMC8590213 DOI: 10.1186/s40352-021-00153-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/31/2021] [Indexed: 05/26/2023]
Abstract
BACKGROUND Women in prison are a vulnerable group, often with a history of abuse, out-of-home care, mental health problems and unemployment. Many are mothers when they become involved in the criminal justice system and their gender and parenting related needs are often not considered. The aim of this rapid review was to thematically synthesize the existing research on the needs and experiences of mothers while in, and following release from, prison in Australia. METHODS We conducted a rapid systematic search of electronic databases, search engines, the websites of key agencies, and contacted key agencies and researchers. RESULTS Twenty-two publications from 12 studies met the inclusion criteria and were thematically synthesized in relation to the mothers, their children, family and community, and systems and services which mothers had contact with. We found that mothers in prison have a history of disadvantage which is perpetuated by the trauma of imprisonment. Release from prison is a particularly challenging time for mothers. In relation to their children, the included studies showed that the imprisonment of mothers impacts their maternal identity and role and disrupts the mother-child relationship. Specific strategies are needed to maintain the mother-child relationship, and to ensure the needs and rights of the child are met. In relation to family and community, we found that although family and social support is an important need of women in prison, such support may not be available. Moreover, the stigma associated with having been in prison is a significant barrier to transitions into the community, including finding employment and housing. In relation to systems and services, although limited services exist to support women in prison and on release, these often do not consider the parenting role. Evaluations of parenting programs in prison found them to be acceptable and beneficial to participants but barriers to access limit the number of women who can participate. CONCLUSION Mothers have gender- and parenting-specific needs which should be considered in planning for corrective services in Australia. Any service redesign must place the woman and her children at the centre of the service.
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Affiliation(s)
- Erica Breuer
- College of Health, Medicine and Wellbeing, University of Newcastle, Level 4 West, Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia.
| | - Marc Remond
- College of Health, Medicine and Wellbeing, University of Newcastle, Level 4 West, Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia
| | | | - Jane Passalaqua
- College of Health, Medicine and Wellbeing, University of Newcastle, Level 4 West, Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia
| | | | | | - Elizabeth Sullivan
- College of Health, Medicine and Wellbeing, University of Newcastle, Level 4 West, Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia
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13
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Hu J, Thompson J, Mudaranthakam DP, Hinton LC, Streeter D, Park M, Terluin B, Gajewski B. Estimating power for clinical trials with Patient Reported Outcomes - using Item Response Theory. J Clin Epidemiol 2021; 141:141-148. [PMID: 34648941 DOI: 10.1016/j.jclinepi.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 09/26/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Patient reported outcomes (PRO) are widely used in quality of life (QOL) studies, health outcomes research, and clinical trials. The importance of PRO has been advocated by health authorities. Patient Reported Outcomes Measurement Information System (PROMIS) is a collection of standardized measures of PROs using Item Response Theory (IRT). However, in clinical trials with PROs as endpoints, observed scores are routinely used for power estimation rather than IRT scores. This paper aims to fill this gap and estimate power in a two-arm clinical trials with PROMIS measures as endpoints with IRT model. STUDY DESIGN AND SETTING We conducted a series of simulations to study the IRT power with validated PROMIS measures controlling factors including sample size, effect size, number of items, and missing data proportion. RESULTS Our results showed that sample size, effect size, and number of items are important indicators of IRT based power estimation for PROMIS measures. When effect size is small and sample size is limited, IRT model provides higher power than the closed form formula. CONCLUSION IRT based simulation should be used for power estimation in two-armed clinical, especially when there is small effect size or small sample size.
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Affiliation(s)
- Jinxiang Hu
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Jeffrey Thompson
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Dinesh Pal Mudaranthakam
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Lynn Chollet Hinton
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - David Streeter
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Michele Park
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Berend Terluin
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Location Vumc, Amsterdan
| | - Byron Gajewski
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
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Gupta S, Jain S, Yeh J, Guddati AK. Unequal allotment of patients in phase III oncology clinical trials. Am J Cancer Res 2021; 11:3735-3741. [PMID: 34354872 PMCID: PMC8332855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/10/2021] [Indexed: 06/13/2023] Open
Abstract
Patient enrollment in cancer clinical trials has traditionally been limited to an equal distribution between cases and controls, however recently some clinical trials have utilized an unequal distribution between the case and control arms. Trends and proportion of phase 3 cancer clinical trials that have an unequal allocation between the years 2010 and 2019 were studied from data extracted from clinicaltrials.gov. 323 trials with two arms and 35 trials with 3 arms were identified as randomized control trials with the primary purpose of a cancer-related treatment that provided allocation data. Amongst the trials with two arms, 238 trials had equal allocation and 85 trials had unequal allocation. Therefore, cancer clinical trials with unequal allocation represent about one in four 2-arm phase 3 trials. Amongst the eligible trials with three arms, 26 trials had equal allocation and 9 trials had unequal allocation. There was no significant difference in the annual proportion of trials with unequal allocation from 2010 to 2019. The categories of cancer which had the highest number of unequally allotted two-arm clinical trials were: gastrointestinal, breast, and genitourinary malignancies. This shift may represent a new trend in clinical trial design to help enhance closer monitoring of adverse events despite higher costs and lower statistical power attached to this method.
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Affiliation(s)
- Shruti Gupta
- Medical College of Georgia, Augusta UniversityAugusta, GA 30909, USA
| | - Shefali Jain
- Medical College of Georgia, Augusta UniversityAugusta, GA 30909, USA
| | - Justin Yeh
- Medical College of Georgia, Augusta UniversityAugusta, GA 30909, USA
| | - Achuta Kumar Guddati
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta UniversityAugusta, GA 30909, USA
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15
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GPs' and patients' views on the value of diagnosing anxiety disorders in primary care: a qualitative interview study. Br J Gen Pract 2021; 71:e450-e457. [PMID: 33824158 PMCID: PMC8049220 DOI: 10.3399/bjgp.2020.0959] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background In the UK between 1998 and 2008, GPs’ recording of anxiety symptoms increased, but their recording of anxiety disorders decreased. The reason for this decline is not clear, nor are the treatment implications for primary care patients. Aim To understand GPs’ and patients’ views on the value of diagnosing anxiety disorders in primary care. Design and setting In-depth interviews were conducted with 15 GPs and 20 patients, purposively sampled from GP practices in Bristol and the surrounding areas. Method Interviews were held either in person or by telephone. A topic guide was used to ensure consistency across the interviews. The interviews were audio-recorded, transcribed verbatim, and analysed thematically. Results GPs reported preferring to use symptom rather than diagnostic codes in order to avoid assigning potentially stigmatising labels, and because they felt diagnostic codes could encourage some patients to adopt a ‘sick role’. In addition, their decision to use a diagnostic code depended on symptom severity and chronicity, and these were hard to establish in a time-limited clinical consultation. In contrast, patients commented that receiving a diagnosis helped them to understand their symptoms, and encouraged them to engage with treatment. Conclusion GPs may be reluctant to diagnose an anxiety disorder, but patients can find a diagnosis helpful in terms of understanding their symptoms and the need for treatment. As limited consultation time can discourage discussions between GPs and patients, followup appointments and continuity of care may be particularly important for the management of anxiety in primary care.
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Fridman L, Rothman L, Howard AW, Hagel BE, Macarthur C. Methodological considerations in MVC epidemiological research. Inj Prev 2020; 27:155-160. [PMID: 33199349 PMCID: PMC8005794 DOI: 10.1136/injuryprev-2020-043987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 12/02/2022]
Abstract
Background The global burden of MVC injuries and deaths among vulnerable road users, has led to the implementation of prevention programmes and policies at the local and national level. MVC epidemiological research is key to quantifying MVC burden, identifying risk factors and evaluating interventions. There are, however, several methodological considerations in MVC epidemiological research. Methods This manuscript collates and describes methodological considerations in MVC epidemiological research, using examples drawn from published studies, with a focus on the vulnerable road user population of children and adolescents. Results Methodological considerations in MVC epidemiological research include the availability and quality of data to measure counts and calculate event rates and challenges in evaluation related to study design, measurement and statistical analysis. Recommendations include innovative data collection (eg, naturalistic design, stepped-wedge clinical trials), combining data sources for a more comprehensive representation of collision events, and the use of machine learning/artificial intelligence for large data sets. Conclusions MVC epidemiological research can be challenging at all levels: data capture and quality, study design, measurement and analysis. Addressing these challenges using innovative data collection and analysis methods is required.
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Affiliation(s)
- Liraz Fridman
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Linda Rothman
- School of Occupational and Public Health Faculty of Community Services, Ryerson University, Toronto, Ontario, Canada
| | - Andrew William Howard
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Orthopaedic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brent E Hagel
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Colin Macarthur
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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Graffigna G, Barello S, Morelli N, Gheduzzi E, Corbo M, Ginex V, Ferrari R, Lascioli A, Feriti C, Masella C. Place4Carers: a mixed-method study protocol for engaging family caregivers in meaningful actions for successful ageing in place. BMJ Open 2020; 10:e037570. [PMID: 32788189 PMCID: PMC7422654 DOI: 10.1136/bmjopen-2020-037570] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Engaging family caregivers could be a critical asset to make the 'ageing-in-place' imperative a reality. This is particularly evident in rural and remote areas, where caregivers can fill the gaps that exist due to the fragmentation of the welfare system. However, there is little knowledge about the expectations that family caregivers have from healthcare services in rural and remote areas.Place4Carers (P4C) project aims to co-produce an innovative organisational model of social and healthcare services for family caregivers of older citizens living in Vallecamonica (Italy). The project is expected to facilitate ageing-in-place for older citizens, thus helping caregivers in their daily care activities. METHODS AND ANALYSIS P4C is a community-based participatory research project featuring five work packages (WPs). WP1 consists of a survey of unmet needs of caregivers and older people receiving services in Vallecamonica. WP2 consists of a scoping literature review to map services that provide interventions of support to caregivers living in remote areas and promote engagement. WP3 organises co-creation workshops with caregivers to co-design, co-manage, and co-assess ideas and proposals for shaping caregiver-oriented services and organisational models. WP3 enriches the results of WP1 (survey) and WP2 (scoping literature review), and aims to co-create new ideas for intervention support with and for caregivers in relation to the objectives, features and characteristics of a new service able to address the caregivers' needs and expectations. WP4 tests the service ideas co-created in WP3 through piloting an intervention based on ideas co-created with caregivers. Finally, WP5 assesses the transferability of the intervention to other similar contexts. ETHICS AND DISSEMINATION The study has been approved by the Ethics Committees of the Department of Psychology of Università Cattolica del Sacro Cuore and Politecnico of Milan. Results will be disseminated through peer-reviewed journals, scientific meetings and meetings with the general population.
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Affiliation(s)
- Guendalina Graffigna
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan and Cremona, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Serena Barello
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan and Cremona, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Niccolò Morelli
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan and Cremona, Italy
- Department of Sociology and Business Law, Università di Bologna, Bologna, Italy
| | - Eleonora Gheduzzi
- Department of Management Engineering, Politecnico di Milano, Milano, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico (CCP), Milano, Italy
- Fondazione NEED Institute, Milan, Italy
| | - Valeria Ginex
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico (CCP), Milano, Italy
- Fondazione NEED Institute, Milan, Italy
| | - Roberta Ferrari
- Azienda Territoriale per i Servizi alla Persona Vallecamonica, Breno, Italy
| | - Andrea Lascioli
- Azienda Territoriale per i Servizi alla Persona Vallecamonica, Breno, Italy
| | - Carolina Feriti
- Azienda Territoriale per i Servizi alla Persona Vallecamonica, Breno, Italy
| | - Cristina Masella
- Department of Management Engineering, Politecnico di Milano, Milano, Italy
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18
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Omega-3 Fatty Acids for Obesity and Asthma: Is the Good Fat Not Quite Good Enough? Ann Am Thorac Soc 2019; 16:542-544. [PMID: 31042092 DOI: 10.1513/annalsats.201901-049ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Ho CLB, Breslin M, Doust J, Reid CM, Nelson MR. Effectiveness of blood pressure-lowering drug treatment by levels of absolute risk: post hoc analysis of the Australian National Blood Pressure Study. BMJ Open 2018; 8:e017723. [PMID: 29555790 PMCID: PMC5875665 DOI: 10.1136/bmjopen-2017-017723] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES In many current guidelines, blood pressure (BP)-lowering drug treatment for primary prevention of cardiovascular disease (CVD) is based on absolute risk. However, in clinical practice, therapeutic decisions are often based on BP levels alone. We sought to investigate which approach was superior by conducting a post hoc analysis of the Australian National Blood Pressure (ANBP) cohort, a seminal study establishing the efficacy of BP lowering in 'mild hypertensive' persons. DESIGN A post hoc subgroup analysis of the ANBP trial results by baseline absolute risk tertile. SETTING AND PARTICIPANTS 3244 participants aged 35-69 years in a community-based randomised placebo controlled trial of blood pressure-lowering medication. INTERVENTIONS Chlorothiazide500 mg versus placebo. PRIMARY OUTCOME MEASURES All-cause mortality and non-fatal events (non-fatal CVD, congestive cardiac failure, renal failure, hypertensive retinopathy or encephalopathy). RESULTS Treatment effects were assessed by HR, absolute risk reduction and number needed to treat. Participants had an average 5-year CVD risk in the intermediate range (10.5±6.5) with moderately elevated BP (mean 159/103 mmHg) and were middle aged (52±8 years). In a subgroup analysis, the relative effects (HR) and absolute effects (absolute risk reduction and number needed to treat) did not statistically differ across the three risk groups except for the absolute benefit in all-cause mortality (p for heterogeneity=0.04). With respect to absolute benefit, drug treatment significantly reduced the number of events in the high-risk group regarding any event with a number needed to treat of 18 (10 to 64), death from any cause with 45 (25 to 196) and major CVD events with 23 (12 to 193). CONCLUSION Our analysis confirms that the benefit of treatment was substantial only in the high-risk tertile, reaffirming the rationale of treating elevated blood pressure in the setting of all risk factors rather than in isolation.
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Affiliation(s)
- Chau Le Bao Ho
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Jenny Doust
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Christopher M Reid
- School of Public Health, Curtin University, Perth, Western Australia, Australia
- CCRE Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- CCRE Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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20
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Maruthi YA, Ramprasad S, Lakshmana Das N. Trace Elemental Characterization of Chalk Dust and Their Associated Health Risk Assessment. Biol Trace Elem Res 2017; 175:466-474. [PMID: 27283836 DOI: 10.1007/s12011-016-0769-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
It is evident that chalk produces dust on use, i.e., particulate matter, which will alter the air quality of classrooms and can cause health hazards in teachers. The possible causes for health effects of chalk dust on teachers are still unclear. Hence, the aim of this study is to estimate the concentration of trace elements (Al, Cr, Mn, Fe, Co, Ni, Si, Pb) in chalk dust collected from classrooms by using ICP-MS. Both suspended and settled chalk dust was collected from selected classrooms. Suspended chalk dust was collected with PM2.5 filter paper using fine dust sampler, and settled chalk dust was collected by placing petriplates at a distance of 3 m from the board for a duration period of 30 min. Scanning electron microscopy images of chalk dust were taken up. Potential health risk analysis was also assessed. Results showed that Al, Fe, and Mn are in higher concentration (>1000 μg kg-1) in both settled and suspended chalk dust. Cr, Mn, Fe, Co, and Ni were beyond the minimal risk levels in both settled and suspended chalk dust. There are no minimal risk levels for the elements Al, Si, and Pb. The concentration of trace elements in suspended chalk dust was higher than that in settled chalk dust. The SEM images of PM2.5 filter papers (suspended chalk dust) showed that all pores of the sampled filter papers are clogged with chalk dust. The few SEM images of the settled chalk dust showed fibrous shape which is associated with good-quality chalk whereas others showed circular and more aggregated nature of chalk dust from low-quality chalk from which the dust production will be very high. As observed from the result that the trace elements concentration was high in the suspended chalk dust, the fact can be correlated with the SEM images which have shown high density of absorbed chalk dust. With reference to human health risk, dermal exposure was the main route of exposure followed by inhalation and ingestion. Al (aluminum), Fe (iron), Si (silicon), and Mn (manganese) are the major contributors for the non-carcinogenic effects. For all the elements, the carcinogenic effect calculated (LADD) is within the global acceptable limit (10-6-10-4).
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Affiliation(s)
- Y A Maruthi
- Department of Environmental Studies, GITAM Institute of Science, GITAM University, Visakhapatnam, AP, India.
| | - S Ramprasad
- Department of Environmental Studies, GITAM Institute of Science, GITAM University, Visakhapatnam, AP, India
| | - N Lakshmana Das
- Department of Physics, GITAM Institute of Science, GITAM University, Visakhapatnam, AP, India
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Doostfatemeh M, Taghi Ayatollah SM, Jafari P. Power and Sample Size Calculations in Clinical Trials with Patient-Reported Outcomes under Equal and Unequal Group Sizes Based on Graded Response Model: A Simulation Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:639-47. [PMID: 27565281 DOI: 10.1016/j.jval.2016.03.1857] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 03/10/2016] [Accepted: 03/19/2016] [Indexed: 05/10/2023]
Abstract
OBJECTIVES To provide a valid sample size strategy based on simulation and to evaluate the statistical power in clinical trials with patient-reported outcomes (PROs) based on a polytomous item response theory model-the graded response model (GRM)-and to compare this framework with the classical test theory (CTT) approach. METHODS One thousand randomized clinical trials were simulated using PRO based on the GRM and under various combinations of the number of patients in each arm, the group allocation ratio, the number of items and categories, and group effects. The power and sample size estimated in the simulations were then compared with those computed using the CTT framework. RESULTS The results indicated that the impact of the most influential factors, including the number of patients, group allocation ratio, group effects, and the number of categories, on the power and sample size of the GRM-based and CTT-based approaches was similar. Nevertheless, the strong impact of the number of items on these issues distinguished the two approaches. CONCLUSIONS It is crucial to use an adapted sample size formula in a GRM-based analysis because the classical formula designed for the CTT-based approach does not consider the impact of the number of items, which could result in an inadequately sized study and a decrease in power. Thus, when clinicians design a randomized clinical trial with polytomous PRO endpoints using classical sample size formula as the base, they should be aware of the possibility of making an incorrect clinical decision.
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Affiliation(s)
| | | | - Peyman Jafari
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
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Munyewende PO, Rispel LC, Chirwa T. Positive practice environments influence job satisfaction of primary health care clinic nursing managers in two South African provinces. HUMAN RESOURCES FOR HEALTH 2014; 12:27. [PMID: 24885785 PMCID: PMC4024627 DOI: 10.1186/1478-4491-12-27] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 04/29/2014] [Indexed: 06/01/2023]
Abstract
BACKGROUND Nurses constitute the majority of the health workforce in South Africa and they play a major role in providing primary health care (PHC) services. Job satisfaction influences nurse retention and successful implementation of health system reforms. This study was conducted in light of renewed government commitment to reforms at the PHC level, and to contribute to the development of solutions to the challenges faced by the South African nursing workforce. The objective of the study was to determine overall job satisfaction of PHC clinic nursing managers and the predictors of their job satisfaction in two South African provinces. METHODS During 2012, a cross-sectional study was conducted in two South African provinces. Stratified random sampling was used to survey a total of 111 nursing managers working in PHC clinics. These managers completed a pre-tested Measure of Job Satisfaction questionnaire with subscales on personal satisfaction, workload, professional support, training, pay, career prospects and standards of care. Mean scores were used to measure overall job satisfaction and various subscales. Predictors of job satisfaction were determined through multiple logistic regression analysis. RESULTS A total of 108 nursing managers completed the survey representing a 97% response rate. The mean age of respondents was 49 years (SD = 7.9) and the majority of them (92%) were female. Seventy-six percent had a PHC clinical training qualification. Overall mean job satisfaction scores were 142.80 (SD = 24.3) and 143.41 (SD = 25.6) for Gauteng and Free State provinces respectively out of a maximum possible score of 215. Predictors of job satisfaction were: working in a clinic of choice (RRR = 3.10 (95% CI: 1.11 to 8.62, P = 0.030)), being tired at work (RRR = 0.19 (95% CI: 0.08 to 0.50, P = 0.001)) and experience of verbal abuse (RRR = 0.18 (95% CI: 0.06 to 0.55, P = 0.001). CONCLUSION Allowing nurses greater choice of clinic to work in, the prevention of violence and addressing workloads could improve the practice environment and job satisfaction of PHC clinic nursing managers.
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Affiliation(s)
- Pascalia Ozida Munyewende
- Centre for Health Policy & Medical Research Council Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Private Bag X3, Wits 2050 Braamfontein, Johannesburg, South Africa
| | - Laetitia Charmaine Rispel
- Centre for Health Policy & Medical Research Council Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Private Bag X3, Wits 2050 Braamfontein, Johannesburg, South Africa
| | - Tobias Chirwa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Do Intensivist Staffing Patterns Influence Hospital Mortality Following ICU Admission? A Systematic Review and Meta-Analyses*. Crit Care Med 2013; 41:2253-74. [DOI: 10.1097/ccm.0b013e318292313a] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wilcox ME, Adhikari NKJ. The effect of telemedicine in critically ill patients: systematic review and meta-analysis. Crit Care 2012; 16:R127. [PMID: 22809335 PMCID: PMC3580710 DOI: 10.1186/cc11429] [Citation(s) in RCA: 162] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 06/08/2012] [Accepted: 07/18/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Telemedicine extends intensivists' reach to critically ill patients cared for by other physicians. Our objective was to evaluate the impact of telemedicine on patients' outcomes. METHODS We searched electronic databases through April 2012, bibliographies of included trials, and indexes and conference proceedings in two journals (2001 to 2012). We selected controlled trials or observational studies of critically ill adults or children, examining the effects of telemedicine on mortality. Two authors independently selected studies and extracted data on outcomes (mortality and length of stay in the intensive care unit (ICU) and hospital) and methodologic quality. We used random-effects meta-analytic models unadjusted for case mix or cluster effects and quantified between-study heterogeneity by using I² (the percentage of total variability across studies attributable to heterogeneity rather than to chance). RESULTS Of 865 citations, 11 observational studies met selection criteria. Overall quality was moderate (mean score on Newcastle-Ottawa scale, 5.1/9; range, 3 to 9). Meta-analyses showed that telemedicine, compared with standard care, is associated with lower ICU mortality (risk ratio (RR) 0.79; 95% confidence interval (CI), 0.65 to 0.96; nine studies, n = 23,526; I2 = 70%) and hospital mortality (RR, 0.83; 95% CI, 0.73 to 0.94; nine studies, n = 47,943; I² = 72%). Interventions with continuous patient-data monitoring, with or without alerts, reduced ICU mortality (RR, 0.78; 95% CI, 0.64 to 0.95; six studies, n = 21,384; I² = 74%) versus those with remote intensivist consultation only (RR, 0.64; 95% CI, 0.20 to 2.07; three studies, n = 2,142; I2 = 71%), but effects were statistically similar (interaction P = 0.74). Effects were also similar in higher (RR, 0.83; 95% CI, 0.68 to 1.02) versus lower (RR, 0.69; 95% CI, 0.40 to 1.19; interaction, P = 0.53) quality studies. Reductions in ICU and hospital length of stay were statistically significant (weighted mean difference (telemedicine-control), -0.62 days; 95% CI, -1.21 to -0.04 days and -1.26 days; 95% CI, -2.49 to -0.03 days, respectively; I2 > 90% for both). CONCLUSIONS Telemedicine was associated with lower ICU and hospital mortality among critically ill patients, although effects varied among studies and may be overestimated in nonrandomized designs. The optimal telemedicine technology configuration and dose tailored to ICU organization and case mix remain unclear.
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Affiliation(s)
- M Elizabeth Wilcox
- Department of Medicine, Toronto Western Hospital, and University of Toronto, McLaughlin Wing 2-411H, 399 Bathurst Street, Toronto ON M5T 2S8, Canada
| | - Neill KJ Adhikari
- Department of Critical Care Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre and University of Toronto, 2075 Bayview Avenue Room D1.08, Toronto ON M4N 3M5, Canada
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Fisher L, Hessler D, Naranjo D, Polonsky W. AASAP: a program to increase recruitment and retention in clinical trials. PATIENT EDUCATION AND COUNSELING 2012; 86:372-377. [PMID: 21831557 PMCID: PMC3219807 DOI: 10.1016/j.pec.2011.07.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 06/07/2011] [Accepted: 07/05/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To evaluate a theory based, subject-centered, staff/subject communication program, AASAP (anticipate, acknowledge, standardize, accept, plan), to increase recruitment and retention in RCTs. METHODS AASAP was evaluated with logistical regression by comparing rates of recruitment (at telephone screening, baseline assessment, initial intervention) and intervention retention (over 16 weeks) before (-AASAP) and after (+AASAP) it was introduced to a 3-arm RCT to reduce disease distress among highly distressed subjects with type 2 diabetes. RESULTS Included were 250 subjects in -AASAP and 338 in +AASAP. Significant improvement in recruitment occurred at each of the 3 recruitment stages: agreed at screening (OR=2.52; p<0.001), attended baseline assessment (OR=1.91; p<0.001), attended initial intervention (OR=1.46; p<0.03). Higher education and shorter diabetes duration predicted better recruitment in -AASAP (OR=2.23; p<0.001), but not in +AASAP. AASAP also improved intervention retention over 16 weeks (OR=3.46; p<0.05). CONCLUSION AASAP is a structured program of subject/staff communication that helps improve external validity by enhancing both subject recruitment and retention. PRACTICAL IMPLICATIONS AASAP can be taught to non-professional staff and can be adapted to a variety of health settings. It can also be used by clinicians to engage patients in programs of ongoing care.
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Affiliation(s)
- Lawrence Fisher
- Department of Family & Community Medicine, University of California, San Francisco, USA.
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Bagheri Z, Ayatollahi SMT, Jafari P. Comparison of three tests of homogeneity of odds ratios in multicenter trials with unequal sample sizes within and among centers. BMC Med Res Methodol 2011; 11:58. [PMID: 21518458 PMCID: PMC3114016 DOI: 10.1186/1471-2288-11-58] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 04/26/2011] [Indexed: 11/10/2022] Open
Abstract
Background Mixed effects logistic models have become a popular method for analyzing multicenter clinical trials with binomial data. However, the statistical properties of these models for testing homogeneity of odds ratios under various conditions, such as within-center and among-centers inequality, are still unknown and not yet compared with those of commonly used tests of homogeneity. Methods We evaluated the effect of within-center and among-centers inequality on the empirical power and type I error rate of the three homogeneity tests of odds ratios including likelihood ratio (LR) test of a mixed logistic model, DerSimonian-Laird (DL) statistic and Breslow-Day (BD) test by simulation study. Moreover, the impacts of number of centers (K), number of observations in each center and amount of heterogeneity were investigated by simulation. Results As compared with the equal sample size design, the power of the three tests of homogeneity will decrease if the same total sample size, which can be allocated equally within one center or among centers, is allocated unequally. The average reduction in the power of these tests was up to 11% and 16% for within-center and among-centers inequality, respectively. Moreover, in this situation, the ranking of the power of the homogeneity tests was BD≥DL≥LR and the power of these tests increased with increasing K. Conclusions This study shows that the adverse effect of among-centers inequality on the power of the homogeneity tests was stronger than that of within-center inequality. However, the financial limitations make the use of unequal sample size designs inevitable in multicenter trials. Moreover, although the power of the BD is higher than that of the LR when K≤6, the proposed mixed logistic model is recommended when K≥8 due to its practical advantages.
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Affiliation(s)
- Zahra Bagheri
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
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Zhu VJ, Overhage MJ, Egg J, Downs SM, Grannis SJ. An empiric modification to the probabilistic record linkage algorithm using frequency-based weight scaling. J Am Med Inform Assoc 2009; 16:738-45. [PMID: 19567789 PMCID: PMC2744724 DOI: 10.1197/jamia.m3186] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 06/02/2009] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To incorporate value-based weight scaling into the Fellegi-Sunter (F-S) maximum likelihood linkage algorithm and evaluate the performance of the modified algorithm. Background Because healthcare data are fragmented across many healthcare systems, record linkage is a key component of fully functional health information exchanges. Probabilistic linkage methods produce more accurate, dynamic, and robust matching results than rule-based approaches, particularly when matching patient records that lack unique identifiers. Theoretically, the relative frequency of specific data elements can enhance the F-S method, including minimizing the false-positive or false-negative matches. However, to our knowledge, no frequency-based weight scaling modification to the F-S method has been implemented and specifically evaluated using real-world clinical data. METHODS The authors implemented a value-based weight scaling modification using an information theoretical model, and formally evaluated the effectiveness of this modification by linking 51,361 records from Indiana statewide newborn screening data to 80,089 HL7 registration messages from the Indiana Network for Patient Care, an operational health information exchange. In addition to applying the weight scaling modification to all fields, we examined the effect of selectively scaling common or uncommon field-specific values. RESULTS The sensitivity, specificity, and positive predictive value for applying weight scaling to all field-specific values were 95.4, 98.8, and 99.9%, respectively. Compared with nonweight scaling, the modified F-S algorithm demonstrated a 10% increase in specificity with a 3% decrease in sensitivity. CONCLUSION By eliminating false-positive matches, the value-based weight modification can enhance the specificity of the F-S method with minimal decrease in sensitivity.
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Affiliation(s)
- Vivienne J Zhu
- Regenstrief Institute, Inc., 410 West 10 Street, Suite 2000, Indianapolis, IN 46202-3012, USA.
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Ziegler R. Mistletoe Preparation Iscador: Are there Methodological Concerns with Respect to Controlled Clinical Trials? EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2009; 6:19-30. [PMID: 18955241 PMCID: PMC2644282 DOI: 10.1093/ecam/nem121] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Accepted: 06/07/2007] [Indexed: 11/14/2022]
Abstract
In Europe many cancer patients use complementary therapies, particularly mistletoe. Only a few controlled clinical trials have been performed with the mistletoe preparation Iscador as a complementary treatment for cancer, many of them with medium to low quality due to methodological shortcomings. Reasons for some quality concerns, particularly discontinuation of treatment and/or participation and premature termination are analyzed. Analysis is based on controlled clinical trials dealing with Iscador. Data stem from the archive of published and ongoing research of the <> (Society for Cancer Research) in Arlesheim, Switzerland. Controlled clinical studies with cancer patients that were started after 01.01.1990 or were not completed by then have been evaluated. Fifty-six controlled studies are documented, 24 of them randomized and 32 non-randomized. Nine of the randomized studies were done by matched-pair design, the others by conventional parallel group design; six of the last were terminated prematurely primarily for slow recruitment due to patient preferences and compliance of physicians. Patient and physician preference seem to be important factors limiting recruitment for randomized trials and hence implementation. This adds to the overall unwillingness of participation by patients with serious diseases. A well-balanced mix of designs using different research methods and outcomes is suggested combined with analyses, in countries where mistletoe therapy in general or Iscador in particular is unknown or not available.
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Affiliation(s)
- Renatus Ziegler
- Verein für Krebsforschung, Institut Hiscia, Kirschweg 9, CH-4144 Arlesheim, Switzerland;
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