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Kwak D, Liang Y, Shi X, Tan X. Comparing Machine Learning and Advanced Methods with Traditional Methods to Generate Weights in Inverse Probability of Treatment Weighting: The INFORM Study. Pragmat Obs Res 2024; 15:173-183. [PMID: 39386162 PMCID: PMC11462432 DOI: 10.2147/por.s466505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 09/19/2024] [Indexed: 10/12/2024] Open
Abstract
Purpose Observational research provides valuable insights into treatments used in patient populations in real-world settings. However, confounding is likely to occur if there are differences in patient characteristics associated with both the exposure and outcome between the groups being evaluated. One approach to reduce confounding and facilitate unbiased comparisons is inverse probability of treatment weighting (IPTW) using propensity scores. Machine learning (ML) and entropy balancing can potentially be used in generating propensity scores for IPTW, but there is limited literature on this application. We aimed to assess the feasibility of applying these methods for reducing confounding in observational studies. These methods were assessed in a study comparing cardiovascular outcomes in adults with type 2 diabetes and established atherosclerotic cardiovascular disease taking once-weekly glucagon-like peptide-1 receptor agonists or dipeptidyl peptidase-4 inhibitors. Methods We applied advanced methods to generate the propensity scores compared to the original logistic regression method in terms of covariate balance. After calculating weights, a weighted Cox proportional hazards model was used to calculate the sample average treatment effect. Support Vector Classification, Support Vector Regression, XGBoost, and LightGBM were the ML models used. Entropy balancing was also performed on features identified in the original cardiovascular outcomes study. Results Accuracy (range: 0.71 to 0.73), area under the curve (0.77 to 0.79), precision (0.53 to 0.60), recall (0.66 to 0.68), and F1 score (0.60 to 0.64) were similar between all of the advanced propensity score methods and traditional logistic regression. Among ML models, only XGBoost achieved balance in all measured baseline characteristics between the two treatment groups, closely approximating the performance of the original logistic regression. Entropy balancing weights provided the best performance among all models in balancing baseline characteristics, achieving near perfect balancing. Conclusion Among the advanced methods examined, entropy balancing weights performed the best for optimizing balancing and can produce similar results compared to traditional logistic regression.
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Affiliation(s)
- Doyoung Kwak
- Department of Electrical & Computer Engineering, Texas A&M University, College Station, TX, USA
| | | | - Xu Shi
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Xi Tan
- Novo Nordisk Inc, Plainsboro, NJ, USA
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Oberprieler NG, Pladevall-Vila M, Johannes C, Layton JB, Golozar A, Lavallee M, Liu F, Kubin M, Vizcaya D. FOUNTAIN: a modular research platform for integrated real-world evidence generation. BMC Med Res Methodol 2024; 24:224. [PMID: 39354358 PMCID: PMC11445988 DOI: 10.1186/s12874-024-02344-w] [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: 10/24/2023] [Accepted: 09/17/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Real-world evidence (RWE) plays a key role in regulatory and healthcare decision-making, but the potentially fragmentated nature of generated evidence may limit its utility for clinical decision-making. Heterogeneity and a lack of reproducibility in RWE resulting from inconsistent application of methodologies across data sources should be minimized through harmonization. METHODS This paper's aim is to describe and reflect upon a multidisciplinary research platform (FOUNTAIN; FinerenOne mUlti-database NeTwork for evidence generAtIoN) with coordinated studies using diverse RWE generation approaches and explore the platform's strengths and limitations. With guidance from an executive advisory committee of multidisciplinary experts and patient representatives, the goal of the FOUNTAIN platform is to harmonize RWE generation across a portfolio of research projects, including research partner collaborations and a common data model (CDM)-based program. FOUNTAIN's overarching objectives as a research platform are to establish long-term collaborations among pharmacoepidemiology research partners and experts and to integrate diverse approaches for RWE generation, including global protocol execution by research partners in local data sources and common protocol execution in multiple data sources through federated data networks, while ensuring harmonization of medical definitions, methodology, and reproducible artifacts across all studies. Specifically, the aim of the multiple studies run within the frame of FOUNTAIN is to provide insight into the real-world utilization, effectiveness, and safety of finerenone across its life-cycle. RESULTS Currently, the FOUNTAIN platform includes 9 research partner collaborations and 8 CDM-mapped data sources from 7 countries (United States, United Kingdom, China, Japan, The Netherlands, Spain, and Denmark). These databases and research partners were selected after a feasibility fit-for-purpose evaluation. Six multicountry, multidatabase, cohort studies are ongoing to describe patient populations, current standard of care, comorbidity profiles, healthcare resource use, and treatment effectiveness and safety in different patient populations with chronic kidney disease and type 2 diabetes. Strengths and potential limitations of FOUNTAIN are described in the context of valid RWE generation. CONCLUSION The establishment of the FOUNTAIN platform has allowed harmonized execution of multiple studies, promoting consistency both within individual studies that employ multiple data sources and across all studies run within the platform's framework. FOUNTAIN presents a proposal to efficiently improve the consistency and generalizability of RWE on finerenone.
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Affiliation(s)
| | - Manel Pladevall-Vila
- RTI Health Solutions, Barcelona, Spain
- The Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
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Deasy JO. Data Science Opportunities To Improve Radiotherapy Planning and Clinical Decision Making. Semin Radiat Oncol 2024; 34:379-394. [PMID: 39271273 DOI: 10.1016/j.semradonc.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Radiotherapy aims to achieve a high tumor control probability while minimizing damage to normal tissues. Personalizing radiotherapy treatments for individual patients, therefore, depends on integrating physical treatment planning with predictive models of tumor control and normal tissue complications. Predictive models could be improved using a wide range of rich data sources, including tumor and normal tissue genomics, radiomics, and dosiomics. Deep learning will drive improvements in classifying normal tissue tolerance, predicting intra-treatment tumor changes, tracking accumulated dose distributions, and quantifying the tumor response to radiotherapy based on imaging. Mechanistic patient-specific computer simulations ('digital twins') could also be used to guide adaptive radiotherapy. Overall, we are entering an era where improved modeling methods will allow the use of newly available data sources to better guide radiotherapy treatments.
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Affiliation(s)
- Joseph O Deasy
- Department of Medical Physics, Attending Physicist, Chief, Service for Predictive Informatics, Chair, Memorial Sloan Kettering Cancer Center, New York, NY..
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4
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Krupa AJ, Chrobak AA, Sołtys Z, Dudek D, Szewczyk B, Siwek M. Insulin resistance, clinical presentation and resistance to selective serotonin and noradrenaline reuptake inhibitors in major depressive disorder. Pharmacol Rep 2024; 76:1100-1113. [PMID: 38980569 PMCID: PMC11387451 DOI: 10.1007/s43440-024-00621-5] [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: 05/03/2024] [Revised: 06/15/2024] [Accepted: 06/26/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND The understanding of mechanisms underlying non-response to antidepressants is limited. The latest data highlights the role of insulin resistance (IR) in major depressive disorder (MDD) pathophysiology, presentation, and treatment efficacy. This work aimed to assess IR in MDD and explore the relationships between IR, MDD presentation and non-response to selective serotonin and noradrenaline reuptake inhibitors (SNRI). METHODS 67 MDD individuals: 36 responsive (MDD T[+]), 31 non-responsive (MDD T[-]) to SNRI and 30 healthy controls were recruited. The treatment response criteria were: Clinical Global Impression Scale-Improvement score of 1 or 2 after ≥ 8 weeks of treatment. Participants were assessed by physician and self-report tools measuring depression, anhedonia, anxiety, bipolarity, sleep quality. Blood samples were collected to assess fasting glucose and insulin levels and calculate HOMA-IR (homeostasis model assessment of insulin resistance). RESULTS MDD T[-] vs. MDD T[+] had significantly higher body mass index, insulin levels, and HOMA-IR. MDD T[-] presented higher levels of depressed mood, appetite/weight changes, loss of interest, energy, overall depressive symptoms, and sleep impairment; some evaluations suggested higher anhedonia and anxiety in MDD T[-] vs. MDD T[+]. Insulin and IR were weakly but significantly correlated with the severity of psychomotor symptoms, energy level, thoughts of death/suicide, self-criticism, appetite/weight, depressed mood symptoms, sleep problems. IR was weakly but significantly correlated with anhedonia. CONCLUSION IR appears to be linked to depressive symptoms characteristic of the "metabolic" MDD subtype, such as psychomotor changes, energy level, anhedonia, sleep problems, appetite/weight changes, state and trait anxiety, sleep quality, and non-response to SNRI.
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Affiliation(s)
- Anna J Krupa
- Department of Affective Disorders, Jagiellonian University Medical College, ul. Kopernika 21a, Krakow, 31-501, Poland
| | - Adrian A Chrobak
- Department of Adult Psychiatry, Jagiellonian University Medical College, Kopernika 21a, Krakow, 31-501, Poland
| | - Zbigniew Sołtys
- Institute of Zoology and Biomedical Research, Laboratory of Experimental Neuropathology, Jagiellonian University, Gronostajowa 9, Krakow, 30-387, Poland
| | - Dominika Dudek
- Department of Adult Psychiatry, Jagiellonian University Medical College, Kopernika 21a, Krakow, 31-501, Poland
| | - Bernadeta Szewczyk
- Department of Neurobiology, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, Krakow, 31-343, Poland
| | - Marcin Siwek
- Department of Affective Disorders, Jagiellonian University Medical College, ul. Kopernika 21a, Krakow, 31-501, Poland.
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de la Borderie G, Chimits D, Boroojerdi B, Brock M, Duda PW, Grimson F, Mahoney P, Strimenopoulou F, Cutter G, Aban I, Brauner S, Petersson M, Howard JF, Bennett N. Maintenance of zilucoplan efficacy in patients with generalised myasthenia gravis up to 24 weeks: a model-informed analysis. Ther Adv Neurol Disord 2024; 17:17562864241279125. [PMID: 39314260 PMCID: PMC11418339 DOI: 10.1177/17562864241279125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 08/09/2024] [Indexed: 09/25/2024] Open
Abstract
Background Clinical efficacy of zilucoplan has been demonstrated in a 12-week, placebo-controlled, phase III study in patients with acetylcholine receptor autoantibody-positive generalised myasthenia gravis (gMG). However, placebo-controlled zilucoplan data past 12 weeks are not available. Objectives Predict the treatment effect of zilucoplan versus control (placebo or standard of care) in patients with gMG up to 24 weeks. Design A model-informed analysis (MIA) within a Bayesian framework. Methods Part 1 of the MIA comprised a control meta-regression using aggregate data on control response over time from randomised studies and a national myasthenia gravis (MG) registry. In Part 2, a combined Bayesian analysis of individual patient-level data from the phase II (NCT03315130), RAISE (NCT04115293) and RAISE-XT (NCT04225871) studies of zilucoplan was conducted using posterior distributions from Part 1 as informative priors. Population mean treatment effect in the change from baseline (CFB) at week 24 in MG-Activities of Daily Living (MG-ADL) and quantitative MG (QMG) scores for zilucoplan versus control were assessed. Results At week 24, the predicted mean CFB in MG-ADL score was -4.55 (95% credible interval: -6.04, -3.13) with zilucoplan versus -2.00 (-3.35, -0.64) with control (difference: -2.55 [-3.76, -1.40]). The probability of a favourable treatment effect as measured by MG-ADL score at week 24 with zilucoplan versus control was >99.9%. There was an 82.8% probability that the difference in the predicted mean CFB in MG-ADL score at week 24 was greater than the clinically meaningful threshold (⩾2.0-point improvement). Comparable results were observed with QMG. Conclusion This MIA demonstrates the maintenance of efficacy with zilucoplan versus control up to 24 weeks. Through combining real-world evidence with data from randomised studies, this novel method to estimate long-term treatment efficacy facilitated reduced exposure to placebo in the phase III RAISE study. This methodology could be used to reduce the length of future placebo-controlled studies.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Gary Cutter
- Department of Biostatistics, The University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Inmaculada Aban
- Department of Biostatistics, The University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Susanna Brauner
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Malin Petersson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - James F. Howard
- Department of Neurology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kryukov M, Moriarty KP, Villamea M, O'Dwyer I, Chow O, Dormont F, Hernandez R, Bar-Joseph Z, Rufino B. Proxy endpoints - bridging clinical trials and real world data. J Biomed Inform 2024; 158:104723. [PMID: 39299565 DOI: 10.1016/j.jbi.2024.104723] [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: 06/20/2024] [Revised: 08/15/2024] [Accepted: 09/03/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVE Disease severity scores, or endpoints, are routinely measured during Randomized Controlled Trials (RCTs) to closely monitor the effect of treatment. In real-world clinical practice, although a larger set of patients is observed, the specific RCT endpoints are often not captured, which makes it hard to utilize real-world data (RWD) to evaluate drug efficacy in larger populations. METHODS To overcome this challenge, we developed an ensemble technique which learns proxy models of disease endpoints in RWD. Using a multi-stage learning framework applied to RCT data, we first identify features considered significant drivers of disease available within RWD. To create endpoint proxy models, we use Explainable Boosting Machines (EBMs) which allow for both end-user interpretability and modeling of non-linear relationships. RESULTS We demonstrate our approach on two diseases, rheumatoid arthritis (RA) and atopic dermatitis (AD). As we show, our combined feature selection and prediction method achieves good results for both disease areas, improving upon prior methods proposed for predictive disease severity scoring. CONCLUSION Having disease severity over time for a patient is important to further disease understanding and management. Our results open the door to more use cases in the space of RA and AD such as treatment effect estimates or prognostic scoring on RWD. Our framework may be extended beyond RA and AD to other diseases where the severity score is not well measured in electronic health records.
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Affiliation(s)
- Maxim Kryukov
- Data & Computational Science, R&D, Sanofi, 240 Richmond Street West, 3rd Floor, Toronto, M5V 1V6, Ontario, Canada.
| | - Kathleen P Moriarty
- Data & Computational Science, R&D, Sanofi, 240 Richmond Street West, 3rd Floor, Toronto, M5V 1V6, Ontario, Canada.
| | | | - Ingrid O'Dwyer
- Data & Computational Science, R&D, Sanofi, 240 Richmond Street West, 3rd Floor, Toronto, M5V 1V6, Ontario, Canada.
| | - Ohn Chow
- Clinical Immunology and Inflammation, R&D, Sanofi, 450 Water St, MA, Cambridge, 02141, MA, United States.
| | - Flavio Dormont
- Clinical Real World Evidence, R&D, Sanofi, 46 Av. de la Grande Armée, Paris, 75017, Île-de-France, France.
| | - Ramon Hernandez
- Clinical Real World Evidence, R&D, Sanofi, 46 Av. de la Grande Armée, Paris, 75017, Île-de-France, France.
| | - Ziv Bar-Joseph
- Data & Computational Science, R&D, Sanofi, 450 Water St, , MA, Cambridge, 02141, MA, United States.
| | - Brandon Rufino
- Data & Computational Science, R&D, Sanofi, 240 Richmond Street West, 3rd Floor, Toronto, M5V 1V6, Ontario, Canada.
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Yada S, Nishiyama T, Wakamiya S, Kawazoe Y, Imai S, Hori S, Aramaki E. Utility analysis and demonstration of real-world clinical texts: A case study on Japanese cancer-related EHRs. PLoS One 2024; 19:e0310432. [PMID: 39259727 PMCID: PMC11389901 DOI: 10.1371/journal.pone.0310432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 08/30/2024] [Indexed: 09/13/2024] Open
Abstract
Real-world data (RWD) in the medical field, such as electronic health records (EHRs) and medication orders, are receiving increasing attention from researchers and practitioners. While structured data have played a vital role thus far, unstructured data represented by text (e.g., discharge summaries) are not effectively utilized because of the difficulty in extracting medical information. We evaluated the information gained by supplementing structured data with clinical concepts extracted from unstructured text by leveraging natural language processing techniques. Using a machine learning-based pretrained named entity recognition tool, we extracted disease and medication names from real discharge summaries in a Japanese hospital and linked them to medical concepts using medical term dictionaries. By comparing the diseases and medications mentioned in the text with medical codes in tabular diagnosis records, we found that: (1) the text data contained richer information on patient symptoms than tabular diagnosis records, whereas the medication-order table stored more injection data than text. In addition, (2) extractable information regarding specific diseases showed surprisingly small intersections among text, diagnosis records, and medication orders. Text data can thus be a useful supplement for RWD mining, which is further demonstrated by (3) our practical application system for drug safety evaluation, which exhaustively visualizes suspicious adverse drug effects caused by the simultaneous use of anticancer drug pairs. We conclude that proper use of textual information extraction can lead to better outcomes in medical RWD mining.
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Affiliation(s)
- Shuntaro Yada
- Division of Information Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, Nara, Japan
| | - Tomohiro Nishiyama
- Division of Information Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, Nara, Japan
| | - Shoko Wakamiya
- Division of Information Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, Nara, Japan
| | - Yoshimasa Kawazoe
- Artificial Intelligence and Digital Twin in Healthcare, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shungo Imai
- Division of Drug Informatics, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Satoko Hori
- Division of Drug Informatics, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Eiji Aramaki
- Division of Information Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, Nara, Japan
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Somolinos-Simón FJ, García-Sáez G, Tapia-Galisteo J, Corcoy R, Elena Hernando M. Cluster analysis of adult individuals with type 1 diabetes: Treatment pathways and complications over a five-year follow-up period. Diabetes Res Clin Pract 2024; 215:111803. [PMID: 39089589 DOI: 10.1016/j.diabres.2024.111803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/14/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024]
Abstract
AIMS To identify subgroups of adults with type 1 diabetes and analyse their treatment pathways and risk of diabetes-related complications over a 5-year follow-up. METHODS We performed a k-means cluster analysis using the T1DExchange Registry (n = 6,302) to identify subgroups based on demographic and clinical characteristics. Annual reassessments linked treatment trajectories with these clusters, considering drug and technology use. Complication risks were analysed using Cox regression. RESULTS Five clusters were identified: 1) A favourable combination of all variables (31.67 %); 2) Longer diabetes duration (22.63 %); 3) Higher HbA1c levels (13.28 %); 4) Higher BMI (15.25 %); 5) Older age at diagnosis (17.17 %). Two-thirds of patients remained in their initial cluster annually. Technology adoption showed improved glycaemic control over time. Cox proportional hazards showed different risk patterns: Cluster 1 had low complication risk; Cluster 2 had the highest risk for retinopathy, coronary artery disease and autonomic neuropathy; Cluster 3 had the highest risk for albuminuria, depression and diabetic ketoacidosis; Cluster 4 had increased risk for multiple complications; Cluster 5 had the highest risk for hypertension and severe hypoglycaemia, with elevated coronary artery disease risk. CONCLUSIONS Clinical characteristics can identify subgroups of patients with T1DM showing differences in treatment and complications during follow-up.
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Affiliation(s)
- Francisco J Somolinos-Simón
- Centre for Biomedical Technology (CTB), ETSI de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - Gema García-Sáez
- Centre for Biomedical Technology (CTB), ETSI de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain; CIBER-BBN, ISCIII, Madrid, Spain.
| | - Jose Tapia-Galisteo
- Centre for Biomedical Technology (CTB), ETSI de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain; CIBER-BBN, ISCIII, Madrid, Spain
| | - Rosa Corcoy
- CIBER-BBN, ISCIII, Madrid, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Elena Hernando
- Centre for Biomedical Technology (CTB), ETSI de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain; CIBER-BBN, ISCIII, Madrid, Spain
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Gaboli M, López Lobato M, Valverde Fernández J, Ferrand Ferri P, Rubio Pérez E, Andrade Ruiz HA, López-Puerta González JM, Madruga-Garrido M. Effect of Nusinersen on Respiratory and Bulbar Function in Children with Spinal Muscular Atrophy: Real-World Experience from a Single Center. Neuropediatrics 2024. [PMID: 39102865 DOI: 10.1055/a-2379-7069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
BACKGROUND Due to the limited data from clinical trials and real-world settings in the realm of nusinersen, there is a need for further evidence. This study seeks to assess the impact of nusinersen, when combined with standard care, on bulbar function, respiratory function, and the necessity for respiratory support among pediatric patients with spinal muscular atrophy (SMA). METHODS Prospective observational study, involving pediatric SMA patients (Types 1-3) undergoing nusinersen treatment at the Hospital Universitario Virgen del Rocío in Spain over at least 24 months. The cohort included 11 SMA type 1 patients, comprising 6 type 1b and 5 type 1c, 12 SMA type 2 patients, and 5 SMA type 3 patients. RESULTS Twenty-eight pediatric patients were enrolled with the majority being male (n = 20). Patients with type 1 were diagnosed and received treatment significantly earlier than those with types 2 and 3 (p < 0.001). Additionally, there was a longer period between diagnosis and the start of treatment in types 2 and 3 (p = 0.002). Follow-up revealed statistically improved functional and respiratory outcomes associated with earlier initiation of nusinersen treatment at 6, 12, and 24 months in all phenotypes. The ability to swallow and feed correctly remained unchanged throughout the study, with SMA type 1c patients maintaining oral feeding in contrast to patients with SMA type 1b. Notably, no deaths were recorded. CONCLUSIONS This study provides important insights into the real-world clinical progress of pediatric SMA patients and their response to nusinersen treatment, highlighting the significance of early intervention for better functional and respiratory outcomes.
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Affiliation(s)
- Mirella Gaboli
- Paediatric Pulmonology Unit, Department of Paediatrics, Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Mercedes López Lobato
- Paediatric Neurology Unit, Department of Paediatrics, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Justo Valverde Fernández
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Department of Paediatrics, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Patricia Ferrand Ferri
- Paediatric Physical Medicine and Rehabilitation Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Eloisa Rubio Pérez
- Methodological and Statistical Management Unit, Fundación para la Gestión de la Investigación en Salud de Sevilla (FISEVI), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Henry A Andrade Ruiz
- Methodological and Statistical Management Unit, Fundación para la Gestión de la Investigación en Salud de Sevilla (FISEVI), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - José María López-Puerta González
- Spine Surgery, Department of Orthopaedic Surgery and Traumatology, Universitary Hospital Virgen del Rocío, Networking Biomedical Research Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Sevilla, Spain
| | - Marcos Madruga-Garrido
- Neurología Pediátrica, Hospital Viamed Santa Angela de la Cruz and Neurolinkia, Sevilla, Spain
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Lighterness A, Adcock M, Scanlon LA, Price G. Data Quality-Driven Improvement in Health Care: Systematic Literature Review. J Med Internet Res 2024; 26:e57615. [PMID: 39173155 PMCID: PMC11377907 DOI: 10.2196/57615] [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: 03/11/2024] [Revised: 05/10/2024] [Accepted: 05/30/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND The promise of real-world evidence and the learning health care system primarily depends on access to high-quality data. Despite widespread awareness of the prevalence and potential impacts of poor data quality (DQ), best practices for its assessment and improvement are unknown. OBJECTIVE This review aims to investigate how existing research studies define, assess, and improve the quality of structured real-world health care data. METHODS A systematic literature search of studies in the English language was implemented in the Embase and PubMed databases to select studies that specifically aimed to measure and improve the quality of structured real-world data within any clinical setting. The time frame for the analysis was from January 1945 to June 2023. We standardized DQ concepts according to the Data Management Association (DAMA) DQ framework to enable comparison between studies. After screening and filtering by 2 independent authors, we identified 39 relevant articles reporting DQ improvement initiatives. RESULTS The studies were characterized by considerable heterogeneity in settings and approaches to DQ assessment and improvement. Affiliated institutions were from 18 different countries and 18 different health domains. DQ assessment methods were largely manual and targeted completeness and 1 other DQ dimension. Use of DQ frameworks was limited to the Weiskopf and Weng (3/6, 50%) or Kahn harmonized model (3/6, 50%). Use of standardized methodologies to design and implement quality improvement was lacking, but mainly included plan-do-study-act (PDSA) or define-measure-analyze-improve-control (DMAIC) cycles. Most studies reported DQ improvements using multiple interventions, which included either DQ reporting and personalized feedback (24/39, 61%), IT-related solutions (21/39, 54%), training (17/39, 44%), improvements in workflows (5/39, 13%), or data cleaning (3/39, 8%). Most studies reported improvements in DQ through a combination of these interventions. Statistical methods were used to determine significance of treatment effect (22/39, 56% times), but only 1 study implemented a randomized controlled study design. Variability in study designs, approaches to delivering interventions, and reporting DQ changes hindered a robust meta-analysis of treatment effects. CONCLUSIONS There is an urgent need for standardized guidelines in DQ improvement research to enable comparison and effective synthesis of lessons learned. Frameworks such as PDSA learning cycles and the DAMA DQ framework can facilitate this unmet need. In addition, DQ improvement studies can also benefit from prioritizing root cause analysis of DQ issues to ensure the most appropriate intervention is implemented, thereby ensuring long-term, sustainable improvement. Despite the rise in DQ improvement studies in the last decade, significant heterogeneity in methodologies and reporting remains a challenge. Adopting standardized frameworks for DQ assessment, analysis, and improvement can enhance the effectiveness, comparability, and generalizability of DQ improvement initiatives.
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Affiliation(s)
- Anthony Lighterness
- Clinical Outcomes and Data Unit, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Michael Adcock
- Clinical Outcomes and Data Unit, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Lauren Abigail Scanlon
- Clinical Outcomes and Data Unit, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Gareth Price
- Radiotherapy Related Research Group, University of Manchester, Manchester, United Kingdom
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Ehman M, Punian J, Weymann D, Regier DA. Next-generation sequencing in oncology: challenges in economic evaluations. Expert Rev Pharmacoecon Outcomes Res 2024:1-18. [PMID: 39096135 DOI: 10.1080/14737167.2024.2388814] [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: 06/20/2024] [Revised: 07/19/2024] [Accepted: 08/01/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Next-generation sequencing (NGS) identifies genetic variants to inform personalized treatment plans. Insufficient evidence of cost-effectiveness impedes the integration of NGS into routine cancer care. The complexity of personalized treatment challenges conventional economic evaluation. Clearly delineating challenges informs future cost-effectiveness analyses to better value and contextualize health, preference-, and equity-based outcomes. AREAS COVERED We conducted a scoping review to characterize the applied methods and outcomes of economic evaluations of NGS in oncology and identify existing challenges. We included 27 articles published since 2016 from a search of PubMed, Embase, and Web of Science. Identified challenges included defining the evaluative scope, managing evidentiary limitations including lack of causal evidence, incorporating preference-based utility, and assessing distributional and equity-based impacts. These challenges reflect the difficulty of generating high-quality clinical effectiveness and real-world evidence (RWE) for NGS-guided interventions. EXPERT OPINION Adapting methodological approaches and developing life-cycle health technology assessment (HTA) guidance using RWE is crucial for implementing NGS in oncology. Healthcare systems, decision-makers, and HTA organizations are facing a pivotal opportunity to adapt to an evolving clinical paradigm and create innovative regulatory and reimbursement processes that will enable more sustainable, equitable, and patient-oriented healthcare.
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Affiliation(s)
- Morgan Ehman
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Jesman Punian
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Deirdre Weymann
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Dean A Regier
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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12
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Baden D, Zukunft S, Hernandez G, Wolgast N, Steinhauser S, Pohlmann A, Schliemann C, Mikesch JH, Steffen B, Sauer T, Hanoun M, Schafer-Eckart K, Krause SW, Hanel M, Einsele H, Jost E, Brummendorf TH, Scholl S, Hochhaus A, Neubauer A, Burchert A, Kaufmann M, Niemann D, Schaich M, Blau W, Kiani A, Gorner M, Kaiser U, Kullmer J, Weber T, Berdel WE, Ehninger G, Muller-Tidow C, Platzbecker U, Serve H, Bornhauser M, Rollig C, Baldus CD, Fransecky L. Time from diagnosis to treatment has no impact on survival in newly diagnosed acute myeloid leukemia treated with venetoclax-based regimens. Haematologica 2024; 109:2469-2477. [PMID: 38654660 PMCID: PMC11290507 DOI: 10.3324/haematol.2024.285225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024] Open
Abstract
In newly diagnosed acute myeloid leukemia (AML), immediate initiation of treatment is standard of care. However, deferral of antileukemic therapy may be indicated to assess comorbidities or pretherapeutic risk factors. We explored the impact of time from diagnosis to treatment on outcomes in newly diagnosed AML undergoing venetoclax-based therapy in two distinct cohorts. By querying the Study Alliance Leukemia database and the global health network TriNetX, we identified 138 and 717 patients respectively with an average age of 76 and 72 years who received venetoclax-based first-line therapy. When comparing patients who started treatment earlier or later than 10 days after initial diagnosis, no significant difference in median overall survival was observed - neither in the SAL cohort (7.7 vs. 9.6 months; P=0.42) nor in the TriNetX cohort (7.5 vs. 7.2 months; P=0.41). Similarly, severe infections, bleeding, and thromboembolic events were equally observed between early and later treatments, both in the overall patient groups and specific subgroups (age ≥75 years or leukocytes ≥20x109/L). This retrospective analysis indicates that delaying the start of venetoclax-based therapy in newly diagnosed AML might be a safe option for selected patients, provided that close clinical monitoring is performed.
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Affiliation(s)
- David Baden
- Department of Internal Medicine II, University Hospital Schleswig-Holstein, Kiel, Germany; University Cancer Center Schleswig-Holstein, University Hospital Schleswig-Holstein, Kiel.
| | - Sven Zukunft
- Medical Department I, University Hospital of TU Dresden, Dresden
| | | | - Nadine Wolgast
- Department of Internal Medicine II, University Hospital Schleswig-Holstein, Kiel, Germany; University Cancer Center Schleswig-Holstein, University Hospital Schleswig-Holstein, Kiel
| | - Sophie Steinhauser
- Department of Internal Medicine II, University Hospital Schleswig-Holstein, Kiel, Germany; University Cancer Center Schleswig-Holstein, University Hospital Schleswig-Holstein, Kiel
| | | | | | | | - Bjorn Steffen
- Medical Department II, J.-W.-Goethe University Hospital Frankfurt
| | - Tim Sauer
- Medical Department V, Heidelberg University Hospital
| | - Maher Hanoun
- Department of Hematology, Essen University Hospital
| | | | | | - Mathias Hanel
- Department for Internal Medicine III, Klinikum Chemnitz
| | | | - Edgar Jost
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany and Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Dusseldorf (ABCD), Aachen
| | - Tim H Brummendorf
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany and Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Dusseldorf (ABCD), Aachen
| | | | | | - Andreas Neubauer
- Department of Internal Medicine, Hematology, Oncology and Immunology, University Hospital Marburg
| | - Andreas Burchert
- Department of Internal Medicine, Hematology, Oncology and Immunology, University Hospital Marburg
| | - Martin Kaufmann
- Department of Hematology, Oncology and Palliative Medicine, Robert-Bosch-Hospital Stuttgart
| | - Dirk Niemann
- Internal Medicine, Hematology/Oncology, Palliative Medicine, Gemeinschaftsklinikum Mittelrhein, Koblenz
| | - Markus Schaich
- Department for Hematology, Oncology and Palliative Medicine, Rems-Murr-Klinikum, Winnenden
| | - Wolfgang Blau
- Department for Internal Medicine III, Helios Dr Schmidt Hospital Wiesbaden
| | - Alexander Kiani
- Department for Oncology and Hematology, Klinikum Bayreuth, and Comprehensive Cancer Center Erlangen-EMN
| | - Martin Gorner
- Department for Hematology, Oncology and Palliative Medicine, Klinikum Bielefeld, Bielefeld
| | - Ulrich Kaiser
- Medical Department II, St. Bernward Hospital, Hildesheim
| | | | - Thomas Weber
- Department for Internal Medicine IV, University Hospital Halle (Saale)
| | | | - Gerhard Ehninger
- Medical Department I, University Hospital of TU Dresden, Dresden
| | | | - Uwe Platzbecker
- Medical Department I, Hematology and Cell Therapy, University Hospital Leipzig
| | - Hubert Serve
- Medical Department II, J.-W.-Goethe University Hospital Frankfurt
| | | | - Christoph Rollig
- Medical Department I, University Hospital of TU Dresden, Dresden
| | - Claudia D Baldus
- Department of Internal Medicine II, University Hospital Schleswig-Holstein, Kiel, Germany; University Cancer Center Schleswig-Holstein, University Hospital Schleswig-Holstein, Kiel
| | - Lars Fransecky
- Department of Internal Medicine II, University Hospital Schleswig-Holstein, Kiel, Germany; University Cancer Center Schleswig-Holstein, University Hospital Schleswig-Holstein, Kiel
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13
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Liu F. Data Science Methods for Real-World Evidence Generation in Real-World Data. Annu Rev Biomed Data Sci 2024; 7:201-224. [PMID: 38748863 DOI: 10.1146/annurev-biodatasci-102423-113220] [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] [Indexed: 08/25/2024]
Abstract
In the healthcare landscape, data science (DS) methods have emerged as indispensable tools to harness real-world data (RWD) from various data sources such as electronic health records, claim and registry data, and data gathered from digital health technologies. Real-world evidence (RWE) generated from RWD empowers researchers, clinicians, and policymakers with a more comprehensive understanding of real-world patient outcomes. Nevertheless, persistent challenges in RWD (e.g., messiness, voluminousness, heterogeneity, multimodality) and a growing awareness of the need for trustworthy and reliable RWE demand innovative, robust, and valid DS methods for analyzing RWD. In this article, I review some common current DS methods for extracting RWE and valuable insights from complex and diverse RWD. This article encompasses the entire RWE-generation pipeline, from study design with RWD to data preprocessing, exploratory analysis, methods for analyzing RWD, and trustworthiness and reliability guarantees, along with data ethics considerations and open-source tools. This review, tailored for an audience that may not be experts in DS, aspires to offer a systematic review of DS methods and assists readers in selecting suitable DS methods and enhancing the process of RWE generation for addressing their specific challenges.
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Affiliation(s)
- Fang Liu
- Department of Applied and Computational Mathematics and Statistics, University of Notre Dame, Notre Dame, Indiana, USA;
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14
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Goudman L, Moens M, Kelly S, Young C, Pilitsis JG. Incidence of Infections, Explantations, and Displacements/Mechanical Complications of Spinal Cord Stimulation During the Past Eight Years. Neuromodulation 2024; 27:1082-1089. [PMID: 37855766 DOI: 10.1016/j.neurom.2023.09.001] [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: 07/24/2023] [Revised: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES The overall awareness and potential of real-world data have drastically increased in the medical field, with potential implications for postmarket medical device surveillance. The goal of this study was to evaluate real-world data on incidence of infections, explantations, and displacements/mechanical complications of spinal cord stimulation (SCS) during the past eight years and to forecast point estimates for the upcoming three years on the basis of the identified patterns. MATERIALS AND METHODS Based on electronic health records from 80 healthcare organizations within the TriNetX data base in the USA, data of 11,934 patients who received SCS as treatment for persistent spinal pain syndrome type 2 (PSPS T2) were extracted. Events of interest were explantations and displacements/mechanical complications of both the lead and implanted pulse generator (IPG), in addition to infection rates from 2015 to 2022. Mann-Kendall tests were performed to detect monotonic trends in the time series. Forecasts were conducted for the upcoming three years for every event of interest. RESULTS Statistically significant increasing time trends were revealed for the annual incidence of IPG and lead displacements/mechanical complications in patients with PSPS T2 over the past eight years. These time trends were visible in both male and female patients and in smokers and nonsmokers. For annual incidence of explantations and infections, no significant time effect was observed. In 2025, the incidence of displacements/mechanical complications of the lead (3.07%) is predicted to be the highest, followed by explantations of the IPG (2.67%) and lead (2.02%). CONCLUSIONS Based on real world data, device explantation was the most frequent event of interest, with negative peaks in the time series in 2016 and 2020, presumably due to the introduction of rechargeable pulse generators and to the COVID-19 pandemic, respectively.
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Affiliation(s)
- Lisa Goudman
- STIMULUS Research Group, Vrije Universiteit Brussel, Brussels, Belgium; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Research Foundation-Flanders, Brussels, Belgium; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.
| | - Maarten Moens
- STIMULUS Research Group, Vrije Universiteit Brussel, Brussels, Belgium; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Sophie Kelly
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Christopher Young
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Julie G Pilitsis
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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15
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Wu YE, Zheng YY, Li QY, Yao BF, Cao J, Liu HX, Hao GX, van den Anker J, Zheng Y, Zhao W. Model-informed drug development in pediatric, pregnancy and geriatric drug development: States of the art and future. Adv Drug Deliv Rev 2024; 211:115364. [PMID: 38936664 DOI: 10.1016/j.addr.2024.115364] [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: 09/25/2023] [Revised: 06/09/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
The challenges of drug development in pediatric, pregnant and geriatric populations are a worldwide concern shared by regulatory authorities, pharmaceutical companies, and healthcare professionals. Model-informed drug development (MIDD) can integrate and quantify real-world data of physiology, pharmacology, and disease processes by using modeling and simulation techniques to facilitate decision-making in drug development. In this article, we reviewed current MIDD policy updates, reflected on the integrity of physiological data used for MIDD and the effects of physiological changes on the drug PK, as well as summarized current MIDD strategies and applications, so as to present the state of the art of MIDD in pediatric, pregnant and geriatric populations. Some considerations are put forth for the future improvements of MIDD including refining regulatory considerations, improving the integrity of physiological data, applying the emerging technologies, and exploring the application of MIDD in new therapies like gene therapies for special populations.
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Affiliation(s)
- Yue-E Wu
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuan-Yuan Zheng
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qiu-Yue Li
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bu-Fan Yao
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jing Cao
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hui-Xin Liu
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Guo-Xiang Hao
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - John van den Anker
- Division of Clinical Pharmacology, Children's National Medical Center, Washington, DC, USA; Departments of Pediatrics, Pharmacology & Physiology, George Washington University, School of Medicine and Health Sciences, Washington, DC, USA; Department of Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, Basel, Switzerland
| | - Yi Zheng
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wei Zhao
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China.
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16
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Lai HW, See CY, Chen JY, Wu VC. Mortality and cardiovascular events in diabetes mellitus patients at dialysis initiation treated with glucagon-like peptide-1 receptor agonists. Cardiovasc Diabetol 2024; 23:277. [PMID: 39080745 PMCID: PMC11287940 DOI: 10.1186/s12933-024-02364-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/15/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Glucagon-like Peptide-1 Receptor Agonists (GLP-1RAs) have demonstrated efficacy in improving mortality and cardiovascular (CV) outcomes. However, the impact of GLP-1RAs therapy on cardiorenal outcomes of diabetic patients at the commencement of dialysis remains unexplored. PURPOSE This study aimed to investigate the long-term benefits of GLP-1RAs in type 2 diabetic patients at dialysis commencement. METHODS A cohort of type 2 diabetic patients initializing dialysis was identified from the TriNetX global database. Patients treated with GLP-1RAs and those treated with long-acting insulin (LAI) were matched by propensity score. We focused on all-cause mortality, four-point major adverse cardiovascular events (4p-MACE), and major adverse kidney events (MAKE). RESULTS Among 82,041 type 2 diabetic patients initializing dialysis, 2.1% (n = 1685) patients were GLP-1RAs users (mean ages 59.3 years; 55.4% male). 1682 patients were included in the propensity-matched group, treated either with GLP-1RAs or LAI. The main causes of acute dialysis in this study were ischemic heart disease (17.2%), followed by heart failure (13.6%) and sepsis (6.5%). Following a median follow-up of 1.4 years, GLP-1RAs uses at dialysis commencement was associated with a reduced risk of mortality (hazard ratio [HR] = 0.63, p < 0.001), 4p-MACE (HR = 0.65, p < 0.001), and MAKE (HR = 0.75, p < 0.001). This association was particularly notable in long-acting GLP-1RAs users, with higher BMI, lower HbA1c, and those with eGFR > 15 ml/min/1.73m2. GLP-1RAs' new use at dialysis commencement was significantly associated with a lower risk of MACE (p = 0.047) and MAKE (p = 0.004). Additionally, GLP-1RAs use among those who could discontinue from acute dialysis or long-term RAs users was associated with a lower risk of mortality, 4p-MACE, and MAKE. CONCLUSION Given to the limitations of this observational study, use of GLP-1RAs at the onset of dialysis was associated with a decreased risk of MACE, MAKE, and all-cause mortality. These findings show the lack of harm associated with the use of GLP-1RAs in diabetic patients at the initiation of acute dialysis.
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Affiliation(s)
| | - Chun Yin See
- Division of Nephrology, Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Jui-Yi Chen
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Centre, Tainan, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Vin-Cent Wu
- Division of Nephrology, Primary Aldosteronism Centre of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- NSARF (National Taiwan University Hospital Study Group of ARF, Consortium for Acute Kidney Injury and Renal Diseases), Taipei, Taiwan.
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, 100, Taiwan.
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17
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Hu YH, Yu F, Zhou YZ, Li AD. Surgical treatment of liver cancer and pancreatic cancer under the China Healthcare Security Diagnosis Related Groups payment system. World J Clin Cases 2024; 12:4673-4679. [PMID: 39070849 PMCID: PMC11235472 DOI: 10.12998/wjcc.v12.i21.4673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Data from the World Health Organization's International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022. Liver and pancreatic cancers accounted for the highest number of new cases. Real-world data (RWD) is now widely preferred to traditional clinical trials in various fields of medicine and healthcare, as the traditional research approach often involves highly selected populations and interventions and controls that are strictly regulated. Additionally, research results from the RWD match global reality better than those from traditional clinical trials. AIM To analyze the cost disparity between surgical treatments for liver and pancreatic cancer under various factors. METHODS This study analyzed RWD 1137 cases within the HB1 group (patients who underwent pancreatectomy, hepatectomy, and/or shunt surgery) in 2023. It distinguished different expenditure categories, including medical, nursing, technical, management, drug, and consumable costs. Additionally, it assessed the contribution of each expenditure category to total hospital costs and performed cross-group comparisons using the non-parametric Kruskal-Wallis test. This study used the Steel-Dwass test for post-hoc multiple comparisons and the Spearman correlation coefficient to examine the relationships between variables. RESULTS The study found that in HB11 and HB13, the total hospitalization costs were significantly higher for pancreaticoduodenectomy than for pancreatectomy and hepatectomy. Although no significant difference was observed in the length of hospital stay between patients who underwent pancreaticoduodenectomy and pancreatectomy, both were significantly longer than those who underwent liver resection. In HB15, no significant difference was observed in the total cost of hospitalization between pancreaticoduodenectomy and pancreatectomy; however, both were significantly higher than those in hepatectomy. Additionally, the length of hospital stay was significantly longer for patients who underwent pancreaticoduodenectomy than for those who underwent pancreatectomy or liver resection. CONCLUSION China Healthcare Security Diagnosis Related Groups payment system positively impacts liver and pancreatic cancer surgeries by improving medical quality and controlling costs. Further research could refine this grouping system and ensure continuous effectiveness and sustainability.
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Affiliation(s)
- Yun-He Hu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Fan Yu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yu-Zhuo Zhou
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ai-Dong Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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18
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Pistollato F, Burkhart G, Deceuninck P, Bernasconi C, Di Virgilio S, Emili L, Fauvel AC, Ferreira Bastos L, Gastaldello A, Gerardi C, Habermann JK, Hanes I, Kyriakopoulou C, Lanka U, Lauriola P, Laverty H, Maisonneuve BGC, Mennecozzi M, Pappalardo F, Pastorino R, Radvilaite V, Roggen EL, Constantino H. What public health challenges and unmet medical needs would benefit from interdisciplinary collaboration in the EU? A survey and multi-stakeholder debate. Front Public Health 2024; 12:1417684. [PMID: 39104886 PMCID: PMC11298480 DOI: 10.3389/fpubh.2024.1417684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/02/2024] [Indexed: 08/07/2024] Open
Abstract
In the past decade, significant European calls for research proposals have supported translational collaborative research on non-communicable and infectious diseases within the biomedical life sciences by bringing together interdisciplinary and multinational consortia. This research has advanced our understanding of disease pathophysiology, marking considerable scientific progress. Yet, it is crucial to retrospectively evaluate these efforts' societal impact. Research proposals should be thoughtfully designed to ensure that the research findings can be effectively translated into actionable policies. In addition, the choice of scientific methods plays a pivotal role in shaping the societal impact of research discoveries. Understanding the factors responsible for current unmet public health issues and medical needs is crucial for crafting innovative strategies for research policy interventions. A multistakeholder survey and a roundtable helped identify potential needs for consideration in the EU research and policy agenda. Based on survey findings, mental health disorders, metabolic syndrome, cancer, antimicrobial resistance, environmental pollution, and cardiovascular diseases were considered the public health challenges deserving prioritisation. In addition, early diagnosis, primary prevention, the impact of environmental pollution on disease onset and personalised medicine approaches were the most selected unmet medical needs. Survey findings enabled the formulation of some research-policies interventions (RPIs), which were further discussed during a multistakeholder online roundtable. The discussion underscored recent EU-level activities aligned with the survey-derived RPIs and facilitated an exchange of perspectives on public health and biomedical research topics ripe for interdisciplinary collaboration and warranting attention within the EU's research and policy agenda. Actionable recommendations aimed at facilitating the translation of knowledge into transformative, science-based policies are also provided.
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Affiliation(s)
| | - Gregor Burkhart
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | | | | | | | - Luca Emili
- InSilicoTrials Technologies, Milan, Italy
| | | | | | | | - Chiara Gerardi
- Center for Health Regulatory Policies, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Jens K. Habermann
- BBMRI-ERIC, Biobanking and Biomolecular Resources Research Infrastructure Consortium, Graz, Austria
| | - Ioan Hanes
- European Lifestyle Medicine Organization, Geneva, Switzerland
| | | | - Uma Lanka
- Research and Toxicology, Humane Society International, London, United Kingdom
| | - Paolo Lauriola
- International Society of Doctors for the Environment, Modena, Italy
| | | | | | | | | | - Roberta Pastorino
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Erwin L. Roggen
- ToxGenSolutions and 3Rs Management & Consulting ApS, Maastricht, Netherlands
| | - Helder Constantino
- Research and Toxicology, Humane Society International, Brussels, Belgium
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19
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Ahn SJ. Real-World Research on Retinal Diseases Using Health Claims Database: A Narrative Review. Diagnostics (Basel) 2024; 14:1568. [PMID: 39061705 PMCID: PMC11276298 DOI: 10.3390/diagnostics14141568] [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: 06/04/2024] [Revised: 07/05/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Real-world data (RWD) has emerged as a crucial component in understanding and improving patient outcomes across various medical conditions, including retinal diseases. Health claims databases, generated from healthcare reimbursement claims, offer a comprehensive source of RWD, providing insights into patient outcomes, healthcare utilization, and treatment effectiveness. However, the use of these databases for research also presents unique challenges. This narrative review explores the role of real-world research on retinal diseases using health claims databases, highlighting their advantages, limitations, and potential contributions to advancing our understanding and management of the diseases. The review examines the applications of health claims databases in retinal disease research, including epidemiological studies, comparative effectiveness and safety analyses, economic burden assessments, and evaluations of patient outcomes and quality of care. Previous findings demonstrate the value of these databases in generating prevalence and incidence estimates, identifying risk factors and predictors, evaluating treatment effectiveness and safety, and understanding healthcare utilization patterns and costs associated with retinal diseases. Despite their strengths, health claims databases face challenges related to data limitations, biases, privacy concerns, and methodological issues. Accordingly, the review also explores future directions and opportunities, including advancements in data collection and analysis, integration with electronic health records, collaborative research networks and consortia, and the evolving regulatory landscape. These developments are expected to enhance the utility of health claims databases for retinal disease research, resulting in more comprehensive and impactful findings across diverse retinal disorders and robust real-world insights from a large population.
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Affiliation(s)
- Seong Joon Ahn
- Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
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Baldwin D, Carmichael J, Cook G, Navani N, Peach J, Slater R, Wheatstone P, Wilkins J, Allen-Delingpole N, Kerr CEP, Siddiqui K. UK Stakeholder Perspectives on Surrogate Endpoints in Cancer, and the Potential for UK Real-World Datasets to Validate Their Use in Decision-Making. Cancer Manag Res 2024; 16:791-810. [PMID: 39044745 PMCID: PMC11264281 DOI: 10.2147/cmar.s441359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 06/24/2024] [Indexed: 07/25/2024] Open
Abstract
Duration of overall survival in patients with cancer has lengthened due to earlier detection and improved treatments. However, these improvements have created challenges in assessing the impact of newer treatments, particularly those used early in the treatment pathway. As overall survival remains most decision-makers' preferred primary endpoint, therapeutic innovations may take a long time to be introduced into clinical practice. Moreover, it is difficult to extrapolate findings to heterogeneous populations and address the concerns of patients wishing to evaluate everyday quality and extension of life. There is growing interest in the use of surrogate or interim endpoints to demonstrate robust treatment effects sooner than is possible with measurement of overall survival. It is hoped that they could speed up patients' access to new drugs, combinations, and sequences, and inform treatment decision-making. However, while surrogate endpoints have been used by regulators for drug approvals, this has occurred on a case-by-case basis. Evidence standards are yet to be clearly defined for acceptability in health technology appraisals or to shape clinical practice. This article considers the relevance of the use of surrogate endpoints in cancer in the UK context, and explores whether collection and analysis of real-world UK data and evidence might contribute to validation.
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Affiliation(s)
- David Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Jonathan Carmichael
- Department of Oncology, The National Institute for Health Research Leeds In Vitro Diagnostics Co-Operative (NIHR Leeds MIC), Leeds, UK
| | - Gordon Cook
- Cancer Research UK Trials Unit, LICTR, University of Leeds & NIHR (Leeds) IVD MIC, Leeds, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
- Department of Thoracic Medicine, University College London Hospital, London, UK
| | - James Peach
- Human Centric Drug Discovery, Wood Centre for Innovation, Oxford, UK
| | | | - Pete Wheatstone
- Patient and Public Involvement and Engagement Group, DATA-CAN, London, UK
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Chadd K, Caute A, Pettican A, Enderby P. Methods to advance health equity and social justice in healthcare: Protocol for a scoping review on the utilisation of routinely collected data. PLoS One 2024; 19:e0306786. [PMID: 38985705 PMCID: PMC11236175 DOI: 10.1371/journal.pone.0306786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/19/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Many areas of healthcare are impacted by a paucity of research that is translatable to clinical practice. Research utilising real-world data, such as routinely collected patient data, may be one option to efficiently create evidence to inform practice and service delivery. Such studies are also valuable for exploring (in)equity of services and outcomes, and benefit from using non-selected samples representing the diversity of the populations served in the 'real world'. This scoping review aims to identify and map the published research which utilises routinely collected clinical healthcare data. A secondary aim is to explore the extent to which this literature supports the pursuit of social justice in health, including health inequities and intersectional approaches. METHOD This review utilises Arksey and O'Malley's methodological framework for scoping reviews and draws on the recommended enhancements of this framework to promote a team-based and mixed methods approach. This includes searching electronic databases and screening papers based on a pre-specified inclusion and exclusion criteria. Data relevant to the research aims will be extracted from included papers, including the clinical/professional area of the topic, the source of data that was used, and whether it addresses elements of social justice. All screening and reviewing will be collaborative and iterative, drawing on strengths of the research team and responsive changes to challenges will be made. Quantitative data will be analysed descriptively, and conceptual content analysis will be utilised to understand qualitative data. These will be collectively synthesised in alignment to the research aims. CONCLUSION Our findings will highlight the extent to which such research is being conducted and published, including gaps and make recommendations for future endeavours for real-world data studies. The findings from this scoping review will be relevant for practitioners and researchers, as well as health service managers, commissioners, and research funders.
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Affiliation(s)
- Katie Chadd
- School of Health and Social Care, University of Essex, Essex, United Kingdom
| | - Anna Caute
- School of Health and Social Care, University of Essex, Essex, United Kingdom
| | - Anna Pettican
- School of Health and Social Care, University of Essex, Essex, United Kingdom
| | - Pam Enderby
- Division of Public Health, University of Sheffield, Sheffield, United Kingdom
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22
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Ruscitti P, Allanore Y, Baldini C, Barilaro G, Bartoloni Bocci E, Bearzi P, Bellis E, Berardicurti O, Biaggi A, Bombardieri M, Cantarini L, Cantatore FP, Caporali R, Caso F, Cervera R, Ciccia F, Cipriani P, Chatzis L, Colafrancesco S, Conti F, Corberi E, Costa L, Currado D, Cutolo M, D'Angelo S, Del Galdo F, Di Cola I, Di Donato S, Distler O, D'Onofrio B, Doria A, Fautrel B, Fasano S, Feist E, Fisher BA, Gabini M, Gandolfo S, Gatto M, Genovali I, Gerli R, Grembiale RD, Guggino G, Hoffmann-Vold AM, Iagnocco A, Iaquinta FS, Liakouli V, Manoussakis MN, Marino A, Mauro D, Montecucco C, Mosca M, Naty S, Navarini L, Occhialini D, Orefice V, Perosa F, Perricone C, Pilato A, Pitzalis C, Pontarini E, Prete M, Priori R, Rivellese F, Sarzi-Puttini P, Scarpa R, Sebastiani G, Selmi C, Shoenfeld Y, Triolo G, Trunfio F, Yan Q, Tzioufas AG, Giacomelli R. Tailoring the treatment of inflammatory rheumatic diseases by a better stratification and characterization of the clinical patient heterogeneity. Findings from a systematic literature review and experts' consensus. Autoimmun Rev 2024; 23:103581. [PMID: 39069240 DOI: 10.1016/j.autrev.2024.103581] [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: 05/12/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024]
Abstract
Inflammatory rheumatic diseases are different pathologic conditions associated with a deregulated immune response, codified along a spectrum of disorders, with autoinflammatory and autoimmune diseases as two-end phenotypes of this continuum. Despite pathogenic differences, inflammatory rheumatic diseases are commonly managed with a limited number of immunosuppressive drugs, sometimes with partial evidence or transferring physicians' knowledge in different patients. In addition, several randomized clinical trials, enrolling these patients, did not meet the primary pre-established outcomes and these findings could be linked to the underlying molecular diversities along the spectrum of inflammatory rheumatic disorders. In fact, the resulting patient heterogeneity may be driven by differences in underlying molecular pathology also resulting in variable responses to immunosuppressive drugs. Thus, the identification of different clinical subsets may possibly overcome the major obstacles that limit the development more effective therapeutic strategies for these patients with inflammatory rheumatic diseases. This clinical heterogeneity could require a diverse therapeutic management to improve patient outcomes and increase the frequency of clinical remission. Therefore, the importance of better patient stratification and characterization is increasingly pointed out according to the precision medicine principles, also suggesting a new approach for disease treatment. In fact, based on a better proposed patient profiling, clinicians could more appropriately balance the therapeutic management. On these bases, we synthetized and discussed the available literature about the patient profiling in regard to therapy in the context of inflammatory rheumatic diseases, mainly focusing on randomized clinical trials. We provided an overview of the importance of a better stratification and characterization of the clinical heterogeneity of patients with inflammatory rheumatic diseases identifying this point as crucial in improving the management of these patients.
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Affiliation(s)
- Piero Ruscitti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Yannick Allanore
- Rheumatology Department, Cochin Hospital, APHP, INSERM U1016, Université Paris Cité, Paris, France
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Barilaro
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases of the Catalan and Spanish Health Systems, Member of ERN-ReCONNET/RITA, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Elena Bartoloni Bocci
- Section of Rheumatology, Department of Medicine and Surgery, University of Perugia, Italy
| | - Pietro Bearzi
- Rheumatology and Clinical Immunology, Department of Medicine, School of Medicine, University of Rome "Campus Bio-Medico", 00128 Rome, Italy; Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Elisa Bellis
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy
| | - Onorina Berardicurti
- Rheumatology and Clinical Immunology, Department of Medicine, School of Medicine, University of Rome "Campus Bio-Medico", 00128 Rome, Italy; Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Alice Biaggi
- Rheumatology and Clinical Immunology, Department of Medicine, School of Medicine, University of Rome "Campus Bio-Medico", 00128 Rome, Italy; Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Michele Bombardieri
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London and Barts NIHR BRC & NHS Trust & National Institute for Health and Care Research (NIHR) Barts Biomedical Research Centre (BRC), London, UK
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy; Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Italy
| | - Francesco Paolo Cantatore
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan, Paediatric Rheumatology Unit, and Clinical Rheumatology Unit, ASST Pini-CTO, Milan, Italy
| | - Francesco Caso
- Rheumatology Research Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases of the Catalan and Spanish Health Systems, Member of ERN-ReCONNET/RITA, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Francesco Ciccia
- Rheumatology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Cipriani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Loukas Chatzis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Serena Colafrancesco
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, Viale del Policlinico 155, 00185 Rome, Italy
| | - Fabrizio Conti
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, Viale del Policlinico 155, 00185 Rome, Italy
| | - Erika Corberi
- Rheumatology and Clinical Immunology, Department of Medicine, School of Medicine, University of Rome "Campus Bio-Medico", 00128 Rome, Italy; Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Luisa Costa
- Rheumatology Research Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Damiano Currado
- Rheumatology and Clinical Immunology, Department of Medicine, School of Medicine, University of Rome "Campus Bio-Medico", 00128 Rome, Italy; Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Rheumatology, Department of Internal Medicine and Specialties, University of Genova Italy, IRCCS Polyclinic Hospital, Genova, Italy
| | - Salvatore D'Angelo
- Rheumatology Depatment of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
| | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ilenia Di Cola
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Stefano Di Donato
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bernardo D'Onofrio
- Department of Internal Medicine and Therapeutics, Università di Pavia, Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Bruno Fautrel
- Sorbonne Université - Assistance Publique Hôpitaux de Paris, INSERM UMRS 1136, Hôpital de La Pitié Salpêtrière, Paris, France
| | - Serena Fasano
- Rheumatology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Eugen Feist
- Department of Rheumatology, Helios Fachklinik, Sophie-von-Boetticher-Straße 1, 39245, Vogelsang-Gommern, Germany; Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Berlin, Germany
| | - Benjamin A Fisher
- Institute of Inflammation and Ageing, University Hospitals Birmingham, Birmingham, UK; Department of Rheumatology, National Institute for Health Research (NIHR), Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Marco Gabini
- Rheumatology Unit, Santo Spirito Hospital, Pescara, Italy
| | - Saviana Gandolfo
- Unit of Rheumatology, San Giovanni Bosco Hospital, Naples, Italy
| | - Mariele Gatto
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy
| | - Irene Genovali
- Rheumatology and Clinical Immunology, Department of Medicine, School of Medicine, University of Rome "Campus Bio-Medico", 00128 Rome, Italy; Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Roberto Gerli
- Section of Rheumatology, Department of Medicine and Surgery, University of Perugia, Italy
| | - Rosa Daniela Grembiale
- Rheumatology Research Unit, Dipartimento di Scienze della Salute, Università degli studi "Magna Graecia" di Catanzaro, Catanzaro, Italy
| | - Giuliana Guggino
- Rheumatology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Anna Maria Hoffmann-Vold
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Rheumatology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy
| | - Francesco Salvatore Iaquinta
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London and Barts NIHR BRC & NHS Trust & National Institute for Health and Care Research (NIHR) Barts Biomedical Research Centre (BRC), London, UK
| | - Vasiliki Liakouli
- Rheumatology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Menelaos N Manoussakis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Annalisa Marino
- Rheumatology and Clinical Immunology, Department of Medicine, School of Medicine, University of Rome "Campus Bio-Medico", 00128 Rome, Italy; Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Daniele Mauro
- Rheumatology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Therapeutics, Università di Pavia, Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Saverio Naty
- Department of Health Sciences, "Magna Græcia" University of Catanzaro, 88100 Catanzaro, Italy
| | - Luca Navarini
- Rheumatology and Clinical Immunology, Department of Medicine, School of Medicine, University of Rome "Campus Bio-Medico", 00128 Rome, Italy; Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Daniele Occhialini
- Rheumatic and Systemic Autoimmune Diseases Unit, Department of Interdisciplinary Medicine (DIM), University of Bari Medical School, Italy
| | - Valeria Orefice
- Rheumatology Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - Federico Perosa
- Rheumatic and Systemic Autoimmune Diseases Unit, Department of Interdisciplinary Medicine (DIM), University of Bari Medical School, Italy
| | - Carlo Perricone
- Section of Rheumatology, Department of Medicine and Surgery, University of Perugia, Italy
| | - Andrea Pilato
- Rheumatology and Clinical Immunology, Department of Medicine, School of Medicine, University of Rome "Campus Bio-Medico", 00128 Rome, Italy; Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Costantino Pitzalis
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London and Barts NIHR BRC & NHS Trust & National Institute for Health and Care Research (NIHR) Barts Biomedical Research Centre (BRC), London, UK; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Elena Pontarini
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London and Barts NIHR BRC & NHS Trust & National Institute for Health and Care Research (NIHR) Barts Biomedical Research Centre (BRC), London, UK
| | - Marcella Prete
- Rheumatic and Systemic Autoimmune Diseases Unit, Department of Interdisciplinary Medicine (DIM), University of Bari Medical School, Italy
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, Viale del Policlinico 155, 00185 Rome, Italy
| | - Felice Rivellese
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London and Barts NIHR BRC & NHS Trust & National Institute for Health and Care Research (NIHR) Barts Biomedical Research Centre (BRC), London, UK
| | - Piercarlo Sarzi-Puttini
- Rheumatology Department, ASST Fatebenefratelli Luigi Sacco University Hospital, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Raffaele Scarpa
- Rheumatology Research Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Yehuda Shoenfeld
- Zabludovwicz autoimmunity center, Sheba medical center, Tel Hashomer Israel, Reichman University, Herzeliya, Israel
| | - Giovanni Triolo
- Rheumatology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Francesca Trunfio
- Rheumatology and Clinical Immunology, Department of Medicine, School of Medicine, University of Rome "Campus Bio-Medico", 00128 Rome, Italy; Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Qingran Yan
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Roberto Giacomelli
- Rheumatology and Clinical Immunology, Department of Medicine, School of Medicine, University of Rome "Campus Bio-Medico", 00128 Rome, Italy; Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
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Gebrye T, Mbada C, Hakimi Z, Fatoye F. Development of quality assessment tool for systematic reviews and meta-analyses of real-world studies: a Delphi consensus survey. Rheumatol Int 2024; 44:1275-1281. [PMID: 38683352 PMCID: PMC11178604 DOI: 10.1007/s00296-024-05595-4] [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: 02/20/2024] [Accepted: 04/08/2024] [Indexed: 05/01/2024]
Abstract
The increasing adoption of real-world studies in healthcare for decision making and planning has further necessitated the need for a specific quality assessment tool for evidence synthesis. This study aimed to develop a quality assessment tool for systematic reviews (SR) and meta-analysis (MA) involving real-world studies (QATSM-RWS) using a formal consensus method. Based on scoping review, the authors identified a list of items for possible inclusion in the quality assessment tool. A Delphi survey was formulated based on the identified items. A total of 89 experts, purposively recruited, with research experience in real-world data were invited to participate in the first round of Delphi survey. The participants who responded in the first Delphi round were invited to participate (n = 15) in the phrasing of the items. Strong level of agreement was found on the proposed list of items after the first round of Delphi. A rate of agreement ≥ 0.70 was used to define which items to keep in the tool. A list of 14 items emerged as suitable for QATSM-RWS. The items were structured under five domains: introduction, methods, results, discussions, and others. All participants agreed with the proposed phrasing of the items. This is the first study that has developed a specific tool that can be used to appraise the quality of SR and MA involving real-world studies. QATSM-RWS may be used by policymakers, clinicians, and practitioners when evaluating and generating real-world evidence. This tool is now undergoing validation process.
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Affiliation(s)
- Tadesse Gebrye
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, Birley Fields Campus, 53 Bonsall Street, Manchester, M15 6GX, UK.
| | - Chidozie Mbada
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, Birley Fields Campus, 53 Bonsall Street, Manchester, M15 6GX, UK
| | | | - Francis Fatoye
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, Birley Fields Campus, 53 Bonsall Street, Manchester, M15 6GX, UK
- Lifestyle Diseases, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
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24
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Tang AS, Woldemariam SR, Miramontes S, Norgeot B, Oskotsky TT, Sirota M. Harnessing EHR data for health research. Nat Med 2024; 30:1847-1855. [PMID: 38965433 DOI: 10.1038/s41591-024-03074-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/17/2024] [Indexed: 07/06/2024]
Abstract
With the increasing availability of rich, longitudinal, real-world clinical data recorded in electronic health records (EHRs) for millions of patients, there is a growing interest in leveraging these records to improve the understanding of human health and disease and translate these insights into clinical applications. However, there is also a need to consider the limitations of these data due to various biases and to understand the impact of missing information. Recognizing and addressing these limitations can inform the design and interpretation of EHR-based informatics studies that avoid confusing or incorrect conclusions, particularly when applied to population or precision medicine. Here we discuss key considerations in the design, implementation and interpretation of EHR-based informatics studies, drawing from examples in the literature across hypothesis generation, hypothesis testing and machine learning applications. We outline the growing opportunities for EHR-based informatics studies, including association studies and predictive modeling, enabled by evolving AI capabilities-while addressing limitations and potential pitfalls to avoid.
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Affiliation(s)
- Alice S Tang
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah R Woldemariam
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Silvia Miramontes
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
| | | | - Tomiko T Oskotsky
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Marina Sirota
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA.
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
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25
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Bandyopadhyay A, Oks M, Sun H, Prasad B, Rusk S, Jefferson F, Malkani RG, Haghayegh S, Sachdeva R, Hwang D, Agustsson J, Mignot E, Summers M, Fabbri D, Deak M, Anastasi M, Sampson A, Van Hout S, Seixas A. Strengths, weaknesses, opportunities, and threats of using AI-enabled technology in sleep medicine: a commentary. J Clin Sleep Med 2024; 20:1183-1191. [PMID: 38533757 PMCID: PMC11217619 DOI: 10.5664/jcsm.11132] [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: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 03/28/2024]
Abstract
Over the past few years, artificial intelligence (AI) has emerged as a powerful tool used to efficiently automate several tasks across multiple domains. Sleep medicine is perfectly positioned to leverage this tool due to the wealth of physiological signals obtained through sleep studies or sleep tracking devices and abundance of accessible clinical data through electronic medical records. However, caution must be applied when utilizing AI, due to intrinsic challenges associated with novel technology. The Artificial Intelligence in Sleep Medicine Committee of the American Academy of Sleep Medicine reviews advancements in AI within the sleep medicine field. In this article, the Artificial Intelligence in Sleep Medicine committee members provide a commentary on the scope of AI technology in sleep medicine. The commentary identifies 3 pivotal areas in sleep medicine that can benefit from AI technologies: clinical care, lifestyle management, and population health management. This article provides a detailed analysis of the strengths, weaknesses, opportunities, and threats associated with using AI-enabled technologies in each pivotal area. Finally, the article broadly reviews barriers and challenges associated with using AI-enabled technologies and offers possible solutions. CITATION Bandyopadhyay A, Oks M, Sun H, et al. Strengths, weaknesses, opportunities, and threats of using AI-enabled technology in sleep medicine: a commentary. J Clin Sleep Med. 2024;20(7):1183-1191.
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Affiliation(s)
- Anuja Bandyopadhyay
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Margarita Oks
- Department of Medicine, Northwell Health System, New York, New York
| | - Haoqi Sun
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Bharati Prasad
- Department of Medicine, University of Illinois, Chicago, Illinois
| | - Sam Rusk
- EnsoData Research, EnsoData, Madison, Wisconsin
| | - Felicia Jefferson
- Department of Biochemistry and Molecular Biology, University of Nevada, Reno, Nevada
| | - Roneil Gopal Malkani
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Neurology Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois
| | - Shahab Haghayegh
- Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ramesh Sachdeva
- Children’s Hospital of Michigan and Central Michigan University College of Medicine, Detroit, Michigan
| | - Dennis Hwang
- Kaiser Permanente Southern California, Los Angeles, California
| | | | - Emmanuel Mignot
- Stanford University, School of Medicine, Stanford, California
| | - Michael Summers
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | | | | | | | - Azizi Seixas
- Department of Informatics and Health Data Science, University of Miami Miller School of Medicine, Miami, Florida
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Näher A, Kopka M, Balzer F, Schulte‐Althoff M. Generalizability in real-world trials. Clin Transl Sci 2024; 17:e13886. [PMID: 39046315 PMCID: PMC11267629 DOI: 10.1111/cts.13886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 06/27/2024] [Indexed: 07/25/2024] Open
Abstract
Real-world evidence (RWE) trials have a key advantage over conventional randomized controlled trials (RCTs) due to their potentially better generalizability. High generalizability of study results facilitates new biological insights and enables targeted therapeutic strategies. Random sampling of RWE trial participants is regarded as the gold standard for generalizability. Additionally, the use of sample correction procedures can increase the generalizability of trial results, even when using nonrandomly sampled real-world data (RWD). This study presents descriptive evidence on the extent to which the design of currently planned or already conducted RWE trials takes sampling into account. It also examines whether random sampling or procedures for correcting nonrandom samples are considered. Based on text mining of publicly available metadata provided during registrations of RWE trials on clinicaltrials.gov, EU-PAS, and the OSF-RWE registry, it is shown that the share of RWE trial registrations with information on sampling increased from 65.27% in 2002 to 97.43% in 2022, with a corresponding increase from 14.79% to 28.30% for trials with random samples. For RWE trials with nonrandom samples, there is an increase from 0.00% to 0.95% of trials in which sample correction procedures are used. We conclude that the potential benefits of RWD in terms of generalizing trial results are not yet being fully realized.
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Affiliation(s)
- Anatol‐Fiete Näher
- Digital Global Public Health, Hasso Plattner Institute for Digital EngineeringUniversity of PotsdamPotsdamGermany
- Institute of Medical InformaticsCharité – Universitätsmedizin BerlinBerlinGermany
| | - Marvin Kopka
- Institute of Medical InformaticsCharité – Universitätsmedizin BerlinBerlinGermany
- Institute of Psychology and Ergonomics (IPA), Division of ErgonomicsTechnische Universität BerlinBerlinGermany
| | - Felix Balzer
- Institute of Medical InformaticsCharité – Universitätsmedizin BerlinBerlinGermany
| | - Matthias Schulte‐Althoff
- Institute of Medical InformaticsCharité – Universitätsmedizin BerlinBerlinGermany
- Department of Information SystemsFreie Universität BerlinBerlinGermany
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Bhatt A. Ethical considerations for real-world evidence studies. Perspect Clin Res 2024; 15:152-154. [PMID: 39140020 PMCID: PMC11318787 DOI: 10.4103/picr.picr_256_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 08/15/2024] Open
Abstract
Real-world evidence (RWE) studies are conducted on patient's data primarily collected for monitoring of health status of patients. The use of real-world data to generate evidence in academic research or for regulatory submission raises a variety of ethical issues such as privacy, confidentiality, data protection, data de-identification, data sharing, scientific design of study, and informed consent requirements. The investigators-researchers and sponsors should adhere to current standards of ethics whilst planning and conduct of RWE studies. The ethics committees should consider ethical issues specific to RWE studies before approval.
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Affiliation(s)
- Arun Bhatt
- Clinical Research and Drug Development, Vadodara, Gujarat, India
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Perka C, Mohaddes M, Zagra L, Ekkernkamp A, Keller N, Stengel D. May the 4th be with you: mixed-methods best-evidence synthesis on 4th-generation alumina-zirconia ceramic bearings in total hip arthroplasty. EFORT Open Rev 2024; 9:632-645. [PMID: 38949170 PMCID: PMC11297405 DOI: 10.1530/eor-23-0218] [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] [Indexed: 07/02/2024] Open
Abstract
Purpose To assess utility, benefits, and risks of 4th-generation alumina-zirconia ceramic pairings in elective total hip arthroplasty (THA). Methods A comprehensive mixed-methods best-evidence synthesis using data from systematic reviews, randomized controlled trials (RCTs), prospective and retrospective cohort studies, as well as joint replacement registries, was conducted to estimate overall revision and survival rates, periprosthetic infection, bearing fractures, and noise phenomena with 4th-generation alumina-zirconia ceramic versus other tribological couplings in elective THA. The systematic review part across multiple databases was registered with PROSPERO (CRD42023418076), and individual study data were extracted for statistical re-analysis. Results Twenty overlapping systematic reviews, 7, 17, and 8 references from RCTs, cohort studies, and joint replacement registries form the basis of this work. According to current best evidence, it is (i) 15-33 times more likely that 4th-generation alumina-zirconia pairings avoid a revision for infection than causing a revision for audible noise, (ii) 38-85 times more likely that 4th-generation alumina-zirconia pairings avoid a revision for infection than causing a revision for ceramic head fractures, and (iii) three to six times more likely that 4th-generation alumina-zirconia pairings avoid a revision for infection than cause a revision for ceramic liner fractures. Conclusion Fourth-generation alumina-zirconia pairings in THA show a favorable benefit-risk ratio, with rare compound-specific adverse events and complications significantly outbalanced by long-term advantages, such as a markedly lower incidence of revision for infection.
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Affiliation(s)
- Carsten Perka
- Center for Musculoskeletal Surgery, Charité Medical University Center, Berlin, Germany
| | - Maziar Mohaddes
- Hässleholms Hospital, Region Skåne, Hässleholm, Sweden
- Orthopedics, Faculty of Medicine, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Axel Ekkernkamp
- BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
- BG Kliniken – Klinikverbund der gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
| | - Niklas Keller
- Harding Center for Risk Literacy, University of Potsdam, Faculty of Health Sciences, Potsdam, Germany
| | - Dirk Stengel
- BG Kliniken – Klinikverbund der gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
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Samuels JM, Albaugh VL, Yu D, Chen Y, Williams DB, Spann MD, Wang L, Flynn CR, English WJ. Sex- and operation-dependent effects on 5-year weight loss results of bariatric surgery. Surg Obes Relat Dis 2024; 20:687-694. [PMID: 38462409 PMCID: PMC11228959 DOI: 10.1016/j.soard.2024.01.013] [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: 11/19/2023] [Revised: 01/10/2024] [Accepted: 01/21/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Weight loss response after bariatric surgery is highly variable, and several demographic factors are associated with differential responses to surgery. Preclinical studies demonstrate numerous sex-specific responses to bariatric surgery, but whether these responses are also operation dependent is unknown. OBJECTIVE To examine sex-specific weight loss outcomes up to 5 years after laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). SETTING Single center, university, United States. METHODS Retrospective, observational cohort study including RYGB (n = 5057) and vertical SG (n = 2041) patients from a single, academic health center. Percentage total weight loss (TWL) over time was examined with generalized linear mixed models to determine the main and interaction effects of surgery type on weight loss by sex. RESULTS TWL demonstrated a strong sex-by-procedure interaction, with women having a significant advantage with RYGB compared with SG (adjusted difference at 5 yr: 8.0% [95% CI: 7.5-8.5]; P < .001). Men also experienced greater TWL over time with RYGB or SG, but the difference was less and clinically insignificant (adjusted difference at 5 yr: 2.9% [2.0-3.8]; P < .001; P interaction between sex and procedure type = .0001). Overall, women had greater TWL than men, and RYGB patients had greater TWL than SG patients (adjusted difference at 5 yr: 3.1% [2.4-3.2] and 6.9% [6.5-7.3], respectively; both P < .0001). Patients with diabetes lost less weight compared with those without (adjusted difference at 5 yr: 3.0% [2.7-3.2]; P < .0001). CONCLUSIONS Weight loss after bariatric surgery is sex- and procedure-dependent. There is an association suggesting a clinically insignificant difference in weight loss between RYGB and SG among male patients at both the 2- and 5-year postsurgery time points.
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Affiliation(s)
- Jason M Samuels
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Vance L Albaugh
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana
| | - Danxia Yu
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - You Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - D Brandon Williams
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew D Spann
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lei Wang
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - C Robb Flynn
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wayne J English
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Sosa-Holwerda A, Park OH, Albracht-Schulte K, Niraula S, Thompson L, Oldewage-Theron W. The Role of Artificial Intelligence in Nutrition Research: A Scoping Review. Nutrients 2024; 16:2066. [PMID: 38999814 PMCID: PMC11243505 DOI: 10.3390/nu16132066] [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: 05/06/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Artificial intelligence (AI) refers to computer systems doing tasks that usually need human intelligence. AI is constantly changing and is revolutionizing the healthcare field, including nutrition. This review's purpose is four-fold: (i) to investigate AI's role in nutrition research; (ii) to identify areas in nutrition using AI; (iii) to understand AI's future potential impact; (iv) to investigate possible concerns about AI's use in nutrition research. Eight databases were searched: PubMed, Web of Science, EBSCO, Agricola, Scopus, IEEE Explore, Google Scholar and Cochrane. A total of 1737 articles were retrieved, of which 22 were included in the review. Article screening phases included duplicates elimination, title-abstract selection, full-text review, and quality assessment. The key findings indicated AI's role in nutrition is at a developmental stage, focusing mainly on dietary assessment and less on malnutrition prediction, lifestyle interventions, and diet-related diseases comprehension. Clinical research is needed to determine AI's intervention efficacy. The ethics of AI use, a main concern, remains unresolved and needs to be considered for collateral damage prevention to certain populations. The studies' heterogeneity in this review limited the focus on specific nutritional areas. Future research should prioritize specialized reviews in nutrition and dieting for a deeper understanding of AI's potential in human nutrition.
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Affiliation(s)
- Andrea Sosa-Holwerda
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - Oak-Hee Park
- College of Health & Human Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | | | - Surya Niraula
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - Leslie Thompson
- Department of Animal and Food Sciences, Texas Tech University, Lubbock, TX 79409, USA
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Hoffmann K, Nesterow I, Peng Y, Henke E, Barnett D, Klengel C, Gruhl M, Bartos M, Nüßler F, Gebler R, Grummt S, Seim A, Bathelt F, Reinecke I, Wolfien M, Weidner J, Sedlmayr M. Streamlining intersectoral provision of real-world health data: a service platform for improved clinical research and patient care. Front Med (Lausanne) 2024; 11:1377209. [PMID: 38903818 PMCID: PMC11188485 DOI: 10.3389/fmed.2024.1377209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/08/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction Obtaining real-world data from routine clinical care is of growing interest for scientific research and personalized medicine. Despite the abundance of medical data across various facilities - including hospitals, outpatient clinics, and physician practices - the intersectoral exchange of information remains largely hindered due to differences in data structure, content, and adherence to data protection regulations. In response to this challenge, the Medical Informatics Initiative (MII) was launched in Germany, focusing initially on university hospitals to foster the exchange and utilization of real-world data through the development of standardized methods and tools, including the creation of a common core dataset. Our aim, as part of the Medical Informatics Research Hub in Saxony (MiHUBx), is to extend the MII concepts to non-university healthcare providers in a more seamless manner to enable the exchange of real-world data among intersectoral medical sites. Methods We investigated what services are needed to facilitate the provision of harmonized real-world data for cross-site research. On this basis, we designed a Service Platform Prototype that hosts services for data harmonization, adhering to the globally recognized Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) international standard communication format and the Observational Medical Outcomes Partnership (OMOP) common data model (CDM). Leveraging these standards, we implemented additional services facilitating data utilization, exchange and analysis. Throughout the development phase, we collaborated with an interdisciplinary team of experts from the fields of system administration, software engineering and technology acceptance to ensure that the solution is sustainable and reusable in the long term. Results We have developed the pre-built packages "ResearchData-to-FHIR," "FHIR-to-OMOP," and "Addons," which provide the services for data harmonization and provision of project-related real-world data in both the FHIR MII Core dataset format (CDS) and the OMOP CDM format as well as utilization and a Service Platform Prototype to streamline data management and use. Conclusion Our development shows a possible approach to extend the MII concepts to non-university healthcare providers to enable cross-site research on real-world data. Our Service Platform Prototype can thus pave the way for intersectoral data sharing, federated analysis, and provision of SMART-on-FHIR applications to support clinical decision making.
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Affiliation(s)
- Katja Hoffmann
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | - Igor Nesterow
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | - Yuan Peng
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | - Elisa Henke
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | - Daniela Barnett
- Data Integration Center, Center for Medical Informatics, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Cigdem Klengel
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | - Mirko Gruhl
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | - Martin Bartos
- Department of Informatics, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Frank Nüßler
- Department of Informatics, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Richard Gebler
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | - Sophia Grummt
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | - Anne Seim
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | | | - Ines Reinecke
- Data Integration Center, Center for Medical Informatics, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Markus Wolfien
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
- Center for Scalable Data Analytics and Artificial Intelligence, Dresden, Germany
| | - Jens Weidner
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | - Martin Sedlmayr
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
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Greene L, Crotty M, Whitehead C, Rahja M, Murad J, Dang K, Partington A, Laver K. Assessing the reach and safety of an innovative urgent care service tailored to older adults. Australas J Ageing 2024; 43:387-393. [PMID: 38268230 DOI: 10.1111/ajag.13267] [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: 08/08/2023] [Revised: 11/02/2023] [Accepted: 11/19/2023] [Indexed: 01/26/2024]
Abstract
Traditional emergency departments (EDs) are overcrowded and sometimes not suitable for older adults with complex needs. Specialised geriatric urgent care pathways for selected patients can alleviate ED demand and improve patient experience. To address urgent care needs for older adults in Southern Adelaide, the Complex And RestorativE (CARE) service was established. CARE offers alternative, geriatrician-led treatment pathways consisting of a ward-based treatment centre and an in-home visiting team called Eyes on Scene (EoS). Both pathways offer medical, nursing and allied health treatment. Routinely collected clinical data were analysed to explore the reach of the service and the incidence and nature of adverse events. Between September 2021 and March 2023, the CARE service attended to 5324 older adults requiring urgent care. A significant proportion of patients were discharged to or remained in their regular place of residence, with few requiring inpatient admissions or referrals to other facilities. A total of 7% of patients required transfer to ED and adverse events were rare. The CARE service demonstrates a feasible and safe alternative model of urgent care for older Australians.
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Affiliation(s)
- Leanne Greene
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Craig Whitehead
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Miia Rahja
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Javaria Murad
- The Complex and RestorativE (CARE) Service, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Kwok Dang
- The Complex and RestorativE (CARE) Service, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Andrew Partington
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Kate Laver
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
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Holthuis EI, Heins MJ, van Houdt WJ, Haas RL, Overbeek JA, Olde Hartman TC, Uijen AA, Wee L, van der Graaf WTA, Husson O. Improving Diagnosis and Care for Patients With Sarcoma: Do Real-World General Practitioners Data and Prospective Data Collections Have a Place Next to Clinical Trials? JCO Clin Cancer Inform 2024; 8:e2400054. [PMID: 38950319 DOI: 10.1200/cci.24.00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/16/2024] [Accepted: 05/10/2024] [Indexed: 07/03/2024] Open
Abstract
There has been growing interest in the use of real-world data (RWD) to address clinically and policy-relevant (research) questions that cannot be answered with data from randomized controlled trials (RCTs) alone. This is, for example, the case in rare malignancies such as sarcomas as limited patient numbers pose challenges in conducting RCTs within feasible timeliness, a manageable number of collaborators, and statistical power. This narrative review explores the potential of RWD to generate real-world evidence (RWE) in sarcoma research, elucidating its application across different phases of the patient journey, from prediagnosis to the follow-up/survivorship phase. For instance, examining electronic health records (EHRs) from general practitioners (GPs) enables the exploration of consultation frequency and presenting symptoms in primary care before a sarcoma diagnosis. In addition, alternative study designs that integrate RWD with well-designed observational RCTs may offer relevant information on the effectiveness of clinical treatments. As, especially in cases of ultrarare sarcomas, it can be an extreme challenge to perform well-powered randomized prospective studies. Therefore, it is crucial to support the adaptation of novel study designs. Regarding the follow-up/survivorship phase, examining EHR from primary and secondary care can provide valuable insights into identifying the short- and long-term effects of treatment over an extended follow-up period. The utilization of RWD also comes with several challenges, including issues related to data quality and privacy, as described in this study. Notwithstanding these challenges, this study underscores the potential of RWD to bridge, at least partially, gaps between evidence and practice and holds promise in contributing to the improvement of sarcoma care.
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Affiliation(s)
- Emily I Holthuis
- Medical Oncology Department, NKI-AVL-Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Marianne J Heins
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
| | - Winan J van Houdt
- Surgical Oncology Department, NKI-AVL-Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Rick L Haas
- Department of Radiotherapy, NKI-AVL-Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute of Medical Innovation, Nijmegen, the Netherlands
| | - Annemarie A Uijen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute of Medical Innovation, Nijmegen, the Netherlands
| | - Leonard Wee
- School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, the Netherlands
| | - Winette T A van der Graaf
- Medical Oncology Department, NKI-AVL-Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Olga Husson
- Medical Oncology Department, NKI-AVL-Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
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Guo L, Reddy KP, Van Iseghem T, Pierce WN. Enhancing data practices for Whole Health: Strategies for a transformative future. Learn Health Syst 2024; 8:e10426. [PMID: 38883871 PMCID: PMC11176597 DOI: 10.1002/lrh2.10426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/22/2024] [Accepted: 04/16/2024] [Indexed: 06/18/2024] Open
Abstract
We explored the challenges and solutions for managing data within the Whole Health System (WHS), which operates as a Learning Health System and a patient-centered healthcare approach that combines conventional and complementary approaches. Addressing these challenges is critical for enhancing patient care and improving outcomes within WHS. The proposed solutions include prioritizing interoperability for seamless data exchange, incorporating patient-centered comparative clinical effectiveness research and real-world data to personalize treatment plans and validate integrative approaches, and leveraging advanced data analytics tools to incorporate patient-reported outcomes, objective metrics, robust data platforms. Implementing these measures will enable WHS to fulfill its mission as a holistic and patient-centered healthcare model, promoting greater collaboration among providers, boosting the well-being of patients and providers, and improving patient outcomes.
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Affiliation(s)
- Lei Guo
- Whole Health VA St. Louis Health Care System St. Louis Missouri USA
- School of Interdisciplinary Health Professions Northern Illinois University DeKalb Illinois USA
| | - Kavitha P Reddy
- Whole Health VA St. Louis Health Care System St. Louis Missouri USA
- Department of Veterans Affairs VHA Office of Patient-Centered Care and Cultural Transformation Washington D.C. USA
- School of Medicine Washington University in St. Louis St. Louis Missouri USA
| | - Theresa Van Iseghem
- Whole Health VA St. Louis Health Care System St. Louis Missouri USA
- School of Medicine Saint Louis University St. Louis Missouri USA
| | - Whitney N Pierce
- Whole Health VA St. Louis Health Care System St. Louis Missouri USA
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Vogel C, Grimm B, Marmor MT, Sivananthan S, Richter PH, Yarboro S, Hanflik AM, Histing T, Braun BJ. Wearable Sensors in Other Medical Domains with Application Potential for Orthopedic Trauma Surgery-A Narrative Review. J Clin Med 2024; 13:3134. [PMID: 38892844 PMCID: PMC11172495 DOI: 10.3390/jcm13113134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/01/2024] [Accepted: 05/09/2024] [Indexed: 06/21/2024] Open
Abstract
The use of wearable technology is steadily increasing. In orthopedic trauma surgery, where the musculoskeletal system is directly affected, focus has been directed towards assessing aspects of physical functioning, activity behavior, and mobility/disability. This includes sensors and algorithms to monitor real-world walking speed, daily step counts, ground reaction forces, or range of motion. Several specific reviews have focused on this domain. In other medical fields, wearable sensors and algorithms to monitor digital biometrics have been used with a focus on domain-specific health aspects such as heart rate, sleep, blood oxygen saturation, or fall risk. This review explores the most common clinical and research use cases of wearable sensors in other medical domains and, from it, derives suggestions for the meaningful transfer and application in an orthopedic trauma context.
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Affiliation(s)
- Carolina Vogel
- University Hospital Tuebingen on Behalf of the Eberhard-Karls-University Tuebingen, BG Unfallklinik, Schnarrenbergstr. 95, 72076 Tuebingen, Germany; (C.V.); (T.H.)
| | - Bernd Grimm
- Luxembourg Institute of Health, Department of Precision Health, Human Motion, Orthopaedics, Sports Medicine and Digital Methods Group, 1445 Strassen, Luxembourg;
| | - Meir T. Marmor
- Orthopaedic Trauma Institute (OTI), San Francisco General Hospital, University of California, San Francisco, CA 94158, USA;
| | | | - Peter H. Richter
- Department of Trauma and Orthopaedic Surgery, Esslingen Hospotal, 73730 Esslingen, Germany;
| | - Seth Yarboro
- Deptartment Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22908, USA;
| | - Andrew M. Hanflik
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Downey Medical Center, Kaiser Permanente, Downey, CA 90027, USA;
| | - Tina Histing
- University Hospital Tuebingen on Behalf of the Eberhard-Karls-University Tuebingen, BG Unfallklinik, Schnarrenbergstr. 95, 72076 Tuebingen, Germany; (C.V.); (T.H.)
| | - Benedikt J. Braun
- University Hospital Tuebingen on Behalf of the Eberhard-Karls-University Tuebingen, BG Unfallklinik, Schnarrenbergstr. 95, 72076 Tuebingen, Germany; (C.V.); (T.H.)
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Xia S, Wung SF, Chen CC, Coompson JLK, Roveda J, Liu J. Data-Fusion-Based Quality Enhancement for HR Measurements Collected by Wearable Sensors. SENSORS (BASEL, SWITZERLAND) 2024; 24:2970. [PMID: 38793825 PMCID: PMC11125147 DOI: 10.3390/s24102970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/24/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024]
Abstract
The advancements of Internet of Things (IoT) technologies have enabled the implementation of smart and wearable sensors, which can be employed to provide older adults with affordable and accessible continuous biophysiological status monitoring. The quality of such monitoring data, however, is unsatisfactory due to excessive noise induced by various disturbances, such as motion artifacts. Existing methods take advantage of summary statistics, such as mean or median values, for denoising, without taking into account the biophysiological patterns embedded in data. In this research, a functional data analysis modeling method was proposed to enhance the data quality by learning individual subjects' diurnal heart rate (HR) patterns from historical data, which were further improved by fusing newly collected data. This proposed data-fusion approach was developed based on a Bayesian inference framework. Its effectiveness was demonstrated in an HR analysis from a prospective study involving older adults residing in assisted living or home settings. The results indicate that it is imperative to conduct personalized healthcare by estimating individualized HR patterns. Furthermore, the proposed calibration method provides a more accurate (smaller mean errors) and more precise (smaller error standard deviations) HR estimation than raw HR and conventional methods, such as the mean.
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Affiliation(s)
- Shenghao Xia
- Statistics GIDP, Department of Mathematics, University of Arizona, Tucson, AZ 85721, USA;
- Department of System and Industrial Engineering, University of Arizona, Tucson, AZ 85721, USA
| | - Shu-Fen Wung
- College of Nursing, University of Arizona, Tucson, AZ 85721, USA;
| | - Chang-Chun Chen
- Department of Electrical and Computer Engineering, University of Arizona, Tucson, AZ 85721, USA; (C.-C.C.); (J.L.K.C.); (J.R.)
| | - Jude Larbi Kwesi Coompson
- Department of Electrical and Computer Engineering, University of Arizona, Tucson, AZ 85721, USA; (C.-C.C.); (J.L.K.C.); (J.R.)
| | - Janet Roveda
- Department of Electrical and Computer Engineering, University of Arizona, Tucson, AZ 85721, USA; (C.-C.C.); (J.L.K.C.); (J.R.)
| | - Jian Liu
- Statistics GIDP, Department of Mathematics, University of Arizona, Tucson, AZ 85721, USA;
- Department of System and Industrial Engineering, University of Arizona, Tucson, AZ 85721, USA
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Sun F, Bedenkov A, Liu BC, Yang J, Xu JF, Ji L, Zhou M, Zhang S, Li X, Song Y, Chen P, Moreno C. Maximizing the Value of Real-World Data and Real-World Evidence to Accelerate Healthcare Transformation in China: Summary of External Advisory Committee Meetings. Pharmaceut Med 2024; 38:157-166. [PMID: 38573457 PMCID: PMC11101539 DOI: 10.1007/s40290-024-00520-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 04/05/2024]
Abstract
Use of real-world data (RWD) is gaining wide attention. To bridge the gap between diverse healthcare stakeholders and to leverage the impact of Chinese real-world evidence (RWE) globally, a multi-stakeholder External Advisory Committee (EAC) and EAC meetings were initiated, aiming to elucidate the current and evolving RWD landscape in China, articulate the values of RWE in ensuring Chinese patients' equitable access to affordable medicines and solutions, and identify strategic opportunities and partnerships for expansion of RWE generation in China. Chinese and international experts who are clinicians and academic researchers were selected as EAC members based on their professional background and familiarity with RWD/RWE. Three EAC meetings were held quarterly in 2023. Various topics were presented and discussed for insights and suggestions. Nine experts from China, one from South Korea, and two from Europe were selected as EAC members and attended these meetings. Experts' presentations were summarized by theme, including the RWD landscape and RWE enablement in China, as well as global development of a patient-centric ecosystem. Experts' insights and suggestions on maximizing the RWD/RWE value to accelerate healthcare transformation in China were collected. We concluded that though data access, sharing, and quality are still challenging, RWD is developing to support evidence generation in the medicinal product lifecycle, inform clinical practice, and empower patient management in China. RWD/RWE creates value, accelerates healthcare transformation, and improves patient outcomes. Fostering a patient-centric ecosystem across healthcare stakeholders and maintaining global partnerships and collaboration are essential for unlocking the power of RWD/RWE.
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Affiliation(s)
- Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases, Peking University, Beijing, China
| | | | - Bi-Cheng Liu
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China
| | - Jiefu Yang
- Department of Cardiology, Beijing Hospital, Beijing, China
| | - Jin-Fu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China
| | - Min Zhou
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaosen Zhang
- Global Evidence Powerhub China, AstraZeneca, Shanghai, China
| | - Xinli Li
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuanlin Song
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pingyan Chen
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China.
- Hainan Institute of Real-World Data, Qionghai, China.
| | - Carmen Moreno
- Global Evidence Powerhub China, AstraZeneca, Shanghai, China.
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Wang AG, Lahoz T, Hvid M, Grufstedt HK, Jørgensen LM. The Amager Project IV: suicidal behavior and aftercare: real world data (RWD) from a prospective observational project. Nord J Psychiatry 2024; 78:267-271. [PMID: 38339969 DOI: 10.1080/08039488.2024.2315163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND In an RCT study, OPAC (outreach, problem solving, adherence, continuity) approach to aftercare after suicide attempts had an effect. The present study used the OPAC method in a clinical setting on Amager Copenhagen to patients after suicide attempt (Group 1) and patients with suicide ideation (Group 2) in a real-world data (RWD) study. AIM To study whether the OPAC method could provide real world evidence (RWE) for results from the RCT study and long-time prospects. METHOD This RWD study included 506 patients and followed them for 5 years. Kaplan-Meyer showed 5 years results. Risk factors for 5 years were calculated. RESULTS 206 males (mean age 37.9) and 300 females (mean age 35.2) participated. A decline in survival accelerated after 3 years. After a 2-year follow-up, Group 1 had an attempted suicide rate of 12,2% and Group 2 5,4%. After 5 years the numbers were 18% and 10%. There were 3 completed suicides. Risk factors were: earlier suicide attempts, one or both parents or they themselves were alcohol/drug abusers, and a poor social network. Group 1 showed the same result as the intervention group in our earlier RCT study. Group 2 did better. Both groups did better than the control group from our RCT study. CONCLUSION The OPAC effect was translated into the daily clinic. Risk factors were previous suicide attempts, alcohol and drug abuse and poor social networks. More specific therapy is needed for some patients to prevent relapse. Focus on enhancing a sense of belongingness and/or treating substance abuse.
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Affiliation(s)
- August G Wang
- Centre of Psychiatry Amager, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health Science, University of Faroe Islands, Torshavn, Faroe Islands
| | - Titia Lahoz
- Centre of Psychiatry Amager, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marianne Hvid
- Centre of Psychiatry Amager, Copenhagen University Hospital, Copenhagen, Denmark
| | - Heidi K Grufstedt
- Centre of Psychiatry Amager, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lene M Jørgensen
- Centre of Psychiatry Amager, Copenhagen University Hospital, Copenhagen, Denmark
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Wells AU. Optimal clinical practice in IPF and PPF: Integrating the scientific ethos and clinical reasoning. Respirology 2024; 29:356-358. [PMID: 38537694 DOI: 10.1111/resp.14710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 04/18/2024]
Abstract
See related article
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Affiliation(s)
- Athol U Wells
- Royal Brompton Hospital and Imperial College, London, UK
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40
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Al Raizah A, Alayoubi F, Abdelnaby GH, Alzahrani H, Bakheet MF, Alskaini MA, Buhumaid R, Al Awadhi S, Kazim SN, Jaiganesh T, Naguib MHH, Al Aseri Z. Clinical Care Pathway and Management of Major Bleeding Associated with Nonvitamin K Antagonist Oral Anticoagulants: A Modified Delphi Consensus from Saudi Arabia and UAE. Mediterr J Hematol Infect Dis 2024; 16:e2024038. [PMID: 38882457 PMCID: PMC11178050 DOI: 10.4084/mjhid.2024.038] [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: 12/13/2023] [Accepted: 04/13/2024] [Indexed: 06/18/2024] Open
Abstract
Background The nonvitamin K antagonist oral anticoagulants (NOACs) have become the mainstay anticoagulation therapy for patients requiring oral anticoagulants (OACs) in the Gulf Council Cooperation (GCC) countries. The frequency of NOAC-associated major bleeding is expected to increase in the Emergency Department (ED). Nonetheless, we still lack local guidelines and recommendations for bleeding management in the region. The present Delphi-based consensus aims to establish a standardized and evidence-based clinical care pathway for managing NOAC-associated major bleeding in the Kingdom of Saudi Arabia (KSA) and the United Arab Emirates (UAE). Methods We adopted a three-step modified Delphi method to develop evidence-based recommendations through two voting rounds and an advisory meeting between the two rounds. A panel of 11 experts from the KSA and UAE participated in the consensus development. Results Twenty-eight statements reached the consensus level. These statements addressed key aspects of managing major bleeding events associated with NOACs, including the increased use of NOAC in clinical practice, clinical care pathways, and treatment options. Conclusion The present Delphi consensus provides evidence-based recommendations and protocols for the management of NOAC-associated bleeding in the region. Patients with major DOAC-induced bleeding should be referred to a well-equipped ED with standardized management protocols. A multidisciplinary approach is recommended for establishing the association between NOAC use and major bleeding. Treating physicians should have prompt access to specific reversal agents to optimize patient outcomes. Real-world evidence and national guidelines are needed to aid all stakeholders involved in NOAC-induced bleeding management.
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Affiliation(s)
- Abdulrahman Al Raizah
- Division of Adult Hematology, Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, PO Box. 22490, 11426, Riyadh, Saudi Arabia
| | | | | | - Hazzaa Alzahrani
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | - Mohammed A Alskaini
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Rasha Buhumaid
- Mohammed Bin Rashid University of Medicine and Health Science, Dubai, United Arab Emirates
| | - Sameer Al Awadhi
- Digestive Diseases Unit, Rashid Hospital, Dubai, United Arab Emirates
| | - Sara Nooruddin Kazim
- Department of Emergency Medicine, Rashid Hospital and Trauma Centre, Dubai Health Authority, Dubai, United Arab Emirates
| | | | | | - Zohair Al Aseri
- Department Emergency Medicine and Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Clinical Sciences, College of Medicine and Riyadh Hospital, Dar Al Uloom University, Riyadh, Saudi Arabia
- Therapeutic Deputyship, Ministry of Health, Riyadh, Saudi Arabia
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Gonzalez-Jaramillo N, Abbühl D, Roa-Díaz ZM, Kobler-Betancourt C, Frahsa A. COVID-19 vaccine acceptance in the general population and under-resourced communities from high-income countries: realist review. BMJ Open 2024; 14:e084560. [PMID: 38631831 PMCID: PMC11029206 DOI: 10.1136/bmjopen-2024-084560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE To compare vaccination willingness before rollout and 1 year post-rollout uptake among the general population and under-resourced communities in high-income countries. DESIGN A realist review. DATA SOURCES Embase, PubMed, Dimensions ai and Google Scholar. SETTING High-income countries. DEFINITIONS We defined vaccination willingness as the proportion of participants willing or intending to receive vaccines prior to availability. We defined vaccine uptake as the real proportion of the population with complete vaccination as reported by each country until November 2021. RESULTS We included data from 62 studies and 18 high-income countries. For studies conducted among general populations, the proportion of vaccination willingness was 67% (95% CI 62% to 72%). In real-world settings, the overall proportion of vaccine uptake among those countries was 73% (95% CI 69% to 76%). 17 studies reported pre-rollout willingness for under-resourced communities. The summary proportion of vaccination willingness from studies reporting results among people from under-resourced communities was 52% (95% CI 0.46% to 0.57%). Real-world evidence about vaccine uptake after rollout among under-resourced communities was limited. CONCLUSION Our review emphasises the importance of realist reviews for assessing vaccine acceptance. Limited real-world evidence about vaccine uptake among under-resourced communities in high-income countries is a call to context-specific actions and reporting.
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Affiliation(s)
| | - Dominik Abbühl
- ISPM, University of Bern, Bern, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Zayne Milena Roa-Díaz
- ISPM, University of Bern, Bern, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
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Mayta-Tovalino F, Espinoza-Carhuancho F, Reyes-Carmona J, Mauricio-Vilchez C, Medina J, Galarza-Valencia D, Vicuña-Quispe C. Emergent Patterns, Collaborative Networks and Thematic Evolution on Black Stain and Dental Caries: A Scientometric Study. J Contemp Dent Pract 2024; 25:326-330. [PMID: 38956846 DOI: 10.5005/jp-journals-10024-3682] [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] [Indexed: 07/04/2024]
Abstract
AIM To conduct a scientometric analysis on black stains, and dental caries, with a focus on identifying emergent patterns, collaborative networks, and thematic evolution. MATERIALS AND METHODS A retrospective, descriptive, observational study was conducted using a scientometric approach. The Scopus database was utilized for literature search, selecting articles published between 1976 and 2023. The literature search was carried out on February 8, 2024, using AND and OR Boolean operators which were adapted to the search strategy. Finally, SciVal used different scientometric indicators such as "Scholarly Output", "Views Count", "Field-Weighted Citation Impact" and the "Citation Count". RESULTS A total of 13 documents from 10 different sources were analyzed, covering a period from 1976 to 2023. Despite an annual growth rate of 0%, each document has an average of 21.08 citations, indicating their relevance in the field. The documents have an average age of 12.9 years and contain 336 references. A total of 143 additional keywords and 26 author keywords were identified. The documents were written by 62 different authors, with an average of 5 coauthors per document and 30.77% international coauthorships. CONCLUSION The results indicate a significant relevance of the documents in the field, a notable collaboration among authors, and a significant thematic evolution in the research topics. The mentioned institutions and sources produced documents with notable results, indicating a significant interest and impact in the field. CLINICAL SIGNIFICANCE This study provides a detailed view of the trends and patterns in the research of dental caries and black stains. The findings can assist dental health professionals in better understanding the prevalence and impact of these conditions. Furthermore, it can guide future research and treatment strategies in this field. How to cite this article: Mayta-Tovalino F, Espinoza-Carhuancho F, Reyes-Carmona J, et al. Emergent Patterns, Collaborative Networks and Thematic Evolution on Black Stain and Dental Caries: A Scientometric Study. J Contemp Dent Pract 2024;25(4):326-330.
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Affiliation(s)
- Frank Mayta-Tovalino
- Academic Department, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru, Phone: +51 1214-2500, e-mail:
| | - Fran Espinoza-Carhuancho
- Academic Department, Grupo de Bibliometría, Evaluación de evidencia y Revisiones Sistemáticas (BEERS), Human Medicine Career, Universidad Cientifica del Sur, Lima, Peru
| | - Jessie Reyes-Carmona
- Academic Department, LICIFO, Faculty of Dentistry, University of Costa Rica, San Jose, Costa Rica
| | - Cesar Mauricio-Vilchez
- Academic Department, Unidad de Investigación, Innovación y Emprendimiento, Faculty of Dentistry, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Julia Medina
- Academic Department, Unidad de Investigación, Innovación y Emprendimiento, Faculty of Dentistry, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Diego Galarza-Valencia
- Academic Department, Unidad de Investigación, Innovación y Emprendimiento, Faculty of Dentistry, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Carlos Vicuña-Quispe
- Academic Department, Sociedad Científica de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru
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Arons A, Seligman HK. The emerging adulthood gap in diabetes prevention research. LANCET REGIONAL HEALTH. AMERICAS 2024; 32:100699. [PMID: 38425415 PMCID: PMC10904267 DOI: 10.1016/j.lana.2024.100699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/09/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
Emerging adulthood, the period between ages 18 and 25, is distinct from older and younger populations in terms of both physiology and social circumstances. As a critical developmental window with long-lasting repercussions, emerging adulthood presents a key opportunity for prevention of cardiovascular disease. Despite significant advances in diabetes and cardiovascular disease prevention for other age groups, 18-25 year-olds remain underrepresented in research. Using diabetes prevention as an example, we analyzed the cited evidence behind four major guidelines that influence US clinical practice on screening and management of prediabetes in children and adults, revealing that the majority of these studies in both the pediatric and adult literature do not include emerging adults in their study populations. This gap between the pediatric and adult diabetes prevention literature creates a missing link connecting childhood risks to adult chronic disease. In this article, we draw attention to this often overlooked age group, and provide tangible recommendations as a path forward for both pediatric and adult researchers to increase the representation of emerging adults in diabetes prevention and other cardiovascular disease prevention studies.
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Affiliation(s)
- Abigail Arons
- Division of General Internal Medicine and Department of Pediatrics, UCSF, 490 Illinois Ave, Floor 7, San Francisco, CA, 94158, USA
| | - Hilary K. Seligman
- Center for Vulnerable Populations and Division of General Internal Medicine, UCSF, 490 Illinois Ave, Floor 7, San Francisco, CA, 94158, USA
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Reniewicz J, Suryaprakash V, Kowalczyk J, Blacha A, Kostello G, Tan H, Wang Y, Reineke P, Manissero D. Artificial intelligence / machine-learning tool for post-market surveillance of in vitro diagnostic assays. N Biotechnol 2024; 79:82-90. [PMID: 38040287 DOI: 10.1016/j.nbt.2023.11.005] [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: 08/10/2023] [Revised: 11/17/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
The study compares an artificial intelligence technology with traditional manual search of literature databases to assess the accuracy and efficiency of retrieving relevant articles for post-market surveillance of in vitro diagnostic and medical devices under the Medical Device Regulation and In Vitro Diagnostic Medical Device Regulation. Over a 3-year period, literature searches and technical assessment searches were performed manually or using the Huma.AI platform to retrieve relevant articles related to the safety and performance of selected in vitro diagnostic and medical devices. The manual search involved refined keyword searches, screening of titles/abstracts / full text, and extraction of relevant information. The Huma.AI search utilized advanced caching techniques and a natural language processing system to identify relevant reports. Searches were conducted on PubMed and PubMed Central. The number of identified relevant reports, precision rates, and time requirements for each approach were analyzed. The Huma.AI system outperformed the manual search in terms of the number of identified relevant articles in almost all cases. The average precision rates per year were significantly higher and more consistent with the Huma.AI search compared with the manual search. The Huma.AI system also took significantly less time to perform the searches and analyze the outputs than the manual search. The study demonstrated that the Huma.AI platform was more effective and efficient in identifying relevant articles compared with the manual approach.
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Affiliation(s)
- Joanna Reniewicz
- QIAGEN Wrocław, ul. Powstańców Śląskich 95, 53-332 Wrocław, Poland
| | | | | | - Anna Blacha
- QIAGEN Manchester Ltd, CityLabs, 2.0 Hathersage Rd, M13 0BH Manchester, UK.
| | - Greg Kostello
- Huma.AI, 3000 El Camino Real, Building 4, Suite 200-69, Palo Alto, CA 94306, USA
| | - Haiming Tan
- Huma.AI, 3000 El Camino Real, Building 4, Suite 200-69, Palo Alto, CA 94306, USA
| | - Yan Wang
- Huma.AI, 3000 El Camino Real, Building 4, Suite 200-69, Palo Alto, CA 94306, USA
| | - Patrick Reineke
- Huma.AI, 3000 El Camino Real, Building 4, Suite 200-69, Palo Alto, CA 94306, USA
| | - Davide Manissero
- QIAGEN Manchester Ltd, CityLabs, 2.0 Hathersage Rd, M13 0BH Manchester, UK
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Choudhary P, Arrieta A, van den Heuvel T, Castañeda J, Smaniotto V, Cohen O. Celebrating the Data from 100,000 Real-World Users of the MiniMed™ 780G System in Europe, Middle East, and Africa Collected Over 3 Years: From Data to Clinical Evidence. Diabetes Technol Ther 2024; 26:32-37. [PMID: 38377326 PMCID: PMC10890936 DOI: 10.1089/dia.2023.0433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Introduction: The present report celebrates the benchmarking of 100,000 MiniMed™ 780G system users in Europe, Middle East, and Africa (EMEA) and summarizes the major insights into the usability and outcomes of this system. Methods: Carelink Personal data (August 2020-August 2023) of users living in EMEA were analyzed. Continuous glucose monitoring-based endpoints were aggregated for (1) the full cohort and (2) a 12-month longitudinal cohort. Subanalyses were done for users on optimal settings (those spending ≥95% of time with glucose target of 100 mg/dL, and ≥95% of time with active insulin time of 2 h), for self-reported age groups (≤15 and ≥56 years) and for various countries/regions. Results: Data from 101,629 users (34 countries) were analyzed. Mean time in range (TIR) was 72.3%, glucose management indicator (GMI) was 7%, time below 70 mg/dL (TBR70) was 2.0% and time below 54 mg/dL (TBR54) was 0.4%. In terms of international targets, 59.6% of users achieved a GMI <7%, 62.5% a TIR >70%, 88.4% a TBR70 < 4%, and 90.0% a TBR54 < 1%. Data improved impressively in optimal setting users (TIR = 78.8%, and users reaching TIR >70% = 86.3%) while safety remained (TBR70 = 2.2% and TBR54 = 0.4%). Data showed consistency across self-reported age groups and geographies. In the longitudinal cohort, TIR reached 75.5% in the first month and remained 73.3% or higher over the 12-month period. Conclusion: Over 100,000 users of the MiniMed™ 780G system have demonstrated consistency in achieving target control of glycemia.
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Affiliation(s)
- Pratik Choudhary
- Kings College Hospital NHS Foundation Trust, London, United Kingdom
- Leicester Diabetes Center, University of Leicester, Leicester, United Kingdom
| | - Arcelia Arrieta
- Medtronic Diabetes, Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Tim van den Heuvel
- Medtronic Diabetes, Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Javier Castañeda
- Medtronic Diabetes, Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Vittorino Smaniotto
- Medtronic Diabetes, Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Ohad Cohen
- Medtronic Diabetes, Medtronic International Trading Sàrl, Tolochenaz, Switzerland
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Ryan DK, Maclean RH, Balston A, Scourfield A, Shah AD, Ross J. Artificial intelligence and machine learning for clinical pharmacology. Br J Clin Pharmacol 2024; 90:629-639. [PMID: 37845024 DOI: 10.1111/bcp.15930] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
Artificial intelligence (AI) will impact many aspects of clinical pharmacology, including drug discovery and development, clinical trials, personalized medicine, pharmacogenomics, pharmacovigilance and clinical toxicology. The rapid progress of AI in healthcare means clinical pharmacologists should have an understanding of AI and its implementation in clinical practice. As with any new therapy or health technology, it is imperative that AI tools are subject to robust and stringent evaluation to ensure that they enhance clinical practice in a safe and equitable manner. This review serves as an introduction to AI for the clinical pharmacologist, highlighting current applications, aspects of model development and issues surrounding evaluation and deployment. The aim of this article is to empower clinical pharmacologists to embrace and lead on the safe and effective use of AI within healthcare.
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Affiliation(s)
- David K Ryan
- Department of Clinical Pharmacology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rory H Maclean
- Department of Clinical Pharmacology, University College London Hospitals NHS Foundation Trust, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Alfred Balston
- Department of Clinical Pharmacology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew Scourfield
- Department of Clinical Pharmacology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Anoop D Shah
- Department of Clinical Pharmacology, University College London Hospitals NHS Foundation Trust, London, UK
- Institute of Health Informatics, University College London, London, UK
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Jack Ross
- Department of Clinical Pharmacology, University College London Hospitals NHS Foundation Trust, London, UK
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Oliveira Alves FJ, Fialho E, Paiva de Araújo JA, Naslund JA, Barreto ML, Patel V, Machado DB. The rising trends of self-harm in Brazil: an ecological analysis of notifications, hospitalisations, and mortality between 2011 and 2022. LANCET REGIONAL HEALTH. AMERICAS 2024; 31:100691. [PMID: 38500959 PMCID: PMC10945432 DOI: 10.1016/j.lana.2024.100691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 03/20/2024]
Abstract
Background Self-harm is considered an important public health issue and is comprised by a wide range of definitions and behaviours. It is estimated that suicide affects more than 700,000 individuals every year, although, globally, there is a lack of evidence on other self-harm behaviour, such as attempted suicide. The objective of this study is to report and examine temporal trends of notifications, hospitalisations related to self-harm and suicide rates in Brazil between 2011 and 2022, as well as investigating differences in sociodemographic characteristics, methods, and region. Methods This ecological study used secondary, Brazilian Health Information System data between 2011 and 2022. Self-harm notifications were collected from the Notifiable Diseases Information System (SINAN); self-harm hospitalisations from the Hospital Information System (SIH), and suicide data from the Mortality Information System (SIM). We calculated self-harm notifications, hospitalisations, and suicide rates by sex, age, race, region, and overall. We assessed time-related trends using Joinpoint regression analyses. Findings From 2011 to 2022, 720,480 self-harm notifications, 104,458 self-harm hospitalisations, and 147,698 suicides were recorded in Brazil. In this period, self-harm notifications (AAPC: 21.13 (CI: 17.50, 25.33)) and suicide (AAPC: 3.70 (CI: 3.05, 4.38)) have increased in the country. Male adults (25-59 years old) and the elderly (>60 years old) continue to be the groups most affected by suicide, with respective rates of 9.59 and 8.60/100,000 in 2022. However, the largest percentage increases have been seen in young people (AAPC: 6.14 (CI: 4.57, 7.88)). The Indigenous population had the highest self-harm notification (103.72, 10,000) and suicide (16.58/100,000) rates, but the lowest hospitalisation rates (1.14/100,000) in 2022), compared to the overall population (70.06, 7.27, and 4.69/100,000, respectively, in 2022). Interpretation The observed trend of increased self-harm notifications and suicide rates suggests the need for a greater allocation of resources to strategies to prevent self-harm and suicide. The Indigenous population seems to be the group with less access to healthcare. Funding Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under award number R01MH128911-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Affiliation(s)
- Flávia Jôse Oliveira Alves
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Erika Fialho
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Jacyra Azevedo Paiva de Araújo
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Maurício L. Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Daiane Borges Machado
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
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Zisis K, Pavi E, Geitona M, Athanasakis K. Real-world data: a comprehensive literature review on the barriers, challenges, and opportunities associated with their inclusion in the health technology assessment process. JOURNAL OF PHARMACY & PHARMACEUTICAL SCIENCES : A PUBLICATION OF THE CANADIAN SOCIETY FOR PHARMACEUTICAL SCIENCES, SOCIETE CANADIENNE DES SCIENCES PHARMACEUTIQUES 2024; 27:12302. [PMID: 38481726 PMCID: PMC10932954 DOI: 10.3389/jpps.2024.12302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/01/2024] [Indexed: 07/23/2024]
Abstract
Objective: This review aimed to assess the current use and acceptance of real-world data (RWD) and real-world evidence (RWE) in health technology assessment (HTA) process. It additionally aimed to discern stakeholders' viewpoints concerning RWD and RWE in HTA and illuminate the obstacles, difficulties, prospects, and consequences associated with the incorporation of RWD and RWE into the realm of HTA. Methods: A comprehensive PRISMA-based systematic review was performed in July 2022 in PubMed/Medline, Scopus, IDEAS-RePEc, International HTA database, and Centre for Reviews and Dissemination with ad hoc supplementary search in Google Scholar and international organization websites. The review included pre-determined inclusion criteria while the selection of eligible studies, the data extraction process and quality assessment were carried out using standardized and transparent methods. Results: Twenty-nine (n = 29) studies were included in the review out of 2,115 studies identified by the search strategy. In various global contexts, disparities in RWD utilization were evident, with randomized controlled trials (RCTs) serving as the primary evidence source. RWD and RWE played pivotal roles, surpassing relative effectiveness assessments (REAs) and significantly influencing decision-making and cost-effectiveness analyses. Identified challenges impeding RWD integration into HTA encompassed limited local data access, complexities in non-randomized trial design, data quality, privacy, and fragmentation. Addressing these is imperative for optimal RWD utilization. Incorporating RWD/RWE in HTA yields multifaceted advantages, enhancing understanding of treatment efficacy, resource utilization, and cost analysis, particularly via patient registries. RWE complements assessments of advanced therapy medicinal products (ATMPs) and rare diseases. Local data utilization strengthens HTA, bridging gaps when RCT data is lacking. RWD aids medical device decision-making, cancer drug reassessment, and indirect treatment comparisons. Challenges include data availability, stakeholder acceptance, expertise, and privacy. However, standardization, training, collaboration, and guidance can surmount these barriers, fostering enhanced RWD utilization in HTA. Conclusion: This study highlights the intricate global landscape of RWD and RWE acceptance in HTA. Recognizing regional nuances, addressing methodological challenges, and promoting collaboration are pivotal, among others, for leveraging RWD and RWE effectively in healthcare decision-making.
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Affiliation(s)
- Konstantinos Zisis
- Laboratory for Health Technology Assessment (LabHTA), Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
- Institute for Health Economics, Athens, Greece
| | - Elpida Pavi
- Laboratory for Health Technology Assessment (LabHTA), Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Mary Geitona
- Department of Social and Educational Policy, Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece
| | - Kostas Athanasakis
- Laboratory for Health Technology Assessment (LabHTA), Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
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Qiao H, Chen Y, Qian C, Guo Y. Clinical data mining: challenges, opportunities, and recommendations for translational applications. J Transl Med 2024; 22:185. [PMID: 38378565 PMCID: PMC10880222 DOI: 10.1186/s12967-024-05005-0] [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: 12/07/2023] [Accepted: 02/18/2024] [Indexed: 02/22/2024] Open
Abstract
Clinical data mining of predictive models offers significant advantages for re-evaluating and leveraging large amounts of complex clinical real-world data and experimental comparison data for tasks such as risk stratification, diagnosis, classification, and survival prediction. However, its translational application is still limited. One challenge is that the proposed clinical requirements and data mining are not synchronized. Additionally, the exotic predictions of data mining are difficult to apply directly in local medical institutions. Hence, it is necessary to incisively review the translational application of clinical data mining, providing an analytical workflow for developing and validating prediction models to ensure the scientific validity of analytic workflows in response to clinical questions. This review systematically revisits the purpose, process, and principles of clinical data mining and discusses the key causes contributing to the detachment from practice and the misuse of model verification in developing predictive models for research. Based on this, we propose a niche-targeting framework of four principles: Clinical Contextual, Subgroup-Oriented, Confounder- and False Positive-Controlled (CSCF), to provide guidance for clinical data mining prior to the model's development in clinical settings. Eventually, it is hoped that this review can help guide future research and develop personalized predictive models to achieve the goal of discovering subgroups with varied remedial benefits or risks and ensuring that precision medicine can deliver its full potential.
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Affiliation(s)
- Huimin Qiao
- Medical Big Data and Bioinformatics Research Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Yijing Chen
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
| | - Changshun Qian
- School of Information Engineering, Jiangxi University of Science and Technology, Ganzhou, China
| | - You Guo
- Medical Big Data and Bioinformatics Research Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, China.
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China.
- School of Information Engineering, Jiangxi University of Science and Technology, Ganzhou, China.
- Ganzhou Key Laboratory of Medical Big Data, Ganzhou, China.
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Peng Y, Bathelt F, Gebler R, Gött R, Heidenreich A, Henke E, Kadioglu D, Lorenz S, Vengadeswaran A, Sedlmayr M. Use of Metadata-Driven Approaches for Data Harmonization in the Medical Domain: Scoping Review. JMIR Med Inform 2024; 12:e52967. [PMID: 38354027 PMCID: PMC10902772 DOI: 10.2196/52967] [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: 09/20/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Multisite clinical studies are increasingly using real-world data to gain real-world evidence. However, due to the heterogeneity of source data, it is difficult to analyze such data in a unified way across clinics. Therefore, the implementation of Extract-Transform-Load (ETL) or Extract-Load-Transform (ELT) processes for harmonizing local health data is necessary, in order to guarantee the data quality for research. However, the development of such processes is time-consuming and unsustainable. A promising way to ease this is the generalization of ETL/ELT processes. OBJECTIVE In this work, we investigate existing possibilities for the development of generic ETL/ELT processes. Particularly, we focus on approaches with low development complexity by using descriptive metadata and structural metadata. METHODS We conducted a literature review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We used 4 publication databases (ie, PubMed, IEEE Explore, Web of Science, and Biomed Center) to search for relevant publications from 2012 to 2022. The PRISMA flow was then visualized using an R-based tool (Evidence Synthesis Hackathon). All relevant contents of the publications were extracted into a spreadsheet for further analysis and visualization. RESULTS Regarding the PRISMA guidelines, we included 33 publications in this literature review. All included publications were categorized into 7 different focus groups (ie, medicine, data warehouse, big data, industry, geoinformatics, archaeology, and military). Based on the extracted data, ontology-based and rule-based approaches were the 2 most used approaches in different thematic categories. Different approaches and tools were chosen to achieve different purposes within the use cases. CONCLUSIONS Our literature review shows that using metadata-driven (MDD) approaches to develop an ETL/ELT process can serve different purposes in different thematic categories. The results show that it is promising to implement an ETL/ELT process by applying MDD approach to automate the data transformation from Fast Healthcare Interoperability Resources to Observational Medical Outcomes Partnership Common Data Model. However, the determining of an appropriate MDD approach and tool to implement such an ETL/ELT process remains a challenge. This is due to the lack of comprehensive insight into the characterizations of the MDD approaches presented in this study. Therefore, our next step is to evaluate the MDD approaches presented in this study and to determine the most appropriate MDD approaches and the way to integrate them into the ETL/ELT process. This could verify the ability of using MDD approaches to generalize the ETL process for harmonizing medical data.
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Affiliation(s)
- Yuan Peng
- Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | | | - Richard Gebler
- Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Robert Gött
- Core Unit Datenintegrationszentrum, University Medicine Greifswald, Greifswald, Germany
| | - Andreas Heidenreich
- Department for Information and Communication Technology (DICT), Data Integration Center (DIC), Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Elisa Henke
- Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Dennis Kadioglu
- Department for Information and Communication Technology (DICT), Data Integration Center (DIC), Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
- Institute for Medical Informatics, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stephan Lorenz
- Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Abishaa Vengadeswaran
- Institute for Medical Informatics, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Martin Sedlmayr
- Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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