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Esfandiari E, Chudyk AM, Grover S, Lau EY, Hoppmann C, Mortenson WB, Mulligan K, Newton C, Pauly T, Pitman B, Rush KL, Sakakibara BM, Symes B, Tsuei S, Petrella RJ, Ashe MC. Social Prescribing Outcomes for Trials (SPOT): Protocol for a modified Delphi study on core outcomes. PLoS One 2023; 18:e0285182. [PMID: 37192189 PMCID: PMC10187912 DOI: 10.1371/journal.pone.0285182] [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: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/18/2023] Open
Abstract
PURPOSE This is a study protocol to co-create with knowledge users a core outcome set focused on middle-aged and older adults (40 years+) for use in social prescribing research. METHODS We will follow the Core Outcome Measures in Effectiveness Trials (COMET) guide and use modified Delphi methods, including collating outcomes reported in social prescribing publications, online surveys, and discussion with our team to finalize the core outcome set. We intentionally center this work on people who deliver and receive social prescribing and include methods to evaluate collaboration. Our three-part process includes: (1) identifying published systematic reviews on social prescribing for adults to extract reported outcomes; and (2) up to three rounds of online surveys to rate the importance of outcomes for social prescribing. For this part, we will invite people (n = 240) who represent the population experienced in social prescribing, including researchers, members of social prescribing organizations, and people who receive social prescribing and their caregivers. Finally, we will (3) convene a virtual team meeting to discuss and rank the findings and finalize the core outcome set and our knowledge mobilization plan. CONCLUSION To our knowledge, this is the first study designed to use a modified Delphi method to co-create core outcomes for social prescribing. Development of a core outcome set contributes to improved knowledge synthesis via consistency in measures and terminology. We aim to develop guidance for future research, and specifically on the use of core outcomes for social prescribing at the person/patient, provider, program, and societal-level.
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Affiliation(s)
- Elham Esfandiari
- Department of Family Practice, The University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada
| | - Anna M. Chudyk
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sanya Grover
- Department of Family Practice, The University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada
| | - Erica Y. Lau
- Department of Emergency Medicine, UBC, Vancouver, BC, Canada
| | | | - W. Ben Mortenson
- UBC Department of Occupational Science and Occupational Therapy, Vancouver, BC, Canada
- GF Strong Rehabilitation Research Program, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | - Kate Mulligan
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Christie Newton
- Department of Family Practice, The University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada
| | - Theresa Pauly
- Department of Gerontology, Simon Fraser University, Burnaby, BC, Canada
| | | | - Kathy L. Rush
- School of Nursing, UBC-Okanagan, Kelowna, BC, Canada
| | - Brodie M. Sakakibara
- UBC Department of Occupational Science and Occupational Therapy, Vancouver, BC, Canada
- Centre for Chronic Disease Prevention and Management, Southern Medical Program, UBC-Okanagan, Kelowna, BC, Canada
| | - Bobbi Symes
- United Way British Columbia, Burnaby, BC, Canada
| | - Sian Tsuei
- Department of Family Practice, The University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, United States of America
| | - Robert J. Petrella
- Department of Family Practice, The University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada
- Department of Family Medicine, Western University, London, Ontario, Canada
- School of Kinesiology, Western University, London, Ontario, Canada
- Western Centre for Public Health & Family Medicine, Western University, London, Ontario, Canada
| | - Maureen C. Ashe
- Department of Family Practice, The University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada
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Williamson J, Jalkanen J, Lahtinen M. Small pharma vendor management practices in clinical trials: A case study within Faron Pharmaceuticals. Drug Discov Today 2023; 28:103553. [PMID: 36921669 DOI: 10.1016/j.drudis.2023.103553] [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: 10/12/2022] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023]
Abstract
Many small pharmaceutical companies find that they lack the resources, knowledge and expertise of the regulatory landscape for adequate vendor management in clinical trials, making the organization vulnerable. Recent research suggests that some pharmaceutical companies have found themselves out of compliance with ICH, FDA or EMA guidelines. This paper aims to perform a comprehensive review of the regulatory landscape for vendor selection, oversight and ongoing evaluation in clinical trials. In addition, the case study performed studies the practices recently implemented at small pharmaceutical company Faron Pharmaceuticals to assess regulatory compliance and identify any potential best practices. Faron Pharmaceuticals conducted a process improvement activity at the beginning of 2022 to improve the vendor selection, oversight and evaluation of their clinical trial partners. The results of this case study indicate that Faron Pharmaceuticals' processes are regulatory compliant, suggesting that QTLs, KPIs, SOPs and communication plans are effective vendor oversight mechanisms for small pharmaceutical companies to utilize.
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Affiliation(s)
- Joab Williamson
- Faron Pharmaceuticals, Joukahaisenkatu 6, 20520 Turku, Finland.
| | - Juho Jalkanen
- Faron Pharmaceuticals, Joukahaisenkatu 6, 20520 Turku, Finland
| | - Maria Lahtinen
- Faron Pharmaceuticals, Joukahaisenkatu 6, 20520 Turku, Finland
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Venkatesh K, Henschke A, Lee RP, Delaney A. Patient-centred outcomes are under-reported in the critical care burns literature: a systematic review. Trials 2022; 23:199. [PMID: 35246209 PMCID: PMC8896280 DOI: 10.1186/s13063-022-06104-3] [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: 03/23/2021] [Accepted: 02/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Developments in the care of critically ill patients with severe burns have led to improved hospital survival, but long-term recovery may be impaired. The extent to which patient-centred outcomes are assessed and reported in studies in this population is unclear. METHODS We conducted a systematic review to assess the outcomes reported in studies involving critically ill burns patients. Randomised controlled trials (RCTs) and cohort studies on the topics of fluid resuscitation, analgesia, haemodynamic monitoring, ventilation strategies, transfusion targets, enteral nutrition and timing of surgery were included. We assessed the outcomes reported and then classified these according to two suggested core outcome sets. RESULTS A comprehensive search returned 6154 studies; 98 papers met inclusion criteria. There were 66 RCTs, 19 clinical studies with concurrent controls and 13 interventional studies without concurrent controls. Outcome reporting was inconsistent across studies. Pain, reported using the visual analogue scale, fluid volume administered and mortality were the only outcomes measured in more than three studies. Sixty-six studies (67%) had surrogate primary outcomes. Follow-up was poor, with median longest follow-up across all studies 5 days (IQR 3-28). When compared to the suggested OMERACT core outcome set, 53% of papers reported on mortality, 28% reported on life impact, 30% reported resource/economic outcomes and 95% reported on pathophysiological manifestations. Burns-specific Falder outcome reporting was globally poor, with only 4.3% of outcomes being reported across the 98 papers. CONCLUSION There are deficiencies in the reporting of outcomes in the literature pertaining to the intensive care management of patients with severe burns, both with regard to the consistency of outcomes as well as a lack of focus on patient-centred outcomes. Long-term outcomes are infrequently reported. The development and validation of a core outcome dataset for severe burns would improve the quality of reporting.
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Affiliation(s)
- Karthik Venkatesh
- Malcolm Fisher Department of Intensive Care, The Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. .,The University of New South Wales, Kensington, Sydney, NSW, Australia.
| | - Alice Henschke
- Department of Intensive Care, Orange Base Hospital, Orange, NSW, Australia.,Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Richard P Lee
- Malcolm Fisher Department of Intensive Care, The Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.,Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Anthony Delaney
- Malcolm Fisher Department of Intensive Care, The Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.,Northern Clinical School, University of Sydney, Sydney, NSW, Australia.,The George Institute for Global Health, Sydney, NSW, Australia
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Sanders J, Makariou N, Tocock A, Magboo R, Thomas A, Aitken LM. OUP accepted manuscript. Eur J Cardiovasc Nurs 2022; 21:655-664. [PMID: 35171231 DOI: 10.1093/eurjcn/zvac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/20/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Julie Sanders
- St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7DN, UK
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, UK
| | - Nicole Makariou
- Barts and the London Medical School, Queen Mary University of London, Charterhouse Square, London, UK
| | - Adam Tocock
- Knowledge and Library Services, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Rosalie Magboo
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, UK
- Critical Care, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Ashley Thomas
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, UK
- Critical Care, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Leanne M Aitken
- School of Health Sciences, City, University of London, Northampton Square, London, UK
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Kang BY, Ibrahim SA, Shokeen D, Schlessinger DI, Kirkham JJ, Schmitt J, Poon E, Maher IA, Sobanko JF, Cartee TV, Alam M. Postinflammatory hyperpigmentation: protocol for development of a core outcome set for clinical trials. Arch Dermatol Res 2021; 314:357-361. [PMID: 34019133 DOI: 10.1007/s00403-021-02239-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/03/2021] [Indexed: 11/30/2022]
Abstract
Postinflammatory hyperpigmentation (PIH) is a disorder of pigmentation that is a common presenting complaint, especially in individuals with skin of color. It is associated with a significant psychological burden and decrement of quality of life. Management options include photoprotection, topical lightening agents, and lasers and energy devices. Clinical trials of melasma report a diversity of outcomes, which often impedes synthesis of results across trials, or comparison of results associated with different treatment modalities. This protocol describes the design of a consensus process that would culminate in the development of a core set of outcomes to be assessed in all clinical trials for PIH. A long list of candidate outcomes will be developed through a systematic review, combined with semi-structured interviews with various stakeholders, including patients, scientists, regulators, and health care professionals. This long list of outcomes will be reviewed and refined by a steering committee. Then two rounds of Delphi surveys of patient and physician groups, respectively, will be used to cull the list, with provisional inclusion of those items deemed "important" by 70% of the respondents. A consensus meeting will be held virtually or in person to vote on these items, and also to consider any changes necessary before acceptance of a final core outcome set. Development of a core outcome set for PIH is expected to improve and standardize outcomes reporting in current and future clinical trials. This, in turn, may facilitate aggregation of research results and permit comparison of outcomes across multiple studies.
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Affiliation(s)
- Bianca Y Kang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA
| | - Divya Shokeen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA
| | - Daniel I Schlessinger
- Division of Dermatology, Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Jamie J Kirkham
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Jochen Schmitt
- Centre for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA
| | - Ian A Maher
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - Joseph F Sobanko
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
- Division of Dermatologic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Todd V Cartee
- Department of Dermatology, Penn State Health, Hershey, PA, USA
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA.
- Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Hébert M, Cartier R, Dagenais F, Langlois Y, Coutu M, Noiseux N, El-Hamamsy I, Stevens LM. Standardizing Postoperative Complications-Validating the Clavien-Dindo Complications Classification in Cardiac Surgery. Semin Thorac Cardiovasc Surg 2020; 33:443-451. [PMID: 32979483 DOI: 10.1053/j.semtcvs.2020.09.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/19/2020] [Indexed: 11/11/2022]
Abstract
Cardiac surgery lacks a method for quantifying postoperative morbidities. The Clavien-Dindo Complications Classification (CDCC) and the Comprehensive Complication Index (CCI) were successfully implemented as outcome reporting methods in other surgical specialties. This study aims to validate these complication scales in cardiac surgery. Between 2010 and 2019, we prospectively collected data on 41,218 adult patients (73% men, mean age 67 ± 11 years) undergoing cardiac surgery at 6 university hospitals. Complications were graded using the CDCC based on the complication's treatment invasiveness with adaptations for common treatments in cardiac surgery. CCI were calculated, representing multiple complications on a scale of 0 (no complication) to 100 (death). Associations with predictors of poor outcome were assessed using mixed-effects models accounting for center as a random effect. CDCC grade was 0 in 23.0%, I in 11.4%, II in 35.3%, IIIa in 6.4%, IIIb in 2.6%, IVa in 16.1%, IVb in 2.1%, and V in 3.1%. Median CCI was 23 (9, 40). A change from lowest to highest observed CDCC grade was associated with an increase in the Society of Thoracic Surgeons mortality score from 1.1% to 4.7%, surgery duration from 177 to 233 minutes, and hospital stay from 5.2 to 17 days (all P < 0.0001). The CCI also increased with greater procedure complexity (P < 0.0001). Increase in CDCC/CCI is associated with greater comorbidities, surgery durations, lengths of stay, and procedure complexity, accurately reflecting the nuances of the adult cardiac surgery postoperative course. These have great potential for uniform outcome reporting and quality improvement initiatives.
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Affiliation(s)
- Mélanie Hébert
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Raymond Cartier
- Faculty of Medicine, Université de Montréal, Montreal, Canada; Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Canada
| | - François Dagenais
- Division of Cardiac Surgery, Quebec Heart and Lung Institute, Québec, Canada
| | - Yves Langlois
- Division of Cardiac Surgery, Jewish General Hospital, Montreal, Canada
| | - Marianne Coutu
- Division of Cardiac Surgery, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | - Nicolas Noiseux
- Faculty of Medicine, Université de Montréal, Montreal, Canada; Division of Cardiac Surgery, Centre Hospitalier Universitaire de l'Université de Montréal, Montreal, Canada
| | - Ismail El-Hamamsy
- Faculty of Medicine, Université de Montréal, Montreal, Canada; Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Canada; Division of Cardiac Surgery, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
| | - Louis-Mathieu Stevens
- Faculty of Medicine, Université de Montréal, Montreal, Canada; Division of Cardiac Surgery, Centre Hospitalier Universitaire de l'Université de Montréal, Montreal, Canada.
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Outcome Measures Reported in Published Clinical Research Studies in Craniosynostosis: A Systematic Review. J Craniofac Surg 2020; 31:1672-1677. [PMID: 32740313 DOI: 10.1097/scs.0000000000006680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
CONTEXT The fair comparison of treatment interventions for craniosynostosis across different studies is expected to be impaired by incomplete reporting and the use of inconsistent outcomes. OBJECTIVE This review assessed the outcomes currently reported in studies of craniosynostosis, and whether these outcomes are formally defined and prespecified in the study methods. DATA SOURCES, SEARCH TERMS, AND STUDY SELECTION Studies were sourced via an electronic, multi-database literature search for "craniosynostosis." All primary, interventional research studies published from 2011 to 2015 were reviewed. DATA EXTRACTION Two independent researchers assessed each study for inclusion and performed the data extraction. For each study, data were extracted on the individual outcomes reported, and whether these outcomes were defined and prespecified in the methods. DATA SYNTHESIS AND RESULTS Of 1027 studies screened, 240 were included and proceeded to data extraction. These studies included 18,365 patients.2192 separate outcomes were reported. Of these, 851 outcomes (38.8%) were clearly defined, 1394 (63.6%) were prespecified in the study methods."Clinical and functional" was the most commonly reported outcome theme (900 outcomes, 41.1%), and "patient-reported" outcomes the least (7 outcomes, 0.3%)."Duration of surgery" was the most commonly reported single outcome (reported 80 times). "Cranial index" was the most variably defined outcome (18 different definitions used). CONCLUSION The outcomes reported following treatment interventions for craniosynostosis are incompletely and variably defined. Improving definitions for these outcomes may aid comparison of different management strategies and improve craniosynostosis care. Suboptimal prespecification of these outcomes in the study methods implied that outcome reporting bias cannot be excluded.
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O'Lone E, Viecelli AK, Craig JC, Tong A, Sautenet B, Herrington WG, Herzog CA, Jafar TH, Jardine M, Krane V, Levin A, Malyszko J, Rocco MV, Strippoli G, Tonelli M, Wang AYM, Wanner C, Zannad F, Winkelmayer WC, Wheeler DC, Craig JC, Tong A, Manns B, Pecoits-Filho R, Harris T, Wheeler DC, Winkelmayer W, Levin A, O'Lone E, Herrington WG, Herzog CA, Rocco MV, Strippoli G, Jardine M, Kleinpeter M, Ju A, Cho Y, Gutman T, Bernier-Jean A, James L, Hamiwka L, Viecelli AK, Jardine A, Bello A, Stengel B, Schiller B, Johnson D, Bavlovlenkov E, Caskey F, Gillespie B, Block G, Phan HA, Heerspink HL, Madero M, Ruospo M, Unruh M, Laville M, Bansal N, Mark P, Blankestijn P, Roy-Chaudhury P, Perlman R, Agarwal R, Mehrotra R, Seliger S, Shafi T, Hiemstra T, Jassal V, Perkovic V, Simplice A, White D, Eilers D, Alexander H, Landry Y, Landry G, Wilkie C. Establishing Core Cardiovascular Outcome Measures for Trials in Hemodialysis: Report of an International Consensus Workshop. Am J Kidney Dis 2020; 76:109-120. [DOI: 10.1053/j.ajkd.2020.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/17/2020] [Indexed: 01/08/2023]
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Abstract
INTRODUCTION Sepsis is the leading cause of death in children worldwide and has recently been declared a major global health issue. New interventions and a concerted effort to enhance our understanding of sepsis are required to address the huge burden of disease, especially in low- and middle-income countries (LMIC) where it is highest. An opportunity therefore exists to ensure that ongoing research in this area is relevant to all stakeholders and is of consistently high quality. One method to address these issues is through the development of a core outcome set (COS). METHODS AND ANALYSIS This study protocol outlines the phases in the development of a core outcome set for paediatric sepsis in LMIC. The first step involves performing a systematic review of all outcomes reported in the research of paediatric sepsis in low middle-income countries. A three-stage international Delphi process will then invite a broad range of participants to score each generated outcome for inclusion into the COS. This will include an initial two-step online survey and finally, a face-to-face consensus meeting where each outcome will be reviewed, voted on and ratified for inclusion into the COS. ETHICS AND DISSEMINATION No core outcome sets exist for clinical trials in paediatric sepsis. This COS will serve to not only highlight the heavy burden of paediatric sepsis in this setting and aid collaboration and participation between all stakeholders, but to promote ongoing essential high quality and relevant research into the topic. A COS in paediatric sepsis in LMIC will advocate for a common language and facilitate interpretation of findings from a variety of settings. A waiver for ethics approval has been granted by University of British Columbia Children's and Women's Research Ethics Board.
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Affiliation(s)
- Gavin Wooldridge
- Pediatric Critical Care, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Niranjan Kissoon
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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O'Lone E, Viecelli AK, Craig JC, Tong A, Sautenet B, Roy D, Herrington WG, Herzog CA, Jafar T, Jardine M, Krane V, Levin A, Malyszko J, Rocco MV, Strippoli G, Tonelli M, Wang AYM, Wanner C, Zannad F, Winkelmayer WC, Webster AC, Wheeler DC. Cardiovascular Outcomes Reported in Hemodialysis Trials. J Am Coll Cardiol 2019; 71:2802-2810. [PMID: 29903353 DOI: 10.1016/j.jacc.2018.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 04/15/2018] [Indexed: 12/17/2022]
Abstract
Patients on long-term hemodialysis are at very high risk for cardiovascular disease but are usually excluded from clinical trials conducted in the general population or in at-risk populations. There are no universally agreed cardiovascular outcomes for trials conducted specifically in the hemodialysis population. In this review, we highlight that trials reporting cardiovascular outcomes in hemodialysis patients are usually of short duration (median 3 to 6 months) and are small (59% of trials have <100 participants). Overall, the cardiovascular outcomes are very heterogeneous and may not reflect outcomes that are meaningful to patients and clinicians in supporting decision making, as they are often surrogates of uncertain clinical importance. Composite outcomes used in different trials rarely share the same components. In a field in which a single trial is often insufficiently powered to fully assess the clinical and economic impact of interventions, differences in outcome reporting across trials make the task of meta-analysis and interpretation of all the available evidence challenging. Core outcome sets are now being established across many specialties in health care to prevent these problems. Through the global Standardized Outcomes in Nephrology-Hemodialysis initiative, cardiovascular disease was identified as a critically important core domain to be reported in all trials in hemodialysis. Informed by the current state of reporting of cardiovascular outcomes, a core outcome measure for cardiovascular disease is currently being established with involvement of patients, caregivers, and health professionals. Consistent reporting of cardiovascular outcomes that are critically important to hemodialysis patients and clinicians will strengthen the evidence base to inform care in this very high-risk population.
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Affiliation(s)
- Emma O'Lone
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Childrens Hospital Westmead, Sydney, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Benedicte Sautenet
- University Francois Rabelais, Tours, France; Department of Nephrology and Clinical Immunology, Tours Hospital, Tours, France; INSERM, U1153, Paris, France
| | - David Roy
- St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - William G Herrington
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center/University of Minnesota, Minneapolis, Minnesota
| | - Tazeen Jafar
- Program in Health Services & Systems Research, Duke-NUS Graduate Medical School, Singapore; Department of Community Health Science, Aga Khan University, Karachi, Pakistan; Section of Nephrology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Meg Jardine
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Vera Krane
- Division of Nephrology, Department of Internal Medicine and Comprehensive Heart Failure Centre, University Hospital of Würzburg, Würzburg, Germany
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada; BC Provincial Renal Agency, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcomes Research, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jolanta Malyszko
- Department of Nephrology, Dialysistherapy and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - Michael V Rocco
- Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Giovanni Strippoli
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; Medical Scientific Office, Diaverum, Lund, Sweden; Diaverum Academy, Bari, Italy
| | - Marcello Tonelli
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada
| | - Angela Yee Moon Wang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Christoph Wanner
- Renal Division, University Hospital of Würzburg, Würzburg, Germany
| | - Faiez Zannad
- Inserm Clinical Investigation Center 1403, Université de Lorraine, CHU de Nancy, Nancy, France; Institut Lorrain du Coeur et des Vaisseaux CHU and Université de Lorraine, Nancy, France
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, Texas
| | - Angela C Webster
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Benstoem C, Moza A, Meybohm P, Stoppe C, Autschbach R, Devane D, Goetzenich A. A core outcome set for adult cardiac surgery trials: A consensus study. PLoS One 2017; 12:e0186772. [PMID: 29095881 PMCID: PMC5667757 DOI: 10.1371/journal.pone.0186772] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 10/06/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Invasive off- or on-pump cardiac surgery (elective and emergency procedures, excluding transplants are routinely performed to treat complications of ischaemic heart disease. Randomised controlled trials (RCT) evaluate the effectiveness of treatments in the setting of cardiac surgery. However, the impact of RCTs is weakened by heterogeneity in outcome measuring and reporting, which hinders comparison across trials. Core outcome sets (COS, a set of outcomes that should be measured and reported, as a minimum, in clinical trials for a specific clinical field) help reduce this problem. In light of the above, we developed a COS for cardiac surgery effectiveness trials. METHODS Potential core outcomes were identified a priori by analysing data on 371 RCTs of 58,253 patients. We reached consensus on core outcomes in an international three-round eDelphi exercise. Outcomes for which at least 60% of the participants chose the response option "no" and less than 20% chose the response option "yes" were excluded. RESULTS Eighty-six participants from 23 different countries involving adult cardiac patients, cardiac surgeons, anaesthesiologists, nursing staff and researchers contributed to this eDelphi. The panel reached consensus on four core outcomes: 1) Measure of mortality, 2) Measure of quality of life, 3) Measure of hospitalisation and 4) Measure of cerebrovascular complication to be included in adult cardiac surgery trials. CONCLUSION This study used robust research methodology to develop a minimum core outcome set for clinical trials evaluating the effectiveness of treatments in the setting of cardiac surgery. As a next step, appropriate outcome measurement instruments have to be selected.
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Affiliation(s)
- Carina Benstoem
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
- * E-mail:
| | - Ajay Moza
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christian Stoppe
- Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Rüdiger Autschbach
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Declan Devane
- Department of Nursing and Midwifery, National University of Ireland Galway, School of Nursing and Midwifery, Galway, Ireland
| | - Andreas Goetzenich
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
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12
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Schlessinger DI, Iyengar S, Yanes AF, Lazaroff JM, Godinez-Puig V, Chen BR, Kurta AO, Henley JK, Chiren SG, Furlan KC, Schmitt J, Deckert S, Poon E, Sobanko JF, Cartee TV, Alam M, Maher IA. Development of a core outcome set for clinical trials in basal cell carcinoma: study protocol for a systematic review of the literature and identification of a core outcome set using a Delphi survey. Trials 2017; 18:490. [PMID: 29061190 PMCID: PMC5654122 DOI: 10.1186/s13063-017-2244-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 09/20/2017] [Indexed: 12/02/2022] Open
Abstract
Background Basal cell carcinoma is the most common skin cancer worldwide. Treatment options include both surgical and topical modalities. Although risk of metastasis is low, basal cell carcinoma can be invasive and infiltrate important underlying structures such as bone or cartilage. While many clinical trials examining therapies for basal cell carcinoma exist, the lack of consensus in outcome reporting across all trials poses a concern. Proper evaluation and comparison of treatment modalities is challenging. In order to address the inconsistencies present, this project aims to determine a core set of outcomes which should be evaluated in all clinical trials of basal cell carcinoma. Methods/design Outcomes will be extracted over four phases: (1) a systematic literature review, (2) patient interviews, (3) other published sources, and (4) stakeholder involvement. Potential outcomes will then be examined by the Steering Committee, who may add or remove outcomes. The Delphi process will then be performed to condense the list of outcomes generated. Two rounds of Delphi surveys will be performed with two groups of participants – physicians and patients. A consensus meeting with relevant stakeholders will be conducted after the Delphi exercise to further select outcomes, taking into account participant scores. By the end of the meeting, members will vote and decide on a final recommended set of core outcomes. For the duration of the study, we will be in collaboration with both the Core Outcome Measures in Effectiveness Trials (COMET) initiative and the Cochrane Skin Group – Core Outcome Set Initiative (CSG-COUSIN). Discussion This study aims to develop a core outcome set to guide assessment in clinical trials on basal cell carcinoma. The end-goal is to improve the consistency of outcome reporting and allow proper evaluation of treatment effectiveness.
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Affiliation(s)
- Daniel I Schlessinger
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St., Ste 1600, Chicago, IL, 60611, USA
| | - Sanjana Iyengar
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St., Ste 1600, Chicago, IL, 60611, USA
| | - Arianna F Yanes
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St., Ste 1600, Chicago, IL, 60611, USA
| | - Jake M Lazaroff
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St., Ste 1600, Chicago, IL, 60611, USA
| | - Victoria Godinez-Puig
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St., Ste 1600, Chicago, IL, 60611, USA
| | - Brian R Chen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St., Ste 1600, Chicago, IL, 60611, USA
| | - Anastasia O Kurta
- Department of Dermatology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Jill K Henley
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah G Chiren
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St., Ste 1600, Chicago, IL, 60611, USA
| | - Karina C Furlan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St., Ste 1600, Chicago, IL, 60611, USA
| | - Jochen Schmitt
- Centre for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Stefanie Deckert
- Centre for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St., Ste 1600, Chicago, IL, 60611, USA
| | - Joseph F Sobanko
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA.,Division of Dermatologic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Todd V Cartee
- Department of Dermatology, Penn State Hershey Dermatology, Hershey, PA, USA
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St., Ste 1600, Chicago, IL, 60611, USA. .,Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Ian A Maher
- Department of Dermatology, Saint Louis University School of Medicine, St. Louis, MO, USA
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13
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Matvienko-Sikar K, Byrne M, Kelly C, Toomey E, Hennessy M, Devane D, Heary C, Harrington J, McGrath N, Queally M, Kearney PM. Development of an infant feeding core outcome set for childhood obesity interventions: study protocol. Trials 2017; 18:463. [PMID: 29017519 PMCID: PMC5634841 DOI: 10.1186/s13063-017-2180-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 09/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background Childhood obesity is a significant public health challenge that affects approximately one in five children worldwide. Infant feeding practices are implicated in the aetiology of childhood obesity. Infant feeding interventions for childhood obesity are increasingly popular but outcome reporting is inconsistent across trials. Lack of standardisation limits examination of intervention effects and mechanisms of change. The aim of the current project is to develop a core set of infant feeding outcomes for children ≤ 1 year old, to be evaluated in childhood obesity intervention trials. Methods This project will use similar methodology to previous core outcome development research. An infant feeding core outcome set (COS) will be developed in four stages: (1) a systematic review of the literature, (2) discussion and clarification of outcomes in a meeting involving multiple stakeholder perspectives, (3) prioritisation of outcomes using the Delphi technique with an expert panel of stakeholders, and (4) achieving consensus on the COS using the nominal group technique (NGT) consensus meeting. An online Delphi survey will be conducted following the NGT meeting to prioritise outcomes identified in the systematic review. An NGT meeting will be conducted with groups of health professionals, non-clinician researchers, and parents of infants ≤ 1 year old, to achieve final consensus on the infant feeding COS. Discussion This study aims to develop a core outcome set of infant feeding outcomes for randomised infant feeding studies to prevent childhood obesity. This research will improve examination and syntheses of the outcomes of such studies to prevent and reduce childhood obesity. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2180-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Molly Byrne
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Colette Kelly
- Discipline of Health Promotion, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Elaine Toomey
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Marita Hennessy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Caroline Heary
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | | | - Niamh McGrath
- School of Public Health, University College Cork, Cork, Ireland
| | - Michelle Queally
- Discipline of Economics, National University of Ireland Galway, Galway, Ireland
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14
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Toward Establishing Core Outcome Domains For Trials in Kidney Transplantation: Report of the Standardized Outcomes in Nephrology-Kidney Transplantation Consensus Workshops. Transplantation 2017; 101:1887-1896. [PMID: 28737661 DOI: 10.1097/tp.0000000000001774] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment decisions in kidney transplantation requires patients and clinicians to weigh the benefits and harms of a broad range of medical and surgical interventions, but the heterogeneity and lack of patient-relevant outcomes across trials in transplantation makes these trade-offs uncertain, thus, the need for a core outcome set that reflects stakeholder priorities. METHODS We convened 2 international Standardized Outcomes in Nephrology-Kidney Transplantation stakeholder consensus workshops in Boston (17 patients/caregivers; 52 health professionals) and Hong Kong (10 patients/caregivers; 45 health professionals). In facilitated breakout groups, participants discussed the development and implementation of core outcome domains for trials in kidney transplantation. RESULTS Seven themes were identified. Reinforcing the paramount importance of graft outcomes encompassed the prevailing dread of dialysis, distilling the meaning of graft function, and acknowledging the terrifying and ambiguous terminology of rejection. Reflecting critical trade-offs between graft health and medical comorbidities was fundamental. Contextualizing mortality explained discrepancies in the prioritization of death among stakeholders-inevitability of death (patients), preventing premature death (clinicians), and ensuring safety (regulators). Imperative to capture patient-reported outcomes was driven by making explicit patient priorities, fulfilling regulatory requirements, and addressing life participation. Specificity to transplant; feasibility and pragmatism (long-term impacts and responsiveness to interventions); and recognizing gradients of severity within outcome domains were raised as considerations. CONCLUSIONS Stakeholders support the inclusion of graft health, mortality, cardiovascular disease, infection, cancer, and patient-reported outcomes (ie, life participation) in a core outcomes set. Addressing ambiguous terminology and feasibility is needed in establishing these core outcome domains for trials in kidney transplantation.
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15
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Schlessinger DI, Iyengar S, Yanes AF, Henley JK, Ashchyan HJ, Kurta AO, Patel PM, Sheikh UA, Franklin MJ, Hanna CC, Chen BR, Chiren SG, Schmitt J, Deckert S, Furlan KC, Poon E, Maher IA, Cartee TV, Sobanko JF, Alam M. Development of a core outcome set for clinical trials in facial aging: study protocol for a systematic review of the literature and identification of a core outcome set using a Delphi survey. Trials 2017; 18:359. [PMID: 28764734 PMCID: PMC5540562 DOI: 10.1186/s13063-017-2104-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/12/2017] [Indexed: 01/15/2023] Open
Abstract
Background Facial aging is a concern for many patients. Wrinkles, loss of volume, and discoloration are common physical manifestations of aging skin. Genetic heritage, prior ultraviolet light exposure, and Fitzpatrick skin type may be associated with the rate and type of facial aging. Although many clinical trials assess the correlates of skin aging, there is heterogeneity in the outcomes assessed, which limits the quality of evaluation and comparison of treatment modalities. To address the inconsistency in outcomes, in this project we will develop a core set of outcomes that are to be evaluated in all clinical trials relevant to facial aging. Methods/design A long list of measureable outcomes will be created from four sources: (1) systematic medical literature review, (2) patient interviews, (3) other published sources, and (4) stakeholder involvement. Two rounds of Delphi processes with homogeneous groups of physicians and patients will be performed to prioritize and condense the list. At a consensus meeting attended by physicians, patients, and stakeholders, outcomes will be further condensed on the basis of participant scores. By the end of the meeting, members will vote and decide on a final recommended set of core outcomes. Subsequent to this, specific measures will be selected or created to assess these outcomes. Discussion The aim of this study is to develop a core outcome set and relevant measures for clinical trials relevant to facial aging. We hope to improve the reliability and consistency of outcome reporting of skin aging, thereby enabling improved evaluation of treatment efficacy and patient satisfaction. Trial registration Core Outcome Measures in Effectiveness Trials (COMET) Initiative, accessible at http://www.comet-initiative.org/studies/details/737. Core Outcomes Set Initiative, (CSG-COUSIN) accessible at https://www.uniklinikum-dresden.de/de/das-klinikum/universitaetscentren/zegv/cousin/meet-the-teams/project-groups/core-outcome-set-for-the-appearance-of-facial-aging. Protocol version date is 28 July 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2104-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel I Schlessinger
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1600, Chicago, IL, USA
| | - Sanjana Iyengar
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1600, Chicago, IL, USA
| | - Arianna F Yanes
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1600, Chicago, IL, USA
| | - Jill K Henley
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Hovik J Ashchyan
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Anastasia O Kurta
- Department of Dermatology, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Payal M Patel
- Department of Dermatology, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Umar A Sheikh
- Department of Dermatology, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Matthew J Franklin
- Department of Dermatology, Penn State Hershey Dermatology, Hershey, PA, USA
| | - Courtney C Hanna
- Department of Dermatology, Penn State Hershey Dermatology, Hershey, PA, USA
| | - Brian R Chen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1600, Chicago, IL, USA
| | - Sarah G Chiren
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1600, Chicago, IL, USA
| | - Jochen Schmitt
- Centre for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Stefanie Deckert
- Centre for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Karina C Furlan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1600, Chicago, IL, USA
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1600, Chicago, IL, USA
| | - Ian A Maher
- Department of Dermatology, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Todd V Cartee
- Department of Dermatology, Penn State Hershey Dermatology, Hershey, PA, USA
| | - Joseph F Sobanko
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA.,Division of Dermatologic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1600, Chicago, IL, USA. .,Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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16
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Development of a core outcome set for clinical trials in squamous cell carcinoma: study protocol for a systematic review of the literature and identification of a core outcome set using a Delphi survey. Trials 2017; 18:321. [PMID: 28701207 PMCID: PMC5506611 DOI: 10.1186/s13063-017-2069-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/26/2017] [Indexed: 02/03/2023] Open
Abstract
Background Squamous cell carcinoma (SCC) is a common skin cancer that poses a risk of metastasis. Clinical investigations into SCC treatment are common, but the outcomes reported are highly variable, omitted, or clinically irrelevant. The outcome heterogeneity and reporting bias of these studies leave clinicians unable to accurately compare studies. Core outcome sets (COSs) are an agreed minimum set of outcomes recommended to be measured and reported in all clinical trials of a given condition or disease. Although COSs are under development for several dermatologic conditions, work has yet to be done to identify core outcomes specific for SCC. Methods/design Outcome extraction for COS generation will occur via four methods: (1) systematic literature review; (2) patient interviews; (3) other published sources; and (4) input from stakeholders in medicine, pharmacy, and other relevant industries. The list of outcomes will be revaluated by the Measuring PRiority Outcome Variables via Excellence in Dermatologic surgery (IMPROVED) Steering Committee. Delphi processes will be performed separately by expert clinicians and patients to condense the list of outcomes generated. A consensus meeting with relevant stakeholders will be conducted after the Delphi exercise to further select outcomes, taking into account participant scores. At the end of the meeting, members will vote and decide on a final recommended set of core outcomes. The Core Outcome Measures in Effectiveness Trials (COMET) organization and the Cochrane Skin Group - Core Outcome Set Initiative (CSG-COUSIN) will serve as advisers throughout the COS generation process. Discussion Comparison of clinical trials via systematic reviews and meta-analyses is facilitated when investigators study outcomes that are relevant and similar. The aim of this project is to develop a COS to guide use for future clinical trials. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2069-2) contains supplementary material, which is available to authorized users.
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17
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Taylor J, Böhnke JR, Wright J, Kellar I, Alderson SL, Hughes T, Holt RIG, Siddiqi N. A core outcome set for evaluating self-management interventions in people with comorbid diabetes and severe mental illness: study protocol for a modified Delphi study and systematic review. Trials 2017; 18:70. [PMID: 28196512 PMCID: PMC5309993 DOI: 10.1186/s13063-017-1805-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 01/14/2017] [Indexed: 12/31/2022] Open
Abstract
Background People with diabetes and comorbid severe mental illness (SMI) form a growing population at risk of increased mortality and morbidity compared to those with diabetes or SMI alone. There is increasing interest in interventions that target diabetes in SMI in order to help to improve physical health and reduce the associated health inequalities. However, there is a lack of consensus about which outcomes are important for this comorbid population, with trials differing in their focus on physical and mental health. A core outcome set, which includes outcomes across both conditions that are relevant to patients and other key stakeholders, is needed. Methods This study protocol describes methods to develop a core outcome set for use in effectiveness trials of self-management interventions for adults with comorbid type-2 diabetes and SMI. We will use a modified Delphi method to identify, rank, and agree core outcomes. This will comprise a two-round online survey and multistakeholder workshops involving patients and carers, health and social care professionals, health care commissioners, and other experts (e.g. academic researchers and third sector organisations). We will also select appropriate measurement tools for each outcome in the proposed core set and identify gaps in measures, where these exist. Discussion The proposed core outcome set will provide clear guidance about what outcomes should be measured, as a minimum, in trials of interventions for people with coexisting type-2 diabetes and SMI, and improve future synthesis of trial evidence in this area. We will also explore the challenges of using online Delphi methods for this hard-to-reach population, and examine differences in opinion about which outcomes matter to diverse stakeholder groups. Trial registration COMET registration: http://www.comet-initiative.org/studies/details/911. Registered on 1 July 2016
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Affiliation(s)
- Johanna Taylor
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Jan R Böhnke
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9LJ, UK
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Sarah L Alderson
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9LJ, UK
| | - Tom Hughes
- Leeds and York Partnership NHS Foundation Trust, 2150 Century Way, Thorpe Park, Leeds, LS15 8ZB, UK
| | - Richard I G Holt
- Diabetes and Endocrinology, Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK.,University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Najma Siddiqi
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, YO10 5DD, UK.,Bradford District Care NHS Foundation Trust, New Mill, Victoria Road, Saltaire, Bradford, BD18 3LD, UK
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18
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Iyengar S, Williamson PR, Schmitt J, Johannsen L, Maher IA, Sobanko JF, Cartee TV, Schlessinger D, Poon E, Alam M. Development of a core outcome set for clinical trials in rosacea: study protocol for a systematic review of the literature and identification of a core outcome set using a Delphi survey. Trials 2016; 17:429. [PMID: 27580586 PMCID: PMC5007842 DOI: 10.1186/s13063-016-1554-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rosacea is a chronic inflammatory disorder affecting millions of individuals worldwide. Diagnosis is based on signs and symptoms with management and treatment aimed to suppress inflammatory lesions, erythema, and telangiectasia. While many clinical trials of rosacea exist, the lack of consensus in outcome reporting across all trials poses a concern. Proper evaluation and comparison of treatment modalities is challenging. In order to address the inconsistencies present, this project aims to determine a core set of outcomes which should be evaluated in all clinical trials of rosacea. METHODS/DESIGN This project will utilize a methodology similar to previous core outcome set research. A long list of outcomes will be extracted over four phases: (1) systematic literature review, (2) patient interviews, (3) other published sources, and (4) stakeholder involvement. Potential outcomes will be examined by the Steering Committee to provide further insight. The Delphi process will then be performed to prioritize and condense the list of outcomes generated. Two homogenous groups of physicians and patients will participate in two consecutive rounds of Delphi surveys. A consensus meeting, composed of physicians, patients, and stakeholders, will be conducted after the Delphi exercise to further select outcomes, taking into account participant scores. By the end of the meeting, members will vote and decide on a final recommended set of core outcomes. For the duration of the study, we will be in collaboration with both the Core Outcome Measures in Effectiveness Trials (COMET) and Cochrane Skin Group - Core Outcome Set Initiative (CSG-COUSIN). DISCUSSION This study aims to develop a core outcome set to guide assessment in clinical trials of rosacea. The end-goal is to improve the reliability and consistency of outcome reporting, thereby allowing sufficient evaluation of treatment effectiveness and patient satisfaction.
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Affiliation(s)
- Sanjana Iyengar
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St., Ste 1600, Chicago, IL 60611 USA
| | | | - Jochen Schmitt
- Centre for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Lena Johannsen
- Centre for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ian A. Maher
- Department of Dermatology, Saint Louis University School of Medicine, St. Louis, MO USA
| | - Joseph F. Sobanko
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA USA
- Division of Dermatologic Surgery, University of Pennsylvania, Philadelphia, PA USA
| | - Todd V. Cartee
- Department of Dermatology, Penn State Hershey Dermatology, Hershey, PA USA
| | - Daniel Schlessinger
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St., Ste 1600, Chicago, IL 60611 USA
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St., Ste 1600, Chicago, IL 60611 USA
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St., Ste 1600, Chicago, IL 60611 USA
- Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
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