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Hanafi I, Kheder K, Sabouni R, Rahmeh AR, Alsalkini M, Hanafi M, Naeem A, Alahdab F. Factors influencing research productivity among Syrian medical professionals amidst conflict: a case-control study. BMC MEDICAL EDUCATION 2024; 24:747. [PMID: 38992638 DOI: 10.1186/s12909-024-05681-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 06/20/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Medical research productivity is globally increasing, with a lagging progress in third-world countries due to significant challenges, including inadequate training and brain drain. Syria had been showing a slow upward trend until the war broke out and severely hindered academic growth and productivity. A deeper understanding of the factors influencing research productivity in this context are fundamental to guide educational policies and resource allocation. Previous cross-sectional studies that evaluated the perspectives of Syrian academics on the issue were limited by the small sample size of published healthcare workers, making it difficult to identify the factors that enabled them to pursue research. METHODS To address this challenge, we employed a case-control design. We isolated published early-career Syrian healthcare workers and compared their characteristics and perceptions to unpublished matched controls. Authors in the fields of medicine, dentistry, and pharmacy affiliated with any Syrian University were identified through an extensive search of PubMed and Google Scholar.These authors were invited to complete a questionnaire that covered participants' research contributions, alongside their self-assessed knowledge, attitudes, and barriers towards research. The questionnaire was publicly published to recruit an equal sample of matching controls, with half consisting of unpublished researchers and the other half of participants without prior research contributions. RESULTS Six-hundred-sixteen participants were recruited. Their knowledge, attitudes, and perceived barriers explained 46% and 34% of the variability in research involvement and publication, respectively (P < 0.001). Getting involved in and publishing research studies associated with higher research-related knowledge and attitudes (P < 0.001). Respondents' assessment of research-related barriers and their academic scores did not differ between cases and controls. Superior research-related knowledge and attitudes were associated with male gender, higher English competency, and better internet connectivity. Meanwhile, extracurricular training and mentors' support were associated with more positive research-related attitudes and less perceived barriers. CONCLUSIONS Research productivity of medical professionals in Syria exhibits a positive correlation with their knowledge and favorable attitudes towards medical research. Noteworthy, the demographic variations are linked to disparities in research-related knowledge and motivation. In conclusion, these results suggest a potential avenue for enhancement through concentrated efforts on improving extracurricular training interventions and mentors' support.
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Affiliation(s)
- Ibrahem Hanafi
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Damascus University, Mazzah, Damascus, Syria.
| | - Kheder Kheder
- Faculty of Medicine, Al Andalus University, Tartus, Syria
| | - Rami Sabouni
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Ahmad Rami Rahmeh
- Department of Ophthalmology, Aleppo University Hospital, Aleppo, Syria
| | | | - Mouaz Hanafi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Ahmad Naeem
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Fares Alahdab
- Houston Methodist Academic Institute, Houston, TX, USA
- Weill Cornell Medical College, New York, NY, USA
- School of Biomedical Informatics, University of Texas, Houston, TX, USA
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[International Multi-stakeholder Consensus Statement on Clinical Trial Integrity]. Semergen 2024; 50:102217. [PMID: 38996807 DOI: 10.1016/j.semerg.2024.102217] [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: 02/06/2024] [Accepted: 02/20/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Science integrity initiatives require specific recommendations for randomised clinical trials (RCT). OBJECTIVE To prepare a set of statements for RCT integrity through an international multi-stakeholder consensus. METHODS The consensus was developed via multi-country multidisciplinary stakeholder group composition and engagement; evidence synthesis of 55 systematic reviews concerning RCT integrity; anonymised two-round modified Delphi survey with consensus threshold based on the average percent of majority opinions; and, a final consensus development meeting. RESULTS There were 30 stakeholders representing 15 countries from 5 continents including trialists, ethicists, methodologists, statisticians, consumer representative, industry representative, systematic reviewers, funding body panel members, regulatory experts, authors, journal editors, peer-reviewers and advisors for resolving integrity concerns. Delphi survey response rate was 86.7% (26/30 stakeholders). There were 111 statements (73 stakeholder-provided, 46 systematic review-generated, 8 supported by both) in the initial long list, with 8 additional statements provided during the consensus rounds. Through consensus the final set consolidated 81 statements (49 stakeholder-provided, 41 systematic review-generated, 9 supported by both). The entire RCT life cycle was covered by the set of statements including general aspects (n=6), design and approval (n=11), conduct and monitoring (n=19), reporting of protocols and findings (n=20), post-publication concerns (n=12), and future research and development (n=13). CONCLUSION Implementation of this multi-stakeholder consensus statement is expected to enhance RCT integrity.
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Filbay SR, Ferreira GE, Metcalf B, Buchbinder R, Ramsay H, Abbott JH, Darlow B, Zadro JR, Davidson SRE, Searle E, McKenzie BJ, Hinman RS. Prioritisation of clinical trial learning needs of musculoskeletal researchers: an inter-disciplinary modified Delphi study by the Australia & New Zealand musculoskeletal clinical trials network. BMC MEDICAL EDUCATION 2024; 24:735. [PMID: 38977986 PMCID: PMC11232127 DOI: 10.1186/s12909-024-05732-4] [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: 04/24/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND There is a need to increase the capacity and capability of musculoskeletal researchers to design, conduct, and report high-quality clinical trials. The objective of this study was to identify and prioritise clinical trial learning needs of musculoskeletal researchers in Australia and Aotearoa New Zealand. Findings will be used to inform development of an e-learning musculoskeletal clinical trials course. METHODS A two-round online modified Delphi study was conducted with an inter-disciplinary panel of musculoskeletal researchers from Australia and Aotearoa New Zealand, representing various career stages and roles, including clinician researchers and consumers with lived experience of musculoskeletal conditions. Round 1 involved panellists nominating 3-10 topics about musculoskeletal trial design and conduct that they believe would be important to include in an e-learning course about musculoskeletal clinical trials. Topics were synthesised and refined. Round 2 asked panellists to rate the importance of all topics (very important, important, not important), as well as select and rank their top 10 most important topics. A rank score was calculated whereby higher scores reflect higher rankings by panellists. RESULTS Round 1 was completed by 121 panellists and generated 555 individual topics describing their musculoskeletal trial learning needs. These statements were grouped into 37 unique topics for Round 2, which was completed by 104 panellists. The topics ranked as most important were: (1) defining a meaningful research question (rank score 560, 74% of panellists rated topic as very important); (2) choosing the most appropriate trial design (rank score 410, 73% rated as very important); (3) involving consumers in trial design through to dissemination (rank score 302, 62% rated as very important); (4) bias in musculoskeletal trials and how to minimise it (rank score 299, 70% rated as very important); and (5) choosing the most appropriate control/comparator group (rank score 265, 65% rated as very important). CONCLUSIONS This modified Delphi study generated a ranked list of clinical trial learning needs of musculoskeletal researchers. Findings can inform training courses and professional development to improve researcher capabilities and enhance the quality and conduct of musculoskeletal clinical trials.
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Affiliation(s)
- Stephanie R Filbay
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
| | - Giovanni E Ferreira
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia
- Sydney Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Ben Metcalf
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Rachelle Buchbinder
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Helen Ramsay
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - J Haxby Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, University of Otago Medical School, Dunedin, New Zealand
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Joshua R Zadro
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia
- Sydney Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Simon R E Davidson
- School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
- University Centre for Rural Health, Lismore, NSW, Australia
| | - Emma Searle
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Bayden J McKenzie
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
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Blackman B, Barnett S, Premkumar A, Sheth NP. Orthopaedic and trauma research in Tanzania: A scoping review. PLoS One 2024; 19:e0304218. [PMID: 38837974 DOI: 10.1371/journal.pone.0304218] [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: 01/11/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024] Open
Abstract
Tanzania is disproportionately burdened by musculoskeletal injuries as it faces unique challenges when dealing with trauma care. This scoping review aims to summarize and assess the current state of orthopaedic and trauma research in Tanzania. By identifying key themes, trends, and gaps in the literature, this review seeks to guide future research initiatives catered specifically to the needs of Tanzania's healthcare system. Utilizing the PRISMA-ScR protocol, OVID Medline, PubMed, and CINAHL databases were searched from inception to June 17, 2023, using keywords such as "Orthopaedics" "Trauma" and "Tanzania". One hundred and ninety-two eligible studies were included and the Arksey and O'Malley framework for scoping studies was followed. There was a notable growth of relevant publications from 2015 onward, with peaks in growth in the years 2019, 2021, and 2020. The studies employed diverse research methodologies, with cross-sectional (n = 41, 21%) and prospective studies (n = 39, 20%) being the most prevalent, and randomized-controlled trials being the least prevalent methodology, making up eight studies (4.2%). The most common study themes were trauma (n = 101, 52.6%), lower extremity (n = 31, 16%), and spine-related issues (n = 27, 14%). Only three studies looked at work-related injuries (1.6%). Road traffic injuries (RTIs) were the most common mechanism of trauma in 77.0% of the trauma focused studies. Fifty-three percent of the studies were conducted by a majority of Tanzanian authors. This scoping review highlights various trends in orthopaedic and trauma research in Tanzania, with a particular emphasis on road traffic-related injuries. Various gaps are explored, including a lack of research on work-related injuries and a paucity of experimental research. Our findings underline areas where future research is warranted. The future of orthopaedic and trauma care in Tanzania depends on the efforts and collaboration of both local and international stakeholders.
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Affiliation(s)
| | - Sarah Barnett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Ajay Premkumar
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Neil P Sheth
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Orthopaedic Surgery, Philadelphia, Pennsylvania, United States of America
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Wu J, Haile SS, Ho W, Klotz L, Yuan M, Lee JY, Krakowsky Y. 'Spin' in urology non-randomised studies comparing therapeutic interventions: a temporal analysis. BJU Int 2024; 133:656-664. [PMID: 38506328 DOI: 10.1111/bju.16342] [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: 03/21/2024]
Abstract
OBJECTIVE To determine the prevalence of 'spin' (i.e., reporting practices that distort the interpretation of results by positively reflecting negative findings or downplaying potential harms) strategies and level of spin in urological observational studies and whether the use of spin has changed over time. MATERIALS AND METHODS MEDLINE and Embase were searched to identify observational studies comparing therapeutic interventions in the top five urology journals and major urological subspecialty journals, published between 2000 and 2001, 2010 and 2011, and 2020 and 2021. RESULTS A total of 235 studies were included. Spin was identified in 81% of studies, with a median of two strategies per study. The most commonly used strategies were inadequate implication for clinical practice (30%), causal language or causal claim (29%), and use of linguistic spin (29%). Moderate to high levels of spin were found in 55% of conclusions. From 2000 to 2020, the average number of strategies used has significantly decreased each decade (H = 27.459, P < 0.001), and the median level of spin in conclusions was significantly lower in studies published in the 2020s and 2010s than in the 2000s (H = 11.649, P = 0.003). CONCLUSIONS Our results suggest that 81% of urological observational studies comparing therapeutic interventions contained spin. Over the past two decades, the use of spin has significantly declined, but this remains an area for improvement, with 70% of included studies published in the 2020s employing spin. Medical writing should scrupulously avoid words or phrases that are not supported by data in the manuscript.
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Affiliation(s)
- Jeremy Wu
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samuel S Haile
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wilson Ho
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laurence Klotz
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery, Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Morgan Yuan
- Division of Plastic, Reconstructive & Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jason Y Lee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Yonah Krakowsky
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery, Women's College Hospital and Mount Sinai Hospital, Toronto, Ontario, Canada
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Cozzi A, Di Leo G, Houssami N, Gilbert FJ, Helbich TH, Álvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, de Lima Docema MF, Depretto C, Dominelli V, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MBI, Losio C, Mann RM, Montemezzi S, Obdeijn IM, Aksoy Ozcan U, Pediconi F, Pinker K, Preibsch H, Raya Povedano JL, Rossi Saccarelli C, Sacchetto D, Scaperrotta GP, Schlooz M, Szabó BK, Taylor DB, Ulus SÖ, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Sardanelli F. Preoperative breast MRI positively impacts surgical outcomes of needle biopsy-diagnosed pure DCIS: a patient-matched analysis from the MIPA study. Eur Radiol 2024; 34:3970-3980. [PMID: 37999727 PMCID: PMC11166778 DOI: 10.1007/s00330-023-10409-5] [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: 08/06/2023] [Revised: 09/16/2023] [Accepted: 10/11/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES To investigate the influence of preoperative breast MRI on mastectomy and reoperation rates in patients with pure ductal carcinoma in situ (DCIS). METHODS The MIPA observational study database (7245 patients) was searched for patients aged 18-80 years with pure unilateral DCIS diagnosed at core needle or vacuum-assisted biopsy (CNB/VAB) and planned for primary surgery. Patients who underwent preoperative MRI (MRI group) were matched (1:1) to those who did not receive MRI (noMRI group) according to 8 confounding covariates that drive referral to MRI (age; hormonal status; familial risk; posterior-to-nipple diameter; BI-RADS category; lesion diameter; lesion presentation; surgical planning at conventional imaging). Surgical outcomes were compared between the matched groups with nonparametric statistics after calculating odds ratios (ORs). RESULTS Of 1005 women with pure unilateral DCIS at CNB/VAB (507 MRI group, 498 noMRI group), 309 remained in each group after matching. First-line mastectomy rate in the MRI group was 20.1% (62/309 patients, OR 2.03) compared to 11.0% in the noMRI group (34/309 patients, p = 0.003). The reoperation rate was 10.0% in the MRI group (31/309, OR for reoperation 0.40) and 22.0% in the noMRI group (68/309, p < 0.001), with a 2.53 OR of avoiding reoperation in the MRI group. The overall mastectomy rate was 23.3% in the MRI group (72/309, OR 1.40) and 17.8% in the noMRI group (55/309, p = 0.111). CONCLUSIONS Compared to those going directly to surgery, patients with pure DCIS at CNB/VAB who underwent preoperative MRI had a higher OR for first-line mastectomy but a substantially lower OR for reoperation. CLINICAL RELEVANCE STATEMENT When confounding factors behind MRI referral are accounted for in the comparison of patients with CNB/VAB-diagnosed pure unilateral DCIS, preoperative MRI yields a reduction of reoperations that is more than twice as high as the increase in overall mastectomies. KEY POINTS • Confounding factors cause imbalance when investigating the influence of preoperative MRI on surgical outcomes of pure DCIS. • When patient matching is applied to women with pure unilateral DCIS, reoperation rates are significantly reduced in women who underwent preoperative MRI. • The reduction of reoperations brought about by preoperative MRI is more than double the increase in overall mastectomies.
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Affiliation(s)
- Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
- Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Nehmat Houssami
- The Daffodil Centre, Faculty of Medicine and Health, The University of Sydney (Joint Venture with Cancer Council NSW), Sydney, Australia
| | - Fiona J Gilbert
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Thomas H Helbich
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Division of Molecular and Structural Preclinical Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Corinne Balleyguier
- Department of Radiology, Institut Gustave Roussy, Villejuif, France
- Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France
| | - Massimo Bazzocchi
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Massimo Calabrese
- Unit of Oncological and Breast Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Julia Camps Herrero
- Department of Radiology, Hospital Universitario de La Ribera, Alzira, Spain
- Ribera Salud Hospitals, Valencia, Spain
| | - Francesco Cartia
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Clauser
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Catherine Depretto
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Dominelli
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gábor Forrai
- Department of Radiology, MHEK Teaching Hospital, Semmelweis University, Budapest, Hungary
- Department of Radiology, Duna Medical Center, GE-RAD Kft, Budapest, Hungary
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Steven E Harms
- Breast Center of Northwest Arkansas, Fayetteville, AR, USA
| | - Sarah Hilborne
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Raffaele Ienzi
- Department of Radiology, Di.Bi.MED, Policlinico Universitario Paolo Giaccone Università degli Studi di Palermo, Palermo, Italy
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Claudio Losio
- Department of Breast Radiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stefania Montemezzi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Inge-Marie Obdeijn
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Umit Aksoy Ozcan
- Department of Radiology, Acıbadem Atasehir Hospital, Istanbul, Turkey
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma "La Sapienza", Rome, Italy
| | - Katja Pinker
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heike Preibsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | | | | | - Daniela Sacchetto
- Kiwifarm S.R.L., La Morra, Italy
- Disaster Medicine Service 118, ASL CN1, Levaldigi, Italy
| | | | - Margrethe Schlooz
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Botond K Szabó
- Department of Radiology, Barking Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Donna B Taylor
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
- Department of Radiology, Royal Perth Hospital, Perth, Australia
| | - Sila Ö Ulus
- Department of Radiology, Acıbadem Atasehir Hospital, Istanbul, Turkey
| | - Mireille Van Goethem
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Department of Radiology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Jeroen Veltman
- Maatschap Radiologie Oost-Nederland, Oldenzaal, The Netherlands
| | - Stefanie Weigel
- Clinic for Radiology and Reference Center for Mammography, University of Münster, Münster, Germany
| | - Evelyn Wenkel
- Department of Radiology, University Hospital of Erlangen, Erlangen, Germany
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy.
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
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Lodhi S, Kibret T, Mangalgi S, Reid L, Noel A, Syed S, Beauregard N, Dhaliwal S, Hussain J, Vinson AJ, Van Spall HG, Sood MM, Shorr R, Bugeja A. Systematic Review of Women Leading and Participating in Nephrology Randomized Clinical Trials. Kidney Int Rep 2024; 9:898-906. [PMID: 38765601 PMCID: PMC11101787 DOI: 10.1016/j.ekir.2024.01.031] [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: 11/07/2023] [Revised: 12/21/2023] [Accepted: 01/15/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Women are underrepresented in the leadership of and participation in randomized controlled trials (RCTs). We conducted a bibliometric review of nephrology RCTs to examine trial leadership by women and participation of women in nephrology RCTs. Methods A bibliometric review of RCTs published in top medical, surgical, or nephrology journals was conducted using MEDLINE and EMBASE from January 2011 to December 2021. Leadership by women as corresponding authors, women trial participation, and trial characteristics were examined with duplicate independent data extraction. Logistic regression was used to examine associations between trial characteristics and women leadership and trial participation. Results A total of 1770 studies were screened and 395 RCTs met eligibility criteria. The number (%) of women in corresponding, first, and last authorship positions were as follows: 89 (22%), 109 (28%), and 74 (19%), respectively, without change over time (P = 0.94). The median percentage (interquartile range [IQR]) of women trial participants was 39.0% (13.5%) with no difference between women or men lead authors (P = 0.15). Men lead authors were statistically less likely to enroll women in RCTs. Women lead authors were less likely to be funded by industry (odds ratio [OR]: 0.30; 95% confidence interval [CI]: 0.14-0.63; P = 0.002) or lead international trials (OR: 0.11; 95% CI: 0.01-0.83; P = 0.03). Trials with sex-specific eligibility criteria were more likely to have women leaders (OR: 2.56; 95% CI: 1.19-5.49; P = 0.02) than those without. Discussion Gender inequalities in RCT leadership and RCT participation exist in nephrology and did not improve over time. Strategies to improve inequalities need to be implemented and evaluated.
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Affiliation(s)
- Sumiya Lodhi
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Taddele Kibret
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Shreepriya Mangalgi
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and Kidney Research Centre, Ottawa, Ontario, Canada
| | - Lindsay Reid
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ariana Noel
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and Kidney Research Centre, Ottawa, Ontario, Canada
| | - Sarah Syed
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Nickolas Beauregard
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Shan Dhaliwal
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Junayd Hussain
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Amanda J. Vinson
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Harriette G.C. Van Spall
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Manish M. Sood
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and Kidney Research Centre, Ottawa, Ontario, Canada
| | - Risa Shorr
- Learning Services, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ann Bugeja
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and Kidney Research Centre, Ottawa, Ontario, Canada
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Pasli M, Tumin D, Guffey R. Simulation-Based Analysis of Trial Design in Regional Anesthesia. Anesthesiol Res Pract 2024; 2024:6651894. [PMID: 38525205 PMCID: PMC10959581 DOI: 10.1155/2024/6651894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/01/2023] [Accepted: 02/12/2024] [Indexed: 03/26/2024] Open
Abstract
Background In regional anesthesia, the efficacy of novel blocks is typically evaluated using randomized controlled trials (RCTs), the findings of which are aggregated in systematic reviews and meta-analyses. Systematic review authors frequently point out the small sample size of RCTs as limiting conclusions from this literature. We sought to determine via statistical simulation if small sample size could be an expected property of RCTs focusing on novel blocks with typical effect sizes. Methods We simulated the conduct of a series of RCTs comparing a novel block versus placebo on a single continuous outcome measure. Simulation analysis inputs were obtained from a systematic bibliographic search of meta-analyses. Primary outcomes were the predicted number of large trials (empirically defined as N ≥ 256) and total patient enrollment. Results Simulation analysis predicted that a novel block would be tested in 16 RCTs enrolling a median of 970 patients (interquartile range (IQR) across 1000 simulations: 806, 1269), with no large trials. Among possible modifications to trial design, decreasing the statistical significance threshold from p < 0.05 to p < 0.005 was most effective at increasing the total number of patients represented in the final meta-analysis, but was associated with early termination of the trial sequence due to futility in block vs. block comparisons. Conclusion Small sample size of regional anesthesia RCTs comparing novel block to placebo is a rational outcome of trial design. Feasibly large trials are unlikely to change conclusions regarding block vs. placebo comparisons.
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Affiliation(s)
- Melisa Pasli
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC, USA
- Department of Academic Affairs, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Ryan Guffey
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, USA
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9
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Dasarathy S, Tu W, Bellar A, Welch N, Kettler C, Tang Q, Liangpunsakul S, Gawrieh S, Radaeva S, Mitchell M. Development and evaluation of objective trial performance metrics for multisite clinical studies: Experience from the AlcHep Network. Contemp Clin Trials 2024; 138:107437. [PMID: 38215876 DOI: 10.1016/j.cct.2024.107437] [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: 07/23/2023] [Revised: 11/05/2023] [Accepted: 01/08/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Recruitment and retention are critical in clinical studies but there are limited objective metrics of trial performance. We tested if development of trial performance metrics will allow for objective evaluation of study quality. Performance metrics were developed using data from the observational cohort (OBS) and randomized clinical trial (RCT) arms of the prospective Alcoholic Hepatitis Network. METHODS Yield-rate (%YR; eligible/screened), recruitment index (RI; mean recruitment time/patient), completion index (CI; average number of days to complete the follow-up/patient), and protocol adherence index (AI; average number of deviations/subject recruited) were determined. RESULTS 2250 patients (1168 for OBS; 1082 for RCT) were screened across 8 sites. Recruitment in the RCT (57% target) was similar to that in the OBS (59% target). Of those screened, 743 (63.6%) subjects in the OBS and 147 (13.6%) subjects in the RCT were enrolled in the study. In OBS study, 253 (34.1%) subjects, and in the RCT, 68 (46.3%) subjects, completed the study or reached a censoring event. Across all sites (range), YR for OBS was 63.6% (41.3-98.3%) and for RCT was 13.6% (5.5-92.6%); RI for OBS was 1.66 (8.79-19.85) and for RCT was 4.05 (19.76-36.43); CI for OBS was 4.87 (22.6-118.3) and for RCT was 8.75 (27.27-161.5); and AR for OBS was 0.56 (0.08-1.04) and for RCT was 1.55 (0.39-3.21. Factors related to participants, research design, study team, and research sponsors contributed to lower performance metrics. CONCLUSIONS Objective measures of clinical trial performance allow for strategies to enhance study quality and development of site-specific improvement plans. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT4072822 NCT03850899.
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Affiliation(s)
- Srinivasan Dasarathy
- Department of Gastroenterology & Hepatology and Inflammation and Immunity, Cleveland Clinic, Cleveland, OH, United States of America.
| | - Wanzhu Tu
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Annette Bellar
- Department of Gastroenterology & Hepatology and Inflammation and Immunity, Cleveland Clinic, Cleveland, OH, United States of America
| | - Nicole Welch
- Department of Gastroenterology & Hepatology and Inflammation and Immunity, Cleveland Clinic, Cleveland, OH, United States of America
| | - Carla Kettler
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Qing Tang
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Suthat Liangpunsakul
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Samer Gawrieh
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Svetlana Radaeva
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States of America
| | - Mack Mitchell
- Department of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
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10
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Wilhøft Kristensen A, Lunde Jensen A, Jensen K, Oksbjerre Dalton S, Friborg J, Grau C. Exploring patient-reported barriers to participating in proton therapy clinical trials. Tech Innov Patient Support Radiat Oncol 2024; 29:100230. [PMID: 38186677 PMCID: PMC10767209 DOI: 10.1016/j.tipsro.2023.100230] [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: 09/13/2023] [Revised: 11/07/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Clinical trials lead the progress in healthcare. To ensure reliable research conclusions, it is essential to enroll diverse patient groups. Identifying and understanding patient-reported barriers to clinical trials may help enhance recruitment among diverse patient groups.The clinical potential of proton therapy (PT) to reduce late effects is being investigated in clinical trials worldwide. Thus, for some patients, PT is only accessible by participating in clinical trials.Individuals with smoking-related head and neck cancer (HNC) are sometimes socioeconomically deprived, leading to barriers to trial participation. This study aims to identify barriers to their participation in a randomised controlled trial (RCT) involving PT. Method Interviews were conducted with 14 HNC patients declining participation in an RCT involving PT. The interviews were transcribed and systematically analysed using an inductive approach identifying categories and themes. Results The identified barriers to RCT-participation are: (1) existential distress, which influenced participants' mental and cognitive capacities, (2) insufficient RCT-related knowledge arising from information overload during clinical consultations, (3) the wish for safety and familiarity during the treatment trajectory, particularly for participants needing accommodation during radiotherapy, and (4) the motivation for study participation was impacted by uncertainty due to randomisation and clinical equipoise. Existential distress is identified as an overarching theme because it influences and amplifies the other three themes. Conclusion Existential distress is a central theme that influences and amplifies other participation barriers in PT RCTs. It affects participants' comprehension of trial information, their preference for familiar environments, and their motivation to participate in clinical trials.
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Affiliation(s)
- Anne Wilhøft Kristensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul Jensens Boulevard 25, 8200 Aarhus N, Denmark
| | - Annesofie Lunde Jensen
- Steno Diabetes Centre, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Kenneth Jensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul Jensens Boulevard 25, 8200 Aarhus N, Denmark
| | | | - Jeppe Friborg
- Department of Clinical Oncology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Cai Grau
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul Jensens Boulevard 25, 8200 Aarhus N, Denmark
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11
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Al Sukhun SA, Vanderpuye V, Taylor C, Ibraheem AF, Wiernik Rodriguez A, Asirwa FC, Francisco M, Moushey A. Global Equity in Clinical Trials: An ASCO Policy Statement. JCO Glob Oncol 2024; 10:e2400015. [PMID: 38484198 PMCID: PMC10954071 DOI: 10.1200/go.24.00015] [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: 01/08/2024] [Accepted: 01/23/2024] [Indexed: 03/19/2024] Open
Abstract
ASCO is a global professional society representing more than 50,000 physicians, other health care professionals, and advocates in over 100 countries specializing in cancer treatment, diagnosis, prevention, and advocacy. ASCO strives, through research, education, and promotion of the highest quality of patient care, to create a world where cancer is prevented or cured, and every survivor is healthy. In this pursuit, health equity remains the guiding institutional principle that applies to all its activities across the cancer care continuum. This ASCO policy statement emphasizes the urgent need for global equity in clinical trials, aiming to enhance access and representation in cancer research as it not only improves cancer outcomes but also upholds principles of fairness and justice in health care.
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Affiliation(s)
| | - Verna Vanderpuye
- National Center for Radiotherapy Ghana, Korle Bu Teaching Hospital, Accra, Ghana
| | | | | | - Andres Wiernik Rodriguez
- Grupo Montecristo Healthcare Division, San José, Escazu, Costa Rica
- Hospital Metropolitano, San José, Costa Rica
- Metropolitano Research Institute, San José, Costa Rica
| | - Fredrick Chite Asirwa
- International Cancer Institute, Kenya International Cancer Institute | ICI, Eldoret, Kenya
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12
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Milton A, Ozols A M I, Cassidy T, Jordan D, Brown E, Arnautovska U, Cook J, Phung D, Lloyd-Evans B, Johnson S, Hickie I, Glozier N. Co-Production of a Flexibly Delivered Relapse Prevention Tool to Support the Self-Management of Long-Term Mental Health Conditions: Co-Design and User Testing Study. JMIR Form Res 2024; 8:e49110. [PMID: 38393768 PMCID: PMC10926903 DOI: 10.2196/49110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 01/11/2024] [Accepted: 01/14/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Supported self-management interventions, which assist individuals in actively understanding and managing their own health conditions, have a robust evidence base for chronic physical illnesses, such as diabetes, but have been underused for long-term mental health conditions. OBJECTIVE This study aims to co-design and user test a mental health supported self-management intervention, My Personal Recovery Plan (MyPREP), that could be flexibly delivered via digital and traditional paper-based mediums. METHODS This study adopted a participatory design, user testing, and rapid prototyping methodologies, guided by 2 frameworks: the 2021 Medical Research Council framework for complex interventions and an Australian co-production framework. Participants were aged ≥18 years, self-identified as having a lived experience of using mental health services or working in a peer support role, and possessed English proficiency. The co-design and user testing processes involved a first round with 6 participants, focusing on adapting a self-management resource used in a large-scale randomized controlled trial in the United Kingdom, followed by a second round with 4 new participants for user testing the co-designed digital version. A final round for gathering qualitative feedback from 6 peer support workers was conducted. Data analysis involved transcription, coding, and thematic interpretation as well as the calculation of usability scores using the System Usability Scale. RESULTS The key themes identified during the co-design and user testing sessions were related to (1) the need for self-management tools to be flexible and well-integrated into mental health services, (2) the importance of language and how language preferences vary among individuals, (3) the need for self-management interventions to have the option of being supported when delivered in services, and (4) the potential of digitization to allow for a greater customization of self-management tools and the development of features based on individuals' unique preferences and needs. The MyPREP paper version received a total usability score of 71, indicating C+ or good usability, whereas the digital version received a total usability score of 85.63, indicating A or excellent usability. CONCLUSIONS There are international calls for mental health services to promote a culture of self-management, with supported self-management interventions being routinely offered. The resulting co-designed prototype of the Australian version of the self-management intervention MyPREP provides an avenue for supporting self-management in practice in a flexible manner. Involving end users, such as consumers and peer workers, from the beginning is vital to address their need for personalized and customized interventions and their choice in how interventions are delivered. Further implementation-effectiveness piloting of MyPREP in real-world mental health service settings is a critical next step.
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Affiliation(s)
- Alyssa Milton
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, Sydney, Australia
| | - Ingrid Ozols A M
- mentalhealth@work (mh@work), Melbourne, Australia
- Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Tayla Cassidy
- One Door Mental Health, Sydney, Australia
- School of Social Work and Arts, Charles Sturt University, Canberra, Australia
| | - Dana Jordan
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Ellie Brown
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Urska Arnautovska
- Faculty of Medicine, The University of Queensland, Woolloongabba, Australia
| | - Jim Cook
- TechLab ICT, University of Sydney, Sydney, Australia
| | - Darren Phung
- TechLab ICT, University of Sydney, Sydney, Australia
| | | | - Sonia Johnson
- Division of Psychiatry, University College London, London, United Kingdom
| | - Ian Hickie
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Nick Glozier
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, Sydney, Australia
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13
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Sharma Y, Cheung L, Patterson KK, Iaboni A. Factors influencing the clinical adoption of quantitative gait analysis technology with a focus on clinical efficacy and clinician perspectives: A scoping review. Gait Posture 2024; 108:228-242. [PMID: 38134709 DOI: 10.1016/j.gaitpost.2023.12.003] [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: 08/18/2023] [Revised: 11/14/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Quantitative gait analysis (QGA) has the potential to support clinician decision-making. However, it is not yet widely accepted in practice. Evidence for clinical efficacy (i.e., efficacy and effectiveness), as well as a users' perspective on using the technology in clinical practice (e.g., ease of use and usefulness) can help impact their widespread adoption. OBJECTIVE To synthesize the literature on the clinical efficacy and clinician perspectives on the use of gait analysis technologies in the clinical care of adult populations. METHODS This scoping review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews. We included peer-reviewed and gray literature (i.e., conference abstracts). A search was conducted in MEDLINE (Ovid), CENTRAL (Ovid), EMBASE (Ovid), CINAHL (EBSCO) and SPORTDiscus (EBSCO). Included full-text studies were critically appraised using the JBI critical appraisal tools. RESULTS A total of 15 full-text studies and two conference abstracts were included in this review. Results suggest that QGA technologies can influence decision-making with some evidence to suggest their role in improving patient outcomes. The main barrier to ease of use was a clinician's lack of data expertise, and main facilitator was receiving support from staff. Barriers to usefulness included challenges finding suitable reference data and data accuracy, while facilitators were enhancing patient care and supporting clinical decision-making. SIGNIFICANCE This review is the first step to understanding how QGA technologies can optimize clinical practice. Many gaps in the literature exist and reveal opportunities to improve the clinical adoption of gait analysis technologies. Further research is needed in two main areas: 1) examining the clinical efficacy of gait analysis technologies and 2) gathering clinician perspectives using a theoretical model like the Technology Acceptance Model to guide study design. Results will inform research aimed at evaluating, developing, or implementing these technologies. FUNDING This work was supported by the Walter and Maria Schroeder Institute for Brain Innovation and Recovery and AGE-WELL Graduate Student Award in Technology and Aging [2021,2022].
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Affiliation(s)
- Yashoda Sharma
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, 550 University Avenue, M5G 2A2 Toronto, ON, Canada
| | - Lovisa Cheung
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, 550 University Avenue, M5G 2A2 Toronto, ON, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada
| | - Kara K Patterson
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, 550 University Avenue, M5G 2A2 Toronto, ON, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada
| | - Andrea Iaboni
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, 550 University Avenue, M5G 2A2 Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, M5T 1R8 Toronto, ON, Canada.
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14
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Kumar A, Yassin N, Marley A, Bellato V, Foppa C, Pellino G, Myrelid P, Millan M, Gros B, Avellaneda N, Catalan-Serra I, El-Hussuna A, Cunha Neves JA, Roseira J, Cunha MF, Verstockt B, Bettenworth D, Mege D, Brookes MJ. Crossing barriers: the burden of inflammatory bowel disease across Western Europe. Therap Adv Gastroenterol 2023; 16:17562848231218615. [PMID: 38144422 PMCID: PMC10748558 DOI: 10.1177/17562848231218615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 11/16/2023] [Indexed: 12/26/2023] Open
Abstract
An estimated 2.5-3 million individuals (0.4%) in Europe are affected by inflammatory bowel disease (IBD). Whilst incidence rates for IBD are stabilising across Europe, the prevalence is rising and subsequently resulting in a significant cost to the healthcare system of an estimated 4.6-5.6 billion euros per year. Hospitalisation and surgical resection rates are generally on a downward trend, which is contrary to the rising cost of novel medication. This signifies a large part of healthcare cost and burden. Despite publicly funded healthcare systems in most European countries, there is still wide variation in how patients receive and/or pay for biologic medication. This review will provide an overview and discuss the different healthcare systems within Western Europe and the barriers that affect overall management of a changing IBD landscape, including differences to hospitalisation and surgical rates, access to medication and clinical trial participation and recruitment. This review will also discuss the importance of standardising IBD management to attain high-quality care for all patients with IBD.
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Affiliation(s)
- Aditi Kumar
- Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, UK B15 2GW
| | - Nuha Yassin
- Department of Colorectal Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Alexandra Marley
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Vittoria Bellato
- Department of Minimally Invasive Surgery, University of Rome ‘Tor Vergata’, Rome, Italy
| | - Caterina Foppa
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gianluca Pellino
- Colorectal Surgery, Vall D’Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Universita degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Pär Myrelid
- Department of Surgery, Linköping University Hospital, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Monica Millan
- Department of Surgery, La Fe University and Polytechnic Hospital, University of Valencia, Valencia, Spain
| | - Beatriz Gros
- Department of Gastroenterology and Hepatology, Reina Sofia University Hospital, Cordoba, Spain
- Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | - Nicolas Avellaneda
- General and Colorectal Surgery Department, CEMIC University Hospital, Buenos Aires, Argentina
| | - Ignacio Catalan-Serra
- Department of Gastroenterology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - João A. Cunha Neves
- Department of Gastroenterology, Algarve University Hospital Centre, Portimão, Portugal
- Algarve Biomedical Centre, University of Algarve, Faro, Portugal
| | - Joana Roseira
- Department of Gastroenterology, Algarve University Hospital Centre, Portimão, Portugal
- Algarve Biomedical Centre, University of Algarve, Faro, Portugal
| | - Miguel F. Cunha
- Algarve Biomedical Centre, University of Algarve, Faro, Portugal
- Department of Colorectal Surgery, Algarve University Hospital Centre, Portimão, Portugal
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Dominik Bettenworth
- CED Schwerpunktpraxis, Münster, Germany
- Medical Faculty, University of Münster, Münster, Germany
| | - Diane Mege
- Department of Digestive and Oncology Surgery, Timone University Hospital, Marseille, France
| | - Matthew J. Brookes
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- School of Medicine and Clinical Practice, Faculty of Sciences and Engineering, University of Wolverhampton, Wolverhampton UK
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15
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Moraga Alapont P, Prieto P, Urroz M, Jiménez M, Carcas AJ, Borobia AM. Evaluation of factors associated with recruitment rates in early phase clinical trials based on the European Clinical Trials Register data. Clin Transl Sci 2023; 16:2654-2664. [PMID: 37890866 PMCID: PMC10719455 DOI: 10.1111/cts.13659] [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: 07/10/2023] [Revised: 09/13/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
Effective participant recruitment is a critical challenge in clinical trials. Inadequate enrollment of participants can precipitate delays, escalated costs, and compromise scientific integrity. Despite its relevance, particularly during the early phases, it persists as an obstacle in the field of clinical research. The primary aim of this study was to analyze the recruitment rates of early-phase clinical trials and evaluate their potential associations with key trial characteristics. Using a descriptive and statistical analysis, a research study was conducted based on the early-phase trials registered at the European Clinical Trials Register (EU-CTR), spanning the timeframe from January 2017 to December 2021. Among the 194 trials examined, we found median recruitment rates of 68%. A more detailed exploration revealed a greater level of success in terms of recruitment achievement in pediatric trials when compared to trials involving adults, non-oncologic trials, or those also developed in non-European countries. It is important to underscore that only 69 trials out of the total managed to conclude recruitment, with the most prevalent reason for premature cessation being the presence of efficacy and safety issues or sponsor's strategy. This number can be greatly improved. Despite certain disparities observed in the information within EU-CTR, we have successfully determined the recruitment rates of the studies and established associations with some of the clinical trial characteristics analyzed. Owing to the inherent constraints of this study, further research is warranted to gain a comprehensive understanding of the intricate interplay between trial characteristics and their impact on recruitment rates in early-phase studies.
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Affiliation(s)
| | - Paula Prieto
- Clinical Pharmacology DepartmentLa Paz University Hospital, IdiPAZMadridSpain
| | - Mikel Urroz
- Pharmacology and Therapeutics Department, School of MedicineUniversidad Autónoma de MadridMadridSpain
| | - María Jiménez
- Clinical Pharmacology DepartmentLa Paz University Hospital, IdiPAZMadridSpain
| | - Antonio J. Carcas
- Clinical Pharmacology DepartmentLa Paz University Hospital, IdiPAZMadridSpain
- Pharmacology and Therapeutics Department, School of MedicineUniversidad Autónoma de MadridMadridSpain
| | - Alberto M. Borobia
- Clinical Pharmacology DepartmentLa Paz University Hospital, IdiPAZMadridSpain
- Pharmacology and Therapeutics Department, School of MedicineUniversidad Autónoma de MadridMadridSpain
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Allan LP, Beilei L, Cameron J, Olaiya MT, Silvera-Tawil D, Adcock AK, English C, Gall SL, Cadilhac DA. A Scoping Review of mHealth Interventions for Secondary Prevention of Stroke: Implications for Policy and Practice. Stroke 2023; 54:2935-2945. [PMID: 37800373 DOI: 10.1161/strokeaha.123.043794] [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: 10/07/2023]
Abstract
Secondary prevention is a major priority for those living with stroke and may be improved through the use of mobile Health (mHealth) interventions. While evidence for the effectiveness of mHealth interventions for secondary prevention of stroke is growing, little attention has been given to the translation of these interventions into real-world use. In this review, we aimed to provide an update on the effectiveness of mHealth interventions for secondary prevention of stroke, and investigate their translation into real-world use. Four electronic databases and the gray literature were searched for randomized controlled trials of mHealth interventions for secondary prevention of stroke published between 2010 and 2023. Qualitative and mixed-methods evaluations of the trials were also included. Data were extracted regarding study design, population, mHealth technology involved, the intervention, and outcomes. Principal researchers from these trials were also contacted to obtain further translational information. From 1151 records, 13 randomized controlled trials and 4 evaluations were identified; sample sizes varied widely (median, 56; range, 24-4298). Short message service messages (9/13) and smartphone applications (6/13) were the main technologies used to deliver interventions. Primary outcomes of feasibility of the intervention were achieved in 4 trials, and primary outcomes of changes in risk factors, lifestyle behaviors, and adherence to medication improved in 6 trials. Only 1 trial had a hard end point (ie, stroke recurrence) as a primary outcome, and no significant differences were observed between groups. There was evidence for only 1 intervention being successfully translated into real-world use. Further evidence is required on the clinical effectiveness of mHealth interventions for preventing recurrent stroke, and the associated delivery costs and cost-effectiveness, before adoption into real-world settings.
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Affiliation(s)
- Liam P Allan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
- Australian e-Health Research Centre, The Commonwealth Scientific and Industrial Research Organisation, New South Wales, Australia (L.P.A., D.S.-T.)
| | - Lin Beilei
- The Nursing and Health School, Zhengzhou University, Henan, China (L.B.)
| | - Jan Cameron
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
- Australian Centre for Heart Health, Royal Melbourne Hospital, Victoria, Australia (J.C.)
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
| | - David Silvera-Tawil
- Australian e-Health Research Centre, The Commonwealth Scientific and Industrial Research Organisation, New South Wales, Australia (L.P.A., D.S.-T.)
| | - Amelia K Adcock
- Cerebrovascular Division, Department of Neurology, West Virginia University, Morgantown (A.K.A.)
| | - Coralie English
- School of Health Sciences, University of Newcastle, New South Wales, Australia (C.E.)
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New South Wales, Australia (C.E.)
- NHMRC Centre of Research Excellence to Accelerate Stroke Trial Innovation and Translation (C.E., D.A.C.)
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.L.G.)
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Victoria, Australia (S.L.G.)
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia (D.A.C.)
- NHMRC Centre of Research Excellence to Accelerate Stroke Trial Innovation and Translation (C.E., D.A.C.)
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17
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Song Y, Ye T, Roberts LR, Larson NB, Winham SJ. Mendelian randomization in hepatology: A review of principles, opportunities, and challenges. Hepatology 2023:01515467-990000000-00618. [PMID: 37874245 DOI: 10.1097/hep.0000000000000649] [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] [Received: 03/27/2023] [Accepted: 08/30/2023] [Indexed: 10/25/2023]
Abstract
Mendelian randomization has become a popular tool to assess causal relationships using existing observational data. While randomized controlled trials are considered the gold standard for establishing causality between exposures and outcomes, it is not always feasible to conduct a trial. Mendelian randomization is a causal inference method that uses observational data to infer causal relationships by using genetic variation as a surrogate for the exposure of interest. Publications using the approach have increased dramatically in recent years, including in the field of hepatology. In this concise review, we describe the concepts, assumptions, and interpretation of Mendelian randomization as related to studies in hepatology. We focus on the strengths and weaknesses of the approach for a non-statistical audience, using an illustrative example to assess the causal relationship between body mass index and NAFLD.
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Affiliation(s)
- Yilin Song
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Ting Ye
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Nicholas B Larson
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Stacey J Winham
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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18
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Goyal R, De Gruttola V, Onnela JP. Framework for converting mechanistic network models to probabilistic models. JOURNAL OF COMPLEX NETWORKS 2023; 11:cnad034. [PMID: 37873517 PMCID: PMC10588735 DOI: 10.1093/comnet/cnad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 08/25/2023] [Indexed: 10/25/2023]
Abstract
There are two prominent paradigms for the modelling of networks: in the first, referred to as the mechanistic approach, one specifies a set of domain-specific mechanistic rules that are used to grow or evolve the network over time; in the second, referred to as the probabilistic approach, one describes a model that specifies the likelihood of observing a given network. Mechanistic models (models developed based on the mechanistic approach) are appealing because they capture scientific processes that are believed to be responsible for network generation; however, they do not easily lend themselves to the use of inferential techniques when compared with probabilistic models. We introduce a general framework for converting a mechanistic network model (MNM) to a probabilistic network model (PNM). The proposed framework makes it possible to identify the essential network properties and their joint probability distribution for some MNMs; doing so makes it possible to address questions such as whether two different mechanistic models generate networks with identical distributions of properties, or whether a network property, such as clustering, is over- or under-represented in the networks generated by the model of interest compared with a reference model. The proposed framework is intended to bridge some of the gap that currently exists between the formulation and representation of mechanistic and PNMs. We also highlight limitations of PNMs that need to be addressed in order to close this gap.
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Affiliation(s)
- Ravi Goyal
- Division of Infectious Diseases and Global Public, Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA USA
| | - Victor De Gruttola
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA USA
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA USA
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19
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Gao T, Monson H, Felfeli T. Bibliometric analysis of the uveitis literature and research trends over the past two decades. BMJ Open Ophthalmol 2023; 8:e001330. [PMID: 37714667 PMCID: PMC10510855 DOI: 10.1136/bmjophth-2023-001330] [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: 05/03/2023] [Accepted: 08/19/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE This study aimed to examine the publication patterns and present a current view of the field of uveitis using a bibliometric analysis. DESIGN Bibliometric analysis. METHODS AND ANALYSIS A comprehensive search of three databases including MEDLINE, EMBASE and Cochrane was conducted from 1 January 2000 to 31 December 2022. Search results from all three databases were subjected to analysis by Bibliometrix, an R programme that analyses large literature dataset with statistical and mathematical models. Visualisation of collaboration networks and relevance between countries was presented with VOSviewer. RESULTS A total of 26 296 articles were included in the analysis. The field of uveitis has undergone a significant exponential growth since 2000, with an average growth rate of 4.14%. The most substantial annual growth was between the years 2021 and 2022 (36%). According to the corresponding author's countries, the three most productive countries were Turkey (3288, 12.6%), the USA (3136, 12%) and Japan (1981, 7.6%). The USA (243, 31.4%), England (117, 15%) and Germany (62, 8%) are the top three countries that contributed to clinical trials. The average international collaboration of all countries was 2.5%. CONCLUSIONS Uveitis literature has undergone significant growth in the past two decades. The demographic factors of publishing countries lead to their various productivity and types of these uveitis studies, which is closely associated with the countries' scientific research resources and patient populations.
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Affiliation(s)
- Tingxiao Gao
- Medical Biophysics, University of Toronto - St George Campus, Toronto, Ontario, Canada
| | - Hayley Monson
- Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada
- The Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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20
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Taoui S, Lepage B, Marx M. Single-Case Experimental Designs and N-of-1 Trials-An Alternative to Randomized Clinical Trials for Clinical Research in Otorhinolaryngology. JAMA Otolaryngol Head Neck Surg 2023; 149:767-768. [PMID: 37535385 DOI: 10.1001/jamaoto.2023.1578] [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: 08/04/2023]
Abstract
This Viewpoint explores the use of single-case experimental designs in otolaryngology research.
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Affiliation(s)
- Soumia Taoui
- Department of Otology, Toulouse University Hospital Center, Toulouse, France
| | - Benoît Lepage
- Department of Epidemiology, Toulouse University Hospital, Toulouse, France
| | - Mathieu Marx
- Department of Otology, Toulouse University Hospital Center, Toulouse, France
- Brain and Cognition Research Center, Toulouse University III, Toulouse, France
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21
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Núñez-Núñez M, Maes-Carballo M, Mignini LE, Chien PFW, Khalaf Y, Fawzy M, Zamora J, Khan KS, Bueno-Cavanillas A. Research integrity in randomized clinical trials: A scoping umbrella review. Int J Gynaecol Obstet 2023; 162:860-876. [PMID: 37062861 DOI: 10.1002/ijgo.14762] [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: 02/16/2023] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Randomized clinical trials (RCTs) are experiencing a crisis of confidence in their trustworthiness. Although a comprehensive literature search yielded several reviews on RCT integrity, an overarching overview is lacking. OBJECTIVES The authors undertook a scoping umbrella review of the research integrity literature concerning RCTs. SEARCH STRATEGY AND SELECTION CRITERIA Following prospective registration (https://osf.io/3ursn), two reviewers independently searched PubMed, Scopus, The Cochrane Library, and Google Scholar, without language or time restrictions, until November 2021. The authors included systematic reviews covering any aspect of research integrity throughout the RCT lifecycle. DATA COLLECTION AND ANALYSIS The authors assessed methodological quality using a modified AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) tool and collated the main findings. MAIN RESULTS A total of 55 relevant reviews, summarizing 6001 studies (median per review, 63; range, 8-1106) from 1964 to 2021, had an overall critically low quality of 96% (53 reviews). Topics covered included general aspects (15%), design and approval (22%), conduct and monitoring (11%), reporting (38%), postpublication concerns (2%), and future research (13%). The most common integrity issues covered were ethics (18%) and transparency (18%). CONCLUSIONS Low-quality reviews identified various integrity issues across the RCT lifecycle, emphasizing the importance of high ethical standards and professionalism while highlighting gaps in the integrity landscape. Multistakeholder consensus is needed to develop specific RCT integrity standards.
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Affiliation(s)
- María Núñez-Núñez
- Pharmacy Department, University Hospital Clínico San Cecilio, Granada, Spain
- Biomedical research institute of Granada (IBS-Granada), Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP-Spain), Madrid, Spain
| | - Marta Maes-Carballo
- General Surgery Department. Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain
- General Surgery Department, Hospital Público Verín, Ourense, Spain
| | | | | | - Yacoub Khalaf
- Guy's & St Thomas' Hospital Foundation Trust, London, UK
| | - Mohamed Fawzy
- IbnSina (Sohag), Banon (Assiut), Qena (Qena), Amshag (Sohag) IVF Facilities, Cairo, Egypt
| | - Javier Zamora
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP-Spain), Madrid, Spain
- Clinical Biostatistics Unit, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Khalid S Khan
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP-Spain), Madrid, Spain
- Preventive Medicine and Public Health, University of Granada Faculty of Medicine, Granada, Spain
| | - Aurora Bueno-Cavanillas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP-Spain), Madrid, Spain
- Preventive Medicine and Public Health, University of Granada Faculty of Medicine, Granada, Spain
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Gupta M, Oliver EA, Chauhan SP, Wagner SM, Mol B, Berghella V. Unpublished completed obstetric randomized clinical trials registered at ClinicalTrials.gov: how big is this issue? Am J Obstet Gynecol MFM 2023; 5:101066. [PMID: 37419451 DOI: 10.1016/j.ajogmf.2023.101066] [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: 02/15/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND A portion of obstetrical randomized clinical trials registered on ClinicalTrials.gov are not published in peer-reviewed journals. OBJECTIVE This study aimed to compare the characteristics of completed published vs unpublished randomized clinical trials in obstetrics registered on ClinicalTrials.gov and to identify barriers to publication. STUDY DESIGN This cross-sectional study queried ClinicalTrials.gov for all completed obstetrical randomized clinical trials registered between January 1, 2009, and December 31, 2018. For each completed obstetrical randomized clinical trial, we abstracted the following registration fields from ClinicalTrials.gov: ClinicalTrials.gov identifier, recruitment status, trial start and completion dates, study results, type of intervention, study phase, enrollment size, funder type, location, and facilities. Calculated variables included time to completion. In May 2021, we used PubMed and Google Scholar to identify the publication status of completed trials, and we compared the characteristics of published vs unpublished randomized clinical trials. The corresponding authors' e-mail addresses for the unpublished studies were collected from ClinicalTrials.gov and departmental websites. Between September 2021 and March 2022, the authors of these completed but unpublished obstetrical randomized clinical trials were contacted and invited to respond to a survey examining perceptions of barriers to publication, responses of which were collected and presented as counts and percentages. RESULTS Of the 647 obstetrical randomized clinical trials marked as completed on ClinicalTrials.gov, 378 (58%) were published, and 269 (42%) were unpublished. Unpublished trials were more likely to have an enrollment size of <50 participants (14.5% published vs 25.3% unpublished; P<.001) and less likely to be conducted at multiple sites (25.4% published vs 17.5% unpublished; P<.02). The main barriers to publication reported in the survey by authors whose trials were not published included lack of time (30%), change in employment or completion of training (25%), and results that were not of statistical significance (15%). CONCLUSION Among the obstetrical randomized clinical trials registered and marked as completed on ClinicalTrials.gov, more than 40% were unpublished. Unpublished trials were more likely to be smaller studies, conducted by researchers who reported experiencing a lack of time as the most common barrier to study publication.
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Affiliation(s)
- Megha Gupta
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (Drs Gupta and Wagner); Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA (Drs Gupta and Wagner).
| | - Emily A Oliver
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA (Dr Oliver)
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX (Dr Chauhan)
| | - Stephen M Wagner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (Drs Gupta and Wagner); Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA (Drs Gupta and Wagner)
| | - Ben Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia (Dr Mol)
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA (Dr Berghella)
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23
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Ghim JL, Ahn S. Transforming clinical trials: the emerging roles of large language models. Transl Clin Pharmacol 2023; 31:131-138. [PMID: 37810626 PMCID: PMC10551746 DOI: 10.12793/tcp.2023.31.e16] [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] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 10/10/2023] Open
Abstract
Clinical trials are essential for medical research, but they often face challenges in matching patients to trials and planning. Large language models (LLMs) offer a promising solution, signaling a transformative shift in the field of clinical trials. This review explores the multifaceted applications of LLMs within clinical trials, focusing on five main areas expected to be implemented in the near future: enhancing patient-trial matching, streamlining clinical trial planning, analyzing free text narratives for coding and classification, assisting in technical writing tasks, and providing cognizant consent via LLM-powered chatbots. While the application of LLMs is promising, it poses challenges such as accuracy validation and legal concerns. The convergence of LLMs with clinical trials has the potential to revolutionize the efficiency of clinical trials, paving the way for innovative methodologies and enhancing patient engagement. However, this development requires careful consideration and investment to overcome potential hurdles.
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Affiliation(s)
- Jong-Lyul Ghim
- Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan 47392, Korea
- Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan 47392, Korea
| | - Sangzin Ahn
- Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan 47392, Korea
- Department of Pharmacology and Pharmacogenomics Research Center, Inje University College of Medicine, Busan 47392, Korea
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24
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Sánchez-Peralta LF, Glover B, Saratxaga CL, Ortega-Morán JF, Nazarian S, Picón A, Pagador JB, Sánchez-Margallo FM. Clinical Validation Benchmark Dataset and Expert Performance Baseline for Colorectal Polyp Localization Methods. J Imaging 2023; 9:167. [PMID: 37754931 PMCID: PMC10532435 DOI: 10.3390/jimaging9090167] [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: 07/28/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 09/28/2023] Open
Abstract
Colorectal cancer is one of the leading death causes worldwide, but, fortunately, early detection highly increases survival rates, with the adenoma detection rate being one surrogate marker for colonoscopy quality. Artificial intelligence and deep learning methods have been applied with great success to improve polyp detection and localization and, therefore, the adenoma detection rate. In this regard, a comparison with clinical experts is required to prove the added value of the systems. Nevertheless, there is no standardized comparison in a laboratory setting before their clinical validation. The ClinExpPICCOLO comprises 65 unedited endoscopic images that represent the clinical setting. They include white light imaging and narrow band imaging, with one third of the images containing a lesion but, differently to another public datasets, the lesion does not appear well-centered in the image. Together with the dataset, an expert clinical performance baseline has been established with the performance of 146 gastroenterologists, who were required to locate the lesions in the selected images. Results shows statistically significant differences between experience groups. Expert gastroenterologists' accuracy was 77.74, while sensitivity and specificity were 86.47 and 74.33, respectively. These values can be established as minimum values for a DL method before performing a clinical trial in the hospital setting.
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Affiliation(s)
- Luisa F. Sánchez-Peralta
- Jesús Usón Minimally Invasive Surgery Centre, E-10071 Cáceres, Spain; (L.F.S.-P.); (J.F.O.-M.); (F.M.S.-M.)
- AI4polypNET Thematic Network, E-08193 Barcelona, Spain
| | - Ben Glover
- Imperial College London, London SW7 2BU, UK; (B.G.); (S.N.)
| | - Cristina L. Saratxaga
- TECNALIA, Basque Research and Technology Alliance (BRTA), E-48160 Derio, Spain; (C.L.S.); (A.P.)
| | - Juan Francisco Ortega-Morán
- Jesús Usón Minimally Invasive Surgery Centre, E-10071 Cáceres, Spain; (L.F.S.-P.); (J.F.O.-M.); (F.M.S.-M.)
- AI4polypNET Thematic Network, E-08193 Barcelona, Spain
| | | | - Artzai Picón
- TECNALIA, Basque Research and Technology Alliance (BRTA), E-48160 Derio, Spain; (C.L.S.); (A.P.)
- Department of Automatic Control and Systems Engineering, University of the Basque Country, E-48013 Bilbao, Spain
| | - J. Blas Pagador
- Jesús Usón Minimally Invasive Surgery Centre, E-10071 Cáceres, Spain; (L.F.S.-P.); (J.F.O.-M.); (F.M.S.-M.)
- AI4polypNET Thematic Network, E-08193 Barcelona, Spain
| | - Francisco M. Sánchez-Margallo
- Jesús Usón Minimally Invasive Surgery Centre, E-10071 Cáceres, Spain; (L.F.S.-P.); (J.F.O.-M.); (F.M.S.-M.)
- AI4polypNET Thematic Network, E-08193 Barcelona, Spain
- RICORS-TERAV Network, ISCIII, E-28029 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, E-28029 Madrid, Spain
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25
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Kounatidou NE, Tzavara C, Palioura S. Systematic review of sample size calculations and reporting in randomized controlled trials in ophthalmology over a 20-year period. Int Ophthalmol 2023; 43:2999-3010. [PMID: 36917324 DOI: 10.1007/s10792-023-02687-1] [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: 11/16/2022] [Accepted: 03/04/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Randomized Controlled Trials (RCTs) are considered the gold standard for the practice of evidence-based medicine. The purpose of this study is to systematically assess the reporting of sample size calculations in ophthalmology RCTs in 5 leading journals over a 20-year period. Reviewing sample size calculations in ophthalmology RCTs will shed light on the methodological quality of RCTs and, by extension, on the validity of published results. METHODS The MEDLINE database was searched to identify full reports of RCTs in the journals Ophthalmology, JAMA Ophthalmology, American Journal of Ophthalmology, Investigative Ophthalmology and Visual Science, and British Journal of Ophthalmology between January and December of the years 2000, 2010 and 2020. Screening identified 559 articles out of which 289 met the inclusion criteria for this systematic review. Data regarding sample size calculation reporting and trial characteristics was extracted for each trial by independent investigators. RESULTS In 2020, 77.9% of the RCTs reported sample size calculations as compared with 37% in 2000 (p < 0.001) and 60.7% in 2010 (p = 0.012). Studies reporting all necessary parameters for sample size recalculation increased significantly from 17.2% in 2000 to 39.3% in 2010 and 43.0% in 2020 (p < 0.001). Reporting of funding was greater in 2020 (98.8%) compared with 2010 (89.3%) and 2000 (53.1%). Registration in a clinical trials database occurred more frequently in 2020 (94.2%) compared to 2000 (1.2%; p < 0.001) and 2010 (68%; p < 0.001). In 2020, 38.4% of studies reported different sample sizes in the online registry from the published article. Overall, the most studied area in 2000 was glaucoma (29.6% of RCTs), whereas in 2010 and 2020, it was retina (40.2 and 37.2% of the RCTs, respectively). The number of patients enrolled in a study and the number of eyes studied was significantly greater in 2020 compared to 2000 and 2010 (p < 0.001). CONCLUSION Sample size calculation reporting in ophthalmology RCTs has improved significantly between the years 2000 and 2020 and is comparable to other fields in medicine. However, reporting of certain parameters remains inconsistent with current publication guidelines.
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Affiliation(s)
| | - Chara Tzavara
- Department of Biostatistics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Sotiria Palioura
- Department of Ophthalmology, University of Cyprus Medical School, Aglantzia, Cyprus.
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26
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Hu J, Zhu A, Vickers A, Allaf ME, Ehdaie B, Schaeffer A, Pavlovich C, Ross AE, Green DA, Wang G, Ginzburg S, Montgomery JS, George A, Graham JN, Ristau BT, Correa A, Shoag JE, Kowalczyk KJ, Zhang TR, Schaeffer EM. Protocol of a multicentre randomised controlled trial assessing transperineal prostate biopsy to reduce infectiouscomplications. BMJ Open 2023; 13:e071191. [PMID: 37208135 DOI: 10.1136/bmjopen-2022-071191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION Approximately one million prostate biopsies are performed annually in the USA, and most are performed using a transrectal approach under local anaesthesia. The risk of postbiopsy infection is increasing due to increasing antibiotic resistance of rectal flora. Single-centre studies suggest that a clean, percutaneous transperineal approach to prostate biopsy may have a lower risk of infection. To date, there is no high-level evidence comparing transperineal versus transrectal prostate biopsy. We hypothesise that transperineal versus transrectal prostate biopsy under local anaesthesia has a significantly lower risk of infection, similar pain/discomfort levels and comparable detection of non-low-grade prostate cancer. METHODS AND ANALYSIS We will perform a multicentre, prospective randomised clinical trial to compare transperineal versus transrectal prostate biopsy for elevated prostate-specific antigen in the first biopsy, prior negative biopsy and active surveillance biopsy setting. Prostate MRI will be performed prior to biopsy, and targeted biopsy will be conducted for suspicious MRI lesions in addition to systematic biopsy (12 cores). Approximately 1700 men will be recruited and randomised in a 1:1 ratio to transperineal versus transrectal biopsy. A streamlined design to collect data and to determine trial eligibility along with the two-stage consent process will be used to facilitate subject recruitment and retention. The primary outcome is postbiopsy infection, and secondary outcomes include other adverse events (bleeding, urinary retention), pain/discomfort/anxiety and critically, detection of non-low-grade (grade group ≥2) prostate cancer. ETHICS AND DISSEMINATION The Institutional Review Board of the Biomedical Research Alliance of New York approved the research protocol (protocol number #18-02-365, approved 20 April 2020). The results of the trial will be presented at scientific conferences and published in peer-reviewed medical journals. TRIAL REGISTRATION NUMBER NCT04815876.
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Affiliation(s)
- Jim Hu
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Alec Zhu
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Andrew Vickers
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Behfar Ehdaie
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anthony Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Christian Pavlovich
- Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ashley E Ross
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David A Green
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Gerald Wang
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Serge Ginzburg
- Einstein Urology, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Jeffrey S Montgomery
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Arvin George
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - John N Graham
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Benjamin T Ristau
- Department of Surgery, Division of Urology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Andres Correa
- Department of Surgical Oncology, Division of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Jonathan E Shoag
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Keith J Kowalczyk
- Department of Urology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Tenny R Zhang
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - E M Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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27
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Sheikh Z, Yu B, Heywood E, Quraishi N, Quraishi S. The assessment and management of deep neck space infections in adults: A systematic review and qualitative evidence synthesis. Clin Otolaryngol 2023. [PMID: 37147934 DOI: 10.1111/coa.14064] [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: 06/30/2022] [Revised: 02/03/2023] [Accepted: 03/19/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVES To summarise current practices in the diagnosis and management of deep neck space infections (DNSIs). To inform future studies in developing a framework in the management of DNSIs. DESIGN This review was registered on PROSPERO (CRD42021226449) and reported in line with PRISMA guidelines. All studies from 2000 that reported the investigation or management of DNSI were included. The search was limited to English language only. Databases searched included AMED, Embase, Medline and HMIC. Quantitative analysis was undertaken with descriptive statistics and frequency synthesis with two independent reviewers. A qualitative narrative synthesis was conducted using a thematic analysis approach. SETTING Secondary or tertiary care centres that undertook management of DNSIs. PARTICIPANTS All adult patients with a DNSI. MAIN OUTCOME MEASURES The role of imaging, radiologically guided aspiration and surgical drainage in DNSIs. RESULTS Sixty studies were reviewed. Thirty-one studies reported on imaging modality, 51 studies reported treatment modality. Aside from a single randomised controlled trial, all other studies were observational (n = 25) or case series (n = 36). Computer tomography (CT) was used to diagnose DNSI in 78% of patients. The mean percentage of management with open surgical drainage was 81% and 29.4% for radiologically guided aspiration, respectively. Qualitative analysis identified seven major themes on DNSI. CONCLUSIONS There are limited methodologically rigorous studies investigating DNSIs. CT imaging was the most used imaging modality. Surgical drainage was commonest treatment choice. Areas of further research on epidemiology, reporting guidelines and management are required.
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Affiliation(s)
- Zain Sheikh
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
- Department of Academic Clinical Training, University of Sheffield, Sheffield, UK
| | - Beverley Yu
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
| | - Emily Heywood
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
| | - Natasha Quraishi
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
| | - Shahed Quraishi
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
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Pellarin M, Youmbi CT, Lotchuang J, Tejpal T, Thangathurai G, Khan A, Cohen D, Simunovic N, Duong A, Ayeni OR. From Protocol to Definitive Study-The State of Randomized Controlled Trial Evidence in Sports Medicine Research: A Systematic Review and Survey Study. Clin J Sport Med 2023; 33:e44-e70. [PMID: 36652662 DOI: 10.1097/jsm.0000000000001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the progression, quality, and challenges associated with conducting and publishing randomized controlled trials (RCTs) in sports medicine. DESIGN Systematic review and survey. SETTING MEDLINE and Embase were searched for all publications before September 17, 2021. A targeted search of clinicaltrials.gov , BMC Musculoskeletal Disorders, PubMed, and Google Scholar were also conducted. The survey was administered to authors using REDCap. PARTICIPANTS Where the systematic search revealed no corresponding published definitive trial, authors of the published pilots were surveyed. INTERVENTIONS Survey assessing limitations to definitive trials. MAIN OUTCOME MEASURES Protocol/method articles, pilot articles, and relevant clinical trial registry records with corresponding definitive trials were pooled. RESULTS Our literature search yielded 27 006 studies; of which, we included 208 studies (60 (28.8%) pilot RCTs, 84 (40.4%) protocol/method articles, and 64 (30.8%) trial registry records). From these, 44 corresponding definitive RCTs were identified. Pilot study and definitive RCT methodological quality increased on average most significantly during the duration of this review (30.6% and 8.2%). Of the 176 authors surveyed, 59 (33.5%) responded; 24.6% (14/57) stated that they completed an unpublished definitive trial, while 52.6% (30/57) reported having one underway. CONCLUSIONS The quality and number of RCT publications within the field of sports medicine has been increasing since 1999. The number of sports medicine-related protocol and pilot articles preceding a definitive trial publication showed a sharp increase over the past 10 years, although only 5 pilot studies have progressed to a definitive RCT.
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Affiliation(s)
- Mitchell Pellarin
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Cheikh Tchouambou Youmbi
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joyce Lotchuang
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Tushar Tejpal
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Gowtham Thangathurai
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Abdullah Khan
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Dan Cohen
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada; and
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada; and
| | - Andrew Duong
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada; and
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada; and
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Khan KS. International multi-stakeholder consensus statement on clinical trial integrity. BJOG 2023. [PMID: 37161843 DOI: 10.1111/1471-0528.17451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 02/06/2023] [Accepted: 03/03/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To prepare a set of statements for randomised clinical trials (RCT) integrity through an international multi-stakeholder consensus. METHODS The consensus was developed via: multi-country multidisciplinary stakeholder group composition and engagement; evidence synthesis of 55 systematic reviews concerning RCT integrity; anonymised two-round modified Delphi survey with consensus threshold based on the average percentage of majority opinions; and, a final consensus development meeting. Prospective registrations: (https://osf.io/bhncy, https://osf.io/3ursn). RESULTS There were 30 stakeholders representing 15 countries from five continents including triallists, ethicists, methodologists, statisticians, consumer representatives, industry representatives, systematic reviewers, funding body panel members, regulatory experts, authors, journal editors, peer-reviewers and advisors for resolving integrity concerns. Delphi survey response rate was 86.7% (26/30 stakeholders). There were 111 statements (73 stakeholder-provided, 46 systematic review-generated, 8 supported by both) in the initial long list, with eight additional statements provided during the consensus rounds. Through consensus the final set consolidated 81 statements (49 stakeholder-provided, 41 systematic review-generated, 9 supported by both). The entire RCT life cycle was covered by the set of statements including general aspects (n = 6), design and approval (n = 11), conduct and monitoring (n = 19), reporting of protocols and findings (n = 20), post-publication concerns (n = 12), and future research and development (n = 13). CONCLUSION Implementation of this multi-stakeholder consensus statement is expected to enhance RCT integrity.
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Calé R, Caldeira D. Direct oral anticoagulants in chronic thromboembolic pulmonary hypertension: More high-quality and multinational trials are needed! Rev Port Cardiol 2023; 42:145-147. [PMID: 36526131 DOI: 10.1016/j.repc.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Rita Calé
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal.
| | - Daniel Caldeira
- Centro Cardiovascular da Universidade de Lisboa-CCUL (CCUL@RISE), CAML, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Serviço de Cardiologia, Departamento do Coração e Vasos, Hospital Universitário de Santa Maria-CHULN, Lisboa, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Portugal; Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Portugal
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A capability framework to inform the fundamental requirements for clinical trial unit development, growth and long term success in outer metropolitan and rural areas. Contemp Clin Trials Commun 2023; 32:101072. [PMID: 36712185 PMCID: PMC9876817 DOI: 10.1016/j.conctc.2023.101072] [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: 08/16/2022] [Revised: 12/20/2022] [Accepted: 01/14/2023] [Indexed: 01/19/2023] Open
Abstract
Background Participation in clinical trials is linked to improved patient outcomes. Despite this, most trial participants either reside in, or are treated in metropolitan areas. TrialHub developed hub-and-spoke models to support and grow clinical trial units in outer metropolitan and regional/rural centres in order to boost clinical trial engagement and reduce demands of trial participation on patients from outer metropolitan and regional/rural areas. The aim of this project was to establish a capability framework for clinical trial unit growth and development. Methods An integrative methods study design was used to inform the co-design and development of the capability framework based on data collected in Victoria during 2020-21. This included reviews of the literature and of existing local resources, infrastructure, and staffing; as well as education, mentoring and support, and a needs assessment through multidisciplinary working groups. Results We developed a capability framework based on the level of support required for outer metropolitan and regional/rural centres with diverse existing capabilities across Victoria. The framework applies a maturity model to assess resources, processes and practices which impact the capacity and capability of centres to conduct trials safely and sustainably. Each level of the model uses a consistent set of factors to describe the core elements required for safe clinical trial delivery. This benchmarking allows targeted investment to ensure safe and high-quality delivery of trials at newly establishing trial units. Conclusion The capability framework developed by TrialHub provides a basis for staged, planned and successful trial unit development and trial implementation. Further validation of the framework is required.
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Abstract
Economic evaluation provides a framework for assessing the costs and consequences of alternative programmes or interventions. One common vehicle for economic evaluations in the healthcare context is the decision-analytic model, which synthesizes information on parameter inputs (for example, probabilities or costs of clinical events or health states) from multiple sources and requires application of mathematical techniques, usually within a software program. A plethora of decision-analytic modelling-based economic evaluations of orthopaedic interventions have been published in recent years. This annotation outlines a number of issues that can help readers, reviewers, and decision-makers interpret evidence from decision-analytic modelling-based economic evaluations of orthopaedic interventions.Cite this article: Bone Joint J 2023;105-B(1):17-20.
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Affiliation(s)
- Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - May Ee Png
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - David Metcalfe
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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The Relative Merits of Observational and Experimental Research: Four Key Principles for Optimising Observational Research Designs. Nutrients 2022; 14:nu14214649. [DOI: 10.3390/nu14214649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
The main barrier to the publication of observational research is a perceived inferiority to randomised designs with regard to the reliability of their conclusions. This commentary addresses this issue and makes a set of recommendations. It analyses the issue of research reliability in detail and fully describes the three sources of research unreliability (certainty, risk and uncertainty). Two of these (certainty and uncertainty) are not adequately addressed in most research texts. It establishes that randomised designs are vulnerable as observation studies to these two sources of unreliability, and are therefore not automatically superior to observational research in all research situations. Two key principles for reducing research unreliability are taken from R.A. Fisher’s early work on agricultural research. These principles and their application are described in detail. The principles are then developed into four key principles that observational researchers should follow when they are designing observational research exercises in nutrition. It notes that there is an optimal sample size for any particular research exercise that should not be exceeded. It concludes that best practice in observational research is to replicate this optimal sized observational exercise multiple times in order to establish reliability and credibility.
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Ullman AJ, Beidas RS, Bonafide CP. Methodological progress note: Hybrid effectiveness-implementation clinical trials. J Hosp Med 2022; 17:912-916. [PMID: 35934981 PMCID: PMC9804495 DOI: 10.1002/jhm.12936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Amanda J. Ullman
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia
- Centre for Children's Health ResearchChildren's Health Queensland Hospital and Health ServiceBrisbaneQueenslandAustralia
- NHMRC Centre for Wiser Wound CareGriffith UniversityBrisbaneQueenslandAustralia
- Centre for Clinical NursingRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Rinad S. Beidas
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI)University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Penn Medicine Nudge UnitUniversity of Pennsylvania Health SystemPhiladelphiaPennsylvaniaUSA
| | - Christopher P. Bonafide
- Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI)University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Section of Hospital MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
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Núñez-Núñez M, Andrews JC, Fawzy M, Bueno-Cavanillas A, Khan KS. Research integrity in clinical trials: innocent errors and spin versus scientific misconduct. Curr Opin Obstet Gynecol 2022; 34:332-339. [PMID: 35895940 DOI: 10.1097/gco.0000000000000807] [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: 11/26/2022]
Abstract
PURPOSE OF REVIEW High-quality research underpins the best healthcare practice. This article focuses on analyzing the current literature to promote research integrity across clinical trials. RECENT FINDINGS Recent admissions of questionable practices by researchers have undermined practitioner and public confidence. There is limited evidence specifically for ethical and professional standards in clinical trials to guide researchers and institutions to embed integrity into research practice. SUMMARY Unintentional errors and spin in research are not uncommon as training in design and conduct of clinical trials is not part of health education for medical and allied health professions. There is unfamiliarity with procedures, such as prospective registration, a priori documentation of statistical analysis plans, openness in data sharing, and so forth. This, combined with the academic culture of secrecy, has led to an environment where scientific suspicion, instead of trust, is the norm. Existing science integrity documents are devoid of specific recommendations about how to translate any guidance into clinical trial practice. There is a need for constructive, supportive and multidisciplinary approaches based on open dialogue and continuous training, targeting the research environment. Research integrity now needs to take centre stage to re-instill confidence in randomized trial evidence to inform clinical practice.
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Affiliation(s)
- María Núñez-Núñez
- Clínico San Cecilio Clinical University Hospital, Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Spain
- Biosanitary Research Institute of Granada (Ibs.Granada), Granada, Spain
| | | | - Mohamed Fawzy
- IbnSina (Sohag), Banon (Assiut), Qena (Qena), Amshag (Sohag) IVF Facilities, Egypt
| | - Aurora Bueno-Cavanillas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Spain
- Biosanitary Research Institute of Granada (Ibs.Granada), Granada, Spain
| | - Khalid Saeed Khan
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Spain
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del Álamo M, Bührer C, Fisher D, Griese M, Lingor P, Palladini G, Sireau N, Hivert V, Sangiorgi L, Guillot F, Halftermeyer J, Soucková L, Nosková K, Demlová R. Identifying obstacles hindering the conduct of academic-sponsored trials for drug repurposing on rare-diseases: an analysis of six use cases. Trials 2022; 23:783. [PMID: 36109818 PMCID: PMC9479412 DOI: 10.1186/s13063-022-06713-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Academic-sponsored trials for rare diseases face many challenges; the present paper identifies hurdles in the set-up of six multinational clinical trials for drug repurposing, as use cases.
Methods
Six academic-sponsored multinational trials aiming to generate knowledge on rare diseases drug repurposing were used as examples to identify problems in their set-up. Coordinating investigators leading these trials provided feedback on hurdles linked to study, country, and site set up, on the basis of pre-identified categories established through the analysis of previous peer-reviewed publications.
Results
Administrative burden and lack of harmonization for trial-site agreements were deemed as a major hurdle. Other main identified obstacles included the following: (1) complexity and restriction on the use of public funding, especially in a multinational set up, (2) drug supply, including procurement tendering rules and country-specific requirements for drug stability, and (3) lack of harmonization on regulatory requirements to get trial approvals.
Conclusion
A better knowledge of the non-commercial clinical research landscape and its challenges and requirements is needed to make drugs—especially those with less commercial gain—accessible to rare diseases patients. Better information about existing resources like research infrastructures, clinical research programs, and counseling mechanisms is needed to support and guide clinicians through the many challenges associated to the set-up of academic-sponsored multinational trials.
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Arizio F, Bonardi A, Cortinovis D, Costanzo A, Cristinziano A, Delle Monache L, Landolfi R, Lettino M, Luppi F, Petrangolini T, Tassielli D. Project R. Evolution for improving clinical research in Italy: challenges and strategies. Curr Med Res Opin 2022; 38:1631-1639. [PMID: 35766278 DOI: 10.1080/03007995.2022.2091332] [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: 12/27/2022]
Abstract
OBJECTIVE The R.Evolution project aimed to reach a consensus on the main challenges of conducting clinical research in Italy and possible strategies and approaches to address them and optimize clinical research management. METHODS A scientific board of experts initially discussed potentially critical areas in clinical research conduct and further explored them through an online national survey. The survey results were further examined by a group of 35 panelists representing different clinical research stakeholders. A Nominal Group Technique and a Delphi approach (two rounds) were used to generate a consensus on critical factors, tools and strategies in clinical research. RESULTS Four main critical areas were identified: study feasibility, authorization procedures, operational aspects and patient management. The main issues are scarce awareness of the value of clinical research, lack of trained workforce and excessive complexity of protocols and administrative procedures. The Delphi panel identified six intervention areas: culture and patient involvement; procedures; staff, contracts, training and incentives; organization and infrastructure; administrative procedures; and ethics committee. CONCLUSION According to the R.Evolution project, possible strategies to improve clinical research management in Italy include a deeper understanding of the value of clinical research, the creation of long-term plans for hiring, training, organizing and motivating clinical trial staff, the simplification and harmonization of administrative procedures, as well as protocol design, and the development of stronger networks of centers and stakeholders.
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Affiliation(s)
- Francesca Arizio
- Oncology Department, AOU San Luigi Gonzaga Orbassano, Turin, Italy
| | - Alessio Bonardi
- Comitato Etico Regionale della Liguria, Policlinico S. Martino Hospital - IRCCS, Genoa, Italy
| | - Diego Cortinovis
- Medical Oncology Department, ASST S. Gerardo Hospital, Monza, Italy
| | - Antonio Costanzo
- Dermatology Unit, Humanitas Research Hospital IRCCS, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | | | | | - Raffaele Landolfi
- Unit of Medical Clinic and Cardiovascular disease, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Fabrizio Luppi
- Department of Medicine and Surgery, University of Milan Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Italy
| | - Teresa Petrangolini
- Patient Advocacy Lab, Università Cattolica Sacro Cuore - ALTEMS, Milan, Italy
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Mukherjee A, Daniel M, Kaur A, Devarapalli S, Kallakuri S, Essue B, Raman U, Thornicroft G, Saxena S, Peiris D, Maulik PK. Operational challenges in the pre-intervention phase of a mental health trial in rural India: reflections from SMART Mental Health. Int J Ment Health Syst 2022; 16:42. [PMID: 35974341 PMCID: PMC9379869 DOI: 10.1186/s13033-022-00549-4] [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: 08/30/2021] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Availability of mental health services in low- and middle-income countries is largely concentrated in tertiary care with limited resources and scarcity of trained professionals at the primary care level. SMART Mental Health is a strategy that combines a community anti-stigma campaign with a primary health care workforce strengthening initiative, using electronic decision support with the goal of better identifying and supporting people with common mental disorders in India. METHODS We describe the challenges faced and lessons learnt during the pre-intervention phase of SMART Mental Health cluster Randomised Controlled Trial. Pre-intervention phase includes preliminary activities for setting-up the trial and research activities prior to delivery of the intervention. Field notes from project site visit, project team meetings and detailed follow-up discussions with members of the project team were used to document operational challenges and strategies adopted to overcome them. The socio-ecological model was used as the analytical framework to organise the findings. RESULTS Key challenges included delays in government approvals, addressing community health worker needs, and building trust in the community. These were addressed through continuous communication, leveraging support of relevant stakeholders, and addressing concerns of community health workers and community. Issues related to use of digital platform for data collection were addressed by a dedicated technical support team. The COVID-19 pandemic and political unrest led to significant and unexpected challenges requiring important adaptations to successfully implement the project. CONCLUSION Setting up of this trial has posed challenges at a combination of community, health system and broader socio-political levels. Successful mitigating strategies to overcome these challenges must be innovative, timely and flexibly delivered according to local context. Systematic ongoing documentation of field-level challenges and subsequent adaptations can help optimise implementation processes and support high quality trials. TRIAL REGISTRATION The trial is registered with Clinical Trials Registry India (CTRI/2018/08/015355). Registered on 16th August 2018. http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=23254&EncHid=&userName=CTRI/2018/08/015355.
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Affiliation(s)
| | - Mercian Daniel
- The George Institute for Global Health, New Delhi, India
| | - Amanpreet Kaur
- The George Institute for Global Health, New Delhi, India
| | | | | | - Beverley Essue
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Usha Raman
- Department of Communication, University of Hyderabad, Hyderabad, India
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - David Peiris
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Pallab K. Maulik
- The George Institute for Global Health, New Delhi, India
- University of New South Wales, Sydney, Australia
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Pilot MA, Lutchman A, Hennet J, Anderson D, Robinson W, Rossanese M, Chrysopoulos A, Demetriou J, De la Puerta B, Mullins RA, Brissot H, Jeffery N, Chanoit G. Comparison of median sternotomy closure-related complication rates using orthopedic wire or suture in dogs: A multi-institutional observational treatment effect analysis. Vet Surg 2022; 51:990-1001. [PMID: 35765719 PMCID: PMC9543654 DOI: 10.1111/vsu.13846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/08/2022] [Accepted: 06/03/2022] [Indexed: 12/24/2022]
Abstract
Objective To determine and compare median sternotomy (MS) closure‐related complication rates using orthopedic wire or suture in dogs. Study design Multi‐institutional, retrospective observational study with treatment effect analysis. Animals 331 client‐owned dogs, of which 68 were excluded. Methods Medical records of dogs with MS were examined across nine referral centers (2004–2020). Signalment, weight, clinical presentation, surgical details, complications, and outcomes were recorded. Follow‐up was performed using patient records and email/telephone contact. Descriptive statistics, treatment effect analysis and logistic regression were performed. Results Median sternotomy closure was performed with wire in 115 dogs and suture in 148. Thirty‐seven dogs experienced closure‐related complications (14.1%), 20 in the wire group and 17 in the suture group. Twenty‐three were listed as mild, four as moderate and 10 as severe. Treatment effect analysis showed a mean of 2.3% reduction in closure‐related complications associated with using suture versus wire (95% CI: −9.1% to +4.5%). In multivariable logistic regression, the only factor associated with increased risk of closure‐related complications was dog size (p = .01). This effect was not modified by the type of closure used (interaction term: OR = 0.99 [95% CI: 0.96/1.01]). Conclusion The incidence of closure‐related complication after MS was low compared to previous reports. The likelihood of developing a closure‐related complication was equivalent between sutures and wires, independent of dog size, despite a higher proportion of complications seen in larger dogs (≥20 kg). Clinical significance Use of either orthopedic wire or suture appear to be an appropriate closure method for sternotomy in dogs of any size.
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Affiliation(s)
- Mariette A Pilot
- Small Animal Referral Hospital Langford Vets, University of Bristol, Bristol, UK
| | - Aaron Lutchman
- The Royal Veterinary College, Queen Mother Hospital for Animals, Hatfield, UK
| | - Julie Hennet
- Anderson Moores Veterinary Specialists, Hursley, UK
| | | | | | - Matteo Rossanese
- Small Animal Teaching Hospital of the University of Liverpool, Neston, UK
| | | | | | | | - Ronan A Mullins
- Section of Small Animal Clinical Sciences, University College Dublin, Dublin, Ireland
| | | | - Nicholas Jeffery
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Guillaume Chanoit
- Small Animal Referral Hospital Langford Vets, University of Bristol, Bristol, UK
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Falloon K, Cohen B, Rieder F. Editorial: shedding new light on extraintestinal manifestations in inflammatory bowel disease-authors' reply. Aliment Pharmacol Ther 2022; 55:1208-1209. [PMID: 35429040 DOI: 10.1111/apt.16907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
LINKED CONTENTThis article is linked to Falloon et al papers. To view these articles, visit https://doi.org/10.1111/apt.16853 and https://doi.org/10.1111/apt.16882
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Affiliation(s)
- Katherine Falloon
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Benjamin Cohen
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Florian Rieder
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
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Prevalence and correlates of invitation to participate in clinical trials among US adults. Prev Med Rep 2022; 26:101742. [PMID: 35251912 PMCID: PMC8889234 DOI: 10.1016/j.pmedr.2022.101742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/22/2022] [Accepted: 02/17/2022] [Indexed: 11/21/2022] Open
Abstract
Only 9% of respondents to HINTS 2020 Cycle 5 reported being ever invited to a clinical trial. Invitation prevalence differed by race, age, education, location, and cancer history. Blacks reported the highest prevalence of invitation and Asians reported the lowest. Older patients were invited more often to participate in clinical trials than younger patients. Invitation prevalence was higher for college graduates and for cancer patients or survivors. Invitation odds were lower for patients in rural areas/small towns than those in metro areas.
Clinical trials are essential to modern medicine, but several barriers, including poor communication, hamper their successful completion. We examined the prevalence and correlates of invitation to participate in clinical trials among a nationally-representative sample of US adults using survey responses from the 2020 HINTS (Cycle 5). Analyses were conducted in 2021. Overall, 9% of respondents reported being invited to a clinical trial, a prevalence that is nearly half of previously reported rates in convenience samples recruited from health care settings. Compared to non-Hispanic Whites, Black respondents reported the higher prevalence of invitation (16.0%) whereas Asian respondents reported the lowest (2%). Prevalence of clinical trial invitation was significantly higher for the 65–74 age and the 75 + age groups. Prevalence of invitation was significantly higher among college graduates (12.0%) and lower for those residing in rural areas/small towns compared to metropolitan areas. Invitation was significantly higher among cancer patients/survivors (16.0%), patients with diabetes (11.7%) and with chronic lung disease (16.7%). Provider and patient factors there were associated with higher invitation rates included using web devices to communicate with providers or to aid health-related discussions, having a specific medical provider, and looking for health information online. This study establishes a population-based prevalence of clinical trial communication that can be monitored as health care providers/organizations increase their focus on enrollment activities. Targeted interventions to improve communication about clinical trials are needed to address socio-demographic disparities and are particularly important for Asian patients, patients with lower income, and those living in rural areas.
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Burgess A, Harris A, Wheeling J. A Pilot Randomized Control Trial to Assess the Impact of Lavender on Anxiety and Comfort After Cesarean Birth and the Barriers Encountered. MCN Am J Matern Child Nurs 2022; 47:85-91. [PMID: 35202010 DOI: 10.1097/nmc.0000000000000803] [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: 11/25/2022]
Abstract
PURPOSE This study aimed to assess the effect of lavender aromatherapy on anxiety and comfort after cesarean birth. STUDY DESIGN Randomized control trial. METHODS Forty-eight patients who had a cesarean birth were asked to complete the six-item State and Trait Anxiety (STAI-6) score to assess their level of anxiety pre- and postapplication of either lavender aromatherapy or placebo during their inpatient postpartum stay. Their comfort and pain levels pre- and postadministration were assessed, and differences between groups were analyzed. Results: There was no difference in postintervention STAI-6 scores between the aromatherapy and placebo groups (p = .56). Women who received the lavender aromatab® had significantly (p = .037) higher self-reported levels of comfort (M 2.6 SD .82) when compared with those who received placebo (M 2.0 SD 1.0). CLINICAL IMPLICATIONS Many women use aromatherapy at home to promote comfort and relaxation. Women feel lavender aromatherapy improves their comfort in the hospital setting after cesarean birth. Clinicians should consider ways to safely use aromatherapy as one option to promote postoperative cesarean birth care.
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Charles A, Korde P, Newby C, Grayzman A, Hiltensperger R, Mahlke C, Moran G, Nakku J, Niwemuhwezi J, Nixdorf R, Paul E, Puschner B, Ramesh M, Ryan GK, Shamba D, Kalha J, Slade M. Proportionate translation of study materials and measures in a multinational global health trial: methodology development and implementation. BMJ Open 2022; 12:e058083. [PMID: 35058270 PMCID: PMC8783829 DOI: 10.1136/bmjopen-2021-058083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Current translation guidelines do not include sufficiently flexible translation approaches for different study materials. We aimed to develop a proportionate methodology to inform translation of all types of study materials in global health trials. DESIGN The design included three stages: (1) categorisation of study materials, (2) integration of existing translation frameworks and (3) methodology implementation (Germany, India, Israel, Tanzania and Uganda) and refinement. PARTICIPANTS The study population comprised 27 mental health service users and 27 mental health workers who were fluent in the local language in stage 7 (pretesting), and 54 bilingual mental health service users, aged 18 years or over, and able to give consent as judged by a clinician for step 9 (psychometric evaluation). SETTING The study took place in preparation for the Using Peer Support in Developing Empowering Mental Health Services (UPSIDES) randomised controlled trial (ISRCTN26008944). PRIMARY OUTCOME MEASURE The primary outcome measure was the Social Inclusion Scale (SIS). RESULTS The typology identifies four categories of study materials: local text, study-generated text, secondary measures and primary measure. The UPSIDES Proportionate Translation Methodology comprises ten steps: preparation, forward translation, reconciliation, back translation, review, harmonisation, pretesting, finalisation, psychometric evaluation and dissemination. The translated primary outcome measure for the UPSIDES Trial (SIS) demonstrated adequate content validity (49.3 vs 48.5, p=0.08), convergent validity and internal consistency (0.73), with minimal floor/ceiling effects. CONCLUSION This methodology can be recommended for translating, cross-culturally adapting and validating all study materials, including standardised measures, in future multisite global trials. The methodology is particularly applicable to multi-national studies involving sites with differing resource levels. The robustness of the psychometric findings is limited by the sample sizes for each site. However, making this limitation explicit is preferable to the typical practice of not reporting adequate details about measure translation and validation. TRAIL REGISTRATION NUMBER ISRCTN26008944.
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Affiliation(s)
- Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Palak Korde
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, Maharashtra, India
| | - Chris Newby
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Alina Grayzman
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | | | - Candelaria Mahlke
- Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Galia Moran
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Juliet Nakku
- Butabika National Referral Hospital, Kampala, Uganda
- Makerere University, Kampala, Uganda
| | | | - Rebecca Nixdorf
- Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eva Paul
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Mary Ramesh
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Ifakara, Morogoro, United Republic of Tanzania
| | - Grace Kathryn Ryan
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Ifakara, Morogoro, United Republic of Tanzania
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, Maharashtra, India
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
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Tumin D, Khanchandani A, Sasser G, Buckman C. Factors Influencing US Hospital and Medical School Participation in Pediatric COVID-19 Research. Hosp Pediatr 2022; 12:e8-e15. [PMID: 34907433 DOI: 10.1542/hpeds.2021-006051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Literature suggests that funding for pediatric clinical trials is inequitably awarded. Furthermore, although coronavirus disease 2019 (COVID-19) affected all hospitals, institutions with already limited resources were more severely impacted. We hypothesized that there would be difference in schools and hospitals that were able to participate in the initial round of pediatric COVID-19 clinical research. METHODS We searched online databases for preregistered studies using the keywords "COVID-19," "COVID," "SARS-CoV-2," "2019-nCov," "2019 novel coronavirus," and "severe acute respiratory syndrome coronavirus 2." Search results were limited to studies enrolling participants from birth to 17 years, studies started in 2020, and studies originating in the United states. We calculated the proportion of institutions with active COVID-19 pediatric clinical studies in 2020 and compared institutional characteristics between institutions with and without at least one qualifying COVID-19 study, using rank-sum tests, χ2 tests, or Fisher's exact tests, as appropriate. RESULTS We identified 150 allopathic medical schools, 34 osteopathic medical schools, and 178 children's hospitals meeting inclusion criteria. Among included institutions, 25% of medical schools and 20% children's hospitals participated in 1 of the registered pediatric COVID-19 studies the year before the study period. Institutions that participated in pediatric COVID-19 studies had more publications, more National Institutes of Health funding, and more studies registered on Clinicaltrials.gov in 2019. CONCLUSIONS Despite the pandemic affecting everyone, participation in early clinical research on the impact of COVID-19 in pediatric populations was concentrated in a few well-resourced institutions that were highly experienced in research.
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Affiliation(s)
| | - Ashish Khanchandani
- Brody School of Medicine at East Carolina University, Greenville, North Carolina
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McCall SJ, Imran M, Hemkens LG, Mc Cord K, Kwakkenbos L, Sampson M, Jawad S, Zwarenstein M, Relton C, Langan SM, Moher D, Fröbert O, Thombs BD, Gale C, Juszczak E. Reporting transparency and completeness in trials: Paper 4 - reporting of randomised controlled trials conducted using routinely collected electronic records - room for improvement. J Clin Epidemiol 2022; 141:198-209. [PMID: 34525409 PMCID: PMC8982641 DOI: 10.1016/j.jclinepi.2021.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/27/2021] [Accepted: 09/07/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To describe characteristics of randomized controlled trials (RCTs) conducted using electronic health records (EHRs), including completeness and transparency of reporting assessed against the 2021 CONSORT Extension for RCTs Conducted Using Cohorts and Routinely Collected Data (CONSORT-ROUTINE) criteria. STUDY DESIGN MEDLINE and Cochrane Methodology Register were searched for a sample of RCTs published from 2011-2018. Completeness of reporting was assessed in a random sample using a pre-defined coding form. RESULTS Of the 183 RCT publications identified, 122 (67%) used EHRs to identify eligible participants, 139 (76%) used the EHR as part of the intervention and 137 (75%) to ascertain outcomes. When 60 publications were evaluated against the CONSORT 2010 item and the corresponding extension for the 8 modified items, four items were 'adequately reported' for most trials. Five new reporting items were identified for the CONSORT-ROUTINE extension; when evaluated, one was 'adequately reported', three were reported 'inadequately or not at all', the other 'partially'. There were, however, some encouraging signs with adequate and partial reporting of many important items, including descriptions of trial design, the consent process, outcome ascertainment and interpretation. CONCLUSION Aspects of RCTs using EHRs are sub-optimally reported. Uptake of the CONSORT-ROUTINE Extension may improve reporting.
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Affiliation(s)
- Stephen J McCall
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit Clinical Trials Unit, University of Oxford, Oxford, United Kingdom; Center for Research on Population and Health, American University of Beirut, Ras Beirut, Lebanon
| | - Mahrukh Imran
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Lars G Hemkens
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Kimberly Mc Cord
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Linda Kwakkenbos
- Behavioural Science Institute, Clinical Psychology, Radboud University, Nijmegen, the Netherlands
| | - Margaret Sampson
- Library Services, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Sena Jawad
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Merrick Zwarenstein
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Clare Relton
- Centre for Clinical Trials and Methodology, Barts Institute of Population Health Science, Queen Mary University, London, United Kingdom
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ole Fröbert
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health,McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada; Department of Psychology, McGill University, Montreal, Quebec, Canada; Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Edmund Juszczak
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit Clinical Trials Unit, University of Oxford, Oxford, United Kingdom; Nottingham Clinical Trials Unit, Applied Health Research Building, University of Nottingham, Nottingham, United Kingdom.
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Silva Junior JB, Rodrigues E Silva AA, Melo FCC, Kumoto MC, Parca RM. Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular Consensus on genetically modified cells. Special Article: Advanced therapy medicinal products in Brazil: regulatory panorama. Hematol Transfus Cell Ther 2021; 43 Suppl 2:S68-S77. [PMID: 34794800 PMCID: PMC8606716 DOI: 10.1016/j.htct.2021.09.010] [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: 09/04/2021] [Accepted: 09/14/2021] [Indexed: 11/26/2022] Open
Abstract
Advanced therapy medicinal products, considered special medications, requires Anvisa approval for use and commercialization in Brazil. They include the advanced cellular therapy products, tissue engineering products and gene therapy products, which due to their complexity involve innovation and risks, optimized regulatory channels for their development and life cycle monitoring. The scientific elements and the compliance with applicable regulatory aspects are fundamental pillars for the advancement of clinical trials, the positive evidence of the benefit-risk profile and the definition of the critical quality attributes, from the perspective of making safe, effective and high-quality products available to the population. The approval models of these products in Brazil adapt to the specificities and characteristics of the technology and the patient target population, with accelerated regulatory analyses, use in emergency situations by risk controls and specific monitoring mechanisms, principally those related to rare diseases without other therapeutic alternatives. The opportune access to the advance therapy product with safety, efficacy and quality involves innovative normative elements that include the long-term follow-up of the safety and efficacy and of the adaptive pharmacovigilance requisites, as well as the traceability mechanisms for the start-off materials, products and patients.
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Affiliation(s)
- João Batista Silva Junior
- Faculdade de Ciências da Saúde da Universidade de Brasília (UnB), Brasília, DF, Brazil; Agência Nacional de Vigilância Sanitária (Anvisa), Brasília, DF, Brazil.
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Birrer DL, Golcher H, Casadei R, Haile SR, Fritsch R, Hussung S, Brunner TB, Fietkau R, Meyer T, Grützmann R, Merkel S, Ricci C, Ingaldi C, Di Marco M, Guido A, Serra C, Minni F, Pestalozzi B, Petrowsky H, DeOliveira M, Bechstein WO, Bruns CJ, Oberkofler CE, Puhan M, Lesurtel M, Heinrich S, Clavien PA. Neoadjuvant Therapy for Resectable Pancreatic Cancer: A New Standard of Care. Pooled Data From 3 Randomized Controlled Trials. Ann Surg 2021; 274:713-720. [PMID: 34334656 DOI: 10.1097/sla.0000000000005126] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of this study was to pool data from randomized controlled trials (RCT) limited to resectable pancreatic ductal adenocarcinoma (PDAC) to determine whether a neoadjuvant therapy impacts on disease-free survival (DFS) and surgical outcome. SUMMARY BACKGROUND DATA Few underpowered studies have suggested benefits from neoadjuvant chemo (± radiation) for strictly resectable PDAC without offering conclusive recommendations. METHODS Three RCTs were identified comparing neoadjuvant chemo (± radio) therapy vs. upfront surgery followed by adjuvant therapy in all cases. Data were pooled targeting DFS as primary endpoint, whereas overall survival (OS), postoperative morbidity, and mortality were investigated as secondary endpoints. Survival endpoints DFS and OS were compared using Cox proportional hazards regression with study-specific baseline hazards. RESULTS A total of 130 patients were randomized (56 in the neoadjuvant and 74 in the control group). DFS was significantly longer in the neoadjuvant treatment group compared to surgery only [hazard ratio (HR) 0.6, 95% confidence interval (CI) 0.4-0.9] (P = 0.01). Furthermore, DFS for the subgroup of R0 resections was similarly longer in the neoadjuvant treated group (HR 0.6, 95% CI 0.35-0.9, P = 0.045). Although postoperative complications (Comprehensive Complication Index, CCI®) occurred less frequently (P = 0.008), patients after neoadjuvant therapy experienced a higher toxicity, but without negative impact on oncological or surgical outcome parameters. CONCLUSION Neoadjuvant therapy can be offered as an acceptable standard of care for patients with purely resectable PDAC. Future research with the advances of precision oncology should now focus on the definition of the optimal regimen.
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Affiliation(s)
- Dominique L Birrer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Henriette Golcher
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Riccardo Casadei
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Sarah R Haile
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Ralph Fritsch
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Saskia Hussung
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas B Brunner
- Department of Radiation Oncology, University Hospital Magdeburg, Magdeburg, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Thomas Meyer
- Department of Surgery, Hospital Ansbach, Ansbach, Germany
| | - Robert Grützmann
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Susanne Merkel
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Claudio Ricci
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Carlo Ingaldi
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Mariacristina Di Marco
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
- Medical Oncology, IRCCS Azienda Ospedaliero, University of Bologna, Bologna, Italy
| | - Alessandra Guido
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Carla Serra
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Francesco Minni
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Henrik Petrowsky
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Michelle DeOliveira
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Wolf O Bechstein
- Department of General, Visceral- and Transplantation Surgery, University Hospital Frankfurt am Main, Frankfurt, Germany
| | - Christiane J Bruns
- Department of General and Transplantation Surgery, University Hospital Cologne, Köln, Germany
| | - Christian E Oberkofler
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Milo Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Mickaël Lesurtel
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, University Lyon I, Lyon, France
| | - Stefan Heinrich
- Department of General, Visceral and Transplantation Surgery, University Hospital of Mainz, Mainz, Germany
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
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Striebich S, Mattern E, Oganowski T, Schäfers R, Ayerle G. Methodological challenges and solution strategies during implementation of a midwife-led multicenter randomized controlled trial (RCT) in maternity hospitals. BMC Med Res Methodol 2021; 21:222. [PMID: 34689745 PMCID: PMC8542460 DOI: 10.1186/s12874-021-01429-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Randomized controlled trials (RCTs), especially multicentric, with complex interventions are methodically challenging. Careful planning under everyday conditions in compliance with the relevant international quality standard (Good Clinical Practice [GCP] guideline) is crucial. Specific challenges exist for RCTs conducted in delivery rooms due to various factors that cannot be planned beforehand. Few published RCTs report challenges and problems in implementing complex interventions in maternity wards. In Germany as well as in other countries, midwives and obstetricians have frequently little experience as investigators in clinical trials. Methods The aim is to describe the key methodological and organizational challenges in conducting a multicenter study in maternity wards and the solution strategies applied to them. In particular, project-related and process-oriented challenges for hospital staff are considered. The exemplarily presented randomized controlled trial “BE-UP” investigates the effectiveness of an alternative design of a birthing room on the rate of vaginal births and women-specific outcomes. Results The results are presented in five sectors: 1) Selection of and support for cooperating hospitals: they are to be selected according to predefined criteria, and strategies to offer continuous support in trial implementation must be mapped out. 2) Establishing a process of requesting informed consent: a quality-assured process to inform pregnant women early on must be feasible and effective. 3) Individual digital real-time randomization: In addition to instructing maternity teams, appropriate measures for technical failure must be provided. 4) The standardized birthing room: The complex intervention is to be implemented according to the study protocol yet adapted to the prevailing conditions in the delivery rooms. 5) GCP-compliant documentation: midwives and obstetricians will be instructed in high-quality data collection, supported by external monitoring throughout the trial. Conclusion Since not all potential challenges can be anticipated in the planning of a trial, study teams need to be flexible and react promptly to any problems that threaten recruitment or the implementation of the complex intervention. Thought should be given to the perspectives of midwives and obstetricians as recruiters and how clinic-intern processes could be adapted to correspond with the trial’s requirements. Trial registration The BE-UP study was registered on 07/03/ 2018 in the German Register for Clinical Trials under Reference No. DRKS00012854 and can also be found on the International Clinical Trials Registry Platform (ICTRP) (see https://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS0001285).
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Affiliation(s)
- Sabine Striebich
- Martin Luther University Halle-Wittenberg, Institute of Health and Nursing Science, Magdeburger Str. 8, 06112, Halle (Saale), Germany.
| | - Elke Mattern
- Hochschule für Gesundheit Bochum - University of Applied Sciences, Gesundheitscampus 6 - 8, 44801, Bochum, Germany
| | - Theresa Oganowski
- Hochschule für Gesundheit Bochum - University of Applied Sciences, Gesundheitscampus 6 - 8, 44801, Bochum, Germany
| | - Rainhild Schäfers
- Hochschule für Gesundheit Bochum - University of Applied Sciences, Gesundheitscampus 6 - 8, 44801, Bochum, Germany
| | - Gertrud Ayerle
- Martin Luther University Halle-Wittenberg, Institute of Health and Nursing Science, Magdeburger Str. 8, 06112, Halle (Saale), Germany
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Price G, Mackay R, Aznar M, McWilliam A, Johnson-Hart C, van Herk M, Faivre-Finn C. Learning healthcare systems and rapid learning in radiation oncology: Where are we and where are we going? Radiother Oncol 2021; 164:183-195. [PMID: 34619237 DOI: 10.1016/j.radonc.2021.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/02/2021] [Accepted: 09/26/2021] [Indexed: 01/31/2023]
Abstract
Learning health systems and rapid-learning are well developed at the conceptual level. The promise of rapidly generating and applying evidence where conventional clinical trials would not usually be practical is attractive in principle. The connectivity of modern digital healthcare information systems and the increasing volumes of data accrued through patients' care pathways offer an ideal platform for the concepts. This is particularly true in radiotherapy where modern treatment planning and image guidance offers a precise digital record of the treatment planned and delivered. The vision is of real-world data, accrued by patients during their routine care, being used to drive programmes of continuous clinical improvement as part of standard practice. This vision, however, is not yet a reality in radiotherapy departments. In this article we review the literature to explore why this is not the case, identify barriers to its implementation, and suggest how wider clinical application might be achieved.
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Affiliation(s)
- Gareth Price
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, United Kingdom.
| | - Ranald Mackay
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, United Kingdom
| | - Marianne Aznar
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, United Kingdom
| | - Alan McWilliam
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, United Kingdom
| | - Corinne Johnson-Hart
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, United Kingdom
| | - Marcel van Herk
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, United Kingdom
| | - Corinne Faivre-Finn
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, United Kingdom
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Houston L, Yu P, Martin A, Probst Y. Clinical researchers' lived experiences with data quality monitoring in clinical trials: a qualitative study. BMC Med Res Methodol 2021; 21:187. [PMID: 34544365 PMCID: PMC8454069 DOI: 10.1186/s12874-021-01385-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 08/17/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fundamental to the success of clinical research that involves human participants is the quality of the data that is generated. To ensure data quality, clinical trials must comply with the Good Clinical Practice guideline which recommends data monitoring. To date, the guideline is broad, requires technology for enforcement, follows strict industry standards, mostly designed for drug-registration trials and based on informal consensus. It is also unknown what challenges clinical trials and researchers face in implementing data monitoring procedures. Thus, this study aimed to describe researcher experiences with data quality monitoring in clinical trials. METHODS We conducted semi-structured telephone interviews following a guided-phenomenological approach. Participants were recruited from the Australian and New Zealand Clinical Trials Registry and were researchers affiliated with a listed clinical study. Each transcript was analysed with inductive thematic analysis before thematic categorisation of themes from all transcripts. Primary, secondary and subthemes were categorised according to the emerging relationships. RESULTS Data saturation were reached after interviewing seven participants. Five primary themes, two secondary themes and 21 subthemes in relation to data quality monitoring emerged from the data. The five primary themes included: education and training, ways of working, working with technology, working with data, and working within regulatory requirements. The primary theme 'education and training' influenced the other four primary themes. While 'working with technology' influenced the 'way of working'. All other themes had reciprocal relationships. There was no relationship reported between 'working within regulatory requirements' and 'working with technology'. The researchers experienced challenges in meeting regulatory requirements, using technology and fostering working relationships for data quality monitoring. CONCLUSION Clinical trials implemented a variety of data quality monitoring procedures tailored to their situation and study context. Standardised frameworks that are accessible to all types of clinical trials are needed with an emphasis on education and training.
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Affiliation(s)
- Lauren Houston
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia.
- Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia.
| | - Ping Yu
- Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
- School of Computing and Information Technology, Faculty of Engineering and Information Science, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Allison Martin
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Yasmine Probst
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
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