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Todd OM, Knight M, Jacobs JA, Derington CG, Sheppard JP, Bress AP. Pharmacologic Treatment of Hypertension in Older Adults. Clin Geriatr Med 2024; 40:629-644. [PMID: 39349036 DOI: 10.1016/j.cger.2024.04.004] [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: 10/02/2024]
Abstract
The authors conducted a review of pharmacologic therapy in older adults with hypertension. They reviewed the evidence supporting their use in older adults, understanding the physiologic changes and potential adverse drug effects associated with aging and antihypertensive medication use, exploring guideline recommendations for antihypertensive use in older adults, and evaluating the associated risks and benefits of specific classes of antihypertensive medications.
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Affiliation(s)
- Oliver M Todd
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, LS2 3AA, United Kingdom; Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford BD9 6RJ, United Kingdom.
| | - Matthew Knight
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, LS2 3AA, United Kingdom
| | - Joshua A Jacobs
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84112, USA. https://twitter.com/JoshJPharmD
| | - Catherine G Derington
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84112, USA
| | - James P Sheppard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
| | - Adam P Bress
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84112, USA
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Moraes FCAD, Lôbo ADOM, Sano VKT, Kelly FA, Burbano RMR. Treatment-related Adverse Events, Including Fatal Toxicities, in Patients With Extensive-stage Small-cell Lung Cancer Receiving Adjuvant Programmed Cell Death 1/Programmed Cell Death Ligand 1 Inhibitors: A Meta-analysis and Trial Sequential Analysis of Randomized Controlled Trials. Clin Oncol (R Coll Radiol) 2024; 36:e408-e419. [PMID: 39079829 DOI: 10.1016/j.clon.2024.06.056] [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: 05/21/2024] [Accepted: 06/28/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND/AIMS The safety profile of programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors when associated with chemotherapy for the treatment of patients with extensive-stage small-cell lung cancer is still not fully unraveled. METHODS We performed a comprehensive searrch of the PubMed, Embase, and Cochrane databases for randomized controlled trials that investigated the addition of PD-1 or PD-L1 inhibitors to standard investigator choice chemotherapy. We used risk -ratios (RRs) with 95% confidence intervals (CIs) for all endpoints. RESULTS Six studies and 2,995 patients were included. At the baseline, the median age of the patients varied from 62 to 65 years, 311 (10.4%) had brain metastases, and 1,060 (35.4%) had liver metastases. PD-1/PD-L1 inhibitors were found to reduce fatal toxicities-related mortality (RR: 0.85; 95% CI: 0.80-0.91; p < 0.001; I2 = 49%). The intervention group had a higher incidence of decreased appetite (RR: 1.19; 95% CI: 1.02-1.40; p = 0.03; I2 = 0%), hyponatremia (RR: 1.51; 95% CI: 1.08-2.12; p = 0.02; I2 = 0%), and hypothyroidism (RR: 3.14; 95% CI: 1.10-8.95; p = 0.03; I2 = 81%) of any grade. Regarding adverse events of grade 3-4, there was no association of the addition of PD-1/PD-L1 inhibitors with an increased occurrence of any of the evaluated outcomes. CONCLUSION In this systematic review and meta-analysis, the incorporation of PD-1/PD-L1 inhibitors to chemotherapy demonstrated an excellent safety profile and to be a promising prospect for reshaping the established treatment paradigms for patients with extensive-stage small cell lung cancer.
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Affiliation(s)
- F C A de Moraes
- Department of Medicine, Federal University of Pará, Belém, Pará, Brazil.
| | - A de O M Lôbo
- Department of Medicine, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - V K T Sano
- Department of Medicine, Federal University of Acre, Rio Branco, Acre, Brazil
| | - F A Kelly
- Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
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Ladebo L, Ernst MT, Mailhac A, Dirksen C, Bojsen-Møller KN, Pottegård A. Real-World Use of Semaglutide for Weight Management: Patient Characteristics and Dose Titration-A Danish Cohort Study. Diabetes Care 2024; 47:1834-1837. [PMID: 39106205 DOI: 10.2337/dc24-1082] [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] [Received: 05/27/2024] [Accepted: 07/24/2024] [Indexed: 08/09/2024]
Abstract
OBJECTIVE To determine patient characteristics and dose titration patterns of real-world semaglutide (Wegovy) users. RESEARCH DESIGN AND METHODS We used a population-based cohort study including Danish adults who filled semaglutide prescriptions from 12 December 2022 to 31 December 2023. Outcomes were patient characteristics, prescriber type, and dose titration patterns. RESULTS We identified 110,748 individuals (median age 49 years; 70% female) filling 773,708 prescriptions for semaglutide. General practitioners initiated treatment in 86%. Common comorbidities included hypertension (30%), dyslipidemia (17%), and arthrosis (17%). Only 13% reached the maximum dose of 2.4 mg by their fifth prescription, while 5.7% stopped after the first prescription. Few users (10%) followed recommended dose increases every 4 weeks. Overall, 25% filled at least one prescription of 2.4 mg, while 33-48% continued with the 1.0-mg dosage from the fourth prescription onward. CONCLUSIONS Real-world semaglutide users generally resembled trial participants, but few follow the dose titration schemes tested in premarket clinical trials.
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Affiliation(s)
- Louise Ladebo
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Martin T Ernst
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Aurélie Mailhac
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Carsten Dirksen
- Department of Respiratory Diseases and Endocrinology, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kirstine N Bojsen-Møller
- Department of Respiratory Diseases and Endocrinology, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anton Pottegård
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Hochleitner M, Pickert L, Nolting NA, Affeldt AM, Becker I, Benzing T, Kochanek M, Polidori MC. Patient- vs organ-based prognostic tools for older patients in critical care units : An observational study with a 3-month follow-up. Med Klin Intensivmed Notfmed 2024:10.1007/s00063-024-01179-z. [PMID: 39320467 DOI: 10.1007/s00063-024-01179-z] [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: 01/14/2024] [Revised: 07/29/2024] [Accepted: 08/12/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Anticipating a doubling of older adults in Europe by 2050, healthcare systems face substantial challenges, particularly in critical care units. However, there is still a lack of evidence-based knowledge for treating and assessing mortality risk in older patients. This study compared the predictive accuracy of two assessment tools for long-term outcomes among older patients: the Multidimensional Prognostic Index (MPI) and the Sequential Organ Failure Assessment (SOFA). As the MPI is based on a more holistic assessment, it may provide a more accurate prediction than the organ-based SOFA. OBJECTIVE Does the MPI provide a more accurate prediction of mortality risk and quality of life for older patients in critical care units than the organ-based SOFA score? METHODS In a 6-month study, 96 patients aged 65 and older admitted to intensive (ICU) or intermediate care units (IMC) were enrolled to assess 90-day mortality using a comprehensive geriatric assessment-based MPI and the SOFA score. The follow-up (FU) involved telephone assessments 30 and 90 days after admission, focusing on posthospitalization health and quality of life. RESULTS Both MPI (p = 0.039) and SOFA score (p = 0.014) successfully predicted mortality among older IMC and ICU patients in logistic regressions. Receiver operating characteristic (ROC) analyses demonstrated comparable areas under the curve (AUCs) for MPI (0.618) and SOFA score (0.621), as well as a similar sensitivity and specificity (MPI 61.0% and 52.9%; SOFA score: 68.9% and 45.1%, respectively). The MPI at admission moreover correlated significantly with quality of life (p < 0.001, r = -0.631 at discharge; p = 0.005, r = -0.377 at 30-day FU; p = 0.004, r = -0.409 at 90-day FU) and nursing needs (Mann-Whitney U‑test, p = 0.002 at 30-day FU; p = 0.011 at 90-day FU) at FU, while the SOFA score did not show significant associations with respect to these parameters. CONCLUSIONS In geriatric critical care, both the MPI and the SOFA score effectively predict mortality risk. While the SOFA score may appear more practical due to its simpler and faster implementation, only the MPI demonstrated significant correlations with quality of life and nursing needs in the FU after 30 and 90 days.
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Affiliation(s)
- Melanie Hochleitner
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Lena Pickert
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Nick A Nolting
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Anna Maria Affeldt
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ingrid Becker
- Institute of Medical Statistics and Computational Biology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Thomas Benzing
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Matthias Kochanek
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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Antonazzo IC, Rozza D, Cortesi PA, Fornari C, Zanzottera Ferrari E, Paris C, Eteve-Pitsaer C, Gnesi M, Mele S, D'Amelio M, Maurizi AR, Palladino P, Mantovani LG, Mazzaglia G. Generalizability and treatment with sodium-glucose co-trasporter-2 inhibitors (SGLT2i) among patients with type 2 diabetes: an assessment using an Italian primary care database. Acta Diabetol 2024:10.1007/s00592-024-02359-1. [PMID: 39207490 DOI: 10.1007/s00592-024-02359-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/04/2024] [Indexed: 09/04/2024]
Abstract
AIMS This study aimed to assess the proportions of type 2 diabetes (T2D) subjects meeting cardiovascular outcome trials (CVOTs) criteria for sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and estimate SGLT2i utilization, along with associated demographic and clinical characteristics, in a primary care setting. METHODS T2D patients in Italy were selected between January 1, 2021, and December 31, 2022, from The Health Improvement Network (THIN®) database. Representativeness was determined by dividing patients meeting key inclusion criteria for four CVOTs (CANVAS, DECLARE-TIMI 58, EMPA-REG OUTCOME, VERTIS-CV) to the total T2D population. Demographic and clinical characteristics of eligible T2D subjects and SGLT2i users were compared, and logistic regression models assessed the likelihood of receiving SGLT2i. RESULTS Out of 17,102 T2D patients, 8,828 met eligibility criteria for at least one CVOT. DECLARE-TIMI 58 exhibited the highest representativeness (51.1%), compared to CANVAS (21.1%), EMPA-REG OUTCOME (5.5%), and VERTIS-CV (4.9%) trials. Eligible CVOTs patients were older (74.6 vs. 68.3 years), with a longer disease duration (10.2 vs. 9.7 years), and higher established cardiovascular disease (CVD) prevalence (36.0 vs. 27.3%) compared to SGLT2i users. Less than 10% of eligible T2D patients received SGLT2i. Males (OR: 1.43; 95%CI: 1.24-1.66) were more likely to be prescribed SGLT2i than other antidiabetic drugs, while the elderly (80 + vs. 40-64 years, OR: 0.17; 95% CI: 0.14-0.22) were less likely. Eligible T2D patients with CVD reported an increased likelihood of receiving SGLT2is compared to other antidiabetics. CONCLUSION This study highlights significant variability in the proportion of T2D subjects meeting SGLT2i CVOT inclusion criteria, with DECLARE-TIMI-58 being the most represented. Low SGLT2i prescription rates in the Italian primary care setting, along with substantial demographic and clinical differences between SGLT-2i users and T2D eligible patients, emphasize the need for targeted interventions to optimize the use of these medications in primary care settings.
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Affiliation(s)
- Ippazio Cosimo Antonazzo
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, Italy
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 56126, Italy
- Laboratory of Public Health, IRCCS Istituto Auxologico Italiano, Milan, 20149, Italy
| | - Davide Rozza
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, Italy
| | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, Italy
- Laboratory of Public Health, IRCCS Istituto Auxologico Italiano, Milan, 20149, Italy
| | - Carla Fornari
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, Italy.
| | | | - Claire Paris
- Cegedim Health data, Boulogne-Billancourt, France
| | | | - Marco Gnesi
- Medical Evidence, Biopharmaceuticals Medical, AstraZeneca, Milan, Italy
| | | | | | - Anna Rita Maurizi
- Medical Affairs, Biopharmaceuticals Medical, AstraZeneca, Milan, Italy
| | | | - Lorenzo Giovanni Mantovani
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, Italy
- Laboratory of Public Health, IRCCS Istituto Auxologico Italiano, Milan, 20149, Italy
| | - Giampiero Mazzaglia
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, Italy
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Holmer HK, Iyer S, Fiordalisi CV, Kuhn E, Forte ML, Murad MH, Wang Z, Tsou AY, Michel JJ, Umscheid CA. Supplementing systematic review findings with healthcare system data: pilot projects from the Agency for Healthcare Research and Quality Evidence-based Practice Center program. J Clin Epidemiol 2024; 174:111484. [PMID: 39097175 DOI: 10.1016/j.jclinepi.2024.111484] [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: 03/05/2024] [Revised: 07/15/2024] [Accepted: 07/22/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVES The US Agency for Healthcare Research and Quality, through the Evidence-based Practice Center (EPC) Program, aims to provide health system decision makers with the highest-quality evidence to inform clinical decisions. However, limitations in the literature may lead to inconclusive findings in EPC systematic reviews (SRs). The EPC Program conducted pilot projects to understand the feasibility, benefits, and challenges of utilizing health system data to augment SR findings to support confidence in healthcare decision-making based on real-world experiences. STUDY DESIGN AND SETTING Three contractors (each an EPC located at a different health system) selected a recently completed SR conducted by their center and identified an evidence gap that electronic health record (EHR) data might address. All pilot project topics addressed clinical questions as opposed to care delivery, care organization, or care disparities topics that are common in EPC reports. Topic areas addressed by each EPC included infantile epilepsy, migraine, and hip fracture. EPCs also tracked additional resources needed to conduct supplemental analyses. The workgroup met monthly in 2022-2023 to discuss challenges and lessons learned from the pilot projects. RESULTS Two supplemental data analyses filled an evidence gap identified in the SRs (raised certainty of evidence, improved applicability) and the third filled a health system knowledge gap. Project challenges fell under three themes: regulatory and logistical issues, data collection and analysis, and interpretation and presentation of findings. Limited ability to capture key clinical variables given inconsistent or missing data within the EHR was a major limitation. The workgroup found that conducting supplemental data analysis alongside an SR was feasible but adds considerable time and resources to the review process (estimated total hours to complete pilot projects ranged from 283 to 595 across EPCs), and that the increased effort and resources added limited incremental value. CONCLUSION Supplementing existing SRs with analyses of EHR data is resource intensive and requires specialized skillsets throughout the process. While using EHR data for research has immense potential to generate real-world evidence and fill knowledge gaps, these data may not yet be ready for routine use alongside SRs.
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Affiliation(s)
- Haley K Holmer
- Scientific Resource Center for the AHRQ EPC Program, Portland, OR, USA.
| | - Suchitra Iyer
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, MD, USA
| | | | - Edi Kuhn
- Scientific Resource Center for the AHRQ EPC Program, Portland, OR, USA
| | - Mary L Forte
- University of Minnesota Evidence-Based Practice Center, Minneapolis, MN, USA
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA
| | - Zhen Wang
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA
| | - Amy Y Tsou
- ECRI Institute Evidence-Based Practice Center, Plymouth Meeting, PA, USA
| | - Jeremy J Michel
- ECRI Institute Evidence-Based Practice Center, Plymouth Meeting, PA, USA
| | - Craig A Umscheid
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, MD, USA
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Corn G, Lund M, Andersson NW, Dohlmann TL, Hlatky MA, Wohlfahrt J, Melbye M. Low-density lipoprotein cholesterol response to statins according to comorbidities and co-medications: A population-based study. Am Heart J 2024; 274:102-112. [PMID: 38710378 DOI: 10.1016/j.ahj.2024.04.018] [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] [Received: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND The response of low-density lipoprotein cholesterol (LDL-C) to statin therapy is variable, and may be affected by the presence of co-morbid conditions or the use of concomitant medications. Systematic variation in the response to statins based on these factors could affect the selection of the statin treatment regimen in population subgroups. We investigated whether common comorbidities and co-medications had clinically important effects on statin responses in individual patients. METHODS This register-based cohort study included 89,006 simvastatin or atorvastatin initiators with measurements of pre-statin and on-statin LDL-C levels, in Denmark, 2008-2018. We defined statin response as the percentage reduction in LDL-C, and used linear regression to estimate percentage reduction differences (PRD) according to 175 chronic comorbidities and 99 co-medications. We evaluated both the statistical significance (P-values corrected for multiple testing) and the clinical importance (PRD of 5 percentage points or more) of the observed associations. RESULTS Concomitant use of oral blood-glucose lowering drugs, which included metformin in 96% of treated individuals, was associated with a greater response to statin therapy that was both statistically significant and clinically important, with a PRD of 5.18 (95% confidence interval: 4.79 to 5.57). No other comorbidity or co-medication reached the prespecified thresholds for a significant, clinically important effect on statin response. Overall, comorbidities and co-medications had little effect on statin response, and altogether explained only 1.7% of the total observed population variance. CONCLUSION Most of the studied comorbidities and co-medications did not have a clinically important effect on statin response, suggesting no need to modify treatment regimens. However, use of metformin was associated with a significantly enhanced LDL-C response to statins, suggesting that lower statin doses may be effective in patients taking metformin.
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Affiliation(s)
- Giulia Corn
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.; Danish Cancer Institute, Statistics and Data Analysis, Copenhagen, Denmark.
| | - Marie Lund
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.; Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niklas W Andersson
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Tine L Dohlmann
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Mark A Hlatky
- Department of Health Policy and Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jan Wohlfahrt
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.; Danish Cancer Institute, Cancer Epidemiology and Surveillance, Copenhagen, Denmark
| | - Mads Melbye
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Danish Cancer Institute, Copenhagen, Denmark; K.G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and Technology, Norway; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
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Butler T, Davey MG, Kerin MJ. Molecular Morbidity Score-Can MicroRNAs Assess the Burden of Disease? Int J Mol Sci 2024; 25:8042. [PMID: 39125612 PMCID: PMC11312210 DOI: 10.3390/ijms25158042] [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: 06/21/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 08/12/2024] Open
Abstract
Multimorbidity refers to the presence of two or more chronic diseases and is associated with adverse outcomes for patients. Factors such as an ageing population have contributed to a rise in prevalence of multimorbidity globally; however, multimorbidity is often neglected in clinical guidelines. This is largely because patients with multimorbidity are systematically excluded from clinical trials. Accordingly, there is an urgent need to develop novel biomarkers and methods of prognostication for this cohort of patients. The hallmarks of ageing are now thought to potentiate the pathogenesis of multimorbidity. MicroRNAs are small, regulatory, noncoding RNAs which have been implicated in the pathogenesis and prognostication of numerous chronic diseases; there is a substantial body of evidence now implicating microRNA dysregulation with the different hallmarks of ageing in the aetiology of chronic diseases. This article proposes using the hallmarks of ageing as a framework to develop a panel of microRNAs to assess the prognostic burden of multimorbidity. This putative molecular morbidity score would have many potential applications, including assessing the efficacy of clinical interventions, informing clinical decision making and facilitating wider inclusion of patients with multimorbidity in clinical trials.
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Affiliation(s)
- Thomas Butler
- Department of Surgery, Lambe Institute for Translational Research, University of Galway, H91 TK33 Galway, Ireland; (M.G.D.); (M.J.K.)
| | - Matthew G. Davey
- Department of Surgery, Lambe Institute for Translational Research, University of Galway, H91 TK33 Galway, Ireland; (M.G.D.); (M.J.K.)
| | - Michael J. Kerin
- Department of Surgery, Lambe Institute for Translational Research, University of Galway, H91 TK33 Galway, Ireland; (M.G.D.); (M.J.K.)
- Department of Surgery, University Hospital Galway, Newcastle Road, H91 YR71 Galway, Ireland
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Wertman E. Essential New Complexity-Based Themes for Patient-Centered Diagnosis and Treatment of Dementia and Predementia in Older People: Multimorbidity and Multilevel Phenomenology. J Clin Med 2024; 13:4202. [PMID: 39064242 PMCID: PMC11277671 DOI: 10.3390/jcm13144202] [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: 06/10/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Dementia is a highly prevalent condition with devastating clinical and socioeconomic sequela. It is expected to triple in prevalence by 2050. No treatment is currently known to be effective. Symptomatic late-onset dementia and predementia (SLODP) affects 95% of patients with the syndrome. In contrast to trials of pharmacological prevention, no treatment is suggested to remediate or cure these symptomatic patients. SLODP but not young onset dementia is intensely associated with multimorbidity (MUM), including brain-perturbating conditions (BPCs). Recent studies showed that MUM/BPCs have a major role in the pathogenesis of SLODP. Fortunately, most MUM/BPCs are medically treatable, and thus, their treatment may modify and improve SLODP, relieving suffering and reducing its clinical and socioeconomic threats. Regrettably, the complex system features of SLODP impede the diagnosis and treatment of the potentially remediable conditions (PRCs) associated with them, mainly due to failure of pattern recognition and a flawed diagnostic workup. We suggest incorporating two SLODP-specific conceptual themes into the diagnostic workup: MUM/BPC and multilevel phenomenological themes. By doing so, we were able to improve the diagnostic accuracy of SLODP components and optimize detecting and favorably treating PRCs. These revolutionary concepts and their implications for remediability and other parameters are discussed in the paper.
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Affiliation(s)
- Eli Wertman
- Department of Neurology, Hadassah University Hospital, The Hebrew University, Jerusalem 9190500, Israel;
- Section of Neuropsychology, Department of Psychology, The Hebrew University, Jerusalem 9190500, Israel
- Or’ad: Organization for Cognitive and Behavioral Changes in the Elderly, Jerusalem 9458118, Israel
- Merhav Neuropsychogeriatric Clinics, Nehalim 4995000, Israel
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Baldwin D, Carmichael J, Cook G, Navani N, Peach J, Slater R, Wheatstone P, Wilkins J, Allen-Delingpole N, Kerr CEP, Siddiqui K. UK Stakeholder Perspectives on Surrogate Endpoints in Cancer, and the Potential for UK Real-World Datasets to Validate Their Use in Decision-Making. Cancer Manag Res 2024; 16:791-810. [PMID: 39044745 PMCID: PMC11264281 DOI: 10.2147/cmar.s441359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 06/24/2024] [Indexed: 07/25/2024] Open
Abstract
Duration of overall survival in patients with cancer has lengthened due to earlier detection and improved treatments. However, these improvements have created challenges in assessing the impact of newer treatments, particularly those used early in the treatment pathway. As overall survival remains most decision-makers' preferred primary endpoint, therapeutic innovations may take a long time to be introduced into clinical practice. Moreover, it is difficult to extrapolate findings to heterogeneous populations and address the concerns of patients wishing to evaluate everyday quality and extension of life. There is growing interest in the use of surrogate or interim endpoints to demonstrate robust treatment effects sooner than is possible with measurement of overall survival. It is hoped that they could speed up patients' access to new drugs, combinations, and sequences, and inform treatment decision-making. However, while surrogate endpoints have been used by regulators for drug approvals, this has occurred on a case-by-case basis. Evidence standards are yet to be clearly defined for acceptability in health technology appraisals or to shape clinical practice. This article considers the relevance of the use of surrogate endpoints in cancer in the UK context, and explores whether collection and analysis of real-world UK data and evidence might contribute to validation.
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Affiliation(s)
- David Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Jonathan Carmichael
- Department of Oncology, The National Institute for Health Research Leeds In Vitro Diagnostics Co-Operative (NIHR Leeds MIC), Leeds, UK
| | - Gordon Cook
- Cancer Research UK Trials Unit, LICTR, University of Leeds & NIHR (Leeds) IVD MIC, Leeds, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
- Department of Thoracic Medicine, University College London Hospital, London, UK
| | - James Peach
- Human Centric Drug Discovery, Wood Centre for Innovation, Oxford, UK
| | | | - Pete Wheatstone
- Patient and Public Involvement and Engagement Group, DATA-CAN, London, UK
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Van Cauwenberge J, Van Baelen K, Maetens M, Geukens T, Nguyen HL, Nevelsteen I, Smeets A, Deblander A, Neven P, Koolen S, Wildiers H, Punie K, Desmedt C. Reporting on patient's body mass index (BMI) in recent clinical trials for patients with breast cancer: a systematic review. Breast Cancer Res 2024; 26:81. [PMID: 38778365 PMCID: PMC11112918 DOI: 10.1186/s13058-024-01832-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/30/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The proportion of patients with breast cancer and obesity is increasing. While the therapeutic landscape of breast cancer has been expanding, we lack knowledge about the potential differential efficacy of most drugs according to the body mass index (BMI). Here, we conducted a systematic review on recent clinical drug trials to document the dosing regimen of recent drugs, the reporting of BMI and the possible exclusion of patients according to BMI, other adiposity measurements and/or diabetes (leading comorbidity of obesity). We further explored whether treatment efficacy was evaluated according to BMI. METHODS A search of Pubmed and ClinicalTrials.gov was performed to identify phase I-IV trials investigating novel systemic breast cancer treatments. Dosing regimens and exclusion based on BMI, adiposity measurements or diabetes, documentation of BMI and subgroup analyses according to BMI were assessed. RESULTS 495 trials evaluating 26 different drugs were included. Most of the drugs (21/26, 81%) were given in a fixed dose independent of patient weight. BMI was an exclusion criterion in 3 out of 495 trials. Patients with diabetes, the leading comorbidity of obesity, were excluded in 67/495 trials (13.5%). Distribution of patients according to BMI was mentioned in 8% of the manuscripts, subgroup analysis was performed in 2 trials. No other measures of adiposity/body composition were mentioned in any of the trials. Retrospective analyses on the impact of BMI were performed in 6 trials. CONCLUSIONS Patient adiposity is hardly considered as most novel drug treatments are given in a fixed dose. BMI is generally not reported in recent trials and few secondary analyses are performed. Given the prevalence of patients with obesity and the impact obesity can have on pharmacokinetics and cancer biology, more attention should be given by investigators and study sponsors to reporting patient's BMI and evaluating its impact on treatment efficacy and toxicity.
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Affiliation(s)
- Josephine Van Cauwenberge
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Herestraat 49, Box 808, 3000, Louvain, Belgium
- Department of Gynecological Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Karen Van Baelen
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Herestraat 49, Box 808, 3000, Louvain, Belgium
- Department of Gynecological Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Marion Maetens
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Herestraat 49, Box 808, 3000, Louvain, Belgium
| | - Tatjana Geukens
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Herestraat 49, Box 808, 3000, Louvain, Belgium
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Ha Linh Nguyen
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Herestraat 49, Box 808, 3000, Louvain, Belgium
| | - Ines Nevelsteen
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Ann Smeets
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Anne Deblander
- Department of Gynecological Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Neven
- Department of Gynecological Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Stijn Koolen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Hospital Pharmacy, Erasmus MC, Rotterdam, The Netherlands
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Kevin Punie
- Department of Medical Oncology, GZA Hospitals Sint-Augustinus, Wilrijk, Belgium
| | - Christine Desmedt
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Herestraat 49, Box 808, 3000, Louvain, Belgium.
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12
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Ellen JG, Matos J, Viola M, Gallifant J, Quion J, Anthony Celi L, Abu Hussein NS. Participant flow diagrams for health equity in AI. J Biomed Inform 2024; 152:104631. [PMID: 38548006 DOI: 10.1016/j.jbi.2024.104631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/29/2023] [Accepted: 03/26/2024] [Indexed: 04/01/2024]
Abstract
Selection bias can arise through many aspects of a study, including recruitment, inclusion/exclusion criteria, input-level exclusion and outcome-level exclusion, and often reflects the underrepresentation of populations historically disadvantaged in medical research. The effects of selection bias can be further amplified when non-representative samples are used in artificial intelligence (AI) and machine learning (ML) applications to construct clinical algorithms. Building on the "Data Cards" initiative for transparency in AI research, we advocate for the addition of a participant flow diagram for AI studies detailing relevant sociodemographic and/or clinical characteristics of excluded participants across study phases, with the goal of identifying potential algorithmic biases before their clinical implementation. We include both a model for this flow diagram as well as a brief case study explaining how it could be implemented in practice. Through standardized reporting of participant flow diagrams, we aim to better identify potential inequities embedded in AI applications, facilitating more reliable and equitable clinical algorithms.
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Affiliation(s)
| | - João Matos
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA; Faculty of Engineering, University of Porto, Porto, Portugal; Institute for Systems and Computer Engineering, Technology and Science (INESCTEC), Porto, Portugal
| | | | - Jack Gallifant
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Critical Care, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Justin Quion
- University of the East Ramon Magsaysay Memorial Medical School, Quezon City, Philippines
| | - Leo Anthony Celi
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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13
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Schlag AK, Nutt DJ, Lynskey M. Using real world evidence to optimize care: the case of medical cannabis. Expert Rev Pharmacoecon Outcomes Res 2024; 24:463-465. [PMID: 38392352 DOI: 10.1080/14737167.2024.2322005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/19/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Anne Katrin Schlag
- Drug Science, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - David J Nutt
- Drug Science, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
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14
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Evans A, Roy D, Dhanda S, Lane S, Coutinho G, Kulasekaran A, Miller-Shakesby D, Ramamoorthi N, Shakir S. A systematic review of flurbiprofen 8.75 mg dose and risk of adverse events (excluding haemorrhagic) resulting from drug-drug interactions. Front Pharmacol 2024; 15:1107185. [PMID: 38510649 PMCID: PMC10952129 DOI: 10.3389/fphar.2024.1107185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/14/2024] [Indexed: 03/22/2024] Open
Abstract
Background: Flurbiprofen 8.75 mg lozenges and oromucosal sprays are used for symptomatic relief of sore throat in patients aged 12 years and over. The documented adverse events of flurbiprofen use include those related to its pharmacological actions, namely, increased risk of haemorrhagic events, however other adverse events (such as nephrotoxicity and cardiac failure) have been known to occur. The likelihood of occurrence of adverse events increases when flurbiprofen is used concomitantly with some other medications. Therefore, the objective of this systematic review was to collate the current evidence on adverse events which occur with flurbiprofen 8.75 mg dose (any formulation), in particular as a result of interaction with other medicinal products, with a focus on non-haemorrhagic events. Methods: Systematic searches of the literature were conducted to identify literature on any formulation of flurbiprofen 8.75 mg up to the date of the electronic database search (data lock: 28 April 2020). Publications were screened to identify studies reporting non-haemorrhagic adverse events with flurbiprofen 8.75 mg and/or non-haemorrhagic adverse events in the comparator arm. Data extraction was performed for eligible studies according to pre-defined criteria and summarised in narratives, tables and figures. Risk of bias and certainty of evidence assessments were planned for each included study where results relating to the primary objective of the systematic review were available. Results: Of 1,528 publications identified by systematic literature searches, 26 met the inclusion criteria and were included in this review. None of these 26 studies contained information on non-haemorrhagic adverse events occurring as a result of a drug-drug interaction (interaction with concomitant medication used with flurbiprofen 8.75 mg), as per the primary objective and secondary objectives of the systematic review. Conclusion: Results from this systematic review on the risk of non-haemorrhagic events did not provide evidence for these events occurring as a result of interaction with other medicinal products. Additional appropriately designed studies would be required to confirm whether these findings suggest a true absence of risk or limitations in reporting.
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Affiliation(s)
- Alison Evans
- Drug Safety Research Unit, Southampton, United Kingdom
- University of Portsmouth, Portsmouth, United Kingdom
| | - Debabrata Roy
- Drug Safety Research Unit, Southampton, United Kingdom
- University of Portsmouth, Portsmouth, United Kingdom
| | - Sandeep Dhanda
- Drug Safety Research Unit, Southampton, United Kingdom
- University of Portsmouth, Portsmouth, United Kingdom
| | - Samantha Lane
- Drug Safety Research Unit, Southampton, United Kingdom
- University of Portsmouth, Portsmouth, United Kingdom
| | - Graça Coutinho
- Global Medical Affairs, Reckitt Benckiser Health Limited, Slough, United Kingdom
| | - Anuradha Kulasekaran
- Global Medical Affairs, Reckitt Benckiser Health Limited, Slough, United Kingdom
| | - David Miller-Shakesby
- Risk Management and Vigilance, Reckitt Benckiser Health Limited, Slough, United Kingdom
| | | | - Saad Shakir
- Drug Safety Research Unit, Southampton, United Kingdom
- University of Portsmouth, Portsmouth, United Kingdom
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15
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Polidori MC. Aging hallmarks, biomarkers, and clocks for personalized medicine: (re)positioning the limelight. Free Radic Biol Med 2024; 215:48-55. [PMID: 38395089 DOI: 10.1016/j.freeradbiomed.2024.02.012] [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: 11/19/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024]
Abstract
The rapidly increasing aging prevalence, complexity, and heterogeneity pose the scientific and medical communities in front of challenges. These are delivered by gaps between basic and translational research, as well as between clinical practice guidelines to improve survival and absence of evidence on personalized strategies to improve functions, wellbeing and quality of life. The triumphs of aging science sheding more and more light on mechanisms of aging as well as those of medical and technological progress to prolong life expectancy are clear. Currently, and in the next two to three decades, all efforts must be put in a closer interdisciplinary dialogue between biogerontologists and geriatricians to enable real-life measures of aging phenotypes to be used to uncover the physiological - and therefore translational - relevance of newly discovered aging clocks, biomarkers, and hallmarks.
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Affiliation(s)
- M Cristina Polidori
- Aging Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Herderstraße 52, 50931, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress- Responses in Aging- Associated Diseases (CECAD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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16
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Vervoort D, Sud M, Zeis TM, Haouzi AA, An KR, Rocha R, Eikelboom R, Fremes SE, Tamis-Holland JE. Do the Few Dictate Care for the Many? Revascularisation Considerations That Go Beyond the Guidelines. Can J Cardiol 2024; 40:275-289. [PMID: 38181974 DOI: 10.1016/j.cjca.2023.11.007] [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: 09/01/2023] [Revised: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 01/07/2024] Open
Abstract
The burden of coronary artery disease (CAD) is large and growing, commonly presenting with comorbidities and older age. Patients may benefit from coronary revascularisation with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), yet half of patients with CAD who would benefit from revascularisation fall outside the eligibility criteria of trials to date. As such, the choice of revascularisation procedures varies depending on the CAD anatomy and complexity, surgical risk and comorbidities, the patient's preferences and values, and the treating team's expertise. The recent American guidelines on coronary revascularisation are comprehensive in describing recommendations for PCI, CABG, or conservative management in patients with CAD. However, individual challenging patient presentations cannot be fully captured in guidelines. The aim of this narrative review is to summarise common clinical scenarios that are not sufficiently described by contemporary clinical guidelines and trials in order to inform heart team members and trainees about the nuanced considerations and available evidence to manage such cases. We discuss clinical cases that fall beyond the current guidelines and summarise the relevant evidence evaluating coronary revascularisation for these patients. In addition, we highlight gaps in knowledge based on a lack of research (eg, ineligibility of certain patient populations), underrepresentation in research (eg, underenrollment of female and non-White patients), and the surge in newer minimally invasive and hybrid techniques. We argue that ultimately, evidence-based medicine, patient preference, shared decision making, and effective heart team communications are necessary to best manage complex CAD presentations potentially benefitting from revascularisation with CABG or PCI.
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Affiliation(s)
- Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Maneesh Sud
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Tessa M Zeis
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alice A Haouzi
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kevin R An
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Rodolfo Rocha
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Eikelboom
- Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Stephen E Fremes
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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17
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Guthrie B, Rogers G, Livingstone S, Morales DR, Donnan P, Davis S, Youn JH, Hainsworth R, Thompson A, Payne K. The implications of competing risks and direct treatment disutility in cardiovascular disease and osteoporotic fracture: risk prediction and cost effectiveness analysis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-275. [PMID: 38420962 DOI: 10.3310/kltr7714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Background Clinical guidelines commonly recommend preventative treatments for people above a risk threshold. Therefore, decision-makers must have faith in risk prediction tools and model-based cost-effectiveness analyses for people at different levels of risk. Two problems that arise are inadequate handling of competing risks of death and failing to account for direct treatment disutility (i.e. the hassle of taking treatments). We explored these issues using two case studies: primary prevention of cardiovascular disease using statins and osteoporotic fracture using bisphosphonates. Objectives Externally validate three risk prediction tools [QRISK®3, QRISK®-Lifetime, QFracture-2012 (ClinRisk Ltd, Leeds, UK)]; derive and internally validate new risk prediction tools for cardiovascular disease [competing mortality risk model with Charlson Comorbidity Index (CRISK-CCI)] and fracture (CFracture), accounting for competing-cause death; quantify direct treatment disutility for statins and bisphosphonates; and examine the effect of competing risks and direct treatment disutility on the cost-effectiveness of preventative treatments. Design, participants, main outcome measures, data sources Discrimination and calibration of risk prediction models (Clinical Practice Research Datalink participants: aged 25-84 years for cardiovascular disease and aged 30-99 years for fractures); direct treatment disutility was elicited in online stated-preference surveys (people with/people without experience of statins/bisphosphonates); costs and quality-adjusted life-years were determined from decision-analytic modelling (updated models used in National Institute for Health and Care Excellence decision-making). Results CRISK-CCI has excellent discrimination, similar to that of QRISK3 (Harrell's c = 0.864 vs. 0.865, respectively, for women; and 0.819 vs. 0.834, respectively, for men). CRISK-CCI has systematically better calibration, although both models overpredict in high-risk subgroups. People recommended for treatment (10-year risk of ≥ 10%) are younger when using QRISK-Lifetime than when using QRISK3, and have fewer observed events in a 10-year follow-up (4.0% vs. 11.9%, respectively, for women; and 4.3% vs. 10.8%, respectively, for men). QFracture-2012 underpredicts fractures, owing to under-ascertainment of events in its derivation. However, there is major overprediction among people aged 85-99 years and/or with multiple long-term conditions. CFracture is better calibrated, although it also overpredicts among older people. In a time trade-off exercise (n = 879), statins exhibited direct treatment disutility of 0.034; for bisphosphonates, it was greater, at 0.067. Inconvenience also influenced preferences in best-worst scaling (n = 631). Updated cost-effectiveness analysis generates more quality-adjusted life-years among people with below-average cardiovascular risk and fewer among people with above-average risk. If people experience disutility when taking statins, the cardiovascular risk threshold at which benefits outweigh harms rises with age (≥ 8% 10-year risk at 40 years of age; ≥ 38% 10-year risk at 80 years of age). Assuming that everyone experiences population-average direct treatment disutility with oral bisphosphonates, treatment is net harmful at all levels of risk. Limitations Treating data as missing at random is a strong assumption in risk prediction model derivation. Disentangling the effect of statins from secular trends in cardiovascular disease in the previous two decades is challenging. Validating lifetime risk prediction is impossible without using very historical data. Respondents to our stated-preference survey may not be representative of the population. There is no consensus on which direct treatment disutilities should be used for cost-effectiveness analyses. Not all the inputs to the cost-effectiveness models could be updated. Conclusions Ignoring competing mortality in risk prediction overestimates the risk of cardiovascular events and fracture, especially among older people and those with multimorbidity. Adjustment for competing risk does not meaningfully alter cost-effectiveness of these preventative interventions, but direct treatment disutility is measurable and has the potential to alter the balance of benefits and harms. We argue that this is best addressed in individual-level shared decision-making. Study registration This study is registered as PROSPERO CRD42021249959. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/12/22) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 4. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Bruce Guthrie
- Advanced Care Research Centre, Centre for Population Health Sciences, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Gabriel Rogers
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Shona Livingstone
- Population Health and Genomics Division, University of Dundee, Dundee, UK
| | - Daniel R Morales
- Population Health and Genomics Division, University of Dundee, Dundee, UK
| | - Peter Donnan
- Population Health and Genomics Division, University of Dundee, Dundee, UK
| | - Sarah Davis
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | - Rob Hainsworth
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Alexander Thompson
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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18
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Hainsworth R, Thompson AJ, Guthrie B, Payne K, Rogers G. International Systematic Review of Utility Values Associated with Cardiovascular Disease and Reflections on Selecting Evidence for a UK Decision-Analytic Model. Med Decis Making 2024; 44:217-234. [PMID: 38174427 PMCID: PMC10865747 DOI: 10.1177/0272989x231214782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/19/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Evaluating interventions for cardiovascular disease (CVD) requires estimates of its effect on utility. We aimed to 1) systematically review utility estimates for CVDs published since 2013 and 2) critically appraise UK-relevant estimates and calculate corresponding baseline utility multipliers. METHODS We searched MEDLINE and Embase (April 22, 2021) using CVD and utility terms. We screened results for primary studies reporting utility distributions for people with experience of heart failure, myocardial infarction, peripheral arterial disease, stable angina, stroke, transient ischemic attack, or unstable angina. We extracted characteristics from studies included. For UK estimates based on the EuroQoL 5-dimension (EQ-5D) measure, we assessed risk of bias and applicability to a decision-analytic model, pooled arms/time points as appropriate, and estimated baseline utility multipliers using predicted utility for age- and sex- matched populations without CVD. We sought utility sources from directly applicable studies with low risk of bias, prioritizing plausibility of severity ordering in our base-case model and highest population ascertainment in a sensitivity analysis. RESULTS Most of the 403 studies identified used EQ-5D (n = 217) and most assessed Organisation for Economic Co-operation and Development populations (n = 262), although measures and countries varied widely. UK studies using EQ-5D (n = 29) produced very heterogeneous baseline utility multipliers for each type of CVD, precluding meta-analysis and implying different possible severity orderings. We could find sources that provided a plausible ordering of utilities while adequately representing health states. CONCLUSIONS We cataloged international CVD utility estimates and calculated UK-relevant baseline utility multipliers. Modelers should consider unreported sources of heterogeneity, such as population differences, when selecting utility evidence from reviews. HIGHLIGHTS Published systematic reviews have summarized estimates of utility associated with cardiovascular disease published up to 2013.We 1) reviewed utility estimates for 7 types of cardiovascular disease published since 2013, 2) critically appraised UK-relevant studies, and 3) estimated the effect of each cardiovascular disease on baseline utility.Our review 1) recommends a consistent and reliable set of baseline utility multipliers for 7 types of cardiovascular disease and 2) provides systematically identified reference information for researchers seeking utility evidence for their own context.
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Affiliation(s)
- Rob Hainsworth
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Alexander J Thompson
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Gabriel Rogers
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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Dewidar O, Pardo JP, Welch V, Hazlewood GS, Darzi AJ, Barnabe C, Pottie K, Petkovic J, Kuria S, Sha Z, Allam S, Busse JW, Schünemann HJ, Tugwell P. Operationalizing the GRADE-equity criterion to inform guideline recommendations: application to a medical cannabis guideline. J Clin Epidemiol 2024; 165:111185. [PMID: 37952701 DOI: 10.1016/j.jclinepi.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Incorporating health equity considerations into guideline development often requires information beyond that gathered through traditional evidence synthesis methodology. This article outlines an operationalization plan for the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-equity criterion to gather and assess evidence from primary studies within systematic reviews, enhancing guideline recommendations to promote equity. We demonstrate its use in a clinical guideline on medical cannabis for chronic pain. STUDY DESIGN AND SETTING We reviewed GRADE guidance and resources recommended by team members regarding the use of evidence for equity considerations, drafted an operationalization plan, and iteratively refined it through team discussion and feedback and piloted it on a medicinal cannabis guideline. RESULTS We propose a seven-step approach: 1) identify disadvantaged populations, 2) examine available data for specific populations, 3) evaluate population baseline risk for primary outcomes, 4) assess representation of these populations in primary studies, 5) appraise analyses, 6) note barriers to implementation of effective interventions for these populations, and 7) suggest supportive strategies to facilitate implementation of effective interventions. CONCLUSION Our approach assists guideline developers in recognizing equity considerations, particularly in resource-constrained settings. Its application across various guideline topics can verify its feasibility and necessary adjustments.
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Affiliation(s)
- Omar Dewidar
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Temerty School of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Jordi Pardo Pardo
- Ottawa Centre for Health Equity, Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Vivian Welch
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Glen S Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea J Darzi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Pottie
- CT Lamont Centre for Primary Care, Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, Western University, London, Ontario, Canada
| | - Jennifer Petkovic
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Shawn Kuria
- Ottawa Centre for Health Equity, Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Zhiming Sha
- Ottawa Centre for Health Equity, Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Allam
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Cochrane Canada, MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada; Department of Biomedical Sciences, Humanitas University, Milan, Italy; Cochrane Canada, McMaster University, Hamilton, Ontario, Canada
| | - Peter Tugwell
- Ottawa Centre for Health Equity, Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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20
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Allison R, Guraka A, Shawa IT, Tripathi G, Moritz W, Kermanizadeh A. Drug induced liver injury - a 2023 update. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2023; 26:442-467. [PMID: 37786264 DOI: 10.1080/10937404.2023.2261848] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Drug-Induced Liver Injury (DILI) constitutes hepatic damage attributed to drug exposure. DILI may be categorized as hepatocellular, cholestatic or mixed and might also involve immune responses. When DILI occurs in dose-dependent manner, it is referred to as intrinsic, while if the injury occurs spontaneously, it is termed as idiosyncratic. This review predominately focused on idiosyncratic liver injury. The established molecular mechanisms for DILI include (1) mitochondria dysfunction, (2) increased reactive oxygen species levels, (3) presence of elevated apoptosis and necrosis, (4) and bile duct injuries associated with immune mediated pathways. However, it should be emphasized that the underlying mechanisms responsible for DILI are still unknown. Prevention strategies are critical as incidences occur frequently, and treatment options are limited once the injury has developed. The aim of this review was to utilize retrospective cohort studies from across the globe to gain insight into epidemiological patterns. This review considers (1) what is currently known regarding the mechanisms underlying DILI, (2) discusses potential risk factors and (3) implications of the coronavirus pandemic on DILI presentation and research. Future perspectives are also considered and discussed and include potential new biomarkers, causality assessment and reporting methods.
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Affiliation(s)
- Rebecca Allison
- College of Science and Technology, University of Derby, Derby, UK
| | - Asha Guraka
- College of Science and Technology, University of Derby, Derby, UK
| | - Isaac Thom Shawa
- College of Science and Technology, University of Derby, Derby, UK
| | - Gyan Tripathi
- School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | | | - Ali Kermanizadeh
- College of Science and Technology, University of Derby, Derby, UK
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21
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Lange CM, Trebicka J, Gerbes A, Canbay A, Geier A, Merle U, Peck-Radosavljevic M, Tacke F, Vogelmann T, Theis S, Heinze H, Zipprich A. Limited access to liver transplantation and TIPS despite high mortality, healthcare resource use and costs of cirrhosis in Germany. Liver Int 2023; 43:2503-2512. [PMID: 37602977 DOI: 10.1111/liv.15688] [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: 04/12/2023] [Revised: 06/27/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND AND AIMS Data on number of patients with cirrhosis in Germany are limited. We therefore aimed to estimate prevalence, comorbidities, mortality, utilization of healthcare resources and costs of patients with cirrhosis and incidence of decompensation of cirrhosis in Germany. METHODS This longitudinal observational study was based on an anonymized representative claims database including 4.9 million persons insured by a statutory health insurance (SHI) between 2015-2020. Patients with decompensated and compensated cirrhosis were selected via diagnostic ICD codes and followed for 2 years. RESULTS Prevalence of cirrhosis in 2015 was 250/100 000, resulting in 201 747 (95% CI: 197 540-206 040) patients extrapolated to the German population. Out of all patients with compensated cirrhosis in 2015 who did not deceased, 16.0% developed a decompensation within 3 years. Overall, 978 patients (Ø-age: 68 years; 60% male) were included in the decompensated, and 5135 patients (Ø-age: 66 years; 59% male) in the compensated cirrhosis cohort. Patients with decompensated cirrhosis had a higher burden of comorbidities (Charlson Comorbidity Index 7.3 vs. 4.4) and 3 times higher costs per quarter (7172 € vs. 2213 €) than patients with compensated cirrhosis. 1-year mortality after decompensation was 51% compared to 8% in compensated cirrhosis. Of note, only few patients with decompensated cirrhosis received a liver transplantation or transjugular intrahepatic portosystemic shunts (TIPS) (1% and 5%). CONCLUSION Patients with cirrhosis have a high healthcare burden in especially decompensated stage. Accordingly, 1-year mortality of decompensated cirrhosis in Germany is high. Despite high health resource utilization, only few patients have access to liver transplantation or TIPS.
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Affiliation(s)
- Christian M Lange
- Department of Medicine II, University Hospital, LMU, Munich, Germany
| | - Jonel Trebicka
- Department of Internal Medicine B, University of Münster, Münster, Germany
| | - Alexander Gerbes
- Department of Medicine II, University Hospital, LMU, Munich, Germany
| | - Ali Canbay
- Department of Internal Medicine, University Hospital of the Knappschaftskrankenhauses Bochum, Bochum, Germany
| | - Andreas Geier
- Division of Hepatology, Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Uta Merle
- Internal Medicine IV Gastroenterology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum (CVK), Campus Charité Mitte (CCM), Berlin, Germany
| | | | | | | | - Alexander Zipprich
- Department of Internal Medicine IV (Gastroenterology, Hepatology, Infectiology), University Hospital Jena, Jena, Germany
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22
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Martínez-Borba V, Martínez-García L, Peris-Baquero Ó, Osma J, del Corral-Beamonte E. Unified Protocol for the transdiagnostic treatment of emotional disorders in people with post COVID-19 condition: study protocol for a multiple baseline n-of-1 trial. Front Psychol 2023; 14:1160692. [PMID: 37920733 PMCID: PMC10618554 DOI: 10.3389/fpsyg.2023.1160692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 09/28/2023] [Indexed: 11/04/2023] Open
Abstract
Background Post COVID-19 syndrome, defined as the persistence of COVID-19 symptoms beyond 3 months, is associated with a high emotional burden. Post COVID-19 patients frequently present comorbid anxiety, depressive and related disorders (emotional disorders, EDs) which have an important impact on their quality of life. Unfortunately, psychological interventions to manage these EDs are rarely provided to post COVID-19 patients. Also importantly, most psychological interventions do not address comorbidity, namely simultaneous EDs present in COVID-19 patients. This study will explore the clinical utility and acceptability of a protocol-based cognitive-behavioral therapy called the Unified Protocol for the transdiagnostic treatment of EDs in patients suffering post COVID-19 condition. Methods A multiple baseline n-of-1 trial will be used, as it allows participants to be their own comparison control. Sample will be composed of 60 patients diagnosed with post COVID-19 conditions and comorbid EDs from three Spanish hospitals. After meeting the eligibility criteria, participants will answer the pre-assessment protocol and then they will be randomly assigned to three different baseline conditions (6, 8, or 10 days of assessments before the intervention). Participants and professionals will be unblinded to participants' allocation. Once the baseline assessment has been completed, participants will receive the online psychological individual intervention through video-calls. The Unified Protocol intervention will comprise 8 sessions of a 1 h duration each. After the intervention, participants will answer the post-assessment protocol. Additional follow-up assessments will be conducted at one, three, six, and twelve months after the intervention. Primary outcomes will be anxiety and depressive symptoms. Secondary outcomes include quality of life, emotion dysregulation, distress tolerance, and satisfaction with the programme. Data analyses will include between-group and within-group differences and visual analysis of patients' progress. Discussion Results from this study will be disseminated in scientific journals. These findings may help to provide valuable information in the implementation of psychological interventions for patients suffering post COVID-19 conditions. Clinical trial registration https://clinicaltrials.gov, identifier (NCT05581277).
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Affiliation(s)
| | - Laura Martínez-García
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Universidad de Zaragoza, Zaragoza, Spain
| | - Óscar Peris-Baquero
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Universidad de Zaragoza, Zaragoza, Spain
| | - Jorge Osma
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Universidad de Zaragoza, Zaragoza, Spain
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23
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Teske AJ, Moudgil R, López-Fernández T, Barac A, Brown SA, Deswal A, Neilan TG, Ganatra S, Abdel Qadir H, Menon V, Sverdlov AL, Cheng RK, Makhoul S, Ghosh AK, Szmit S, Zaha V, Addison D, Zhang L, Herrmann J, Chong JH, Agarwala V, Iakobishvili Z, Guerrero P, Yang EH, Leja M, Akhter N, Guha A, Okwuosa TM, Silva CC, Collier P, DeCara J, Bauer B, Lenneman CE, Sadler D. Global Cardio Oncology Registry (G-COR): Registry Design, Primary Objectives, and Future Perspectives of a Multicenter Global Initiative. Circ Cardiovasc Qual Outcomes 2023; 16:e009905. [PMID: 37702048 PMCID: PMC10824596 DOI: 10.1161/circoutcomes.123.009905] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND Global collaboration in cardio-oncology is needed to understand the prevalence of cancer therapy-related cardiovascular toxicity in different risk groups, practice settings, and geographic locations. There are limited data on the socioeconomic and racial/ethnic disparities that may impact access to care and outcomes. To address these gaps, we established the Global Cardio-Oncology Registry, a multinational, multicenter prospective registry. METHODS We assembled cardiologists and oncologists from academic and community settings to collaborate in the first Global Cardio-Oncology Registry. Subsequently, a survey for site resources, demographics, and intention to participate was conducted. We designed an online data platform to facilitate this global initiative. RESULTS A total of 119 sites responded to an online questionnaire on their practices and main goals of the registry: 49 US sites from 23 states and 70 international sites from 5 continents indicated a willingness to participate in the Global Cardio-Oncology Registry. Sites were more commonly led by cardiologists (85/119; 72%) and were more often university/teaching (81/119; 68%) than community based (38/119; 32%). The average number of cardio-oncology patients treated per month was 80 per site. The top 3 Global Cardio-Oncology Registry priorities in cardio-oncology care were breast cancer, hematologic malignancies, and patients treated with immune checkpoint inhibitors. Executive and scientific committees and specific committees were established. A pilot phase for breast cancer using Research Electronic Data Capture Cloud platform recently started patient enrollment. CONCLUSIONS We present the structure for a global collaboration. Information derived from the Global Cardio-Oncology Registry will help understand the risk factors impacting cancer therapy-related cardiovascular toxicity in different geographic locations and therefore contribute to reduce access gaps in cardio-oncology care. Risk calculators will be prospectively derived and validated.
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Affiliation(s)
- Arco J Teske
- Department of Cardiology, University Medical Centre Utrecht, The Netherlands (A.J.T.)
| | - Rohit Moudgil
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (R.M., V.M., P.C.)
| | | | - Ana Barac
- Medstar Heart Institute, Georgetown University, WA, DC (A.B.)
| | | | | | - Tomas G Neilan
- Massachusetts General Hospital, Harvard Medical School, Boston (T.G.N.)
| | - Sarju Ganatra
- Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA (S.G.)
| | | | - Venu Menon
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (R.M., V.M., P.C.)
| | - Aaron L Sverdlov
- Newcastle Centre of Excellence in Cardio-Oncology, Calvary Mater Newcastle, Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, NSW, Australia (A.L.S.)
| | | | - Silvia Makhoul
- Hospital Juan A Fernández/Hospital Británico de Buenos Aires Buenos Aires, Argentina (S.M.)
| | - Arjun K Ghosh
- Barts Heart Centre, St Bartholomew's Hospital (A.K.G.), London, United Kingdom
- University College London Hospital (A.K.G.), London, United Kingdom
- Hatter Cardiovascular Institute (A.K.G.), London, United Kingdom
| | - Sebastian Szmit
- Centre of Postgraduate Medical Education, Warsaw, Poland (S.S.)
| | - Vlad Zaha
- UT Southwestern Medical Center, Dallas, TX (V.Z.)
| | | | - Lili Zhang
- Montefiore Medical Center/Albert Einstein College of Medicine, NY (L.Z.)
| | | | | | - Vivek Agarwala
- Narayana Superspeciality Hospital and Cancer Institute and RN Tagore Cancer Center, Kolkata, India (V.A.)
| | - Zaza Iakobishvili
- Department of Cardiology, Tel Aviv Jaffa District Clalit Health Services, Tel Aviv, Israel (Z.I.)
| | | | - Eric H Yang
- University of California Los Angeles (E.H.Y.)
| | - Monika Leja
- University of Michigan Medical Center, Ann Arbor (M.L.)
| | - Nausheen Akhter
- Northwestern University Feinberg School of Medicine, Chicago, IL (N.A.)
| | - Avirup Guha
- Cardio-Oncology Program, Department of Medicine, Georgia Cancer Center, Medical College of Georgia at Augusta University, GA (A.G.)
| | | | | | - Patrick Collier
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (R.M., V.M., P.C.)
| | - Jeanne DeCara
- University of Chicago School of Medicine, IL (J.D.C.)
| | - Brenton Bauer
- COR Healthcare Associates/Torrance Memorial Medical Center, CA (B.B.)
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Sparks JA, Harrold LR, Simon TA, Wittstock K, Kelly S, Lozenski K, Khaychuk V, Michaud K. Comparative effectiveness of treatments for rheumatoid arthritis in clinical practice: A systematic review. Semin Arthritis Rheum 2023; 62:152249. [PMID: 37573754 DOI: 10.1016/j.semarthrit.2023.152249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To assess real-world comparative effectiveness studies of biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs) in adults with rheumatoid arthritis (RA) through a systematic review. METHODS We searched Medline for journal articles (2001-2021) and Embase® for abstracts presented at the European Alliance of Associations for Rheumatology and American College of Rheumatology (ACR) 2020 and 2021 annual meetings on non-randomized studies comparing the effectiveness of b/tsDMARDs using ACR-recommended disease activity measures, measures of functional status, and patient-reported outcomes (HAQ, PROMIS PF, patient pain, Patient and Physician Global Assessment of disease activity). Methodological heterogeneity between studies precluded meta-analyses. Risk of bias was assessed using the Cochrane Risk Of Bias In Non-randomized Studies of Interventions-I tool. RESULTS Of 1283 records screened, 68 were selected for data extraction, of which 1 was excluded due to critical risk of bias. Most studies were multicenter observational cohort/registry studies (n = 60) and were published between 2011 and 2021 (n = 60). Mean or median reported RA duration was between 6 and 15 years. Disease Activity Score in 28 joints (46 studies), Clinical Disease Activity Index (37 studies), and Health Assessment Questionnaire-Disability Index (32 studies) were the most common outcomes used in clinical practice, with regional differences identified. The most common comparison was between tumor necrosis factor inhibitors (TNFis) and non-TNFi bDMARDs (35 studies). There were no evident differences between b/tsDMARDs in clinical effectiveness. CONCLUSION This systematic review summarizing real-world evidence from a very large number of global studies found there are many effective options for the treatment of RA, but relatively less evidence to support the use of any one b/tsDMARD or drug class over another. Treatment for patients with RA should be tailored to suit individual clinical profiles. Further research is needed to identify whether specific patient subgroups may benefit from specific drug classes.
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Affiliation(s)
- Jeffrey A Sparks
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Leslie R Harrold
- CorEvitas, LLC, Waltham, MA, USA; University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | | | | | | | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, NE, USA; FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA.
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25
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Westerlind H, Glintborg B, Hammer HB, Saevarsdottir S, Krogh NS, Hetland ML, Hauge EM, Martinez Tejada I, Sexton J, Askling J. Remission, response, retention and persistence to treatment with disease-modifying agents in patients with rheumatoid arthritis: a study of harmonised Swedish, Danish and Norwegian cohorts. RMD Open 2023; 9:e003027. [PMID: 37673441 PMCID: PMC10496677 DOI: 10.1136/rmdopen-2023-003027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/21/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE Precision medicine in rheumatoid arthritis (RA) requires a good understanding of treatment outcomes and often collaborative efforts that call for data harmonisation. We aimed to describe how harmonisation across study cohorts can be achieved and investigate how the observed proportions reaching remission vary across remission criteria, study types, disease-modifying antirheumatic drugs (DMARDs) and countries, and how they relate to other treatment outcomes. METHODS We used data from eight existing large-scale, clinical RA registers and a pragmatic trial from Sweden, Denmark and Norway. In these, we defined three types of treatment cohorts; methotrexate monotherapy (as first DMARD), tumour necrosis factor inhibitors (TNFi) (as first biological DMARD) and rituximab. We developed a harmonised study protocol defining time points during 36 months of follow-up, collected clinical visit data on treatment response, retention, persistence and six alternative definitions of remission, and investigated how these outcomes differed within and between cohorts, by treatment. RESULTS Cohort sizes ranged from ~50 to 22 000 patients with RA. The proportions reaching each outcome varied across outcome metric, but with small to modest variations within and between cohorts, countries and treatment. Retention and persistence rates were high (>50% at 1 year), yet <33% of patients starting methotrexate or TNFi, and only 10% starting rituximab, remained on drug without other DMARDs added and achieved American Congress of Rheumatology/European Alliance of Associations for Rheumatology or Simplified Disease Activity Index remission at 1 year. CONCLUSION Harmonisation of data from different RA data sources can be achieved without compromising internal validity or generalisability. The low proportions reaching remission, point to an unmet need for treatment optimisation in RA.
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Affiliation(s)
- Helga Westerlind
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Bente Glintborg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Hilde Berner Hammer
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Saedis Saevarsdottir
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Niels Steen Krogh
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Merete Lund Hetland
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital Skejby, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Isabel Martinez Tejada
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Joseph Sexton
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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26
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MacRae C, Morales D, Mercer SW, Lone N, Lawson A, Jefferson E, McAllister D, van den Akker M, Marshall A, Seth S, Rawlings A, Lyons J, Lyons RA, Mizen A, Abubakar E, Dibben C, Guthrie B. Impact of data source choice on multimorbidity measurement: a comparison study of 2.3 million individuals in the Welsh National Health Service. BMC Med 2023; 21:309. [PMID: 37582755 PMCID: PMC10426056 DOI: 10.1186/s12916-023-02970-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/03/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Measurement of multimorbidity in research is variable, including the choice of the data source used to ascertain conditions. We compared the estimated prevalence of multimorbidity and associations with mortality using different data sources. METHODS A cross-sectional study of SAIL Databank data including 2,340,027 individuals of all ages living in Wales on 01 January 2019. Comparison of prevalence of multimorbidity and constituent 47 conditions using data from primary care (PC), hospital inpatient (HI), and linked PC-HI data sources and examination of associations between condition count and 12-month mortality. RESULTS Using linked PC-HI compared with only HI data, multimorbidity was more prevalent (32.2% versus 16.5%), and the population of people identified as having multimorbidity was younger (mean age 62.5 versus 66.8 years) and included more women (54.2% versus 52.6%). Individuals with multimorbidity in both PC and HI data had stronger associations with mortality than those with multimorbidity only in HI data (adjusted odds ratio 8.34 [95% CI 8.02-8.68] versus 6.95 (95%CI 6.79-7.12] in people with ≥ 4 conditions). The prevalence of conditions identified using only PC versus only HI data was significantly higher for 37/47 and significantly lower for 10/47: the highest PC/HI ratio was for depression (14.2 [95% CI 14.1-14.4]) and the lowest for aneurysm (0.51 [95% CI 0.5-0.5]). Agreement in ascertainment of conditions between the two data sources varied considerably, being slight for five (kappa < 0.20), fair for 12 (kappa 0.21-0.40), moderate for 16 (kappa 0.41-0.60), and substantial for 12 (kappa 0.61-0.80) conditions, and by body system was lowest for mental and behavioural disorders. The percentage agreement, individuals with a condition identified in both PC and HI data, was lowest in anxiety (4.6%) and highest in coronary artery disease (62.9%). CONCLUSIONS The use of single data sources may underestimate prevalence when measuring multimorbidity and many important conditions (especially mental and behavioural disorders). Caution should be used when interpreting findings of research examining individual and multiple long-term conditions using single data sources. Where available, researchers using electronic health data should link primary care and hospital inpatient data to generate more robust evidence to support evidence-based healthcare planning decisions for people with multimorbidity.
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Affiliation(s)
- Clare MacRae
- Advanced Care Research Centre, University of Edinburgh, Bio Cube 1, Edinburgh BioQuarter, 13 Little France Road, Edinburgh, UK.
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
| | - Daniel Morales
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Stewart W Mercer
- Advanced Care Research Centre, University of Edinburgh, Bio Cube 1, Edinburgh BioQuarter, 13 Little France Road, Edinburgh, UK
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Nazir Lone
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Andrew Lawson
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Emily Jefferson
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - David McAllister
- Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 9LX, UK
| | - Marjan van den Akker
- Institute of General Practice, Goethe University Frankfurt, Frankfurt Am Main, Germany
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Louvain, Belgium
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Alan Marshall
- School of Social and Political Science, University of Edinburgh, Chrystal Macmillan Building, Edinburgh, EH8 9LD, UK
| | - Sohan Seth
- School of Informatics, The University of Edinburgh, Edinburgh, UK
| | - Anna Rawlings
- Swansea University Medical School, Data Science Building, Singleton Campus, Swansea, UK
| | - Jane Lyons
- Swansea University Medical School, Data Science Building, Singleton Campus, Swansea, UK
| | - Ronan A Lyons
- Swansea University Medical School, Data Science Building, Singleton Campus, Swansea, UK
| | - Amy Mizen
- Swansea University Medical School, Data Science Building, Singleton Campus, Swansea, UK
| | - Eleojo Abubakar
- Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 9LX, UK
| | - Chris Dibben
- University of Edinburgh Institute of Geography, Institute of Geography Edinburgh, Edinburgh, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, University of Edinburgh, Bio Cube 1, Edinburgh BioQuarter, 13 Little France Road, Edinburgh, UK
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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27
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Corn G, Melbye M, Hlatky MA, Wohlfahrt J, Lund M. Association Between Age and Low-Density Lipoprotein Cholesterol Response to Statins : A Danish Nationwide Cohort Study. Ann Intern Med 2023; 176:1017-1026. [PMID: 37523692 DOI: 10.7326/m22-2643] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND There is large patient-to-patient variability in the low-density lipoprotein cholesterol (LDL-C) response to statin treatment. The reduction in LDL-C may depend on the age of the patient treated-particularly in older adults, who have been substantially underrepresented in randomized controlled trials. OBJECTIVE To investigate the association between age and the LDL-C reduction by statins. DESIGN Nationwide, register-based cohort study. SETTING Denmark, 2008 to 2018. PARTICIPANTS 82 958 simvastatin or atorvastatin initiators with LDL-C measurements before and during statin use. MEASUREMENTS Statin response, defined as percentage reduction in prestatin LDL-C level, and percentage reduction differences (PRDs) according to age and simvastatin or atorvastatin dose based on a longitudinal model for LDL-C. RESULTS Among 82 958 statin initiators, 10 388 (13%) were aged 75 years or older. With low- to moderate-intensity statins, initiators aged 75 years or older had greater mean LDL-C percentage reductions than initiators younger than 50 years-for example, 39.0% versus 33.8% for simvastatin, 20 mg, and 44.2% versus 40.2% for atorvastatin, 20 mg. The adjusted PRD for initiators aged 75 years compared with initiators aged 50 years was 2.62 percentage points. This association was consistent for primary prevention (2.54 percentage points) and secondary prevention (2.32 percentage points) but smaller for initiators of high-intensity statins (atorvastatin, 40 mg: 1.36 percentage points; atorvastatin, 80 mg: -0.58 percentage point). LIMITATION Use of administrative data, observational pre-post comparison with a moderately high proportion of missing data, lack of information on body mass index, and the mainly White study population may limit generalizability. CONCLUSION Low- to moderate-intensity statins were associated with a greater reduction in LDL-C levels in older persons than younger persons and may be more appealing as initial treatment in older adults who are at increased risk for adverse events. PRIMARY FUNDING SOURCE The Independent Research Fund Denmark, Brødrene Hartmanns Fond, and Fonden til Lægevidenskabens Fremme.
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Affiliation(s)
- Giulia Corn
- Department of Epidemiology Research, Statens Serum Institut, and Danish Cancer Society Research Center, Copenhagen, Denmark (G.C., J.W.)
| | - Mads Melbye
- Danish Cancer Society Research Center and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; K.G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and Technology, Trondheim, Norway; and Department of Genetics, Stanford University School of Medicine, Stanford, California (M.M.)
| | - Mark A Hlatky
- Department of Health Policy and Department of Medicine, Stanford University School of Medicine, Stanford, California (M.A.H.)
| | - Jan Wohlfahrt
- Department of Epidemiology Research, Statens Serum Institut, and Danish Cancer Society Research Center, Copenhagen, Denmark (G.C., J.W.)
| | - Marie Lund
- Department of Epidemiology Research, Statens Serum Institut; Department of Clinical Medicine, University of Copenhagen; and Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark (M.L.)
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O'Mahony D, Cherubini A, Guiteras AR, Denkinger M, Beuscart JB, Onder G, Gudmundsson A, Cruz-Jentoft AJ, Knol W, Bahat G, van der Velde N, Petrovic M, Curtin D. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med 2023; 14:625-632. [PMID: 37256475 PMCID: PMC10447584 DOI: 10.1007/s41999-023-00777-y] [Citation(s) in RCA: 86] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/31/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE STOPP/START is a physiological systems-based explicit set of criteria that attempts to define the clinically important prescribing problems relating to potentially inappropriate medications (PIMs-STOPP criteria) and potential prescribing omissions (PPOs-START criteria). The previous two versions of STOPP/START criteria were published in 2008 and 2015. The present study describes the revised and updated third version of the criteria. METHODS A detailed system-by-system review of the published literature from April 2014 to March 2022 was undertaken with the aim of including clinically important new explicit PIM and PPO criteria and removing any criteria considered to be no longer correct or outdated. A panel of 11 academic physicians with recognized expertise in geriatric pharmacotherapy from 8 European countries participated in a Delphi panel with the task of validating the draft criteria. The panel was presented with the draft new criteria using the SurveyMonkey® on-line platform in which panelists were asked to indicate their level of agreement on a five-point Likert scale. RESULTS Two hundred and four evidence-based draft criteria (one hundred and forty-five STOPP criteria, fifty-nine START criteria) were presented to panelists for assessment using the Delphi validation method. Over the course of four rounds of Delphi validation, the panel achieved consensus on 133 STOPP criteria and 57 START criteria, i.e., 190 STOPP/START criteria in total representing a 66.7% increase in the number of criteria compared to STOPP/START version 2 published in 2015. CONCLUSION A fully revised and updated version of STOPP/START criteria has been validated by a European expert panel using the Delphi consensus process.
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Affiliation(s)
- Denis O'Mahony
- Department of Medicine (Geriatric Medicine), School of Medicine, University College Cork, Cork, Ireland.
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di Ricerca Per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | - Michael Denkinger
- Institute for Geriatric Research, University of Ulm Geriatric Center, Alb-Donau, Ulm, Germany
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, 59000, Lille, France
| | - Graziano Onder
- Fondazione Policlinico Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gülistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Nathalie van der Velde
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Denis Curtin
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
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Chen A, Li Q, Shenkman E, Wu Y, Guo Y, Bian J. Exploring the Effect of Eligibility Criteria on AD Severity and Severe Adverse Event in Eligible Patients. IEEE INTERNATIONAL CONFERENCE ON HEALTHCARE INFORMATICS. IEEE INTERNATIONAL CONFERENCE ON HEALTHCARE INFORMATICS 2023; 2023:756-759. [PMID: 39070248 PMCID: PMC11273173 DOI: 10.1109/ichi57859.2023.00139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Clinical trials were vital tools to prove the effectiveness and safety of medications. To maximize generalizability, the study sample should represent the sample population and the target population. However, the clinical trial design tends to favor the evaluation of drug safety and procedure (i.e., internal validity) without clear knowledge of its penalty on trial generalizability (i.e., external validity). Alzheimer's Disease (AD) trials are known to have generalizability issues. Thus, in this study, we explore the effect of eligibility criteria on the AD severity patients and the severe adverse event (SAE) among the eligible patients.
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Affiliation(s)
- Aokun Chen
- Department of Health Outcome and Biomedical Informatics, College of Medicine University of Florida Gainesville, FL,USA
| | - Qian Li
- Department of Health Outcome and Biomedical Informatics, College of Medicine University of Florida Gainesville, FL,USA
| | - Elizabeth Shenkman
- Department of Health Outcome and Biomedical Informatics, College of Medicine University of Florida Gainesville, FL,USA
| | - Yonghui Wu
- Department of Health Outcome and Biomedical Informatics, College of Medicine University of Florida Gainesville, FL,USA
| | - Yi Guo
- Department of Health Outcome and Biomedical Informatics, College of Medicine University of Florida Gainesville, FL,USA
| | - Jiang Bian
- Department of Health Outcome and Biomedical Informatics, College of Medicine University of Florida Gainesville, FL,USA
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Visuri I, Eriksson C, Karlqvist S, Lykiardopoulos B, Karlén P, Grip O, Söderman C, Almer S, Hertervig E, Marsal J, Malmgren C, Delin J, Strid H, Sjöberg M, Bergemalm D, Hjortswang H, Halfvarson J. Long-term outcomes of vedolizumab in inflammatory bowel disease: the Swedish prospective multicentre SVEAH extension study. Therap Adv Gastroenterol 2023; 16:17562848231174953. [PMID: 37274297 PMCID: PMC10236258 DOI: 10.1177/17562848231174953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/24/2023] [Indexed: 06/06/2023] Open
Abstract
Background Real-world data on long-term outcomes of vedolizumab (VDZ) are scarce. Objective To assess long-term outcomes (up to 3 years) of VDZ in treating inflammatory bowel disease (IBD). Design A nationwide, prospective multicentre extension of a Swedish observational study on VDZ assessing Effectiveness And Healthcare resource utilization in patients with IBD (SVEAH). Methods After re-consent, data of patients with Crohn's disease (CD) (n = 68) and ulcerative colitis (UC) (n = 46) treated with VDZ were prospectively recorded using an electronic case report form integrated with the Swedish IBD Register (SWIBREG). The primary outcome was clinical remission (defined as Harvey-Bradshaw Index ⩽4 in CD and partial Mayo score ⩽2 in UC) at 104 and 156 weeks in patients with a response and/or remission 12 weeks after starting VDZ. Secondary outcomes included health-related quality of life (HRQoL) and biochemical outcomes. Results VDZ continuation rates were high at weeks 104 and 156, 88% and 84%, respectively, for CD and 87% and 78%, respectively, for UC. Of the 53 CD patients with a response/remission at 12 weeks, 40 (75%) patients were in remission at 104 weeks and 42 (79%) patients at 156 weeks. For UC, these numbers were 25/31 (81%) and 22/31 (71%), respectively. Improvements were seen in the Short Health Scale (p < 0.01 for each dimension; CD, n = 51; UC, n = 33) and the EuroQol 5-Dimensions, 5-levels index value (p < 0.01; CD, n = 39; UC, n = 30). Median plasma-C-reactive protein concentrations (mg/L) decreased from 5 at baseline to 4 in CD (p = 0.01, n = 53) and from 5 to 4 in UC (p = 0.03, n = 34) at 156 weeks. Correspondingly, median faecal-calprotectin (µg/g) decreased from 641 to 114 in CD patients (p < 0.01, n = 26) and from 387 to 37 in UC patients (p = 0.02, n = 17). Conclusion VDZ demonstrated high continuation rates and was associated with improvements in clinical outcomes, HRQoL measures and inflammatory markers at 2 and 3 years after treatment initiation in this prospective national SVEAH extension study. Registration ENCePP registration number: EUPAS22735.
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Affiliation(s)
- Isabella Visuri
- Department of Gastroenterology, Faculty of
Medicine and Health, Örebro University, Södra Grev Rosengatan 30, Örebro,
SE-70182 Sweden
| | - Carl Eriksson
- Department of Gastroenterology, Faculty of
Medicine and Health, Örebro University, Örebro, Sweden
- Clinical Epidemiology Division, Department of
Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sara Karlqvist
- Department of Gastroenterology, Faculty of
Medicine and Health, Örebro University, Örebro, Sweden
| | - Byron Lykiardopoulos
- Department of Gastroenterology and Hepatology,
Linköping University, Linköping, Sweden
| | - Per Karlén
- Department of Internal Medicine, Danderyd
Hospital, Stockholm, Sweden
| | - Olof Grip
- Department of Gastroenterology, Skåne
University Hospital, Malmö/Lund, Sweden
| | | | - Sven Almer
- Department of Medicine Solna, Division of
Gastroenterolgy, Karolinska Institutet, Stockholm, Sweden
- IBD-Unit, Division of Gastroenterology,
Karolinska University Hospital, Stockholm, Sweden
| | - Erik Hertervig
- Department of Gastroenterology, Skåne
University Hospital, Malmö/Lund, Sweden
| | - Jan Marsal
- Department of Gastroenterology, Skåne
University Hospital, Malmö/Lund, Sweden
| | | | - Jenny Delin
- Department of Gastroenterology, Ersta
Hospital, Stockholm, Sweden
| | - Hans Strid
- Department of Internal Medicine, Södra
Älvsborgs Hospital, Borås, Sweden
| | - Mats Sjöberg
- Department of Internal Medicine, Skaraborgs
Hospital, Lidköping, Sweden
| | - Daniel Bergemalm
- Department of Gastroenterology, Faculty of
Medicine and Health, Örebro University, Örebro, Sweden
| | - Henrik Hjortswang
- Department of Gastroenterology and Hepatology,
Linköping University, Linköping, Sweden
- Department of Health, Medicine, and Caring
Sciences, Linköping University, Linköping, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of
Medicine and Health, Örebro University, Örebro, Sweden
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Eckstrom E, Zauflik M, De Lima B. Matching enrolled trial participants to disease demographics: Using IRB submissions to identify opportunities for researcher training. J Clin Transl Sci 2023; 7:e114. [PMID: 37313384 PMCID: PMC10260342 DOI: 10.1017/cts.2023.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 06/15/2023] Open
Abstract
Background Many diseases are highly prevalent in older adults, yet older adults are often underrepresented in corresponding trials. Our objectives were to (1) determine alignment between Institutional Review Board (IRB) protocol age ranges and enrollment demographics to disease demographics pre- and post-implementation of the 2019 National Institutes of Health (NIH) Lifespan Policy and (2) raise awareness about inclusive recruitment to principal investigators (PIs). Methods This was a pre-post study. We reviewed investigator-initiated studies meeting eligibility criteria at Oregon Health & Science University from 2017 to 2018 to determine baseline alignment. Alignment was defined by the level of matching between protocol/enrollment age and disease demographics: 2 points for full match, 1 point for partial match, and 0 points for mismatch. After the NIH policy implementation, we reviewed new studies for alignment. When a mismatch was determined, we contacted PIs (either at initial IRB protocol submission or during ongoing recruitment) to raise awareness and provide strategies to expand inclusion of older adults in their trials. Results Studies that matched IRB protocol ages to disease demographics significantly improved from 78% pre-implementation to 91.2% post-implementation. Similarly, study enrollment ages matching disease demographics increased by 13.4% following the implementation (74.5%-87.9%). Out of 18 post-implementation mismatched studies, 7 PIs accepted a meeting and 3 subsequently changed their protocol age ranges. Conclusion This study highlights strategies that translational institutes and academic institutions could use to identify research studies whose participants do not align with disease demographics, offering opportunities for researcher awareness and training to enhance inclusion.
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Affiliation(s)
- Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
- Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Meredith Zauflik
- Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Bryanna De Lima
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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32
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Chen A, Li Q, He X, Jaffee MS, Hogan WR, Wang F, Guo Y, Bian J. Impacts of Eligibility Criteria on Trial Participants' Age in Alzheimer's Disease Clinical Trials. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2023; 2022:368-376. [PMID: 37128470 PMCID: PMC10148327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Overly restricted and poorly designed eligibility criteria reduce the generalizability of the results from clinical trials. We conducted a study to identify and quantify the impacts of study traits extracted from eligibility criteria on the age of study populations in Alzheimer's Disease (AD) clinical trials. Using machine learning methods and SHapley Additive exPlanation (SHAP) values, we identified 30 and 34 study traits that excluded older patients from AD trials in our 2 generated target populations respectively. We also found that study traits had different magnitudes of impacts on the age distributions of the generated study populations across racial-ethnic groups. To our best knowledge, this was the first study that quantified the impact of eligibility criteria on the age of AD trial participants. Our research is a first step in addressing the overly restrictive eligibility criteria in AD clinical trials.
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Affiliation(s)
- Aokun Chen
- University of Florida, Gainesville, Florida, USA
| | - Qian Li
- University of Florida, Gainesville, Florida, USA
| | - Xing He
- University of Florida, Gainesville, Florida, USA
| | | | | | - Fei Wang
- Weill Cornell Medicine, New York City, New York, USA
| | - Yi Guo
- University of Florida, Gainesville, Florida, USA
| | - Jiang Bian
- University of Florida, Gainesville, Florida, USA
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Killett A, Langdon PE, Ryan H, Shiggins C, Heywood R, Jimoh OF, Redley M, Bunning K. Inclusion of adults with conditions that have the potential to affect capacity and or communication in research: triangulation from a mixed-methods study of current practice and values across multiple stakeholders. BMJ Open 2023; 13:e068366. [PMID: 37116998 PMCID: PMC10151840 DOI: 10.1136/bmjopen-2022-068366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVES We aimed to: (A) describe researcher decision-making when including or excluding adults with conditions that have the potential to affect capacity and/or communication in research and (B) explore the underlying values and reasoning of stakeholders in research which falls under the provisions of the Mental Capacity Act, 2005. DESIGN The mixed-methods design included semistructured interviews with adults with conditions that have the potential to affect capacity and/or communication, supporters, researchers, research ethics committee members and an online survey with researchers. Triangulation was used to integrate the data and examine the complementarity of the findings. SETTING England and Wales. PARTICIPANTS There were 61 participants who took part in semistructured interviews, of which 39 were adults with conditions with potential to affect capacity and/or communication, 6 were in support roles for adults with conditions with potential to affect capacity and/or communication (including family members and professionals in advocacy organisations), 8 were members of research ethics committees flagged under the Mental Capacity Act to review research where there could be issues of mental capacity and 8 were researchers with experience of working with adults with conditions that have the potential to affect capacity and/or communication. The online survey had 128 participants, researchers with experience of working with adults with conditions that have the potential to affect capacity and/or communication. RESULTS All stakeholders were supportive of the genuine inclusion of adults with conditions that have the potential to affect capacity and/or communication in research, and exclusion was seen as a form of discrimination. Many researchers were daunted by meeting the threshold within the legislation for including participants who may lack capacity. CONCLUSION Further training, expertise and resources are required to promote the successful inclusion in research of adults with conditions that have the potential to affect capacity and/or communication.
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Affiliation(s)
- Anne Killett
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Peter E Langdon
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
- Centre for Mental Health and Wellbeing Research, University of Warwick, Coventry, UK
- Brooklands Hospital, Coventry and Warwickshire Partnership NHS Trust, Birmingham, UK
- Herefordshire and Worcestershire Health and Care NHS Trust, Worcester, UK
| | - Hayley Ryan
- Faculty of Medicine and Health, University of East Anglia, Norwich, UK
| | - Ciara Shiggins
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- La Trobe University Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
| | | | - Oluseyi F Jimoh
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Marcus Redley
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Karen Bunning
- School of Health Sciences, University of East Anglia, Norwich, UK
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Mathioudakis AG, Khaleva E, Fally M, Williamson PR, Jensen JU, Felton TW, Brightling C, Bush A, Winders T, Linnell J, Ramiconi V, Coleman C, Welte T, Roberts G, Vestbo J. Core outcome sets, developed collaboratively with patients, can improve the relevance and comparability of clinical trials. Eur Respir J 2023; 61:61/4/2202107. [PMID: 37012082 DOI: 10.1183/13993003.02107-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/16/2023] [Indexed: 04/05/2023]
Affiliation(s)
- Alexander G Mathioudakis
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- A.G. Mathioudakis, E. Khaleva and M. Fally contributed equally to this work
| | - Ekaterina Khaleva
- Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- A.G. Mathioudakis, E. Khaleva and M. Fally contributed equally to this work
| | - Markus Fally
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- A.G. Mathioudakis, E. Khaleva and M. Fally contributed equally to this work
| | - Paula R Williamson
- Department of Health Data Science, University of Liverpool, MRC/NIHR Trials Methodology Research Partnership, Liverpool, UK
| | - Jens-Ulrik Jensen
- Department of Medicine, Section of Respiratory Medicine, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tim W Felton
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- Acute Intensive Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Chris Brightling
- Institute for Lung Health, Leicester NIHR BRC, University of Leicester, Leicester, UK
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial School of Medicine, Imperial College London, London, UK
| | - Tonya Winders
- Allergy and Asthma Network, Vienna, VA, USA
- Global Allergy and Airways Patient Platform, Vienna, VA, USA
| | - John Linnell
- European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - Valeria Ramiconi
- European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | | | - Tobias Welte
- Department of Respiratory Medicine and German Centre of Lung Research (DZL), Hannover Medical School, Hanover, Germany
| | - Graham Roberts
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jørgen Vestbo
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Bogaerts JMK, Warmerdam LA, Achterberg WP, Gussekloo J, Poortvliet RKE. Proxy Decision-Making for Clinical Research in Nursing Home Residents With Dementia: A Qualitative Analysis. J Am Med Dir Assoc 2023; 24:541-547.e2. [PMID: 36924797 DOI: 10.1016/j.jamda.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVES The benefit-risk ratio of many interventions remains unclear in older adults with dementia. Efforts for more representative trial inclusion are made; however, recruiting and particularly gaining informed consent remains complex. For research participation, dementia compels the designation of a legal guardian (LG) to give proxy consent. To advance future trial development, we aimed to provide more insights into the factors that affect the proxy decision-making process in dementia research. DESIGN A qualitative analysis of semi-structured interviews about proxy decision-making on participation in dementia research. SETTING AND PARTICIPANTS LGs of nursing home residents that gave (n = 19) and refrained from giving (n = 18) proxy consent for a clinical trial (the ∗∗∗BLINDED∗∗∗ study) in the Netherlands. METHODS Verbatim transcripts were thematically analyzed by using a preliminary deductive framework with room for induction of additional emerging themes, being an overall abductive approach. Based on that theme list, related factors of the decision-making process were grouped into overarching levels and merged into a step-by-step process. RESULTS When discussing proxy decision-making on the participation of an older adult with dementia in a clinical trial, LGs described interconnected factors on the level of the study and patient. Past experiences and attitudes of the LG influenced the weighing of these study- and patient-related factors, leading to a preliminary decision. Other proxies and treating health care professionals (HCPs) were named as important other stakeholders of the decision-making process. CONCLUSIONS AND IMPLICATIONS When giving proxy consent for research participation, LGs weigh study- and patient-related factors, leading to an initial benefit-risk evaluation. This weighing process is influenced by LG-related factors and can be modulated by other proxies or treating HCPs, leading to a definitive decision. Although insights into these underlying mechanisms could facilitate the proxy decision-making process for both LGs and researchers, treating HCPs could act as an independent party.
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Affiliation(s)
- Jonathan M K Bogaerts
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
| | - Laurie A Warmerdam
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; University Network for the Care sector South Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Rosalinde K E Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; University Network for the Care sector South Holland, Leiden University Medical Center, Leiden, the Netherlands
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Skou ST, Nyberg M, Dideriksen M, Overgaard JA, Bodilsen C, Soja AMB, Attarzadeh AP, Bieder MJ, Dridi NP, Heltberg A, Gæde PH, Reventlow JL, Arnfred S, Bodtger U, Thygesen LC, Jäger M, Bricca A. Study protocol for a multicenter randomized controlled trial of personalized exercise therapy and self-management support for people with multimorbidity: The MOBILIZE study. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231154447. [PMID: 36762033 PMCID: PMC9903016 DOI: 10.1177/26335565231154447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Revised: 12/01/2022] [Accepted: 01/15/2023] [Indexed: 02/04/2023]
Abstract
Background Despite the great individual and societal burden associated with multimorbidity, little is known about how to effectively manage it. Objective The aim of this multicenter randomized controlled trial (RCT) is to investigate the 12-month effects of a personalized exercise therapy and self-management support program in addition to usual care in people with multimorbidity. Design This is a protocol for a pragmatic, parallel-group (1:1 ratio), superiority RCT conducted at five intervention sites (two hospitals, a private practice physiotherapy clinic and two municipal rehabilitation centers) in Region Zealand, Denmark. A total of 228 persons with multimorbidity aged 18 years or older, will be randomly allocated to one of two groups. Both groups will receive usual care, defined as routine care for multimorbidity at the discretion of the treating doctor, while the intervention group will also participate in a 12-week exercise therapy and self-management support program tailored to people with multimorbidity at one of the intervention sites. The primary outcome will be the between-group difference in change in EQ-5D-5L from baseline to the follow-up at 12 months. Secondary outcomes include objectively-measured physical function and physical activity, inflammatory markers, disease and treatment burden, anxiety, depression, stress, sleep, pain and other self-reported parameters. In parallel with the RCT, an observational cohort will follow persons aged ≥18 years with multimorbidity not adhering to all eligibility criteria, as well as people fulfilling all eligibility criteria, but unwilling to participate in the RCT. This study was approved by the Regional Committee on Health Research Ethics for Region Zealand (SJ-857) and results will be communicated in scientific papers, at relevant conferences and to a broader audience. Discussion Exercise therapy and self-management support is safe and effective in people with single conditions. However, it is still unclear whether this holds true for individuals with multimorbidity. This pragmatic, multicenter RCT will provide high-quality evidence on the benefits and harms of exercise therapy and self-management support and, if the results support it, lead to the development of a plan for implementation in clinical practice.
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Affiliation(s)
- Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Mette Nyberg
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Mette Dideriksen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Jan A Overgaard
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- Department of Rehabilitation, Lolland Municipality, Maribo, Denmark
| | - Christine Bodilsen
- Department of Exercise and Health, Roskilde Municipality, Roskilde, Denmark
| | - Anne MB Soja
- Department of Internal Medicine 1, Section of Cardiology, Holbæk Hospital, Holbæk, Denmark
| | - Amir P Attarzadeh
- Centre for Evidence-Based Orthopaedics, Department of Orthopedic Surgery, Zealand University Hospital, Køge, Denmark
| | - Manuel J Bieder
- Department of Orthopaedic Surgery, Næstved Hospital, Næstved, Denmark
| | - Nadia P Dridi
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Andreas Heltberg
- Department of General Practice, Institute of Public Health, University of Copenhagen, København K, Denmark
| | - Peter H Gæde
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense M, Denmark
| | | | - Sidse Arnfred
- Psychiatric Research Unit, Copenhagen University Hospital – Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Institute for Regional Health Research, University of Southern Denmark, Odense M, Denmark
- Pulmonary Research Unit Region Zealand (PLUZ), Department of Respiratory Medicine, Zealand University Hospital Næstved, Næstved, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen K, Denmark
| | - Madalina Jäger
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- Danish Centre for Motivation and Behaviour Science, University of Southern Denmark, Odense M, Denmark
| | - Alessio Bricca
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
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Nelson MLA, Singh H, Nie J, MacDonald S, Bayley M, Fortin C, Upshur R. Comparing stroke rehabilitation inpatients and clinical trials eligibility criteria: A secondary chart review analysis revealing that most patients could have been excluded from rehabilitation trials based on comorbidity status. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231211668. [PMID: 37927973 PMCID: PMC10624005 DOI: 10.1177/26335565231211668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
Background The generalizability of treatments examined in rehabilitation randomized controls trials (RCTs) partly depend on the similarity between trial subjects and a stroke rehabilitation inpatient population. The aim of this study was to determine the proportion of stroke rehabilitation inpatients that would have been eligible or ineligible to participate in published stroke RCTs. Methods This was a secondary analysis of chart review data collected as part of an independent quality improvement initiative. Data pertaining to the characteristics of stroke rehabilitation inpatients (e.g. age, cognitive impairment, previous stroke, comorbidities) were extracted from the medical charts of patients consecutively admitted to an inpatient stroke rehabilitation unit at a large urban rehabilitation hospital in Canada. Using the exclusion criteria categories of stroke RCTs identified from a systematic scoping review of 428 RCTs, we identified how many stroke rehabilitation inpatients would have been eligible or ineligible to participate in stroke RCTs based on their age, cognitive impairment, previous stroke and presence of comorbidities. Results In total, 110 stroke rehabilitation inpatients were included. Twenty-four percent of patients were 80 years of age or older, 84.5% had queries or concerns regarding patient cognitive abilities, 28.0% had a previous stroke, and 31.8% had a severe stroke. Stroke rehabilitation inpatients had six comorbidities on average. Based on these factors, most stroke rehabilitation inpatients could have been excluded from stroke RCTs, with cognitive impairment the most common RCT exclusion criteria. Conclusions Changes to the design of RCTs would support the development of clinical practice guidelines that reflect stroke rehabilitation inpatient characteristics, enhancing equity, diversity, and inclusion within samples and the generalizability of results.
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Affiliation(s)
- Michelle LA Nelson
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jason Nie
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Shannon MacDonald
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Hennick Bridgepoint Hospital, Sinai Health, Toronto, ON, Canada
| | - Mark Bayley
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | | | - Ross Upshur
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
- Institute of Clinical Evaluative Science, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, ON, Canada
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Doody P, Lord JM, Greig CA, Whittaker AC. Frailty: Pathophysiology, Theoretical and Operational Definition(s), Impact, Prevalence, Management and Prevention, in an Increasingly Economically Developed and Ageing World. Gerontology 2022; 69:927-945. [PMID: 36476630 PMCID: PMC10568610 DOI: 10.1159/000528561] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
The world's population is ageing, and most older adults experience a later life burdened with disease and disability. Frailty is a multidimensional and dynamic condition characterized by declines in reserve and function across multiple physiological systems, such that the ability to cope with every day or acute stressors becomes compromised. It is projected to become one of the most serious public health challenges economically developed societies will face in the coming century. This review provides a comprehensive overview of frailty, exploring its pathophysiology, theoretical and operational definition(s), impact, prevalence, management, and prevention, within the context of its emergence as a major public health challenge, in an increasingly economically developed and ageing world. Further, this review discusses the major limitations, deficiencies, and knowledge gaps presently within the field, and future research directions pertinent to the advancement of frailty research and the promotion of healthy longevity among the increasing global population of older adults.
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Affiliation(s)
- Paul Doody
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- The Irish Longitudinal Study on Ageing, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Janet M. Lord
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham., Birmingham, UK
| | - Carolyn A. Greig
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham., Birmingham, UK
| | - Anna C. Whittaker
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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Hanlon P, Butterly E, Shah ASV, Hannigan LJ, Wild SH, Guthrie B, Mair FS, Dias S, Welton NJ, McAllister DA. Assessing trial representativeness using serious adverse events: an observational analysis using aggregate and individual-level data from clinical trials and routine healthcare data. BMC Med 2022; 20:410. [PMID: 36303169 PMCID: PMC9615407 DOI: 10.1186/s12916-022-02594-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The applicability of randomised controlled trials of pharmacological agents to older people with frailty/multimorbidity is often uncertain, due to concerns that trials are not representative. However, assessing trial representativeness is challenging and complex. We explore an approach assessing trial representativeness by comparing rates of trial serious adverse events (SAE) to rates of hospitalisation/death in routine care. METHODS This was an observational analysis of individual (125 trials, n=122,069) and aggregate-level drug trial data (483 trials, n=636,267) for 21 index conditions compared to population-based routine healthcare data (routine care). Trials were identified from ClinicalTrials.gov . Routine care comparison from linked primary care and hospital data from Wales, UK (n=2.3M). Our outcome of interest was SAEs (routinely reported in trials). In routine care, SAEs were based on hospitalisations and deaths (which are SAEs by definition). We compared trial SAEs in trials to expected SAEs based on age/sex standardised routine care populations with the same index condition. Using IPD, we assessed the relationship between multimorbidity count and SAEs in both trials and routine care and assessed the impact on the observed/expected SAE ratio additionally accounting for multimorbidity. RESULTS For 12/21 index conditions, the pooled observed/expected SAE ratio was <1, indicating fewer SAEs in trial participants than in routine care. A further 6/21 had point estimates <1 but the 95% CI included the null. The median pooled estimate of observed/expected SAE ratio was 0.60 (95% CI 0.55-0.64; COPD) and the interquartile range was 0.44 (0.34-0.55; Parkinson's disease) to 0.87 (0.58-1.29; inflammatory bowel disease). Higher multimorbidity count was associated with SAEs across all index conditions in both routine care and trials. For most trials, the observed/expected SAE ratio moved closer to 1 after additionally accounting for multimorbidity count, but it nonetheless remained below 1 for most. CONCLUSIONS Trial participants experience fewer SAEs than expected based on age/sex/condition hospitalisation and death rates in routine care, confirming the predicted lack of representativeness. This difference is only partially explained by differences in multimorbidity. Assessing observed/expected SAE may help assess the applicability of trial findings to older populations in whom multimorbidity and frailty are common.
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Affiliation(s)
- Peter Hanlon
- School for Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Elaine Butterly
- School for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Anoop S V Shah
- London School of Hygiene and Tropical Medicine, London, UK
| | - Laurie J Hannigan
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Bruce Guthrie
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Frances S Mair
- School for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Tan YY, Papez V, Chang WH, Mueller SH, Denaxas S, Lai AG. Comparing clinical trial population representativeness to real-world populations: an external validity analysis encompassing 43 895 trials and 5 685 738 individuals across 989 unique drugs and 286 conditions in England. THE LANCET. HEALTHY LONGEVITY 2022; 3:e674-e689. [PMID: 36150402 DOI: 10.1016/s2666-7568(22)00186-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Randomised controlled trials (RCTs) inform prescription guidelines, but stringent eligibility criteria exclude individuals with vulnerable characteristics, which we define as comorbidities, concomitant medication use, and vulnerabilities due to age. Poor external validity can result in inadequate treatment decision information. Our first aim was to quantify the extent of exclusion of individuals with vulnerable characteristics from RCTs for all prescription drugs. Our second aim was to quantify the prevalence of individuals with vulnerable characteristics from population electronic health records who are actively prescribed such drugs. In tandem, these two aims will allow us to assess the representativeness between RCT and real-world populations and identify vulnerable populations potentially at risk of inadequate treatment decision information. When a vulnerable population is highly excluded from RCTs but has a high prevalence of individuals actively being prescribed the same medication, there is likely to be a gap in treatment decision information. Our third aim was to investigate the use of real-world evidence in contributing towards quantifying missing treatment risk or benefit through an observational study. METHODS We extracted RCTs from ClinicalTrials.gov from its inception to April 28, 2021, and primary care records from the Clinical Practice Research Datalink Gold database from Jan 1, 1998, to Dec 31, 2020. We referred to the British National Formulary to classify prescription drugs into drug categories. We conducted descriptive analyses and quantified RCT exclusion and prevalence of individuals with vulnerable characteristics for comparison to identify populations without treatment decision information. Exclusion and prevalence were assessed separately for different age groups, individual clinical specialities, and for quantities of concomitant conditions by clinical specialities, where multimorbidity was defined as having two or more clinical specialties, and medications prescribed, where polypharmacy was defined as having five or more medications prescribed. Population trends of individuals with multimorbidity or polypharmacy were assessed separately by age group. We conducted an observational cohort study to validate the use of real-world evidence in contributing towards quantifying treatment risk or benefit for patients with dementia on anti-dementia drugs with and without a contraindicated clinical speciality. To do so, we identified the clinical specialities that anti-dementia drug RCTs highly excluded yet had corresponding high prevalence in the real-world population, forming the groups with highest risk of having scarce treatment decision information. Cox regression was used to assess if the risk of mortality outcomes differs between both groups. FINDINGS 43 895 RCTs from ClinicalTrials.gov and 5 685 738 million individuals from primary care records were used. We considered 989 unique drugs and 286 conditions across 13 drug-category cohorts. For the descriptive analyses, the median RCT exclusion proportion across 13 drug categories was 81·5% (IQR 76·7-85·5) for adolescents (aged <18 years), 26·3% (IQR 21·0-29·5) for individuals older than 60 years, 40·5% (IQR 33·7-43·0) for individuals older than 70 years, and 52·9% (IQR 47·1-56·0) for individuals older than 80 years. Multimorbidity had a median exclusion proportion of 91·1% (IQR 88·9-91·8) and median prevalence of 41·0% (IQR 34·9-46·0). Concomitant medication use had a median exclusion proportion of 52·5% (IQR 50·0-53·7) and a median prevalence of 94·3% (IQR 84·3-97·2), and polypharmacy had a median prevalence of 47·7% (IQR 38·0-56·1). Population trends show increasing multimorbidity with age and consistently high polypharmacy across age groups. Populations with cardiovascular or otorhinolaryngological comorbidities had the highest risk of having scarce treatment decision information. For the observational study, populations with cardiovascular or psychiatric comorbidities had highest risk of having scarce treatment decision information. Patients with dementia with an anti-dementia prescription and contraindicated cardiovascular condition had a higher risk of mortality (hazard ratio [HR] 1·20 [95% CI 1·13-1·28 ; p<0·0001]) compared with patients with dementia without a contraindicated cardiovascular condition. Patients with dementia with comorbid delirium (HR 1·25 [95% CI 1·06-1·48]; p<0·0088), intellectual disability (HR 2·72 [95% CI 1·53-4·81]; p=0·0006), and schizophrenia and schizotypal delusional disorders (HR 1·36 [95% CI 1·02-1·82]; p=0·036) had a higher risk of mortality compared with patients with dementia without these conditions. INTERPRETATION Overly stringent RCT exclusion criteria do not appropriately account for the heterogeneity of vulnerable characteristics observed in real-world populations. Treatment decision information is scarce for such individuals, which might affect health outcomes. We discuss the challenges facing the inclusivity of such individuals and highlight the strength of real-world evidence as an integrative solution in complementing RCTs and increasing the completeness of evidence-based medicine assessments in evaluating the effectiveness of treatment decisions. FUNDING Wellcome Trust, National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre, Academy of Medical Sciences, and the University College London Overseas Research Scholarship.
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Affiliation(s)
- Yen Yi Tan
- Institute of Health Informatics, University College London, London, UK.
| | - Vaclav Papez
- Institute of Health Informatics, University College London, London, UK
| | - Wai Hoong Chang
- Institute of Health Informatics, University College London, London, UK
| | | | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
| | - Alvina G Lai
- Institute of Health Informatics, University College London, London, UK
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Massano D, Carraro E, Mussolin L, Buffardi S, Barat V, Zama D, Muggeo P, Vendemini F, Sau A, Moleti ML, Verzegnassi F, D'Amico S, Casini T, Garaventa A, Schiavello E, Cellini M, Vinti L, Farruggia P, Perruccio K, Cesaro S, De Santis R, Marinoni M, D'Alba I, Mura RM, Burnelli R, Mascarin M, Pillon M. Brentuximab vedotin in the treatment of paediatric patients with relapsed or refractory Hodgkin's lymphoma: Results of a real-life study. Pediatr Blood Cancer 2022; 69:e29801. [PMID: 35656841 DOI: 10.1002/pbc.29801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/22/2022] [Accepted: 05/06/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Brentuximab vedotin (BV) is an antibody drug-conjugated anti-CD30 approved for the treatment of adult classical Hodgkin's lymphoma (HL), whereas it is considered as off-label indication in paediatrics. The aim of the study was to evaluate the safety and efficacy of BV to treat patients aged less than 18 years with refractory/relapsed HL. MATERIALS AND METHODS In this multicentre, retrospective study, 68 paediatric patients who received at least one dose of BV between November 2011 and August 2020 were enrolled. A median of nine doses of BV were administered as monotherapy (n = 31) or combined with other therapies (n = 37). BV was administrated alone as consolidation therapy after stem cell transplantation (SCT) in 12 patients, before SCT in 18 patients, whereas in 15 patients it was used before and after SCT as consolidation therapy. Median follow-up was 2.8 years (range: 0.6-8.9 years). RESULTS The best response was observed in the 86% of patients; the overall response rate was 66%. The 3-year progression-free survival was 58%, whereas the overall survival was 75%. No statistically significant differences between patients treated with BV monotherapy or combination were highlighted. In multivariate analysis, patients with non-nodular sclerosis HL and not transplanted had an increased risk of failure. Overall, 46% of patients had grade 3-4 adverse events that led to BV discontinuation in five of them. CONCLUSION In conclusion, our study confirms that BV was a safe and effective drug, able to induce complete remission, either as monotherapy or in association with standard therapy.
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Affiliation(s)
- Davide Massano
- Paediatric Hematology, Oncology and Stem Cell Transplant Division, Padova University Hospital, Padua, Italy
| | - Elisa Carraro
- Paediatric Hematology, Oncology and Stem Cell Transplant Division, Padova University Hospital, Padua, Italy
| | - Lara Mussolin
- Maternal and Child Health Department, Padova University Hospital, Padua, Italy.,Istituto di Ricerca Pediatrica Città della Speranza, Padua, Italy
| | - Salvatore Buffardi
- Paediatric Haemato-Oncology Department, Santobono-Pausilipon Children's Hospital, Napoli, Italy
| | - Veronica Barat
- Paediatric Onco-Hematology and Stem Cell Transplant Division, City of Health and Science, Regina Margherita Children's Hospital, Torino, Italy
| | - Daniele Zama
- Department of Paediatrics, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Paola Muggeo
- Department of Paediatric Oncology and Hematology, University Hospital of Policlinico, Bari, Italy
| | - Francesca Vendemini
- Department of Paediatrics, Ospedale San Gerardo, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Antonella Sau
- Paediatric Hematology-Oncology Unit, Ospedale Civico, Pescara, Italy
| | - Maria Luisa Moleti
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | | | - Salvatore D'Amico
- Department of Clinical and Experimental Medicine, Paediatric Haemato-Oncology Unit, University of Catania, Catania, Italy
| | - Tommaso Casini
- Paediatric Haematology-Oncology Unit, Meyer Paediatric Hospital, Florence, Italy
| | - Alberto Garaventa
- Paediatric Oncology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elisabetta Schiavello
- Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Paediatric Oncology Unit, Milan, Italy
| | - Monica Cellini
- Department of Paediatrics, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Luciana Vinti
- Department of Paediatric Hematology and Oncology, IRCSS Ospedale Bambino Gesù, Rome, Italy
| | - Piero Farruggia
- Paediatric Hematology and Oncology Unit, Oncology Department, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
| | - Katia Perruccio
- Paediatric Hematology-Oncology Unit, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Simone Cesaro
- Paediatric Hematology Oncology Unit, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Raffaela De Santis
- IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Maddalena Marinoni
- Paediatric Department, Hospital 'F. Del Ponte', University of Insubria, Varese, Italy
| | - Irene D'Alba
- Division of Paediatric Hematology and Oncology, Ospedale G. Salesi, Ancona, Italy
| | - Rosa Maria Mura
- Paediatric Hematology and Oncology Unit, Ospedale Pediatrico Microcitemico, Cagliari, Italy
| | - Roberta Burnelli
- Paediatric Hemato-Oncology Unit, Azienda Ospedaliero Universitaria Sant'Anna di Ferrara, Ferrara, Italy
| | - Maurizio Mascarin
- AYA Oncology and Paediatric Radiotherapy Unit, CRO-Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Marta Pillon
- Paediatric Hematology, Oncology and Stem Cell Transplant Division, Padova University Hospital, Padua, Italy
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Dawson S, Banister K, Biggs K, Cotton S, Devane D, Gardner H, Gillies K, Gopalakrishnan G, Isaacs T, Khunti K, Nichol A, Parker A, Russell AM, Shepherd V, Shiely F, Shorter G, Starling B, Williams H, Willis A, Witham MD, Treweek S. Trial Forge Guidance 3: randomised trials and how to recruit and retain individuals from ethnic minority groups-practical guidance to support better practice. Trials 2022; 23:672. [PMID: 35978338 PMCID: PMC9383663 DOI: 10.1186/s13063-022-06553-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/16/2022] [Indexed: 11/23/2022] Open
Abstract
Randomised trials, especially those intended to directly inform clinical practice and policy, should be designed to reflect all those who could benefit from the intervention under test should it prove effective. This does not always happen. The UK National Institute for Health and Care Research (NIHR) INCLUDE project identified many groups in the UK that are under-served by trials, including ethnic minorities.This guidance document presents four key recommendations for designing and running trials that include the ethnic groups needed by the trial. These are (1) ensure eligibility criteria and recruitment pathway do not limit participation in ways you do not intend, (2) ensure your trial materials are developed with inclusion in mind, (3) ensure staff are culturally competent and (4) build trusting partnerships with community organisations that work with ethnic minority groups. Each recommendation comes with best practice advice, public contributor testimonials, examples of the inclusion problem tackled by the recommendation, or strategies to mitigate the problem, as well as a collection of resources to support implementation of the recommendations.We encourage trial teams to follow the recommendations and, where possible, evaluate the strategies they use to implement them. Finally, while our primary audience is those designing, running and reporting trials, we hope funders, grant reviewers and approvals agencies may also find our guidance useful.
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Affiliation(s)
- Shoba Dawson
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, BS8 2PS UK
| | - Katie Banister
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD UK
| | - Katie Biggs
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA UK
| | - Seonaidh Cotton
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD UK
| | - Declane Devane
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), School of Nursing and Midwifery, National University of Ireland Galway, University Road, Galway, Ireland
| | - Heidi Gardner
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD UK
| | | | - Talia Isaacs
- UCL Centre for Applied Linguistics, IOE, UCL’s Faculty of Education and Society, University College London, London, WC1H 0AL UK
| | - Kamlesh Khunti
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW UK
- National Institute for Health Research (NIHR), Applied Research Collaboration (ARC) East Midlands, University of Leicester, Leicester, UK
| | - Alistair Nichol
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Adwoa Parker
- York Clinical Trials Unit, University of York, York, UK
| | - Amy M. Russell
- WHO Disability Team, Geneva/ Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Victoria Shepherd
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Frances Shiely
- Health Research Board Clinical Research Facility and School of Public Health, University College Cork, Cork, Ireland
| | - Gillian Shorter
- Drug and Alcohol Research Network, Queen’s University Belfast, Belfast, UK
- Centre for Improving Health Related Quality of Life, School of Psychology, Queen’s University Belfast, Belfast, UK
| | - Bella Starling
- Public Programmes Team (now Vocal), Manchester University NHS Foundation Trust, Research & Innovation Division, The Nowgen Centre, 29 Grafton Street, Manchester, M13 9WU UK
- NIHR Manchester Biomedical Research Centre, NIHR Manchester Clinical Research Facility, Manchester, UK
| | - Hywel Williams
- Centre of Evidence-Based Dermatology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH UK
| | - Andrew Willis
- NIHR ARC East Midlands, University of Leicester, Leicester, UK
| | - Miles D. Witham
- NIHR Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle University and Newcastle upon Tyne NHS Trust, Newcastle, NE4 5PL UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD UK
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Miao M, Rietdijk R, Brunner M, Debono D, Togher L, Power E. Implementation of Web-Based Psychosocial Interventions for Adults With Acquired Brain Injury and Their Caregivers: Systematic Review. J Med Internet Res 2022; 24:e38100. [PMID: 35881432 PMCID: PMC9328122 DOI: 10.2196/38100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/16/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND More than 135 million people worldwide live with acquired brain injury (ABI) and its many psychosocial sequelae. This growing global burden necessitates scalable rehabilitation services. Despite demonstrated potential to increase the accessibility and scalability of psychosocial supports, digital health interventions are challenging to implement and sustain. The Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework can offer developers and researchers a comprehensive overview of considerations to implement, scale, and sustain digital health interventions. OBJECTIVE This systematic review identified published, peer-reviewed primary evidence of implementation outcomes, strategies, and factors for web-based psychosocial interventions targeting either adults with ABI or their formal or informal caregivers; evaluated and summarized this evidence; synthesized qualitative and quantitative implementation data according to the NASSS framework; and provided recommendations for future implementation. Results were compared with 3 hypotheses which state that complexity (dynamic, unpredictable, and poorly characterized factors) in most or all NASSS domains increases likelihood of implementation failure; success is achievable, but difficult with many complicated domains (containing multiple interacting factors); and simplicity (straightforward, predictable, and few factors) in most or all domains increases the likelihood of success. METHODS From a comprehensive search of MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, speechBITE, and neuroBITE, we reviewed primary implementation evidence from January 2008 to June 2020. For web-based psychosocial interventions delivered via standard desktop computer, mobile phone, tablet, television, and virtual reality devices to adults with ABI or their formal or informal caregivers, we extracted intervention characteristics, stakeholder involvement, implementation scope and outcomes, study design and quality, and implementation data. Implementation data were both narratively synthesized and descriptively quantified across all 7 domains (condition, technology, value proposition, adopters, organization, wider system, and their interaction over time) and all subdomains of the NASSS framework. Study quality and risk of bias were assessed using the 2018 Mixed Methods Appraisal Tool. RESULTS We identified 60 peer-reviewed studies from 12 countries, including 5723 adults with ABI, 1920 carers, and 50 health care staff. The findings aligned with all 3 hypotheses. CONCLUSIONS Although studies were of low methodological quality and insufficient number to statistically test relationships, the results appeared consistent with recommendations to reduce complexity as much as possible to facilitate implementation. Although studies excluded individuals with a range of comorbidities and sociocultural challenges, such simplification of NASSS domain 1 may have been necessary to advance intervention value propositions (domain 3). However, to create equitable digital health solutions that can be successfully implemented in real-world settings, it is recommended that developers involve people with ABI, their close others, and health care staff in addressing complexities in domains 2 to 7 from the earliest intervention design stages. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020186387; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020186387. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1177/20552076211035988.
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Affiliation(s)
- Melissa Miao
- University of Technology Sydney, Sydney, Australia
| | | | | | | | | | - Emma Power
- University of Technology Sydney, Sydney, Australia
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Skou ST, Mair FS, Fortin M, Guthrie B, Nunes BP, Miranda JJ, Boyd CM, Pati S, Mtenga S, Smith SM. Multimorbidity. Nat Rev Dis Primers 2022; 8:48. [PMID: 35835758 PMCID: PMC7613517 DOI: 10.1038/s41572-022-00376-4] [Citation(s) in RCA: 262] [Impact Index Per Article: 131.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 02/06/2023]
Abstract
Multimorbidity (two or more coexisting conditions in an individual) is a growing global challenge with substantial effects on individuals, carers and society. Multimorbidity occurs a decade earlier in socioeconomically deprived communities and is associated with premature death, poorer function and quality of life and increased health-care utilization. Mechanisms underlying the development of multimorbidity are complex, interrelated and multilevel, but are related to ageing and underlying biological mechanisms and broader determinants of health such as socioeconomic deprivation. Little is known about prevention of multimorbidity, but focusing on psychosocial and behavioural factors, particularly population level interventions and structural changes, is likely to be beneficial. Most clinical practice guidelines and health-care training and delivery focus on single diseases, leading to care that is sometimes inadequate and potentially harmful. Multimorbidity requires person-centred care, prioritizing what matters most to the individual and the individual's carers, ensuring care that is effectively coordinated and minimally disruptive, and aligns with the patient's values. Interventions are likely to be complex and multifaceted. Although an increasing number of studies have examined multimorbidity interventions, there is still limited evidence to support any approach. Greater investment in multimorbidity research and training along with reconfiguration of health care supporting the management of multimorbidity is urgently needed.
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Affiliation(s)
- Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark.
| | - Frances S Mair
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruno P Nunes
- Postgraduate Program in Nursing, Faculty of Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Epidemiology and Health Policy & Management, Johns Hopkins University, Baltimore, MD, USA
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sally Mtenga
- Department of Health System Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Susan M Smith
- Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Russell Building, Tallaght Cross, Dublin, Ireland
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Al‑Foheidi M, Albeshri A, Moamenkahan S, Abdullah A, Abualola M, Alharbi M, Refa A, Bayer A, Shaheen A, Aga S, Khan M, Al‑Mansour M, Ibrahim E. Combination of palbociclib with adjuvant endocrine therapy for treatment of hormone receptor‑positive and human epidermal growth factor receptor 2‑negative metastatic breast cancer: An experience at two cancer centers in Saudi Arabia. Mol Clin Oncol 2022; 17:119. [PMID: 35747598 PMCID: PMC9204325 DOI: 10.3892/mco.2022.2552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/12/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Meteb Al‑Foheidi
- Princess Noorah Oncology Center, National Guard Health Affairs, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Asem Albeshri
- Princess Noorah Oncology Center, National Guard Health Affairs, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Safwan Moamenkahan
- Princess Noorah Oncology Center, National Guard Health Affairs, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Abdulmajid Abdullah
- Princess Noorah Oncology Center, National Guard Health Affairs, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Muhannad Abualola
- Princess Noorah Oncology Center, National Guard Health Affairs, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Muath Alharbi
- Princess Noorah Oncology Center, National Guard Health Affairs, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Ahmed Refa
- Oncology Center, International Medical Center, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Ali Bayer
- Oncology Center, International Medical Center, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Ahmed Shaheen
- Oncology Center, International Medical Center, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Syed Aga
- Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Muhammad Khan
- Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Mubarak Al‑Mansour
- Princess Noorah Oncology Center, National Guard Health Affairs, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Ezzeldin Ibrahim
- Oncology Center, International Medical Center, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
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Howard-Anderson J, Dai W, Yahav D, Hamasaki T, Turjeman A, Koppel F, Franceschini E, Hill C, Sund Z, Chambers HF, Fowler VG, Boucher HW, Evans SR, Paul M, Holland TL, Doernberg SB. A Desirability of Outcome Ranking Analysis of a Randomized Clinical Trial Comparing Seven Versus Fourteen Days of Antibiotics for Uncomplicated Gram-Negative Bloodstream Infection. Open Forum Infect Dis 2022; 9:ofac140. [PMID: 35615299 PMCID: PMC9125302 DOI: 10.1093/ofid/ofac140] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/17/2022] [Indexed: 11/21/2022] Open
Abstract
Background Although a short course (7 days) of antibiotics has been demonstrated to be noninferior to a conventional course (14 days) in terms of mortality and infectious complications for patients with a Gram-negative bacterial bloodstream infection (GNB), it is unknown whether a shorter treatment duration can provide a better overall clinical outcome. Methods We applied a bloodstream infection-specific desirability of outcome ranking (DOOR) analysis to the results of a previously completed, randomized controlled trial comparing short versus conventional course antibiotic therapy for hospitalized patients with uncomplicated GNB. We determined the probability that a randomly selected participant in the short course group would have a more desirable overall outcome than a participant in the conventional duration group. We performed (1) partial credit analyses allowing for calculated and variable weighting of DOOR ranks and (2) subgroup analyses to elucidate which patients may benefit the most from short durations of therapy. Results For the 604 patients included in the original study (306 short course, 298 conventional course), the probability of having a more desirable outcome with a short course of antibiotics compared with a conventional course was 51.1% (95% confidence interval, 46.7% to 55.4%), indicating no significant difference. Partial credit analyses indicated that the DOOR results were similar across different patient preferences. Prespecified subgroup analyses using DOOR did not reveal significant differences between short and conventional courses of therapy. Conclusions Both short and conventional durations of antibiotic therapy provide comparable clinical outcomes when using DOOR to consider benefits and risks of treatment options for GNB.
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Affiliation(s)
- Jessica Howard-Anderson
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Weixiao Dai
- The Biostatistics Center and Department of Biostatics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Dafna Yahav
- Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Toshimitsu Hamasaki
- The Biostatistics Center and Department of Biostatics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Adi Turjeman
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Fidi Koppel
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Erica Franceschini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Carol Hill
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Zoë Sund
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Henry F Chambers
- Department of Internal Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, California, USA
| | - Vance G Fowler
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Helen W Boucher
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA
| | - Scott R Evans
- The Biostatistics Center and Department of Biostatics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Mical Paul
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
- Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Thomas L Holland
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Sarah B Doernberg
- Department of Internal Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, California, USA
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Zhao D, Yao C. Pragmatic Clinical Studies: An Emerging Clinical Research Discipline for Improving Evidence-Based Practice of Cardiovascular Diseases in Asia. Korean Circ J 2022; 52:401-413. [PMID: 35656900 PMCID: PMC9160648 DOI: 10.4070/kcj.2022.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 04/13/2022] [Indexed: 11/11/2022] Open
Abstract
Pragmatic clinical studies, an emerging clinical research discipline, include a wide range of studies that are largely embedded with routine clinical practice and aim to evaluate the comparative effectiveness and safety of different clinical intervention strategies. Increased availability and quality of electronic medical/health records drives the development of pragmatic clinical studies. In this review, we describe evolution of the conceptual framework of pragmatic clinical studies and share perspectives on the importance of pragmatic clinical studies in evidence-based practice for cardiovascular diseases, as a complement to conventional randomized controlled trials. We also highlight specific needs of pragmatic clinical studies in improving evidence-based practice for cardiovascular disease in Asian countries. The main challenges of pragmatic clinical studies are discussed briefly in this review.
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Affiliation(s)
- Dong Zhao
- Capital Medical University Beijing Anzhen Hospital-Beijing Institute of Heart, Lung & Blood Vessel Diseases, Beijing, China.
| | - Chen Yao
- Peking University Clinical Research Institute. Peking University First Hospital, Beijing, China
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Robertson C, Aceves-Martins M, Cruickshank M, Imamura M, Avenell A. Does weight management research for adults with severe obesity represent them? Analysis of systematic review data. BMJ Open 2022; 12:e054459. [PMID: 35641006 PMCID: PMC9157335 DOI: 10.1136/bmjopen-2021-054459] [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: 01/06/2023] Open
Abstract
OBJECTIVE Our objective was to determine the extent to which current evidence from long-term randomised controlled trials (RCTs) of weight management is generalisable and applicable to underserved adult groups with obesity (body mass index (BMI) ≥35 kg/m2). METHODS Descriptive analysis of 131 RCTs, published after 1990-May 2017 with ≥1 year of follow-up, included in a systematic review of long-term weight management interventions for adults with BMI ≥35 kg/m2 (the REBALANCE Project). Studies were identified from MEDLINE, EMBASE, PsychINFO, SCI, CENTRAL and from hand searching. Reporting of trial inclusion and exclusion criteria, trial recruitment strategies, baseline characteristics and outcomes were analysed using a predefined list of characteristics informed by the PROGRESS (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital)-Plus framework and the UK Equality Act 2010. RESULTS Few (6.1%) trials reported adapting recruitment to appeal to underserved groups. 10.0% reported culturally adapting their trial materials. Only 6.1% of trials gave any justification for their exclusion criteria, yet over half excluded participation for age or mental health reasons. Just over half (58%) of the trials reported participants' race or ethnicity, and one-fifth reported socioeconomic status. Where outcomes were reported for underserved groups, the most common analysis was by sex (47.3%), followed by race or ethnicity (16.8%). 3.1% of trials reported outcomes according to socioeconomic status. DISCUSSION Although we were limited by poor trial reporting, our results indicate inadequate representation of people most at risk of obesity. Guidance for considering underserved groups may improve the appropriateness of research and inform greater engagement with health and social care services. FUNDING National Institute for Health Research Health Technology Assessment Programme (project number: 15/09/04). PROSPERO REGISTRATION NUMBER CRD42016040190.
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Affiliation(s)
- Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Mari Imamura
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Mohamed MO. Prevention is better than cure: modifiable risk factors for heart failure better understood. Eur J Heart Fail 2022; 24:481-482. [PMID: 35119161 DOI: 10.1002/ejhf.2448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/31/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Mohamed O Mohamed
- Keele Cardiovascular Research Group, Keele University, United Kingdom
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50
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Faber CG, Geerts M, Hoeijmakers JG, de Greef BT. Follow-up Author Response: Intravenous Immunoglobulin Therapy in Patients With Painful Idiopathic Small Fiber Neuropathy. Neurology 2022; 98:129-130. [PMID: 35039458 DOI: 10.1212/wnl.0000000000013083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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