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Qin Z, Zhu Y, Shi DD, Chen R, Li S, Wu J. The gap between statistical and clinical significance: time to pay attention to clinical relevance in patient-reported outcome measures of insomnia. BMC Med Res Methodol 2024; 24:177. [PMID: 39118002 PMCID: PMC11308508 DOI: 10.1186/s12874-024-02297-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 07/25/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Appropriately defining and using the minimal important change (MIC) and the minimal clinically important difference (MCID) are crucial for determining whether the results are clinically significant. The aim of this study is to survey the status of randomized controlled trials (RCTs) for insomnia interventions to assess the inclusion and interpretation of MIC/MCID values. METHODS We conducted a cross-sectional study to survey the status of RCTs for insomnia interventions to assess the inclusion and appropriate interpretation of MIC/MCID values. A literature search was conducted by searching the main sleep medicine journals indexed in PubMed, the Excerpta Medica Database (EMBASE), and the Cochrane Central Register of Controlled Trials (CENTRAL) to identify a broad range of search terms. We included RCTs with no restriction on the intervention. The included studies used the Insomnia Severity Index (ISI) or the Pittsburgh Sleep Quality Index (PSQI) questionnaire as the outcome measures. RESULTS 81 eligible studies were identified, and more than one-third of the included studies used MIC/MCID (n = 31, 38.3%). Among them, 21 studies with ISI as the outcome used MIC defined as a relative decrease ranging from 3 to 8 points. The most frequently used MIC value was a 6-point decrease (n = 7), followed by 8-point (n = 6) and 7-point decrease (n = 4), a 4 to 5-points decrease (n = 3), and a 30% reduction from baseline; 6 studies used MCID values, ranging from 2.8 to 4 points. The most frequently used MCID value was a 4-point decrease in the ISI (n = 4). 4 studies with PSQI as the outcome used a 3-point change as the MIC (n = 2) and a 2.5 to 2.7-point difference as MCID (n = 2). 4 non-inferiority design studies considered interval estimation when drawing clinically significant conclusions in their MCID usage. CONCLUSIONS The lack of consistent MIC/MCID interpretation and usage in outcome measures for insomnia highlights the urgent need for further efforts to address this issue and improve reporting practices.
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Affiliation(s)
- Zongshi Qin
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China.
| | - Yidan Zhu
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
| | - Dong-Dong Shi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rumeng Chen
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Sen Li
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China.
| | - Jiani Wu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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Bellmann L, Wiederhold AJ, Trübe L, Twerenbold R, Ückert F, Gottfried K. Introducing Attribute Association Graphs to Facilitate Medical Data Exploration: Development and Evaluation Using Epidemiological Study Data. JMIR Med Inform 2024; 12:e49865. [PMID: 39046780 PMCID: PMC11306949 DOI: 10.2196/49865] [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: 06/12/2023] [Revised: 10/11/2023] [Accepted: 05/04/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Interpretability and intuitive visualization facilitate medical knowledge generation through big data. In addition, robustness to high-dimensional and missing data is a requirement for statistical approaches in the medical domain. A method tailored to the needs of physicians must meet all the abovementioned criteria. OBJECTIVE This study aims to develop an accessible tool for visual data exploration without the need for programming knowledge, adjusting complex parameterizations, or handling missing data. We sought to use statistical analysis using the setting of disease and control cohorts familiar to clinical researchers. We aimed to guide the user by identifying and highlighting data patterns associated with disease and reveal relations between attributes within the data set. METHODS We introduce the attribute association graph, a novel graph structure designed for visual data exploration using robust statistical metrics. The nodes capture frequencies of participant attributes in disease and control cohorts as well as deviations between groups. The edges represent conditional relations between attributes. The graph is visualized using the Neo4j (Neo4j, Inc) data platform and can be interactively explored without the need for technical knowledge. Nodes with high deviations between cohorts and edges of noticeable conditional relationship are highlighted to guide the user during the exploration. The graph is accompanied by a dashboard visualizing variable distributions. For evaluation, we applied the graph and dashboard to the Hamburg City Health Study data set, a large cohort study conducted in the city of Hamburg, Germany. All data structures can be accessed freely by researchers, physicians, and patients. In addition, we developed a user test conducted with physicians incorporating the System Usability Scale, individual questions, and user tasks. RESULTS We evaluated the attribute association graph and dashboard through an exemplary data analysis of participants with a general cardiovascular disease in the Hamburg City Health Study data set. All results extracted from the graph structure and dashboard are in accordance with findings from the literature, except for unusually low cholesterol levels in participants with cardiovascular disease, which could be induced by medication. In addition, 95% CIs of Pearson correlation coefficients were calculated for all associations identified during the data analysis, confirming the results. In addition, a user test with 10 physicians assessing the usability of the proposed methods was conducted. A System Usability Scale score of 70.5% and average successful task completion of 81.4% were reported. CONCLUSIONS The proposed attribute association graph and dashboard enable intuitive visual data exploration. They are robust to high-dimensional as well as missing data and require no parameterization. The usability for clinicians was confirmed via a user test, and the validity of the statistical results was confirmed by associations known from literature and standard statistical inference.
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Affiliation(s)
- Louis Bellmann
- Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Leona Trübe
- Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raphael Twerenbold
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Hamburg-Kiel-Lübeck, Hamburg, Germany
- University Center of Cardiovascular Science, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Ückert
- Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Gottfried
- Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Pehora C, Johnston B, Shah U, Mireskandari K, Ali A, Crawford MW. Efficacy of the Subtenon Block in Children Undergoing Strabismus Surgery: A Systematic Review and Meta-Analysis. Am J Ophthalmol 2024; 268:108-122. [PMID: 39048060 DOI: 10.1016/j.ajo.2024.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/08/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE To investigate the efficacy of the subtenon block in preventing postoperative complications in children undergoing strabismus surgery. DESIGN Systematic review and meta-analysis. METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Scopus, Web of Science, and clinicaltrials.gov. All randomized controlled trials investigating the efficacy of the subtenon block in children undergoing strabismus surgery were included. Outcomes included severity of pain after surgery, number of children requiring postoperative opioid and nonopioid analgesia, and the incidences of postoperative nausea and vomiting, oculocardiac events, and block-related complications. We pooled continuous outcomes using a random-effects model to calculate the mean difference (MD) and/or standardized MD and corresponding 95% confidence intervals (CI). Dichotomous outcomes were pooled using a random-effect model to calculate the relative risk (RR) and corresponding 95% CI. Risk of bias was assessed using the Cochrane Risk of Bias instrument and quality of evidence was assessed using a Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS Nine randomized controlled trials (607 participants) were included. We found evidence for an effect of the subtenon block in reducing pain at 20 to 40 minutes after surgery (MD -1.9, 95% CI -2.2 to -1.5; high-quality evidence) and on admission to PACU (MD -1.8, 95% CI -2.2 to -1.4; moderate-quality evidence); however, there was no difference in pain scores at 6 hours after surgery. In addition, evidence was found that the subtenon block decreased the number of children requiring postoperative opioid (RR 0.59, 95% CI 0.37-0.92; high-quality evidence) and nonopioid (RR 0.52, 95% CI 0.27-0.98; moderate-quality evidence) analgesia, and the incidences of postoperative vomiting (RR 0.31, 95% CI 0.12-0.7; high-quality evidence) and intraoperative oculocardiac events (RR 0.40, 95% CI 0.26-0.60; high-quality evidence). Other secondary outcomes had low or moderate-quality evidence. Risk of bias was low in six trials and high in three. There were no reports of block-related complications. CONCLUSIONS Our findings suggest that the subtenon block reduces the severity of early postoperative pain and the incidences of postoperative vomiting and intraoperative oculocardiac events compared with controls in children undergoing strabismus surgery. REVIEW REGISTRATION PROSPERO (CRD42015025443).
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Affiliation(s)
- Carolyne Pehora
- From the Department of Anesthesia and Pain Medicine (C.P., B.J., U.S., M.W.C.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bradley Johnston
- From the Department of Anesthesia and Pain Medicine (C.P., B.J., U.S., M.W.C.), The Hospital for Sick Children, Toronto, Ontario, Canada; Systematic Overviews Through Advancing Research Technology, Child Health Evaluative Sciences (B.J.), The Hospital for Sick Children Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Ushma Shah
- From the Department of Anesthesia and Pain Medicine (C.P., B.J., U.S., M.W.C.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine (U.S., M.W.C.), University of Toronto, Toronto, Ontario, Canada
| | - Kamiar Mireskandari
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children (K.M., A.A.), University of Toronto, Toronto, Ontario, Canada
| | - Asim Ali
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children (K.M., A.A.), University of Toronto, Toronto, Ontario, Canada
| | - Mark W Crawford
- From the Department of Anesthesia and Pain Medicine (C.P., B.J., U.S., M.W.C.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine (U.S., M.W.C.), University of Toronto, Toronto, Ontario, Canada.
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Luciano RD, da Silva BL, Chen XB, Bergstrom DJ. Turbulent blood flow in a cerebral artery with an aneurysm. J Biomech 2024; 172:112214. [PMID: 38991421 DOI: 10.1016/j.jbiomech.2024.112214] [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: 01/08/2024] [Revised: 06/20/2024] [Accepted: 06/27/2024] [Indexed: 07/13/2024]
Abstract
Unruptured intracranial aneurysms are common in the general population, and many uncertainties remain when predicting rupture risks and treatment outcomes. One of the cutting-edge tools used to investigate this condition is computational fluid dynamics (CFD). However, CFD is not yet mature enough to guide the clinical management of this disease. In addition, recent studies have reported significant flow instabilities when refined numerical methods are used. Questions remain as to how to properly simulate and evaluate this flow, and whether these instabilities are really turbulence. The purpose of the present study is to evaluate the impact of the simulation setup on the results and investigate the occurrence of turbulence in a cerebral artery with an aneurysm. For this purpose, direct numerical simulations were performed with up to 200 cardiac cycles and with data sampling rates of up to 100,000 times per cardiac cycle. Through phase-averaging or triple decomposition, the contributions of turbulence and of laminar pulsatile waves to the velocity, pressure and wall shear stress fluctuations were distinguished. For example, the commonly used oscillatory shear index was found to be closely related to the laminar waves introduced at the inlet, rather than turbulence. The turbulence energy cascade was evaluated through energy spectrum estimates, revealing that, despite the low flow rates and Reynolds number, the flow is turbulent near the aneurysm. Phase-averaging was shown to be an approach that can help researchers better understand this flow, although the results are highly dependent on simulation setup and post-processing choices.
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Affiliation(s)
- R D Luciano
- Department of Mechanical Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, Canada.
| | - B L da Silva
- Department of Mechanical Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, Canada
| | - X B Chen
- Department of Mechanical Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, Canada; Division of Biomedical Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, Canada
| | - D J Bergstrom
- Department of Mechanical Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, Canada
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Ghosh NR, Esmaeilinezhad Z, Zając J, Creasy RA, Lorenz SG, Klatt KC, Bala MM, Beathard KM, Johnston BC. Evidence-Based Practice Competencies among Nutrition Professionals and Students: A Systematic Review. J Nutr 2024; 154:1414-1427. [PMID: 38159813 PMCID: PMC11347811 DOI: 10.1016/j.tjnut.2023.12.044] [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: 10/12/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Evidence-based practice (EBP) promotes shared decision-making between clinicians and patients. OBJECTIVE The aim was to determine EBP competencies among nutrition professionals and students reported in the literature. METHODS We conducted a systematic review by searching Medline, Embase, CINAHL, ERIC, CENTRAL, ProQuest Dissertations and Theses Global, BIOSIS Citation Index, and clinicaltrials.gov up to March 2023. Eligible primary studies had to assess one of the 6 predefined EBP competencies: formulating clinical questions; searching literature for best evidence; assessing studies for methodological quality; effect size; certainty of evidence for effects; and determining the applicability of study results considering patient values and preferences. Two reviewers independently screened articles and extracted data, and results were summarized for each EBP competency. RESULTS We identified 12 eligible cross-sectional survey studies, comprising 1065 participants, primarily registered dietitians, across 6 countries, with the majority assessed in the United States (n = 470). The reporting quality of the survey studies was poor overall, with 43% of items not reported. Only 1 study (8%) explicitly used an objective questionnaire to assess EBP competencies. In general, the 6 competencies were incompletely defined or reported (e.g., it was unclear what applicability and critical appraisal referred to and what study designs were appraised by the participants). Two core competencies, interpreting effect size and certainty of evidence for effects, were not assessed. CONCLUSIONS The overall quality of study reports was poor, and the questionnaires were predominantly self-perceived, as opposed to objective assessments. No studies reported on competencies in interpreting effect size or certainty of evidence, competencies essential for optimizing clinical nutrition decision-making. Future surveys should objectively assess core EBP competencies using sensible, specific questionnaires. Furthermore, EBP competencies need to be standardized across dietetic programs to minimize heterogeneity in the training, understanding, evaluation, and application among dietetics practitioners. This study was registered at PROSPERO as CRD42022311916.
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Affiliation(s)
- Nirjhar R Ghosh
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, United States
| | - Zahra Esmaeilinezhad
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, United States
| | - Joanna Zając
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Rebecca A Creasy
- Department of Food Science and Technology, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, United States
| | - Saundra G Lorenz
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, United States
| | - Kevin C Klatt
- Department of Nutrition Sciences and Toxicology, University of California, Berkeley, CA, United States
| | - Malgorzata M Bala
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Karen M Beathard
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, United States
| | - Bradley C Johnston
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, United States; Department of Epidemiology & Biostatistics, School of Public Health, Texas A&M University, College Station, USA.
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Furukawa Y, Sakata M, Yamamoto R, Nakajima S, Kikuchi S, Inoue M, Ito M, Noma H, Takashina HN, Funada S, Ostinelli EG, Furukawa TA, Efthimiou O, Perlis M. Components and Delivery Formats of Cognitive Behavioral Therapy for Chronic Insomnia in Adults: A Systematic Review and Component Network Meta-Analysis. JAMA Psychiatry 2024; 81:357-365. [PMID: 38231522 PMCID: PMC10794978 DOI: 10.1001/jamapsychiatry.2023.5060] [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: 05/26/2023] [Accepted: 11/07/2023] [Indexed: 01/18/2024]
Abstract
Importance Chronic insomnia disorder is highly prevalent, disabling, and costly. Cognitive behavioral therapy for insomnia (CBT-I), comprising various educational, cognitive, and behavioral strategies delivered in various formats, is the recommended first-line treatment, but the effect of each component and delivery method remains unclear. Objective To examine the association of each component and delivery format of CBT-I with outcomes. Data Sources PubMed, Cochrane Central Register of Controlled Trials, PsycInfo, and International Clinical Trials Registry Platform from database inception to July 21, 2023. Study Selection Published randomized clinical trials comparing any form of CBT-I against another or a control condition for chronic insomnia disorder in adults aged 18 years and older. Insomnia both with and without comorbidities was included. Concomitant treatments were allowed if equally distributed among arms. Data Extraction and Synthesis Two independent reviewers identified components, extracted data, and assessed trial quality. Random-effects component network meta-analyses were performed. Main Outcomes and Measures The primary outcome was treatment efficacy (remission defined as reaching a satisfactory state) posttreatment. Secondary outcomes included all-cause dropout, self-reported sleep continuity, and long-term remission. Results A total of 241 trials were identified including 31 452 participants (mean [SD] age, 45.4 [16.6] years; 21 048 of 31 452 [67%] women). Results suggested that critical components of CBT-I are cognitive restructuring (remission incremental odds ratio [iOR], 1.68; 95% CI, 1.28-2.20) third-wave components (iOR, 1.49; 95% CI, 1.10-2.03), sleep restriction (iOR, 1.49; 95% CI, 1.04-2.13), and stimulus control (iOR, 1.43; 95% CI, 1.00-2.05). Sleep hygiene education was not essential (iOR, 1.01; 95% CI, 0.77-1.32), and relaxation procedures were found to be potentially counterproductive(iOR, 0.81; 95% CI, 0.64-1.02). In-person therapist-led programs were most beneficial (iOR, 1.83; 95% CI, 1.19-2.81). Cognitive restructuring, third-wave components, and in-person delivery were mainly associated with improved subjective sleep quality. Sleep restriction was associated with improved subjective sleep quality, sleep efficiency, and wake after sleep onset, and stimulus control with improved subjective sleep quality, sleep efficiency, and sleep latency. The most efficacious combination-consisting of cognitive restructuring, third wave, sleep restriction, and stimulus control in the in-person format-compared with in-person psychoeducation, was associated with an increase in the remission rate by a risk difference of 0.33 (95% CI, 0.23-0.43) and a number needed to treat of 3.0 (95% CI, 2.3-4.3), given the median observed control event rate of 0.14. Conclusions and Relevance The findings suggest that beneficial CBT-I packages may include cognitive restructuring, third-wave components, sleep restriction, stimulus control, and in-person delivery but not relaxation. However, potential undetected interactions could undermine the conclusions. Further large-scale, well-designed trials are warranted to confirm the contribution of different treatment components in CBT-I.
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Affiliation(s)
- Yuki Furukawa
- Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan
| | - Masatsugu Sakata
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Ryuichiro Yamamoto
- College of Sociology, Department of Psychology and Humanities, Edogawa University, Nagareyama, Chiba, Japan
| | - Shun Nakajima
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
- International Institute for Integrative Sleep Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shino Kikuchi
- Core Laboratory, Center for Psycho-oncology and Palliative Care, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Mari Inoue
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
- Graduate School of Medical Science, Kitasato University, Kanagawa, Japan
| | - Masami Ito
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Hiroku Noma
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hikari Nishimura Takashina
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Satoshi Funada
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Edoardo G. Ostinelli
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, National Institute for Health and Care Research, Oxford Health Biomedical Research Centre, Oxford, United Kingdom
- Oxford Health National Health Service Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Toshi A. Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
- Department of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Michael Perlis
- Behavioral Sleep Medicine Program, Department of Psychiatry, School of Nursing, University of Pennsylvania, Philadelphia
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Heimke F, Furukawa Y, Siafis S, Johnston BC, Engel RR, Furukawa TA, Leucht S. Understanding effect size: an international online survey among psychiatrists, psychologists, physicians from other medical specialities, dentists and other health professionals. BMJ MENTAL HEALTH 2024; 27:e300978. [PMID: 38388002 PMCID: PMC10882338 DOI: 10.1136/bmjment-2023-300978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND AND OBJECTIVE Various ways exist to display the effectiveness of medical treatment options. This study examined various psychiatric, medical and allied professionals' understanding and perceived usefulness of eight effect size indices for presenting both dichotomous and continuous outcome data. METHODS We surveyed 1316 participants from 13 countries using an online questionnaire. We presented hypothetical treatment effects of interventions versus placebo concerning chronic pain using eight different effect size measures. For each index, the participants had to judge the magnitude of the shown effect, to indicate how certain they felt about their own answer and how useful they found the given effect size index. FINDINGS Overall, 762 (57.9%) participants fully completed the questionnaire. In terms of understanding, the best results emerged when both the control event rate (CER) and the experimental event rate (EER) were presented. The difference in minimal importance difference units (MID unit) was understood worst. Respondents also found CER and EER to be the most useful presentation approach while they rated MID unit as the least useful. Confidence in the risk ratio ranked high, even though it was rather poorly understood. CONCLUSIONS AND CLINICAL IMPLICATIONS For dichotomous outcomes, presenting the effects in terms of the CER and EER could lead to the most correct interpretation. Relative measures including the risk ratio must be supplemented with absolute measures such as the CER and EER. Effects on continuous outcomes were better understood through standardised mean differences than mean differences. These can also be supplemented by dichotomised CER and EER.
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Affiliation(s)
- Ferdinand Heimke
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Technical University of Munich, Munich, Bavaria, Germany
| | - Yuki Furukawa
- Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Technical University of Munich, Munich, Bavaria, Germany
- German Center for Mental Health (DZPG), partner site München/Augsburg, Munich, Germany
| | - Bradley C Johnston
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, Texas, USA
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Rolf R Engel
- Department of Psychiatry and Psychotherapy, Klinikum der Ludwig-Maximilians-Universität München, Munich, Bavaria, Germany
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Technical University of Munich, Munich, Bavaria, Germany
- German Center for Mental Health (DZPG), partner site München/Augsburg, Munich, Germany
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Yao L, Sadeghirad B, Li M, Li J, Wang Q, Crandon HN, Martin G, Morgan R, Florez ID, Hunskaar BS, Wells J, Moradi S, Zhu Y, Ahmed MM, Gao Y, Cao L, Yang K, Tian J, Li J, Zhong L, Couban RJ, Guyatt GH, Agoritsas T, Busse JW. Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials. BMJ 2023; 383:e076226. [PMID: 38101924 DOI: 10.1136/bmj-2023-076226] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
OBJECTIVE We explored the comparative effectiveness of available therapies for chronic pain associated with temporomandibular disorders (TMD). DESIGN Systematic review and network meta-analysis of randomised clinical trials (RCTs). DATA SOURCES MEDLINE, EMBASE, CINAHL, CENTRAL, and SCOPUS were searched to May 2021, and again in January 2023. STUDY SELECTION Interventional RCTs that enrolled patients presenting with chronic pain associated with TMD. DATA EXTRACTION AND SYNTHESIS Pairs of reviewers independently identified eligible studies, extracted data, and assessed risk of bias. We captured all reported patient-important outcomes, including pain relief, physical functioning, emotional functioning, role functioning, social functioning, sleep quality, and adverse events. We conducted frequentist network meta-analyses to summarise the evidence and used the GRADE approach to rate the certainty of evidence and categorise interventions from most to least beneficial. RESULTS 233 trials proved eligible for review, of which 153-enrolling 8713 participants and exploring 59 interventions or combinations of interventions-were included in network meta-analyses. All subsequent effects refer to comparisons with placebo or sham procedures. Effects on pain for eight interventions were supported by high to moderate certainty evidence. The three therapies probably most effective for pain relief were cognitive behavioural therapy (CBT) augmented with biofeedback or relaxation therapy (risk difference (RD) for achieving the minimally important difference (MID) in pain relief of 1 cm on a 10 cm visual analogue scale: 36% (95% CI 33 to 39)), therapist-assisted jaw mobilisation (RD 36% (95% CI 31 to 40)), and manual trigger point therapy (RD 32% (29 to 34)). Five interventions were less effective, yet more effective than placebo, showing RDs ranging between 23% and 30%: CBT, supervised postural exercise, supervised jaw exercise and stretching, supervised jaw exercise and stretching with manual trigger point therapy, and usual care (such as home exercises, self stretching, reassurance).Moderate certainty evidence showed four interventions probably improved physical functioning: supervised jaw exercise and stretching (RD for achieving the MID of 5 points on the short form-36 physical component summary score: 43% (95% CI 33 to 51)), manipulation (RD 43% (25 to 56)), acupuncture (RD 42% (33 to 50)), and supervised jaw exercise and mobilisation (RD 36% (19 to 51)). The evidence for pain relief or physical functioning among other interventions, and all evidence for adverse events, was low or very low certainty. CONCLUSION When restricted to moderate or high certainty evidence, interventions that promote coping and encourage movement and activity were found to be most effective for reducing chronic TMD pain. REGISTRATION PROSPERO (CRD42021258567).
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Affiliation(s)
- Liang Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, 1280 Main St. West, Hamilton, Ontario, Canada
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, 1280 Main St. West, Hamilton, Ontario, Canada
| | - Meixuan Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Health Technology Assessment Centre, Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jing Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Health Technology Assessment Centre, Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Qi Wang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Holly N Crandon
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
- Institute for Management and Innovation, University of Toronto, Mississauga, Ontario, Canada
| | - Grace Martin
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Morgan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Ivan D Florez
- Department of Pediatrics, University of Antioquia, Medellin, Colombia
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
- Pediatric Intensive Care Unit, Clínica Las Americas, Medellin, Colombia
| | | | - Jeff Wells
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Sara Moradi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
| | - Ying Zhu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Muhammad Muneeb Ahmed
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Liujiao Cao
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Health Technology Assessment Centre, Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Jialing Li
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, China
| | - Linda Zhong
- School of Biological Sciences, Nanyang Technological University, Singapore
| | - Rachel J Couban
- Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Division of General Internal Medicine, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland
- The MAGIC Evidence Ecosystem Foundation, Oslo, Norway
| | - Jason W Busse
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, 1280 Main St. West, Hamilton, Ontario, Canada
- Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
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9
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Hemilä H, Chalker E. Vitamin C reduces the severity of common colds: a meta-analysis. BMC Public Health 2023; 23:2468. [PMID: 38082300 PMCID: PMC10712193 DOI: 10.1186/s12889-023-17229-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Randomized trials have shown that vitamin C shortens the duration of common colds. Some trials reported greater effects on severe cold symptoms compared with mild symptoms. This review systematically compares the effects of vitamin C on severe and mild common cold symptoms. METHODS We included all placebo-controlled trials of orally administered vitamin C in doses of at least 1 g/day for the common cold for people in good health at baseline. The analysis was restricted to trials which reported both the total duration of the common cold, and the severity of the common cold measured using severity scales, the duration of more severe stages of the cold, or proxies for severe colds such as days indoors. Findings were pooled using the inverse variance, fixed effect options of the metacont function of the R package meta to calculate the ratio of means estimate. RESULTS Fifteen comparisons from 10 trials which reported both mild and severe symptoms were identified. All trials were randomized and double-blind. Compared to placebo, vitamin C significantly decreased the severity of the common cold by 15% (95% CI 9-21%). The direct comparison of the effect of vitamin C on mild and severe symptoms was limited to five comparisons which found that vitamin C had a significant benefit on the duration of severe symptoms. In this subset, there was a significant difference in the size of the effect of vitamin C on the overall duration of colds versus the duration of severe colds (P = 0.002), and vitamin C had no significant effect on the duration of mild symptoms. CONCLUSIONS The common cold is the leading cause of acute morbidity and a major cause of absenteeism from work and school. However, absenteeism is dependent on the severity of symptoms. The finding that vitamin C may have a greater effect on more severe measures of the common cold is therefore important. Further research on the therapeutic effects of vitamin C on the common cold should measure outcomes of differing levels of severity.
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Affiliation(s)
- Harri Hemilä
- Department of Public Health, University of Helsinki, POB 20, Helsinki, FI, FI-00014, Finland.
| | - Elizabeth Chalker
- Biological Data Science Institute, Australian National University, Canberra, ACT, 2601, Australia
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10
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Xue JJ, Cui YY, Busse JW, Ge L, Zhou T, Huang WH, Ding SS, Zhang J, Yang KH. Transversus thoracic muscle plane block for pain during cardiac surgery: a systematic review and meta-analysis. Int J Surg 2023; 109:2500-2508. [PMID: 37246971 PMCID: PMC10442103 DOI: 10.1097/js9.0000000000000470] [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: 01/09/2023] [Accepted: 05/08/2023] [Indexed: 05/30/2023]
Abstract
STUDY OBJECTIVE The role of transversus thoracic muscle plane blocks (TTMPBs) during cardiac surgery is controversial. We conducted a systematic review to establish the effectiveness of this procedure. DESIGN Systematic review. We searched PubMed, Embase, Web of Science, CENTRAL, WanFang Data, and the China National Knowledge Infrastructure to June 2022, and followed the GRADE approach to evaluate the certainty of evidence. STUDY ELIGIBILITY CRITERIA Eligible studies enrolled adult patients scheduled to undergo cardiac surgery and randomized them to receive a TTMPB or no block/sham block. MAIN RESULTS Nine trials that enrolled 454 participants were included. Compared to no block/sham block, moderate certainty evidence found that TTMPB probably reduces postoperative pain at rest at 12 h [weighted mean difference (WMD) -1.51 cm on a 10 cm visual analogue scale for pain, 95% CI -2.02 to -1.00; risk difference (RD) for achieving mild pain or less (≤3 cm), 41%, 95% CI 17-65) and 24 h (WMD -1.07 cm, 95% CI -1.83 to -0.32; RD 26%, 95% CI 9-37). Moderate certainty evidence also supported that TTMPB probably reduces pain during movement at 12 h (WMD -3.42 cm, 95% CI -4.47 to -2.37; RD 46%, 95% CI 12-80) and at 24 h (WMD -1.73 cm, 95% CI -3.24 to -0.21; RD 32%, 95% CI 5-59), intraoperative opioid use [WMD -28 milligram morphine equivalent (MME), 95% CI -42 to -15], postoperative opioid consumption (WMD -17 MME, 95% CI -29 to -5), postoperative nausea and vomiting (absolute risk difference 255 less per 1000 persons, 95% CI 140-314), and intensive care unit (ICU) length of stay (WMD -13 h, 95% CI -21 to -6). CONCLUSION Moderate certainty evidence showed TTMPB during cardiac surgery probably reduces postoperative pain at rest and with movement, opioid consumption, ICU length of stay, and the incidence of nausea and vomiting.
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Affiliation(s)
- Jian-jun Xue
- Evidence-based Medicine Center, School of Basic Medical Science, Lanzhou University, Gansu Lanzhou
- Department of Anesthesiology, Gansu Province Hospital of Traditional Chinese Medicine
- Gansu Clinical Research Center of Integrative Anesthesiology
| | - Yi-yang Cui
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Chengguan District
| | - Jason W. Busse
- Department of Anesthesia
- The Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
| | - Long Ge
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China
| | - Ting Zhou
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Chengguan District
| | - Wei-hua Huang
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Chengguan District
| | - Sheng-shuang Ding
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Chengguan District
| | - Jie Zhang
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Chengguan District
| | - Ke-hu Yang
- Evidence-based Medicine Center, School of Basic Medical Science, Lanzhou University, Gansu Lanzhou
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China
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11
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Kresoja KP, Unterhuber M, Wachter R, Thiele H, Lurz P. A cardiologist's guide to machine learning in cardiovascular disease prognosis prediction. Basic Res Cardiol 2023; 118:10. [PMID: 36939941 PMCID: PMC10027799 DOI: 10.1007/s00395-023-00982-7] [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] [Received: 09/22/2022] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 03/21/2023]
Abstract
A modern-day physician is faced with a vast abundance of clinical and scientific data, by far surpassing the capabilities of the human mind. Until the last decade, advances in data availability have not been accompanied by analytical approaches. The advent of machine learning (ML) algorithms might improve the interpretation of complex data and should help to translate the near endless amount of data into clinical decision-making. ML has become part of our everyday practice and might even further change modern-day medicine. It is important to acknowledge the role of ML in prognosis prediction of cardiovascular disease. The present review aims on preparing the modern physician and researcher for the challenges that ML might bring, explaining basic concepts but also caveats that might arise when using these methods. Further, a brief overview of current established classical and emerging concepts of ML disease prediction in the fields of omics, imaging and basic science is presented.
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Affiliation(s)
- Karl-Patrik Kresoja
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
- Leipzig Heart Institute, Leipzig Heart Science at Heart Center Leipzig, Leipzig, Germany
| | - Matthias Unterhuber
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
- Leipzig Heart Institute, Leipzig Heart Science at Heart Center Leipzig, Leipzig, Germany
| | - Rolf Wachter
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
- Clinic for Cardiology and Pneumology, University Medicine Göttingen, Göttingen, Germany
- German Cardiovascular Research Center (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany.
- Leipzig Heart Institute, Leipzig Heart Science at Heart Center Leipzig, Leipzig, Germany.
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany.
- Leipzig Heart Institute, Leipzig Heart Science at Heart Center Leipzig, Leipzig, Germany.
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12
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Sturmberg JP, Kissling B, Kühlein T. Shared decision-making in the realm of uncertainty: The example of coronary artery disease through an EBM and complexity science lens. J Eval Clin Pract 2022. [PMID: 36419338 DOI: 10.1111/jep.13794] [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: 09/23/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022]
Abstract
Patients look to their clinicians for explanations and treatments that achieve predictable cures with certainty. Clinicians usually respond accordingly. Acknowledging uncertainty, while necessary, is difficult, anxiety-provoking and at times overwhelming for patients and clinicians alike. We here present three case studies to illustrate the uncertainties of managing patients with potentially life-threatening illnesses. Research aims to provide answers to clinical problems. But, conducting research almost inevitably entails a reduction of real-world complexities. Research ultimately can only provide 'partial or in general answers' mostly revealing new questions. Due to the complexity of clinical care, research cannot really achieve certainty and predictability for an individual within his specific living context and values. In an unavoidably uncertain environment, instead of oversimplifying, clinicians like patients-as far as possible-ought to better embrace a complexity thinking frame. This provides a deeper understanding how living bodies function as-a-whole within their living contexts. Uncertainty and unpredictability, being inherent elements of complexity thinking, cannot be overcome. However, it may be made easier to cope with uncertainty by at least adopting the thinking in probabilities for benefits and harms of patient related outcomes as introduced in Sackett's Evidence-Based Medicine framework. Through the lenses of evidence-based medicine and complexity sciences this paper critically explores the clinical management of three patients diagnosed as having coronary artery disease. They all received the same treatment even though they presented with very different clinical complaints arising from different disease manifestations. Looking at these case studies the authors reflect on the reasons behind this astonishing, but widely seen medical behaviour of 'one size fits all'. They critically reflect the importance of research and evidence in view of a person-centred solution.
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Affiliation(s)
- Joachim P Sturmberg
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Thomas Kühlein
- Allgemeinmedizinisches Institut, Universitätsklinikum Erlangen, Erlangen, Germany
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13
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Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of liver support systems for adults with acute‐on‐chronic liver failure.
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14
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Martí-Carvajal AJ, Gluud C, Gluud LL, Pavlov CS, Mauro E, Monge Martín D, Liu JP, Nicola S, Comunián-Carrasco G, Martí-Amarista CE. Liver support systems for adults with acute liver failure. Hippokratia 2022. [DOI: 10.1002/14651858.cd015059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Arturo J Martí-Carvajal
- Facultad de Ciencias de la Salud Eugenio Espejo; Universidad UTE (Cochrane Ecuador); Quito Ecuador
- Facultad de Medicina, Universidad Francisco de Vitoria (Cochrane Madrid); Madrid Spain
- Cátedra Rectoral de Medicina Basada en la Evidencia; Universidad de Carabobo; Valencia Venezuela
| | - Christian Gluud
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research; The Capital Region, Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
- Department of Regional Health Research; The Faculty of Health Sciences, University of Southern Denmark; Odense Denmark
| | - Lise Lotte Gluud
- Gastrounit, Medical Division; Copenhagen University Hospital Hvidovre; Hvidovre Denmark
| | - Chavdar S Pavlov
- Cochrane Hepato-Biliary Group; Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
- Department of Therapy ; IM Sechenov First Moscow State Medical University; Moscow Russian Federation
- Department of Gastroenterology; Botkin Hospital; Moscow Russian Federation
| | - Ezequiel Mauro
- Liver Unit & Liver Transplant Unit; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | - Diana Monge Martín
- Facultad de Medicina; Universidad Francisco de Vitoria (Cochrane Madrid); Madrid Spain
| | - Jian Ping Liu
- Centre for Evidence-Based Chinese Medicine; Beijing University of Chinese Medicine; Beijing China
| | - Susana Nicola
- Centro Asociado Cochrane Ecuador, Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC); Universidad UTE; Quito Ecuador
| | - Gabriella Comunián-Carrasco
- Cátedra Rectoral de Medicina Basada en la Evidencia; Universidad de Carabobo; Valencia Venezuela
- Departamento de Obstetricia y Ginecología; Universidad de Carabobo; Valencia Venezuela
| | - Cristina Elena Martí-Amarista
- Division of General, Geriatric and Hospital Medicine; Stony Brook University, Renaissance School of Medicine HSC, Level 2, Rm 155; Stony Brook, 11794-8228 New York USA
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15
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Jiangping W, Xiaolin Q, Han S, Zhou X, Mao N, Zhibo D, Ting G, Shidong H, Xiangwei L, Xin Y, Guoyin S. Network Meta-Analysis of Perioperative Analgesic Effects of Different Interventions on Postoperative Pain After Arthroscopic Shoulder Surgery Based on Randomized Controlled Trials. Front Med (Lausanne) 2022; 9:921016. [PMID: 35872801 PMCID: PMC9304654 DOI: 10.3389/fmed.2022.921016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundShoulder arthroscopic surgery is a common surgical method used in orthopedics. However, severe postoperative pain can significantly limit the early joint movement of patients and adversely affect the impact of the surgery. At present, there is no consistent and effective analgesic scheme for the management of postoperative pain after arthroscopic surgery of the shoulder.PurposeThe aim of this study was to search for the most effective analgesic scheme to control pain in the perioperative period of arthroscopic surgery of the shoulder.Study DesignNetwork meta-analysis.MethodsWe searched 5 different databases (i.e., Medline, PubMed, Embase, Web of Science, and the Cochrane Library) from January 2011 to January 2021 for English literature. Thereafter, we sifted out randomized controlled trials (RCTs), which compared different intervention schemes for pain management after shoulder arthroscopy and selected only 12 h, 24 h, or 48 h after the patient leaves the operating room as an optimal period for administration of analgesic intervention schemes. Only patients with shoulder disease who have undergone arthroscopic shoulder surgery were included in this study. The Cochrane “risk of bias” was used for the quality assessment. Moreover, some additional tests were performed to enhance the credibility of the results.ResultsTwenty-nine RCTs involving 1,885 patients were included in this frequentist network meta-analysis (NMA). These articles mainly were divided into two distinct groups, namely, the nerve block group and the non-nerve block group. Regarding the nerve block group, at postoperative 12 h, the intervention suprascapular nerve block + interscalene nerve block (SSNB + INB) was ranked first, whereas INB + intra-articular injection (INB + IAI) was ranked first at 24 h and 48 h postoperation. In the non-nerve block group, external application (EA) was ranked first at postoperative 12 h, but oral administration (OA) exhibited a better analgesic effect at postoperative 24 h and postoperative 48 h.ConclusionWe conclude that the analgesic effect of SSNB+INB was the best at postoperative 12 h, and INB+IAI was the best at postoperative 24 h and 48 h in the nerve block group. For the non-nerve block group, the effect of EA was the best at postoperative 12 h, and the analgesic effect of OA at postoperative 24 h and 48 h was significantly better than any other interventions.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42021286777.
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Affiliation(s)
- Wu Jiangping
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Quan Xiaolin
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Shu Han
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
- *Correspondence: Shu Han
| | - Xiaolan Zhou
- Medical Record Statistics Section, The Second Hospital of Chongqing Medical University, Chongqing, China
- Xiaolan Zhou
| | - Nie Mao
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Deng Zhibo
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Gong Ting
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Hu Shidong
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Li Xiangwei
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Yuan Xin
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Shu Guoyin
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
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16
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Siafis S, Bursch N, Müller K, Schmid L, Schuster F, Waibel J, Huynh T, Matthes F, Rodolico A, Brieger P, Bühner M, Heres S, Leucht S, Hamann J. Evidence-based Shared-Decision-Making Assistant (SDM-assistant) for choosing antipsychotics: protocol of a cluster-randomized trial in hospitalized patients with schizophrenia. BMC Psychiatry 2022; 22:406. [PMID: 35715740 PMCID: PMC9204887 DOI: 10.1186/s12888-022-04036-5] [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: 05/03/2022] [Accepted: 06/01/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Choosing an antipsychotic medication is an important medical decision in the treatment of schizophrenia. This decision requires risk-benefit assessments of antipsychotics, and thus, shared-decision making between physician and patients is strongly encouraged. Although the efficacy and side-effect profiles of antipsychotics are well-established, there is no clear framework for the communication of the evidence between physicians and patients. For this reason, we developed an evidence-based shared-decision making assistant (SDM-assistant) that presents high-quality evidence from network meta-analysis on the efficacy and side-effect profile of antipsychotics and can be used as a basis for shared-decision making between physicians and patients when selecting antipsychotic medications. METHODS The planned matched-pair cluster-randomised trial will be conducted in acute psychiatric wards (n = 14 wards planned) and will include adult inpatients with schizophrenia or schizophrenia-like disorders (N = 252 participants planned). On the intervention wards, patients and their treating physicians will use the SDM-assistant, whenever a decision on choosing an antipsychotic is warranted. On the control wards, antipsychotics will be chosen according to treatment-as-usual. The primary outcome will be patients' perceived involvement in the decision-making during the inpatient stay as measured with the SDM-Q-9. We will also assess therapeutic alliance, symptom severity, side-effects, treatment satisfaction, adherence, quality of life, functioning and rehospitalizations as secondary outcomes. Outcomes could be analysed at discharge and at follow-up after three months from discharge. The analysis will be conducted per-protocol using mixed-effects linear regression models for continuous outcomes and logistic regression models using generalised estimating equations for dichotomous outcomes. Barriers and facilitators in the implementation of the intervention will also be examined using a qualitative content analysis. DISCUSSION This is the first trial to examine a decision assistant specifically designed to facilitate shared-decision making for choosing antipsychotic medications, i.e., SDM-assistant, in acutely ill inpatients with schizophrenia. If the intervention can be successfully implemented, SDM-assistant could advance evidence-based medicine in schizophrenia by putting medical evidence on antipsychotics into the context of patient preferences and values. This could subsequently lead to a higher involvement of the patients in decision-making and better therapy decisions. TRIAL REGISTRATION German Clinical Trials Register (ID: DRKS00027316 , registration date 26.01.2022).
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Affiliation(s)
- Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Nicola Bursch
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Lisa Schmid
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Jakob Waibel
- Department of Informatics, Technical University of Munich, Munich, Germany
| | - Tri Huynh
- Department of Informatics, Technical University of Munich, Munich, Germany
| | - Florian Matthes
- Department of Informatics, Technical University of Munich, Munich, Germany
| | - Alessandro Rodolico
- Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, Catania, Italy
| | | | - Markus Bühner
- Psychological Methodology and Diagnostics, Ludwig Maximilian University, Munich, Germany
| | | | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Johannes Hamann
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
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17
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Tan K, Lo SN, Cust AE, Wolfe R, Mar V. Sensitivity of two Australian melanoma risk tools to identify high-risk individuals among people presenting with their first primary melanoma. Australas J Dermatol 2022; 63:352-358. [PMID: 35522684 DOI: 10.1111/ajd.13841] [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: 12/25/2021] [Revised: 03/08/2022] [Accepted: 03/26/2022] [Indexed: 12/01/2022]
Abstract
AIMS Regular skin examinations for early detection of melanoma are recommended for high-risk individuals, but there is minimal consensus regarding what constitutes 'high-risk'. Melanoma risk prediction models may guide this. We compared two online melanoma risk prediction tools: Victorian Melanoma Service (VMS) and Melanoma Institute Australia (MIA) risk tools; to assess classification differences of patients at high-risk of a first primary melanoma. METHODS Risk factor data for 357 patients presenting with their first primary melanoma were entered into both risk tools. Predicted risks were recorded: 5-year absolute risk (VMS tool and MIA tool); 10-year, lifetime, and relative risk estimates (MIA tool). Sensitivities for each tool were calculated using the same high-risk thresholds. The MIA risk tool showed greater sensitivity on comparison of 5-year absolute risks (90% MIA vs 78% VMS). Patients had significantly higher odds of being classified as high or very-high risk using the MIA risk tool overall, and for each patient subgroup. Using either tool, patients of male gender or with synchronous multiple first primary melanomas were more likely to be correctly classified as high- or very-high risk using 5-year absolute risk thresholds; but tumour invasiveness was unrelated to risk. Classification differed when using the MIA risk categories based on relative risk. CONCLUSIONS Both melanoma risk prediction tools had high sensitivity for identifying individuals at high-risk and could be used for optimising prevention campaigns. The choice of which risk tool, measure, and threshold for risk stratification depends on the intended purpose of risk prediction, and ideally requires information on specificity.
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Affiliation(s)
- Katrina Tan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anne E Cust
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Victoria Mar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
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Antao V, Grad R, Thériault G, Dickinson JA, Szafran O, Singh H, Rezkallah R, Waugh E, Bell NR. Going against the status quo in screening: Call to action to improve teaching in preventive health care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:340-344. [PMID: 35552217 PMCID: PMC9097728 DOI: 10.46747/cfp.6805340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Viola Antao
- Associate Professor in the Department of Family and Community Medicine at the University of Toronto in Ontario.
| | - Roland Grad
- Associate Professor in the Department of Family Medicine at McGill University in Montréal, Que
| | - Guylène Thériault
- Academic Lead for the Physicianship Component and Director of Pedagogy at Outaouais Medical Campus in the Faculty of Medicine at McGill University
| | - James A Dickinson
- Professor in the Department of Family Medicine and the Department of Community Health Sciences at the University of Calgary in Alberta
| | - Olga Szafran
- Associate Director of Research in the Department of Family Medicine at the University of Alberta in Edmonton
| | - Harminder Singh
- Associate Professor in the Department of Internal Medicine and the Department of Community Health Sciences at the University of Manitoba in Winnipeg, and in the Department of Medical Oncology and Hematology at CancerCare Manitoba; he is also Adjunct Scientist at the CancerCare Manitoba Research Institute
| | | | - Earle Waugh
- Professor Emeritus and Emeritus Director of the Centre for Health and Culture in the Department of Family Medicine at the University of Alberta
| | - Neil R Bell
- Professor in the Department of Family Medicine at the University of Alberta
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Wang Y, Li M, Kazis LE, Xia W. Clinical outcomes of COVID-19 infection among patients with Alzheimer's disease or mild cognitive impairment. Alzheimers Dement 2022; 18:911-923. [PMID: 35377523 PMCID: PMC9073985 DOI: 10.1002/alz.12665] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Alzheimer's disease (AD) and COVID-19 share common risk factors including hypertension. Angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) are frequently prescribed antihypertension medications. METHODS This study analyzed 436,823 veterans tested for SARS-CoV-2 infection. We conducted both classical and propensity score weighted logistic models to compare COVID-19 outcomes between patients with AD or mild cognitive impairment (MCI) to those without cognitive impairment, and examined effect of ACEI/ARB prescription. RESULTS There was a statistically significant association between AD and increased odds of infection and mortality. MCI was not found to be a risk factor for infection. Subjects with MCI exhibited poor clinical outcomes. Prescribing ARBs but not ACEIs was significantly associated with a lower risk of COVID-19 occurrence among AD and MCI patients. DISCUSSION Exploring beneficial effects of existing medications to reduce the impact of COVID-19 on patients with AD or MCI is highly significant. HIGHLIGHTS There is significant association between Alzheimer's disease (AD) and increased risk of COVID-19 infection and odds of mortality. Subjects with mild cognitive impairment (MCI) defined by claims data exhibit poor clinical outcomes, but MCI was not found to be a risk factor for severe acute respiratory syndrome coronavirus 2 infection. Prescribing angiotensin II receptor blockers was significantly associated with a lower risk of COVID-19 occurrence among AD/MCI patients.
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Affiliation(s)
- Ying Wang
- Geriatric Research Education and Clinical CenterBedford VA Healthcare SystemBedfordMassachusettsUSA
- Department of Mathematical SciencesBentley UniversityWalthamMassachusettsUSA
| | - Mingfei Li
- Department of Mathematical SciencesBentley UniversityWalthamMassachusettsUSA
- Center for Healthcare Organization and Implementation ResearchBedford VA Healthcare SystemBedfordMassachusettsUSA
| | - Lewis E. Kazis
- Center for Healthcare Organization and Implementation ResearchBedford VA Healthcare SystemBedfordMassachusettsUSA
- Department of Health Law, Policy and ManagementBoston University School of Public HealthBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
- Spaulding Rehabilitation HospitalCharlestownMassachusettsUSA
| | - Weiming Xia
- Geriatric Research Education and Clinical CenterBedford VA Healthcare SystemBedfordMassachusettsUSA
- Department of Pharmacology and Experimental TherapeuticsBoston University School of MedicineBostonMassachusettsUSA
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Antao V, Grad R, Thériault G, Dickinson JA, Szafran O, Singh H, Rezkallah R, Waugh E, Bell NR. À l’encontre du statu quo en matière de dépistage. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:e140-e145. [PMID: 35552220 PMCID: PMC9097729 DOI: 10.46747/cfp.6805e140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Viola Antao
- Professeure agrégée au département de médecine familiale et communautaire à l'Université de Toronto (Ontario).
| | - Roland Grad
- Professeur agrégé au département de médecine familiale à l'Université McGill à Montréal (Québec)
| | - Guylène Thériault
- Directrice du volet Rôle du médecin et directrice du centre de pédagogie au Campus Outaouais de la Faculté de médecine de l'Université McGill
| | - James A Dickinson
- Professeur au département de médecine familiale et au département des sciences de santé communautaire à l'Université de Calgary (Alberta)
| | - Olga Szafran
- Directrice adjointe de recherche au Département de médecine familiale de l'Université de l'Alberta à Edmonton
| | - Harminder Singh
- Professeur agrégé au département de médecine interne et au département des sciences de santé communautaire à l'Université du Manitoba à Winnipeg et au département d'hématologie et d'oncologie médicale à ActionCancer Manitoba; il est également scientifique adjoint à l'Institut de recherche d'ActionCancer Manitoba
| | | | - Earle Waugh
- Professeur émérite et directeur émérite du centre de santé et de culture du département de médecine familiale de l'Université de l'Alberta
| | - Neil R Bell
- Professeur au département de médecine familiale à l'Université de l'Alberta
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Similar Effects of Exercise Therapy, Nonsteroidal Anti-inflammatory Drugs, and Opioids for Knee Osteoarthritis Pain: A Systematic Review with Network Meta-analysis. J Orthop Sports Phys Ther 2022; 52:207-216. [PMID: 35442752 DOI: 10.2519/jospt.2022.10490] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare the effectiveness of opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and exercise therapy for knee osteoarthritis pain. DESIGN Systematic review with network meta-analysis. LITERATURE SEARCH We searched the databases MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from inception to April 15, 2021. Web of Science was used for citation tracking. STUDY SELECTION CRITERIA Randomized controlled trials comparing exercise therapy, NSAIDs, and opioids in any combination for knee osteoarthritis pain. DATA SYNTHESIS Network meta-analysis comparing exercise therapy, NSAIDs, opioids, and placebo/control for knee osteoarthritis pain. Additional trials from previous reviews were included to create the external placebo/control anchor. RESULTS We included 13 trials (1398 patients) with direct comparisons, supplemented with data from 101 additional trials. The treatment effect of NSAIDs for knee osteoarthritis pain was similar to that of opioids (standardized mean difference [SMD], 0.02; 95% confidence interval [CI], -0.14 to 0.18; Grading of Recommendations, Assessment, Development and Evaluations [GRADE]: low certainty). Exercise therapy had a larger effect than NSAIDs (SMD, 0.54; 95% CI, 0.19 to 0.89; GRADE: very low certainty). No estimate could be made for exercise vs opioids due to the lack of studies. Exercise therapy ranked as the "best" intervention in the network meta-analysis, followed by NSAIDs, opioids, and placebo/control intervention (GRADE: low certainty). CONCLUSION Exercise therapy ranked as the best treatment for knee osteoarthritis pain, followed by NSAIDs and opioids. The difference between treatments was small and likely not clinically relevant, and the overall confidence in the ranking was low. The results highlight the limited evidence for comparative effectiveness between exercise therapy, NSAIDs, and opioids for knee osteoarthritis pain. J Orthop Sports Phys Ther 2022;52(4):207-216. doi:10.2519/jospt.2022.10490.
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Johnston BC, Merdad R, Sherifali D, Kebbe M, Birken CS, Buchholz A, Ge L, Gehring ND, Hadjiyannakis S, Hamilton J, Hatanaka D, Henderson M, Lebel T, Moore SA, Morrison KM, Salas XR, Sebastianski M, Zenlea IS, Ball GDC. Updating the Canadian clinical practice guideline for managing pediatric obesity: a protocol. CMAJ Open 2022; 10:E155-E164. [PMID: 35232814 PMCID: PMC8896489 DOI: 10.9778/cmajo.20200289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Since the first national guideline for managing obesity in adults and children in Canada was published in 2007, new evidence has emerged and guideline standards have evolved. Our purpose is to describe the protocol used to update the Canadian clinical practice guideline for managing pediatric obesity. METHODS This guideline will update the pediatric components of the 2007 Canadian clinical practice guideline for the management of obesity. In partnership with Obesity Canada, we began preliminary work in 2019; activities are scheduled for completion in 2022. The guideline will follow standards developed by the National Academy of Medicine and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group. Guideline development will be informed by 5 complementary literature reviews: a scoping review that focuses on clinical assessment in pediatric obesity management and 4 systematic reviews to synthesize evidence regarding families' values and preferences as well as the safety and effectiveness of interventions (psychological and behavioural; pharmacotherapeutic; and surgical). We will use standard systematic review methodology, including summarizing and assessing the certainty of evidence and determining the strength of recommendations. Competing interests will be managed proactively according to recommendations from the Guidelines International Network. Diverse stakeholders, including families and clinicians, will be engaged throughout guideline development. INTERPRETATION The guideline will support Canadian families and clinicians to make informed, value-sensitive and evidence-based clinical decisions related to managing pediatric obesity. The guideline and accompanying resources for end-users will be published in English and French, and we will partner with Obesity Canada to optimize dissemination using integrated and end-of-project knowledge translation.
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Affiliation(s)
- Bradley C Johnston
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Roah Merdad
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Diana Sherifali
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Maryam Kebbe
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Catherine S Birken
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Annick Buchholz
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Long Ge
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Nicole D Gehring
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Stasia Hadjiyannakis
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Jill Hamilton
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Dawn Hatanaka
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Mélanie Henderson
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Tracy Lebel
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Sarah A Moore
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Katherine M Morrison
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Ximena Ramos Salas
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Meghan Sebastianski
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Ian S Zenlea
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Geoff D C Ball
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont.
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23
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Witte LPW, Tikkinen KAO, Guyatt GH, Malde S. Evidence-based urology: importance of relative vs absolute effect. Eur Urol Focus 2021; 7:1226-1229. [PMID: 34836837 DOI: 10.1016/j.euf.2021.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/30/2021] [Indexed: 10/19/2022]
Abstract
In order to effectively apply research evidence - in particular the results of clinical trials - to daily patient care, clinicians need to understand the magnitude of treatment benefits and harms, and the ways authors may express that magnitude. Authors may express outcomes using either relative or absolute measures, or both together. Relative measures make the magnitude of treatment effect appear much greater than absolute. Absolute effects are, however, more important to patients than relative effects. Here, using examples from the urological literature, we discuss the concepts of relative and absolute measures. PATIENT SUMMARY: When presenting the results of a trial, different ways of describing the same risk can influence the way patients and their doctors perceive the results. Reports can choose relative or absolute measures - or report both. Absolute measures are more informative in understanding the risk of an outcome patients face when not treated, and how treatment improves that risk.
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Affiliation(s)
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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24
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Rizzo RRN, Ferraro MC, Wewege MA, Cashin AG, Leake HB, O'Hagan ET, Jones MD, Gustin SM, McLachlan AJ, Day R, McAuley JH. Targeting Neurotrophic Factors for Low Back Pain and Sciatica: A Systematic Review and Meta-analysis. Rheumatology (Oxford) 2021; 61:2243-2254. [PMID: 34677587 DOI: 10.1093/rheumatology/keab785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/30/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This meta-analysis aims to investigate the efficacy and safety of medicines that target neurotrophic factors for low back pain (LBP) or sciatica. METHODS We searched published and trial registry reports of randomised controlled trials evaluating the effect of medicines that target neurotrophic factors to LBP or sciatica in seven databases from inception to December 2020. Two reviewers independently identified studies, extracted data, and assessed the risk of bias and certainty in the evidence. RESULTS Nine studies (3349 participants) were included in the meta-analyses. Low certainty evidence showed that anti-NGF may reduce pain at four weeks (MD -6.63, 95% CI -8.51 to -4.76), and 12 weeks (MD -6.10, -8.34 to -3.87), and may increase adverse effects for chronic LBP (OR 1.16, 0.99-1.36). Higher doses of anti-NGF may offer a clinically important reduction in pain at the cost of increased adverse effects for chronic LBP. Very low certainty evidence showed that anti-NGF and glial cell line-derived neurotrophic factor (pro-GDNF) may not reduce pain for sciatica at four weeks (MD -1.40, -8.26-5.46), at 12 weeks (MD -2.91, -13.69-7.67), and may increase adverse effects for sciatica (OR 3.27, 1.78-6.00). CONCLUSION Anti-NGF may offer small reductions in pain intensity for chronic LBP. The effect may depend on the dose and types of medicines. For sciatica, anti-NGF or pro-GDNF may not reduce pain. Medicines that target neurotrophic factors for LBP or sciatica are associated with different adverse effects from commonly prescribed medicines for these conditions.
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Affiliation(s)
- Rodrigo R N Rizzo
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Michael C Ferraro
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Michael A Wewege
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Hayley B Leake
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - Edel T O'Hagan
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Matthew D Jones
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Psychology, University of New South Wales, Sydney, Australia
| | - Andrew J McLachlan
- Sydney Pharmacy School, University of Sydney, Sydney, NSW, 2050, Australia
| | - Richard Day
- Clinical Pharmacology & Toxicology, St. Vincent's Hospital, Sydney, Australia.,St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Health Sciences, University of New South Wales, Sydney, Australia
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25
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Chu DK, Golden DBK, Guyatt GH. Translating Evidence to Optimize Patient Care Using GRADE. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:4221-4230. [PMID: 34624540 DOI: 10.1016/j.jaip.2021.09.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
Optimal evidence-based clinical practice requires systematic summaries of the best available evidence, including ratings of the quality of that evidence, and is facilitated by the availability of trustworthy guidelines. In this review, we describe the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to rating quality of evidence and moving from evidence to recommendations using examples from allergy-immunology. GRADE focuses on systematic summaries of the best evidence, systematic reviews and trustworthy guidelines, and emphasizes a structured approach to determining quality (certainty) of bodies of evidence, absolute magnitude of effects of desirable and undesirable consequences (benefits and harms), and use of evidence to develop clinical recommendations. Adopted by over 110 organizations worldwide, including the American Academy of Allergy, Asthma, and Immunology/American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters, GRADE is foundational to the optimal interpretation of research evidence and its application in clinical practice. This review supports the clinician's ability to find and use the information in GRADE guidelines to help care for patients in the clinic.
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Affiliation(s)
- Derek K Chu
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Research Institute of St. Joe's Hamilton, Hamilton, Ontario, Canada.
| | - David B K Golden
- Department of Medicine, Division of Allergy-Immunology, Johns Hopkins University, Baltimore, Md
| | - Gordon H Guyatt
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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26
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Tikkinen KAO, Guyatt GH. Understanding of research results, evidence summaries and their applicability-not critical appraisal-are core skills of medical curriculum. BMJ Evid Based Med 2021; 26:231-233. [PMID: 33737327 PMCID: PMC8479738 DOI: 10.1136/bmjebm-2020-111542] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Kari A O Tikkinen
- Departments of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland
| | - Gordon H Guyatt
- Departments of Health Research Methods, Evidence, and Impact (HEI), and Medicine, McMaster University, Hamilton, Ontario, Canada
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27
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AminiLari M, Wang L, Neumark S, Adli T, Couban RJ, Giangregorio A, Carney CE, Busse JW. Medical Cannabis and Cannabinoids for Impaired Sleep: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Sleep 2021; 45:6373351. [PMID: 34546363 DOI: 10.1093/sleep/zsab234] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/09/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES We conducted a systematic review to explore the effectiveness of medical cannabis for impaired sleep. METHODS We searched MEDLINE, EMBASE, CENTRAL and PsychINFO to January 2021 for randomized trials of medical cannabis or cannabinoids for impaired sleep vs. any non-cannabis control. When possible, we pooled effect estimates for all patient-important sleep-related outcomes and used the GRADE approach to appraise the certainty of evidence. RESULTS Thirty-nine trials (5,100 patients) were eligible for review, of which 38 evaluated oral cannabinoids and 1 administered inhaled cannabis. The median follow-up was 35 days, and most trials (33 of 39) enrolled patients living with chronic cancer or noncancer chronic pain. Among patients with chronic pain, moderate certainty evidence found that medical cannabis probably results in a small improvement in sleep quality versus placebo (modeled risk difference [RD] for achieving the minimally important difference [MID], 8% [95% CI, 3 to 12]). Moderate to high certainty evidence shows that medical cannabis vs. placebo results in a small improvement in sleep disturbance for chronic non-cancer pain (modeled RD for achieving the MID, 19% [95% CI, 11 to 28]) and a very small improvement in sleep disturbance for chronic cancer pain (WMD of -0.19cm [95%CI, -0.36 to -0.03cm]; interaction p=0.03). Moderate to high certainty evidence shows medical cannabis, versus placebo, results in a substantial increase in the risk of dizziness (RD 29% [95%CI, 16 to 50], for trials with ≥3 months follow-up), and a small increase in the risk of somnolence, dry mouth, fatigue, and nausea (RDs ranged from 6% to 10%). CONCLUSION Medical cannabis and cannabinoids may improve impaired sleep among people living with chronic pain, but the magnitude of benefit is likely small.
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Affiliation(s)
- Mahmood AminiLari
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Li Wang
- The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Samuel Neumark
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Taranah Adli
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Rachel J Couban
- The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Aidan Giangregorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada
| | | | - Jason W Busse
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada.,The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada.,Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.,The Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Ontario, Canada
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28
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Martí-Carvajal AJ, De Sanctis JB, Dayer M, Martí-Amarista CE, Alegría E, Monge Martín D, Abd El Aziz M, Correa-Pérez A, Nicola S, Parise Vasco JM. Interleukin-receptor antagonist and tumor necrosis factor inhibitors for the primary and secondary prevention of atherosclerotic cardiovascular diseases. Hippokratia 2021. [DOI: 10.1002/14651858.cd014741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Arturo J Martí-Carvajal
- Facultad de Ciencias de la Salud Eugenio Espejo (Centro Cochrane Ecuador); Universidad UTE; Quito Ecuador
- Facultad de Medicina (Centro Cochrane Madrid); Universidad Francisco de Vitoria; Madrid Spain
- Cátedra Rectoral de Medicina Basada en la Evidencia; Universidad de Carabobo; Valencia Venezuela
| | - Juan Bautista De Sanctis
- The Institute of Molecular and Translational Medicine; Palacky University Olomouc, Faculty of Medicine and Dentistry; Olomouc Czech Republic
| | - Mark Dayer
- Department of Cardiology; Somerset NHS Foundation Trust; Taunton UK
| | | | - Eduardo Alegría
- Faculty of Medicine; Universidad Francisco de Vitoria; Madrid Spain
| | | | - Mohamed Abd El Aziz
- Internal medicine; Texas Tech University Health Sciences Center El PasoPaul L. Foster School of Medicine; El Paso, Texas USA
| | - Andrea Correa-Pérez
- Faculty of Medicine; Universidad Francisco de Vitoria; Madrid Spain
- Clinical Biostatistics Unit; Hospital Universitario Ramón y Cajal (IRYCIS); Madrid Spain
| | - Susana Nicola
- Centro Asociado Cochrane Ecuador, Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC); Universidad UTE; Quito Ecuador
| | - Juan Marcos Parise Vasco
- Centro Asociado Cochrane Ecuador, Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC); Universidad UTE; Quito Ecuador
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29
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Leucht S, Siafis S, Engel RR, Schneider-Thoma J, Bighelli I, Cipriani A, Furukawa TA, Davis JM. How Efficacious Are Antipsychotic Drugs for Schizophrenia? An Interpretation Based on 13 Effect Size Indices. Schizophr Bull 2021; 48:27-36. [PMID: 34405881 PMCID: PMC8781341 DOI: 10.1093/schbul/sbab094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The magnitude of the superiority of antipsychotics over placebo is debated. One reason is that the effect-size index which is usually used in meta-analyses is in standard deviation units. Many other indices, some of which are more intuitive, exist. METHODS We explain the formulae, advantages, and limitations of 13 effect-size indices: Mean Difference (MD), Standardized-Mean-Difference (SMD), Correlation Coefficient, Ratio-of-Means (RoM, endpoint and change data), Improvement Fraction (IF), Drug-Response Fraction (DRF), Minimally-Clinically-Important-Difference-Units (MCIDU), Number-Needed-to-Treat-derived from SMD (NNT), Odds Ratio (OR), Relative Risk (RR), and Risk Difference (RD) derived from SMD, Drug-response and Placebo-response in percent. We applied these indices to meta-analyses comparing antipsychotic drugs with placebo for acute schizophrenia. RESULTS The difference of all antipsychotics pooled vs placebo (105 trials with 22741 participants) was: MD 9.4 (95% CI 8.4,10.2) PANSS points, SMD 0.47 (0.42,0.51), Correlation coefficient 0.23 (0.21,0.25), RoM endpoint 0.83 (0.81,0.85), RoM change 1.94 (1.84,2.02), IF (%) 49 (46,51), DRF (%) 94 (84,102), MCIDU 0.63 (0.56,0.68), NNT 5 (5,6), OR 2.34 (2.14, 2.52), RR 1.67 (1.59,1.73), RD 20% (18-22), and 50% (48, 52) improved on drug compared to 30% on placebo. Results of individual drugs compared to placebo are presented, as well. CONCLUSIONS Taken together these indices show a substantial, but not a large superiority of antipsychotics compared to placebo. The general chronicity of the patients in the trials must be considered. Future meta-analyses should report other effect size indices in addition to the Standardized-Mean-Difference, in particular percentage responders in the drug and placebo groups. They can be easily derived and would enhance the interpretation of research findings.
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Affiliation(s)
- Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,To whom correspondence should be addressed; tel: 89-4140-4249, fax: 89-4140-4888, e-mail:
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Rolf R Engel
- Department of Psychiatry and Psychotherapy, School of Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Irene Bighelli
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior and Department of Clinical Epidemiology, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - John M Davis
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA,Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Hanson NA, Lavallee MB, Thiele RH. Apophenia and anesthesia: how we sometimes change our practice prematurely. Can J Anaesth 2021; 68:1185-1196. [PMID: 33963519 PMCID: PMC8104920 DOI: 10.1007/s12630-021-02005-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/08/2021] [Accepted: 02/16/2021] [Indexed: 12/21/2022] Open
Abstract
Human beings are predisposed to identifying false patterns in statistical noise, a likely survival advantage during our evolutionary development. Moreover, humans seem to prefer "positive" results over "negative" ones. These two cognitive features lay a framework for premature adoption of falsely positive studies. Added to this predisposition is the tendency of journals to "overbid" for exciting or newsworthy manuscripts, incentives in both the academic and publishing industries that value change over truth and scientific rigour, and a growing dependence on complex statistical techniques that some reviewers do not understand. The purpose of this article is to describe the underlying causes of premature adoption and provide recommendations that may improve the quality of published science.
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Affiliation(s)
- Neil A Hanson
- Department of Anesthesiology, University of Virginia Health System, PO Box 800710, ville, VA, 22908-0710, USA.
| | - Matthew B Lavallee
- Department of Anesthesiology, University of Virginia Health System, PO Box 800710, ville, VA, 22908-0710, USA
| | - Robert H Thiele
- Department of Anesthesiology, University of Virginia Health System, PO Box 800710, ville, VA, 22908-0710, USA
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Raittio E, Raittio L. Verbal communication of effect-sizes, possible comparators, and uncertainty of evidence in the Finnish clinical practice guidelines: Omitting effect-sizes and comparators without expressing much uncertainty. J Eval Clin Pract 2021; 27:759-766. [PMID: 33084201 DOI: 10.1111/jep.13499] [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: 08/10/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Our aim was to investigate verbal representations of intervention effect-size, uncertainty of evidence, and possible intervention comparators in statements concerning effects of interventions in Finnish clinical practice guidelines. METHOD We selected 10 clinical practice guidelines on common diseases and risk factors published by The Finnish Medical Society Duodecim. All the statements that considered beneficial effects of interventions and that were graded with a level of evidence (levels A, high, to D, very low) were included in analyses. We assessed whether the statements verbally represented intervention effect-size, uncertainty of evidence or a possible comparator, and the reported outcome. RESULTS Of 385 statements, verbal representation of beneficial effect-sizes occurred in 25 (6%) statements. Most (72%) statements indicated that intervention had a beneficial effect, but did not specify effect-size. Less than half (42%) of the statements represented uncertainty verbally. Comparisons to placebo or no-treatment were rare (3%) and 18% of the statements compared interventions to other treatments. Against instructions, a considerable part (35%) of statements with B-level evidence did not represent uncertainty. CONCLUSION Communicating beneficial intervention effects, effect-sizes, possible comparators, and uncertainty of evidence require much broader attention in the clinical practice guideline context.
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Affiliation(s)
- Eero Raittio
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Oral Health Care, City of Tampere, Tampere, Finland
| | - Lauri Raittio
- The Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Siafis S, Rodolico A, Çıray O, Murphy DG, Parellada M, Arango C, Leucht S. Imputing the Number of Responders from the Mean and Standard Deviation of CGI-Improvement in Clinical Trials Investigating Medications for Autism Spectrum Disorder. Brain Sci 2021; 11:908. [PMID: 34356141 PMCID: PMC8305379 DOI: 10.3390/brainsci11070908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Response to treatment, according to Clinical Global Impression-Improvement (CGI-I) scale, is an easily interpretable outcome in clinical trials of autism spectrum disorder (ASD). Yet, the CGI-I rating is sometimes reported as a continuous outcome, and converting it to dichotomous would allow meta-analysis to incorporate more evidence. METHODS Clinical trials investigating medications for ASD and presenting both dichotomous and continuous CGI-I data were included. The number of patients with at least much improvement (CGI-I ≤ 2) were imputed from the CGI-I scale, assuming an underlying normal distribution of a latent continuous score using a primary threshold θ = 2.5 instead of θ = 2, which is the original cut-off in the CGI-I scale. The original and imputed values were used to calculate responder rates and odds ratios. The performance of the imputation method was investigated with a concordance correlation coefficient (CCC), linear regression, Bland-Altman plots, and subgroup differences of summary estimates obtained from random-effects meta-analysis. RESULTS Data from 27 studies, 58 arms, and 1428 participants were used. The imputation method using the primary threshold (θ = 2.5) had good performance for the responder rates (CCC = 0.93 95% confidence intervals [0.86, 0.96]; β of linear regression = 1.04 [0.95, 1.13]; bias and limits of agreements = 4.32% [-8.1%, 16.74%]; no subgroup differences χ2 = 1.24, p-value = 0.266) and odds ratios (CCC = 0.91 [0.86, 0.96]; β = 0.96 [0.78, 1.14]; bias = 0.09 [-0.87, 1.04]; χ2 = 0.02, p-value = 0.894). The imputation method had poorer performance when the secondary threshold (θ = 2) was used. DISCUSSION Assuming a normal distribution of the CGI-I scale, the number of responders could be imputed from the mean and standard deviation and used in meta-analysis. Due to the wide limits of agreement of the imputation method, sensitivity analysis excluding studies with imputed values should be performed.
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Affiliation(s)
- Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, 81675 Munich, Germany;
| | - Alessandro Rodolico
- Department of Experimental and Clinical Medicine, Psychiatric Clinic University Hospital ‘Gaspare Rodolico’, University of Catania, 95125 Catania, Italy;
| | - Oğulcan Çıray
- Department of Child and Adolescent Psychiatry, Mardin State Hospital, 47100 Artuklu, Mardin, Turkey;
| | - Declan G. Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK;
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, 28003 Madrid, Spain; (M.P.); (C.A.)
- School of Medicine, Universidad Complutense, 28040 Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, 28003 Madrid, Spain; (M.P.); (C.A.)
- School of Medicine, Universidad Complutense, 28040 Madrid, Spain
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, 81675 Munich, Germany;
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Foundational Statistical Principles in Medical Research: A Tutorial on Odds Ratios, Relative Risk, Absolute Risk, and Number Needed to Treat. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115669. [PMID: 34070675 PMCID: PMC8198228 DOI: 10.3390/ijerph18115669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 01/21/2023]
Abstract
Evidence-based medicine is predicated on the integration of best available research evidence with clinical expertise and patient values to inform care. In medical research, several distinct measures are commonly used to describe the associations between variables, and a sound understanding of these pervasive measures is foundational in the clinician’s ability to interpret, synthesize, and apply available evidence from the medical literature. Accordingly, this article aims to provide an educational tutorial/topic primer on some of the most ubiquitous measures of association and risk quantification in medical research, including odds ratios, relative risk, absolute risk, and number needed to treat, using several real-world examples from the medical literature.
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Koetsenruijter J, Wronski P, Ghosh S, Müller W, Wensing M. The effect of an additional structured methods presentation on decision-makers’ reading time and helpfulness of the methods in a quantitative report: a nonrandomized trial (Preprint). JMIR Med Inform 2021; 10:e29813. [PMID: 35412464 PMCID: PMC9044155 DOI: 10.2196/29813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 12/20/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jan Koetsenruijter
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Pamela Wronski
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Sucheta Ghosh
- Scientific Databases and Visualization Group (SDBV), Heidelberg Institute for Theoretical Studies gGmbH, Heidelberg, Germany
| | - Wolfgang Müller
- Scientific Databases and Visualization Group (SDBV), Heidelberg Institute for Theoretical Studies gGmbH, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Trevena LJ, Bonner C, Okan Y, Peters E, Gaissmaier W, Han PKJ, Ozanne E, Timmermans D, Zikmund-Fisher BJ. Current Challenges When Using Numbers in Patient Decision Aids: Advanced Concepts. Med Decis Making 2021; 41:834-847. [PMID: 33660535 DOI: 10.1177/0272989x21996342] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Decision aid developers have to convey complex task-specific numeric information in a way that minimizes bias and promotes understanding of the options available within a particular decision. Whereas our companion paper summarizes fundamental issues, this article focuses on more complex, task-specific aspects of presenting numeric information in patient decision aids. METHODS As part of the International Patient Decision Aids Standards third evidence update, we gathered an expert panel of 9 international experts who revised and expanded the topics covered in the 2013 review working in groups of 2 to 3 to update the evidence, based on their expertise and targeted searches of the literature. The full panel then reviewed and provided additional revisions, reaching consensus on the final version. RESULTS Five of the 10 topics addressed more complex task-specific issues. We found strong evidence for using independent event rates and/or incremental absolute risk differences for the effect size of test and screening outcomes. Simple visual formats can help to reduce common judgment biases and enhance comprehension but can be misleading if not well designed. Graph literacy can moderate the effectiveness of visual formats and hence should be considered in tool design. There is less evidence supporting the inclusion of personalized and interactive risk estimates. DISCUSSION More complex numeric information. such as the size of the benefits and harms for decision options, can be better understood by using incremental absolute risk differences alongside well-designed visual formats that consider the graph literacy of the intended audience. More research is needed into when and how to use personalized and/or interactive risk estimates because their complexity and accessibility may affect their feasibility in clinical practice.
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Affiliation(s)
- Lyndal J Trevena
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Ask Share Know NHMRC Centre for Research Excellence, The University of Sydney, Australia
| | - Carissa Bonner
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Ask Share Know NHMRC Centre for Research Excellence, The University of Sydney, Australia
| | - Yasmina Okan
- Centre for Decision Research, University of Leeds, Leeds, UK
| | | | | | - Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA.,School of Medicine, Tufts University, Medford, MA, USA
| | | | - Danielle Timmermans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, North Holland, The Netherlands
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Wronski P, Wensing M, Ghosh S, Gärttner L, Müller W, Koetsenruijter J. Use of a quantitative data report in a hypothetical decision scenario for health policymaking: a computer-assisted laboratory study. BMC Med Inform Decis Mak 2021; 21:32. [PMID: 33509172 PMCID: PMC7845041 DOI: 10.1186/s12911-021-01401-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quantitative data reports are widely produced to inform health policy decisions. Policymakers are expected to critically assess provided information in order to incorporate the best available evidence into the decision-making process. Many other factors are known to influence this process, but little is known about how quantitative data reports are actually read. We explored the reading behavior of (future) health policy decision-makers, using innovative methods. METHODS We conducted a computer-assisted laboratory study, involving starting and advanced students in medicine and health sciences, and professionals as participants. They read a quantitative data report to inform a decision on the use of resources for long-term care in dementia in a hypothetical decision scenario. Data were collected through eye-tracking, questionnaires, and a brief interview. Eye-tracking data were used to generate 'heatmaps' and five measures of reading behavior. The questionnaires provided participants' perceptions of understandability and helpfulness as well as individual characteristics. Interviews documented reasons for attention to specific report sections. The quantitative analysis was largely descriptive, complemented by Pearson correlations. Interviews were analyzed by qualitative content analysis. RESULTS In total, 46 individuals participated [students (85%), professionals (15%)]. Eye-tracking observations showed that the participants spent equal time and attention for most parts of the presented report, but were less focused when reading the methods section. The qualitative content analysis identified 29 reasons for attention to a report section related to four topics. Eye-tracking measures were largely unrelated to participants' perceptions of understandability and helpfulness of the report. CONCLUSIONS Eye-tracking data added information on reading behaviors that were not captured by questionnaires or interviews with health decision-makers.
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Affiliation(s)
- Pamela Wronski
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Sucheta Ghosh
- Scientific Databases and Visualization Group (SDBV), Heidelberg Institute for Theoretical Studies - HITS gGmbH, Schloss-Wolfsbrunnenweg 35, 69118, Heidelberg, Germany
| | - Lukas Gärttner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Wolfgang Müller
- Scientific Databases and Visualization Group (SDBV), Heidelberg Institute for Theoretical Studies - HITS gGmbH, Schloss-Wolfsbrunnenweg 35, 69118, Heidelberg, Germany
| | - Jan Koetsenruijter
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Goldenberg JZ, Day A, Brinkworth GD, Sato J, Yamada S, Jönsson T, Beardsley J, Johnson JA, Thabane L, Johnston BC. Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data. BMJ 2021; 372:m4743. [PMID: 33441384 PMCID: PMC7804828 DOI: 10.1136/bmj.m4743] [Citation(s) in RCA: 168] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine the efficacy and safety of low carbohydrate diets (LCDs) and very low carbohydrate diets (VLCDs) for people with type 2 diabetes. DESIGN Systematic review and meta-analysis. DATA SOURCES Searches of CENTRAL, Medline, Embase, CINAHL, CAB, and grey literature sources from inception to 25 August 2020. STUDY SELECTION Randomized clinical trials evaluating LCDs (<130 g/day or <26% of a 2000 kcal/day diet) and VLCDs (<10% calories from carbohydrates) for at least 12 weeks in adults with type 2 diabetes were eligible. DATA EXTRACTION Primary outcomes were remission of diabetes (HbA1c <6.5% or fasting glucose <7.0 mmol/L, with or without the use of diabetes medication), weight loss, HbA1c, fasting glucose, and adverse events. Secondary outcomes included health related quality of life and biochemical laboratory data. All articles and outcomes were independently screened, extracted, and assessed for risk of bias and GRADE certainty of evidence at six and 12 month follow-up. Risk estimates and 95% confidence intervals were calculated using random effects meta-analysis. Outcomes were assessed according to a priori determined minimal important differences to determine clinical importance, and heterogeneity was investigated on the basis of risk of bias and seven a priori subgroups. Any subgroup effects with a statistically significant test of interaction were subjected to a five point credibility checklist. RESULTS Searches identified 14 759 citations yielding 23 trials (1357 participants), and 40.6% of outcomes were judged to be at low risk of bias. At six months, compared with control diets, LCDs achieved higher rates of diabetes remission (defined as HbA1c <6.5%) (76/133 (57%) v 41/131 (31%); risk difference 0.32, 95% confidence interval 0.17 to 0.47; 8 studies, n=264, I2=58%). Conversely, smaller, non-significant effect sizes occurred when a remission definition of HbA1c <6.5% without medication was used. Subgroup assessments determined as meeting credibility criteria indicated that remission with LCDs markedly decreased in studies that included patients using insulin. At 12 months, data on remission were sparse, ranging from a small effect to a trivial increased risk of diabetes. Large clinically important improvements were seen in weight loss, triglycerides, and insulin sensitivity at six months, which diminished at 12 months. On the basis of subgroup assessments deemed credible, VLCDs were less effective than less restrictive LCDs for weight loss at six months. However, this effect was explained by diet adherence. That is, among highly adherent patients on VLCDs, a clinically important reduction in weight was seen compared with studies with less adherent patients on VLCDs. Participants experienced no significant difference in quality of life at six months but did experience clinically important, but not statistically significant, worsening of quality of life and low density lipoprotein cholesterol at 12 months. Otherwise, no significant or clinically important between group differences were found in terms of adverse events or blood lipids at six and 12 months. CONCLUSIONS On the basis of moderate to low certainty evidence, patients adhering to an LCD for six months may experience remission of diabetes without adverse consequences. Limitations include continued debate around what constitutes remission of diabetes, as well as the efficacy, safety, and dietary satisfaction of longer term LCDs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020161795.
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Affiliation(s)
- Joshua Z Goldenberg
- Department of Nutrition, Texas A&M University, College Station, TX, USA
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | | | - Grant D Brinkworth
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Sydney, NSW, Australia
| | - Junko Sato
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Satoru Yamada
- Diabetes Center, Kitasato Institute Hospital, Kitasato University, Tokyo, Japan
| | - Tommy Jönsson
- Center for Primary Health Care Research, Lund University/Region Skåne, Skåne University Hospital, Malmö, Sweden
| | | | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Bradley C Johnston
- Department of Nutrition, Texas A&M University, College Station, TX, USA
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Busse JW, Sadeghirad B, Oparin Y, Chen E, Goshua A, May C, Hong PJ, Agarwal A, Chang Y, Ross SA, Emary P, Florez ID, Noor ST, Yao W, Lok A, Ali SH, Craigie S, Couban R, Morgan RL, Culig K, Brar S, Akbari-Kelachayeh K, Pozdnyakov A, Shergill Y, Sivananthan L, Zihayat B, Das A, Guyatt GH. Management of Acute Pain From Non-Low Back, Musculoskeletal Injuries : A Systematic Review and Network Meta-analysis of Randomized Trials. Ann Intern Med 2020; 173:730-738. [PMID: 32805127 DOI: 10.7326/m19-3601] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients and clinicians can choose from several treatment options to address acute pain from non-low back, musculoskeletal injuries. PURPOSE To assess the comparative effectiveness of outpatient treatments for acute pain from non-low back, musculoskeletal injuries by performing a network meta-analysis of randomized clinical trials (RCTs). DATA SOURCES MEDLINE, EMBASE, CINAHL, PEDro (Physiotherapy Evidence Database), and Cochrane Central Register of Controlled Trials to 2 January 2020. STUDY SELECTION Pairs of reviewers independently identified interventional RCTs that enrolled patients presenting with pain of up to 4 weeks' duration from non-low back, musculoskeletal injuries. DATA EXTRACTION Pairs of reviewers independently extracted data. Certainty of evidence was evaluated by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. DATA SYNTHESIS The 207 eligible studies included 32 959 participants and evaluated 45 therapies. Ninety-nine trials (48%) enrolled populations with diverse musculoskeletal injuries, 59 (29%) included patients with sprains, 13 (6%) with whiplash, and 11 (5%) with muscle strains; the remaining trials included various injuries ranging from nonsurgical fractures to contusions. Topical nonsteroidal anti-inflammatory agents (NSAIDs) proved to have the greatest net benefit, followed by oral NSAIDs and acetaminophen with or without diclofenac. Effects of these agents on pain were modest (around 1 cm on a 10-cm visual analogue scale, approximating the minimal important difference). Regarding opioids, compared with placebo, acetaminophen plus an opioid improved intermediate pain (1 to 7 days) but not immediate pain (≤2 hours), tramadol was ineffective, and opioids increased the risk for gastrointestinal and neurologic harms (all moderate-certainty evidence). LIMITATIONS Only English-language studies were included. The number of head-to-head comparisons was limited. CONCLUSION Topical NSAIDs, followed by oral NSAIDs and acetaminophen with or without diclofenac, showed the most convincing and attractive benefit-harm ratio for patients with acute pain from non-low back, musculoskeletal injuries. No opioid achieved benefit greater than that of NSAIDs, and opioids caused the most harms. PRIMARY FUNDING SOURCE National Safety Council. (PROSPERO: CRD42018094412).
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Affiliation(s)
- Jason W Busse
- McMaster University and Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Ontario, Canada (J.W.B.)
| | - Behnam Sadeghirad
- McMaster University, Hamilton, Ontario, Canada (B.S., Y.O., E.C., S.A.R., P.E., S.T.N., W.Y., A.L., S.H.A., S.C., R.C., R.L.M., K.A., A.P., Y.S., A.D., G.H.G.)
| | - Yvgeniy Oparin
- McMaster University, Hamilton, Ontario, Canada (B.S., Y.O., E.C., S.A.R., P.E., S.T.N., W.Y., A.L., S.H.A., S.C., R.C., R.L.M., K.A., A.P., Y.S., A.D., G.H.G.)
| | - Eric Chen
- McMaster University, Hamilton, Ontario, Canada (B.S., Y.O., E.C., S.A.R., P.E., S.T.N., W.Y., A.L., S.H.A., S.C., R.C., R.L.M., K.A., A.P., Y.S., A.D., G.H.G.)
| | - Anna Goshua
- Stanford University, Stanford, California (A.G.)
| | - Curtis May
- University of British Columbia, Vancouver, British Columbia, Canada (C.M.)
| | - Patrick J Hong
- University of Toronto, Toronto, Ontario, Canada (P.J.H., A.A., K.C.)
| | - Arnav Agarwal
- University of Toronto, Toronto, Ontario, Canada (P.J.H., A.A., K.C.)
| | - Yaping Chang
- McMaster University, Hamilton, and OrthoEvidence, Burlington, Ontario, Canada (Y.C.)
| | - Stephanie A Ross
- McMaster University, Hamilton, Ontario, Canada (B.S., Y.O., E.C., S.A.R., P.E., S.T.N., W.Y., A.L., S.H.A., S.C., R.C., R.L.M., K.A., A.P., Y.S., A.D., G.H.G.)
| | - Peter Emary
- McMaster University, Hamilton, Ontario, Canada (B.S., Y.O., E.C., S.A.R., P.E., S.T.N., W.Y., A.L., S.H.A., S.C., R.C., R.L.M., K.A., A.P., Y.S., A.D., G.H.G.)
| | - Ivan D Florez
- McMaster University, Hamilton, Ontario, Canada, and University of Antioquia, Medellin, Colombia (I.D.F.)
| | - Salmi T Noor
- McMaster University, Hamilton, Ontario, Canada (B.S., Y.O., E.C., S.A.R., P.E., S.T.N., W.Y., A.L., S.H.A., S.C., R.C., R.L.M., K.A., A.P., Y.S., A.D., G.H.G.)
| | - William Yao
- McMaster University, Hamilton, Ontario, Canada (B.S., Y.O., E.C., S.A.R., P.E., S.T.N., W.Y., A.L., S.H.A., S.C., R.C., R.L.M., K.A., A.P., Y.S., A.D., G.H.G.)
| | - Annie Lok
- McMaster University, Hamilton, Ontario, Canada (B.S., Y.O., E.C., S.A.R., P.E., S.T.N., W.Y., A.L., S.H.A., S.C., R.C., R.L.M., K.A., A.P., Y.S., A.D., G.H.G.)
| | - Syed Hussain Ali
- McMaster University, Hamilton, Ontario, Canada (B.S., Y.O., E.C., S.A.R., P.E., S.T.N., W.Y., A.L., S.H.A., S.C., R.C., R.L.M., K.A., A.P., Y.S., A.D., G.H.G.)
| | - Samantha Craigie
- McMaster University, Hamilton, Ontario, Canada (B.S., Y.O., E.C., S.A.R., P.E., S.T.N., W.Y., A.L., S.H.A., S.C., R.C., R.L.M., K.A., A.P., Y.S., A.D., G.H.G.)
| | - Rachel Couban
- McMaster University, Hamilton, Ontario, Canada (B.S., Y.O., E.C., S.A.R., P.E., S.T.N., W.Y., A.L., S.H.A., S.C., R.C., R.L.M., K.A., A.P., Y.S., A.D., G.H.G.)
| | - Rebecca L Morgan
- McMaster University, Hamilton, Ontario, Canada (B.S., Y.O., E.C., S.A.R., P.E., S.T.N., W.Y., A.L., S.H.A., S.C., R.C., R.L.M., K.A., A.P., Y.S., A.D., G.H.G.)
| | - Kayli Culig
- University of Toronto, Toronto, Ontario, Canada (P.J.H., A.A., K.C.)
| | - Sonia Brar
- University at Buffalo, Buffalo, New York (S.B.)
| | - Khashayar Akbari-Kelachayeh
- McMaster University, Hamilton, Ontario, Canada (B.S., Y.O., E.C., S.A.R., P.E., S.T.N., W.Y., A.L., S.H.A., S.C., R.C., R.L.M., K.A., A.P., Y.S., A.D., G.H.G.)
| | - Alex Pozdnyakov
- McMaster University, Hamilton, Ontario, Canada (B.S., Y.O., E.C., S.A.R., P.E., S.T.N., W.Y., A.L., S.H.A., S.C., R.C., R.L.M., K.A., A.P., Y.S., A.D., G.H.G.)
| | - Yaad Shergill
- McMaster University, Hamilton, Ontario, Canada (B.S., Y.O., E.C., S.A.R., P.E., S.T.N., W.Y., A.L., S.H.A., S.C., R.C., R.L.M., K.A., A.P., Y.S., A.D., G.H.G.)
| | | | | | - Aninditee Das
- McMaster University, Hamilton, Ontario, Canada (B.S., Y.O., E.C., S.A.R., P.E., S.T.N., W.Y., A.L., S.H.A., S.C., R.C., R.L.M., K.A., A.P., Y.S., A.D., G.H.G.)
| | - Gordon H Guyatt
- McMaster University, Hamilton, Ontario, Canada (B.S., Y.O., E.C., S.A.R., P.E., S.T.N., W.Y., A.L., S.H.A., S.C., R.C., R.L.M., K.A., A.P., Y.S., A.D., G.H.G.)
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Smith SM, Dworkin RH, Turk DC, McDermott MP, Eccleston C, Farrar JT, Rowbotham MC, Bhagwagar Z, Burke LB, Cowan P, Ellenberg SS, Evans SR, Freeman RL, Garrison LP, Iyengar S, Jadad A, Jensen MP, Junor R, Kamp C, Katz NP, Kesslak JP, Kopecky EA, Lissin D, Markman JD, Mease PJ, O'Connor AB, Patel KV, Raja SN, Sampaio C, Schoenfeld D, Singh J, Steigerwald I, Strand V, Tive LA, Tobias J, Wasan AD, Wilson HD. Interpretation of chronic pain clinical trial outcomes: IMMPACT recommended considerations. Pain 2020; 161:2446-2461. [PMID: 32520773 PMCID: PMC7572524 DOI: 10.1097/j.pain.0000000000001952] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Interpreting randomized clinical trials (RCTs) is crucial to making decisions regarding the use of analgesic treatments in clinical practice. In this article, we report on an Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) consensus meeting organized by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks, the purpose of which was to recommend approaches that facilitate interpretation of analgesic RCTs. We review issues to consider when drawing conclusions from RCTs, as well as common methods for reporting RCT results and the limitations of each method. These issues include the type of trial, study design, statistical analysis methods, magnitude of the estimated beneficial and harmful effects and associated precision, availability of alternative treatments and their benefit-risk profile, clinical importance of the change from baseline both within and between groups, presentation of the outcome data, and the limitations of the approaches used.
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Affiliation(s)
- Shannon M Smith
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, United States
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| | - Robert H Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, United States
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, United States
| | - Dennis C Turk
- Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Michael P McDermott
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, United States
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, United States
| | | | - John T Farrar
- Departments of Epidemiology, Neurology, and Anesthesia, University of Pennsylvania, Philadelphia, PA, United States
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Zubin Bhagwagar
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
- Rallybio, New Haven, CT, United States
| | - Laurie B Burke
- School of Pharmacy, University of Maryland, Baltimore, MD, United States
- LORA Group, LLC, Royal Oak, MD, United States
| | - Penney Cowan
- American Chronic Pain Association, Rocklin, CA, United States
| | - Susan S Ellenberg
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, United States
| | - Scott R Evans
- Department of Epidemiology and Biostatistics, The George Washington University, Washington, DC, United States
| | - Roy L Freeman
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Louis P Garrison
- Department of Pharmacy, University of Washington, Seattle, WA, United States
| | | | - Alejandro Jadad
- Department of Anesthesia, Faculty of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | | | - Cornelia Kamp
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, United States
- Clinical Materials Services Unit, University of Rochester Medical Center, Rochester, NY, United States
| | - Nathaniel P Katz
- Tufts University School of Medicine, Boston, MA, United States
- Analgesic Solutions, Natick, MA, United States
| | | | | | - Dmitri Lissin
- Scilex Pharmaceuticals, Palo Alto, CA, United States
| | - John D Markman
- Neuromedicine Pain Management and Translational Pain Research, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Philip J Mease
- Rheumatology Clinical Research, Swedish Medical Center, Seattle, WA, United States
- University of Washington School of Medicine, Seattle, WA, United States
| | - Alec B O'Connor
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Kushang V Patel
- Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Srinivasa N Raja
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Cristina Sampaio
- Faculdade Medicinda de Lisboa, Universidade de Lisboa, Lisboa, Portugal
- CHDI Foundation, Princeton, NJ, United States
| | - David Schoenfeld
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Jasvinder Singh
- Departments of Medicine and Epidemiology, University of Alabama at Birmingham School of Medicine, Birmingham, AB, United States
| | | | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA, United States
| | | | - Jeffrey Tobias
- Aquila Consulting Group, LLC, Petaluma, CA, United States
| | - Ajay D Wasan
- Departments of Anesthesiology and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Wang L, Cohen JC, Devasenapathy N, Hong BY, Kheyson S, Lu D, Oparin Y, Kennedy SA, Romerosa B, Arora N, Kwon HY, Jackson K, Prasad M, Jayasekera D, Li A, Guarna G, Natalwalla S, Couban RJ, Reid S, Khan JS, McGillion M, Busse JW. Prevalence and intensity of persistent post-surgical pain following breast cancer surgery: a systematic review and meta-analysis of observational studies. Br J Anaesth 2020; 125:346-357. [DOI: 10.1016/j.bja.2020.04.088] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/11/2020] [Accepted: 04/16/2020] [Indexed: 12/24/2022] Open
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Martí-Carvajal AJ, Valli C, Martí-Amarista CE, Solà I, Martí-Fàbregas J, Bonfill Cosp X. Citicoline for treating people with acute ischemic stroke. Cochrane Database Syst Rev 2020; 8:CD013066. [PMID: 32860632 PMCID: PMC8406786 DOI: 10.1002/14651858.cd013066.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Stroke is one of the leading causes of long-lasting disability and mortality and its global burden has increased in the past two decades. Several therapies have been proposed for the recovery from, and treatment of, ischemic stroke. One of them is citicoline. This review assessed the benefits and harms of citicoline for treating patients with acute ischemic stroke. OBJECTIVES To assess the clinical benefits and harms of citicoline compared with placebo or any other control for treating people with acute ischemic stroke. SEARCH METHODS We searched in the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE Ovid, Embase Ovid, LILACS until 29 January 2020. We searched the World Health Organization Clinical Trials Search Portal and ClinicalTrials.gov. Additionally, we also reviewed reference lists of the retrieved publications and review articles, and searched the websites of the US Food and Drug Administration (FDA) and European Medicines Agency (EMA). SELECTION CRITERIA We included randomized controlled trials (RCTs) in any setting including participants with acute ischemic stroke. Trials were eligible for inclusion if they compared citicoline versus placebo or no intervention. DATA COLLECTION AND ANALYSIS We selected RCTs, assessed the risk of bias in seven domains, and extracted data by duplicate. Our primary outcomes of interest were all-cause mortality and the degree of disability or dependence in daily activities at 90 days. We estimated risk ratios (RRs) for dichotomous outcomes. We measured statistical heterogeneity using the I² statistic. We conducted our analyses using the fixed-effect and random-effects model meta-analyses. We assessed the overall quality of evidence for six pre-specified outcomes using the GRADE approach. MAIN RESULTS We identified 10 RCTs including 4281 participants. In all these trials, citicoline was given either orally, intravenously, or a combination of both compared with placebo or standard care therapy. Citicoline doses ranged between 500 mg and 2000 mg per day. We assessed all the included trials as having high risk of bias. Drug companies sponsored six trials. A pooled analysis of eight trials indicates there may be little or no difference in all-cause mortality comparing citicoline with placebo (17.3% versus 18.5%; RR 0.94, 95% CI 0.83 to 1.07; I² = 0%; low-quality evidence due to risk of bias). Four trials found no difference in the proportion of patients with disability or dependence in daily activities according to the Rankin scale comparing citicoline with placebo (21.72% versus 19.23%; RR 1.11, 95% CI 0.97 to 1.26; I² = 1%; low-quality evidence due to risk of bias). Meta-analysis of three trials indicates there may be little or no difference in serious cardiovascular adverse events comparing citicoline with placebo (8.83% versus 7.77%; RR 1.04, 95% CI 0.84 to 1.29; I² = 0%; low-quality evidence due to risk of bias). Overall, either serious or non-serious adverse events - central nervous system, gastrointestinal, musculoskeletal, etc. - were poorly reported and harms may have been underestimated. Four trials assessing functional recovery with the Barthel Index at a cut-off point of 95 points or more did not find differences comparing citicoline with placebo (32.78% versus 30.70%; RR 1.03, 95% CI 0.94 to 1.13; I² = 24%; low-quality evidence due to risk of bias). There were no differences in neurological function (National Institutes of Health Stroke Scale at a cut-off point of ≤ 1 points) comparing citicoline with placebo according to five trials (24.31% versus 22.44%; RR 1.08, 95% CI 0.96 to 1.21; I² = 27%, low-quality evidence due to risk of bias). A pre-planned Trial Sequential Analysis suggested that no more trials may be needed for the primary outcomes but no trial provided information on quality of life. AUTHORS' CONCLUSIONS This review assessed the clinical benefits and harms of citicoline compared with placebo or any other standard treatment for people with acute ischemic stroke. The findings of the review suggest there may be little to no difference between citicoline and its controls regarding all-cause mortality, disability or dependence in daily activities, severe adverse events, functional recovery and the assessment of the neurological function, based on low-certainty evidence. None of the included trials assessed quality of life and the safety profile of citicoline remains unknown. The available evidence is of low quality due to either limitations in the design or execution of the trials.
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Affiliation(s)
- Arturo J Martí-Carvajal
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE (Cochrane Ecuador), Quito, Ecuador
- School of Medicine, Universidad Francisco de Vitoria (Cochrane Madrid), Madrid, Spain
| | - Claudia Valli
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Joan Martí-Fàbregas
- Unitat de Malalties Vasculars Cerebrals - Stroke Unit, Servei De Neurologia - Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Xavier Bonfill Cosp
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Srivastava A, Chau K, Kwon H, Guo Q, Johnston BC. Early and frequent exposure to antibiotics in children and the risk of obesity: systematic review and meta-analysis of observational studies. F1000Res 2020; 9:711. [PMID: 32913641 PMCID: PMC7429923 DOI: 10.12688/f1000research.24553.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 01/01/2023] Open
Abstract
Background: This study aimed to systematically evaluate the available evidence on prenatal and early infancy antibiotic exposure and the association with overweight and obesity in later childhood. Methods: We conducted a comprehensive search of Embase, MEDLINE, and Web of Science for observational studies assessing prenatal and early antibiotic exposure on the risk of overweight and obesity. We independently assessed the risk of bias using the ROBINS instrument and the overall quality of evidence using the GRADE approach. Results: Our search identified thirteen observational studies including 554,983 participants; most studies were at moderate risk of bias. We found a statistically significant impact of early antibiotic exposure and the risk of being overweight later in childhood (OR 1.18; 95% CI 1.05 to 1.34) (very low quality evidence). We also found that early childhood antibiotic exposure was associated with the risk for childhood obesity (OR 1.14; 95% CI 1.04 to 1.24) (very low quality evidence). Conclusions: Very low quality evidence suggests that exposure to antibiotics early in life may be associated with an increased risk of being overweight and obese in later childhood. However, very low quality evidence raises serious questions about the plausibility of prenatal and early infancy antibiotic exposure being causally related to weight in children. PROSPERO registration:
CRD42016050011 (14/12/2016)
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Affiliation(s)
| | - Kim Chau
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Henry Kwon
- Department of Medicine, Wayne State University, Detroit, MI, USA
| | - Qin Guo
- Department of Pediatrics, West China Second University Hospital, Chengdu, China
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Friederichs H, Birkenstein R, Becker JC, Marschall B, Weissenstein A. Risk literacy assessment of general practitioners and medical students using the Berlin Numeracy Test. BMC FAMILY PRACTICE 2020; 21:143. [PMID: 32664885 PMCID: PMC7362657 DOI: 10.1186/s12875-020-01214-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 07/07/2020] [Indexed: 11/24/2022]
Abstract
Background The responsibility for helping patients understand potential health benefits and risks, especially regarding screening tests, falls largely to general practitioners (GPs). The Berlin Numeracy Test (BNT) specifically measures risk literacy (i.e., the ability to understand different aspects of statistical numeracy associated with accurate interpretation of information about risks). This study explored the association between risk literacy levels and clinical experience in GPs vs. medical students. Additionally, the effect of GP risk literacy on evaluation of the predictive value of screening tests was examined. Methods The participants were 84 GPs and 92 third-year medical students who completed the BNT (total score range 0–4 points). The GPs received an additional case scenario on mammography screening as a simple measure of performance in applying numeracy skills. Results Despite having an average of 25.9 years of clinical experience, GPs scored no better than medical students on risk literacy (GPs: 2.33 points, 95% confidence interval [CI] 2.08–2.59; students: 2.34, 95% CI 2.07–2.61; P = .983). Of all GPs, 71.6% (n = 58) greatly overestimated the real predictive value. Conclusions In this study, we found no difference in risk literacy between current students and current GPs. GPs lack risk literacy and consequently do not fully understand numeric estimates of probability in routine screening procedures.
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Affiliation(s)
- Hendrik Friederichs
- Study Hospital Münster, Institute for Education and Student Affairs, Medical Faculty of Münster, Malmedyweg 17-19, D-48149, Münster, Germany.
| | - Roman Birkenstein
- Study Hospital Münster, Institute for Education and Student Affairs, Medical Faculty of Münster, Malmedyweg 17-19, D-48149, Münster, Germany
| | - Jan C Becker
- Study Hospital Münster, Institute for Education and Student Affairs, Medical Faculty of Münster, Malmedyweg 17-19, D-48149, Münster, Germany
| | - Bernhard Marschall
- Study Hospital Münster, Institute for Education and Student Affairs, Medical Faculty of Münster, Malmedyweg 17-19, D-48149, Münster, Germany
| | - Anne Weissenstein
- Department of Internal Medicine, Marien-Hospital, Erftstadt, NRW, Germany
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Morgott M, Heinmüller S, Hueber S, Schedlbauer A, Kühlein T. Do guidelines help us to deviate from their recommendations when appropriate for the individual patient? A systematic survey of clinical practice guidelines. J Eval Clin Pract 2020; 26:709-717. [PMID: 31206241 DOI: 10.1111/jep.13187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/03/2019] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Clinical practice guidelines (CPG) were introduced to summarize the best scientific evidence available. Thereby, CPG were meant to support evidence-based medicine (EBM). However, besides evidence, EBM also asks for patients' preferences and physicians' experiences to be considered when coming to therapeutic decisions. Thus, deviations from CPG recommendations are sometimes necessary when practicing EBM. We wanted to examine whether CPG support deviations from their recommendations when appropriate. For operationalization, we asked whether absolute effect sizes (AES) for benefit and/or harm of suggested therapies were provided along with the respective CPG recommendation. METHODS This systematic survey comprised the most common CPG on chronic coronary heart disease (CCHD) and type 2 diabetes mellitus (T2DM) from English- and German-speaking countries. Only CPG recommendations on pharmacotherapy were evaluated. If AES of a recommended therapy were reported, we rated how easily findable they were within the CPG. Moreover, we assessed whether the CPG provided patient information material and whether this material supplied AES allowing patients to determine the effects to be expected. RESULTS In the 13 CPG surveyed, 144 recommendations on pharmacotherapy were identified. For 108 recommendations (75%), no AES for benefit and/or harm were reported. Thirty-one recommendations (22%) were accompanied by one or more AES for either benefit or harm. Along with five recommendations (3%), one or more AES for both benefit and harm were given. AES were considered easy to find for three of these 36 recommendations (8%). Patient information material was provided in three of the 13 CPG (23%) accounting for AES in one occasion only. CONCLUSION Current CPG on T2DM and CCHD do not sufficiently offer AES for benefits and harms of recommended therapies. Thus, they lack satisfactory information to support deviations from CPG recommendations. Consequently, CPG in their present form do not adequately facilitate EBM.
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Affiliation(s)
- Marc Morgott
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Institute of General Practice, Erlangen, Germany
| | - Stefan Heinmüller
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Institute of General Practice, Erlangen, Germany
| | - Susann Hueber
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Institute of General Practice, Erlangen, Germany
| | - Angela Schedlbauer
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Institute of General Practice, Erlangen, Germany
| | - Thomas Kühlein
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Institute of General Practice, Erlangen, Germany
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Comparison of blogshots with plain language summaries of Cochrane systematic reviews: a qualitative study and randomized trial. Trials 2020; 21:426. [PMID: 32450904 PMCID: PMC7249676 DOI: 10.1186/s13063-020-04360-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/28/2020] [Indexed: 11/16/2022] Open
Abstract
Background Cochrane, an organization dedicated to the production and dissemination of high-quality evidence on health, endeavors to reach consumers by developing appropriate summary formats of its systematic reviews. However, the optimal type of presentation of evidence to consumers is still unknown. Objective The aim of this study was to investigate consumer preferences for different summary formats of Cochrane systematic reviews (CSRs), using both qualitative and quantitative approaches. Methods Initially, we conducted three focus groups with medical students (n = 7), doctors (n = 4), and patients (n = 9) in 2017 to explore their health information search habits and preferences for CSR summary formats. Based on those findings, we conducted a randomized trial with medical students at the University of Split School of Medicine, Croatia, and with patients from three Dalmatian family practices to determine whether they prefer CSR blogshots (n = 115) or CSR plain language summaries (PLSs; n = 123). Results Participants in the focus groups favored brief and explicit CSR summary formats with fewer numbers. Although we found no difference in participants’ preferences for a specific summary format in the overall sample, subgroup analysis showed that patients preferred blogshots over PLSs in comparison to medical students (P = 0.003, eta squared effect size η2 = 0.04). Conclusion CSR summaries should be produced in a format that meets the expectations and needs of consumers. Use of blogshots as a summary format could enhance the dissemination of CSRs among patients. Trial registration The trial was registered in ClinicalTrials.gov, NCT03542201. Registered on May 31st 2018.
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Granan LP, Reme SE, Jacobsen HB, Stubhaug A, Ljoså TM. The Oslo University Hospital Pain Registry: development of a digital chronic pain registry and baseline data from 1,712 patients. Scand J Pain 2020; 19:365-373. [PMID: 30699072 DOI: 10.1515/sjpain-2017-0160] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/05/2019] [Indexed: 12/26/2022]
Abstract
Background and aims Chronic pain is a leading cause to years lived with disability worldwide. However, few of the interventions used in pain medicine have proven efficacy, and evidence from the existing studies may not be valid for the general pain population. Therefore, it is of utmost need that we describe chronic pain conditions in their most relevant aspects, their various guises, as well as the real world outcomes of our clinical interventions. The most obvious and crude way to make these assessments are through large registries where patient characteristics, treatment characteristics (including but not limited to what, when, how often and by whom), treatment outcomes and patient outcomes are scrutinized and recorded. Methods and results This article describes in detail the design and baseline data of the comprehensive Oslo University Hospital Pain Registry (OPR). OPR is the local registry of the largest university and interdisciplinary outpatient pain clinic in Norway. Data registration started in October 2015, and approximately 1,000 patients are assessed and treated at the clinic each year. During the first 2 years of running the OPR (through September 2017), a total of 1,712 patient baseline reports were recorded from 2,001 patients. Clinicians enter data about relevant treatments and interventions, while patients provide self-reported data on aspects related to pain and pain management. The patients complete an electronic registration immediately before their first consultation at the outpatient pain clinic. The baseline questions of the OPR cover: Basic demographics; The Modified Oswestry Disability Index to assess general function; A pain drawing to assess pain location; Questions regarding the temporal aspects of pain; Six 0-10 Numeric Rating Scales to assess pain intensity and bothersomeness; The EQ-5D-5L to measure health-related quality of life; The Hopkins Symptom Check List-25 to assess psychological distress; A single question about self-rated health; The general self-efficacy scale to assess the patient's perceived self-efficacy; The Bodily Distress Syndrome checklist to assess functional disorders; The Injustice Experience Questionnaire to assess whether the patients experience injustice; Chalder Fatigue Questionnaire to assess fatigue; The Insomnia Severity Index to assesses the levels of insomnia symptoms; The Pain Catastrophizing Scale to measure pain catastrophizing and exaggerated negative orientation toward pain stimuli and pain experience; And the SF36v2 to assess patients' self-report of generic health and wellbeing. The baseline data show that chronic pain patients have a high degree of negative impact in all aspects of their lives. Conclusions and implications The OPR is the most comprehensive pain registry for multidisciplinary and interdisciplinary outpatient pain clinics in Norway. Detailed design of the registry and key baseline data are presented. Registries are of great value in that they enable real world effectiveness outcomes for patients with chronic pain conditions. The OPR can thus serve as a model for similar initiatives elsewhere. The OPR cohort may also serve as a historical control in future studies, both with experimental and observational design.
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Affiliation(s)
- Lars-Petter Granan
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, P. O. Box 4956 Nydalen, N-0424 Oslo, Norway.,Advisory Unit on Pain Management Health Region South-East, Oslo, Norway.,Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway, Phone: +47 91 85 95 05
| | - Silje Endresen Reme
- Advisory Unit on Pain Management Health Region South-East, Oslo, Norway.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Henrik Børsting Jacobsen
- Advisory Unit on Pain Management Health Region South-East, Oslo, Norway.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,National Advisory Unit for Neuropathic Pain, Oslo, Norway
| | - Audun Stubhaug
- Advisory Unit on Pain Management Health Region South-East, Oslo, Norway.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tone Marte Ljoså
- Advisory Unit on Pain Management Health Region South-East, Oslo, Norway.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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47
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Ritti-Dias RM, Correia MDA, Farah BQ. Visual data: a new tool to improve the presentation of clinical trial results. EINSTEIN-SAO PAULO 2019; 18:eAE4729. [PMID: 31778465 PMCID: PMC6896661 DOI: 10.31744/einstein_journal/2020ae4729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 06/12/2019] [Indexed: 11/05/2022] Open
Abstract
Randomized controlled trials are known to be the best tool to determine the effects of an intervention; however, most healthcare professionals are not able to adequately understand the results. In this report, concepts, applications, examples, and advantages of using visual data as a complementary tool in the results section of original articles are presented. Visual simplification of data presentation will improve general understanding of clinical research.
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Affiliation(s)
| | | | - Breno Quintella Farah
- Universidade Federal Rural de PernambucoRecifePEBrazilUniversidade Federal Rural de Pernambuco, Recife, PE, Brazil.
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Hemilä H, Friedrich JO. Many continuous variables should be analyzed using the relative scale: a case study of β 2-agonists for preventing exercise-induced bronchoconstriction. Syst Rev 2019; 8:282. [PMID: 31744533 PMCID: PMC6865024 DOI: 10.1186/s13643-019-1183-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/05/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The relative scale adjusts for baseline variability and therefore may lead to findings that can be generalized more widely. It is routinely used for the analysis of binary outcomes but only rarely for continuous outcomes. Our objective was to compare relative vs absolute scale pooled outcomes using data from a recently published Cochrane systematic review that reported only absolute effects of inhaled β2-agonists on exercise-induced decline in forced-expiratory volumes in 1 s (FEV1). METHODS From the Cochrane review, we selected placebo-controlled cross-over studies that reported individual participant data (IPD). Reversal in FEV1 decline after exercise was modeled as a mean uniform percentage point (pp) change (absolute effect) or average percent change (relative effect) using either intercept-only or slope-only, respectively, linear mixed-effect models. We also calculated the pooled relative effect estimates using standard random-effects, inverse-variance-weighting meta-analysis using study-level mean effects. RESULTS Fourteen studies with 187 participants were identified for the IPD analysis. On the absolute scale, β2-agonists decreased the exercise-induced FEV1 decline by 28 pp., and on the relative scale, they decreased the FEV1 decline by 90%. The fit of the statistical model was significantly better with the relative 90% estimate compared with the absolute 28 pp. estimate. Furthermore, the median residuals (5.8 vs. 10.8 pp) were substantially smaller in the relative effect model than in the absolute effect model. Using standard study-level meta-analysis of the same 14 studies, β2-agonists reduced exercise-induced FEV1 decline on the relative scale by a similar amount: 83% or 90%, depending on the method of calculating the relative effect. CONCLUSIONS Compared with the absolute scale, the relative scale captures more effectively the variation in the effects of β2-agonists on exercise-induced FEV1-declines. The absolute scale has been used in the analysis of FEV1 changes and may have led to sub-optimal statistical analysis in some cases. The choice between the absolute and relative scale should be determined based on biological reasoning and empirical testing to identify the scale that leads to lower heterogeneity.
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Affiliation(s)
- Harri Hemilä
- Department of Public Health, POB 20 University of Helsinki, Tukholmankatu 8 B, FI-00014, Helsinki, Finland.
| | - Jan O Friedrich
- Critical Care and Medicine Departments and Li Ka Shing Knowledge Institute, University of Toronto and St. Michael's Hospital, Toronto, Canada
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Zimmerman S, Sloane PD, Resnick B. Encouraging the Use of Research to Guide Practice and Policy. J Am Med Dir Assoc 2019; 20:1063-1064. [DOI: 10.1016/j.jamda.2019.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022]
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Johnson KW, Torres Soto J, Glicksberg BS, Shameer K, Miotto R, Ali M, Ashley E, Dudley JT. Artificial Intelligence in Cardiology. J Am Coll Cardiol 2019; 71:2668-2679. [PMID: 29880128 DOI: 10.1016/j.jacc.2018.03.521] [Citation(s) in RCA: 477] [Impact Index Per Article: 95.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 03/01/2018] [Accepted: 03/05/2018] [Indexed: 01/24/2023]
Abstract
Artificial intelligence and machine learning are poised to influence nearly every aspect of the human condition, and cardiology is not an exception to this trend. This paper provides a guide for clinicians on relevant aspects of artificial intelligence and machine learning, reviews selected applications of these methods in cardiology to date, and identifies how cardiovascular medicine could incorporate artificial intelligence in the future. In particular, the paper first reviews predictive modeling concepts relevant to cardiology such as feature selection and frequent pitfalls such as improper dichotomization. Second, it discusses common algorithms used in supervised learning and reviews selected applications in cardiology and related disciplines. Third, it describes the advent of deep learning and related methods collectively called unsupervised learning, provides contextual examples both in general medicine and in cardiovascular medicine, and then explains how these methods could be applied to enable precision cardiology and improve patient outcomes.
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Affiliation(s)
- Kipp W Johnson
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, New York; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jessica Torres Soto
- Division of Cardiovascular Medicine, Stanford University, Palo Alto, California; Departments of Medicine, Genetics, and Biomedical Data Science, Stanford University, Palo Alto, California; Center for Inherited Cardiovascular Disease, Stanford University, Palo Alto, California
| | - Benjamin S Glicksberg
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, New York; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York; Institute for Computational Health Sciences, University of California, San Francisco, California
| | - Khader Shameer
- Department of Information Services, Center for Research Informatics and Innovation, Northwell Health, New Hyde Park, New York
| | - Riccardo Miotto
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, New York; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mohsin Ali
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, New York; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Euan Ashley
- Division of Cardiovascular Medicine, Stanford University, Palo Alto, California; Departments of Medicine, Genetics, and Biomedical Data Science, Stanford University, Palo Alto, California; Center for Inherited Cardiovascular Disease, Stanford University, Palo Alto, California
| | - Joel T Dudley
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, New York; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York.
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