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Vilaplana A, Morell M, Valero-Arrese L, Marshall LV, Saló A, Crowe T, Romero L, de Rojas T, Carceller F, Moreno L. Incorporation of patient-reported outcomes in early-phase clinical trials for childhood and adolescent cancer. Pediatr Blood Cancer 2024; 71:e31165. [PMID: 38961582 DOI: 10.1002/pbc.31165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION The assessment of quality of life (QoL) should be one of the main objectives in paediatric clinical trials. Even though researchers, regulators and advocates support the use of patient-reported outcomes (PROs), this has not been fully implemented. The aim of this study is to assess the measurement of QoL and the usage of PROs, palatability assessments and medication diaries in early-phase clinical trials for childhood and adolescent cancer. METHODS Early-phase clinical trials for children and adolescents with cancer opened between 2005 and 2022 at the Royal Marsden Hospital (London, UK) and Vall d'Hebron University Hospital (Barcelona, Spain) were interrogated for trial characteristics and the use of QoL questionnaires, PROs, palatability assessments and medication diaries. RESULTS Overall, 72 clinical trials were analysed: 12 (16.7%) evaluated QoL and eight (11.1%) evaluated PROs. Palatability was tested in 21/40 (52.5%) trials of oral drugs and 23/72 (31.9%) incorporated medication diaries. No studies mentioned patient involvement in the trial protocol. Use of PROs increased from one of 36 (2.8%) to seven of 36 (19.4%) between the first period (2005-2016) and the second period (2017-2022) (p = .02). Implementation of medication diaries increased from seven of 36 (19.4%) to 16/36 (44.4%) in each period, respectively (p = .02). CONCLUSION Only a minor proportion of the international/multicentric early-phase trials evaluated included QoL/PROs and medication diaries or palatability questionnaires to help assess these, although this trend seems to be increasing over recent years. Greater implementation of QoL/PROs has the potential to improve the patient's wellbeing and facilitate symptom control, to enhance patient/parent involvement in future trial designs and to provide information for drug prioritisation.
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Affiliation(s)
- Andrea Vilaplana
- Childhood Cancer and Blood Disorders Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Mariona Morell
- Childhood Cancer and Blood Disorders Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
- Paediatric Haematology and Oncology Division, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Lorena Valero-Arrese
- Childhood Cancer and Blood Disorders Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
- Paediatric Haematology and Oncology Division, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Lynley V Marshall
- Paediatric & Adolescent Oncology Drug Development Unit, The Royal Marsden NHS Foundation Trust and Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Anna Saló
- Paediatric Haematology and Oncology Division, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Tracey Crowe
- Paediatric & Adolescent Oncology Drug Development Unit, The Royal Marsden NHS Foundation Trust and Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Laura Romero
- Paediatric Haematology and Oncology Division, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Fernando Carceller
- Paediatric & Adolescent Oncology Drug Development Unit, The Royal Marsden NHS Foundation Trust and Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Lucas Moreno
- Childhood Cancer and Blood Disorders Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
- Paediatric Haematology and Oncology Division, Vall d'Hebron University Hospital, Barcelona, Spain
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Verma S, Leiter LA, Mangla KK, Nielsen NF, Hansen Y, Bonaca MP. Epidemiology and Burden of Peripheral Artery Disease in People With Type 2 Diabetes: A Systematic Literature Review. Diabetes Ther 2024; 15:1893-1961. [PMID: 39023686 PMCID: PMC11330435 DOI: 10.1007/s13300-024-01606-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 05/31/2024] [Indexed: 07/20/2024] Open
Abstract
Type 2 diabetes (T2D) and lower-extremity peripheral artery disease (PAD) are growing global health problems associated with considerable cardiovascular (CV) and limb-related morbidity and mortality, poor quality of life and high healthcare resource use and costs. Diabetes is a well-known risk factor for PAD, and the occurrence of PAD in people with T2D further increases the risk of long-term complications. As the available evidence is primarily focused on the overall PAD population, we undertook a systematic review to describe the burden of comorbid PAD in people with T2D. The MEDLINE, Embase and Cochrane Library databases were searched for studies including people with T2D and comorbid PAD published from 2012 to November 2021, with no restriction on PAD definition, study design or country. Hand searching of conference proceedings, reference lists of included publications and relevant identified reviews and global burden of disease reports complemented the searches. We identified 86 eligible studies, mostly observational and conducted in Asia and Europe, presenting data on the epidemiology (n = 62) and on the clinical (n = 29), humanistic (n = 12) and economic burden (n = 12) of PAD in people with T2D. The most common definition of PAD relied on ankle-brachial index values ≤ 0.9 (alone or with other parameters). Incidence and prevalence varied substantially across studies; nonetheless, four large multinational randomised controlled trials found that 12.5%-22% of people with T2D had comorbid PAD. The presence of PAD in people with T2D was a major cause of lower-limb and CV complications and of all-cause and CV mortality. Overall, PAD was associated with poor quality of life, and with substantial healthcare resource use and costs. To our knowledge, this systematic review provides the most comprehensive overview of the evidence on the burden of PAD in people with T2D to date. In this population, there is an urgent unmet need for disease-modifying agents to improve outcomes.
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Affiliation(s)
- Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada.
| | - Lawrence A Leiter
- Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
| | | | | | | | - Marc P Bonaca
- CPC Clinical Research, Cardiology and Vascular Medicine, University of Colorado, Aurora, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
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Manswell K, Le V, Henry K, Casey M, Anumolu N, Putman MS. The State of Patient-Reported Outcome Measures in Rheumatology. J Rheumatol 2024; 51:920-927. [PMID: 38825357 DOI: 10.3899/jrheum.2023-1073] [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] [Accepted: 05/06/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE We sought to evaluate the quality and timeliness of patient-reported outcome (PRO) measure reporting, which have not been previously studied. METHODS Clinical trials that informed new US Food and Drug Administration (FDA) approvals for the first rheumatological indication between 1995 and 2021 were identified. Data were recorded to determine whether collected PROs were published, met minimum clinically important difference (MCID) or statistical significance (P < 0.05) thresholds, and were consistent with Consolidated Standards of Reporting Trials (CONSORT)-PRO standards. Hazard ratios and Kaplan-Meier estimate were used to assess the time from FDA approval to PRO publication. RESULTS Thirty-one FDA approvals corresponded with 110 pivotal trials and 262 reported PROs. Of the 90 included studies, 1 (1.1%) met all 5 recommended items, 10 (11.1%) met 4 items, 17 (18.9%) met 3 items, 21 (23.3%) met 2 items, 26 (28.9%) met 1 item, and 15 (16.7%) met none of the reporting standards. Most PROs met MCID thresholds (149/262; 56.9%) and were statistically significant (223/262; 85.1%). Of our subset analysis, one-third of PROs were not published upfront (70/212; 33%) and 1 of 9 (22/212; 10.4%) remained unpublished ≥ 4 years after initial trial reporting. Publication rates were highest for the Health Assessment Questionnaire-Disability Index (97.4%) and lowest for the 36-item Short Form Health Survey (81.8%). Less than half of these published PROs met MCID and statistical significance thresholds (94/212; 44.3%). CONCLUSION One in 9 PROs remained unpublished for ≥ 4 years after initial trial reporting, and compliance with CONSORT-PRO reporting guidelines was poor. Efforts should be made to ensure PROs are adequately reported and expeditiously published.
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Affiliation(s)
- Kenrick Manswell
- K. Manswell, BS, V. Le, BS, K. Henry, BS, M. Casey, BS, N. Anumolu, BS, M.S. Putman MD, MSci, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Victoria Le
- K. Manswell, BS, V. Le, BS, K. Henry, BS, M. Casey, BS, N. Anumolu, BS, M.S. Putman MD, MSci, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kathryn Henry
- K. Manswell, BS, V. Le, BS, K. Henry, BS, M. Casey, BS, N. Anumolu, BS, M.S. Putman MD, MSci, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Maximilian Casey
- K. Manswell, BS, V. Le, BS, K. Henry, BS, M. Casey, BS, N. Anumolu, BS, M.S. Putman MD, MSci, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Natalie Anumolu
- K. Manswell, BS, V. Le, BS, K. Henry, BS, M. Casey, BS, N. Anumolu, BS, M.S. Putman MD, MSci, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael S Putman
- K. Manswell, BS, V. Le, BS, K. Henry, BS, M. Casey, BS, N. Anumolu, BS, M.S. Putman MD, MSci, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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Kang M, Yoo S, Jung Y, Lim H, Lee MH, Ryu JK, Lee JI. Factors affecting peripheral neuropathy induced by nanoparticle albumin-bound paclitaxel in patients with pancreatic cancer. Br J Clin Pharmacol 2024. [PMID: 39152547 DOI: 10.1111/bcp.16210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/19/2024] Open
Abstract
AIM Chemotherapy-induced peripheral neuropathy (CIPN) is a major toxicity limiting the use of nab-paclitaxel (Nab-P) in treating patients with pancreatic cancer. The aim of this study was to identify the factors affecting CIPN using patient-reported outcome measures and the minimally invasive volumetric absorptive microsampling (VAMS) technique. METHODS The maximum concentrations of paclitaxel (Cmax) were measured from 81 VAMS samples collected from 44 participants with pancreatic cancer. The association between CIPN development and demographic, clinical and pharmacokinetic factors was determined using univariable and multivariable logistic regression. The association between CIPN severity and the factors was evaluated using Spearman's rank correlation. The impact of Cmax and the number of treatment cycles on the severity was assessed using multivariable linear regression. RESULTS The development of CIPN was significantly associated with cumulative dose (odds ratio 1.005, 95% confidence interval [CI] 1.003-1.007), treatment cycles (3.47, 2.25-5.85), alkaline phosphate (0.992, 0.985-0.998) and age (1.092, 1.020-1.179), with an area under the receiver operating characteristic curve of 0.89 (95% CI 0.83-0.95). The severity of CIPN significantly worsened with increasing cumulative dose (coefficient 0.58, 95% CI 0.44-0.69), treatment cycles (0.57, 0.44-0.68) and age (0.18, 0.00-0.35). The severity of CIPN was predictable from treatment cycles (P = .0002) and Cmax (P = .01). CONCLUSION The higher the cumulative dose of Nab-P, treatment cycles and age, the more frequently and severely do the patients experience CIPN. In predicting the severity of CIPN using Cmax, minimally invasive VAMS is a feasible alternative to venous blood sampling.
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Affiliation(s)
- Minseo Kang
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Seunghyun Yoo
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Yeolmae Jung
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Hayun Lim
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Myeong Hwan Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Kon Ryu
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jangik I Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
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Reuter U, Heinze A, Gendolla A, Sieder C, Hentschke C. Erenumab versus topiramate: migraine-related disability, impact and health-related quality of life. Eur J Neurol 2024:e16437. [PMID: 39132915 DOI: 10.1111/ene.16437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND AND PURPOSE HER-MES was the first head-to-head study of erenumab against topiramate (standard of care). This post hoc analysis of the HER-MES study evaluated the effect of erenumab versus topiramate on patient-reported outcomes at week 24. METHODS Adult patients with episodic or chronic migraine (n = 777) were randomized (1:1) to monthly subcutaneous erenumab (n = 389) or daily oral topiramate (n = 388). Migraine-related disability, as measured by the Headache Impact Test 6 (HIT-6) and Short Form 36 Health Survey version 2 (SF-36v2), was analysed in the entire study cohort and true completers. RESULTS In the erenumab group (vs. topiramate), significant improvements were reported in Headache Impact Test 6 total scores (composite populations, -10.88 vs. -7.72; true completers, -11.92 vs. -10.61) and a higher proportion of patients achieved a ≥5-point reduction from baseline with erenumab (composite populations, 72.2% vs. 53.9%; true completers, 79.64% vs. 71.43%). The adjusted mean change from baseline in the SF-36v2 score was greater with erenumab for both physical component summary (composite population, 5.48 vs. 3.63; true completers, 5.95 vs. 5.23) and mental component summary (composite populations, 1.00 vs. -1.18; true completers, 1.74 vs. -0.33). A higher proportion of patients on erenumab versus topiramate had a ≥5-point improvement in SF-36v2 for the physical component summary (composite populations, 47.7% vs. 37.4%; true completers, 52.1% vs. 48.9%) and mental component summary (composite populations, 25.3% vs. 16.8%; true completers, 27.3% vs. 17.7%). CONCLUSIONS This post hoc analysis demonstrated that patients treated with erenumab had significant improvements in headache impact and quality of life as measured by patient-reported outcomes versus patients treated with topiramate.
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Affiliation(s)
- Uwe Reuter
- Department of Neurology, Charite Universitatsmedizin Berlin, Berlin, Germany
- Universitatsmedizin Greifswald, Greifswald, Germany
| | - Axel Heinze
- Schmerzklinik Kiel, Migraine and Headache Center, Kiel, Germany
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Balachandran AT, Orange ST, Wang Y, Lustin R, Vega A, Quiles N. Comparison of two popular transducers to measure sit-to-stand power in older adults. PLoS One 2024; 19:e0308808. [PMID: 39133754 PMCID: PMC11318872 DOI: 10.1371/journal.pone.0308808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 07/31/2024] [Indexed: 08/15/2024] Open
Abstract
The Tendo Unit (TU) and GymAware (GA) are the two most frequently used linear transducers for assessing muscle power in older adults via the sit-to-stand (STS) test. Unlike TU, GA incorporates a sensor mechanism to correct for non-vertical movements, which may lead to systematic differences between devices. The aim of this study therefore was to compare GA to TU for measuring STS power in community-dwelling older adults. Community-dwelling adults (n = 51, aged ≥65 years, 61% female) completed a single chair stand, with peak power measured simultaneously using GA and TU. Participants also completed the pneumatic leg press, 8-Foot Up and Go (TUG) test, Short Physical Performance Battery (SPPB), and self-reported measures of physical function. Intraclass correlations (ICC) were used to assess agreement, and Pearson's correlations were used to assess correlations. The study protocol was prospectively registered on the Open Science Framework. In alignment with our pre-registered hypothesis, peak power demonstrated an ICC of 0.93 (95% CI: 0.88, 0.96). For secondary aims, both transducers showed a correlation greater than 0.8 compared to pneumatic leg press power. For physical performance outcomes, both TU and GA showed similar correlations, as hypothesized: SPPB (r = 0.29 for TU vs. 0.33 for GA), Chair Stands (r = -0.41 vs. -0.38), TUG Fast (r = -0.53 vs. -0.52), mobility questionnaire (r = 0.52 vs. 0.52) and physical function questionnaire (r = 0.44 vs. 0.43). GA and TU peak power showed a high degree of agreement and similar correlations with physical and self-reported performance measures, suggesting that both methods can be used for assessing STS power in older adults.
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Affiliation(s)
- Anoop T. Balachandran
- Department of Family, Nutrition and Exercise Sciences, Queens College, New York, NY, United States of America
| | - Samuel T. Orange
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Yipeng Wang
- Department of Biostatistics, University of Florida, Gainesville, FL, United States of America
| | - Renee Lustin
- Department of Family, Nutrition and Exercise Sciences, Queens College, New York, NY, United States of America
| | - Andy Vega
- Department of Family, Nutrition and Exercise Sciences, Queens College, New York, NY, United States of America
| | - Norberto Quiles
- Department of Family, Nutrition and Exercise Sciences, Queens College, New York, NY, United States of America
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Shahbaz M, Harding JE, Milne B, Walters A, von Randow M, Gamble GD. Effect of utilizing either a self-reported questionnaire or administrative data alone or in combination on the findings of a randomized controlled trial of the long-term effects of antenatal corticosteroids. PLoS One 2024; 19:e0308414. [PMID: 39110714 PMCID: PMC11305536 DOI: 10.1371/journal.pone.0308414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 07/23/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION A combination of self-reported questionnaire and administrative data could potentially enhance ascertainment of outcomes and alleviate the limitations of both in follow up studies. However, it is uncertain how access to only one of these data sources to assess outcomes impact study findings. Therefore, this study aimed to determine whether the study findings would be altered if the outcomes were assessed by different data sources alone or in combination. METHODS At 50-year follow-up of participants in a randomized trial, we assessed the effect of antenatal betamethasone exposure on the diagnosis of diabetes, pre-diabetes, hyperlipidemia, hypertension, mental health disorders, and asthma using a self-reported questionnaire, administrative data, a combination of both, or any data source, with or without adjudication by an expert panel of five clinicians. Differences between relative risks derived from each data source were calculated using the Bland-Altman approach. RESULTS There were 424 participants (46% of those eligible, aged 49 years, SD 1, 50% male). There were no differences in study outcomes between participants exposed to betamethasone and those exposed to placebo when the outcomes were assessed using different data sources. When compared to the study findings determined using adjudicated outcomes, the mean difference (limits of agreement) in relative risks derived from other data sources were: self-reported questionnaires 0.02 (-0.35 to 0.40), administrative data 0.06 (-0.32 to 0.44), both questionnaire and administrative data 0.01 (-0.41 to 0.43), and any data source, 0.01 (-0.08 to 0.10). CONCLUSION Utilizing a self-reported questionnaire, administrative data, both questionnaire and administrative data, or any of these sources for assessing study outcomes had no impact on the study findings compared with when study outcomes were assessed using adjudicated outcomes.
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Affiliation(s)
- Mohammad Shahbaz
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Jane E. Harding
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Barry Milne
- Centre of Methods and Policy Application in Social Sciences, University of Auckland, Auckland, New Zealand
| | - Anthony Walters
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Martin von Randow
- Centre of Methods and Policy Application in Social Sciences, University of Auckland, Auckland, New Zealand
| | - Greg D. Gamble
- Liggins Institute, The University of Auckland, Auckland, New Zealand
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Namavarian A, Cheng EY, Shapiro J, Ziai H, Talei B, Pai A, Enepekides D, Gantous AM. Selective Neurectomy for Postfacial Paralysis Synkinesis: A Systematic Review. Facial Plast Surg 2024; 40:525-537. [PMID: 38806148 DOI: 10.1055/s-0044-1786824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Abstract
Facial synkinesis is characterized by unintentional contractions of facial musculature secondary to aberrant facial nerve healing. The associated impairment in facial functioning results in a significant decrease in patients' quality of life. The mainstay treatment for postfacial paralysis synkinesis (PFPS) is chemodenervation and physiotherapy, which requires long-term maintenance neurotoxin injections. This can lead to treatment resistance. Selective neurectomy of the distal branches of the facial nerve has been suggested as an effective surgical treatment of PFPS. This study aims to provide a comprehensive systematic review evaluating the efficacy of selective neurectomy for patients presenting with PFPS. Ovid MEDLINE, Ovid Embase, PubMed, Web of Science, and CINAHL were searched from inception until July 2022. Studies that investigated postoperative outcomes of pediatric and/or adult patients who underwent selective neurectomy as a treatment for PFPS were included. The database search identified 1,967 studies, and 11 were ultimately included based on inclusion and exclusion criteria. These 11 studies represented 363 patients. Studies reported on outcomes following selective neurectomy with or without adjuvant therapies for patients with PFPS. The main outcome categories identified were clinician-reported outcomes and patient-reported outcomes. The studies that used clinician-reported outcomes found an improvement in both synkinesis and facial nerve paralysis (FNP) outcomes following selective neurectomy according to their respective grading systems. Three studies looked at patient-reported outcomes and found increased patient-reported quality of life and satisfaction following selective neurectomy. The most reported complications were upper lip contracture, uneven cheek surface, lagophthalmos, and temporary oral incompetence. Selective neurectomy has demonstrated stable or improved synkinesis, FNP, and quality of life outcomes in patients with PFPS. This approach should be considered for patients with PFPS, particularly for patients with refractory symptoms or those who are unable to undergo continued medical management.
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Affiliation(s)
- Amirpouyan Namavarian
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Emily YiQin Cheng
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justin Shapiro
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Talei
- Beverly Hills Center for Facial Plastic Surgery, Beverly Hills, California
| | - Akshat Pai
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andres M Gantous
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Adebagbo OD, Rahmani B, Park JB, Chen A, Garvey SR, Lee D, Saxena N, Lee BT, Boustany A, Lin SJ, Cauley RP. Effect of pedicle type on breast reduction: Clinical and patient-reported outcomes. J Plast Reconstr Aesthet Surg 2024; 95:7-14. [PMID: 38865843 DOI: 10.1016/j.bjps.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE The choice of pedicle in reduction mammaplasty is highly variable with prior studies demonstrating high patient satisfaction in most cases. This study aimed to examine the impact of pedicle type on clinical and patient-reported outcomes in patients undergoing reduction mammaplasty. METHODS A total of 588 patients underwent bilateral reduction mammaplasty with Wise pattern or modified Robertson incision by 13 surgeons at a single institution. Clinical outcomes were compared according to the pedicle type in all patients and BREAST-Q responders (32% response rate). Survey respondents were sub-grouped by resection volume, and the BREAST-Q satisfaction scores were compared. RESULTS Among all included reduction mammoplasties, 439 (75%) were performed using inferior pedicles, and 149 (25%) using superior or superomedial pedicles. Responders and non-responders were similar in preoperative characteristics including age, body measurements, and comorbidities. Although a higher incidence of infection occurred among the responders, clinical outcomes were comparable across all pedicle types. A total of 187 patients completed the BREAST-Q. Compared to the superior pedicle group, respondents in the inferior pedicle group reported higher nipple satisfaction, even when adjusted for resection weight over 500 g. In contrast, the superior pedicle group had better sexual well-being scores, which persisted in resection weight less than 500 g (all p values <0.05). CONCLUSION Inferior pedicles were associated with greater nipple satisfaction and superior pedicles were associated with greater sexual satisfaction. Our findings suggest that those with resections less than 500 g were more satisfied with superior pedicles whereas those with greater resections were more satisfied with inferior pedicles.
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Affiliation(s)
- Oluwaseun D Adebagbo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Tufts University School of Medicine, Boston, MA, USA
| | - Benjamin Rahmani
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - John B Park
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Amy Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Shannon R Garvey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Daniela Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Nimish Saxena
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Tufts University School of Medicine, Boston, MA, USA
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Ashley Boustany
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Ryan P Cauley
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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Królikowska A, Reichert P, Senorski EH, Karlsson J, Becker R, Prill R. Scores and sores: Exploring patient-reported outcomes for knee evaluation in orthopaedics, sports medicine and rehabilitation. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39072858 DOI: 10.1002/ksa.12334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 07/30/2024]
Abstract
Recognizing and addressing the controversies surrounding using patient-reported outcome measures (PROMs) is crucial for enhancing evaluation standards in clinical studies in orthopedics, sports medicine, and rehabilitation. The article comprehensively described the challenges of using PROMs to evaluate knee conditions in these fields. Apart from defining and characterizing patient-reported outcomes and their measures, the article discussed controversies around them, such as using them as primary outcomes. It highlighted the importance of standardizing and validating PROMs. Several initiatives taken to improve the selection of appropriate outcomes for clinical research purposes were described. Additionally, the potential of technology, mainly digital health tools and mobile applications, was mentioned in the context of enhancing the collection and analysis of PROMs. The article also raised the issue of the readability of PROMs, defined as the ease with which they can be read and understood by patients. The article concluded that adopting a complementary approach to treatment evaluation by integrating subjective and objective measures is imperative for accurately assessing efficacy. This comprehensive approach provides a more holistic understanding of patient outcomes, forms the foundation for evidence-based medicine, and informs future healthcare policies. Proactive measures are urgently needed to address concerns and improve the reliability and validity of PROMs for clinical practice and research. LEVEL OF EVIDENCE: level V.
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Affiliation(s)
- Aleksandra Królikowska
- Ergonomics and Biomedical Monitoring Laboratory, Department of Physiotherapy, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Paweł Reichert
- Department of Orthopaedics, Traumatology and Hand Surgery, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Eric Hamrin Senorski
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roland Becker
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
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Visaggi P, Ghisa M, Vespa E, Barchi A, Mari A, Pasta A, Marabotto E, de Bortoli N, Savarino EV. Optimal Assessment, Treatment, and Monitoring of Adults with Eosinophilic Esophagitis: Strategies to Improve Outcomes. Immunotargets Ther 2024; 13:367-383. [PMID: 39071859 PMCID: PMC11283784 DOI: 10.2147/itt.s276869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/20/2024] [Indexed: 07/30/2024] Open
Abstract
Eosinophilic esophagitis (EoE) is a chronic type 2 inflammation-mediated disease characterized by an eosinophil-predominant inflammation of the esophagus and symptoms of esophageal dysfunction. Relevant treatment outcomes in the setting of EoE include the improvement of histology, symptoms, and endoscopy findings, quality of life (QoL), and the psychological burden of the disease. Established validated tools for the assessment of EoE include questionnaires on dysphagia and QoL (ie, DSQ, EEsAI, and EoE-IQ). More recently, esophageal symptom-specific anxiety and hypervigilance, assessed using the esophageal hypervigilance and anxiety scale (EHAS), have emerged as contributors to disease burden, confirming the importance of psychological aspects in EoE patients. The EoE endoscopic reference score (EREFS) is the only validated endoscopy score in EoE and can quantify mucosal disease burden. However, esophageal panometry using the functional lumen imaging probe (FLIP) and high-resolution manometry (HRM) have shown potential to optimize the assessment of fibrostenotic features of EoE, providing novel insights into the pathophysiology of symptoms. There is a growing number of licenced and off-label therapeutic options in EoE, with various randomized controlled trials demonstrating the efficacy of proton pump inhibitors, topical steroids, food elimination diets, biological drugs, and esophageal dilatation. However, standardized optimal management strategies of EoE are currently lacking. In this review, we provide an overview of established and novel assessment tools in EoE including patient reported outcomes, FLIP panometry, HRM, endoscopy, and histology outcome measures to improve the outcomes of EoE patients. In addition, we summarize available therapeutic options for EoE based on the most recent evidence.
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Affiliation(s)
- Pierfrancesco Visaggi
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Matteo Ghisa
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Edoardo Vespa
- Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Milan, 20132, Italy
| | - Alberto Barchi
- Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Milan, 20132, Italy
| | - Amir Mari
- Gastroenterology Unit, Nazareth Hospital EMMS, Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
| | - Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Nicola de Bortoli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Edoardo Vincenzo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
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12
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Adegboye O, Churchill J, Moorjani J, Johnson H, Capper S, Booker J, Parnham A, Lau M, Sangar V, Faivre-Finn C. The Development and Feasibility of a Novel Electronic Patient-Reported Outcome Measures (Eproms) Questionnaire in patients with penile cancer. Clin Genitourin Cancer 2024:102168. [PMID: 39117530 DOI: 10.1016/j.clgc.2024.102168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/14/2024] [Accepted: 07/15/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Penile cancer (PeCa) is a rare cancer with surgical options that affect patients' quality-of-life. Patient-reported outcome measures (PROMs) are uncommonly utilized in this cohort despite their several patient-centered benefits and there are recommendations to further digitalize PROMs. This prospective, population-based study aimed to report the development and feasibility of a novel electronic patient-reported outcome measures (ePROMs) questionnaire for patients with PeCa. MATERIALS AND METHODS A novel ePROMs questionnaire was developed and sent to patients 3 days before outpatient clinic appointments. The questionnaire included up to 30 items on patient symptomology and quality-of-life, including a self-reported quality-of-life score (rated 0 being worst and 100 being best). Data were collected for patients followed up between August 2021 and May 2022. The primary feasibility outcomes, adherence and engagement, were measured by response and drop-out rates. Differences in responders and nonresponders were also ascertained. Secondary outcomes explored the clinical utility of the questionnaire. Responders were subcategorized into 3 groups: circumcision (Ci), partial penectomy (PP) or total penectomy (TP) and differences were analyzed. This study was approved by the local Trust Governance Panel, including for ethical considerations. RESULTS 220 adult males were sent ePROMs questionnaires, and 141 (64%) responded initially. The mean dropout rate of subsequent questionnaires was 56%. The maximum number of questionnaires sent to and completed by a patient was 8 (n = 1). Nonresponders were older (P < .0001), with poorer performance status (P < .0001) and lower body mass index (P = .0288). TP patients reported the lowest median quality-of-life score 68.50 (8-99), followed by the Ci group (72.0, 37-94) and the PP group (76.0, 10-99). CONCLUSIONS Patients initially engaged and adhered to the ePROMs questionnaire but struggled to maintain this over time. Clinical data gathered by the questionnaire may be utilized to inform patient care. The questionnaire requires additional validation, research, and education.
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Affiliation(s)
- Oluwatobi Adegboye
- Department of Medicine and Health, University of Manchester, Manchester, UK; Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK.
| | - James Churchill
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - John Moorjani
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - Helen Johnson
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - Sharon Capper
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - Jane Booker
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - Arie Parnham
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - Maurice Lau
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - Vijay Sangar
- Department of Medicine and Health, University of Manchester, Manchester, UK; Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - Corinne Faivre-Finn
- Department of Medicine and Health, University of Manchester, Manchester, UK; Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
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13
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Verlis K, McCaffery K, Copp T, Dodd R, Laidsaar-Powell R, Nickel B. Exploring the factors impacting choice and quality of overnight private hospital stays and consumer perspectives on patient reported experience measures (PREMs) in Australia: a qualitative interview study. J Patient Rep Outcomes 2024; 8:75. [PMID: 39030440 PMCID: PMC11264639 DOI: 10.1186/s41687-024-00755-3] [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: 12/11/2023] [Accepted: 07/02/2024] [Indexed: 07/21/2024] Open
Abstract
OBJECTIVES Patient reported experience measures (PREMs) are tools often utilised in hospitals to support quality improvements and to provide objective feedback on care experiences. Less commonly PREMs can be used to support consumers choices in their hospital care. Little is known about the experience and views of the Australian consumer regarding PREMs nor the considerations these consumers have when they need to make decisions about attending hospital. This study aimed to explore consumer awareness of PREMs, consumer attitudes towards PREMs and the utility of PREMs as a decision-making tool in accessing hospital care. METHODS Qualitative study involving semi-structured interviews conducted over the phone. Participants (n = 40) were recruited from across Australia and purposively sampled according to key characteristics: holding private health insurance, > 30-years of age, may have accessed private hospital care in the past year, variety of educational and cultural backgrounds, and if urban or rural residing. Interviews were audio-recorded, transcribed, and analysed thematically. RESULTS Four overarching themes and six subthemes were identified from the data. Major findings were that prior awareness of PREMs was limited; however, many had filled in a PREM either for themselves or for someone they cared for following a hospital stay. Most respondents preferred to listen to experience of self or family/friends or the recommendation of their physician when choosing a hospital to attend. Participants appeared to be more interested in the treating clinician than the hospital with this clinician often dictating the hospital or hospital options. If provided choice in hospital, issues of additional costs, timeliness of treatment and location were important factors. CONCLUSION While PREMs were considered a possible tool to assist in hospital decision-making process, previous hospital experiences, the doctor and knowing up-front cost are an overriding consideration for consumers when choosing their hospital. Consideration to format and presentation of PREMs data is needed to facilitate understanding and allow meaningful comparisons. Future research could examine the considerations of those consumers who primarily access public healthcare facilities and how to improve the utility of PREMs.
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Affiliation(s)
- Krista Verlis
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Tessa Copp
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rachael Dodd
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- The Daffodil Centre, Faculty of Medicine and Health, A Joint Venture Between The University of Sydney and Cancer Council NSW, Sydney, NSW, Australia
| | - Rebekah Laidsaar-Powell
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Psycho-Oncology Cooperative Research Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Brooke Nickel
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Klassen AF, Mansouri J, Kaur M, Rae C, Poulsen L, Dayan S, Cano SJ, Pusic AL. Development and validation of a patient-reported outcome measure for hair loss treatment: The HAIR-Q. J Cosmet Dermatol 2024. [PMID: 39013033 DOI: 10.1111/jocd.16465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 06/20/2024] [Accepted: 07/03/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) for hair loss focus mainly on Alopecia Areata. We created a PROM (i.e., HAIR-Q) that is applicable to any hair loss condition. The HAIR-Q measures satisfaction with hair. PATIENTS/METHODS Concept elicitation interviews were conducted and analyzed to develop a draft scale. Content validity was established through multiple rounds of patient and expert input. Psychometric properties of the scale were examined in an online sample (i.e., Prolific) using Rasch measurement theory (RMT) analysis. Test-retest reliability and tests of construct validation were examined. RESULTS Content validity of a 22-item draft scale was established with input from 11 patients, 12 experts and an online Prolific sample of 59 people who had a variety of hair loss treatments. In the RMT analysis (n = 390), 8 items were dropped. Data for the 14-item scale fit the Rasch model (χ2 = 89.85, df = 70, p = 0.06). All 14 items had ordered thresholds and good item fit. Reliability was high with person separation index and Cronbach alpha values ≥0.91, and intraclass correlation coefficient of 0.94 based on a sample of 97 participants. Higher (better) scores on the scale were associated with having more hair, looking younger than ones' age, satisfaction with hair overall, being less bothered by hair loss, and for those who had a hair loss treatment in the past year, being more satisfied with their hair now than before treatment (p < 0.001). CONCLUSION The HAIR-Q evidenced reliability and validity and can be used in research and to inform clinical care to measure satisfaction with hair from the patient perspective.
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Affiliation(s)
- Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Jasmine Mansouri
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Manraj Kaur
- Department of Surgery, Patient Reported Outcome, Value, and Experience (PROVE) Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Lotte Poulsen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark
- Løntoft, Nyhøj and Poulsen Plastic Surgery, Odense, Denmark
| | - Steven Dayan
- Dayan Facial Plastic Surgery, Chicago, Illinois, USA
| | - Stefan J Cano
- Modus Outcomes (A Division of Thread), Cheltenham, UK
| | - Andrea L Pusic
- Department of Surgery, Patient Reported Outcome, Value, and Experience (PROVE) Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
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15
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Lefkovits YR, Heriot N, Sporik A, Perera S, Friedlander M, Dixon C, Cohen PA, Lee YC, Hyde S, Richardson G, Webb P, Rome R, King M, Zalcberg J, Schofield P. Incorporating patient-reported outcome measures (PROMs) into a clinical quality registry (CQR) for ovarian cancer: considerations and challenges. BMC Health Serv Res 2024; 24:778. [PMID: 38978033 PMCID: PMC11232149 DOI: 10.1186/s12913-024-11042-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/24/2024] [Indexed: 07/10/2024] Open
Abstract
As medical treatment increasingly focuses on improving health-related quality of life, patient-reported outcome measures (PROMs) are an essential component of clinical research. The National Gynae-Oncology Registry (NGOR) is an Australian clinical quality registry. A suitable PROM was required for the NGOR ovarian cancer module to complement clinical outcomes and provide insights into outcomes important to patients. Our narrative review aimed to identify existing ovarian cancer-specific PROMs and ascertain which tool would be most appropriate for implementation into the NGOR ovarian cancer module.A literature review of Cochrane Library, Embase, MEDLINE and PubMed databases was performed to identify existing ovarian cancer-specific PROM tools. A steering committee was convened to (1) determine the purpose of, and criteria for our required PROM; and (2) to review the available tools against the criteria and recommend the most appropriate one for implementation within the NGOR.The literature review yielded five tools: MOST, EORTC QLQ-OV28, FACIT-O, NFOSI-18 and QOL-OVCA. All were developed and validated for use in clinical trials, but none had been validated for use in clinical quality registry. Our expert steering committee pre-determined purpose of a PROM tool for use within the NGOR was to enable cross-service comparison and benchmarking to drive quality improvements. They identified that while there was no ideal, pre-existing, ovarian cancer-specific PROM tool for implementation into the NGOR, on the basis of its psychometric properties, its available translations, its length and its ability to be adapted, the EORTC tool is most fit-for-purpose for integration into the NGOR.This process enabled identification of the tool most appropriate to provide insights into how ovarian cancer treatments impact patients' quality of life and permit benchmarking across health services.
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Affiliation(s)
- Yael R Lefkovits
- Royal Melbourne Hospital, Parkville, Melbourne, Victoria, Australia.
- School of Public Health and Preventive Medicine, Faculty of Medicine, Monash University, Melbourne, Australia.
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Melbourne, Victoria, Australia.
| | - Natalie Heriot
- School of Public Health and Preventive Medicine, Faculty of Medicine, Monash University, Melbourne, Australia
| | - Alice Sporik
- School of Public Health and Preventive Medicine, Faculty of Medicine, Monash University, Melbourne, Australia
| | - Sharnel Perera
- School of Public Health and Preventive Medicine, Faculty of Medicine, Monash University, Melbourne, Australia
| | - Michael Friedlander
- Department of Medical Oncology, University of New South Wales, Sydney, Australia
| | - Cyril Dixon
- Ovarian Cancer Australia, Melbourne, Victoria, Australia
| | - Paul A Cohen
- Discipline of Obstetrics and Gynaecology, Medical School, University of Western Australia, Crawley, Western Australia, Australia
- Department of Gynaecological Oncology, St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
- Institute of Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Yeh Chen Lee
- Medical Oncology Department, Prince of Wales Hospital, Randwick, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Simon Hyde
- Department of Gynaecological Oncology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Gary Richardson
- Szalmuk Family Department of Medical Oncology, Cabrini Research, Malvern, Victoria, Australia
| | - Penelope Webb
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Robert Rome
- Clinical Institute of Obstetrics and Gynaecology, Epworth HealthCare, East Melbourne, Victoria, Australia
| | - Madeleine King
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - John Zalcberg
- School of Public Health and Preventive Medicine, Faculty of Medicine, Monash University, Melbourne, Australia
| | - Penelope Schofield
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Melbourne, Victoria, Australia
- Behavioural Sciences Unit, Health Services Research and Implementation Sciences, Peter MacCallum Centre, Melbourne, Victoria, Australia
- Department of Psychology and Iverson Health Innovation Research Institute, Swinburne University, Melbourne, Victoria, Australia
- Department of Behavioural Sciences in Cancer, Swinburne University, Hawthorne, Victoria, Australia
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Daneshi K, Mansour HRK, Pacheco-Barrios N, Asaju A, Pérez Pachon M, Hoyos A, Khajuria A. A Bibliometric Analysis of the Top 100 Papers on Gluteal Augmentation. Aesthet Surg J Open Forum 2024; 6:ojae053. [PMID: 39100865 PMCID: PMC11295219 DOI: 10.1093/asjof/ojae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024] Open
Abstract
Background Gluteoplasty or gluteal augmentation is a popular cosmetic procedure that is used to improve the volume, shape, and contour of the buttocks. Objectives This bibliometric analysis aims to characterize emerging research trends and to assess the methodological quality of the highest impact gluteoplasty research. Methods The 100 most-cited publications in gluteoplasty were identified on Web of Science, across all available journal years (from Inception to August 2023). Study details, including the citation count, main content focus, and outcome measures, were extracted and tabulated from each publication. Oxford Centre for Evidence Based Medicine level of evidence (LOE) of each study was assessed. Results The 100 most-cited publications regarding gluteoplasty were cited by a total of 2375 publications. Citations per publication ranged from 5 to 176 (mean 23.75 ± 25.86), with the highest-cited study being authored by Simonacci, discussing autologous fat grafting (n = 176). Most publications were LOE 5 (n = 55), representative of the large number of case series and reports. The number of publications for LOE 1, 2, 3, and 4 was 1, 9, 13, and 22, respectively. The main content focus was "surgical technique" in 38 publications, followed by "outcomes" (n = 34) and "risk factors/prognosis" (n = 10). Patient-reported outcome measures (PROMs) were used in 20 publications, and 33 publications reported aesthetic outcome measures. Conclusions This analysis demonstrates a need for improvement in research methodologies regarding gluteoplasty research. This advancement would be facilitated by robust, high-quality research through randomized control trials and multicenter studies, as well as the further development of validated PROMs for gluteoplasty. Level of Evidence 2
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Affiliation(s)
| | | | | | | | | | | | - Ankur Khajuria
- Corresponding Author: Dr Ankur Khajuria, Department of Surgery and Cancer, London W2 1NY, UK. E-mail:
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17
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La Rosa GRM. Rethinking dental research: the importance of patient-reported outcomes and minimally clinically important difference. Evid Based Dent 2024:10.1038/s41432-024-01034-2. [PMID: 38961312 DOI: 10.1038/s41432-024-01034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Affiliation(s)
- Giusy Rita Maria La Rosa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, Catania, Italy.
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18
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Gallo L, Rae C, Voineskos S, Simonsen NV, Pusic AL, Poulsen L, Sørensen JA, Klassen AF, Cano SJ. Further psychometric evaluation of the WOUND-Q: A responsiveness study. Wound Repair Regen 2024; 32:451-463. [PMID: 38656503 DOI: 10.1111/wrr.13179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/19/2024] [Accepted: 03/28/2024] [Indexed: 04/26/2024]
Abstract
The WOUND-Q is a modular patient-reported outcome measure (PROM) with 13 scales measuring constructs across 4 domains (i.e., wound characteristics, health related quality of life, experience of care and wound treatment). The psychometrics of the WOUND-Q were previously assessed and the 13 scales evidenced good validity and reliability. However, the responsiveness (i.e., ability to detect clinical change) of the WOUND-Q has yet to be assessed. The objective of this study was to evaluate responsiveness for 9 WOUND-Q scales that assess outcomes, in a sample of people 18 years of age or older with chronic wounds that were present for at least 3 months. This study conducted a 4 month follow-up of 421 participants who completed the WOUND-Q as part of a previous psychometric study. Participants completed an online survey answering questions about their current wound state (e.g., number, type, size, smell, drainage), anchor questions about change, as well as the WOUND-Q scales that they had completed in their initial assessment. Pre-defined hypotheses were tested with a 75% acceptance threshold indicating sufficient evidence of responsiveness. Minimally important differences (MIDs) were also calculated using both anchor-based and distribution-based methods. Of 390 invited participants, 320 provided responses, ranging in age from 19 to 84 years. Acceptance of hypotheses ranged from 60% to 100%, with only the Symptom scale not meeting the 75% threshold. The findings of this study provide evidence that the WOUND-Q can validly measure clinical change in patients with chronic wounds.
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Affiliation(s)
- Lucas Gallo
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Sophocles Voineskos
- Division of Plastic, Reconstructive & Aesthetic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nina Vestergaard Simonsen
- Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lotte Poulsen
- Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Jens Ahm Sørensen
- Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Stefan J Cano
- Modus Outcomes (a Division of Thread), Cheltenham, UK
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19
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Ciccodicola E, Liang A, Kay RM, Wren TAL. Pediatric Outcomes Data Collection Instrument Scores Within Gross Motor Function Classification Scale Levels and Functional Mobility Scale Ratings in Individuals With Cerebral Palsy. J Pediatr Orthop 2024; 44:e542-e548. [PMID: 38595088 DOI: 10.1097/bpo.0000000000002684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND AND OBJECTIVE The Pediatric Outcomes Data Collection Instrument (PODCI) is a patient/parent-reported outcome measure used in children with cerebral palsy (CP). PODCI score variability has not been widely examined in patients of Gross Motor Function Classification System (GMFCS) level IV or using the Functional Mobility Scale (FMS). The purpose of this study is to examine the distribution of PODCI scores within patients with CP GMFCS levels I-IV and FMS levels 1-6. METHODS Retrospectively identified patients with CP whose parent/caregiver had completed the PODCI at their visit were grouped based on GMFCS and FMS level. One-way ANOVA with pairwise Bonferroni-adjusted post hoc tests was performed to compare the effect of GMFCS and FMS levels (1, 2-4, 5, or 6) on PODCI scores. RESULTS Three hundred sixty-seven patients were included (128 female, 11.7 years, SD 3.6). Global, Sports, Transfer, and Upper Extremity scores differed among all GMFCS levels ( P ≤0.056) and were significantly lower for GMFCS IV compared with all other levels. Happiness, Expectations, and Pain scores did not differ significantly among GMFCS levels including level IV ( P >0.06). Similar trends were seen at all FMS distances (5, 50, and 500âm). At 50âm, Global, Sports, Transfer, and Upper Extremity scores differed significantly among all FMS levels ( P <0.001) except that Upper Extremity Scores were similar between levels 2-4 and level 5 ( P =1.00). Happiness and Pain scores were not different between FMS levels ( P >0.27). Expectations scores differed only between FMS 1 and FMS 6 with FMS 6 being higher at the 50-m distance only ( P =0.03). CONCLUSIONS Parent-reported outcome measures are important for providing patient-centered care. Providers can examine these measures alongside functional classification systems to create a more complete clinical picture of the patient. Providers should be aware of the score trends seen in our results when evaluating the PODCI for individuals with CP to improve shared decision-making and better monitor their need for future care. LEVEL OF EVIDENCE Level III-retrospective study.
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Affiliation(s)
- Eva Ciccodicola
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles
| | - Adriana Liang
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles
| | - Robert M Kay
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Tishya A L Wren
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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20
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Plotsker EL, Stern CS, Graziano FD, Rubenstein RN, Vingan PS, Haglich K, Monge J, Disa JJ, Mehrara BJ, Dayan JH, Allen R, Matros E, McCarthy C, Nelson JA. Surgical Management of Textured Breast Implants: Assessing Risk and Analyzing Patient-Reported Outcomes. Plast Reconstr Surg 2024; 154:39-52. [PMID: 37535711 PMCID: PMC10837321 DOI: 10.1097/prs.0000000000010957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND Textured implants have been linked to breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). Patients who undergo explantation have options for reconstruction, but data on safety and patient-reported outcomes (PROs) are limited. The purpose of this study was to classify complications and PROs in patients opting for surgical management of textured implants. METHODS Complication rates and BREAST-Q scores were compared between (1) asymptomatic patients who underwent conversion from textured to smooth implants ( n = 224), (2) symptomatic patients who underwent conversion from textured to smooth implants ( n = 83), (3) patients who underwent explantation without replacement ( n = 44), and (4) patients who underwent replacement with autologous reconstruction ( n = 33). Linear regression examined PROs controlling for clinical and surgical variables. RESULTS Overall complication rates in 384 patients (637 implants) differed across groups ( P = 0.034), with the highest rate (25%) in patients who underwent explantation without replacement. These patients were specifically more impacted by minor complications, notably seroma. Capsulectomy extent did not significantly impact complications. Asymptomatic and symptomatic smooth implant patients had improvements in Satisfaction with Breasts ( P < 0.05). Autologous reconstruction patients had significant improvements in Satisfaction with Breasts sustained after 3 months postoperatively ( P < 0.01) and Sexual Well-being sustained after 6-months postoperatively ( P < 0.05). Patients who underwent removal without replacement had lower Physical Well-being of the Chest scores at 1 year or more than the other groups. CONCLUSIONS Replacement of textured implants with smooth implants or flaps is safe and is associated with improved satisfaction with breasts and quality of life. The degree of capsulectomy does not appear to impact the incidence of perioperative complications. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
| | | | - Francis D. Graziano
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Robyn N. Rubenstein
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Perri S. Vingan
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Kathryn Haglich
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Jasmine Monge
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Joseph J. Disa
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Babak J. Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Joseph H. Dayan
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Robert Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Evan Matros
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
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Rubino D, Bjorner JB, Rathor N, Sharma AM, von Huth Smith L, Wharton S, Wadden T, Zeuthen N, Kolotkin RL. Effect of semaglutide 2.4 mg on physical functioning and weight- and health-related quality of life in adults with overweight or obesity: Patient-reported outcomes from the STEP 1-4 trials. Diabetes Obes Metab 2024; 26:2945-2955. [PMID: 38698650 DOI: 10.1111/dom.15620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 05/05/2024]
Abstract
AIMS To summarize the effects of semaglutide 2.4 mg on weight-related quality of life (WRQOL) and health-related quality of life (HRQOL), focusing on the confirmatory secondary endpoint of physical functioning. MATERIALS AND METHODS The STEP 1-4 Phase 3a, 68-week, double-blind, randomized controlled trials assessed the efficacy and safety of semaglutide 2.4 mg versus placebo in individuals with overweight/obesity. WRQOL and HRQOL were assessed by change from baseline to Week 68 in two different but complementary measures, the Impact of Weight on Quality of Life-Lite Clinical Trials Version (IWQOL-Lite-CT; STEP 1 and 2) and the SF-36v2 Health Survey Acute (SF-36v2; STEP 1-4). RESULTS Superiority for semaglutide 2.4 mg over placebo based on IWQOL-Lite-CT and SF-36v2 physical functioning scores was confirmed in STEP 1 and 2 and in STEP 1, 2 and 4, respectively. At Week 68, a greater proportion of participants treated with semaglutide 2.4 mg than with placebo reached meaningful within-person change (MWPC) thresholds for IWQOL-Lite-CT Physical Function scores in STEP 1 (51.8% vs. 28.3%; p < 0.0001) and STEP 2 (39.6% vs. 29.5%; p = 0.0083) and the MWPC threshold for SF-36v2 Physical Functioning in STEP 1 (39.8% vs. 24.1%; p < 0.0001), STEP 2 (41.0% vs. 27.3%; p = 0.0001) and STEP 4 (18.0% vs. 6.6%; p < 0.0001). All other IWQOL-Lite-CT and SF-36v2 scale scores in STEP 1-4 were numerically improved with semaglutide 2.4 mg versus placebo, except for SF-36v2 Role Emotional in STEP 2. CONCLUSIONS Semaglutide 2.4 mg significantly improved physical functioning, with greater proportions of participants achieving MWPC compared with placebo, and showed beneficial effects on WRQOL and HRQOL beyond physical functioning.
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Affiliation(s)
- Domenica Rubino
- Washington Center for Weight Management and Research, Arlington, Virginia, USA
| | - Jakob B Bjorner
- QualityMetric Inc., LLC, Johnston, Rhode Island, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Arya M Sharma
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Sean Wharton
- York University, McMaster University and Wharton Weight Management Clinic, Toronto, Ontario, Canada
| | - Thomas Wadden
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Ronette L Kolotkin
- Quality of Life Consulting, Durham, North Carolina, USA
- Duke Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Centre of Health Research, Helse Førde Hospital Trust, Førde, Norway
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
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22
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Therrien F, Ward C, Chokka P, Habert J, Ismail Z, McIntyre RS, MacKenzie EM. Adjunctive Brexpiprazole for Patient Life Engagement in Major Depressive Disorder: A Canadian, Phase 4, Open-Label, Interventional Study: Brexpiprazole d'appoint pour l'engagement dans la vie des patients souffrant de trouble dépressif majeur: une étude interventionnelle canadienne ouverte de phase 4. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:513-523. [PMID: 38425284 PMCID: PMC11168343 DOI: 10.1177/07067437241233965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVES To characterize the effects of adjunctive brexpiprazole on patient life engagement and depressive symptoms in patients with major depressive disorder (MDD) using patient-reported outcomes. METHODS An 8-week, Phase 4, open-label, interventional study was conducted at 15 Canadian trial sites between April 2021 and May 2022. Adult outpatients with MDD (at least moderately severe) and inadequate response to 1-2 antidepressants continued their current antidepressant and received oral adjunctive brexpiprazole 0.5-2 mg/day. Co-primary endpoints were change from baseline to Week 8 in Inventory of Depressive Symptomatology Self-Report (IDS-SR) 10-item Life Engagement subscale score, and IDS-SR 30-item total score. Safety was assessed by standard variables. RESULTS Of 122 enrolled patients, 120 (98.4%) were treated (mean [SD] dose: 1.2 [0.4] mg/day) and analyzed, and 111 (91.0%) completed the study. Statistically significant least squares mean improvements to Week 8 were observed on IDS-SR10 Life Engagement subscale score (baseline mean [SD]: 16.1 [4.7]; change [95% confidence interval]: -8.11 [-9.34, -6.88]; p < 0.001) and IDS-SR total score (baseline mean [SD]: 41.3 [9.8]; change [95% confidence interval]: -17.38 [-20.08, -14.68]; p < 0.001). Improvements were observed from Week 2, onwards. Treatment-emergent adverse events with incidence ≥5% were fatigue (n = 13, 10.8%), headache (n = 13, 10.8%), insomnia (n = 12, 10.0%), nausea (n = 9, 7.5%), tremor (n = 8, 6.7%), and weight increase (n = 7, 5.8%). Six patients (5.0%) discontinued due to adverse events. Mean (SD) change in body weight from baseline to last visit was +1.9 (3.4) kg. CONCLUSIONS Using an exploratory patient-reported outcome measure, patients with MDD and inadequate response to antidepressants who received open-label adjunctive brexpiprazole showed early and clinically meaningful improvement in patient life engagement, which should be further assessed in a prospective randomized controlled trial. Patient-rated depressive symptoms (on the validated 30-item IDS-SR) also improved. Adjunctive brexpiprazole was well tolerated, and no new safety signals were observed. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04830215.
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Affiliation(s)
| | - Caroline Ward
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey, USA
| | - Pratap Chokka
- Chokka Center for Integrative Health, Edmonton, Alberta, Canada
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey Habert
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences; Hotchkiss Brain Institute and O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Roger S. McIntyre
- Department of Psychiatry and Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
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Basu P, Mwanahamuntu M, Pinder LF, Muwonge R, Lucas E, Nyambe N, Chisele S, Shibemba AL, Sauvaget C, Sankaranarayanan R, Prendiville W, Parham GP. A portable thermal ablation device for cervical cancer prevention in a screen-and-treat setting: a randomized, noninferiority trial. Nat Med 2024:10.1038/s41591-024-03080-w. [PMID: 38918630 DOI: 10.1038/s41591-024-03080-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/17/2024] [Indexed: 06/27/2024]
Abstract
Implementing standard-of-care cryotherapy or electrosurgical excision to treat cervical precancers is challenging in resource-limited settings. An affordable technological alternative that is as effective as standard-of-care techniques would greatly improve access to treatment. This randomized controlled trial aims to demonstrate the noninferiority efficacy of a portable, battery-driven thermal ablation (TA) device compared to cryotherapy and electrosurgical excision (large loop excision of transformation zone (LLETZ)) to treat cervical precancer in a screen-and-treat program in Zambia. A total of 3,124 women positive on visual inspection with acetic acid and eligible for ablative therapy were randomized to one of the treatment arms. Human papillomavirus (HPV) testing was performed at baseline and at the follow-up. The primary outcome was treatment success, defined as either type-specific HPV clearance at the follow-up in participants positive for HPV at baseline, or a negative visual inspection with acetic acid test for those who had a negative HPV test at baseline. After a median follow-up of 12 months, treatment success rates were 74.0%, 71.1% and 71.4% for the TA, cryotherapy and LLETZ arms, respectively, thus demonstrating noninferiority (P = 0.83). TA was a safe and well-accepted procedure. Only 3.6% of those randomized to TA reported moderate-to-severe pain, compared to 6.5% and 1.9% for the cryotherapy and LLETZ arms, respectively. Thus, our randomized controlled trial demonstrates the safety and efficacy of TA, which is not inferior to cryotherapy or surgical excision.ClinicalTrials.gov registration: NCT02956239 .
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Affiliation(s)
- Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France.
| | - Mulindi Mwanahamuntu
- Department of Obstetrics and Gynecology, University Teaching Hospital, Lusaka, Zambia
| | - Leeya F Pinder
- Department of Obstetrics and Gynecology, University Teaching Hospital, Lusaka, Zambia
| | - Richard Muwonge
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Eric Lucas
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Namakau Nyambe
- Department of Obstetrics and Gynecology, University Teaching Hospital, Lusaka, Zambia
| | - Samson Chisele
- Department of Obstetrics and Gynecology, University Teaching Hospital, Lusaka, Zambia
| | | | - Catherine Sauvaget
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Walter Prendiville
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Groesbeck P Parham
- Department of Obstetrics and Gynecology, University Teaching Hospital, Lusaka, Zambia
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Kramer J, Wilens TE, Rao V, Villa R, Yule AM. Feasibility of a 2-Part Substance Use Screener Self-Administered by Patients on Paper: Observational Study. JMIR Form Res 2024; 8:e52801. [PMID: 38916950 PMCID: PMC11234052 DOI: 10.2196/52801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/26/2024] [Accepted: 05/08/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Measurement-based care in behavioral health uses patient-reported outcome measures (PROMs) to screen for mental health symptoms and substance use and to assess symptom change over time. While PROMs are increasingly being integrated into electronic health record systems and administered electronically, paper-based PROMs continue to be used. It is unclear if it is feasible to administer a PROM on paper when the PROM was initially developed for electronic administration. OBJECTIVE This study aimed to examine the feasibility of patient self-administration of a 2-part substance use screener-the Tobacco, Alcohol, Prescription medications, and other Substances (TAPS)-on paper. This screener was originally developed for electronic administration. It begins with a limited number of questions and branches to either skip or reflex to additional questions based on an individual's responses. In this study, the TAPS was adapted for paper use due to barriers to electronic administration within an urgent care behavioral health clinic at an urban health safety net hospital. METHODS From August 2021 to March 2022, research staff collected deidentified paper TAPS responses and tracked TAPS completion rates and adherence to questionnaire instructions. A retrospective chart review was subsequently conducted to obtain demographic information for the patients who presented to the clinic between August 2021 and March 2022. Since the initial information collected from TAPS responses was deidentified, demographic information was not linked to the individual TAPS screeners that were tracked by research staff. RESULTS A total of 507 new patients were seen in the clinic with a mean age of 38.7 (SD 16.6) years. In all, 258 (50.9%) patients were male. They were predominantly Black (n=212, 41.8%), White (n=152, 30%), and non-Hispanic or non-Latino (n=403, 79.5%). Most of the patients were publicly insured (n=411, 81.1%). Among these 507 patients, 313 (61.7%) completed the TAPS screener. Of these 313 patients, 76 (24.3%) adhered to the instructions and 237 (75.7%) did not follow the instructions correctly. Of the 237 respondents who did not follow the instructions correctly, 166 (70%) answered more questions and 71 (30%) answered fewer questions than required in TAPS part 2. Among the 237 patients who did not adhere to questionnaire instructions, 44 (18.6%) responded in a way that contradicted their response in part 1 of the screener and ultimately affected their overall TAPS score. CONCLUSIONS It was challenging for patients to adhere to questionnaire instructions when completing a substance use screener on paper that was originally developed for electronic use. When selecting PROMs for measurement-based care, it is important to consider the structure of the questionnaire and how the PROM will be administered to determine if additional support for PROM self-administration needs to be implemented.
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Affiliation(s)
- Joanna Kramer
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
| | - Timothy E Wilens
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Vinod Rao
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Richard Villa
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
| | - Amy M Yule
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
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Stasi S, Papagiannis G, Triantafyllou A, Papagelopoulos P, Koulouvaris P. Post-Arthroplasty Spatiotemporal Gait Parameters in Patients with Hip Osteoarthritis or Developmental Dysplasia of the Hip: An Observational Study. J Funct Morphol Kinesiol 2024; 9:110. [PMID: 39051271 PMCID: PMC11270259 DOI: 10.3390/jfmk9030110] [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: 05/31/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024] Open
Abstract
Total hip arthroplasty (THA) is a preferred treatment for primary osteoarthritis (OA) or secondary degenerative arthropathy due to developmental hip dysplasia (DDH). Gait analysis is considered a gold standard for evaluating post-arthroplasty walking patterns. This study compared post-THA spatiotemporal gait parameters (SGPs) between OA and DDH patients and explored correlations with demographic and clinical variables. Thirty patients (15 per group) were recorded during gait and their SGPs were analyzed. Functionality was evaluated with the Oxford Hip Score (OHS). The OA patients were significantly older than DDH patients (p < 0.005). Significant and moderate to strong were the correlations between SGPs, age, and four items of the OHS concerning hip pain and activities of daily life (0.31 < Pearson's r < 0.51 all p < 0.05). Following THA, both groups exhibited similar levels of the examined gait parameters. Post-arthroplasty SGPs and OHS correlations indicate limitations in certain activities. Given the absence of pre-operative data and the correlation between age and SGPs and OHS, ANCOVA testing revealed that age adjusts OHS and SGP values, while pre-operative diagnosis has no main effect. These findings indicate that hip OA or DDH do not affect postoperative SGPs and patients' functionality. Future studies should examine both kinematic and kinetic data to better evaluate the post-THA gait patterns of OA and DDH patients.
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Affiliation(s)
- Sophia Stasi
- 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 12462 Athens, Greece;
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece; (G.P.); (P.P.); (P.K.)
| | - Georgios Papagiannis
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece; (G.P.); (P.P.); (P.K.)
| | - Athanasios Triantafyllou
- 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 12462 Athens, Greece;
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece; (G.P.); (P.P.); (P.K.)
| | - Panayiotis Papagelopoulos
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece; (G.P.); (P.P.); (P.K.)
| | - Panagiotis Koulouvaris
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece; (G.P.); (P.P.); (P.K.)
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Kasper B, Gounder M, Hernandez L, Baumgarten C, Ratan R. Capturing Patient Voice to Improve Outcomes That Matter to Patients with Desmoid Tumor. Cancer Manag Res 2024; 16:617-628. [PMID: 38863992 PMCID: PMC11166168 DOI: 10.2147/cmar.s362694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024] Open
Abstract
Desmoid tumors (DT) are rare, intermediate-grade sarcomas characterized by locally aggressive growths that commonly occur intra-abdominally, in the abdominal wall, or in the extremities. Desmoid tumors are 2-3-fold more common in females than males, with most patients aged <40 years at diagnosis. Clinical course of DT is highly variable but rarely fatal, with median overall survival >80% at 20 years. However, patient morbidity and DT symptom burden can be high. DT significantly reduce patient quality of life, imposing substantial physical, emotional, and social burdens. Pain, fatigue, and insomnia are common symptoms; disfigurement, mobility restrictions, and, rarely, the need for amputation may also result. Despite its limited impact on survival, patients with DT may have anxiety and depression levels commensurate with those associated with malignant sarcomas. Thus, DT impose an array of significant, long-term morbidities on a young patient population. In order to evaluate the impact of these morbidities, patient-reported outcome (PRO) tools are used, which assess outcomes of importance to patients that extend beyond traditional oncology endpoints. General or oncology-related PROs can be used; although currently, the only DT-specific, validated PRO measure is the GOunder/Desmoid Tumor Research Foundation DEsmoid Symptom/Impact Scale (GODDESS©), consisting of an 11-item DT Symptom Scale (DTSS) and a 17-item DT Impact Scale (DTIS). DTSS and DTIS were secondary endpoints in DeFi, a randomized phase 3 trial of nirogacestat; blinded, pooled data from DeFi were used to validate GODDESS reliability and responsiveness as a PRO measure in DT. Another DT-specific PRO measure, the Desmoid-Type Fibromatosis Quality of Life (DTF-QoL) questionnaire, has been developed but not validated. As novel DT therapies continue to be developed, incorporating DT-specific PRO measures into clinical trials will be key to capturing patient voice, improving outcomes of importance to this unique patient population, and assisting patients and providers in selecting optimal treatment.
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Affiliation(s)
- Bernd Kasper
- Sarcoma Unit, Mannheim Cancer Center (MCC), Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Mrinal Gounder
- Sarcoma Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Lynne Hernandez
- The Desmoid Tumor Research Foundation, Woodcliff Lake, NJ, USA
| | - Christina Baumgarten
- sos-desmoid e.V. Mannheim; SPAGN Sarcoma Patients Advocacy Global Network e.V, Wölferscheim, Germany
| | - Ravin Ratan
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Robertson EG, Hetherington K, Daly R, Donoghoe MW, Handelsman N, Ziegler DS, Wakefield CE. The feasibility and acceptability of collecting psychosocial outcome measures embedded within a precision medicine trial for childhood cancer. Cancer Med 2024; 13:e7339. [PMID: 38898768 PMCID: PMC11187165 DOI: 10.1002/cam4.7339] [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: 10/15/2023] [Revised: 05/07/2024] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Patient-reported outcomes measures (PROMs) are increasingly being collected within cancer clinical trials, yet limited literature on the feasibility and acceptability of doing so. METHODS We collected parent-proxy and adolescent (≥12 years old) PROMs through a longitudinal, psychosocial sub-study ('PRISM-Impact') embedded in a precision medicine trial for children with poor prognosis cancer ('PRISM'). We report on feasibility (response, participation, and attrition rates; follow-up and responding to elevated distress) and acceptability (parents' perceived benefit/burden of participation; and impact on decision to participate in PRISM) of PRISM-Impact. RESULTS Over the reporting period, 462 families were eligible for PRISM-Impact. Family and adolescent response rates were 53% and 45%, respectively. Parents whose child had relapsed were more likely to participate in PRISM-Impact than parents whose child had not (p < 0.001). Parent and adolescent attrition rates were 30% and 56% respectively. We conducted 478 calls for intake and to follow-up on missing questionnaires, and 122 calls to respond to elevated distress. Parents reported wanting to participate in PRISM-Impact for altruistic reasons and because they valued psychosocial research. Parents reported little-to-no burden and some benefit from participating in PRISM-Impact, with little change in ratings overtime. Most parents felt that participating in PRISM-Impact did not impact their desire to participate in PRISM (72%), with some feeling more eager to participate (19%). CONCLUSIONS PRISM-Impact response rates were comparable to other psycho-oncology studies, despite the poor prognosis population. Integration of PROMs within a paediatric oncology trial is acceptable to parents, and may provide a more comprehensive assessment of the impact of trial participation.
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Affiliation(s)
- Eden G. Robertson
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & HealthUNSW SydneyKensingtonNew South WalesAustralia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
- Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
| | - Kate Hetherington
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & HealthUNSW SydneyKensingtonNew South WalesAustralia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
- Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
| | - Rebecca Daly
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & HealthUNSW SydneyKensingtonNew South WalesAustralia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
- Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
| | - Mark W. Donoghoe
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & HealthUNSW SydneyKensingtonNew South WalesAustralia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
- Stats Central, Mark Wainwright Analytical CentreUNSW SydneyKensingtonNew South WalesAustralia
| | - Nicholas Handelsman
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & HealthUNSW SydneyKensingtonNew South WalesAustralia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
- Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
| | - David S. Ziegler
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & HealthUNSW SydneyKensingtonNew South WalesAustralia
- Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
- Children's Cancer InstituteUNSW SydneySydneyNew South WalesAustralia
| | - Claire E. Wakefield
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & HealthUNSW SydneyKensingtonNew South WalesAustralia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
- Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia
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Demedis J, Bingen K, Cherven B, Frederick NN, Freyer DR, Levine J, Bhutada JS, Quinn GP, Bober SL, DuVall AS. Development of a Patient-Reported Sexual Health Outcomes Battery for Use in Adolescent and Young Adult Cancer Clinical Trials. J Adolesc Young Adult Oncol 2024; 13:369-373. [PMID: 38569163 DOI: 10.1089/jayao.2023.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Affiliation(s)
- Jenna Demedis
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Hematology/Oncology/BMT, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kristin Bingen
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brooke Cherven
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Natasha N Frederick
- Center for Cancer and Blood Disorders, Connecticut Children's, Hartford, Connecticut, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - David R Freyer
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Jennifer Levine
- Center for Cancer and Blood Disorders, Section of Oncology, Childrens National Medical Center, Washington, District of Columbia, USA
| | - Jessica Sheth Bhutada
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Gwendolyn P Quinn
- Department of OB-GYN, Perlmutter Cancer Center, Grossman School of Medicine, New York University, New York, New York, USA
| | - Sharon L Bober
- Department of Psychooncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Adam S DuVall
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois, USA
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois, USA
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Isaacs DA, Hay KR, Hoadley J, McDonell KE, Brown AE, Wynn A, Claassen DO, Gibson J. Influence of anosognosia on patient-reported outcomes for psychiatric symptoms and quality of life in Huntington's disease. Parkinsonism Relat Disord 2024; 123:106969. [PMID: 38614044 PMCID: PMC11169743 DOI: 10.1016/j.parkreldis.2024.106969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/16/2024] [Accepted: 04/07/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION Anosognosia, defined as reduced awareness of one's deficit or symptom, is common in Huntington's disease (HD) and detectable at each disease stage. The impact of anosognosia on self-reporting in HD populations is critical to understand given growing use of patient-reported outcomes in HD clinical care and research. We aimed to determine the influence of anosognosia on patient-reported outcome measures assessing psychiatric symptoms and quality of life in HD. METHODS We enrolled HD patients to complete a battery of patient-reported and rater-administered measures, including the Anosognosia Scale, at baseline and 6 months later. Patient-reported outcome measures included NeuroQoL short forms for depression, anxiety, satisfaction with social roles and activities, and positive affect and well-being and Patient-Reported Outcomes Measurement Information System short forms for emotional distress-anger and sleep-related impairment. Anosognosia Scale-Difference Score indexed patient-clinician agreement on patient motor, cognitive, and behavioral abilities. We conducted multivariable linear regression analyses to quantify the association of baseline anosognosia with 6-month patient-reported outcomes. RESULTS Of 79 patients with complete Anosognosia Scale data at baseline, 25 (31.6 %) met the scale's criterion for anosognosia. In the regression analyses, baseline Difference Score improved prediction of 6-month patient-reported outcomes for depression, anxiety, anger, and positive affect and well-being (χ2(1) value range for likelihood ratio tests contrasting models with and without Difference Score: 13.1-20.9, p-values <0.001). Patients with more anosognosia self-reported less severe psychiatric symptoms and more positive affect and well-being. CONCLUSION Study results suggest that anosognosia influences patient-reported outcomes for psychiatric symptoms and quality of life in HD populations.
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Affiliation(s)
- David A Isaacs
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA; Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN, 37232, USA.
| | - Kaitlyn R Hay
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
| | - Jennifer Hoadley
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
| | - Katherine E McDonell
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
| | - Amy E Brown
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
| | - Amy Wynn
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
| | - Daniel O Claassen
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
| | - Jessie Gibson
- University of Virginia School of Nursing, 202 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA.
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Kartal Özcan E, Karabulut M, Karakoç K, Müjdeci B. Is There an Association Between Self-Reported Dual-Task Performance and Fear of Falling in Older Adults? J Aging Phys Act 2024; 32:370-375. [PMID: 38262398 DOI: 10.1123/japa.2023-0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/07/2023] [Accepted: 11/14/2023] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Is there an association between self-reported dual-task performance and fear of falling in older adults? BACKGROUND/OBJECTIVES Fear of falling tends to increase with age and can negatively impact dual-task abilities, leading to potential declines in overall quality of life. Therefore, it becomes crucial to evaluate dual-task performance in older adults, particularly prior to the onset of fear of falling. This study aims to investigate the potential association between self-reported dual-task performance and fear of falling in older adults. METHODS A total of 51 individuals (19 females and 32 males) were recruited. The participants met the inclusion criteria were administered the Dual-Task Questionnaire (DTQ), Falls Efficiency Scale International, and Physical Activity Scale for the Elderly. Multiple linear regression was performed to predict DTQ scores based on age, body mass index, and Physical Activity Scale for the Elderly. RESULTS A moderate positive correlation was found between Falls Efficiency Scale International scores and self-reported DTQ scores (r: .448, p: .001). Age, body mass index, and Physical Activity Scale for the Elderly were not found to be significant predictors of DTQ scores. CONCLUSIONS Our study reveals a moderate positive association between fear of falling and self-reported dual-task performance in older adults. A direct relationship between physical activity performance, fear of falling, and self-reported dual-task performance was observed among older adults. Significance/Implications: Integrating self-reported measures like the DTQ in clinical evaluations can provide valuable insights into dual-task abilities of older adults.
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Affiliation(s)
- Ecem Kartal Özcan
- Department of Audiology, Gulhane Faculty of Health Sciences, University of Health Sciences, Ankara, Turkey
| | - Mustafa Karabulut
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kürşad Karakoç
- Audiology and Speech Pathology Doctoral Programme, Graduate School of Health Sciences, Ankara University, Ankara, Turkey
- Department of Audiology, Faculty of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Banu Müjdeci
- Department of Audiology, Faculty of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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Ojo AS, Araoye MO, Ali A, Sarma R. The impact of current therapeutic options on the health-related quality of life of patients with relapse/refractory multiple myeloma: a systematic review of clinical studies. J Cancer Surviv 2024; 18:673-697. [PMID: 36645615 DOI: 10.1007/s11764-023-01332-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/05/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE Patients with relapse and/or refractory multiple myeloma (RRMM) have a high disease burden with poor health-related quality of life (HRQoL) which worsens with each additional relapse. We aimed to review the impact of triplet, doublet, monotherapies, and salvage autologous stem cell transplantation on the HRQoL of RRMM patients. METHODS We performed a comprehensive literature search of Medline/PubMed, Wiley Cochrane Library, EMBASE, Scopus, CINAHL, and Clinicaltrials.gov to identify clinical studies in RRMM patients with HRQoL as an outcome measure. The ISOQoL and CONSORT-PRO extension guidelines were used to assess the quality of HRQoL reporting. We synthesized the result using a qualitative analysis. RESULTS A total of 10,245 RRMM patients enrolled in 28 eligible studies received either a triplet, doublet regimen, monotherapy, or salvage autologous stem cell transplantation. The EORTC QLQ-C30 was the most used questionnaire, and compliance with HRQoL reporting standards is generally poor among studies without an additional HRQoL publication. Most of the current therapeutic options are at best able to maintain HRQoL at baseline but not improve it. The methodological and reporting heterogeneity among the studies complicates generalizations. CONCLUSIONS Many of the current treatment regimens for RRMM have demonstrated clinical effectiveness in trials. Unlike newly diagnosed MM, these regimens are less likely to result in significant improvement in HRQoL in RRMM. This should be communicated to patients before initiating therapies. IMPLICATIONS FOR CANCER SURVIVORS Individualized therapeutic approach for RRMM should be chosen based on a shared decision-making process that aligns clinical efficacy with patients' treatment priorities and HRQoL.
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Affiliation(s)
- Ademola S Ojo
- Department of Internal Medicine, Howard University Hospital, 2041 Georgia Ave. NW, Washington, DC, USA.
| | - Mojisola O Araoye
- Hematology/Oncology Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ahmed Ali
- Department of Medicine, Hematology/Oncology Division, Howard University Hospital, Washington, DC, USA
| | - Ravi Sarma
- Department of Medicine, Hematology/Oncology Division, Howard University Hospital, Washington, DC, USA
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Nowojewski A, Bark E, Shih VH, Dearden R. Patient adherence and response time in electronic patient-reported outcomes: insights from three longitudinal clinical trials. Qual Life Res 2024; 33:1691-1706. [PMID: 38598132 DOI: 10.1007/s11136-024-03644-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Patient-reported outcome measures (PROMs) are used to collect data on disease symptoms in support of clinical trial endpoints. Clinical studies can last a year or more, and the patients' adherence and response time to daily at-home questionnaires may vary significantly over time. The aim of this study was to understand patterns and changes in patients' completion of daily PROMs during longitudinal clinical studies. METHODS Data were collected from 1342 patients randomized into three respiratory clinical trials (NCT03401229, NCT03347279, and NCT03406078). PROMs were completed by patients using electronic handheld devices that collected the starting and completion times. A Bayesian generalized linear mixed-effects model was used to identify unbiased coefficients associated with PROM adherence and response time using patient, site, and calendar features as covariates. RESULTS Adherence decreased over time after randomization, and the rate of decrease was higher in younger patients. The 14-day pre-randomization adherence was correlated with adherence throughout the study. Patients were also more adherent during working days compared to non-working days. Oldest patients took twice as long to complete PROMs throughout the study; however, the response time for all patients decreased during the first month of the study regardless of age. Response time increased 7 days before and after the date of a scheduled clinic visit and when a patient-reported higher symptom burden. CONCLUSION Detailed analyses of adherence and response time for daily PROMs in clinical trials can provide significant insights about trends of patient behavior in longitudinal clinical studies with high baseline adherence.
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Affiliation(s)
- Andrzej Nowojewski
- Imaging & Data Analytics, Clinical Pharmacology & Safety Sciences, AstraZeneca, R&D BioPharmaceuticals, Cambridge, UK.
| | - Erik Bark
- BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Vivian H Shih
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA
| | - Richard Dearden
- Imaging & Data Analytics, Clinical Pharmacology & Safety Sciences, AstraZeneca, R&D BioPharmaceuticals, Cambridge, UK
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Orlando L, Maiello E, Orditura M, Diana A, Antoniol G, Morritti MG, Aieta M, Ciccarese M, Pisconti S, Bordonaro R, Russo A, Febbraro A, Schiavone P, Quaranta A, Caliolo C, Loparco D, Cinefra M, Colucci G, Cinieri S. Phase II randomized trial comparing metronomic anthracycline-containing chemotherapy versus standard schedule in untreated HER2 negative advanced breast cancer: activity and quality of life results of the GOIM 21003 trial. Breast 2024; 75:103725. [PMID: 38615483 PMCID: PMC11021991 DOI: 10.1016/j.breast.2024.103725] [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: 01/06/2024] [Revised: 03/03/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Optimizing chemotherapy to achieve disease and symptoms control is a noteworthy purpose in advanced breast cancer (ABC). We reported the activity and quality of life of a phase II study, comparing metronomic regimen with standard schedule as first line chemotherapy for ABC. METHODS Patients with HER2 negative ABC were randomized to non-pegylated liposomal doxorubicin (NPLD, 60 mg/m2 every 3 weeks) and cyclophosphamide (CTX, 600 mg/m2 every 3 weeks) (Arm A) or NPLD (20 mg/m2 day, on day 1, 8 and 15 every 4 weeks) and metronomic daily oral CTX 50 mg (ARM B). Primary end-points were overall response rate (ORR) and quality of life, secondary progression-free survival (PFS), overall survival (OS) and toxicity. RESULTS From August 2012 to December 2017, 121 patients were enrolled, 105 evaluable. Median follow-up was 21.3 months. Most patients had hormone receptor positive. ORR was 43 % in arm A and 50 % in arm B. Median PFS was 8.9 months in arm A and 6,4 months in arm B. There was no difference in OS. Total score was not clinically different between the two arms. Grade 4 neutropenia was observed in 12 patients and 16 patients respectively; alopecia G2 in 41 % (77 %) vs 14 (27 %) in arm A and in arm B respectively. One cardiac toxicity was observed (arm A). CONCLUSIONS First line metronomic chemotherapy for HER2 negative ABC had similar clinical activity and quite better tolerability than standard schedule and could be considered a further treatment option when chemotherapy is indicated.
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Affiliation(s)
- Laura Orlando
- Medical Oncology Division, "Antonio Perrino" Hospital, Brindisi, Italy.
| | - Evaristo Maiello
- Medical Oncology Division, "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | | | - Anna Diana
- Medical Oncology Division, Ospedale del Mare, Napoli, Italy
| | | | - Maria Grazia Morritti
- Medical Oncology Division, "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Michele Aieta
- Hemato-Oncology Department, CROB-IRCCS, Rionero in Vulture, Potenza, Italy
| | | | - Salvatore Pisconti
- Medical Oncology Division, "San Giuseppe Moscati" Hospital, Taranto, Italy
| | | | - Antonio Russo
- Medical Oncology Division, "Paolo Giaccone" Hospital, Palermo, Italy
| | - Antonio Febbraro
- Medical Oncology Division, Ospedale Sacro Cuore di Gesù-Fatebenefratelli, Benevento, Italy
| | - Paola Schiavone
- Medical Oncology Division, "Antonio Perrino" Hospital, Brindisi, Italy
| | | | - Chiara Caliolo
- Medical Oncology Division, "Antonio Perrino" Hospital, Brindisi, Italy
| | - Dario Loparco
- Medical Oncology Division, "Antonio Perrino" Hospital, Brindisi, Italy
| | | | | | - Saverio Cinieri
- Medical Oncology Division, "Antonio Perrino" Hospital, Brindisi, Italy
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Ghai S, Nilson F, Gustavsson J, Ghai I. Influence of compression garments on proprioception: A systematic review and meta-analysis. Ann N Y Acad Sci 2024; 1536:60-81. [PMID: 38722733 DOI: 10.1111/nyas.15144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2024]
Abstract
Compression garments (CGs) are commonly used in rehabilitation and sports contexts to enhance performance and speed up recovery. Despite the growing use of CGs in recent decades, there is no unanimous consensus on their overall influence on joint proprioception. In this current meta-analysis, we aim to fill this knowledge gap by assessing the impact of CGs on joint proprioception. We conducted a literature search across seven databases and one registry. Ultimately, we included 27 studies with 671 participants. The meta-analysis revealed that wearing CGs resulted in a significant reduction in absolute error during joint position sensing (Hedges' g: -0.64, p = 0.006) as compared to no CGs. However, further analyses of variables such as constant error (p = 0.308), variable error (p = 0.541) during joint position sense tests, threshold to detect passive motion (p = 0.757), and active movement extent discrimination (p = 0.842) did not show a significant impact of CGs. The review also identified gaps in the reporting of certain outcomes, such as parameters of CGs, reporting of performance, individual-reported outcomes, and lack of placebo comparators. Consequently, this review provides guidelines for future studies that may facilitate evidence-based synthesis and ultimately contribute to a better understanding of the overall influence of CGs on joint proprioception.
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Affiliation(s)
- Shashank Ghai
- Department of Political, Historical, Religious and Cultural Studies, Karlstad University, Karlstad, Sweden
- Centre for Societal Risk Research, Karlstad University, Karlstad, Sweden
| | - Finn Nilson
- Department of Political, Historical, Religious and Cultural Studies, Karlstad University, Karlstad, Sweden
- Centre for Societal Risk Research, Karlstad University, Karlstad, Sweden
- Institute of Civil Society Research, Marie Cederschiold University, Stockholm, Sweden
| | - Johanna Gustavsson
- Department of Political, Historical, Religious and Cultural Studies, Karlstad University, Karlstad, Sweden
- Centre for Societal Risk Research, Karlstad University, Karlstad, Sweden
| | - Ishan Ghai
- School of Life Sciences, Jacobs University Bremen, Bremen, Germany
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Bellino S, La Salvia A. The Importance of Patient Reported Outcomes in Oncology Clinical Trials and Clinical Practice to Inform Regulatory and Healthcare Decision-Making. Drugs R D 2024; 24:123-127. [PMID: 39023849 PMCID: PMC11315859 DOI: 10.1007/s40268-024-00478-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2024] [Indexed: 07/20/2024] Open
Affiliation(s)
- Stefania Bellino
- Center for Drug Research and Evaluation, National Institute of Health (Istituto Superiore di Sanità), Viale Regina Elena, 299, 00161, Rome, Italy.
| | - Anna La Salvia
- Center for Drug Research and Evaluation, National Institute of Health (Istituto Superiore di Sanità), Viale Regina Elena, 299, 00161, Rome, Italy
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Klockgether T, Synofzik M. Consensus Recommendations for Clinical Outcome Assessments and Registry Development in Ataxias: Ataxia Global Initiative (AGI) Working Group Expert Guidance. CEREBELLUM (LONDON, ENGLAND) 2024; 23:924-930. [PMID: 37020147 PMCID: PMC11102398 DOI: 10.1007/s12311-023-01547-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/07/2023]
Abstract
To accelerate and facilitate clinical trials, the Ataxia Global Initiative (AGI) was established as a worldwide research platform for trial readiness in ataxias. One of AGI's major goals is the harmonization and standardization of outcome assessments. Clinical outcome assessments (COAs) that describe or reflect how a patient feels or functions are indispensable for clinical trials, but similarly important for observational studies and in routine patient care. The AGI working group on COAs has defined a set of data including a graded catalog of COAs that are recommended as a standard for future assessment and sharing of clinical data and joint clinical studies. Two datasets were defined: a mandatory dataset (minimal dataset) that can ideally be obtained during a routine clinical consultation and a more demanding extended dataset that is useful for research purposes. In the future, the currently most widely used clinician-reported outcome measure (ClinRO) in ataxia, the scale for the assessment and rating of ataxia (SARA), should be developed into a generally accepted instrument that can be used in upcoming clinical trials. Furthermore, there is an urgent need (i) to obtain more data on ataxia-specific, patient-reported outcome measures (PROs), (ii) to demonstrate and optimize sensitivity to change of many COAs, and (iii) to establish methods and evidence of anchoring change in COAs in patient meaningfulness, e.g., by determining patient-derived minimally meaningful thresholds of change.
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Affiliation(s)
- Thomas Klockgether
- Department of Neurology, University Hospital Bonn, Bonn, Germany.
- German Center for Neurodegenerative Diseases (DZNE), Venusberg-Campus, 53127, Bonn, Germany.
- Division Translational Genomics of Neurodegenerative Diseases, Center for Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.
| | - Matthis Synofzik
- German Center for Neurodegenerative Diseases (DZNE), Venusberg-Campus, 53127, Bonn, Germany
- Division Translational Genomics of Neurodegenerative Diseases, Center for Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
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Valente AC, Lopes LPN, Matheus ME. Medical cannabis use in oncology and associated outcomes: A scoping review. J Oncol Pharm Pract 2024; 30:737-751. [PMID: 38477532 DOI: 10.1177/10781552241239006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Natural and synthetic cannabinoids are being used worldwide to treat various symptoms in cancer patients. This study aims to map the therapeutic benefits and adverse effects associated with the use of cannabis-based drugs in these outcomes. METHODS Following Joanna Briggs Institute guidelines a scoping review was conducted. The study protocol was available in the Open Science Framework public repository. An extensive search strategy involving databases like Cochrane Library, Embase, CINAHL, Medline/PubMed, Lilacs, Google Scholar, and Open Gray for gray literature analysis was executed by a skilled librarian. The inclusion criteria were primary studies (observational and randomized) that evaluated the efficacy and safety of cannabinoids in cancer patients. The review encompassed studies of diverse designs, publication years, and types, as long as they addressed cannabinoids' impact in oncology. RESULTS Twenty-nine (82.86%) out of total of 35 were randomized and 6 (14.14%) were non-randomized. About 57.1% of studies utilized registered products as interventions, with THC being the most natural cannabinoid cited in variable doses and administration routes. Moreover, 62.85% of studies specified the cancer types (breast, lung, sarcomas, hematological and reproductive system), while only one study detailed cancer staging. The evaluated outcomes encompassed nausea and vomiting (77.14%), appetite (11.43%), pain (8.57%), and tumor regression (2.86%) across different proportions of studies. CONCLUSION Cannabinoids show promise in managing pain, emesis, and anorexia/cachexia linked to cancer progression. New randomized clinical trials with a larger number of participants and observational studies on long-term safety are crucial to affirm their medicinal utility for cancer patients unresponsive to conventional drugs.
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Affiliation(s)
| | | | - Maria Eline Matheus
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Thomas RJ, Yerkovich ST, Goyal V, Chang AB, Rutter C, Masters IB, Marchant JM. The utility of elective flexible bronchoscopy to improve quality of life and clinical outcomes for children: A systematic review. Pediatr Pulmonol 2024; 59:1589-1595. [PMID: 38411339 DOI: 10.1002/ppul.26940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Elective flexible bronchoscopy (FB) is now widely available and standard practice for a variety of indications in children with respiratory conditions. However, there is limited evidence regarding the utility of elective FB in children. This systematic review (SRs) aimed to determine the utility of FB on its impact in clinical decision making and quality of life (QoL). METHODS We searched Pubmed, Cochrane central register of controlled trials, Embase, World Health Organization Clinical Trials Registry Platform and Cochrane database of SRs from inception to April 20, 2023. We included SRs and randomized controlled trials (RCTs) that used parallel group design (comparing use of elective FB vs. no FB, or a wait-list approach [early FB vs. usual wait FB]) in children aged ≤ 18 years. Our protocol was prospectively registered and used Cochrane methodology for systemic reviews of interventions. RESULTS Our search identified 859 articles; 102 duplicates were removed, and 753 articles were excluded by title and abstract. Four full text articles were reviewed and subsequently excluded, as none met the inclusion criteria outlined in our patient, intervention, comparator, outcome measures framework. CONCLUSIONS There is a paucity of high-quality RCT evidence to support the routine use of elective FB in children with respiratory conditions. However, available retrospective and a single prospective study demonstrate the high utility of FB in the elective pediatric setting. REGISTRATION PROSPERO CRD42021291305.
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Affiliation(s)
- Rahul J Thomas
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Vikas Goyal
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Departments of Paediatrics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Cameron Rutter
- Academic Division, Library, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ian Brent Masters
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
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Roncolato F, King MT, O'Connell RL, Lee YC, Joly F, Hilpert F, Lanceley A, Yoshida Y, Bryce J, Donnellan P, Oza A, Avall-Lundqvist E, Berek JS, Ledermann JA, Berton D, Sehouli J, Kaminsky MC, Stockler MR, Friedlander M. Hidden in plain sight - Survival consequences of baseline symptom burden in women with recurrent ovarian cancer. Gynecol Oncol 2024; 185:128-137. [PMID: 38412736 DOI: 10.1016/j.ygyno.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/15/2024] [Accepted: 02/18/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To describe the baseline symptom burden(SB) experienced by patients(pts) with recurrent ovarian cancer(ROC) prior and associations with progression free survival (PFS) and overall survival (OS). METHODS We analysed baseline SB reported by pts. with platinum resistant/refractory ROC (PRR-ROC) or potentially‑platinum sensitive ROC receiving their third or greater line of chemotherapy (PPS-ROC≥3) enrolled in the Gynecologic Cancer InterGroup - Symptom Benefit Study (GCIG-SBS) using the Measure of Ovarian Symptoms and Treatment concerns (MOST). The severity of baseline symptoms was correlated with PFS and OS. RESULTS The 948 pts. reported substantial baseline SB. Almost 80% reported mild to severe pain, and 75% abdominal symptoms. Shortness of breath was reported by 60% and 90% reported fatigue. About 50% reported moderate to severe anxiety, and 35% moderate to severe depression. Most (89%) reported 1 or more symptoms as moderate or severe, 59% scored 6 or more symptoms moderate or severe, and 46% scored 9 or more symptoms as moderate or severe. Higher SB was associated with significantly shortened PFS and OS; five symptoms had OS hazard ratios larger than 2 for both moderate and severe symptom cut-offs (trouble eating, vomiting, indigestion, loss of appetite, and nausea; p < 0.001). CONCLUSION Pts with ROC reported high SB prior to starting palliative chemotherapy, similar among PRR-ROC and PPS-ROC≥3. High SB was strongly associated with early progression and death. SB should be actively managed and used to stratify patients in clinical trials. Clinical trials should measure and report symptom burden and the impact of treatment on symptom control.
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Affiliation(s)
- Felicia Roncolato
- The University of Sydney, NHMRC Clinical Trials Centre, School of Medicine, Australia; Western Sydney University, Australia; Department of Medical Oncology, Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia
| | - Madeleine T King
- The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Rachel L O'Connell
- The University of Sydney, NHMRC Clinical Trials Centre, School of Medicine, Australia
| | - Yeh Chen Lee
- The University of Sydney, NHMRC Clinical Trials Centre, School of Medicine, Australia; School of Clinical Medicine, UNSW, Sydney, Australia; Department of Medical Oncology, Prince of Wales and Royal Hospital for Women, Randwick, NSW, Australia
| | - Florence Joly
- Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Paris, France; Centre Francois Baclesse, Caen, France
| | - Felix Hilpert
- Arbeitsgesmeinschaft Gynakologische Onkologie Studiengruppe (AGO) und North-Eastern German Society of Gynecological Oncology (NOGGO), Kiel, Germany; Onkologisches Therapiezentrum, Krankenhaus, Jerusalem, Hamburg, Germany
| | - Anne Lanceley
- Department of Women's Cancer, UCL Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, University College London, UK
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, University of Fukui, Japan
| | - Jane Bryce
- Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO), Napoli, Italy; Ascension St. John Clinical Research Institute, Tulsa, OK, USA; Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Paul Donnellan
- Cancer Trials Ireland, Galway University Hospital, Galway, Ireland
| | - Amit Oza
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Elisabeth Avall-Lundqvist
- Nordic Society of Gynaecological Oncology (NSGO), Copenhagen, Denmark; Department of Oncology and Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden; Department of Oncology-Pathology, Karolinksa Institutet, Stockholm, Sweden
| | - Jonathan S Berek
- Cooperative Gynecologic Oncology Investigators (COGI), Stanford, CA, USA; Stanford Women's Cancer Centre, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Dominique Berton
- Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Paris, France; Institut de Cancerologie de l'Ouest, Centre Rene, Gauducheau, Saint Herblain, France
| | - Jalid Sehouli
- Arbeitsgesmeinschaft Gynakologische Onkologie Studiengruppe (AGO) und North-Eastern German Society of Gynecological Oncology (NOGGO), Berlin, Germany; Department of Gynecology and Oncological Surgery, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Marie-Christine Kaminsky
- Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Paris, France; Institut de Cancerologie de Lorraine, Vandoeuvre Les Nancy, France
| | - Martin R Stockler
- The University of Sydney, NHMRC Clinical Trials Centre, School of Medicine, Australia
| | - Michael Friedlander
- School of Clinical Medicine, UNSW, Sydney, Australia; Department of Medical Oncology, Prince of Wales and Royal Hospital for Women, Randwick, NSW, Australia.
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Sampogna F, Dattolo A, Cocuroccia B, Moretta G, Provini A, Sordi D, Fusari R, Melo Salcedo N, Abeni D. Clinical severity measures and patient-reported outcomes in atopic dermatitis. J Eur Acad Dermatol Venereol 2024; 38:e545-e547. [PMID: 38158340 DOI: 10.1111/jdv.19753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024]
Affiliation(s)
- F Sampogna
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - A Dattolo
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | | | - G Moretta
- Dermatology Unit, IDI-IRCCS, Rome, Italy
| | - A Provini
- Dermatology Unit, IDI-IRCCS, Rome, Italy
| | - D Sordi
- Dermatology Unit, IDI-IRCCS, Rome, Italy
| | - R Fusari
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | | | - D Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
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Rodrigues A, Abi-Nader S, Durand R, Rompré P, Janati AI, Atsu S, Morris M, Emami E. Effectiveness of zygomatic-implant fixed rehabilitation for the atrophic edentulous maxilla: protocol for a systematic review and network meta-analysis. Syst Rev 2024; 13:146. [PMID: 38822368 PMCID: PMC11140941 DOI: 10.1186/s13643-024-02561-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/14/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Atrophic edentulous maxilla is a debilitating condition caused by the progressive and irreversible bone resorption following loss of teeth, that results in bone of inadequate volume and density. This makes conventional implant therapy extremely challenging without complex reconstructive procedures. Several techniques such as sinus augmentation, short implants, and tilted implants have been used for the rehabilitation of the atrophic maxilla. In recent years, zygomatic implants have emerged as a graftless rehabilitation technique. However, few studies compare zygomatic-implant fixed rehabilitation with other fixed rehabilitation techniques. The existing body of evidence on zygomatic implants is largely based on clinical and disease-oriented outcomes. METHODS A network meta-analysis (NMA) will be conducted in order to compare the effectiveness of zygomatic-implant fixed rehabilitation with the other rehabilitation techniques. Experimental and observational studies comparing different implant-assisted fixed rehabilitation in adults with atrophic maxilla will be included. The primary and secondary outcomes will be patient's satisfaction and quality of life respectively. Additional outcomes include the implant's survival/success, and biological and prosthetic complications. An electronic search will be performed through various databases for articles in English and French, without time limits. Risk of bias will be assessed using the Revised Cochrane Risk-of-Bias tool for randomized controlled trials, and ROBINS-I for non-randomized and observational studies. Two independent reviewers will screen the titles and abstracts and extract data. Any discrepancy between reviewers will be discussed and resolved through consensus or with the help of a third reviewer. Pairwise meta-analyses will be performed using a random effects model. I2, τ2, transitivity, subgroup/meta-regression analyses will assess and explain heterogeneity and distribution of effect modifiers. A network plot will be created to connect the different interventions directly and indirectly. Interventions will be ranked using the surface under cumulative ranking curve. Confidence in the results of the NMA will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). DISCUSSION This study will be the first to assess the effectiveness of zygomatic-implant fixed rehabilitation for the atrophic maxilla using NMA. The evidence obtained will aid clinical decision-making and will advance the knowledge of the rehabilitation techniques for the atrophic maxilla. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023353303.
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Affiliation(s)
- Anisha Rodrigues
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Samer Abi-Nader
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Robert Durand
- Faculty of Dental Medicine, Université de Montréal, Montreal, Canada
| | | | - Amal Idrissi Janati
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Saadet Atsu
- Materials Engineering, McGill University, Montreal, Canada
| | - Martin Morris
- Schulich Library, Mcgill University, Montreal, Canada
| | - Elham Emami
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada.
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Dhaenens BAE, van Dijk SA, Fertitta L, Taal W, Wolkenstein P, Oostenbrink R. Quality of life in individuals with neurofibromatosis type 1 associated cutaneous neurofibromas: validation of the Dutch cNF-Skindex. J Patient Rep Outcomes 2024; 8:52. [PMID: 38811427 PMCID: PMC11136889 DOI: 10.1186/s41687-024-00732-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/17/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Almost all patients with Neurofibromatosis type 1 (NF1) develop cutaneous neurofibroma (cNF), benign dermal tumours that have a large impact on the patient's Quality of Life (QoL). The French cNF-Skindex is the first questionnaire to specifically assess cNF-related QoL in patients with NF1. We aimed to adapt and validate a Dutch version of the cNF-Skindex. METHODS The questionnaire was translated using forward and backwards translation, and subsequently administered to a sample of 59 patients on two separate occasions. Feasibility was evaluated by the presence of floor/ceiling effects. Reliability was assessed by evaluating internal consistency and test-retest reliability, by calculating Cronbach's alpha and Spearman's rank correlation coefficients. The EQ-5D-5L and SF-36 were used to evaluate convergent validity, using Spearman's rank correlation coefficients. An exploratory factor analysis was performed to study the data's internal structure. Multivariable linear regression was used to model the relationship between patient characteristics and the cNF-Skindex. RESULTS The Dutch cNF-Skindex demonstrated excellent feasibility and reliability (Cronbach's alpha 0.96, test-retest correlation coefficient 0.88). Convergent validity was confirmed for the EQ-5D-5L and relevant SF-36 scales. All items and subdomains from the original questionnaire were confirmed following exploratory factor analysis. The patient characteristics included in the multivariable linear regression were not significantly associated with the cNF-Skindex score. CONCLUSIONS The Dutch cNF-Skindex displayed excellent psychometric properties, enabling use in the Netherlands.
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Affiliation(s)
- Britt A E Dhaenens
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, Rotterdam, 3015 CN, The Netherlands.
- The ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.
| | - Sarah A van Dijk
- The ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, Rotterdam, 3000 CA, The Netherlands
| | - Laura Fertitta
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique- Hôpitaux de Paris, Creteil, France
| | - Walter Taal
- The ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, Rotterdam, 3000 CA, The Netherlands
| | - Pierre Wolkenstein
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique- Hôpitaux de Paris, Creteil, France
| | - Rianne Oostenbrink
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, Rotterdam, 3015 CN, The Netherlands
- The ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Full Member of the European Reference Network on Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands
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Srinivasan R, Rodgers-Melnick SN, Rivard RL, Kaiser C, Vincent D, Adan F, Dusek JA. Implementing paper-based patient-reported outcome collection within outpatient integrative health and medicine. PLoS One 2024; 19:e0303985. [PMID: 38809886 PMCID: PMC11135778 DOI: 10.1371/journal.pone.0303985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/04/2024] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVE To investigate the feasibility of pre- and post-encounter patient-reported outcome (PRO) measure collection within an outpatient integrative health and medicine (IHM) clinic and to characterize factors associated with successful completion. METHODS We conducted a retrospective review of 27,464 outpatient IHM encounters including 9,520 chiropractic; 8,237 acupuncture; 5,847 massage; 2,345 IHM consultation; and 1,515 osteopathic manipulation treatment encounters at four clinics offering IHM over 18 months. Patients were asked to complete paper questionnaires rating pain, anxiety, and stress from 0-10 immediately pre- and post-encounter. Generalized linear mixed effect regression models were used to examine the relationship between demographic, clinical, and operational covariates and completing (1) pre-encounter and (2) paired (i.e., pre and post) PROs. RESULTS Patients (N = 5587, mean age 49 years, 74% white, 77% female) generally presented for musculoskeletal conditions (81.7%), with a chief complaint of pain (55.1%). 21,852 (79.6%) encounters were among patients who completed pre-encounter PROs; 11,709/21,852 (53.6%) completed subsequent post-encounter PROs. Odds of PRO completion were more impacted by provider, operational, and clinical-level factors than patient factors. Covariates associated with increased odds of pre-encounter PRO completion included being female, having additional IHM encounters, and having a pain or anxiety complaint. Covariates associated with increased odds of paired PRO completion included being aged 31-40 vs. 51-60 years and having additional IHM encounters. CONCLUSION Implementing a paper-based PRO collection system in outpatient IHM is feasible; however, collecting post-encounter PROs was challenging. Future endeavors should leverage the electronic health record and patient portals to optimize PRO collection and engage patients and clinical providers.
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Affiliation(s)
- Roshini Srinivasan
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
| | - Samuel N. Rodgers-Melnick
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Rachael L. Rivard
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
- Center for Evaluation Survey and Research, HealthPartners Institute, Minneapolis, MN, United States of America
| | - Christine Kaiser
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
| | - David Vincent
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
| | - Francoise Adan
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Jeffery A. Dusek
- Susan Samueli Integrative Health Institute, University of California Irvine, Irvine, CA, United States of America
- Department of Medicine, University of California Irvine, Irvine, CA, United States of America
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Sandhu AT, Calma J, Skye M, Kalwani N, Zheng J, Schirmer J, Din N, Brown Johnson C, Gupta A, Lan R, Yu B, Spertus JA, Heidenreich PA. Clinical Impact of Routine Assessment of Patient-Reported Health Status in Heart Failure Clinic: The PRO-HF Trial. Circulation 2024; 149:1717-1728. [PMID: 38583147 DOI: 10.1161/circulationaha.124.069624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The impact of routine clinic use of patient-reported outcome (PRO) measures on clinical outcomes in patients with heart failure (HF) has not been well-characterized. We tested if clinic-based use of a disease-specific PRO improves patient-reported quality of life at 1 year. METHODS The PRO-HF trial (Patient-Reported Outcome Measurement in Heart Failure Clinic) was an open-label, parallel, patient-level randomized clinical trial of routine PRO assessment or usual care at an academic HF clinic between August 30, 2021, and June 30, 2022, with 1 year of follow-up. In the PRO assessment arm, participants completed the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) at each HF clinic visit, and results were shared with their treating clinician. The usual care arm completed the KCCQ-12 at randomization and 1 year later, which was not shared with the treating clinician. The primary outcome was the KCCQ-12 overall summary score (OSS) between 12 and 15 months after randomization. Secondary outcomes included domains of the KCCQ-12, hospitalization and emergency department visit rates, HF medication therapy, clinic visit frequency, and testing rates. RESULTS Across 17 clinicians, 1248 participants were enrolled and randomized to PRO assessment (n=624) or usual care (n=624). The median age was 63.9 years (interquartile range [IQR], 51.8-72.8), 38.9% were women, and the median baseline KCCQ-12 OSS was 82.3 (IQR, 58.3-94.8). Final KCCQ-12 (available in 87.9% of the PRO arm and 85.1% in usual care; P=0.16) median OSS were 87.5 (IQR, 68.8-96.9) in the PRO arm and 87.6 (IQR, 69.7-96.9) in the usual care arm with a baseline-adjusted mean difference of 0.2 ([95% CI, -1.7 to 2.0]; P=0.85). The results were consistent across prespecified subgroups. A post hoc analysis demonstrated a significant interaction with greater benefit among participants with a baseline KCCQ-12 OSS of 60 to 80 but not in less or more symptomatic participants. No significant differences were found in 1-year mortality, hospitalizations, emergency department visits, medication therapy, clinic follow-up, or testing rates between arms. CONCLUSIONS Routine PRO assessment in HF clinic visits did not impact patient-reported quality of life or other clinical outcomes. Alternate strategies and settings for embedding PROs into routine clinical care should be tested. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04164004.
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Affiliation(s)
- Alexander T Sandhu
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
- Stanford Prevention Research Center (A.T.S.), Stanford University, CA
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
| | - Jamie Calma
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
| | - Megan Skye
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
| | - Neil Kalwani
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
| | - Jimmy Zheng
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - Jessica Schirmer
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
| | - Natasha Din
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
| | - Cati Brown Johnson
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - Anshal Gupta
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - Roy Lan
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - Brian Yu
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - John A Spertus
- University of Missouri-Kansas City Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.)
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
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Jung A, Challoumas D, Pagels L, Armijo-Olivo S, Braun T, Luedtke K. Guidelines for the development and validation of patient-reported outcome measures: a scoping review. BMJ Evid Based Med 2024:bmjebm-2023-112681. [PMID: 38782559 DOI: 10.1136/bmjebm-2023-112681] [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] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE The objectives of this scoping review were to provide an overview of existing guidelines for the development and validation of patient-reported outcome measures (PROMs), review them for comprehensiveness and clarity and provide recommendations for their use based on the goals of the instrument developers. DESIGN Scoping review. METHODS A literature search was performed in PubMed, Scopus, PsycInfo and Google Scholar up to 2 June 2023 to identify guidelines for the development and validation of PROMs. Screening of records and reports as well as data extraction were performed by two reviewers. To assess the comprehensiveness of the included guidelines, a mapping synthesis was performed and steps to develop and validate a measurement instrument outlined in the included guidelines were mapped to an a priori framework including 20 steps, which was based on the guideline by de Vet et al. RESULTS A total of 40 guidelines were included. Statistical advice (at least partially) was provided in 98% of the guidelines (39/40) and 88% (35/40) of the guidelines included examples for steps required to develop and validate PROMs. However, 78% (31/40) of the guidelines were not comprehensive and two essential steps in PROM development ('consideration and elaboration of the measurement model' and 'responsiveness') were not included in 80% and 72% of the guidelines, respectively. Three guidelines included all 20 steps and six included almost all steps (≥90% of steps) for developing and validating a PROM. DISCUSSION Most guidelines on PROM development and validation do not appear to be comprehensive, and some crucial steps are missing in most guidelines. Nevertheless, for some purposes of PROMs, many guidelines provide helpful advice and support. CONCLUSION At least 15 guidelines may be recommended, including three comprehensive guidelines that can be recommended for the development and validation of PROMs for most purposes (eg, to discriminate between subjects with a particular condition and subjects without that condition, to evaluate the effects of treatments (between a pre and post time-points) or to evaluate a status quo).
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Affiliation(s)
- Andres Jung
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Lübeck, Germany
- Department of Sport Science and Sport, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Dimitris Challoumas
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Larissa Pagels
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Lübeck, Germany
| | - Susan Armijo-Olivo
- Faculty of Business and Social Sciences, Hochschule Osnabrück, Osnabrück, Germany
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, Rehabilitation Research Center, University of Alberta, Edmonton, Alberta, Canada
| | - Tobias Braun
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit Bochum, Bochum, Germany
- Department of Health, HSD Hochschule Dopfer GmbH, Köln, Germany
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), Universität zu Lübeck, Lübeck, Germany
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Jayasinghe RT, Ahern S, Maharaj AD, Romero L, Ruseckaite R. Identifying Existing Guidelines, Frameworks, Checklists, and Recommendations for Implementing Patient-Reported Outcome Measures: Protocol for a Scoping Review. JMIR Res Protoc 2024; 13:e52572. [PMID: 38771621 DOI: 10.2196/52572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/19/2023] [Accepted: 03/11/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Implementing patient-reported outcome measures (PROMs) to measure and evaluate health outcomes is increasing worldwide. Along with this emerging trend, it is important to identify which guidelines, frameworks, checklists, and recommendations exist, and if and how they have been used in implementing PROMs, especially in clinical quality registries (CQRs). OBJECTIVE This review aims to identify existing publications, as well as publications that discuss the application of actual guidelines, frameworks, checklists, and recommendations on PROMs' implementation for various purposes such as clinical trials, clinical practice, and CQRs. In addition, the identified publications will be used to guide the development of a new guideline for PROMs' implementation in CQRs, which is the aim of the broader project. METHODS A literature search of the databases MEDLINE, Embase, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials will be conducted since the inception of the databases, in addition to using Google Scholar and gray literature to identify literature for the scoping review. Predefined inclusion and exclusion criteria will be used for all phases of screening. Existing publications of guidelines, frameworks, checklists, recommendations, and publications discussing the application of those methodologies for implementing PROMs in clinical trials, clinical practice, and CQRs will be included in the final review. Data relating to bibliographic information, aim, the purpose of PROMs use (clinical trial, practice, or registries), name of guideline, framework, checklist and recommendations, the rationale for development, and their purpose and implications will be extracted. Additionally, for publications of actual methodologies, aspects or domains of PROMs' implementation will be extracted. A narrative synthesis of included publications will be conducted. RESULTS The electronic database searches were completed in March 2024. Title and abstract screening, full-text screening, and data extraction will be completed in May 2024. The review is expected to be completed by the end of August 2024. CONCLUSIONS The findings of this scoping review will provide evidence on any existing methodologies and tools for PROMs' implementation in clinical trials, clinical practice, and CQRs. It is anticipated that the publications will help us guide the development of a new guideline for PROMs' implementation in CQRs. TRIAL REGISTRATION PROSPERO CRD42022366085; https://tinyurl.com/bdesk98x. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52572.
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Affiliation(s)
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ashika D Maharaj
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lorena Romero
- The Ian Potter Library, Alfred Hospital, Melbourne, Australia
| | - Rasa Ruseckaite
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Emad-Eldin M, Balata GF, Elshorbagy EA, Hamed MS, Attia MS. Insulin therapy in type 2 diabetes: Insights into clinical efficacy, patient-reported outcomes, and adherence challenges. World J Diabetes 2024; 15:828-852. [PMID: 38766443 PMCID: PMC11099362 DOI: 10.4239/wjd.v15.i5.828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/01/2024] [Accepted: 03/20/2024] [Indexed: 05/10/2024] Open
Abstract
Insulin therapy plays a crucial role in the management of type 2 diabetes as the disease progresses. Over the past century, insulin formulations have undergone significant modifications and bioengineering, resulting in a diverse range of available insulin products. These products show distinct pharmacokinetic and pharmacodynamic profiles. Consequently, various insulin regimens have em-erged for the management of type 2 diabetes, including premixed formulations and combinations of basal and bolus insulins. The utilization of different insulin regimens yields disparate clinical outcomes, adverse events, and, notably, patient-reported outcomes (PROs). PROs provide valuable insights from the patient's perspective, serving as a valuable mine of information for enhancing healthcare and informing clinical decisions. Adherence to insulin therapy, a critical patient-reported outcome, significantly affects clinical outcomes and is influenced by multiple factors. This review provides insights into the clinical effectiveness of various insulin preparations, PROs, and factors impacting insulin therapy adherence, with the aim of enhancing healthcare practices and informing clinical decisions for individuals with type 2 diabetes.
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Affiliation(s)
- Mahmoud Emad-Eldin
- Department of Pharmacy Practice, Faculty of Pharmacy, Zagazig University, Zagazig HFQM+872, Al-Sharqia Governorate, Egypt
| | - Gehan F Balata
- Department of Pharmacy Practice, Faculty of Pharmacy, Heliopolis University, Cairo 44519, Egypt
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
| | - Eman A Elshorbagy
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
| | - Mona S Hamed
- Department of Community at Faculty of Medicine, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
| | - Mohamed S Attia
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
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Lyhne JD, Smith A'B, Jensen LH, Hansen TF, Frostholm L, Timm S. Missingness mechanisms and generalizability of patient reported outcome measures in colorectal cancer survivors - assessing the reasonableness of the "missing completely at random" assumption. BMC Med Res Methodol 2024; 24:104. [PMID: 38702599 PMCID: PMC11067079 DOI: 10.1186/s12874-024-02236-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/26/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Patient-Reported Outcome Measures (PROM) provide important information, however, missing PROM data threaten the interpretability and generalizability of findings by introducing potential bias. This study aims to provide insight into missingness mechanisms and inform future researchers on generalizability and possible methodological solutions to overcome missing PROM data problems during data collection and statistical analyses. METHODS We identified 10,236 colorectal cancer survivors (CRCs) above 18y, diagnosed between 2014 and 2018 through the Danish Clinical Registries. We invited a random 20% (2,097) to participate in a national survey in May 2023. We distributed reminder e-mails at day 10 and day 20, and compared Initial Responders (response day 0-9), Subsequent Responders (response day 10-28) and Non-responders (no response after 28 days) in demographic and cancer-related characteristics and PROM-scores using linear regression. RESULTS Of the 2,097 CRCs, 1,188 responded (57%). Of these, 142 (7%) were excluded leaving 1,955 eligible CRCs. 628 (32%) were categorized as initial responders, 418 (21%) as subsequent responders, and 909 (47%) as non-responders. Differences in demographic and cancer-related characteristics between the three groups were minor and PROM-scores only marginally differed between initial and subsequent responders. CONCLUSION In this study of long-term colorectal cancer survivors, we showed that initial responders, subsequent responders, and non-responders exhibit comparable demographic and cancer-related characteristics. Among respondents, Patient-Reported Outcome Measures were also similar, indicating generalizability. Assuming Patient-Reported Outcome Measures of subsequent responders represent answers by the non-responders (would they be available), it may be reasonable to judge the missingness mechanism as Missing Completely At Random.
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Affiliation(s)
- Johanne Dam Lyhne
- Department of Oncology, University Hospital of Southern Denmark, Beriderbakken 4, Vejle, 7100, Denmark.
| | - Allan 'Ben' Smith
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Lars Henrik Jensen
- Department of Oncology, University Hospital of Southern Denmark, Beriderbakken 4, Vejle, 7100, Denmark
| | - Torben Frøstrup Hansen
- Department of Oncology, University Hospital of Southern Denmark, Beriderbakken 4, Vejle, 7100, Denmark
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Signe Timm
- Department of Oncology, University Hospital of Southern Denmark, Beriderbakken 4, Vejle, 7100, Denmark
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Efficace F, Buckstein R, Abel GA, Giesinger JM, Fenaux P, Bewersdorf JP, Brunner AM, Bejar R, Borate U, DeZern AE, Greenberg P, Roboz GJ, Savona MR, Sparano F, Boultwood J, Komrokji R, Sallman DA, Xie Z, Sanz G, Carraway HE, Taylor J, Nimer SD, Della Porta MG, Santini V, Stahl M, Platzbecker U, Sekeres MA, Zeidan AM. Toward a more patient-centered drug development process in clinical trials for patients with myelodysplastic syndromes/neoplasms (MDS): Practical considerations from the International Consortium for MDS (icMDS). Hemasphere 2024; 8:e69. [PMID: 38774655 PMCID: PMC11106800 DOI: 10.1002/hem3.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/04/2024] [Accepted: 04/01/2024] [Indexed: 05/24/2024] Open
Abstract
Notable treatment advances have been made in recent years for patients with myelodysplastic syndromes/neoplasms (MDS), and several new drugs are under development. For example, the emerging availability of oral MDS therapies holds the promise of improving patients' health-related quality of life (HRQoL). Within this rapidly evolving landscape, the inclusion of HRQoL and other patient-reported outcomes (PROs) is critical to inform the benefit/risk assessment of new therapies or to assess whether patients live longer and better, for what will likely remain a largely incurable disease. We provide practical considerations to support investigators in generating high-quality PRO data in future MDS trials. We first describe several challenges that are to be thoughtfully considered when designing an MDS-focused clinical trial with a PRO endpoint. We then discuss aspects related to the design of the study, including PRO assessment strategies. We also discuss statistical approaches illustrating the potential value of time-to-event analyses and their implications within the estimand framework. Finally, based on a literature review of MDS randomized controlled trials with a PRO endpoint, we note the PRO items that deserve special attention when reporting future MDS trial results. We hope these practical considerations will facilitate the generation of rigorous PRO data that can robustly inform MDS patient care and support treatment decision-making for this patient population.
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Affiliation(s)
- Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Health Outcomes Research UnitGIMEMA Data CenterRomeItaly
| | - Rena Buckstein
- Department of Medical Oncology/HematologySunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Gregory A. Abel
- Divisions of Population Sciences and Hematologic MalignanciesDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | | | - Pierre Fenaux
- Hôpital Saint LouisAssistance Publique Hôpitaux de Paris and Paris Cité UniversityParisFrance
| | - Jan Philipp Bewersdorf
- Leukemia Service, Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Andrew M. Brunner
- Leukemia Program, Harvard Medical SchoolMassachusetts General Hospital Cancer CenterBostonMassachusettsUSA
| | - Rafael Bejar
- Division of Hematology and Oncology, Moores Cancer CenterUC San DiegoLa JollaCaliforniaUSA
| | - Uma Borate
- Ohio State University Comprehensive Cancer Center/James Cancer HospitalOhio State UniversityColumbusOhioUSA
| | - Amy E. DeZern
- Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins HospitalBaltimoreMarylandUSA
| | - Peter Greenberg
- Department of Medicine, Division of Hematology, Cancer InstituteStanford University School of MedicineStanfordCaliforniaUSA
| | - Gail J. Roboz
- Weill Cornell Medical College and New York Presbyterian HospitalNew YorkNew YorkUSA
| | - Michael R. Savona
- Department of Medicine, Division of Hematology/OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Francesco Sparano
- Italian Group for Adult Hematologic Diseases (GIMEMA), Health Outcomes Research UnitGIMEMA Data CenterRomeItaly
| | - Jacqueline Boultwood
- Blood Cancer UK Molecular Haematology Unit, Radcliffe Department of MedicineNuffield Division of Clinical Laboratory SciencesUniversity of OxfordOxfordUK
| | - Rami Komrokji
- Department of Malignant HematologyH. Lee Moffitt Cancer CenterTampaFloridaUSA
| | - David A. Sallman
- Department of Malignant HematologyH. Lee Moffitt Cancer CenterTampaFloridaUSA
| | - Zhuoer Xie
- Department of Malignant HematologyH. Lee Moffitt Cancer CenterTampaFloridaUSA
| | - Guillermo Sanz
- Health Research Institute La Fe, Valencia, SpainHospital Universitario y Politécnico La FeValenciaSpain
| | - Hetty E. Carraway
- Leukemia Program, Hematology and Medical OncologyTaussig Cancer Institute, Cleveland ClinicClevelandOhioUSA
| | - Justin Taylor
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Stephen D. Nimer
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Matteo Giovanni Della Porta
- Department of Biomedical SciencesIRCCS Humanitas Clinical and Research Center & Humanitas UniversityMilanItaly
| | - Valeria Santini
- Myelodysplastic Syndromes Unit, Department of Experimental and Clinical Medicine, Hematology, Azienda Ospedaliero Universitaria CareggiUniversity of FlorenceFlorenceItaly
| | - Maximilian Stahl
- Department of Medical OncologyDana‐Farber Cancer Institute and Harvard Medical SchoolBostonMassachusettsUSA
| | - Uwe Platzbecker
- Department of Hematology and Cellular TherapyUniversity Hospital LeipzigLeipzigGermany
| | - Mikkael A. Sekeres
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Amer M. Zeidan
- Section of Hematology, Department of Internal MedicineYale University School of Medicine and Yale Cancer CenterNew HavenConnecticutUSA
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Fehm T, Cottone F, Dunton K, André F, Krop I, Park YH, De Laurentiis M, Miyoshi Y, Armstrong A, Borrego MR, Yerushalmi R, Duhoux FP, Takano T, Lu W, Egorov A, Kim SB. Trastuzumab deruxtecan versus treatment of physician's choice in patients with HER2-positive metastatic breast cancer (DESTINY-Breast02): patient-reported outcomes from a randomised, open-label, multicentre, phase 3 trial. Lancet Oncol 2024; 25:614-625. [PMID: 38697155 DOI: 10.1016/s1470-2045(24)00128-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND In DESTINY-Breast02, patients with HER2-positive unresectable or metastatic breast cancer who received trastuzumab deruxtecan demonstrated superior progression-free and overall survival compared with those receiving treatment of physician's choice. We present the patient-reported outcomes (PROs) and hospitalisation data. METHODS In this randomised, open-label, phase 3 trial conducted at 227 clinical sites globally, enrolled patients had to be aged 18 years or older with HER2-positive unresectable or metastatic breast cancer that had progressed on trastuzumab emtansine and had an Eastern Cooperative Oncology Group performance status of 0 or 1. Patients were randomly assigned (2:1) using block randomisation (block size of 3) to receive trastuzumab deruxtecan (5·4 mg/kg intravenously once every 21 days) or treatment of physician's choice by an independent biostatistician using an interactive web-based system. Patients and investigators remained unmasked to treatment. Treatment of physician's choice was either capecitabine (1250 mg/m2 orally twice per day on days 1-14) plus trastuzumab (8 mg/kg intravenously on day 1 then 6 mg/kg once per day) or capecitabine (1000 mg/m2) plus lapatinib (1250 mg orally once per day on days 1-21), with a 21-day schedule. The primary endpoint, which was progression-free survival based on blinded independent central review, has previously been reported. PROs were assessed in the full analysis set (all patients randomly assigned to the study) using the oncology-specific European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), breast cancer-specific EORTC Quality of Life Questionnaire Breast 45 (QLQ-BR45), and the generic HRQoL EQ-5D-5L questionnaire. Analyses included change from baseline and time to definitive deterioration for PRO variables of interest and hospitalisation-related endpoints. This study is registered with ClinicalTrials.gov, NCT03523585, and is closed to recruitment. FINDINGS Between Sept 6, 2018, and Dec 31, 2020, 608 patients were randomly assigned to receive either trastuzumab deruxtecan (n=406; two did not receive treatment) or treatment of physician's choice (n=202; seven did not receive treatment). Overall, 603 patients (99%) were female and five (<1%) were male. The median follow-up was 21·5 months (IQR 15·2-28·4) in the trastuzumab deruxtecan group and 18·6 months (IQR 8·8-26·0) in the treatment of physician's choice group. Median treatment duration was 11·3 months (IQR 6·2-20·5) in the trastuzumab deruxtecan group and approximately 4·5 months in the treatment of physician's choice group (4·4 months [IQR 2·5-8·7] with trastuzumab; 4·6 months [2·1-8·9] with capecitabine; and 4·5 months [2·1-10·6] with lapatinib). Baseline EORTC QLQ-C30 global health status (GHS) scores were similar with trastuzumab deruxtecan (n=393) and treatment of physician's choice (n=187), and remained stable with no clinically meaningful change (defined as ≥10-point change from baseline) over time. Median time to definitive deterioration was delayed with trastuzumab deruxtecan compared with treatment of physician's choice for the primary PRO variable EORTC QLQ-C30 GHS (14·1 months [95% CI 10·4-18·7] vs 5·9 months [4·3-7·9]; HR 0·5573 [0·4376-0·7099], p<0·0001) and all other prespecified PROs (EORTC QLQ-C30 subscales, EORTC QLQ-BR45 arm and breast symptoms, and EQ-5D-5L visual analogue scale). Patient hospitalisation rates were similar in the trastuzumab deruxtecan (92 [23%] of 406) and treatment of physician's choice (41 [20%] of 202) groups; however, median time to hospitalisation was 133 days (IQR 56-237) with trastuzumab deruxtecan versus 83 days (30-152) with treatment of physician's choice. INTERPRETATION Overall, GHS and quality of life were maintained for both treatment groups, with prespecified PRO variables favouring trastuzumab deruxtecan over treatment of physician's choice, suggesting that despite a longer treatment duration, there was no detrimental impact on patient health-related quality of life with trastuzumab deruxtecan. When considered with efficacy and safety data from DESTINY-Breast02, these results support the overall benefit of trastuzumab deruxtecan for patients with HER2-positive unresectable or metastatic breast cancer previously treated with trastuzumab emtansine. FUNDING Daiichi Sankyo and AstraZeneca.
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Affiliation(s)
- Tanja Fehm
- University Hospital Düsseldorf, Center for Integrated Oncology ABCD, Düsseldorf, Germany.
| | | | | | - Fabrice André
- Institut Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Ian Krop
- Yale Cancer Center, New Haven, CT, USA
| | | | | | - Yasuo Miyoshi
- Hyogo College of Medicine University Hospital, Hyogo, Japan
| | | | | | - Rinat Yerushalmi
- Rabin Medical Center-Beilinson Campus, Tel Aviv University, Tel Aviv, Israel
| | | | - Toshimi Takano
- The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | - Sung-Bae Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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