1
|
Mwebesa E, Awor S, Natuhamya C, Dricile R, Legason ID, Okimait D, Mangwi Ayiasi R, Tumwesigye NM. Impact of mass media campaigns on knowledge of malaria prevention measures among pregnant mothers in Uganda: a propensity score-matched analysis. Malar J 2024; 23:256. [PMID: 39182108 PMCID: PMC11344330 DOI: 10.1186/s12936-024-05083-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 08/17/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Uganda grapples with a considerable malaria burden, reporting prevalence rates of over 33% in some regions. To address this, the Uganda Ministry of Health employs audiovisual platforms for disseminating malaria prevention messages. However, the impact of these messages on pregnant women's knowledge of malaria prevention remains insufficiently explored. This paper therefore emphasizes the influence of audiovisual messages on the knowledge of malaria prevention measures among pregnant women in Uganda. METHODS Secondary data obtained from the Uganda Malaria Indicator Survey (MIS) 2018-2019 was used for this analysis. Women aged 15-49 were included in the study. A total of 8868 women were selected using a two-stage sample design. The two stages of selection included clusters and households. Women who were currently pregnant were included in the study, resulting in a weighted sample of 721 women. Propensity score-matched analysis was used to evaluate the impact of access to malaria messages on knowledge of prevention measures. RESULTS The study revealed that 39% [95% CI 34.0-44.2] of pregnant women were exposed to malaria messages before the survey. Those exposed had a 17.2% higher knowledge [ATT = 0.172; 95% CI 0.035-0.310] of using mosquito nets for prevention compared to those unexposed. Among women exposed, radios accounted for most form of access to mass media campaigns [64.8, 95% CI 57.0-71.8] followed by interpersonal communication [45.0, 95% CI 37.6-52.6], community health workers [38.8, 95% CI 29.6-48.8], community events [21.4, 95% CI 15.8-28.3], and social mobilization [18.3, 95% CI 12.7-25.8]. CONCLUSION Results highlight the importance of radios in spreading important malaria prevention messages to pregnant women. Being exposed to these messages is linked to increased awareness and knowledge about the proper use of insecticide-treated bed nets (ITNs) for preventing malaria. This finding underscores the importance of evaluating different channels for mass media campaigns to ensure the effective delivery of information about malaria prevention to the intended audiences.
Collapse
Affiliation(s)
- Edson Mwebesa
- Faculty of Science, Muni University, Arua, Uganda.
- School of Science and Aerospace Studies, Moi University, Eldoret, Kenya.
| | - Susan Awor
- School of Public Health, University of California Berkeley, Berkeley, USA
| | | | - Ratib Dricile
- Faculty of Health Sciences, Muni University, Arua, Uganda
| | - Ismail D Legason
- Faculty of Health Sciences, Muni University, Arua, Uganda
- Department of Oncology, Medical Sciences Division, University of Oxford, Oxford, UK
| | - David Okimait
- Faculty of Arts & Social Sciences, Africa Renewal University, Buloba, Uganda
| | | | | |
Collapse
|
2
|
Zhun Hong Wong N, Wei Ting Yap D, Lei Ng S, Yu Ning Ng J, James JJ, Wei Chieh Kow A. Oncological outcomes in minimally invasive vs. open distal pancreatectomy: a systematic review and network meta-analysis. Front Surg 2024; 11:1369169. [PMID: 38933652 PMCID: PMC11203400 DOI: 10.3389/fsurg.2024.1369169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/08/2024] [Indexed: 06/28/2024] Open
Abstract
Background Advancements in surgical techniques have improved outcomes in patients undergoing pancreatic surgery. To date there have been no meta-analyses comparing robotic and laparoscopic approaches for distal pancreatectomies (DP) in patients with pancreatic adenocarcinoma (PDAC). This systematic review and network meta-analysis aims to explore the oncological outcomes of laparoscopic distal pancreatectomy (LDP), robotic distal pancreatectomy (RDP) and open distal pancreatectomy (ODP). Methods A systematic search was conducted for studies reporting laparoscopic, robotic or open surgery for DP. Frequentist network meta-analysis of oncological outcomes (overall survival, resection margins, tumor recurrence, examined lymph nodes, administration of adjuvant therapy) were performed. Results Fifteen studies totalling 9,301 patients were included in the network meta-analysis. 1,946, 605 and 6,750 patients underwent LDP, RDP and ODP respectively. LDP (HR: 0.761, 95% CI: 0.642-0.901, p = 0.002) and RDP (HR: 0.757, 95% CI: 0.617-0.928, p = 0.008) were associated with overall survival (OS) benefit when compared to ODP. LDP (HR: 1.00, 95% CI: 0.793-1.27, p = 0.968) was not associated with OS benefit when compared to RDP. There were no significant differences between LDP, RDP and ODP for resection margins, tumor recurrence, examined lymph nodes and administration of adjuvant therapy. Conclusion This study highlights the longer OS in both LDP and RDP when compared to ODP for patients with PDAC. Systematic Review Registration https://www.crd.york.ac.uk/, PROSPERO (CRD42022336417).
Collapse
Affiliation(s)
- Nicky Zhun Hong Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dominic Wei Ting Yap
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sherryl Lei Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Junie Yu Ning Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Juanita Jaslin James
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alfred Wei Chieh Kow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University Hospital Singapore, Singapore, Singapore
| |
Collapse
|
3
|
Dhakal B, McLeod GF, Insch A, Boden J. Modified inverse propensity weighting method to alleviate estimation errors in the model with multiple endogenous variables. MethodsX 2024; 12:102513. [PMID: 38192361 PMCID: PMC10772818 DOI: 10.1016/j.mex.2023.102513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/03/2023] [Indexed: 01/10/2024] Open
Abstract
Multiple mental health disorders affect on decisions of people. The disorders are also outcomes of other factors. Health studies commonly follow an inverse propensity weight (IPW) method to address estimation errors associated with the presence of one confounder or covariate number exceeding the recommended sample size. However, approaches of IPW appropriate to alleviate the estimation error associated with multiple confounders distributed unequally in the study samples were not explained in our search literature. This study used longitudinal cohort data from Christchurch Health and Development Study and demonstrated IPW approach to address two confounders with similar natures in terms of etiological process. In our sample, some individuals had no mental health disorder at all, while others had either one of depression or anxiety or both. The methodological step to evaluate a new IPW approach include * Estimated IPWs from all possible combinations of the major depression and anxiety disorder: (a) IPW based on anxiety factor only assuming both mental health problems resulted from the same etiological processes; (b) IPW based on major depression factor only assuming both mental health problems resulted from the same etiological processes; (c) IPW assuming three (independent) categories of etiological processes: neither; either; both of major depression or anxiety disorder, (d) IPW assuming four (independent) categories of etiological processes: neither; major depression only; any anxiety disorder only; both. (e) No IPW or control model (no confounding problem.•Estimated outcome model with one each IPW at a time and one without IPw (control model).•Compared fit statistics of all estimated models.•The IPW derived assuming four categories of etiological processes produced the robust based fit statistics criteria. The study showed significant effects of both mental health problems on investment but the anxiety revealed a stronger effect than that of major depression.
Collapse
Affiliation(s)
- Bhubaneswor Dhakal
- Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch 8140, New Zealand
| | - Geraldine. F.H. McLeod
- Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch 8140, New Zealand
| | - Andrea Insch
- Department of Marketing, University of Otago, Dunedin, New Zealand
| | - Joseph.M. Boden
- Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch 8140, New Zealand
| |
Collapse
|
4
|
Christiansen EA, Kümler I. Real-world effectiveness of palbociclib in HR+/HER2- metastatic breast cancer: a literature review. Future Sci OA 2024; 10:2340329. [PMID: 38817360 PMCID: PMC11137848 DOI: 10.2144/fsoa-2023-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 12/01/2023] [Indexed: 06/01/2024] Open
Abstract
Approximately 70% of newly diagnosed breast cancers are of the HR+/HER2- subtype. For the treatment of patients with HR+/HER2- metastatic breast cancer, current guidelines recommend the use of a CDK4/6 inhibitor (palbociclib, ribociclib or abemaciclib) in combination with endocrine therapy. In this review we assess existing literature concerning real-world effectiveness of palbociclib. Survival outcomes in terms of progression-free survival and overall survival are discussed and compared among the included real-world studies and in relation to the phase III PALOMA trials.
Collapse
Affiliation(s)
- Emilie Adrian Christiansen
- Faculty of Health & Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Iben Kümler
- Department of Oncology, Herlev & Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls vej 7, 2730 Herlev, Denmark
| |
Collapse
|
5
|
Gomes M, Turner AJ, Sammon C, Dawoud D, Ramagopalan S, Simpson A, Siebert U. Acceptability of Using Real-World Data to Estimate Relative Treatment Effects in Health Technology Assessments: Barriers and Future Steps. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:623-632. [PMID: 38369282 DOI: 10.1016/j.jval.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES Evidence about the comparative effects of new treatments is typically collected in randomized controlled trials (RCTs). In some instances, RCTs are not possible, or their value is limited by an inability to capture treatment effects over the longer term or in all relevant population subgroups. In these cases, nonrandomized studies (NRS) using real-world data (RWD) are increasingly used to complement trial evidence on treatment effects for health technology assessment (HTA). However, there have been concerns over a lack of acceptability of this evidence by HTA agencies. This article aims to identify the barriers to the acceptance of NRS and steps that may facilitate increases in the acceptability of NRS in the future. METHODS Opinions of the authorship team based on their experience in real-world evidence research in academic, HTA, and industry settings, supported by a critical assessment of existing studies. RESULTS Barriers were identified that are applicable to key stakeholder groups, including HTA agencies (eg, the lack of comprehensive methodological guidelines for using RWD), evidence generators (eg, avoidable deviations from best practices), and external stakeholders (eg, data controllers providing timely access to high-quality RWD). Future steps that may facilitate future acceptability of NRS include improvements in the quality, integration, and accessibility of RWD, wider use of demonstration projects to highlight the value and applicability of nonrandomized designs, living, and more detailed HTA guidelines, and improvements in HTA infrastructure relating to RWD. CONCLUSION NRS can represent a crucial source of evidence on treatment effects for use in HTA when RCT evidence is limited.
Collapse
Affiliation(s)
- Manuel Gomes
- Department of Applied Health Research, University College London, London, England, UK
| | | | | | - Dalia Dawoud
- Science, Policy and Research Programme, National Institute for Health and Care Excellence, London, England, UK; Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | | | - Alex Simpson
- Global Access, F. Hoffmann-La Roche Ltd, Grenzacherstrasse, Basel, Switzerland.
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria; Center for Health Decision Science and Department of Health Policy and Management, Harvard T.H Chan School of Public Health, Boston, MA, USA; Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
6
|
Struebing A, McKibbon C, Ruan H, Mackay E, Dennis N, Velummailum R, He P, Tanaka Y, Xiong Y, Springford A, Rosenlund M. Augmenting external control arms using Bayesian borrowing: a case study in first-line non-small cell lung cancer. J Comp Eff Res 2024; 13:e230175. [PMID: 38573331 PMCID: PMC11036906 DOI: 10.57264/cer-2023-0175] [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: 12/01/2023] [Accepted: 03/01/2024] [Indexed: 04/05/2024] Open
Abstract
Aim: This study aimed to improve comparative effectiveness estimates and discuss challenges encountered through the application of Bayesian borrowing (BB) methods to augment an external control arm (ECA) constructed from real-world data (RWD) using historical clinical trial data in first-line non-small-cell lung cancer (NSCLC). Materials & methods: An ECA for a randomized controlled trial (RCT) in first-line NSCLC was constructed using ConcertAI Patient360™ to assess chemotherapy with or without cetuximab, in the bevacizumab-inappropriate subpopulation. Cardinality matching was used to match patient characteristics between the treatment arm (cetuximab + chemotherapy) and ECA. Overall survival (OS) was assessed as the primary outcome using Cox proportional hazards (PH). BB was conducted using a static power prior under a Weibull PH parameterization with borrowing weights from 0.0 to 1.0 and augmentation of the ECA from a historical control trial. Results: The constructed ECA yielded a higher overall survival (OS) hazard ratio (HR) (HR = 1.53; 95% CI: 1.21-1.93) than observed in the matched population of the RCT (HR = 0.91; 95% CI: 0.73-1.13). The OS HR decreased through the incorporation of BB (HR = 1.30; 95% CI: 1.08-1.54, borrowing weight = 1.0). BB was applied to augment the RCT control arm via a historical control which improved the precision of the observed HR estimate (1.03; 95% CI: 0.86-1.22, borrowing weight = 1.0), in comparison to the matched population of the RCT alone. Conclusion: In this study, the RWD ECA was unable to successfully replicate the OS estimates from the matched population of the selected RCT. The inability to replicate could be due to unmeasured confounding and variations in time-periods, follow-up and subsequent therapy. Despite these findings, we demonstrate how BB can improve precision of comparative effectiveness estimates, potentially aid as a bias assessment tool and mitigate challenges of traditional methods when appropriate external data sources are available.
Collapse
Affiliation(s)
| | | | - Haoyao Ruan
- Cytel Inc., Toronto, Ontario, M5J, 2P1, Canada
| | - Emma Mackay
- Cytel Inc., Toronto, Ontario, M5J, 2P1, Canada
| | | | | | - Philip He
- Daiichi Sankyo, Inc., Basking Ridge, NJ 07920, USA
| | - Yoko Tanaka
- Daiichi Sankyo, Inc., Basking Ridge, NJ 07920, USA
| | - Yan Xiong
- Daiichi Sankyo, Inc., Basking Ridge, NJ 07920, USA
| | | | - Mats Rosenlund
- Daiichi Sankyo Europe, Munich, 81379, Germany
- Department of Learning, Informatics, Management & Ethics (LIME), Karolinska Institutet, Stockholm, 171 77, Sweden
| |
Collapse
|
7
|
Moore D, Nyakutsikwa B, Allen T, Lam E, Birch S, Tickle M, Pretty IA, Walsh T. Effect of fluoridated water on invasive NHS dental treatments for adults: the LOTUS retrospective cohort study and economic evaluation. PUBLIC HEALTH RESEARCH 2024; 12:1-147. [PMID: 38785327 DOI: 10.3310/rfqa3841] [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: 05/25/2024] Open
Abstract
Background Most water fluoridation studies were conducted on children before the widespread introduction of fluoride toothpastes. There is a lack of evidence that can be applied to contemporary populations, particularly adolescents and adults. Objective To pragmatically assess the clinical and cost effectiveness of water fluoridation for preventing dental treatment and improving oral health in a contemporary population of adults, using a natural experiment design. Design Retrospective cohort study using routinely collected National Health Service dental claims (FP17) data. Setting National Health Service primary dental care: general dental practices, prisons, community dental services, domiciliary settings, urgent/out-of-hours and specialised referral-only services. Participants Dental patients aged 12 years and over living in England (n = 6,370,280). Intervention and comparison Individuals exposed to drinking water with a fluoride concentration ≥ 0.7 mg F/l between 2010 and 2020 were matched to non-exposed individuals on key characteristics using propensity scores. Outcome measures Primary: number of National Health Service invasive dental treatments (restorations/'fillings' and extractions) received per person between 2010 and 2020. Secondary: decayed, missing and filled teeth, missing teeth, inequalities, cost effectiveness and return on investment. Data sources National Health Service Business Services Authority dental claims data. Water quality monitoring data. Primary outcome Predicted mean number of invasive dental treatments was 3% lower in the optimally fluoridated group than in the sub/non-optimally fluoridated group (incidence rate ratio 0.969, 95% CI 0.967 to 0.971), a difference of -0.173 invasive dental treatments (95% CI -0.185 to -0.161). This magnitude of effect is smaller than what most stakeholders we engaged with (n = 50/54) considered meaningful. Secondary outcomes Mean decayed, missing and filled teeth were 2% lower in the optimally fluoridated group, with a difference of -0.212 decayed, missing and filled teeth (95% CI -0.229 to -0.194). There was no statistically significant difference in the mean number of missing teeth per person (0.006, 95% CI -0.008 to 0.021). There was no compelling evidence that water fluoridation reduced social inequalities in treatments received or missing teeth; however, decayed, missing and filled teeth data did not demonstrate a typical inequalities gradient. Optimal water fluoridation in England in 2010-20 was estimated to cost £10.30 per person (excluding original setup costs). Mean National Health Service treatment costs for fluoridated patients 2010-20 were 5.5% lower per person, by £22.26 (95% CI -£23.09 to -£21.43), and patients paid £7.64 less in National Health Service dental charges per person (2020 prices). Limitations Pragmatic, observational study with potential for non-differential errors of misclassification in fluoridation assignment and outcome measurement and residual and/or unmeasured confounding. Decayed, missing and filled teeth data have not been validated. Water fluoridation cost estimates are based on existing programmes between 2010 and 2020, and therefore do not include the potentially significant capital investment required for new programmes. Conclusions Receipt of optimal water fluoridation between 2010 and 2020 resulted in very small health effects, which may not be meaningful for individuals, and we could find no evidence of a reduction in social inequalities. Existing water fluoridation programmes in England produced a positive return on investment between 2010 and 2020 due to slightly lower National Health Service treatment costs. These relatively small savings should be evaluated against the projected costs and lifespan of any proposed capital investment in water fluoridation, including new programmes. Future work National Health Service dental data are a valuable resource for research. Further validation and measures to improve quality and completeness are warranted. Trial registrations This trial is registered as ISRCTN96479279, CAG: 20/CAG/0072, IRAS: 20/NE/0144. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128533) and is published in full in Public Health Research; Vol. 12, No. 5. See the NIHR Funding and Awards website for further award information.
Collapse
Affiliation(s)
- Deborah Moore
- Division of Dentistry, The University of Manchester, Manchester, UK
| | | | - Thomas Allen
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Emily Lam
- Independent Patient and Public Engagement Representative
| | - Stephen Birch
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Martin Tickle
- Division of Dentistry, The University of Manchester, Manchester, UK
| | - Iain A Pretty
- Division of Dentistry, The University of Manchester, Manchester, UK
| | - Tanya Walsh
- Division of Dentistry, The University of Manchester, Manchester, UK
| |
Collapse
|
8
|
Pegram C, Diaz-Ordaz K, Brodbelt DC, Chang YM, von Hekkel AF, Wu CH, Church DB, O'Neill DG. Target Trial Emulation: Does surgical versus non-surgical management of cranial cruciate ligament rupture in dogs cause different outcomes? Prev Vet Med 2024; 226:106165. [PMID: 38503655 DOI: 10.1016/j.prevetmed.2024.106165] [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: 01/16/2023] [Revised: 02/07/2024] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
Target trial emulation applies design principles from randomised controlled trials to the analysis of observational data for causal inference and is increasingly used within human epidemiology. Using anonymised veterinary clinical data from the VetCompass Programme, this study applied the target trial emulation framework to determine whether surgical (compared to non-surgical) management for cranial cruciate ligament (CCL) rupture in dogs causes improved short- and long-term lameness and analgesia outcomes. The emulated target trial included dogs diagnosed with CCL rupture between January 1, 2019 and December 31, 2019 within the VetCompass database. Inclusion in the emulated trial required dogs aged ≥ 1.5 and < 12 years, first diagnosed with unilateral CCL rupture during 2019 and with no prior history of contralateral ligament rupture or stifle surgery. Dogs were retrospectively observed to have surgical or non-surgical management. Informed from a directed acyclic graph derived from expert opinion, data on the following variables were collected: age, breed, bodyweight, neuter status, insurance status, non-orthopaedic comorbidities, orthopaedic comorbidities and veterinary group. Inverse probability of treatment weighting (IPTW) was used to adjust for confounding, with weights calculated based on a binary logistic regression exposure model. Censored dogs were accounted for in the IPTW analysis using inverse probability of censoring weighting (IPCW). The IPCWs were combined with IPTWs and used to weight each dog's contribution to binary logistic regression outcome models. Standardized mean differences (SMD) examined the balance of covariate distribution between treatment groups. The emulated trial included 615 surgical CCL rupture cases and 200 non-surgical cases. The risk difference for short-term lameness in surgically managed cases (compared with non-surgically managed cases) was -25.7% (95% confidence interval (CI) -36.7% to -15.9%) and the risk difference for long-term lameness -31.7% (95% CI -37.9% to -18.1%). The study demonstrated the application of the target trial framework to veterinary observational data. The findings show that surgical management causes a reduction in short- and long-term lameness compared with non-surgical management in dogs.
Collapse
Affiliation(s)
- Camilla Pegram
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK.
| | - Karla Diaz-Ordaz
- University College London, Department of Statistical Science, Gower Street, London WC1E 6BT, UK
| | - Dave C Brodbelt
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK
| | - Yu-Mei Chang
- Research Support Office, The Royal Veterinary College, Hatfield, Herts AL9 7TA, UK
| | - Anna Frykfors von Hekkel
- Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK
| | - Chieh-Hsi Wu
- Statistical Sciences Research Institute, University of Southampton, University Road, Highfield, Southampton SO17 1BJ, UK
| | - David B Church
- Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK
| | - Dan G O'Neill
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK
| |
Collapse
|
9
|
Vallabhaneni SR, Patel SR, Campbell B, Boyle JR, Cook A, Crosher A, Holder SM, Jenkins MP, Ormesher DC, Rosala-Hallas A, Jackson RJ. Editor's Choice - Comparison of Open Surgery and Endovascular Techniques for Juxtarenal and Complex Neck Aortic Aneurysms: The UK COMPlex AneurySm Study (UK-COMPASS) - Peri-operative and Midterm Outcomes. Eur J Vasc Endovasc Surg 2024; 67:540-553. [PMID: 38428672 DOI: 10.1016/j.ejvs.2024.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Treatment of juxtarenal and complex neck abdominal aortic aneurysms (AAAs) is now commonly by endovascular rather than open surgical repair (OSR). Published comparisons show poor validity and scientific precision. UK-COMPASS is a comparative cohort study of endovascular treatments vs. OSR for patients with an AAA unsuitable for standard on label endovascular aneurysm repair (EVAR). METHODS All procedures for AAA in England (November 2017 to October 2019) were identified, AAA anatomy assessed in a Corelab, peri-operative risk scores determined, and propensity scoring used to identify patients suitable for either endovascular treatment or OSR. Patients were stratified by aneurysm neck length (0 - 4 mm, 5 - 9 mm, or ≥ 10 mm) and operative risk; the highest quartile was considered high risk and the remainder standard risk. Death was the primary outcome measure. Endovascular treatments included fenestrated EVAR (FEVAR) and off label standard EVAR (± adjuncts). RESULTS Among 8 994 patients, 2 757 had AAAs that were juxtarenal, short neck, or complex neck in morphology. Propensity score stratification and adjustment method comparisons included 1 916 patients. Widespread off label use of standard EVAR devices was noted (35.6% of patients). The adjusted peri-operative mortality rate was 2.9%, lower for EVAR (1.2%; p = .001) and FEVAR (2.2%; p = .001) than OSR (4.5%). In standard risk patients with a 0 - 4 mm neck, the mortality rate was 7.4% following OSR and 2.3% following FEVAR. Differences were smaller for patients with a neck length ≥ 5 mm: 2.1% OSR vs. 1.0% FEVAR. At 3.5 years of follow up, the overall mortality rate was 20.7% in the whole study population, higher following FEVAR (27.6%) and EVAR (25.2%) than after OSR (14.2%). However, in the 0 - 4 mm neck subgroup, overall survival remained equivalent. The aneurysm related mortality rate was equivalent between treatments, but re-intervention was more common after EVAR and FEVAR than OSR. CONCLUSION FEVAR proves notably safer than OSR in the peri-operative period for juxtarenal aneurysms (0 - 4 mm neck length), with comparable midterm survival. For patients with short neck (5 - 9 mm) and complex neck (≥ 10 mm) AAAs, overall survival was worse in endovascularly treated patients compared with OSR despite relative peri-operative safety. This warrants further research and a re-appraisal of the current clinical application of endovascular strategies, particularly in patients with poor general survival outlook owing to comorbidity and age.
Collapse
Affiliation(s)
- Srinivasa R Vallabhaneni
- Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Liverpool, UK; Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK.
| | - Shaneel R Patel
- Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Liverpool, UK; Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
| | - Bruce Campbell
- Royal Devon University Healthcare Trust, Exeter, UK; University of Exeter Medical School, Exeter, UK
| | - Jonathan R Boyle
- Cambridge University Hospitals NHS Trust, Cambridge, UK; Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | | | - Alastair Crosher
- Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Sophie M Holder
- Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Michael P Jenkins
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - David C Ormesher
- East Lancashire Hospitals NHS Trust, Royal Blackburn Teaching Hospital, Blackburn, UK
| | - Anna Rosala-Hallas
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Richard J Jackson
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| |
Collapse
|
10
|
Brnabic AJM, Curtis SE, Johnston JA, Lo A, Zagar AJ, Lipkovich I, Kadziola Z, Murray MH, Ryan T. Incidence of type 2 diabetes, cardiovascular disease and chronic kidney disease in patients with multiple sclerosis initiating disease-modifying therapies: Retrospective cohort study using a frequentist model averaging statistical framework. PLoS One 2024; 19:e0300708. [PMID: 38517926 PMCID: PMC10959335 DOI: 10.1371/journal.pone.0300708] [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: 05/15/2023] [Accepted: 03/04/2024] [Indexed: 03/24/2024] Open
Abstract
Researchers are increasingly using insights derived from large-scale, electronic healthcare data to inform drug development and provide human validation of novel treatment pathways and aid in drug repurposing/repositioning. The objective of this study was to determine whether treatment of patients with multiple sclerosis with dimethyl fumarate, an activator of the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway, results in a change in incidence of type 2 diabetes and its complications. This retrospective cohort study used administrative claims data to derive four cohorts of adults with multiple sclerosis initiating dimethyl fumarate, teriflunomide, glatiramer acetate or fingolimod between January 2013 and December 2018. A causal inference frequentist model averaging framework based on machine learning was used to compare the time to first occurrence of a composite endpoint of type 2 diabetes, cardiovascular disease or chronic kidney disease, as well as each individual outcome, across the four treatment cohorts. There was a statistically significantly lower risk of incidence for dimethyl fumarate versus teriflunomide for the composite endpoint (restricted hazard ratio [95% confidence interval] 0.70 [0.55, 0.90]) and type 2 diabetes (0.65 [0.49, 0.98]), myocardial infarction (0.59 [0.35, 0.97]) and chronic kidney disease (0.52 [0.28, 0.86]). No differences for other individual outcomes or for dimethyl fumarate versus the other two cohorts were observed. This study effectively demonstrated the use of an innovative statistical methodology to test a clinical hypothesis using real-world data to perform early target validation for drug discovery. Although there was a trend among patients treated with dimethyl fumarate towards a decreased incidence of type 2 diabetes, cardiovascular disease and chronic kidney disease relative to other disease-modifying therapies-which was statistically significant for the comparison with teriflunomide-this study did not definitively support the hypothesis that Nrf2 activation provided additional metabolic disease benefit in patients with multiple sclerosis.
Collapse
Affiliation(s)
- Alan J M Brnabic
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, United States of America
| | - Sarah E Curtis
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, United States of America
| | - Joseph A Johnston
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, United States of America
| | - Albert Lo
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, United States of America
| | - Anthony J Zagar
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, United States of America
| | - Ilya Lipkovich
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, United States of America
| | - Zbigniew Kadziola
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, United States of America
| | - Megan H Murray
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, United States of America
| | - Timothy Ryan
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, United States of America
| |
Collapse
|
11
|
Aashima, Sharma R. Is health insurance really benefitting Indian population? Evidence from a nationally representative sample survey. Int J Health Plann Manage 2024; 39:293-310. [PMID: 37910629 DOI: 10.1002/hpm.3716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/01/2023] [Accepted: 10/05/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Universal health coverage (UHC) is the centrepiece of the sustainable development goals and aims to ensure access to essential and quality healthcare services to all without facing financial hardships. Several health insurance programmes have been launched in India to progress towards UHC. OBJECTIVE This study aims to assess the impact of health insurance (overall health insurance, government sponsored health insurance (GSHI), and private voluntary health insurance) on accessibility and utilization of inpatient care, out-of-pocket health expenditure (OOPE), catastrophic health expenditure (CHE), and impoverishment in India. DATA AND METHODOLOGY The 75th round of National Sample Survey Office was used in the study, which covered 555,115 individuals, 113,823 households, and 91,445 hospitalization incidence all over India. Descriptive statistics, multivariable logistic regression, and propensity score matching (PSM) methods were employed. RESULTS Enrolment under health insurance has impacted the accessibility and utilization pattern of hospitalization to some extent for the insured. PSM showed that enrolment under GSHI schemes reduced OOPE by INR 3314 (USD 49) and CHE incidence by 1%-4% at various thresholds. Among poor persons, there was a marginal but statistically significant reduction of OOPE among those enrolled under GSHI schemes (p < 0.05). However, GSHI schemes did not statistically significantly reduce the CHE burden for poor persons enrolled (p > 0.05). Furthermore, enrolment under private voluntary health insurance reduced OOPE by INR 13,511 (USD 198) and CHE by 13.47% at 10% threshold, 4.61% at 25% threshold, and 2.65% at 40% threshold. However, its uptake was primarily confined to richer economic quintiles and urban areas that exacerbates equity concerns. All the results were confirmed through robustness measures employed. CONCLUSIONS There is a necessity to increase awareness and uptake of health insurance, along with introducing comprehensive insurance packages covering both inpatient and outpatient care. Also, increasing public health spending, strengthening public healthcare facilities, and improving regulatory implementation of private healthcare providers are imperative to augment financial protection.
Collapse
Affiliation(s)
- Aashima
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| |
Collapse
|
12
|
Zhu R, Zhu H. Survival Benefit from Cancer-Directed Surgery for Metastatic Head and Neck Cancer. Laryngoscope 2024; 134:1288-1298. [PMID: 37658720 DOI: 10.1002/lary.31019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVES This study aimed to gather evidence for the survival benefit of cancer-directed surgery (CDS) in metastatic head and neck cancer (M1 HNC) and identify which patients will benefit most from CDS. METHODS Patients with M1 HNC were identified within the SEER database. According to whether received CDS, patients were divided into the CDS and non-CDS groups. The bias between the two groups was minimized using Propensity Score Matching (PSM), and the prognostic role of CDS was investigated using Kaplan-Meier analysis, log-rank test, and Cox proportional hazard models. The primary endpoint was overall survival (OS), and the secondary endpoint was cancer-specific survival (CSS). RESULTS A total of 3215 patients with M1 HNC were extracted, including 566 patients who received CDS that were 1:1 propensity score-matched with patients who did not receive CDS. In the matched dataset, the median OS and CSS in CDS groups were significantly higher than in non-CDS groups (OS: 19.0 vs. 9.0 months, p < 0.001; CSS: 21.0 vs. 9.0 months, p < 0.001). Meanwhile, multivariable Cox regression analysis also revealed that CDS was a favorable prognostic factor for both OS and CSS. Furthermore, subgroups of patients with M1 HNC (younger age, being married, grade I-II, oropharynx site, earlier T/N stage, radiotherapy) were inclined to benefit from CDS, while those patients who received chemotherapy failed to benefit from CDS. CONCLUSIONS This study indicated that CDS was associated with improved survival in M1 HNC, especially for those subpopulations that benefit more from CDS treatment. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1288-1298, 2024.
Collapse
Affiliation(s)
- Runqiu Zhu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- School of Stomatology, College of Medicine, Zhejiang University, Hangzhou, China
| | - Huiyong Zhu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
13
|
Silva AF, Dourado I, Lua I, Jesus GS, Guimarães NS, Morais GAS, Anderle RVR, Pescarini JM, Machado DB, Santos CAST, Ichihara MY, Barreto ML, Magno L, Souza LE, Macinko J, Rasella D. Income determines the impact of cash transfers on HIV/AIDS: cohort study of 22.7 million Brazilians. Nat Commun 2024; 15:1307. [PMID: 38346964 PMCID: PMC10861499 DOI: 10.1038/s41467-024-44975-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: 09/04/2023] [Accepted: 01/10/2024] [Indexed: 02/15/2024] Open
Abstract
Living with extremely low-income is an important risk factor for HIV/AIDS and can be mitigated by conditional cash transfers. Using a cohort of 22.7 million low-income individuals during 9 years, we evaluated the effects of the world's largest conditional cash transfer, the Programa Bolsa Família, on HIV/AIDS-related outcomes. Exposure to Programa Bolsa Família was associated with reduced AIDS incidence by 41% (RR:0.59; 95%CI:0.57-0.61), mortality by 39% (RR:0.61; 95%CI:0.57-0.64), and case fatality rates by 25% (RR:0.75; 95%CI:0.66-0.85) in the cohort, and Programa Bolsa Família effects were considerably stronger among individuals of extremely low-income [reduction of 55% for incidence (RR:0.45, 95% CI:0.42-0.47), 54% mortality (RR:0.46, 95% CI:0.42-0.49), and 37% case-fatality (RR:0.63, 95% CI:0.51 -0.76)], decreasing gradually until having no effect in individuals with higher incomes. Similar effects were observed on HIV notification. Programa Bolsa Família impact was also stronger among women and adolescents. Several sensitivity and triangulation analyses demonstrated the robustness of the results. Conditional cash transfers can significantly reduce AIDS morbidity and mortality in extremely vulnerable populations and should be considered an essential intervention to achieve AIDS-related sustainable development goals by 2030.
Collapse
Affiliation(s)
- Andréa F Silva
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Iracema Lua
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Gabriela S Jesus
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
- Faculty of Medicine, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Nathalia S Guimarães
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Gabriel A S Morais
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Rodrigo V R Anderle
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Julia M Pescarini
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Daiane B Machado
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Carlos A S T Santos
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Maria Y Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Mauricio L Barreto
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Laio Magno
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
- Department of Life Sciences, State University of Bahia (UNEB), Salvador, Brazil
| | - Luis E Souza
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - James Macinko
- Departments of Health Policy and Management and Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil.
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.
| |
Collapse
|
14
|
Nabatame M, Takeuchi M, Takeda C, Kawakami K. Association between sedation during spinal anesthesia and mortality in older patients undergoing hip fracture surgery: A nationwide retrospective cohort study in Japan. J Clin Anesth 2024; 92:111322. [PMID: 37952283 DOI: 10.1016/j.jclinane.2023.111322] [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: 04/21/2023] [Revised: 09/13/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
STUDY OBJECTIVE Intraoperative sedation plays an important role in the management of regional anesthesia. Few studies have investigated the association of sedation during spinal anesthesia with postoperative mortality in older patients as a primary outcome. This study aimed to test the hypothesis that sedation during spinal anesthesia increases postoperative mortality in older patients undergoing hip fracture surgery. DESIGN Retrospective, cohort study. SETTING Acute and subacute care hospitals in Japan. PATIENTS Patients aged 65 years and older who received hip fracture surgery under spinal anesthesia between April 2014 and May 2022. EXPOSURE Sedation during spinal anesthesia. MEASUREMENTS Postoperative in-hospital all-cause mortality within 30 days. MAIN RESULTS In total, 25,554 eligible patients were identified. Propensity score matching created 4735 pairs, and baseline patient characteristics were acceptably balanced between the sedation and non-sedation groups. There was no significant difference in 30-day postoperative mortality between the two groups (hazard ratio [95% CIs]: 0.92 [0.59-1.44]). CONCLUSIONS There was no association between sedation during hip fracture surgery in older patients under spinal anesthesia and postoperative mortality. However, these results are limited to our population, and further prospective studies are needed to determine the safety of sedation.
Collapse
Affiliation(s)
- Maki Nabatame
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Chikashi Takeda
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| |
Collapse
|
15
|
de Oliveira Fernandes Junior I, Arcuri LJ. Myeloablative or reduced-intensity/non-myeloablative hematopoietic cell transplantation for Philadelphia-positive acute lymphoblastic leukemia in adults older than 40 years old - a secondary analysis of a CIBMTR database. Ann Hematol 2024; 103:603-607. [PMID: 37940716 DOI: 10.1007/s00277-023-05532-8] [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: 10/27/2022] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
Few studies have addressed the role of reduced-intensity conditioning (RIC) and non-myeloablative (NMA) regimens in older adults with Philadelphia acute lymphoblastic leukemia (Ph + ALL). The objective of this current study was to compare the outcomes of RIC/NMA versus TBI-based myeloablative (MAC) regimens in Ph + ALL patients older than 40 years old who underwent hematopoietic cell transplantation (HCT) in CR1. We used a freely available database from the CIBMTR. Transplants were performed between 2013 and 2017. With a median follow-up of 37.6 months, we have included 629 patients. We used propensity score weighting. Three-year OSs were 64% in the TBI-MAC group and 66% in the RIC/NMA group. OS was not different (HR = 0.92; p = 0.69). Three-year relapse incidences were 21.6% and 27.6% in the TBI-MAC and RIC/NMA groups. RIC/NMA was not associated with an increase in relapse rate (HR 1.02; p = 0.91). Three-year NRMs were 24.3% in the TBI-MAC group and 20.3% in the RIC/NMA group. RIC/NMA was not associated with superior NRM (HR 0.88; p = 0.57). In summary, we have shown that RIC/NMA regimens achieve outcomes comparable to TBI-based MAC in Ph+ ALL older patients in CR1 who may tolerate a TBI-based MAC regimen.
Collapse
Affiliation(s)
| | - Leonardo Javier Arcuri
- Instituto Nacional de Cancer, Bone Marrow Transplantation Department, Rio de Janeiro, Brazil.
- Hospital Israelita Albert Einstein, Academic Research Organization, Guaramomis 480/64, São Paulo, 04076-010, Brazil.
| |
Collapse
|
16
|
Davies AR, Sabharwal S, Liddle AD, Zamora B, Rangan A, Reilly P. The risk of revision is higher following shoulder hemiarthroplasty compared with total shoulder arthroplasty for osteoarthritis: a matched cohort study of 11,556 patients from the National Joint Registry, UK. Acta Orthop 2024; 95:73-85. [PMID: 38289339 PMCID: PMC10828514 DOI: 10.2340/17453674.2024.39916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/20/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND AND PURPOSE Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) are used in the management of osteoarthritis of the glenohumeral joint. We aimed to determine whether TSA or HA resulted in a lower risk of adverse outcomes in patients of all ages with osteoarthritis and an intact rotator cuff and in a subgroup of patients aged 60 years or younger. PATIENTS AND METHODS Shoulder arthroplasties recorded in the National Joint Registry, UK, between April 1, 2012 and June 30, 2021, were linked to Hospital Episode Statistics in England. Elective TSAs and HAs were matched on propensity scores based on 11 variables. The primary outcome was all-cause revision. Secondary outcomes were combined revision/non-revision reoperations, 30-day inpatient complications, 1-year mortality, and length of stay. 95% confidence intervals (CI) were reported. RESULTS 11,556 shoulder arthroplasties were included: 7,641 TSAs, 3,915 HAs. At 8 years 95% (CI 94-96) of TSAs and 91% (CI 90-92) of HAs remained unrevised. The hazard ratio (HR) varied across follow-up: 4-year HR 2.7 (CI 1.9-3.5), 8-year HR 2.0 (CI 0.5-3.5). Rotator cuff insufficiency was the most common revision indication. In patients aged 60 years or younger prosthesis survival at 8 years was 92% (CI 89-94) following TSA and 84% (CI 80-87) following HA. CONCLUSION The risk of revision was higher following HA in patients with osteoarthritis and an intact rotator cuff. Patients aged 60 years and younger had a higher risk of revision following HA.
Collapse
Affiliation(s)
| | - Sanjeeve Sabharwal
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust
| | - Alexander D Liddle
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust; Department of Surgery and Cancer, Imperial College London
| | | | - Amar Rangan
- Department of Health Sciences, University of York, UK
| | - Peter Reilly
- Department of Bioengineering, Imperial College London; Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust
| |
Collapse
|
17
|
Hiroshimaya T, Fujimoto Y, Sasaki H, Motoi T, Nagata E, Taniguchi N, Oho T. Association between periodontal disease and malignant soft tissue sarcomas. Oral Dis 2024. [PMID: 38191825 DOI: 10.1111/odi.14853] [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: 05/27/2023] [Revised: 11/20/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Malignant soft tissue sarcoma (MSTS) is a rare disease, but is seen in patients undergoing orthopedic surgery. Although the association of periodontal disease with various cancers occurring in the oral cavity, gastrointestinal tract, lungs, and prostate, has been reported, the association between periodontal disease and MSTS remains unclear. This study investigated the association between periodontal disease and MSTS in patients undergoing orthopedic surgery. SUBJECTS AND METHODS One hundred fifteen patients who underwent orthopedic surgery between 2017 and 2021 were retrospectively enrolled (mean age = 66.8 ± 10.7 years). The patient background was adjusted by the propensity score (PS). Subsequently, the association of periodontal disease with MSTS was analyzed using PS inverse probability of treatment weighting (IPTW). Periodontal status was determined by evaluating the periodontal inflamed surface area, which was calculated by measuring the periodontal probing pocket depth and detecting bleeding on probing. RESULTS Multivariate logistic regression analysis after adjustment by the PS showed that severe periodontitis was significantly associated with MSTS (odds ratio 2.81, p = 0.04). Furthermore, IPTW showed that severe periodontitis was significantly associated with MSTS (odds ratio 3.21, p = 0.01). CONCLUSION The results indicate an association between periodontal inflammation and MSTS.
Collapse
Affiliation(s)
- Takatoshi Hiroshimaya
- Department of Preventive Dentistry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yusuke Fujimoto
- Department of Orthopaedic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiromi Sasaki
- Department of Orthopaedic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Toshihiro Motoi
- Department of Preventive Dentistry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Emi Nagata
- Division of Preventive Dentistry, Kagoshima University Hospital, Kagoshima, Japan
| | - Noboru Taniguchi
- Department of Orthopaedic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takahiko Oho
- Department of Preventive Dentistry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| |
Collapse
|
18
|
Rosen EM, Ritchey ME, Girman CJ. Can Weight of Evidence, Quantitative Bias, and Bounding Methods Evaluate Robustness of Real-world Evidence for Regulator and Health Technology Assessment Decisions on Medical Interventions? Clin Ther 2023; 45:1266-1276. [PMID: 37798219 DOI: 10.1016/j.clinthera.2023.09.010] [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: 10/28/2022] [Revised: 06/07/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE High-quality evidence is crucial for health care intervention decision-making. These decisions frequently use nonrandomized data, which can be more vulnerable to biases than randomized trials. Accordingly, methods to quantify biases and weigh available evidence could elucidate the robustness of findings, giving regulators more confidence in making approval and reimbursement decisions. METHODS We conducted an integrative literature review to identify methods for determining probability of causation, evaluating weight of evidence, and conducting quantitative bias analysis as related to health care interventions. Eligible studies were published from 2012 to 2021, applicable to pharmacoepidemiology, and presented a method that met our objective. FINDINGS Twenty-two eligible studies were classified into 4 categories: (1) quantitative bias analysis; (2) weight of evidence methods; (3) Bayesian networks; and (4) miscellaneous. All of the methods have strengths, limitations, and situations in which they are more well suited than others. Some methods seem to lend themselves more to applications of health care evidence on medical interventions than others. IMPLICATIONS To provide robust evidence for and improve confidence in regulatory or reimbursement decisions, we recommend applying multiple methods to triangulate associations of medical interventions, accounting for biases in different ways. This approach could lead to well-defined robustness assessments of study findings and appropriate science-driven decisions by regulators and payers for public health.
Collapse
Affiliation(s)
- Emma M Rosen
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA; CERobs Consulting, LLC, Wrightsville Beach, North Carolina, USA
| | - Mary E Ritchey
- CERobs Consulting, LLC, Wrightsville Beach, North Carolina, USA; Med Tech Epi, LLC; Philadelphia, Pennsylvania, USA; Center for Pharmacoepidemiology & Treatment Science, Rutgers University, New Brunswick, New Jersey, USA
| | - Cynthia J Girman
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA; CERobs Consulting, LLC, Wrightsville Beach, North Carolina, USA.
| |
Collapse
|
19
|
Liu C, Lin MTY, Lee IXY, Mehta JS, Liu YC. Impact of corrected refractive power on the corneal denervation and ocular surface in small-incision lenticule extraction and LASIK. J Cataract Refract Surg 2023; 49:1106-1113. [PMID: 37867284 PMCID: PMC10583913 DOI: 10.1097/j.jcrs.0000000000001278] [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: 04/20/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE To evaluate the impact of corrected refractive power on the corneal denervation and ocular surface in small-incision lenticule extraction (SMILE) and laser in situ keratomileusis (LASIK). SETTING Singapore National Eye Center, Singapore. DESIGN Prospective study. METHODS 88 eyes undergoing SMILE or LASIK were divided into low-moderate (manifest refractive spherical equivalent [MRSE] <-6.0 diopters [D]) and high myopic (MRSE ≥-6.0 D) groups. In vivo confocal microscopy and clinical assessments were performed preoperatively and at 1 month, 3 months, 6 months, and 12 months postoperatively. RESULTS In SMILE, high myopic treatment presented with significantly greater reduction in the corneal nerve fiber area (CNFA) and nerve fiber fractal dimension (CFracDim) compared with low-moderate myopic treatment (both P < .05). There was a significant and negative correlation between the corrected MRSE and the reduction in corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length, CNFA, and CFracDim after SMILE (r = -0.38 to -0.66, all P < .05). In LASIK, a significant correlation between the MRSE and the changes in CNBD, corneal nerve fiber total branch density, CNFA (r = -0.37 to -0.41), and corneal nerve fiber width (r = 0.43) was observed (all P < .05). Compared with SMILE, LASIK had greater reduction in CNBD and CNFA for every diopter increase in the corrected MRSE. High myopic SMILE, compared with low-moderate myopic SMILE, resulted in significantly lower tear break-up time at 1 and 6 months (both P < .05). The changes in CNFA and CFracDim were significantly associated with Schirmer test values (both P < .001). CONCLUSIONS Postoperative corneal denervation was related to corrected refractive power in both SMILE and LASIK. With the same refractive correction, LASIK led to more prominent corneal denervation.
Collapse
Affiliation(s)
- Chang Liu
- From the Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore (C. Liu, Lin, Lee, Mehta, Y.-C. Liu); Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore (C. Liu, Mehta); Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore (Mehta, Y.-C. Liu); Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore (Mehta, Y.-C. Liu); Department of Ophthalmology, National Taiwan University, Taiwan (Y.-C. Liu)
| | - Molly Tzu-Yu Lin
- From the Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore (C. Liu, Lin, Lee, Mehta, Y.-C. Liu); Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore (C. Liu, Mehta); Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore (Mehta, Y.-C. Liu); Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore (Mehta, Y.-C. Liu); Department of Ophthalmology, National Taiwan University, Taiwan (Y.-C. Liu)
| | - Isabelle Xin Yu Lee
- From the Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore (C. Liu, Lin, Lee, Mehta, Y.-C. Liu); Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore (C. Liu, Mehta); Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore (Mehta, Y.-C. Liu); Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore (Mehta, Y.-C. Liu); Department of Ophthalmology, National Taiwan University, Taiwan (Y.-C. Liu)
| | - Jodhbir S. Mehta
- From the Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore (C. Liu, Lin, Lee, Mehta, Y.-C. Liu); Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore (C. Liu, Mehta); Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore (Mehta, Y.-C. Liu); Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore (Mehta, Y.-C. Liu); Department of Ophthalmology, National Taiwan University, Taiwan (Y.-C. Liu)
| | - Yu-Chi Liu
- From the Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore (C. Liu, Lin, Lee, Mehta, Y.-C. Liu); Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore (C. Liu, Mehta); Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore (Mehta, Y.-C. Liu); Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore (Mehta, Y.-C. Liu); Department of Ophthalmology, National Taiwan University, Taiwan (Y.-C. Liu)
| |
Collapse
|
20
|
Wald R, Gaudry S, da Costa BR, Adhikari NKJ, Bellomo R, Du B, Gallagher MP, Hoste EA, Lamontagne F, Joannidis M, Liu KD, McAuley DF, McGuinness SP, Nichol AD, Ostermann M, Palevsky PM, Qiu H, Pettilä V, Schneider AG, Smith OM, Vaara ST, Weir M, Dreyfuss D, Bagshaw SM. Initiation of continuous renal replacement therapy versus intermittent hemodialysis in critically ill patients with severe acute kidney injury: a secondary analysis of STARRT-AKI trial. Intensive Care Med 2023; 49:1305-1316. [PMID: 37815560 DOI: 10.1007/s00134-023-07211-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/22/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND There is controversy regarding the optimal renal-replacement therapy (RRT) modality for critically ill patients with acute kidney injury (AKI). METHODS We conducted a secondary analysis of the STandard versus Accelerated Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial to compare outcomes among patients who initiated RRT with either continuous renal replacement therapy (CRRT) or intermittent hemodialysis (IHD). We generated a propensity score for the likelihood of receiving CRRT and used inverse probability of treatment with overlap-weighting to address baseline inter-group differences. The primary outcome was a composite of death or RRT dependence at 90-days after randomization. RESULTS We identified 1590 trial participants who initially received CRRT and 606 who initially received IHD. The composite outcome of death or RRT dependence at 90-days occurred in 823 (51.8%) patients who commenced CRRT and 329 (54.3%) patients who commenced IHD (unadjusted odds ratio (OR) 0.90; 95% confidence interval (CI) 0.75-1.09). After balancing baseline characteristics with overlap weighting, initial receipt of CRRT was associated with a lower risk of death or RRT dependence at 90-days compared with initial receipt of IHD (OR 0.81; 95% CI 0.66-0.99). This association was predominantly driven by a lower risk of RRT dependence at 90-days (OR 0.61; 95% CI 0.39-0.94). CONCLUSIONS In critically ill patients with severe AKI, initiation of CRRT, as compared to IHD, was associated with a significant reduction in the composite outcome of death or RRT dependence at 90-days.
Collapse
Affiliation(s)
- Ron Wald
- Division of Nephrology, St. Michael's Hospital, University of Toronto, Li Ka Shing Knowledge Institute, Toronto, ON, Canada.
| | - Stephane Gaudry
- AP-HP, Hôpital Avicenne, Service de Réanimation Médico-Chirurgicale, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France
- UMR S1155, French National Institute of Health and Medical Research (INSERM), CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Bruno R da Costa
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Neill K J Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
- School of Medicine, The University of Melbourne, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Bin Du
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Martin P Gallagher
- The George Institute for Global Health, University of New South Wales, Kensington, NSW, Australia
| | - Eric A Hoste
- Intensive Care Unit, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - François Lamontagne
- Department of Medicine, Université de Sherbrooke, Centre de Recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Kathleen D Liu
- Division of Intensive Care and Nephrology, University of California San Francisco, San Francisco, CA, USA
| | - Daniel F McAuley
- The Regional Intensive Care Unit, The Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Royal Victoria Hospital, Belfast, UK
| | - Shay P McGuinness
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland and Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Alistair D Nichol
- Department of Critical Care Medicine, University College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublin, Ireland
- Monash University, Melbourne, Australia
| | - Marlies Ostermann
- Department of Critical Care Medicine, King's College London, Guy's & St Thomas Hospital, London, UK
| | - Paul M Palevsky
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Kidney Medicine Section, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Haibo Qiu
- Department of Critical Care Medicine, Zhongda Hospital Southeast University, Nanjing, China
| | - Ville Pettilä
- Division of Intensive Care Medicine, Department of Perioperative, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antoine G Schneider
- Department of Critical Care Medicine Centre, Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Orla M Smith
- Department of Critical Care, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Suvi T Vaara
- Department of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matthew Weir
- Division of Nephrology, London Health Sciences Centre, London, ON, Canada
| | - Didier Dreyfuss
- UMR S1155, French National Institute of Health and Medical Research (INSERM), CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service de Médecine Intensive Réanimation, Sorbonne Université, Hôpital Louis Mourier, Assistance Publique, Université de Paris-Cité, Paris, France
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| |
Collapse
|
21
|
Hartsuyker P, Kanczuk ME, Lawn D, Beg S, Mengistu TS, Hiskens M. The effect of class 3 obesity on the functionality of supraglottic airway devices: a historical cohort analysis with propensity score matching. Can J Anaesth 2023; 70:1744-1752. [PMID: 37833471 DOI: 10.1007/s12630-023-02582-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 10/15/2023] Open
Abstract
PURPOSE Supraglottic airway devices (SGAs) have been increasingly used as a primary airway in patients undergoing anesthesia as an alternative to endotracheal tubes. Second-generation devices have expanded their applicability to include uses in patients with obesity. Nevertheless, there is limited evidence of SGA suitability for patients with class 3 obesity (body mass index [BMI] ≥ 40 kg·m-2). As such, we compared rates of SGA functionality between patients with class 3 obesity and patients without class 3 obesity undergoing general anesthesia. METHODS We performed a propensity score matching analysis using inverse probability of treatment weighting to compare the functionality of SGAs in adult patients with class 3 obesity vs without class 3 obesity. These patients underwent surgery at a hospital in Queensland, Australia from November 2017 to September 2020 and had a SGA inserted as part of their anesthetic care. All data were collected from patients' electronic medical records. We included 321 patients in the cohort with class 3 obesity and 471 in the cohort without class 3 obesity (control/comparison). The estimated effect of class 3 obesity on SGAs was calculated using adjusted odds ratios (AORs) with their 95% confidence intervals (CIs). RESULTS The overall weighted prevalence of nonfunctional SGAs was 3.2%, with a significantly higher rate in the class 3 obesity cohort compared with the control cohort (4.7% vs 2.1%) (P = 0.04). This adjusted analysis illustrates that class 3 obesity was associated with an almost four times higher odds of a nonfunctional SGA (odds ratio [OR], 2.3; 95% CI, 1.0 to 5.1; AOR, 3.9; 95% CI, 1.4 to 10.6) than patients without class 3 obesity. CONCLUSION Patients with class 3 obesity (BMI ≥ 40 kg·m-2) had greater than three-fold odds of nonfunctional intraoperative SGAs than patients without class 3 obesity.
Collapse
Affiliation(s)
- Patrick Hartsuyker
- James Cook University, North Mackay, QLD, Australia.
- Mackay Hospital and Health Service (MHHS), Mackay Base Hospital, Mackay, QLD, Australia.
- Mackay Institute of Research and Innovation, Mackay Base Hospital, Mackay, QLD, Australia.
| | - Marcelo E Kanczuk
- Mackay Hospital and Health Service (MHHS), Mackay Base Hospital, Mackay, QLD, Australia
- Mackay Institute of Research and Innovation, Mackay Base Hospital, Mackay, QLD, Australia
| | - David Lawn
- Mackay Hospital and Health Service (MHHS), Mackay Base Hospital, Mackay, QLD, Australia
| | - Salwa Beg
- Mackay Hospital and Health Service (MHHS), Mackay Base Hospital, Mackay, QLD, Australia
| | - Tesfaye S Mengistu
- Mackay Institute of Research and Innovation, Mackay Base Hospital, Mackay, QLD, Australia
- School of Public Health, University of Queensland, Herston, QLD, Australia
| | - Matthew Hiskens
- Mackay Institute of Research and Innovation, Mackay Base Hospital, Mackay, QLD, Australia
| |
Collapse
|
22
|
Jiang L, Thall PF, Yan F, Kopetz S, Yuan Y. BASIC: A Bayesian adaptive synthetic-control design for phase II clinical trials. Clin Trials 2023; 20:486-496. [PMID: 37313712 PMCID: PMC10504821 DOI: 10.1177/17407745231176445] [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] [Indexed: 06/15/2023]
Abstract
BACKGROUND Randomized controlled trials are considered the gold standard for evaluating experimental treatments but often require large sample sizes. Single-arm trials require smaller sample sizes but are subject to bias when using historical control data for comparative inferences. This article presents a Bayesian adaptive synthetic-control design that exploits historical control data to create a hybrid of a single-arm trial and a randomized controlled trial. METHODS The Bayesian adaptive synthetic control design has two stages. In stage 1, a prespecified number of patients are enrolled in a single arm given the experimental treatment. Based on the stage 1 data, applying propensity score matching and Bayesian posterior prediction methods, the usefulness of the historical control data for identifying a pseudo sample of matched synthetic-control patients for making comparative inferences is evaluated. If a sufficient number of synthetic controls can be identified, the single-arm trial is continued. If not, the trial is switched to a randomized controlled trial. The performance of The Bayesian adaptive synthetic control design is evaluated by computer simulation. RESULTS The Bayesian adaptive synthetic control design achieves power and unbiasedness similar to a randomized controlled trial but on average requires a much smaller sample size, provided that the historical control data patients are sufficiently comparable to the trial patients so that a good number of matched controls can be identified in the historical control data. Compared to a single-arm trial, The Bayesian adaptive synthetic control design yields much higher power and much smaller bias. CONCLUSION The Bayesian adaptive synthetic-control design provides a useful tool for exploiting historical control data to improve the efficiency of single-arm phase II clinical trials, while addressing the problem of bias when comparing trial results to historical control data. The proposed design achieves power similar to a randomized controlled trial but may require a substantially smaller sample size.
Collapse
Affiliation(s)
- Liyun Jiang
- Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter F Thall
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fangrong Yan
- Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Scott Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ying Yuan
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
23
|
Jeon J, Lee DB, Shin SJ, Han DH, Chang JS, Han YD, Kim H, Lim JS, Kim HS, Ahn JB. Effect of High-Versus Low-Frequency of Abdominopelvic Computed Tomography Follow-Up Testing on Overall Survival in Patients With Stage II Or III Colon Cancer. Clin Colorectal Cancer 2023; 22:307-317. [PMID: 37271592 DOI: 10.1016/j.clcc.2023.05.003] [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: 02/20/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Intensive surveillance of colon cancer by using the abdominopelvic computed tomography (AP-CT) is common in real world practice; however, it is still unclear whether high-frequency surveillance using AP-CT in patients with these risk factors is superior to that in the low-frequency surveillance. PATIENTS AND METHODS We retrospectively reviewed 1803 patients with stage II-III colon cancer receiving curative surgery between January 1, 2005 to December 31, 2015. We evaluated the average scan-to-scan intervals of postoperative AP-CT testing and assigned patients with an interval of 5 to 8 and 9 to 13 months to the high-frequency (HF) and low-frequency (LF) groups, respectively. The cutoff value of preoperative and postoperative CEA levels was 5 ng/mL. We also applied propensity score matching (PSM) and inverse probability of treatment weighting to adjust clinicopathologic differences between the 2 groups. RESULTS We matched 1:1 for each surveillance group yielding a cohort of 776 matched patients. After PSM, Baseline demographics were overall well balanced between 2 groups. Stage III (OR, 2.00; 95% Confidence interval [CI], 1.21-3.30) and postoperative CEA elevation (OR, 2.30; 95% CI, 1.08-4.92) were independent risk factors of recurrence in multivariate analyses. Patient in the HF group had more surgery plus chemo- or radiotherapy as postrecurrence treatment than patient in the LF group (46.2% vs. 23.1%, P = .017). This trend was retained after PSM, although it is not significant (44.4% vs. 23.1%, P = .060). However, survival outcomes of high-frequency AP-CT surveillance were not superior to those of low-frequency surveillance in all subgroups, including stage III (HR 0.99, 95% CI 0.40-2.47) and postoperative CEA elevation (HR 1.36, 95% CI 0.45-4.11). CONCLUSION High-frequency AP-CT testing is associated with a higher proportion of surgery plus chemo- or radiotherapy as postrecurrence treatment, without improvement in 5-year overall survival.
Collapse
Affiliation(s)
| | - Da Bin Lee
- Yonsei University College of Medicine, Seoul, Korea
| | - Sang Joon Shin
- Yonsei Cancer Center, Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dai Hoon Han
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Dae Han
- Department of Colorectal Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyunwook Kim
- Yonsei Cancer Center, Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Seok Lim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Han Sang Kim
- Yonsei Cancer Center, Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; Graduate School of Medical Science, Brain Korea 21 FOUR Project, Yonsei University College of Medicine, Seoul, Korea.
| | - Joong Bae Ahn
- Yonsei Cancer Center, Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
24
|
Mak HW, Bu F, Fancourt D. Mental health and wellbeing among people with informal caring responsibilities across different time points during the COVID-19 pandemic: a population-based propensity score matching analysis. Perspect Public Health 2023; 143:275-284. [PMID: 35787706 PMCID: PMC10576404 DOI: 10.1177/17579139221104973] [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] [Indexed: 11/16/2022]
Abstract
AIMS Due to a prolonged period of national and regional lockdown measures during the coronavirus (COVID-19) pandemic, there has been an increase reliance on informal care for informal carers. In light of this, the current study compared the experiences of carers and non-carers on various mental health and wellbeing measures across six key time points during the pandemic. METHODS Data analysed were from the University College London (UCL) COVID -19 Social Study. Our study focused on six time points in England: (1) the first national lockdown (March-April 2020); (2) the beginning of first lockdown rules easing (May 2020); (3) the second national lockdown (November 2020); (4) the third national lockdown (January 2021); (5) the easing of the third lockdown (March 2021); and (6) the end of restrictions (July-August 2021). We considered five mental health and wellbeing measures: depressive symptoms, anxiety symptoms, loneliness, life satisfaction, and sense of being worthwhile. Propensity score matching was applied for the analyses. RESULTS We found that informal carers experienced higher levels of depressive and anxiety symptoms than non-carers across much of the pandemic. During the first national lockdown, carers also experienced a higher sense of life being worthwhile. No association was found between informal caring responsibilities and levels of loneliness and life satisfaction. CONCLUSION Given that carers are an essential national healthcare support, especially during a pandemic, it is crucial to integrate carers' needs into healthcare planning and delivery. These results highlight that there is a pressing need to provide adequate and targeted mental health support for carers during and following this pandemic.
Collapse
Affiliation(s)
- Hei Wan Mak
- Department of Behavioural Science and Health, University College London, London, UK
| | - Feifei Bu
- Department of Behavioural Science and Health, University College London, London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, 1–19 Torrington Place, London WC1E 7HB, UK
| |
Collapse
|
25
|
Hamasaki H, Yanai H. Association of the use of psychotropic drugs with hospitalization, cardiovascular events, and mortality in patients with type 2 diabetes: a propensity score-matched cohort study. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1181998. [PMID: 37476651 PMCID: PMC10354430 DOI: 10.3389/fcdhc.2023.1181998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/16/2023] [Indexed: 07/22/2023]
Abstract
Background Use of psychotropic drugs (PD) may be associated with impairment of physical function. However, few studies have assessed the impact of PD on health outcomes in patients with type 2 diabetes. This study aimed to examine the associations between psychotropic drug use and handgrip strength (HGS) and between the use of PD and hospitalization in patients with type 2 diabetes. Methods From April 2013 to December 2015, we conducted a retrospective cohort study in patients with type 2 diabetes at the National Center for Global Health and Medicine Kohnodai Hospital. Patients aged 20 years and over who can measure HGS were included. All participants received nutritional guidance regarding diet therapy for type 2 diabetes at baseline. Nonpsychotropic drug users were matched one-to-one with the PD users using propensity score matching method with respect to their baseline covariates. The differences in HGS and the number of patients who had hospitalizations during the study period were examined. By Cox proportional hazard regression analysis, the association between the use of PD and repeated hospitalizations was estimated. Results A total of 1,282 patients were enrolled and followed up for 2.36 ± 0.73 years. In the propensity score matching cohort, HGS was significantly lower (p = 0.006) in PD users than non-PD users. PD users had more hospitalizations than non-PD users. Cox proportional hazard regression analysis confirmed the association of repeated hospitalizations with the use of PD (hazard ratio = 2.138; 95% confidence interval, 1.144-3.995, p = 0.017)). In addition, HGS was significantly and inversely correlated with the number of hospitalizations (r = -0.143, p = 0.013). Conclusions The use of PD could increase the risk of repeated hospitalizations. Skeletal muscle may play a role in reducing the risk of hospitalization in patients who are treated with PD.
Collapse
Affiliation(s)
| | - Hidekatsu Yanai
- Department of Diabetes and Endocrinology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Japan
| |
Collapse
|
26
|
Reed DK, Ma J, Gerde HK. Resiliency and vulnerability in early grades writing performance during the COVID-19 pandemic. ASSESSING WRITING 2023; 57:100741. [PMID: 37220599 PMCID: PMC10196154 DOI: 10.1016/j.asw.2023.100741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 05/25/2023]
Abstract
To explore potential pandemic-related learning gaps on expressive writing skills, predominantly Hispanic (≈50%) and White (≈30%) primary-grade students responded to grade-specific writing prompts in the fall semesters before and after school closures. Responses were evaluated with an analytic rubric consisting of five traits (focus, organization, development, grammar, mechanics), each scored on a 1-4 scale. Data first were analyzed descriptively and, after propensity score weighting, with ordinal response models (for analytic scores) and generalized linear mixed effects models (for composite scores). Compared to first graders in 2019 (n = 310), those in 2020 (n = 203) scored significantly lower overall as well as on all rubric criteria and were more likely to write unintelligible responses. Second graders in 2020 (n = 194) performed significantly lower than those in 2019 (n = 328) in some traits but not all, and there was a widening gap between students who did/not score proficiently. A three-level longitudinal model analyzing the sample of students moving from first to second grade in fall 2020 (n = 90) revealed significant improvements, but students still performed significantly lower than second graders in the previous year. Implications for student resiliency and instructional planning are discussed.
Collapse
|
27
|
Gan D, Liu LY, Zhong Y, Wu YN, Lai YY, Wei W, Guo XL, Tian R, Yu SY, Liang FR, Hu WH, Yang J. Acupuncture benefits to women with recurrent implantation failure: A propensity score-matched cohort study. Heliyon 2023; 9:e18193. [PMID: 37539224 PMCID: PMC10395475 DOI: 10.1016/j.heliyon.2023.e18193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 08/05/2023] Open
Abstract
Objectives The current study aims to assess the effectiveness of acupuncture in improving the live birth rate (LBR), ongoing pregnancy rate (OPR), clinical pregnancy rate (CPR), biochemical pregnancy rate (BPR), and pregnancy loss (early abortion rate, late abortion rate, ectopic pregnancy rate) in patients with recurrent implantation failure (RIF). Design This retrospective study compares the outcomes of patients with RIF who underwent frozen embryo transfer (FET) with or without acupuncture. Setting The medical records of patients diagnosed with RIF and visiting Chengdu Xi'nan Gynecological Hospital between January 2018 and June 2021 were reviewed. The Chengdu Xi'nan Gynecological Hospital Ethics Committee approved this retrospective study (No. 2021-029). Participants A total of 923 patients with RIF who underwent FET were included in this study. The patients were divided into two groups: the Acupuncture (n = 303) and the Non-acupuncture groups (n = 620). Exposure The Acupuncture group consisted of 303 RIF patients who received acupuncture therapy in addition to standard hormone replacement therapy (HRT)/delayed hormone replacement therapy (d-HRT) for FET. The Non-acupuncture group consisted of 620 RIF patients who received only standard HRT/d-HRT for FET. Primary and secondary outcome measures The primary outcome was the LBR. The secondary outcome referred to OPR, CPR, BPR, and pregnancy loss. Results The Acupuncture group had significantly higher BPR (P = 0.08) and CPR (P = 0.049) than the Non-acupuncture group. A potentially higher LBR (P = 0.16) and OPR (P = 0.248) were observed in the Acupuncture group than in the Non-acupuncture group. However, the survival analysis did not show that acupuncture significantly promoted live birth. Conclusions Acupuncture is an appropriate adjunctive technique in the in vitro fertilization process as it improves biochemical and clinical pregnancies. Therefore, it is necessary to be cautious about the role of acupuncture throughout the whole pregnancy cycle.
Collapse
Affiliation(s)
- Di Gan
- Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu, China
- Sichuan Jinxin Xinan Women and Children Hospital, Chengdu, China
| | - Li-Ying Liu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ying Zhong
- Redefine Perfection Pte. Ltd., Novena, Singapore
| | - Yong-Na Wu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuan-Yuan Lai
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wei Wei
- Sichuan Jinxin Xinan Women and Children Hospital, Chengdu, China
| | - Xiao-Li Guo
- Sichuan Jinxin Xinan Women and Children Hospital, Chengdu, China
| | - Rui Tian
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Si-Yi Yu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fan-Rong Liang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wen-Hui Hu
- Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu, China
| | - Jie Yang
- Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu, China
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Sichuan Jinxin Xinan Women and Children Hospital, Chengdu, China
| |
Collapse
|
28
|
Wang Y, Ma J, Ma S, Wang J, Li J. Causal Evaluation of Post-Marketing Drugs for Drug-induced Liver Injury from Electronic Health Records. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083643 DOI: 10.1109/embc40787.2023.10340721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Drug-induced liver injury (DILI) is one of the most common and serious adverse drug reactions that can lead to acute liver failure and death. Detection of DILI and causal estimation of drug-hepatotoxicity association are of great importance for patient safety. This paper proposes a framework for causal estimation of post-marketing drugs for DILI from real-world electronic health record (EHR) data. Randomized clinical trials were replicated at scale by automatically generating different user and non-user cohorts for each potential drug, and average treatment effects (ATEs) of drugs were estimated using targeted maximum likelihood estimation. Ten years of real-world EHRs were used to validate the framework. Of all 1199 single-ingredient drugs analyzed, 7 novel and 7 known drug-hepatotoxicity associations were found to be causal.
Collapse
|
29
|
Breeze PR, Squires H, Ennis K, Meier P, Hayes K, Lomax N, Shiell A, Kee F, de Vocht F, O’Flaherty M, Gilbert N, Purshouse R, Robinson S, Dodd PJ, Strong M, Paisley S, Smith R, Briggs A, Shahab L, Occhipinti J, Lawson K, Bayley T, Smith R, Boyd J, Kadirkamanathan V, Cookson R, Hernandez‐Alava M, Jackson CH, Karapici A, Sassi F, Scarborough P, Siebert U, Silverman E, Vale L, Walsh C, Brennan A. Guidance on the use of complex systems models for economic evaluations of public health interventions. HEALTH ECONOMICS 2023; 32:1603-1625. [PMID: 37081811 PMCID: PMC10947434 DOI: 10.1002/hec.4681] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 05/03/2023]
Abstract
To help health economic modelers respond to demands for greater use of complex systems models in public health. To propose identifiable features of such models and support researchers to plan public health modeling projects using these models. A working group of experts in complex systems modeling and economic evaluation was brought together to develop and jointly write guidance for the use of complex systems models for health economic analysis. The content of workshops was informed by a scoping review. A public health complex systems model for economic evaluation is defined as a quantitative, dynamic, non-linear model that incorporates feedback and interactions among model elements, in order to capture emergent outcomes and estimate health, economic and potentially other consequences to inform public policies. The guidance covers: when complex systems modeling is needed; principles for designing a complex systems model; and how to choose an appropriate modeling technique. This paper provides a definition to identify and characterize complex systems models for economic evaluations and proposes guidance on key aspects of the process for health economics analysis. This document will support the development of complex systems models, with impact on public health systems policy and decision making.
Collapse
Affiliation(s)
- Penny R. Breeze
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Hazel Squires
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Kate Ennis
- British Medical Journal Technology Appraisal GroupLondonUK
| | - Petra Meier
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowScotlandUK
| | - Kate Hayes
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Nik Lomax
- School of GeographyUniversity of LeedsLeedsUK
| | - Alan Shiell
- Department of Public HealthLaTrobe UniversityMelbourneAustralia
| | - Frank Kee
- Centre for Public HealthQueen's University BelfastBelfastUK
| | - Frank de Vocht
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
- NIHR Applied Research Collaboration West (ARC West)BristolUK
| | - Martin O’Flaherty
- Department of Public Health, Policy and SystemsUniversity of LiverpoolLiverpoolUK
| | | | - Robin Purshouse
- Department of Automatic Control and Systems EngineeringUniversity of SheffieldSheffieldUK
| | | | - Peter J Dodd
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Mark Strong
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | | | - Richard Smith
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Andrew Briggs
- London School of Hygiene & Tropical MedicineLondonUK
| | - Lion Shahab
- Department of Behavioural Science and HealthUCLLondonUK
| | - Jo‐An Occhipinti
- Brain and Mind CentreUniversity of SydneyNew South WalesCamperdownAustralia
| | - Kenny Lawson
- Brain and Mind CentreUniversity of SydneyNew South WalesCamperdownAustralia
| | | | - Robert Smith
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Jennifer Boyd
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | | | | | | | | | - Amanda Karapici
- NIHR SPHRLondon School of Hygiene and Tropical MedicineLondonUK
| | - Franco Sassi
- Centre for Health Economics & Policy InnovationImperial College Business SchoolLondonUK
| | - Peter Scarborough
- Nuffield Department of Population HealthUniversity of OxfordOxfordshireOxfordUK
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology AssessmentUMIT TIROL ‐ University for Health Sciences and TechnologyHall in TirolTyrolAustria
- Division of Health Technology Assessment and BioinformaticsONCOTYROL ‐ Center for Personalized Cancer MedicineInnsbruckAustria
- Center for Health Decision ScienceDepartments of Epidemiology and Health Policy & ManagementHarvard T.H. Chan School of Public HealthMassachusettsBostonUSA
- Program on Cardiovascular Research, Institute for Technology Assessment and Department of RadiologyMassachusetts General HospitalHarvard Medical SchoolMassachusettsBostonUSA
| | - Eric Silverman
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Luke Vale
- Health Economics GroupPopulation Health Sciences InstituteNewcastle UniversityNewcastleUK
| | - Cathal Walsh
- Health Research Institute and MACSIUniversity of LimerickLimerickIreland
| | - Alan Brennan
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| |
Collapse
|
30
|
Sodhi R, Penkunas MJ, Pal A. Free drug provision for tuberculosis increases patient follow-ups and successful treatment outcomes in the Indian private sector: a quasi experimental study using propensity score matching. BMC Infect Dis 2023; 23:421. [PMID: 37344775 DOI: 10.1186/s12879-023-08396-5] [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: 01/05/2023] [Accepted: 06/11/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND The private sector is an important yet underregulated component of the TB treatment infrastructure in India. The Joint Effort for Elimination of Tuberculosis (Project JEET) aims to link private sector TB care with the constellation of social support mechanisms available through the Indian National TB Elimination Programme (NTEP), including the provision of free fixed-dose combination (FDCs) drugs to patients. This quasi-experimental study analysed routinely collected data to determine the impact of free drugs on patient follow-ups and treatment outcomes. METHODS We used data for private sector patients enrolled with Project JEET who were diagnosed with pulmonary and extrapulmonary TB between 1 and 2019 and 31 March 2020, and completed treatment by 31 December 2021. Propensity score matching was used to create a dataset to compare the number of follow-ups and proportion of successful treatment outcomes for patients on free drugs to a control group who paid out-of-pocket. 11,621 matched pairs were included in the analysis. Logistic regression and ordinary least squares regression models were used to estimate the impact of free drugs on number of follow-ups and treatment success, where latter is defined as treatment completion or cure. RESULTS After controlling for potential confounders, patients on free drugs received on average 2.522 (95% C.I.: 2.325 to 2.719) additional follow-ups compared to patients who paid out of pocket. This equates to a 25% mean and 32% median increase in follow-ups for patients availing free drugs. For treatment success, patients receiving free drugs had 45% higher odds of a successful treatment (Odds Ratio: 1.452, 95% C.I.: 1.288 to 1.637). CONCLUSIONS Patients receiving free drugs were found to follow up with their treatment coordinator more frequently, in part likely to enable drug refilling, compared to patients who were paying out of pocket. These additional contacts would have offered opportunities to address concerns regarding side effects, provide additional treatment information, and connect with social support services, all of which subsequently contributed to patients' continual engagement with their treatment. This potentially represents the unmeasured effect of free drugs on continual social support, which translates into a higher odds of treatment success for patients.
Collapse
Affiliation(s)
- Ridhima Sodhi
- Clinton Health Access Initiative, Inc., New Delhi, India.
| | | | - Arnab Pal
- Clinton Health Access Initiative, Inc., New Delhi, India
| |
Collapse
|
31
|
Saha AK, Das S, Biswas D, Sain B, Mitra M, Chakraborty R, Basu S, Shamim S, Mukherjee A, Ghosh D, Biswas S, Kumar S, Gowsami DN, Todi SK. Treatment Outcome with High versus low-to-moderate Dosing of Corticosteroids in Early vis-a-vis Late-onset Hypoxic Cases of COVID-19: A Multicentric Retrospective Cohort Study. IJID REGIONS 2023; 7:31-42. [PMID: 36164344 PMCID: PMC9492392 DOI: 10.1016/j.ijregi.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 12/15/2022]
Abstract
Background Corticosteroid dosing in COVID-19 cases associated with early-onset and late-onset hypoxia have not been separately explored. Methods In this retrospective cohort study, we divided hypoxic COVID-19 cases into groups based on timing of initiation of corticosteroids relative to onset of symptoms; Group A (≤6th day), Group B (7th-9th day) and Group C (≥10th day), each group being sub-grouped into high and low-to-moderate dose corticosteroid recipients. Cox regression with propensity scoring was used to compare 28-day mortality between high and low-to-moderate dose recipients separately in Group A, Group B, Group C. Results Among 505 patients included, propensity score matched Cox regression showed greater risk of all-cause mortality among high dose recipients in Group A [HR= 7.35, 95%CI 3.36-16.11, p-value<0·01, N=114] and Group B [HR=3.17, 95%CI 1.65-6.07, p-value<0·01, N=251]. In Group C, mortality was lowest [12.8% (18/140)] with no significant difference between sub-groups [HR=2.52, 95%CI 0.22-29.15, p-value=0.459, N=140]. Kruskal-Wallis Test between Group A, Group B and Group C for six pre-defined exposure variables showed significant differences for Neutrophil:Lymphocyte Ratio (NLR). Conclusion When steroids were initiated early (owing to an earlier onset of hypoxic symptoms), a high dose of corticosteroid was associated with greater overall 28-day mortality compared to a low-to-moderate dose. NLR, a marker for individual immune response, varied between treatment groups.
Collapse
Affiliation(s)
- Arpit Kumar Saha
- Assistant Professor, Department of Microbiology, Santiniketan Medical College (under West Bengal University of Health Sciences), Bolpur, West Bengal, India
| | - Suvajit Das
- Assistant Professor, Department of Pharmacology, Rampurhat Government Medical College and Hospital (under West Bengal University of Health Sciences), Rampurhat, West Bengal, India
| | - Daliya Biswas
- Assistant Professor, Department of Community Medicine, North Bengal Medical College and Hospital (under West Bengal University of Health Sciences), Darjeeling, West Bengal India
| | - Baijaeek Sain
- Junior Clinical Fellow - Surgery Aneurin Bevan University Health Board, NHS Wales, the UK
| | - Mrinmoy Mitra
- Consultant, Pulmonary Medicine and Critical Care Medicine, AMRI Hospitals Mukundapur, Kolkata, West Bengal, India
| | - Ritam Chakraborty
- Consultant, Pulmonary Medicine and Critical Care Medicine, AMRI Hospitals Mukundapur, Kolkata, West Bengal, India
| | - Sushmita Basu
- Consultant, Critical Care Medicine, AMRI Hospitals Mukundapur, Kolkata, West Bengal, India
| | - Shelley Shamim
- Associate Professor, Department of Pulmonary Medicine, Calcutta National Medical College (under West Bengal University of Health Sciences), Kolkata, West Bengal, India
| | - Avik Mukherjee
- Medical Faculty, Department of Neuro-Medicine, Calcutta Medical College and Hospital (under West Bengal University of Health Sciences), Kolkata, West Bengal, India
| | - Debajyoti Ghosh
- Medical Faculty, Department of PMR, R G Kar Medical College and Hospitals (under West Bengal University of Health Sciences), Kolkata, West Bengal, India
| | - Sujash Biswas
- Associate Professor, Department of Forensic Medicine and Toxicology, Rampurhat Government Medical College and Hospital (under West Bengal University of Health Sciences), Rampurhat, West Bengal, India
| | - Simit Kumar
- Professor and Head, Department of Microbiology, Rampurhat Government Medical College and Hospital (under West Bengal University of Health Sciences), Rampurhat, West Bengal, India
| | - D N Gowsami
- Professor and Head, Department of Community Medicine, Rampurhat Government Medical College (under West Bengal University of Health Sciences), Rampurhat, West Bengal, India
| | - S K Todi
- Director, Critical Care Unit, AMRI Hospitals Mukundapur, Kolkata, West Bengal, India
| |
Collapse
|
32
|
Hyun MK, Lee JW, Ko SH. Chronic disease management program applied to type 2 diabetes patients and prevention of diabetic complications: a retrospective cohort study using nationwide data. BMC Public Health 2023; 23:928. [PMID: 37221526 DOI: 10.1186/s12889-023-15763-z] [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: 06/08/2022] [Accepted: 04/26/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND The outcomes of education and counseling by medical professionals for patients with type 2 diabetes mellitus (T2DM) are unclear. This study examined the effects of the Chronic Disease Management Program (CDMP), a health insurance fee-for-service benefit, on the incidence of diabetic complications in patients newly diagnosed with T2DM using the National Health Insurance data. METHODS Patients newly diagnosed with T2DM aged ≥ 20 years from 2010 to 2014 were followed up until 2015. Selection bias was minimized using propensity score matching. A stratified Cox proportional hazards model was used to analyze the association between the CDMP and the risk of incident diabetic complications. Subgroup analysis was performed for patients with high medication adherence, which was indicated by a medication possession ratio (MPR) ≥ 80. RESULTS Among the 11,915 patients with T2DM in the cohort, 4,617 were assigned to the CDMP and non-CDMP group each. The CDMP helped reduce the overall and microvascular risks of complications compared to the non-CDMP group; however, the protective effect against macrovascular complications was only observed in those aged ≥ 40 years. Subgroup analysis of the group aged ≥ 40 years with high adherence (an MPR ≥ 80) showed that the CDMP effectively reduced the incidence of micro- and macrovascular complications. CONCLUSIONS Effective management of T2DM is crucial in preventing complications in patients with the condition, and includes regular monitoring and adjustment of treatment by qualified physicians. Nevertheless, long-term prospective studies on the effects of CDMP are required to confirm this finding.
Collapse
Affiliation(s)
- Min Kyung Hyun
- Department of Preventive Medicine, College of Korean Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Jang Won Lee
- Department of Preventive Medicine, College of Korean Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Seung-Hyun Ko
- Department of Internal Medicine, Division of Endocrinology and Metabolism, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| |
Collapse
|
33
|
Li S, Suehs BT, Fu A, Sangaré L, Kim C, Gastanaga VM, Liu J, Yan H, Xu Y, Mikhael J. Heart Failure Among Patients with Multiple Myeloma Treated with Carfilzomib-Based Versus Non-Carfilzomib-Based Regimens in the United States by Race. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023:S2152-2650(23)00137-4. [PMID: 37258396 DOI: 10.1016/j.clml.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/28/2023] [Accepted: 04/24/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Carfilzomib treatment for multiple myeloma (MM) can increase heart failure risk. Whether this risk differs by race is unknown. PATIENTS AND METHODS We sought to estimate the incidence rates (IRs) of heart failure hospitalization among mostly 65-years-and-older US patients with MM by race treated with carfilzomib- and non-carfilzomib-based regimens in the real-world using Centers for Medicare & Medicaid Services Medicare Fee-for-Service data, Optum Clinformatics Data Mart, and Humana Research Database. The risk of heart failure hospitalization associated with a carfilzomib-based regimen was evaluated using propensity score matching among Black and White patients receiving second or later lines of therapy. RESULTS Most patient-episodes (88%) were in persons 65 years or older for the 3 cohorts combined. The IR (95% CI) of heart failure hospitalization was higher for patient-episodes treated with a carfilzomib-based regimen than those with a non-carfilzomib-based regimen for both White (14.5 [12.2-17.0] vs. 10.7 [10.3-11.2] events per person-years) and Black patients (15.8 [10.1-23.5] vs. 12.1 [10.9-13.4] events per person-years) in the Medicare cohort. After propensity score matching, the hazard ratio (95% CI) of increased heart failure hospitalization comparing carfilzomib-based to non-carfilzomib-based regimens for White patients (1.6 [1.3-2.0]) was similar to that of Black patients (1.7 [1.0-2.9]) in the Medicare Database, and in the Humana Database (1.4 [0.8-2.6] and 1.2 [0.4-3.5], respectively). CONCLUSION Although the IR of heart failure among patients with MM treated with a carfilzomib-based regimen was slightly higher, no evidence suggested the relative risk was different between White and Black patients with MM.
Collapse
Affiliation(s)
- Shuling Li
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, United States.
| | | | - Alan Fu
- Amgen Inc, Center for Observational Research (CfOR), Thousand Oaks, CA, United States
| | - Laura Sangaré
- Amgen Inc, Center for Observational Research (CfOR), Thousand Oaks, CA, United States
| | - Chris Kim
- Amgen Inc, Center for Observational Research (CfOR), Thousand Oaks, CA, United States
| | - Victor M Gastanaga
- Amgen Inc, Center for Observational Research (CfOR), Thousand Oaks, CA, United States
| | - Jiannong Liu
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
| | - Heng Yan
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
| | - Yihua Xu
- Humana Healthcare Research, Louisville, KY, United States
| | - Joseph Mikhael
- Applied Cancer Research and Drug Discovery Division, Translational Genomics Research Institute (TGen), City of Hope Cancer Center, Phoenix, AZ, United States
| |
Collapse
|
34
|
Domb BG, Owens JS, Glein RM, Jimenez AE, Maldonado DR. Borderline Dysplasia After Primary Hip Arthroscopy with Capsular Plication and Labral Preservation: Ten-Year Survivorship and Patient-Reported Outcomes. J Bone Joint Surg Am 2023; 105:687-699. [PMID: 37083686 DOI: 10.2106/jbjs.22.00340] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND The arthroscopic management of borderline hip dysplasia (BHD) is controversial, and long-term follow-up data are scarce. The purpose of this study was to report prospectively collected survivorship and patient-reported outcome measures (PROMs) at a minimum 10-year follow-up following primary hip arthroscopy with capsular plication and labral preservation in patients with BHD. METHODS Data were prospectively collected on all patients who underwent primary hip arthroscopy between September 2008 and September 2011. Patients with BHD (defined by a lateral center-edge angle [LCEA] between 18° and 25°) were included. Preoperative and minimum 10-year follow-up scores for the modified Harris hip score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain were collected. Exclusion criteria were prior ipsilateral hip surgery, Workers' Compensation status, Tönnis grade of >1, previous hip conditions, or LCEA of <18°. Survivorship was defined as no conversion to total hip arthroplasty (THA). The risk factors for THA conversion were analyzed. The achievement rate for the minimal clinically important difference (MCID) was reported. A propensity-matched comparison with a control group without BHD was performed. RESULTS Forty-five (80%) of 56 eligible hips were included in this study: 38 hips (84%) of female patients and 7 hips (16%) of male patients. The mean patient age was 31.0 ± 12.9 years, and the mean patient body mass index (BMI) was 24.5 ± 5.4 kg/m2. The 10-year survivorship was 82.2%, and there was significant improvement in all PROMs and VAS pain from baseline to the minimum 10-year follow-up (p < 0.001). The odds of undergoing conversion to THA were 4.4 times higher for patients with a BMI of ≥23 kg/m2 and 7.1 times higher for patients who were ≥42 years of age. The MCID was achieved at high rates for the mHHS (79%), NAHS (79%), HOS-SSS (70%), and VAS pain (76%). The minimum 10-year survivorship, PROMs, and MCID achievement rates for the BHD group were comparable with those for the control group. CONCLUSIONS Patients with BHD who underwent primary hip arthroscopy with capsular plication and labral preservation demonstrated an overall survivorship of 82.2% and significant improvement in all PROMs and achieved the MCID at high rates at a minimum 10-year follow-up. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois
- American Hip Institute, Chicago, Illinois
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois
| | - Rachel M Glein
- American Hip Institute Research Foundation, Chicago, Illinois
| | | | | |
Collapse
|
35
|
Parola A, Simonsen A, Lin JM, Zhou Y, Wang H, Ubukata S, Koelkebeck K, Bliksted V, Fusaroli R. Voice Patterns as Markers of Schizophrenia: Building a Cumulative Generalizable Approach Via a Cross-Linguistic and Meta-analysis Based Investigation. Schizophr Bull 2023; 49:S125-S141. [PMID: 36946527 PMCID: PMC10031745 DOI: 10.1093/schbul/sbac128] [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] [Indexed: 03/23/2023]
Abstract
BACKGROUND AND HYPOTHESIS Voice atypicalities are potential markers of clinical features of schizophrenia (eg, negative symptoms). A recent meta-analysis identified an acoustic profile associated with schizophrenia (reduced pitch variability and increased pauses), but also highlighted shortcomings in the field: small sample sizes, little attention to the heterogeneity of the disorder, and to generalizing findings to diverse samples and languages. STUDY DESIGN We provide a critical cumulative approach to vocal atypicalities in schizophrenia, where we conceptually and statistically build on previous studies. We aim at identifying a cross-linguistically reliable acoustic profile of schizophrenia and assessing sources of heterogeneity (symptomatology, pharmacotherapy, clinical and social characteristics). We relied on previous meta-analysis to build and analyze a large cross-linguistic dataset of audio recordings of 231 patients with schizophrenia and 238 matched controls (>4000 recordings in Danish, German, Mandarin and Japanese). We used multilevel Bayesian modeling, contrasting meta-analytically informed and skeptical inferences. STUDY RESULTS We found only a minimal generalizable acoustic profile of schizophrenia (reduced pitch variability), while duration atypicalities replicated only in some languages. We identified reliable associations between acoustic profile and individual differences in clinical ratings of negative symptoms, medication, age and gender. However, these associations vary across languages. CONCLUSIONS The findings indicate that a strong cross-linguistically reliable acoustic profile of schizophrenia is unlikely. Rather, if we are to devise effective clinical applications able to target different ranges of patients, we need first to establish larger and more diverse cross-linguistic datasets, focus on individual differences, and build self-critical cumulative approaches.
Collapse
Affiliation(s)
- Alberto Parola
- Department of Linguistics, Cognitive Science and Semiotics, Aarhus University, Aarhus, Denmark
- The Interacting Minds Center, Institute of Culture and Society, Aarhus University, Aarhus, Denmark
- Department of Psychology, University of Turin, Turin, Italy
| | - Arndis Simonsen
- The Interacting Minds Center, Institute of Culture and Society, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jessica Mary Lin
- Department of Linguistics, Cognitive Science and Semiotics, Aarhus University, Aarhus, Denmark
- The Interacting Minds Center, Institute of Culture and Society, Aarhus University, Aarhus, Denmark
| | - Yuan Zhou
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Huiling Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shiho Ubukata
- Department of Psychiatry, Kyoto University, Kyoto, Japan
| | - Katja Koelkebeck
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Hospital and Institute of the University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Duisburg-Essen, Germany
| | - Vibeke Bliksted
- The Interacting Minds Center, Institute of Culture and Society, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Riccardo Fusaroli
- Department of Linguistics, Cognitive Science and Semiotics, Aarhus University, Aarhus, Denmark
- The Interacting Minds Center, Institute of Culture and Society, Aarhus University, Aarhus, Denmark
- Linguistic Data Consortium, University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
36
|
Pickreign JD. Iterative proportional fitting as a balancing method in observational studies. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2023. [DOI: 10.1007/s10742-023-00304-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
|
37
|
Zaleski A, Sigler B, Leggitt A, Choudhary S, Berns R, Rhee K, Schwarzwald H. The Influence of a Wearable-Based Reward Program on Health Care Costs: Retrospective, Propensity Score-Matched Cohort Study. J Med Internet Res 2023; 25:e45064. [PMID: 36917152 PMCID: PMC10131601 DOI: 10.2196/45064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/09/2023] [Accepted: 02/21/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) technology holds great promise as an easily accessible and effective solution to improve population health at scale. Despite the abundance of mHealth offerings, only a minority are grounded in evidence-based practice, whereas even fewer have line of sight into population-level health care spending, limiting the clinical utility of such tools. OBJECTIVE This study aimed to explore the influence of a health plan-sponsored, wearable-based, and reward-driven digital health intervention (DHI) on health care spending over 1 year. The DHI was delivered through a smartphone-based mHealth app available only to members of a large commercial health plan and leveraged a combination of behavioral economics, user-generated sensor data from the connected wearable device, and claims history to create personalized, evidence-based recommendations for each user. METHODS This study deployed a propensity score-matched, 2-group, and pre-post observational design. Adults (≥18 years of age) enrolled in a large, national commercial health plan and self-enlisted in the DHI for ≥7 months were allocated to the intervention group (n=56,816). Members who were eligible for the DHI but did not enlist were propensity score-matched to the comparison group (n=56,816). Average (and relative change from baseline) medical and pharmacy spending per user per month was computed for each member of the intervention and comparison groups during the pre- (ie, 12 months) and postenlistment (ie, 7-12 months) periods using claims data. RESULTS Baseline characteristics and medical spending were similar between groups (P=.89). On average, the total included sample population (N=113,632) consisted of young to middle-age (mean age 38.81 years), mostly White (n=55,562, 48.90%), male (n=46,731, 41.12%) and female (n=66,482, 58.51%) participants. Compared to a propensity score-matched cohort, DHI users demonstrated approximately US $10 per user per month lower average medical spending (P=.02) with a concomitant increase in preventive care activities and decrease in nonemergent emergency department admissions. These savings translated to approximately US $6.8 million in avoidable health care costs over the course of 1 year. CONCLUSIONS This employer-sponsored, digital health engagement program has a high likelihood for return on investment within 1 year owing to clinically meaningful changes in health-seeking behaviors and downstream medical cost savings. Future research should aim to elucidate health behavior-related mechanisms in support of these findings and continue to explore novel strategies to ensure equitable access of DHIs to underserved populations that stand to benefit the most.
Collapse
Affiliation(s)
- Amanda Zaleski
- Clinical Evidence Development, Aetna Medical Affairs, CVS Health, Hartford, CT, United States
| | - Brittany Sigler
- Aetna Digital Product Development, CVS Health, Wellesley, MA, United States
| | - Alan Leggitt
- Aetna Analytics & Behavior Change, CVS Health, New York, NY, United States
| | - Shruti Choudhary
- Aetna Analytics & Behavior Change, CVS Health, New York, NY, United States
| | - Ryan Berns
- Aetna Analytics & Behavior Change, CVS Health, New York, NY, United States
| | - Kyu Rhee
- Aetna Medical Affairs, CVS Health, Hartford, CT, United States
| | | |
Collapse
|
38
|
Kemp Bohan PM, Chang SC, Grunkemeier GL, Spitzer HV, Carpenter EL, Adams AM, Vreeland TJ, Nelson DW. Impact of Mediating and Confounding Variables on the Volume-Outcome Association in the Treatment of Pancreatic Cancer. Ann Surg Oncol 2023; 30:1436-1448. [PMID: 36460898 DOI: 10.1245/s10434-022-12908-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/28/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND High-volume centers (HVC), academic centers (AC), and longer travel distances (TD) have been associated with improved outcomes for patients undergoing surgery for pancreatic adenocarcinoma (PAC). Effects of mediating variables on these associations remain undefined. The purpose of this study is to examine the direct effects of hospital volume, facility type, and travel distance on overall survival (OS) in patients undergoing surgery for PAC and characterize the indirect effects of patient-, disease-, and treatment-related mediating variables. PATIENTS AND METHODS Using the National Cancer Database, patients with non-metastatic PAC who underwent resection were stratified by annual hospital volume (< 11, 11-19, and ≥ 20 cases/year), facility type (AC versus non-AC), and TD (≥ 40 versus < 40 miles). Associations with survival were evaluated using multiple regression models. Effects of mediating variables were assessed using mediation analysis. RESULTS In total, 19,636 patients were included. Treatment at HVC or AC was associated with lower risk of death [hazard ratio (HR) 0.90, confidence interval (CI) 0.88-0.92; HR 0.89, CI 0.86-0.91, respectively]. TD did not impact OS. Patient-, disease-, and treatment-related variables explained 25.5% and 41.8% of the survival benefit attained from treatment at HVC and AC, reducing the survival benefit directly attributable to each variable to 4.9% and 6.4%, respectively. CONCLUSIONS Treatment of PAC at HVC and AC was associated with improved OS, but the magnitude of this benefit was less when mediating variables were considered. From a healthcare utilization and cost-resource perspective, further research is needed to identify patients who would benefit most from selective referral to HVC or AC.
Collapse
Affiliation(s)
| | - Shu-Ching Chang
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Portland, OR, USA
| | - Gary L Grunkemeier
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Portland, OR, USA
| | - Holly V Spitzer
- Department of Surgery, William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | | | - Alexandra M Adams
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Timothy J Vreeland
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Daniel W Nelson
- Department of Surgery, William Beaumont Army Medical Center, Fort Bliss, TX, USA.
| |
Collapse
|
39
|
Peel JK, Keshavjee S, Naimark D, Liu M, Del Sorbo L, Cypel M, Barrett K, Pullenayegum EM, Sander B. Determining the impact of ex-vivo lung perfusion on hospital costs for lung transplantation: A retrospective cohort study. J Heart Lung Transplant 2023; 42:356-367. [PMID: 36411188 DOI: 10.1016/j.healun.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/04/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Ex-vivo lung perfusion (EVLP) has improved organ utilization for lung transplantation, but it is not yet known whether the benefits of this technology offset its additional costs. We compared the institutional costs of lung transplantation before vs after EVLP was available to identify predictors of costs and determine the health-economic impact of EVLP. METHODS We performed a retrospective, before-after, propensity-score weighted cohort study of patients wait-listed for lung transplant at University Health Network (UHN) in Ontario, Canada, between January 2005 and December 2019 using institutional administrative data. We compared costs, in 2019 Canadian Dollars ($), between patients referred for transplant before EVLP was available (Pre-EVLP) to after (Modern EVLP). Cumulative costs were estimated using a novel application of multistate survival models. Predictors of costs were identified using weighted log-gamma generalized linear regression. RESULTS A total of 1,199 patients met inclusion criteria (352 Pre-EVLP; 847 Modern EVLP). Mean total costs for the transplant hospitalization were $111,878 ($94,123-$130,767) in the Pre-EVLP era and $110,969 ($87,714-$136,000) in the Modern EVLP era. Cumulative five-year costs since referral were $278,777 ($82,575-$298,135) in the Pre-EVLP era and $293,680 ($252,832-$317,599) in the Modern EVLP era. We observed faster progression to transplantation when EVLP was available. EVLP availability was not a predictor of waitlist (cost ratio [CR] 1.04 [0.81-1.37]; p = 0.354) or transplant costs (CR 1.02 [0.80-1.29]; p = 0.425) but was associated with lower costs during posttransplant years 1&2 (CR 0.75 [0.58-1.06]; p = 0.05) and posttransplant years 3+ (CR 0.43 [0.26-0.74]; p = 0.001). CONCLUSIONS At our center, EVLP availability was associated with faster progression to transplantation at no significant marginal cost.
Collapse
Affiliation(s)
- John Kenneth Peel
- Department of Anesthesiology, University Health Network, Toronto, Ontario, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Shaf Keshavjee
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - David Naimark
- Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mingyao Liu
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Lorenzo Del Sorbo
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marcelo Cypel
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Kali Barrett
- Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eleanor M Pullenayegum
- Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; ICES, Ontario, Canada; Public Health Ontario, Ontario, Canada.
| |
Collapse
|
40
|
Gedeborg R, Igl W, Svennblad B, Wilén P, Delcoigne B, Michaëlsson K, Ljung R, Feltelius N. Federated analyses of multiple data sources in drug safety studies. Pharmacoepidemiol Drug Saf 2023; 32:279-286. [PMID: 36527437 DOI: 10.1002/pds.5587] [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: 08/01/2022] [Revised: 11/30/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Studies of rare side effects of new drugs with limited exposure may require pooling of multiple data sources. Federated Analyses (FA) allow real-time, interactive, centralized statistical processing of individual-level data from different data sets without transfer of sensitive personal data. METHODS We review IT-architecture, legal considerations, and statistical methods in FA, based on a Swedish Medical Products Agency methodological development project. RESULTS In a review of all post-authorisation safety studies assessed by the EMA during 2019, 74% (20/27 studies) reported issues with lack of precision in spite of mean study periods of 9.3 years. FA could potentially improve precision in such studies. Depending on the statistical model, the federated approach can generate identical results to a standard analysis. FA may be particularly attractive for repeated collaborative projects where data is regularly updated. There are also important limitations. Detailed agreements between involved parties are strongly recommended to anticipate potential issues and conflicts, document a shared understanding of the project, and fully comply with legal obligations regarding ethics and data protection. FA do not remove the data harmonisation step, which remains essential and often cumbersome. Reliable support for technical integration with the local server architecture and security solutions is required. Common statistical methods are available, but adaptations may be required. CONCLUSIONS Federated Analyses require competent and active involvement of all collaborating parties but have the potential to facilitate collaboration across institutional and national borders and improve the precision of postmarketing drug safety studies.
Collapse
Affiliation(s)
- Rolf Gedeborg
- Department of Efficacy and Safety 1, Division of Licensing, Medical Products Agency, Uppsala, Sweden
| | - Wilmar Igl
- Statistics Group, Department of Efficacy and Safety 2, Division of Licensing, Medical Products Agency, Uppsala, Sweden
| | - Bodil Svennblad
- Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Peter Wilén
- Department of Legal Affairs, Medical Products Agency, Uppsala, Sweden
| | - Bénédicte Delcoigne
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Rickard Ljung
- Division of Use and Information, Medical Products Agency, Uppsala, Sweden
| | - Nils Feltelius
- Division of Use and Information, Medical Products Agency, Uppsala, Sweden
| |
Collapse
|
41
|
Evans M, Berry S, Nazeri A, Malkin SJ, Ashley D, Hunt B, Bain SC. The challenges and pitfalls of incorporating evidence from cardiovascular outcomes trials in health economic modelling of type 2 diabetes. Diabetes Obes Metab 2023; 25:639-648. [PMID: 36342041 DOI: 10.1111/dom.14917] [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: 09/20/2022] [Revised: 10/26/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2022]
Abstract
The clinical evidence base for evaluating modern type 2 diabetes interventions has expanded greatly in recent years, with numerous efficacious treatment options available (including dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors). The cardiovascular safety of these interventions has been assessed individually versus placebo in numerous cardiovascular outcomes trials (CVOTs), statistically powered to detect differences in a composite endpoint of major adverse cardiovascular events. There have been growing calls to incorporate these data in the long-term modelling of type 2 diabetes interventions because current diabetes models were developed prior to the conduct of the CVOTs and therefore rely on risk equations developed in the absence of these data. However, there are numerous challenges and pitfalls to avoid when using data from CVOTs. The primary concerns are around the heterogeneity of the trials, which have different study durations, inclusion criteria, rescue medication protocols and endpoint definitions; this results in significant uncertainty when comparing two or more interventions evaluated in separate CVOTs, as robust adjustment for these differences is difficult. Analyses using CVOT data inappropriately can dilute clear evidence from head-to-head clinical trials, and blur healthcare decision making. Calibration of existing models may represent an approach to incorporating CVOT data into diabetes modelling, but this can only offer a valid comparison of one intervention versus placebo based on a single CVOT. Ideally, model development should utilize patient-level data from CVOTs to prepare novel risk equations that can better model modern therapies for type 2 diabetes.
Collapse
Affiliation(s)
- Marc Evans
- University Hospital Llandough, Cardiff, UK
| | | | | | | | | | - Barnaby Hunt
- Ossian Health Economics and Communications, Basel, Switzerland
| | | |
Collapse
|
42
|
Gul MH, Htun ZM, de Jesus Perez V, Suleman M, Arshad S, Imran M, Vyasabattu M, Wood JP, Anstead M, Morris PE. Predictors and outcomes of acute pulmonary embolism in COVID-19; insights from US National COVID cohort collaborative. Respir Res 2023; 24:59. [PMID: 36810085 PMCID: PMC9942071 DOI: 10.1186/s12931-023-02369-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 02/16/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVES To investigate whether COVID-19 patients with pulmonary embolism had higher mortality and assess the utility of D-dimer in predicting acute pulmonary embolism. PATIENTS AND METHODS Using the National Collaborative COVID-19 retrospective cohort, a cohort of hospitalized COVID-19 patients was studied to compare 90-day mortality and intubation outcomes in patients with and without pulmonary embolism in a multivariable cox regression analysis. The secondary measured outcomes in 1:4 propensity score-matched analysis included length of stay, chest pain incidence, heart rate, history of pulmonary embolism or DVT, and admission laboratory parameters. RESULTS Among 31,500 hospitalized COVID-19 patients, 1117 (3.5%) patients were diagnosed with acute pulmonary embolism. Patients with acute pulmonary embolism were noted to have higher mortality (23.6% vs.12.8%; adjusted Hazard Ratio (aHR) = 1.36, 95% CI [1.20-1.55]), and intubation rates (17.6% vs. 9.3%, aHR = 1.38[1.18-1.61]). Pulmonary embolism patients had higher admission D-dimer FEU (Odds Ratio(OR) = 1.13; 95%CI [1.1-1.15]). As the D-dimer value increased, the specificity, positive predictive value, and accuracy of the test increased; however, sensitivity decreased (AUC 0.70). At cut-off D-dimer FEU 1.8 mcg/ml, the test had clinical utility (accuracy 70%) in predicting pulmonary embolism. Patients with acute pulmonary embolism had a higher incidence of chest pain and history of pulmonary embolism or deep vein thrombosis. CONCLUSIONS Acute pulmonary embolism is associated with worse mortality and morbidity outcomes in COVID-19. We present D-dimer as a predictive risk tool in the form of a clinical calculator for the diagnosis of acute pulmonary embolism in COVID-19.
Collapse
Affiliation(s)
- Muhammad H Gul
- Internal Medicine Department, University of Kentucky, MN 602, H Building, 1000 S Limestone, Lexington, KY, 40506, USA.
| | - Zin Mar Htun
- Pulmonary Critical Care Department, University of Maryland, Baltimore & National Institute of Health Sciences, Baltimore, MD, USA
| | | | - Muhammad Suleman
- Cardiology Department, Peshawar Institute of Cardiology, Peshawar, Pakistan
| | - Samiullah Arshad
- Internal Medicine Department, University of Kentucky, MN 602, H Building, 1000 S Limestone, Lexington, KY, 40506, USA
| | - Muhammad Imran
- Cardiothoracic Surgery Department, Armed Institute of Cardiology Rawalpindi, Rawalpindi, Punjab, Pakistan
| | - Mahender Vyasabattu
- Internal Medicine Department, University of Kentucky, MN 602, H Building, 1000 S Limestone, Lexington, KY, 40506, USA
| | - Jeremy P Wood
- Division of Cardiovascular Medicine, The Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA
- Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, KY, USA
| | - Michael Anstead
- Pulmonary Critical Care Department, University of Kentucky, Lexington, KY, USA
| | - Peter E Morris
- Pulmonary Critical Care Department, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
43
|
Owens JS, Jimenez AE, Lee MS, Monahan PF, Maldonado DR, Domb BG. High-Level Athletes With Borderline Hip Dysplasia Achieve Favorable Outcomes and Return to Sport Rates Following Primary Hip Arthroscopy: Minimum 5-Year Outcomes Comparison to a Propensity-Matched Control Group. Arthroscopy 2023; 39:271-282. [PMID: 36055477 DOI: 10.1016/j.arthro.2022.08.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 08/03/2022] [Accepted: 08/14/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) To report minimum 5-year patient-reported outcomes (PROs) and return to sport (RTS) rates in high-level athletes with borderline hip dysplasia (BHD) following primary hip arthroscopy for labral pathology and femoroacetabular impingement syndrome and (2) to compare results to a propensity-matched control group of athletes with normal acetabular coverage. METHODS Data were reviewed for surgeries performed between February 2009 and February 2016. Patients were eligible if they underwent primary hip arthroscopy in the setting of BHD (lateral center-edge angle [LCEA] 18-25°) and competed in professional, collegiate, or high school sports. Inclusion criteria were preoperative and minimum 5-year follow-up scores for the modified Harris Hip Score (mHHS), Non-Arthritis Hip Score, Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and visual analog scale for pain. Rates of achieving the minimal clinically importance difference (MCID), patient acceptable symptomatic state (PASS), and maximum outcome improvement satisfaction threshold (MOIST) were recorded in addition to RTS. BHD athletes were matched by age at the time of surgery, sex, body mass index, Tönnis grade, follow-up time, sport type, and competition level to a control group of 58 athletes with normal acetabular coverage (LCEA 25°-40°) for comparison. RESULTS A total of 34 BHD athletes were included with a mean follow-up of 73.6 ± 10.7 months. BHD athletes showed significant improvements in all PROs, demonstrated high RTS rates (90.0%), and achieved PASS/MCID/MOIST for mHHS (MCID: 80.0%, PASS: 93.3%, MOIST: 80.0%) and HOS-SSS (MCID: 76.7%, PASS: 73.3%) at high rates. When compared to a propensity-matched group with normal acetabular coverage, BHD athletes demonstrated similar postoperative PROs, rates of achieving psychometric thresholds, and RTS rates (P > .05). Additionally, by the latest follow-up, no athlete in either group required conversion to total hip arthroplasty. CONCLUSIONS High-level athletes with BHD undergoing primary hip arthroscopy for labral pathology and femoroacetabular impingement syndrome may expect favorable midterm outcomes and high RTS rates. These results were comparable to a control group of athletes with normal coverage. LEVEL OF EVIDENCE Level III, retrospective cohort study.
Collapse
Affiliation(s)
- Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Michael S Lee
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Peter F Monahan
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - David R Maldonado
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A; American Hip Institute, Chicago, Illinois, U.S.A.
| |
Collapse
|
44
|
Palomba ML, Ghione P, Patel AR, Nahas M, Beygi S, Hatswell AJ, Kanters S, Limbrick-Oldfield EH, Wade SW, Ray MD, Owen J, Neelapu SS, Gribben J, Radford J, Bobillo S. A 24-month updated analysis of the comparative effectiveness of ZUMA-5 (axi-cel) vs. SCHOLAR-5 external control in relapsed/refractory follicular lymphoma. Expert Rev Anticancer Ther 2023; 23:199-206. [PMID: 36723678 PMCID: PMC11104735 DOI: 10.1080/14737140.2023.2171994] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/11/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND In the ZUMA-5 trial (Clinical trials identification: NCT03105336), axicabtagene ciloleucel (axi-cel; a chimeric antigen receptor T-cell therapy) demonstrated high rates of durable response in relapsed/refractory (r/r) follicular lymphoma (FL) patients and clear superiority relative to the SCHOLAR-5 external control cohort. We update this comparison using the ZUMA-5 24-month data. RESEARCH DESIGN AND METHODS The SCHOLAR-5 cohort is comprised of r/r FL patients who initiated ≥3rd line of therapy after July 2014 and meeting ZUMA-5 eligibility criteria. Groups were balanced for patient characteristics through propensity scoring on prespecified prognostic factors using standardized mortality ratio (SMR) weighting. The overall response rate was compared using a weighted logistic regression. Time-to-event outcomes were evaluated using a Cox regression. RESULTS For SCHOLAR-5, the sum of weights for the 143 patients was 85 after SMR weighting, versus 86 patients in ZUMA-5. The median follow-up was 29.4 months and 25.4 months for ZUMA-5 and SCHOLAR-5, respectively. The hazard ratios for overall survival and progression-free survival were 0.52 (95% confidence interval (CI): 0.28-0.95) and 0.28 (95% CI: 0.17-0.45), favoring axi-cel. CONCLUSION This updated analysis, using a longer minimum follow-up than a previously published analysis, shows that the improved efficacy of axi-cel, relative to available therapies, in r/r FL is durable. .
Collapse
Affiliation(s)
- M Lia Palomba
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paola Ghione
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Myrna Nahas
- Kite, A Gilead Company, Santa Monica, CA, USA
| | - Sara Beygi
- Kite, A Gilead Company, Santa Monica, CA, USA
| | | | | | | | - Sally W Wade
- Wade Outcomes Research and Consulting, Salt Lake City, UT, USA
| | | | | | - Sattva S Neelapu
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - John Radford
- The University of Manchester and Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | |
Collapse
|
45
|
Djulbegovic B, Hozo I, Lizarraga D, Thomas J, Barbee M, Shah N, Rubeor T, Dale J, Reiser J, Guyatt G. Evaluation of a fast-and-frugal clinical decision algorithm ('pathways') on clinical outcomes in hospitalised patients with COVID-19 treated with anticoagulants. J Eval Clin Pract 2023; 29:3-12. [PMID: 36229950 PMCID: PMC9840687 DOI: 10.1111/jep.13780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 01/27/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Critics have charged that evidence-based medicine (EBM) overemphasises algorithmic rules over unstructured clinical experience and intuition, but the role of structured decision support systems in improving health outcomes remains uncertain. We aim to assess if delivery of anticoagulant prophylaxis in hospitalised patients with COVID-19 according to an algorithm based on evidence-based clinical practice guideline (CPG) improved clinical outcomes compared with administration of anticoagulant treatment given at individual practitioners' discretion. METHODS An observational design consisting of the analysis of all acutely ill, consecutive patients (n = 1783) with confirmed COVID-19 diagnosis admitted between 10 March 2020 to 11 January 2022 to an US academic center. American Society of Haematology CPG for anticoagulant prophylaxis in hospitalised patients with COVID-19 was converted into a clinical pathway and translated into fast-and-frugal decision (FFT) tree ('algorithm'). We compared delivery of anticoagulant prophylaxis in hospitalised patients with COVID-19 according to the FFT algorithm with administration of anticoagulant treatment given at individual practitioners' discretion. RESULTS In an adjusted analysis, using combination of Lasso (least absolute shrinkage and selection operator) and propensity score based weighting [augmented inverse-probability weighting] statistical techniques controlling for cluster data, the algorithm did not reduce death, venous thromboembolism, or major bleeding, but helped avoid longer hospital stay [number of patients needed to be treated (NNT) = 40 (95% CI: 23-143), indicating that for every 40 patients (23-143) managed on FFT algorithm, one avoided staying in hospital longer than 10 days] and averted admission to intensive-care unit (ICU) [NNT = 19 (95% CI: 13-40)]. All model's selected covariates were well balanced. The results remained robust to sensitivity analyses used to test the stability of the findings. CONCLUSIONS When delivered using a structured FFT algorithm, CPG shortened the hospital stay and help avoided admission to ICU, but it did not affect other relevant outcomes.
Collapse
Affiliation(s)
- Benjamin Djulbegovic
- Department of Computational & Quantitative Medicine, City of Hope, Beckman Research Institute, Duarte, California, USA.,Division of Health Analytics, Beckman Research Institute, Duarte, California, USA.,Evidence-Based Medicine & Comparative Effectiveness Research, Beckman Research Institute, Duarte, California, USA
| | - Iztok Hozo
- Department of Mathematics, Indiana University, Gary, Indiana, USA
| | - David Lizarraga
- Department of Computational & Quantitative Medicine, City of Hope, Beckman Research Institute, Duarte, California, USA.,Division of Health Analytics, Beckman Research Institute, Duarte, California, USA.,Evidence-Based Medicine & Comparative Effectiveness Research, Beckman Research Institute, Duarte, California, USA
| | - Joseph Thomas
- Rush University Medical Center (RUMC), Chicago, Illinois, USA.,Division of Hospital Medicine, Department of Hospital Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Barbee
- Rush University Medical Center (RUMC), Chicago, Illinois, USA.,Division of Hospital Medicine, Department of Hospital Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Nupur Shah
- Rush University Medical Center (RUMC), Chicago, Illinois, USA.,Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Tyler Rubeor
- Rush University Medical Center (RUMC), Chicago, Illinois, USA
| | - Jordan Dale
- Houston Methodist Academic Institute, Houston, Texas, USA
| | - Jochen Reiser
- Rush University Medical Center (RUMC), Chicago, Illinois, USA.,Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
46
|
Ehrlich A, Ioannidis K, Nasar M, Abu Alkian I, Daskal Y, Atari N, Kliker L, Rainy N, Hofree M, Shafran Tikva S, Houri I, Cicero A, Pavanello C, Sirtori CR, Cohen JB, Chirinos JA, Deutsch L, Cohen M, Gottlieb A, Bar-Chaim A, Shibolet O, Mandelboim M, Maayan SL, Nahmias Y. Efficacy and safety of metabolic interventions for the treatment of severe COVID-19: in vitro, observational, and non-randomized open-label interventional study. eLife 2023; 12:79946. [PMID: 36705566 PMCID: PMC9937660 DOI: 10.7554/elife.79946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 01/26/2023] [Indexed: 01/28/2023] Open
Abstract
Background Viral infection is associated with a significant rewire of the host metabolic pathways, presenting attractive metabolic targets for intervention. Methods We chart the metabolic response of lung epithelial cells to SARS-CoV-2 infection in primary cultures and COVID-19 patient samples and perform in vitro metabolism-focused drug screen on primary lung epithelial cells infected with different strains of the virus. We perform observational analysis of Israeli patients hospitalized due to COVID-19 and comparative epidemiological analysis from cohorts in Italy and the Veteran's Health Administration in the United States. In addition, we perform a prospective non-randomized interventional open-label study in which 15 patients hospitalized with severe COVID-19 were given 145 mg/day of nanocrystallized fenofibrate added to the standard of care. Results SARS-CoV-2 infection produced transcriptional changes associated with increased glycolysis and lipid accumulation. Metabolism-focused drug screen showed that fenofibrate reversed lipid accumulation and blocked SARS-CoV-2 replication through a PPARα-dependent mechanism in both alpha and delta variants. Analysis of 3233 Israeli patients hospitalized due to COVID-19 supported in vitro findings. Patients taking fibrates showed significantly lower markers of immunoinflammation and faster recovery. Additional corroboration was received by comparative epidemiological analysis from cohorts in Europe and the United States. A subsequent prospective non-randomized interventional open-label study was carried out on 15 patients hospitalized with severe COVID-19. The patients were treated with 145 mg/day of nanocrystallized fenofibrate in addition to standard-of-care. Patients receiving fenofibrate demonstrated a rapid reduction in inflammation and a significantly faster recovery compared to patients admitted during the same period. Conclusions Taken together, our data suggest that pharmacological modulation of PPARα should be strongly considered as a potential therapeutic approach for SARS-CoV-2 infection and emphasizes the need to complete the study of fenofibrate in large randomized controlled clinical trials. Funding Funding was provided by European Research Council Consolidator Grants OCLD (project no. 681870) and generous gifts from the Nikoh Foundation and the Sam and Rina Frankel Foundation (YN). The interventional study was supported by Abbott (project FENOC0003). Clinical trial number NCT04661930.
Collapse
Affiliation(s)
- Avner Ehrlich
- Grass Center for Bioengineering, Benin School of Computer Science and EngineeringJerusalemIsrael
- Department of Cell and Developmental Biology, Silberman Institute of Life SciencesJerusalemIsrael
| | - Konstantinos Ioannidis
- Grass Center for Bioengineering, Benin School of Computer Science and EngineeringJerusalemIsrael
- Department of Cell and Developmental Biology, Silberman Institute of Life SciencesJerusalemIsrael
| | - Makram Nasar
- Division of Infectious Diseases, Barzilai Medical CenterAshkelonIsrael
| | | | - Yuval Daskal
- Grass Center for Bioengineering, Benin School of Computer Science and EngineeringJerusalemIsrael
- Department of Cell and Developmental Biology, Silberman Institute of Life SciencesJerusalemIsrael
| | - Nofar Atari
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical CenterTel HashomerIsrael
| | - Limor Kliker
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical CenterTel HashomerIsrael
| | - Nir Rainy
- Laboratory Division, Shamir (Assaf Harofeh) Medical CenterZerifinItaly
| | - Matan Hofree
- Klarman Cell Observatory, The Broad Institute of Harvard and MITCambridgeUnited States
| | - Sigal Shafran Tikva
- Laboratory Division, Shamir (Assaf Harofeh) Medical CenterZerifinItaly
- Hadassah Research and Innovation CenterJerusalemIsrael
- Department of Nursing, Faculty of School of Life and Health Sciences, The Jerusalem College of Technology Lev Academic CenterJerusalemIsrael
| | - Inbal Houri
- Department of Gastroenterology, Sourasky Medical CenterTel AvivIsrael
| | - Arrigo Cicero
- IRCSS S.Orsola-Malpighi University HospitalBolognaItaly
| | - Chiara Pavanello
- Centro Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di MilanoMilanoItaly
- Centro Dislipidemie, Niguarda HospitalMilanoItaly
| | | | - Jordana B Cohen
- Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | - Julio A Chirinos
- Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | | | - Merav Cohen
- Grass Center for Bioengineering, Benin School of Computer Science and EngineeringJerusalemIsrael
- Department of Cell and Developmental Biology, Silberman Institute of Life SciencesJerusalemIsrael
| | - Amichai Gottlieb
- Division of Infectious Diseases, Barzilai Medical CenterAshkelonIsrael
| | - Adina Bar-Chaim
- Laboratory Division, Shamir (Assaf Harofeh) Medical CenterZerifinItaly
| | - Oren Shibolet
- Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | | | - Shlomo L Maayan
- Division of Infectious Diseases, Barzilai Medical CenterAshkelonIsrael
| | - Yaakov Nahmias
- Grass Center for Bioengineering, Benin School of Computer Science and EngineeringJerusalemIsrael
- Department of Cell and Developmental Biology, Silberman Institute of Life SciencesJerusalemIsrael
| |
Collapse
|
47
|
Mussa EC, Palermo T, Angeles G, Kibur M, Otchere F, Valli E, Waidler J, Quiñones S, Serdan AGG, Vinci V, Ouedraogo LM, Kebede GB, Tadele G, Adamu S, Abebe T, Tadesse Y, Nega F, Kebede M, Muluye F, Matsentu A, Aklilu D. Impact of community-based health insurance on health services utilisation among vulnerable households in Amhara region, Ethiopia. BMC Health Serv Res 2023; 23:55. [PMID: 36658561 PMCID: PMC9850585 DOI: 10.1186/s12913-023-09024-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 09/29/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Ethiopia piloted community-based health insurance in 2011, and as of 2019, the programme was operating in 770 districts nationwide, covering approximately 7 million households. Enrolment in participating districts reached 50%, holding promise to achieve the goal of Universal Health Coverage in the country. Despite the government's efforts to expand community-based health insurance to all districts, evidence is lacking on how enrolment in the programme nudges health seeking behaviour among the most vulnerable rural households. This study aims to examine the effect of community-based health insurance enrolment among the most vulnerable and extremely poor households participating in Ethiopia's Productive Safety Net Programme on the utilisation of healthcare services in the Amhara region. METHODS Data for this study came from Amhara pilot integrated safety net programme baseline survey in Ethiopia and were collected between December 2018 and February 2019 from 5,398 households. We used propensity score matching method to estimate the impacts of enrolment in community-based health insurance on outpatient, maternal, and child preventive and curative healthcare services utilisation. RESULTS Results show that membership in community-based health insurance increases the probabilities of visiting health facilities for curative care in the past month by 8.2 percentage points (95% CI 5.3 to 11.1), seeking care from a health professional by 8.4 percentage points (95% CI 5.5 to 11.3), and visiting a health facility to seek any medical assistance for illness and check-ups in the past 12 months by 13.9 percentage points (95% CI 10.5 to 17.4). Insurance also increases the annual household per capita health facility visits by 0.84 (95% CI 0.64 to 1.04). However, we find no significant effects of community-based health insurance membership on utilisation of maternal and child healthcare services. CONCLUSIONS Findings that community-based health insurance increased outpatient services utilisation implies that it could also contribute towards universal health coverage and health equity in rural and informal sectors. The absence of significant effects on maternal and child healthcare services may be due to the free availability of such services for everyone at the public health facilities, regardless of insurance membership. Outpatient services use among insured households is still not universal, and understanding of the barriers to use, including supply-side constraints, will help improve universal health coverage.
Collapse
Affiliation(s)
- Essa Chanie Mussa
- UNICEF Office of Research—Innocenti, Via Degli Alfani 58, Florence, 50121 Italy ,grid.59547.3a0000 0000 8539 4635Department of Agricultural Economics, University of Gondar, Gondar, Ethiopia
| | - Tia Palermo
- grid.273335.30000 0004 1936 9887Department of Epidemiology and Environmental Health, University at Buffalo (State University of New York), Buffalo, NY 14214-8001 USA
| | - Gustavo Angeles
- grid.10698.360000000122483208Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516 USA
| | - Martha Kibur
- UNICEF Country Office of Ethiopia, Box 1169, Addis Ababa, Ethiopia
| | - Frank Otchere
- UNICEF Office of Research—Innocenti, Via Degli Alfani 58, Florence, 50121 Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Comparing g-computation, propensity score-based weighting, and targeted maximum likelihood estimation for analyzing externally controlled trials with both measured and unmeasured confounders: a simulation study. BMC Med Res Methodol 2023; 23:18. [PMID: 36647031 PMCID: PMC9843888 DOI: 10.1186/s12874-023-01835-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To have confidence in one's interpretation of treatment effects assessed by comparing trial results to external controls, minimizing bias is a critical step. We sought to investigate different methods for causal inference in simulated data sets with measured and unmeasured confounders. METHODS The simulated data included three types of outcomes (continuous, binary, and time-to-event), treatment assignment, two measured baseline confounders, and one unmeasured confounding factor. Three scenarios were set to create different intensities of confounding effect (e.g., small and blocked confounding paths, medium and blocked confounding paths, and one large unblocked confounding path for scenario 1 to 3, respectively) caused by the unmeasured confounder. The methods of g-computation (GC), inverse probability of treatment weighting (IPTW), overlap weighting (OW), standardized mortality/morbidity ratio (SMR), and targeted maximum likelihood estimation (TMLE) were used to estimate average treatment effects and reduce potential biases. RESULTS The results with the greatest extent of biases were from the raw model that ignored all the potential confounders. In scenario 2, the unmeasured factor indirectly influenced the treatment assignment through a measured controlling factor and led to medium confounding. The methods of GC, IPTW, OW, SMR, and TMLE removed most of bias observed in average treatment effects for all three types of outcomes from the raw model. Similar results were found in scenario 1, but the results tended to be biased in scenario 3. GC had the best performance followed by OW. CONCLUSIONS The aforesaid methods can be used for causal inference in externally controlled studies when there is no large, unblockable confounding path for an unmeasured confounder. GC and OW are the preferable approaches.
Collapse
|
49
|
Vo TT. A cautionary note on the use of G-computation in population adjustment. Res Synth Methods 2023; 14:338-341. [PMID: 36633531 DOI: 10.1002/jrsm.1621] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 12/26/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023]
Abstract
In a recent issue of the Journal; Remiro-Azócar et al. introduce a new method to adjust for population difference between two trials; when the individual patient data (IPD) are only accessible for one study. The proposed method generates the covariate data for the trial without IPD; then using a G-computation approach to transport information about the treatment effect from the other study with IPD to this trial. The authors advocate the use of G-computation over matching-adjusted indirect comparison because (i) the former allows for "useful extrapolation" when there is poor case-mix overlap between populations; and (ii) nonparametric; data-adaptive methods can be used to reduce the risk of (outcome) model misspecification. In this commentary; we provide a different perspective from these arguments. Despite certain disagreements; we believe that the proposed data generation approaches can open new and interesting research directions for population adjustment methodology in the future.
Collapse
Affiliation(s)
- Tat-Thang Vo
- Department of Statistics and Data Science, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
50
|
Yamakawa S, Nagayama H, Tomori K, Ikeda K, Niimi A. Effectiveness of active occupational therapy in patients with acute stroke: A propensity score-weighted retrospective study. FRONTIERS IN REHABILITATION SCIENCES 2023; 3:1045231. [PMID: 36684684 PMCID: PMC9849931 DOI: 10.3389/fresc.2022.1045231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023]
Abstract
Background and purpose The effects of therapy and patient characteristics on rehabilitation outcomes in patients with acute stroke are unclear. We investigated the effects of intensive occupational therapy (OT) on patients with acute stroke. Methods We performed a retrospective cohort study using the 2005-2016 Japan Rehabilitation Database, from which we identified patients with stroke (n = 10,270) who were admitted to acute care hospitals (n = 37). We defined active OT (AOT) and non-AOT as OT intervention times (total intervention time/length of hospital stay) longer or shorter than the daily physical therapy intervention time, respectively. The outcomes assessed were the Functional Independence Measure (FIM) and National Institutes of Health Stroke Scale (NIHSS) scores, duration of hospitalization, and rate of discharge. Propensity scores and inverse probability of treatment weighting analyses adjusted for patient characteristics were performed to investigate the effects of AOT on patient outcomes. Results We enrolled 3,501 patients (1,938 and 1,563 patients in the AOT and non-AOT groups, respectively) in the study. After inverse probability of treatment weighting, the AOT group had a shorter length of hospitalization (95% confidence interval: -3.7, -1.3, p < 0.001), and the FIM (95% confidence interval: 2.0, 5.7, p < 0.001) and NIHSS (95% confidence interval; 0.3, 1.1, p < 0.001) scores improved significantly. Subgroup analysis showed that lower NHISS scores for aphasia, gaze, and neglect and lower overall NIHSS and FIM scores on admission led to a greater increase in FIM scores in the AOT group. Conclusions AOT improved the limitations in performing activities of daily living (ADL) and physical function in patients with acute stroke and reduced the length of hospitalization. Additionally, subgroup analysis suggested that the increase in FIM score was greater in patients with severe limitations in performing ADLs and worse cognitive impairment, such as neglect, on admission.
Collapse
Affiliation(s)
- Shiori Yamakawa
- Department of Occupational Therapy, Kinugasa Hospital, Yokosuka, Japan
| | - Hirofumi Nagayama
- Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Japan,Correspondence: Hirofumi Nagayama
| | - Kounosuke Tomori
- Department of Occupational Therapy, Tokyo University of Technology, Tokyo, Japan
| | - Kohei Ikeda
- Department of Occupational Therapy, Kinugasa Hospital, Yokosuka, Japan
| | - Ayaka Niimi
- Department of Occupational Therapy, Yokohama Brain and Spine Center, Yokohama, Japan
| |
Collapse
|