1
|
Truthmann J, Freyer Martins Pereira J, Richter A, Schuster F, Witte A, Böhm S, Greser A, Kamin P, Stracke S, Dörr M, Bülow R, Engeli S, Gágyor I, Hummers E, Chenot JF. Prednisolone Versus Colchicine for Acute Gout in Primary Care (COPAGO): protocol for a two-arm multicentre, pragmatic, prospective, randomized, double-blind, controlled clinical trial of prednisolone and colchicine for non-inferiority with a parallel group design. Trials 2023; 24:643. [PMID: 37798801 PMCID: PMC10557330 DOI: 10.1186/s13063-023-07666-6] [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: 07/12/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Gout is the most common form of rheumatic disease in which monosodium urate crystals are deposited in the joints followed by acute inflammatory reactions. There are various approved drugs that can be prescribed for pain relief during an acute gout attack. However, to date, no direct comparison of efficacy of colchicine and prednisolone for the treatment of acute gout attacks has been investigated. Furthermore, the majority of previous research studies were not only conducted in tertiary centres but also excluded patients with common comorbidities due to contraindications to naproxen. METHODS This pragmatic, prospective, double-blind, double-dummy, parallel-group, randomized, non-inferiority trial investigates whether prednisolone (intervention) is non-inferior to treatment with colchicine (active control) in patients with acute gout. Adult patients presenting with acute gout to their general practitioners in 60 practices across 3 university sites (Greifswald, Göttingen, and Würzburg) are eligible to participate in the study. Participants in the intervention group receive 30 mg prednisolone for 5 days. Those in the control group receive low-dose colchicine (day 1: 1.5 mg; days 2-5: 1 mg). The primary outcome is the absolute level of the most severe pain on day 3 (in the last 24 h) measured with an 11-item numerical rating scale. Day 0 is the day patients take their study medication for the first time. They are then asked to fill out a study diary the same time each day for pain quantification. Pain scores are used for comparison between the two medications. Secondary outcomes are average response to treatment, swelling, tenderness and physical function of the joint, patients' global assessment of treatment success, use of additional pain medication and non-pharmacological pain therapies. For safety reasons, potential side effects and course of systolic blood pressure are assessed. DISCUSSION This trial will provide evidence on the effectiveness of pain reduction and side effects of colchicine and prednisolone in acute gout in primary care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05698680 first posted on January 26, 2023 (retrospectively registered). URL of trial registry record: https://clinicaltrials.gov/study/NCT05698680.
Collapse
Affiliation(s)
- Julia Truthmann
- Department of General Practice, Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Germany.
| | - Julia Freyer Martins Pereira
- Department of General Practice, Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Germany
| | - Adrian Richter
- Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Germany
| | - Franziska Schuster
- Coordinating Center for Clinical Studies, University Medical Center Greifswald, Greifswald, Germany
| | - Amelie Witte
- Coordinating Center for Clinical Studies, University Medical Center Greifswald, Greifswald, Germany
| | - Susanne Böhm
- Coordinating Center for Clinical Studies, University Medical Center Greifswald, Greifswald, Germany
| | - Alexandra Greser
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Petra Kamin
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Sylvia Stracke
- Department of Internal Medicine, University Medical Center, Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine, University Medical Center, Greifswald, Germany
| | - Robin Bülow
- Institute for Radiology and Neuroradiology, University Medical Center Greifswald, Greifswald, Germany
| | - Stefan Engeli
- Coordinating Center for Clinical Studies, University Medical Center Greifswald, Greifswald, Germany
- Institute of Pharmacology, University Medical Center Greifswald, Greifswald, Germany
| | - Ildikó Gágyor
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Jean-François Chenot
- Department of General Practice, Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Germany
| |
Collapse
|
2
|
Lorenzo JPP, Sollano MHMZ, Salido EO, Li-Yu J, Tankeh-Torres SA, Wulansari Manuaba IAR, Rahman MM, Paul BJ, Mok MY, De Silva M, Padhan P, Lim AL, Marcial M, Vicera JJ, Haq SA, Salman S, Liyanage CK, Keen HI, Yew Kuang C, Wei JCC, Hellmi RY, Chan CE, Louthrenoo W. 2021 Asia-Pacific League of Associations for Rheumatology clinical practice guideline for treatment of gout. Int J Rheum Dis 2021; 25:7-20. [PMID: 34931463 DOI: 10.1111/1756-185x.14266] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Gout is the most prevalent inflammatory arthritis in the Asia-Pacific region and worldwide. This clinical practice guideline (CPG) aims to provide recommendations based on systematically obtained evidence and values and preferences tailored to the unique needs of patients with gout and hyperuricemia in Asia, Australasia, and the Middle East. The target users of these guidelines are general practitioners and specialists, including rheumatologists, in these regions. METHODS Relevant clinical questions were formulated by the Steering Committee. Systematic reviews of evidence were done, and certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation methodology. A multi-sectoral consensus panel formulated the final recommendations. RESULTS The Asia-Pacific League of Associations for Rheumatology Task Force developed this CPG for treatment of gout with 3 overarching principles and 22 recommendation statements that covered the treatment of asymptomatic hyperuricemia (2 statements), treatment of acute gout (4 statements), prophylaxis against gout flare when initiating urate-lowering therapy (3 statements), urate-lowering therapy (3 statements), treatment of chronic tophaceous gout (2 statements), treatment of complicated gout and non-responders (2 statements), treatment of gout with moderate to severe renal impairment (1 statement), and non-pharmacologic interventions (5 statements). CONCLUSION Recommendations for clinically relevant scenarios in the management of gout were formulated to guide physicians in administering individualized care.
Collapse
Affiliation(s)
| | | | - Evelyn O Salido
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Julie Li-Yu
- University of Santo Tomas, Manila, Philippines
| | | | | | | | | | - Mo Yin Mok
- Department of Biomedical Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | | | - Prasanta Padhan
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | | | | | | | - Syed Atiqul Haq
- Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sami Salman
- Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Chiranthi K Liyanage
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Helen I Keen
- University of Western and Perth, Perth, WA, Australia.,Murdoch University, Perth, WA, Australia
| | - Cheng Yew Kuang
- Farrer Park Medical Center, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Rakhma Yanti Hellmi
- Rheumatology Division, Dr Kariadi General Hospital Medical Center, Diponegoro University, Semarang, Indonesia
| | | | - Worawit Louthrenoo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
3
|
Abstract
Gout flares are central to the patient experience of gout and are included in the Outcome Measures in Rheumatology (OMERACT) core outcome domain set for long-term gout studies. Although a valid definition for gout flare has been developed, there is no consensus around how flare outcomes are measured and reported in long-term clinical studies. Current methods of flare measurement, which are centered on measuring flares as a binary outcome (i.e., present vs absent), do not reflect the variable pattern of flares over time, nor the multidimensional patient experience of gout flares which include factors related to pain severity, functional disability, impact on family and social life, and psychological wellbeing. This review will discuss the importance and challenges of gout flare measurement.
Collapse
Affiliation(s)
- Sarah Stewart
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand.
| | - Angelo Gaffo
- Department of Medicine, University of Alabama and Birmingham, Alabama, United States.
| |
Collapse
|
4
|
Zeng L, Qasim A, Neogi T, Fitzgerald JD, Dalbeth N, Mikuls TR, Guyatt GH, Brignardello-Petersen R. Efficacy and Safety of Pharmacologic Interventions in Patients Experiencing a Gout Flare: A Systematic Review and Network Meta-Analysis. Arthritis Care Res (Hoboken) 2021; 73:755-764. [PMID: 32741131 PMCID: PMC10572733 DOI: 10.1002/acr.24402] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/23/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare the relative efficacy and safety of pharmacologic antiinflammatory interventions for gout flares. METHODS We searched Ovid Medline, Embase, and Cochrane library for randomized controlled trials (RCTs) that compared pharmacologic antiinflammatory treatment of gout flares. We conducted a network meta-analysis (NMA) using a frequentist framework and assessed the certainty of evidence and made conclusions using the Grading of Recommendations Assessment, Development, and Evaluation for NMA. RESULTS In the 30 eligible RCTs, canakinumab provided the highest pain reduction at day 2 and at longest follow-up (mean difference relative to acetic acid derivative nonsteroidal antiinflammatory drugs [NSAIDs] -41.12 [95% confidence interval (95% CI) -53.36, -29.11] on a 0-100 scale at day 2, and mean difference -12.84 [95% CI -20.76, -4.91] at longest follow-up; both moderate certainty; minimum important difference -19). Intravenous or intramuscular corticosteroids were inferior to canakinumab but may be better than the other commonly used interventions (low to very low certainty). For joint tenderness, canakinumab may be the most effective intervention at day 2. Acetic acid derivative NSAIDs improved joint swelling better than ibuprofen NSAIDs at day 2 (mean difference -0.29 [95% CI -0.56, -0.02] on a 0-4 scale; moderate certainty) and improved patient global assessment (PtGA) greater than ibuprofen NSAIDs at the longest follow-up (mean difference -0.44 [95% CI -0.86, -0.02]; moderate). CONCLUSION Canakinumab may be superior to other alternatives and intravenous or intramuscular corticosteroids may be the second best in pain reduction. Acetic acid derivative NSAIDs may be superior to ibuprofen NSAIDs in improving joint swelling and PtGA.
Collapse
Affiliation(s)
- Linan Zeng
- West China Second University Hospital, Sichuan University, Chengdu, China, and McMaster University, Hamilton, Ontario, Canada
| | - Anila Qasim
- McMaster University, Hamilton, Ontario, Canada
| | | | - John D Fitzgerald
- University of California, Los Angeles and VA Greater Los Angeles Health Care System, Los Angeles, California
| | | | - Ted R Mikuls
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha
| | | | | |
Collapse
|
5
|
Janssen CA, Oude Voshaar MAH, Ten Klooster PM, Vonkeman HE, van de Laar MAFJ. Development and validation of a patient-reported gout attack intensity score for use in gout clinical studies. Rheumatology (Oxford) 2019; 58:1928-1934. [PMID: 30859221 PMCID: PMC6812713 DOI: 10.1093/rheumatology/kez064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/04/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Inflammation-related symptoms such as pain, swelling and tenderness of the affected joint are frequently assessed using 5-point diary rating scales in gout clinical trials. Combining these into a single gout attack symptom intensity score may be a useful summary measure for these data, which is potentially more responsive to change compared with the individual components. The objective of this study was to develop a patient-reported gout flare intensity score, the Gout Attack Intensity Score (GAIS), for use in clinical studies, that includes components for gout-related pain, swelling and tenderness. METHODS Data from a randomized controlled trial comparing anakinra to standard of care for the treatment of acute gout attacks were used for this study. A 7-day flare diary was completed by patients, including questions relating to intensity of pain, swelling and tenderness (5-point rating scales). Scalability of these items was assessed using Mokken Scale Analysis, and reliability using greatest lower bound reliability coefficients. Known-groups validity was evaluated, as well as the responsiveness to change and the presence of floor and ceiling effects. RESULTS Scalability of the single items was supported, and GAIS scores were reliable (greatest lower bound >0.80). GAIS scores demonstrated responsiveness to change with high effect sizes (>0.8), and discriminated better between responders and non-responders compared with its single-item components. No floor and ceiling effects were found. CONCLUSION The GAIS seems to be a reliable and responsive instrument for assessing patient-reported gout attack intensity that may be used in gout clinical studies.
Collapse
Affiliation(s)
- Carly A Janssen
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Martijn A H Oude Voshaar
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Peter M Ten Klooster
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Harald E Vonkeman
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Mart A F J van de Laar
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
| |
Collapse
|
6
|
Vranken L, Boonen A, Spaetgens B. Outcome measurement in acute gout: about constructs, perspectives, scales and timing. Rheumatology (Oxford) 2019; 58:1891-1893. [PMID: 31502647 DOI: 10.1093/rheumatology/kez198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/17/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Care and Pubic Health Research Institute (CAPHRI), University Maastricht, Maastricht, The Netherlands
| | - Bart Spaetgens
- Department of Internal Medicine, Maastricht, The Netherlands
| |
Collapse
|
7
|
Janssen CA, Oude Voshaar MAH, Ten Klooster PM, Jansen TLTA, Vonkeman HE, van de Laar MAFJ. A systematic literature review of patient-reported outcome measures used in gout: an evaluation of their content and measurement properties. Health Qual Life Outcomes 2019; 17:63. [PMID: 30975212 PMCID: PMC6460780 DOI: 10.1186/s12955-019-1125-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/26/2019] [Indexed: 01/01/2023] Open
Abstract
Background Gout is a common, monosodium urate crystal-driven inflammatory arthritis. Besides its clinical manifestations, patients often also suffer from pain, physical impairment, emotional distress and work productivity loss, as a result of the disease. Patient-reported outcome measures (PROMs) are commonly used to assess these consequences of the disease. However, current instrument endorsements for measuring such outcomes in acute and chronic gout clinical settings are based on limited psychometric evidence. The objective of this systematic literature review was to identify currently available PROMs for gout, and to critically evaluate their content and psychometric properties, in order to evaluate the current status regarding PROMs for use in gout patients. Methods Systematic literature searches were performed in the PubMed and EMBASE databases. The methodological quality of included papers was appraised using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist, and evaluation of measurement properties (reliability, responsiveness, construct validity, floor and ceiling effects) was done in accordance with published quality criteria. Item content was appraised by linking health concepts to the International Classification of Functioning Disability and Health (ICF) framework. Results In total, 13 PROMs were identified, of which three were targeted specifically at gout patients. The majority of the PROMs were rated positively for content validity. For most instruments, limited evidence was available for construct validity and reliability. Instruments to assess pain scored well on responsiveness and floor and ceiling effects, but not much is known about their reliability in gout. Conclusions The physical functioning subscale of the SF-36v2 (Short Form-36 item version 2) is the only PROM that had sufficient supporting evidence for all its psychometric properties. Many of the commonly used PROMs in gout are currently not yet well supported and more studies on their measurement properties are needed among both acute and chronic gout populations. Electronic supplementary material The online version of this article (10.1186/s12955-019-1125-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Carly A Janssen
- Department of Psychology, Health and Technology, University of Twente, PO BOX 217, 7500 AE, Enschede, the Netherlands.
| | - Martijn A H Oude Voshaar
- Department of Psychology, Health and Technology, University of Twente, PO BOX 217, 7500 AE, Enschede, the Netherlands
| | - Peter M Ten Klooster
- Department of Psychology, Health and Technology, University of Twente, PO BOX 217, 7500 AE, Enschede, the Netherlands
| | - Tim L Th A Jansen
- Department of Rheumatology, VieCuri Medical Center, Venlo, The Netherlands
| | - Harald E Vonkeman
- Department of Psychology, Health and Technology, University of Twente, PO BOX 217, 7500 AE, Enschede, the Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Mart A F J van de Laar
- Department of Psychology, Health and Technology, University of Twente, PO BOX 217, 7500 AE, Enschede, the Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
| |
Collapse
|
8
|
Kiltz U, Smolen J, Bardin T, Cohen Solal A, Dalbeth N, Doherty M, Engel B, Flader C, Kay J, Matsuoka M, Perez-Ruiz F, da Rocha Castelar-Pinheiro G, Saag K, So A, Vazquez Mellado J, Weisman M, Westhoff TH, Yamanaka H, Braun J. Treat-to-target (T2T) recommendations for gout. Ann Rheum Dis 2016; 76:632-638. [PMID: 27658678 DOI: 10.1136/annrheumdis-2016-209467] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 08/26/2016] [Accepted: 08/27/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The treat-to-target (T2T) concept has been applied successfully in several inflammatory rheumatic diseases. Gout is a chronic disease with a high burden of pain and inflammation. Because the pathogenesis of gout is strongly related to serum urate levels, gout may be an ideal disease in which to apply a T2T approach. Our aim was to develop international T2T recommendations for patients with gout. METHODS A committee of experts with experience in gout agreed upon potential targets and outcomes, which was the basis for the systematic literature search. Eleven rheumatologists, one cardiologist, one nephrologist, one general practitioner and one patient met in October 2015 to develop T2T recommendations based on the available scientific evidence. Levels of evidence, strength of recommendations and levels of agreement were derived. RESULTS Although no randomised trial was identified in which a comparison with standard treatment or an evaluation of a T2T approach had been performed in patients with gout, indirect evidence was provided to focus on targets such as normalisation of serum urate levels. The expert group developed four overarching principles and nine T2T recommendations. They considered dissolution of crystals and prevention of flares to be fundamental; patient education, ensuring adherence to medications and monitoring of serum urate levels were also considered to be of major importance. CONCLUSIONS This is the first application of the T2T approach developed for gout. Since no publication reports a trial comparing treatment strategies for gout, highly credible overarching principles and level D expert recommendations were created and agreed upon.
Collapse
Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, and Ruhr University Bochum, Herne, Germany
| | - J Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - T Bardin
- Assisitance Publique Hôpitaux de Paris Rheumatology Department, Lariboisière Hospital, University Paris Diderot, Sorbonne Paris-Cité and INSERM, UMR 1132, Paris, France
| | - A Cohen Solal
- Research Medical Unit INSERM, Université Paris VII-Denis Diderot Assistance Publique-Hôpitaux de Paris, Service de Cardiologie, Hôpital Lariboisière, Paris, France
| | - N Dalbeth
- University of Auckland and Auckland District Health Board, Auckland, New Zealand
| | - M Doherty
- University of Nottingham, Nottingham, UK
| | - B Engel
- Medical Faculty, Institute of General Practice and Family Medicine, University Bonn, Bonn, Germany
| | - C Flader
- Rheumazentrum Ruhrgebiet, and Ruhr University Bochum, Herne, Germany
| | - J Kay
- UMass Memorial Medical Center and University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - M Matsuoka
- Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - F Perez-Ruiz
- Rheumatology Division, Hospital de Cruces, Baracaldo, Vizcaya, Spain
| | | | - K Saag
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - A So
- Service de Rhumatologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - J Vazquez Mellado
- Servicio de Reumatología, Hospital General de México, México City, México
| | - M Weisman
- Division of Rheumatology, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - T H Westhoff
- Medical Department I, Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - H Yamanaka
- Tokyo Women's Medical University, Tokyo, Japan
| | - J Braun
- Rheumazentrum Ruhrgebiet, and Ruhr University Bochum, Herne, Germany
| |
Collapse
|
9
|
Rock C, Thom KA, Harris AD, Li S, Morgan D, Milstone AM, Caffo B, Joshi M, Leekha S. A Multicenter Longitudinal Study of Hospital-Onset Bacteremia: Time for a New Quality Outcome Measure? Infect Control Hosp Epidemiol 2016; 37:143-8. [PMID: 26493213 PMCID: PMC4731295 DOI: 10.1017/ice.2015.261] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Central-line-associated bloodstream infection (CLABSI) rate is an important quality measure, but it suffers from subjectivity and interrater variability, and decreasing national CLABSI rates may compromise its power to discriminate between hospitals. This study evaluates hospital-onset bacteremia (HOB, ie, any positive blood culture obtained 48 hours post admission) as a healthcare-associated infection-related outcome measure by assessing the association between HOB and CLABSI rates and comparing the power of each to discriminate quality among intensive care units (ICUs). METHODS In this multicenter study, ICUs provided monthly CLABSI and HOB rates for 2012 and 2013. A Poisson regression model was used to assess the association between these 2 rates. We compared the power of each measure to discriminate between ICUs using standardized infection ratios (SIRs) with 95% confidence intervals (CIs). A measure was defined as having greater power to discriminate if more of the SIRs (with surrounding CIs) were different from 1. RESULTS In 80 ICUs from 16 hospitals in the United States and Canada, a total of 663 CLABSIs, 475,420 central line days, 11,280 HOBs, and 966,757 patient days were reported. An absolute change in HOB of 1 per 1,000 patient days was associated with a 2.5% change in CLABSI rate (P<.001). Among the 80 ICUs, 20 (25%) had a CLABSI SIR and 60 (75%) had an HOB SIR that was different from 1 (P<.001). CONCLUSION Change in HOB rate is strongly associated with change in CLABSI rate and has greater power to discriminate between ICU performances. Consideration should be given to using HOB to replace CLABSI as an outcome measure in infection prevention quality assessments.
Collapse
Affiliation(s)
- Clare Rock
- 1Department of Medicine,Division of Infectious Diseases,Johns Hopkins University,Baltimore,Maryland
| | - Kerri A Thom
- 2Department of Epidemiology and Public Health,University of Maryland School of Medicine,Baltimore,Maryland
| | - Anthony D Harris
- 2Department of Epidemiology and Public Health,University of Maryland School of Medicine,Baltimore,Maryland
| | - Shanahan Li
- 3Department of Biostatistics,Indiana University Fairbanks School of Public Health,Indianapolis,Indiana
| | - Daniel Morgan
- 2Department of Epidemiology and Public Health,University of Maryland School of Medicine,Baltimore,Maryland
| | - Aaron M Milstone
- 4Department of Pediatrics,Division of Pediatric Infectious Diseases,Johns Hopkins University School of Medicine,Baltimore,Maryland
| | - Brian Caffo
- 5Department of Biostatistics,Bloomberg School of Public Health,Johns Hopkins University,Baltimore,Maryland
| | - Manjari Joshi
- 6Division of Infectious Diseases,University of Maryland Medical Center,School of Medicine,Baltimore,Maryland
| | - Surbhi Leekha
- 2Department of Epidemiology and Public Health,University of Maryland School of Medicine,Baltimore,Maryland
| |
Collapse
|
10
|
Ulloa RE, Apiquian R, Victoria G, Arce S, González N, Palacios L. Validity and reliability of the Spanish version of the Personal and Social Performance scale in adolescents with schizophrenia. Schizophr Res 2015; 164:176-80. [PMID: 25728908 DOI: 10.1016/j.schres.2015.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Personal and Social Performance (PSP) scale is a widely used tool to evaluate adults with schizophrenia; however, more studies are needed regarding its usefulness in the assessment of adolescent patients, since the evaluation of their functioning could require adaptations according to development. OBJECTIVE To examine construct validity, convergent validity, internal consistency and interrater reliability of the PSP in a sample of Mexican adolescents with schizophrenia. METHODS A total of 40 patients with a DSM-IV diagnosis of schizophrenia or schizophreniform disorder were evaluated with PSP, CGAS, PANSS and the MATRICS battery. Construct and convergent validity were determined by the correlation between PSP with PANSS factors, MATRICS dimensions and CGAS. In addition, reliability was evaluated with Cronbach's alpha and intraclass correlation coefficients. RESULTS PSP scores correlated with negative, excitement and cognitive factors of PANSS, CGAS as well as MATRICS domains. The PSP also showed high internal consistency and interrater reliability. CONCLUSIONS The PSP is a valid and reliable instrument for the assessment of adolescent patients.
Collapse
Affiliation(s)
- Rosa-Elena Ulloa
- Child Psychiatric Hospital Dr. Juan N Navarro, Mexico City, Mexico.
| | - Rogelio Apiquian
- Arete Proyectos, Mexico City, Mexico; Universidad de las Américas, Mexico City, Mexico
| | | | - Sofía Arce
- Child Psychiatric Hospital Dr. Juan N Navarro, Mexico City, Mexico
| | | | - Lino Palacios
- Instituto Nacional de Psiquiatría, Mexico City, Mexico
| |
Collapse
|
11
|
Outcome Measures for Gout Clinical Trials: a Summary of Progress. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2015. [DOI: 10.1007/s40674-015-0014-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
12
|
Singh JA, Taylor WJ, Dalbeth N, Simon LS, Sundy J, Grainger R, Alten R, March L, Strand V, Wells G, Khanna D, McQueen F, Schlesinger N, Boonen A, Boers M, Saag KG, Schumacher HR, Edwards NL. OMERACT endorsement of measures of outcome for studies of acute gout. J Rheumatol 2013; 41:569-73. [PMID: 24334651 DOI: 10.3899/jrheum.131246] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the extent to which participants at the Outcome Measures in Rheumatology (OMERACT) 11 meeting agree that instruments used in clinical trials to measure OMERACT core outcome domains in acute gout fulfill OMERACT filter requirements of truth, discrimination, and feasibility; and where future research efforts need to be directed. METHODS Results of a systematic literature review and analysis of individual-level data from recent clinical studies of acute gout were presented to OMERACT participants. The information was discussed in breakout groups, and opinion was defined by subsequent voting in a plenary session. Endorsement was defined as at least 70% of participants voting in agreement with the proposition (where the denominator excluded those participants who did not vote or who voted "don't know"). RESULTS The following measures were endorsed for use in clinical trials of acute gout: (1) 5-point Likert scale and/or visual analog scale (0 to 100 mm) to measure pain; (2) 4-point Likert scale for joint swelling; (3) 4-point Likert scale for joint tenderness; and (4) 5-point Likert scale for patient global assessment of response to treatment. Measures for the activity limitations domain were not endorsed. CONCLUSION Measures of pain, joint swelling, joint tenderness, and patient global assessment in acute gout were endorsed at OMERACT 11. These measures should now be used in clinical trials of acute gout.
Collapse
Affiliation(s)
- Jasvinder A Singh
- From Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Medicine, University of Otago, Wellington; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; SDG LLC, Cambridge, Massachusetts,; Duke University School of Medicine, Durham, North Carolina, USA, and Duke-National University of Singapore Graduate Medical School, Singapore; Schlosspark-Klinik Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Sydney Institute of Bone and Joint Research and Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia; Stanford University Division of Immunology and Rheumatology, Portolo Valley, California, USA; University of Ottawa, London, Ontario, Canada; University of Michigan Medical School, Ann Arbor, Michigan, USA; University of Auckland, Department of Molecular Medicine and Pathology, Grafton, Auckland, New Zealand; Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Maastricht University Medical Center, Division of Rheumatology, and Caphri Research Institute, University Maastricht; VU University Medical Center, Amsterdam, the Netherlands; University of Pennsylvania and Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Department of Rheumatology, University of Florida, Gainsville, Florida, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|