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Woudstra K, Tummers M, Klijn CJM, Sondag L, Schreuder F, Reuzel R, Rovers M. Participatory methods used in the evaluation of medical devices: a comparison of focus groups, interviews, and a survey. BMC Health Serv Res 2024; 24:462. [PMID: 38609933 PMCID: PMC11015660 DOI: 10.1186/s12913-024-10887-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Stakeholder engagement in evaluation of medical devices is crucial for aligning devices with stakeholders' views, needs, and values. Methods for these engagements have however not been compared to analyse their relative merits for medical device evaluation. Therefore, we systematically compared these three methods in terms of themes, interaction, and time-investment. METHODS We compared focus groups, interviews, and an online survey in a case-study on minimally invasive endoscopy-guided surgery for patients with intracerebral haemorrhage. The focus groups and interviews featured two rounds, one explorative focussing on individual perspectives, and one interactive focussing on the exchange of perspectives between participants. The comparison between methods was made in terms of number and content of themes, how participants interact, and hours invested by all researchers. RESULTS The focus groups generated 34 themes, the interviews 58, and the survey 42. Various improvements for the assessment of the surgical procedure were only discussed in the interviews. In focus groups, participants were inclined to emphasise agreement and support, whereas the interviews consisted of questions and answers. The total time investment for researchers of focus groups was 95 h, of interviews 315 h, and survey 81 h. CONCLUSIONS Within the context of medical device evaluation, interviews appeared to be the most appropriate method for understanding stakeholder views since they provide a scope and depth of information that is not generated by other methods. Focus groups were useful to rapidly bring views together. Surveys enabled a quick exploration. Researchers should account for these methodological differences and select the method that is suitable for their research aim.
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Affiliation(s)
- Kas Woudstra
- Department of Health Evidence, Radboudumc, Nijmegen, Netherlands.
- Department of Operating Rooms, Radboudumc, Nijmegen, Netherlands.
| | - Marcia Tummers
- Department of Health Evidence, Radboudumc, Nijmegen, Netherlands
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboudumc, Nijmegen, Netherlands
| | - Lotte Sondag
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboudumc, Nijmegen, Netherlands
| | - Floris Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboudumc, Nijmegen, Netherlands
| | - Rob Reuzel
- Department of Health Evidence, Radboudumc, Nijmegen, Netherlands
| | - Maroeska Rovers
- Department of Operating Rooms, Radboudumc, Nijmegen, Netherlands
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Klarenbeek SE, Aarts MJ, van den Heuvel MM, Prokop M, Tummers M, Schuurbiers-Siebers OCJ. Impact of time-to-treatment on survival for early-stage non-small cell lung cancer in The Netherlands-a nationwide observational cohort study. Transl Lung Cancer Res 2023; 12:2015-2029. [PMID: 38025812 PMCID: PMC10654436 DOI: 10.21037/tlcr-23-256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/29/2023] [Indexed: 12/01/2023]
Abstract
Background Varied outcomes on the relation between time-to-treatment and survival in early-stage non-small cell lung cancer (NSCLC) patients are reported. We examined this relation in a large multicentric retrospective cohort study and identified factors associated with extended time-to-treatment. Methods We included 9,536 patients with clinical stage I-II NSCLC, diagnosed and treated in 2014-2019, from the Netherlands Cancer Registry that includes nation-wide data. Time-to-treatment was defined as the number of days between first outpatient visit for suspected lung cancer and start of treatment. The effect of extended time-to-treatment beyond the first quartile and survival was studied with Cox proportional hazard regression. Analyses were stratified for stage and type of therapy. Time-to-treatment was adjusted for multiple covariates including performance status and socioeconomic status. Factors associated with treatment delay were identified by multilevel logistic regression. Results Median time-to-treatment was 47 days [interquartile range (IQR): 34-65] for stage I and 46 days (IQR: 34-62) for stage II. The first quartile extended to 33 days for both stages. Risk of death increased significantly with extended time-to-treatment for surgical treatment of clinical stage II patients [adjusted hazard ratio (aHR) >33 days: 1.36, 95% confidence intervals (CI): 1.09-1.70], but not in stage II patients treated with radiotherapy or in stage I patients. Causes of prolonged time-to-treatment were multifactorial including diagnostic tests, such as endoscopic ultrasound (EUS) or endobronchial ultrasound (EBUS). Conclusions Clinical stage II patients benefit from fast initiation of surgical treatment. Surprisingly this appears to be accounted for by patients who are clinically stage II but pathologically stage I. Further study is needed on characterizing these patients and the significance of lymph node- or distant micrometastasis in guiding time-to-treatment and treatment strategy.
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Affiliation(s)
- Sosse E. Klarenbeek
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mieke J. Aarts
- Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Michel M. van den Heuvel
- Department of Pulmonary Diseases, Radboud Institute for Molecular Life Sciences, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcia Tummers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olga C. J. Schuurbiers-Siebers
- Department of Pulmonary Diseases, Radboud Institute for Molecular Life Sciences, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Pruijn IMJ, van Heemskerken P, Kunst HPM, Tummers M, Kievit W. Patient-preferred outcomes in patients with vestibular schwannoma: a qualitative content analysis of symptoms, side effects and their impact on health-related quality of life. Qual Life Res 2023; 32:2887-2897. [PMID: 37258945 PMCID: PMC10474211 DOI: 10.1007/s11136-023-03433-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE During counseling and management of patients with vestibular schwannoma (VS), the emphasis is shifting from tumour control and nerve preservation towards maintaining or improving health-related quality of life (HRQoL). Understanding the patients' perspective and impact of VS is, therefore, of utmost importance. The current study aimed to identify treatment outcomes preferred by patients and to explore the patient-reported VS symptoms and management-related side effects and their impact on HRQoL. METHODS Patients with VS were contacted through the Dutch VS association Stichting Hoormij and questioned using a semi-structured, cross-sectional online survey. Patients were asked to report and rank symptoms and side effects, with their impact on HRQoL and frequency of occurrence. Results were structured through qualitative content analysis. Coded symptoms, side effects, impacts, frequencies, and patient-preferred outcomes were analysed and summarized with descriptive statistics. RESULTS Of the 231 respondents, 71% were actively treated. Hearing (symptoms vs. side effects: 78.8% vs. 63.6%), balance (62.3%; 48.8%), and energy issues (33.8%; 32.6%) were the most frequently mentioned symptoms and management-related side effects. Fatigue, deafness, headaches, and hearing loss had the highest impact on HRQoL. The majority of patients identified hearing preservation (61%), balance preservation (38.5%), and reduced tinnitus (34.6%) to be the patient-preferred outcomes. CONCLUSION This qualitative study demonstrates that in this population many patients with VS encounter participation difficulties in their daily physical and social activities and value hearing and balance preservation, reduced tinnitus, and restored energy as preferred outcomes as they are hampered by symptoms and side effects related to hearing, balance, and energy. Healthcare professionals should consider these key points and use these and the patient-preferred outcomes in consultation, shared decision making, treatment, and follow-up to optimize patient-centred care.
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Affiliation(s)
- Ineke M J Pruijn
- Department of Otorhinolaryngology, Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6525 EX, Nijmegen, The Netherlands.
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center, Nijmegen/Maastricht, The Netherlands.
| | - Phylisha van Heemskerken
- Department of Otorhinolaryngology, Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6525 EX, Nijmegen, The Netherlands
- Department of Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Henricus P M Kunst
- Department of Otorhinolaryngology, Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6525 EX, Nijmegen, The Netherlands
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center, Nijmegen/Maastricht, The Netherlands
- Department of Otorhinolaryngology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marcia Tummers
- Department of Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Wietske Kievit
- Department of Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Woudstra K, Reuzel R, Rovers M, Tummers M. An Overview of Stakeholders, Methods, Topics, and Challenges in Participatory Approaches Used in the Development of Medical Devices: A Scoping Review. Int J Health Policy Manag 2022; 12:6839. [PMID: 37579489 PMCID: PMC10125077 DOI: 10.34172/ijhpm.2022.6839] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 09/23/2022] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND There is a wide variety of participatory approaches to involve stakeholders in the development of medical devices, but there is no comprehensive overview of these approaches. We therefore studied what participatory approaches are used in the development of medical devices as well as the most important characteristics and challenges of these approaches. METHODS We conducted a scoping review and searched PubMed, Embase and Web of Science for articles published between July 2014 and July 2019. Papers were included if they presented original research featuring any form of stakeholder participation in the development of medical devices. We used The Spectrum of Public Participation to categorise the approach of each paper. Subsequently, we described the characteristics of each approach: the stakeholders involved, data collection methods, and topics addressed. We also identified challenges of the approaches as reported by researchers. RESULTS 277 papers were included, which could be categorised into three levels of participation: collaboration, involvement, and consultation. Patients and healthcare professionals are frequently engaged in all approaches. The most often used methods are workshops in the collaboration approach papers, and interviews in the involvement and consultation approach papers. Topics addressed in all approaches are: the problem, device requirements, design choices, testing, and procedural aspects of involvement. Reported challenges entail issues related to sampling, analysis, social dynamics, feasibility, and the limited number of topics that can be addressed. CONCLUSION Participatory approaches reported in literature can be categorised in three overarching approaches that have comparable methodological characteristics. This suggests that if researchers want to apply a participatory approach it is not necessary to adopt a pre-determined approach, such as 'participatory action research' (PAR). Instead, they can independently determine the degree of participation, stakeholders, methods, topics, and strategies to account for challenges, making sure the participatory approach fits their research question and context.
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Affiliation(s)
- Kas Woudstra
- Department of Health Evidence and Operation Rooms, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob Reuzel
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maroeska Rovers
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcia Tummers
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
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Scholte M, Woudstra K, Grutters JPC, Hannink G, Tummers M, Reuzel RPB, Rovers MM. Towards early and broad evaluation of innovative surgical devices: integrating evidence synthesis, stakeholder involvement, and health economic modeling into the clinical research stages of the IDEAL framework. BMJ Surg Interv Health Technologies 2022; 4:e000153. [PMID: 36110424 PMCID: PMC9442474 DOI: 10.1136/bmjsit-2022-000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/20/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Mirre Scholte
- Operating Rooms, Radboud Institute of Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Kas Woudstra
- Operating Rooms, Radboud Institute of Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Janneke P C Grutters
- Operating Rooms and Health Evidence, Radboud Institute of Health Sciences, Radboudumc, Nijmegen, Netherlands
| | - Gerjon Hannink
- Operating Rooms, Radboud Institute of Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Marcia Tummers
- Health Evidence, Radboud Institute of Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Rob P B Reuzel
- Health Evidence, Radboud Institute of Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Maroeska M Rovers
- Operating Rooms and Health Evidence, Radboud Institute of Health Sciences, Radboudumc, Nijmegen, Netherlands
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Grutters JPC, Kluytmans A, van der Wilt GJ, Tummers M. Methods for Early Assessment of the Societal Value of Health Technologies: A Scoping Review and Proposal for Classification. Value Health 2022; 25:1227-1234. [PMID: 35168892 DOI: 10.1016/j.jval.2021.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 11/23/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Early assessments of health technologies help to better align and integrate their development and assessment. Such assessments can take many forms and serve different purposes, hampering users in their selection of the most appropriate method for a specific goal. The aim of this scoping review was to structure the large set of methods according to their specific goal. METHODS A scoping review was conducted using PubMed and reference lists of retrieved articles, to identify review studies with a methodological focus. From the included reviews, all individual methods were listed. Based on additional literature and examples, we extracted the specific goal of each method. All goals were clustered to derive a set of subclasses and methods were grouped into these subclasses. RESULTS Of the 404 screened, 5 reviews were included, and 1 was added when searching reference lists. The reviews described 56 methods, of which 43 (77%) were included and classified as methods to (1) explore the nature and magnitude of the problem, (2) estimate the nature and magnitude of the expected (societal) value, (3) identify conditions for the potential value to materialize, and (4) help develop and design the type of research that is needed. CONCLUSIONS The wide range of methods for exploring the societal value of health technologies at an early stage of development can be subdivided into a limited number of classes, distinguishing methods according to their specific objective. This facilitates selection of appropriate methods, depending on the specific needs and aims.
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Affiliation(s)
| | - Anouck Kluytmans
- Faculty of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gert Jan van der Wilt
- Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - Marcia Tummers
- Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
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Ter Haar ELM, Tummers M, Bronkhorst EM, van de Kerkhof PCM, de Jong EMGJ, Lubeek SFK. Age-based treatment differences in and reluctance to treating older adults with systemic antipsoriatic therapy - a mixed-method pilot study. J DERMATOL TREAT 2022; 33:2983-2990. [PMID: 35762362 DOI: 10.1080/09546634.2022.2089330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Evidence-based guidance in older adults (≥65 years) with psoriasis is sparse and undertreatment might be present. OBJECTIVES To assess prescribing patterns, comfort levels, barriers and needs of dermatologists when treating older adults with systemic antipsoriatic therapy. METHODS A mixed-methods design was used including a survey among all Dutch dermatologists and residents, followed by semi-structured interviews. RESULTS Most of the survey respondents applied systemic treatment to the same extent in older versus younger patients (n = 49; 67.1%) and weren't reluctant prescribing systemic therapy (n = 50; 68.5%) in older adults. However, 26% (n = 19) of the respondents treated older adults less often with systemic therapy compared to younger patients and 68.1% (n = 49) performed additional actions in older adults, e.g. intensified monitoring or dose reduction. Based on the survey and interviews (n = 10), the main reasons for these age-based treatment differences were comorbidity, comedication, and fear of adverse events. More evidence-based guidance, education, and time to assess older adults were identified as most important needs, especially regarding frailty screening. CONCLUSIONS Age-based treatment differences in and reluctance to treating older adults with systemic antipsoriatic therapy were common. There is a need for more evidence-based guidance, education, and consultation time, to improve treatment in this growing population.
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Affiliation(s)
- Elke L M Ter Haar
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcia Tummers
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewald M Bronkhorst
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Satish F K Lubeek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Klarenbeek SE, Aarts MJ, van den Heuvel MM, Prokop M, Tummers M, Schuurbiers OCJ. Impact of time-to-treatment on survival for advanced non-small cell lung cancer patients in the Netherlands: a nationwide observational cohort study. Thorax 2022; 78:467-475. [PMID: 35450944 DOI: 10.1136/thoraxjnl-2021-218059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 03/21/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND The assumption that more rapid treatment improves survival of advanced non-small cell lung cancer (NSCLC) has not yet been proven. We studied the relation between time-to-treatment and survival in advanced stage NSCLC patients in a large multicentric nationwide retrospective cohort. Additionally, we identified factors associated with delay. METHOD We selected 10 306 patients, diagnosed and treated between 2014 and 2019 for clinical stage III and IV NSCLC, from the Netherlands Cancer Registry that includes nationwide data from 109 Dutch hospitals. Associations between survival and time-to-treatment were tested with Cox proportional hazard regression analyses. Time-to-treatment was adjusted for multiple covariates including diagnostic procedures and type of therapy. Factors associated with delay were identified by multilevel logistic regression. RESULTS Risk of death significantly decreased with longer time-to-treatment for stage III patients receiving only radiotherapy (adjusted HR, aHR >21 days: 0.59 (95% CI 0.48 to 0.73)) or any type of systemic therapy (aHR >49 days: 0.72 (95% CI 0.56 to 0.91)) and stage IV patients receiving chemotherapy and/or immunotherapy (aHR >21 days: 0.81 (95% CI 0.73 to 0.88)). No significant association was found for stage III patients treated with chemoradiotherapy and stage IV patients treated with targeted therapy. More complex diagnostic procedures often delay treatment. CONCLUSION Although in general it is important to start treatment as early as possible, our study finds no evidence that a more rapid start of treatment improves outcomes in advanced stage NSCLC patients. The benefit of urgent treatment is probably confounded by unmeasured patient and tumour characteristics and, clinical urgency dictating timelines of treatment. Time-to-treatment and its impact should be continuously evaluated as therapeutic strategies continue to evolve and improve.
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Affiliation(s)
- Sosse E Klarenbeek
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mieke J Aarts
- Research and Development, Dutch Association of Comprehensive Cancer Centres, Utrecht, The Netherlands
| | - Michel M van den Heuvel
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcia Tummers
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olga C J Schuurbiers
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
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Woudstra K, Tummers M, Rovers MM, Reuzel R. Innovators' views on involving users and patients in surgical device development: a qualitative interview study. BMJ Open 2021; 11:e050801. [PMID: 34417218 PMCID: PMC8381300 DOI: 10.1136/bmjopen-2021-050801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Involving end-users and patients in the development of surgical devices, even when patients are not end-users, is deemed important in policy and in academia since it could improve strategic choices in research and development (R&D). Nonetheless, research into innovators' views on end-user and patient involvement is rare. This study explores what end-users and patients are being involved by innovators during development, what methods for involvement are being used and what topics are being discussed with these end-users and patients. DESIGN A qualitative study featuring semi-structured interviews with innovators of surgical devices. Interviews were recorded and a thematic analysis was performed on verbatim transcripts. PARTICIPANTS 15 interviews were conducted with 19 innovators of 14 surgical devices. SETTING Innovation practices of surgical devices in the Netherlands and Belgium. RESULTS End-users were engaged in R&D with formal methods and in unsystematic ways. These users all work in the clinical domain, for example, as surgeons or nurses. The innovators engaged users to analyse problems for which a device could be a solution, define functionalities, make design choices, analyse usability, ensure safety and improve aesthetics. Patients were rarely involved. Innovators stated that patients are not considered to be end-users, that physicians can represent patient interests and that involving patients is unethical as false expectations could be raised. CONCLUSION Innovators involve end-users with methods and unsystematic ways in the development of surgical devices. Despite governmental calls for patient involvement in the development of medical devices and surgical devices, innovators do not generally involve patients.
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Affiliation(s)
- Kas Woudstra
- Operation Rooms, Health Evidence, Radboudumc, Nijmegen, The Netherlands
| | - Marcia Tummers
- Operation Rooms, Health Evidence, Radboudumc, Nijmegen, The Netherlands
| | - Maroeska M Rovers
- Operation Rooms, Health Evidence, Radboudumc, Nijmegen, The Netherlands
| | - Rob Reuzel
- Operation Rooms, Health Evidence, Radboudumc, Nijmegen, The Netherlands
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Grutters JPC, Govers TM, Nijboer J, Tummers M, van der Wilt GJ, Rovers MM. Exploratory, Participatory and Iterative Assessment of Value: A Response to Recent Commentaries. Int J Health Policy Manag 2021; 10:42-44. [PMID: 32610832 PMCID: PMC7947703 DOI: 10.34172/ijhpm.2020.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/16/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Janneke P C Grutters
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim M Govers
- Department for Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jorte Nijboer
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcia Tummers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gert Jan van der Wilt
- Department for Health Evidence, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maroeska M Rovers
- Department for Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Jansen M, Baltussen R, Bijlmakers L, Tummers M. The Dutch Citizen Forum on Public Reimbursement of Healthcare: A Qualitative Analysis of Opinion Change. Int J Health Policy Manag 2020; 11:118-127. [PMID: 32610763 PMCID: PMC9278612 DOI: 10.34172/ijhpm.2020.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 05/27/2020] [Indexed: 11/23/2022] Open
Abstract
Background: A deliberative Citizen Forum ‘Choices in healthcare’ was held in the Netherlands to obtain insight into the criteria informed citizens would propose for the public reimbursement of healthcare. During 3 weekends, 24 citizens participated in evidence-informed deliberation on the basis of 8 case studies. The aim of this study was to assess how the opinions of 8 participants in the deliberative Citizens Forum changed and if so, why participants themselves believe their opinions have changed, whether participation influenced their perceived reasonableness of other participants in the forum and whether it influenced their opinions about involvement of citizens in decision-making.
Methods: Semi-structured interviews were held with 8 participants before and after their participation in the Citizen Forum. Using the method of reconstructing interpretive frames opinions about the public reimbursement of healthcare were reconstructed.
Results: Participants’ opinions changed over time; they became more aware of the complexity of decision-making and came to accept that there are limits to the available resources and accept cost as a criterion for reimbursement decisionmaking. Participants report that exchanging arguments and personal experiences with other participants made them change their initial opinions. Participants ascribed increases in the perceived reasonableness of other participants’ opinions to feelings of group-bonding and becoming more familiar with each other’s personal circumstances. Participants further believe that citizens represent an additional opinion to that of other stakeholders and believe their opinions should be considered in relation to those of other stakeholders, given they are provided with opportunities for critical discussion.
Conclusion: Organized deliberation should allow for the exchange of arguments and the sharing of personal experiences which is linked to learning. On the one hand this is reflected in the uptake of new arguments and on the other hand in the revision, specification or expansion of personal argumentation. Providing opportunities for critical deliberation is key to prevent citizens from adhering to initial emotional reactions that remain unchallenged and which may no longer be supported after deliberation.
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Affiliation(s)
- Maarten Jansen
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob Baltussen
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leon Bijlmakers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcia Tummers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Ghaeminia H, Nienhuijs ME, Toedtling V, Perry J, Tummers M, Hoppenreijs TJ, Van der Sanden WJ, Mettes TG. Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth. Cochrane Database Syst Rev 2020; 5:CD003879. [PMID: 32368796 PMCID: PMC7199383 DOI: 10.1002/14651858.cd003879.pub5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Prophylactic removal of asymptomatic disease-free impacted wisdom teeth is the surgical removal of wisdom teeth in the absence of symptoms and with no evidence of local disease. Impacted wisdom teeth may be associated with pathological changes, such as pericoronitis, root resorption, gum and alveolar bone disease (periodontitis), caries and the development of cysts and tumours. When surgical removal is performed in older people, the risk of postoperative complications, pain and discomfort is increased. Other reasons to justify prophylactic removal of asymptomatic disease-free impacted third molars have included preventing late lower incisor crowding, preventing damage to adjacent structures such as the second molar or the inferior alveolar nerve, in preparation for orthognathic surgery, in preparation for radiotherapy or during procedures to treat people with trauma to the affected area. Removal of asymptomatic disease-free wisdom teeth is a common procedure, and researchers must determine whether evidence supports this practice. This review is an update of an review originally published in 2005 and previously updated in 2012 and 2016. OBJECTIVES To evaluate the effects of removal compared with retention (conservative management) of asymptomatic disease-free impacted wisdom teeth in adolescents and adults. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 10 May 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2019, Issue 4), MEDLINE Ovid (1946 to 10 May 2019), and Embase Ovid (1980 to 10 May 2019). The US National Institutes of Health Trials Registry (ClinicalTrials.gov)and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. . SELECTION CRITERIA We included randomised controlled trials (RCTs), with no restriction on length of follow-up, comparing removal (or absence) with retention (or presence) of asymptomatic disease-free impacted wisdom teeth in adolescents or adults. We also considered quasi-RCTs and prospective cohort studies for inclusion if investigators measured outcomes with follow-up of five years or longer. DATA COLLECTION AND ANALYSIS Eight review authors screened search results and assessed the eligibility of studies for inclusion according to the review inclusion criteria. Eight review authors independently and in duplicate conducted the risk of bias assessments. When information was unclear, we contacted the study authors for additional information. MAIN RESULTS This review update includes the same two studies that were identified in our previous version of the review: one RCT with a parallel-group design, which was conducted in a dental hospital setting in the United Kingdom, and one prospective cohort study, which was conducted in the private sector in the USA. Primary outcome No eligible studies in this review reported the effects of removal compared with retention of asymptomatic disease-free impacted wisdom teeth on health-related quality of life Secondary outcomes We found only low- to very low-certainty evidence of the effects of removal compared with retention of asymptomatic disease-free impacted wisdom teeth for a limited number of secondary outcome measures. One prospective cohort study, reporting data from a subgroup of 416 healthy male participants, aged 24 to 84 years, compared the effects of the absence (previous removal or agenesis) against the presence of asymptomatic disease-free impacted wisdom teeth on periodontitis and caries associated with the distal aspect of the adjacent second molar during a follow-up period of three to over 25 years. Very low-certainty evidence suggests that the presence of asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting the adjacent second molar in the long term. In the same study, which is at serious risk of bias, there is insufficient evidence to demonstrate a difference in caries risk associated with the presence or absence of impacted wisdom teeth. One RCT with 164 randomised and 77 analysed adolescent participants compared the effect of extraction with retention of asymptomatic disease-free impacted wisdom teeth on dimensional changes in the dental arch after five years. Participants (55% female) had previously undergone orthodontic treatment and had 'crowded' wisdom teeth. No evidence from this study, which was at high risk of bias, was found to suggest that removal of asymptomatic disease-free impacted wisdom teeth has a clinically significant effect on dimensional changes in the dental arch. The included studies did not measure any of our other secondary outcomes: costs, other adverse events associated with retention of asymptomatic disease-free impacted wisdom teeth (pericoronitis, root resorption, cyst formation, tumour formation, inflammation/infection) and adverse effects associated with their removal (alveolar osteitis/postoperative infection, nerve injury, damage to adjacent teeth during surgery, bleeding, osteonecrosis related to medication/radiotherapy, inflammation/infection). AUTHORS' CONCLUSIONS Insufficient evidence is available to determine whether asymptomatic disease-free impacted wisdom teeth should be removed or retained. Although retention of asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting adjacent second molars in the long term, the evidence is very low certainty. Well-designed RCTs investigating long-term and rare effects of retention and removal of asymptomatic disease-free impacted wisdom teeth, in a representative group of individuals, are unlikely to be feasible. In their continuing absence, high quality, long-term prospective cohort studies may provide valuable evidence in the future. Given the current lack of available evidence, patient values should be considered and clinical expertise used to guide shared decision-making with people who have asymptomatic disease-free impacted wisdom teeth. If the decision is made to retain these teeth, clinical assessment at regular intervals to prevent undesirable outcomes is advisable.
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Affiliation(s)
- Hossein Ghaeminia
- Department of Oral and Maxillofacial Surgery, Rijnstate Hospital Arnhem, Arnhem, Netherlands
| | - Marloes El Nienhuijs
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Verena Toedtling
- Department of Oral and Maxillofacial Surgery, Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - John Perry
- Hospital Dental Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Marcia Tummers
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Theo Jm Hoppenreijs
- Department of Oral and Maxillofacial Surgery, Rijnstate Hospital, Arnhem, Netherlands
| | - Wil Jm Van der Sanden
- Department of Quality and Safety of Oral Health Care, College of Dental Science, Radboud University Medical Center, Nijmegen, Netherlands
| | - Theodorus G Mettes
- School of Dentistry, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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Klarenbeek SE, Weekenstroo HHA, Sedelaar JPM, Fütterer JJ, Prokop M, Tummers M. The Effect of Higher Level Computerized Clinical Decision Support Systems on Oncology Care: A Systematic Review. Cancers (Basel) 2020; 12:E1032. [PMID: 32331449 PMCID: PMC7226340 DOI: 10.3390/cancers12041032] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To deal with complexity in cancer care, computerized clinical decision support systems (CDSSs) are developed to support quality of care and improve decision-making. We performed a systematic review to explore the value of CDSSs using automated clinical guidelines, Artificial Intelligence, datamining or statistical methods (higher level CDSSs) on the quality of care in oncology. MATERIALS AND METHODS The search strategy combined synonyms for 'CDSS' and 'cancer.' Pubmed, Embase, The Cochrane Library, Institute of Electrical and Electronics Engineers, Association of Computing Machinery digital library and Web of Science were systematically searched from January 2000 to December 2019. Included studies evaluated the impact of higher level CDSSs on process outcomes, guideline adherence and clinical outcomes. RESULTS 11,397 studies were selected for screening, after which 61 full-text articles were assessed for eligibility. Finally, nine studies were included in the final analysis with a total population size of 7985 patients. Types of cancer included breast cancer (63.1%), lung cancer (27.8%), prostate cancer (4.1%), colorectal cancer (3.1%) and other cancer types (1.9%). The included studies demonstrated significant improvements of higher level CDSSs on process outcomes and guideline adherence across diverse settings in oncology. No significant differences were reported for clinical outcomes. CONCLUSION Higher level CDSSs seem to improve process outcomes and guidelines adherence but not clinical outcomes. It should be noticed that the included studies primarily focused on breast and lung cancer. To further explore the impact of higher level CDSSs on quality of care, high-quality research is required.
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Affiliation(s)
- Sosse E Klarenbeek
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Harm H A Weekenstroo
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - J P Michiel Sedelaar
- Department of Urology, Radboud Institute for Health Science, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Marcia Tummers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
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Grutters JPC, Govers T, Nijboer J, Tummers M, van der Wilt GJ, Rovers MM. Problems and Promises of Health Technologies: The Role of Early Health Economic Modeling. Int J Health Policy Manag 2019; 8:575-582. [PMID: 31657184 PMCID: PMC6819627 DOI: 10.15171/ijhpm.2019.36] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 05/18/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To assess whether early health economic modeling helps to distinguish those healthcare innovations that are potentially cost-effective from those that are not potentially cost-effective. We will also study what information is retrieved from the health economic models to inform further development, research and implementation decisions. METHODS We performed secondary analyses on an existing database of 32 health economic modeling assessments of 30 innovations, performed by our group. First, we explored whether the assessments could distinguish innovations with potential cost-effectiveness from innovations without potential cost-effectiveness. Second, we explored which recommendations were made regarding development, implementation and further research of the innovation. RESULTS Of the 30 innovations, 1 (3%) was an idea that was not yet being developed and 14 (47%) were under development. Eight (27%) innovations had finished development, and another 7 (23%) innovations were on the market. Although all assessments showed that the innovation had the potential to become cost-effective, due to improved patient outcomes, cost savings or both, differences were found in the magnitude of the potential benefits, and the likelihood of reaching this potential. The assessments informed how the innovation could be further developed or positioned to maximize its cost-effectiveness, and informed further research. CONCLUSION The early health economic assessments provided insight in the potential cost-effectiveness of an innovation in its intended context, and the associated uncertainty. None of the assessments resulted in a firm 'no-go' recommendation, but recommendations could be provided on further research and development in order to maximize value for money.
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Affiliation(s)
- Janneke P C Grutters
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Tim Govers
- Medvalue, Radboudumc, Nijmegen, The Netherlands
| | | | - Marcia Tummers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Gert Jan van der Wilt
- Department for Health Evidence, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - Maroeska M Rovers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
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Kluytmans A, Tummers M, van der Wilt GJ, Grutters J. Early Assessment of Proof-of-Problem to Guide Health Innovation. Value Health 2019; 22:601-606. [PMID: 31104741 DOI: 10.1016/j.jval.2018.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/24/2018] [Accepted: 11/27/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Although the relevance of both push and pull factors is acknowledged in models of innovation, needs, broadly defined, are rarely considered, whereas supply-driven innovation in publicly funded health systems carries the risk that it may not match the underlying problems experienced by patients and consumers. OBJECTIVES To explore a mixed-methods, multistakeholder approach that focuses on pertinent problems when assessing the potential value of an innovation as applied to a case of surgical innovation in meniscus surgery. METHODS Through interviews of stakeholders (n = 11) we sought to identify current problems of meniscus surgery in the Netherlands. On the basis of the subsequent problem definitions, we used stakeholder and literature input to quantify the room for improvement and stakeholder engagement to uncover possible barriers and facilitators to the implementation of the proposed innovation. RESULTS Despite being enthusiastic about the ingenuity of the proposed innovation and seeing some potential for cost saving, most stakeholders (n = 10) agreed that there are no major problems in current meniscus surgery meriting the innovation. They even discerned pragmatic barriers that would challenge the potential cost savings. CONCLUSIONS By adopting a problem-oriented multistakeholder approach to early health technology assessment, we were able to estimate the potential value of an innovation in its social context, finding that, beyond the initial enthusiasm, the proposed innovation was unlikely to resolve the problems distinguished by the stakeholders. We concluded that our multistakeholder, mixed-methods approach to early health technology assessment is feasible and helps foster more demand-driven innovations.
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Affiliation(s)
- Anouck Kluytmans
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcia Tummers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gert Jan van der Wilt
- Department for Health Evidence, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janneke Grutters
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
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Tummers M, van Hoorn R, Levering C, Booth A, van der Wilt GJ, Kievit W. Optimal search strategies for identifying moderators and predictors of treatment effects in PubMed. Health Info Libr J 2018; 36:318-340. [PMID: 30006959 DOI: 10.1111/hir.12230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/07/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Treatment effects differ across patients. To guide selection of treatments for patients, it is essential to acknowledge these differences and identify moderators or predictors. Our aim was to generate optimal search strategies (commonly known as filters) for PubMed to retrieve papers identifying moderators and predictors of treatment effects. METHODS Six journals were hand-searched for articles on moderators or predictors. Selected articles were randomly allocated to a development and validation set. Search terms were extracted from the development set and tested for their performance. Search filters were created from combinations of these terms and tested in the validation set. RESULTS Of 4407 articles, 198 were considered to be relevant. The most sensitive filter in the development set '("Epidemiologic Methods" [MeSH] OR assign* OR control*[tiab] OR trial*[tiab]) AND therapy*[sh]' yielded in the validation set a sensitivity of 89% [88%-90%] and a specificity of 80% [79%-82%]. CONCLUSIONS The search filters created in this study can help to efficiently retrieve evidence on moderators and predictors of treatment effect. Testing of the filters in multiple domains should reveal robustness across disciplines. These filters can facilitate the retrieval of evidence on moderators and predictors of treatment effects, helping the implementation of stratified or personalised health care.
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Affiliation(s)
- Marcia Tummers
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ralph van Hoorn
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Charlotte Levering
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrew Booth
- School of Health and Related Research (ScHARR), Health Economics and Decision Science (HEDS), University of Sheffield Regent Court, Sheffield, UK
| | - Gert Jan van der Wilt
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wietske Kievit
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Booth A, Noyes J, Flemming K, Gerhardus A, Wahlster P, van der Wilt GJ, Mozygemba K, Refolo P, Sacchini D, Tummers M, Rehfuess E. Structured methodology review identified seven (RETREAT) criteria for selecting qualitative evidence synthesis approaches. J Clin Epidemiol 2018; 99:41-52. [PMID: 29548841 DOI: 10.1016/j.jclinepi.2018.03.003] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 01/04/2018] [Accepted: 03/07/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To compare and contrast different methods of qualitative evidence synthesis (QES) against criteria identified from the literature and to map their attributes to inform selection of the most appropriate QES method to answer research questions addressed by qualitative research. STUDY DESIGN AND SETTING Electronic databases, citation searching, and a study register were used to identify studies reporting QES methods. Attributes compiled from 26 methodological papers (2001-2014) were used as a framework for data extraction. Data were extracted into summary tables by one reviewer and then considered within the author team. RESULTS We identified seven considerations determining choice of methods from the methodological literature, encapsulated within the mnemonic Review question-Epistemology-Time/Timescale-Resources-Expertise-Audience and purpose-Type of data. We mapped 15 different published QES methods against these seven criteria. The final framework focuses on stand-alone QES methods but may also hold potential when integrating quantitative and qualitative data. CONCLUSION These findings offer a contemporary perspective as a conceptual basis for future empirical investigation of the advantages and disadvantages of different methods of QES. It is hoped that this will inform appropriate selection of QES approaches.
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Affiliation(s)
- Andrew Booth
- Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
| | - Jane Noyes
- School of Social Sciences, Bangor University, Bangor, UK
| | - Kate Flemming
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
| | - Ansgar Gerhardus
- Department for Health Services Research, Institute for Public Health and Nursing Research (IPP) and Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Philip Wahlster
- Center for General Practice, Medical Faculty, Saarland University, Homburg (Saar), Germany; Department of Health Services Research, University of Bremen, Bremen, Germany
| | - Gert Jan van der Wilt
- Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, Nijmegen 6500 HB, The Netherlands
| | - Kati Mozygemba
- Department for Health Services Research, Institute for Public Health and Nursing Research (IPP) and Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Pietro Refolo
- Institute of Bioethics and Medical Humanities, "Agostino Gemelli" School of Medicine, Università Cattolica del Sacro Cuore, 1 Largo F. Vito, Rome 00168, Italy
| | - Dario Sacchini
- Institute of Bioethics and Medical Humanities, "Agostino Gemelli" School of Medicine, Università Cattolica del Sacro Cuore, 1 Largo F. Vito, Rome 00168, Italy
| | - Marcia Tummers
- Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, Nijmegen 6500 HB, The Netherlands
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Marchioninistr. 15, Munich 81377, Germany
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van Hoorn R, Tummers M, Booth A, Gerhardus A, Rehfuess E, Hind D, Bossuyt PM, Welch V, Debray TPA, Underwood M, Cuijpers P, Kraemer H, van der Wilt GJ, Kievit W. The development of CHAMP: a checklist for the appraisal of moderators and predictors. BMC Med Res Methodol 2017; 17:173. [PMID: 29268721 PMCID: PMC5740883 DOI: 10.1186/s12874-017-0451-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 12/05/2017] [Indexed: 12/14/2022] Open
Abstract
Background Personalized healthcare relies on the identification of factors explaining why individuals respond differently to the same intervention. Analyses identifying such factors, so called predictors and moderators, have their own set of assumptions and limitations which, when violated, can result in misleading claims, and incorrect actions. The aim of this study was to develop a checklist for critically appraising the results of predictor and moderator analyses by combining recommendations from published guidelines and experts in the field. Methods Candidate criteria for the checklist were retrieved through systematic searches of the literature. These criteria were evaluated for appropriateness using a Delphi procedure. Two Delphi rounds yielded a pilot checklist, which was tested on a set of papers included in a systematic review on reinforced home-based palliative care. The results of the pilot informed a third Delphi round, which served to finalize the checklist. Results Forty-nine appraisal criteria were identified in the literature. Feedback was obtained from fourteen experts from (bio)statistics, epidemiology and other associated fields elicited via three Delphi rounds. Additional feedback from other researchers was collected in a pilot test. The final version of our checklist included seventeen criteria, covering the design (e.g. a priori plausibility), analysis (e.g. use of interaction tests) and results (e.g. complete reporting) of moderator and predictor analysis, together with the transferability of the results (e.g. clinical importance). There are criteria both for individual papers and for bodies of evidence. Conclusions The proposed checklist can be used for critical appraisal of reported moderator and predictor effects, as assessed in randomized or non-randomized studies using individual participant or aggregate data. This checklist is accompanied by a user’s guide to facilitate implementation. Its future use across a wide variety of research domains and study types will provide insights about its usability and feasibility. Electronic supplementary material The online version of this article (10.1186/s12874-017-0451-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ralph van Hoorn
- Radboud Institute for Health Sciences, Radboud university medical center, Geert Grooteplein 21, Nijmegen, 6525, EZ, The Netherlands.
| | - Marcia Tummers
- Radboud Institute for Health Sciences, Radboud university medical center, Geert Grooteplein 21, Nijmegen, 6525, EZ, The Netherlands
| | - Andrew Booth
- Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield Regent Court, Sheffield, UK
| | - Ansgar Gerhardus
- Department of Health Services Research, Institute for Public Health and Nursing Research, University of Bremen and Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology; Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - Daniel Hind
- Clinical Trials Research Unit, University of Sheffield Regent Court, Sheffield, UK
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University; Cochrane Netherlands, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Helena Kraemer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Gert Jan van der Wilt
- Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Wietkse Kievit
- Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
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Rehfuess EA, Booth A, Brereton L, Burns J, Gerhardus A, Mozygemba K, Oortwijn W, Pfadenhauer LM, Tummers M, van der Wilt GJ, Rohwer A. Towards a taxonomy of logic models in systematic reviews and health technology assessments: A priori, staged, and iterative approaches. Res Synth Methods 2017; 9:13-24. [PMID: 28677339 DOI: 10.1002/jrsm.1254] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 12/19/2022]
Abstract
The complexity associated with how interventions result-or fail to result-in outcomes and how context matters is increasingly recognised. Logic models provide an important tool for handling complexity, with contrasting uses in programme evaluation and evidence synthesis. To reconcile these, we developed an approach that combines the strengths of both traditions, propose a taxonomy of logic models, and provide guidance on how to choose between approaches and types of logic models in systematic reviews and health technology assessments (HTA). The taxonomy distinguishes 3 approaches (a priori, staged, and iterative) and 2 types (systems-based and process-orientated) of logic models. An a priori logic model is specified at the start of the systematic review/HTA and remains unchanged. With a staged logic model, the reviewer prespecifies several points, at which major data inputs require a subsequent version. An iterative logic model is continuously modified throughout the systematic review/HTA process. System-based logic models describe the system, in which the interaction between participants, intervention, and context takes place; process-orientated models display the causal pathways leading from the intervention to multiple outcomes. The proposed taxonomy of logic models offers an improved understanding of the advantages and limitations of logic models across the spectrum from a priori to fully iterative approaches. Choice of logic model should be informed by scope of evidence synthesis, presence/absence of clearly defined population, intervention, comparison, outcome (PICO) elements, and feasibility considerations. Applications across distinct interventions and methodological approaches will deliver good practice case studies and offer further insights on the choice and implementation of logic modelling approaches.
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Affiliation(s)
- Eva A Rehfuess
- Institute of Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Louise Brereton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.,College of Health and Social Sciences, University of Lincoln, Lincoln, UK
| | - Jacob Burns
- Institute of Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Ansgar Gerhardus
- Department of Health Services Research, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Kati Mozygemba
- Department of Health Services Research, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
| | | | - Lisa M Pfadenhauer
- Institute of Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Marcia Tummers
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gert-Jan van der Wilt
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anke Rohwer
- Institute of Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.,Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Parow, South Africa
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Baltussen R, Jansen MPM, Bijlmakers L, Grutters J, Kluytmans A, Reuzel RP, Tummers M, der Wilt GJV. Value Assessment Frameworks for HTA Agencies: The Organization of Evidence-Informed Deliberative Processes. Value Health 2017; 20:256-260. [PMID: 28237205 DOI: 10.1016/j.jval.2016.11.019] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/13/2016] [Accepted: 11/17/2016] [Indexed: 05/09/2023]
Abstract
Priority setting in health care has been long recognized as an intrinsically complex and value-laden process. Yet, health technology assessment agencies (HTAs) presently employ value assessment frameworks that are ill fitted to capture the range and diversity of stakeholder values and thereby risk compromising the legitimacy of their recommendations. We propose "evidence-informed deliberative processes" as an alternative framework with the aim to enhance this legitimacy. This framework integrates two increasingly popular and complementary frameworks for priority setting: multicriteria decision analysis and accountability for reasonableness. Evidence-informed deliberative processes are, on one hand, based on early, continued stakeholder deliberation to learn about the importance of relevant social values. On the other hand, they are based on rational decision-making through evidence-informed evaluation of the identified values. The framework has important implications for how HTA agencies should ideally organize their processes. First, HTA agencies should take the responsibility of organizing stakeholder involvement. Second, agencies are advised to integrate their assessment and appraisal phases, allowing for the timely collection of evidence on values that are considered relevant. Third, HTA agencies should subject their decision-making criteria to public scrutiny. Fourth, agencies are advised to use a checklist of potentially relevant criteria and to provide argumentation for how each criterion affected the recommendation. Fifth, HTA agencies must publish their argumentation and install options for appeal. The framework should not be considered a blueprint for HTA agencies but rather an aspirational goal-agencies can take incremental steps toward achieving this goal.
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Affiliation(s)
- Rob Baltussen
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
| | | | - Leon Bijlmakers
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janneke Grutters
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anouck Kluytmans
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob P Reuzel
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcia Tummers
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gert Jan van der Wilt
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
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21
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Brereton L, Ingleton C, Gardiner C, Goyder E, Mozygemba K, Lysdahl KB, Tummers M, Sacchini D, Leppert W, Blaževičienė A, van der Wilt GJ, Refolo P, De Nicola M, Chilcott J, Oortwijn W. Lay and professional stakeholder involvement in scoping palliative care issues: Methods used in seven European countries. Palliat Med 2017; 31:181-192. [PMID: 27280411 DOI: 10.1177/0269216316649154] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stakeholders are people with an interest in a topic. Internationally, stakeholder involvement in palliative care research and health technology assessment requires development. Stakeholder involvement adds value throughout research (from prioritising topics to disseminating findings). Philosophies and understandings about the best ways to involve stakeholders in research differ internationally. Stakeholder involvement took place in seven countries (England, Germany, Italy, Lithuania, the Netherlands, Norway and Poland). Findings informed a project that developed concepts and methods for health technology assessment and applied these to evaluate models of palliative care service delivery. AIMS To report on stakeholder involvement in the INTEGRATE-HTA project and how issues identified informed project development. DESIGN Using stakeholder consultation or a qualitative research design, as appropriate locally, stakeholders in seven countries acted as 'advisors' to aid researchers' decision making. Thematic analysis was used to identify key issues across countries. SETTING/PARTICIPANTS A total of 132 stakeholders (82 professionals and 50 'lay' people) aged ⩾18 participated in individual face-to-face or telephone interviews, consultation meetings or focus groups. RESULTS Different stakeholder involvement methods were used successfully to identify key issues in palliative care. A total of 23 issues common to three or more countries informed decisions about the intervention and comparator of interest, sub questions and specific assessments within the health technology assessment. CONCLUSION Stakeholders, including patients and families undergoing palliative care, can inform project decision making using various involvement methods according to the local context. Researchers should consider local understandings about stakeholder involvement as views of appropriate and feasible methods vary. Methods for stakeholder involvement, especially consultation, need further development.
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Affiliation(s)
| | - Christine Ingleton
- 2 School of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Clare Gardiner
- 2 School of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | | | - Kati Mozygemba
- 4 Department of Health Services Research, University of Bremen, Bremen, Germany
| | | | - Marcia Tummers
- 6 Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Dario Sacchini
- 7 Institute of Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Wojciech Leppert
- 8 Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Aurelija Blaževičienė
- 9 Department of Nursing and Care, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gert Jan van der Wilt
- 6 Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Pietro Refolo
- 7 Institute of Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina De Nicola
- 7 Institute of Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Wija Oortwijn
- 10 Health Unit, ECORYS Nederland B.V., Rotterdam, The Netherlands
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Refolo P, Sacchini D, Brereton L, Gerhardus A, Hofmann B, Lysdahl KB, Mozygemba K, Oortwijn W, Tummers M, van der Wilt GJ, Wahlster P, Spagnolo AG. Why is it so difficult to integrate ethics in Health Technology Assessment (HTA)? The epistemological viewpoint. Eur Rev Med Pharmacol Sci 2016; 20:4202-4208. [PMID: 27831656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Ethics has been identified as a key element in Health Technology Assessment (HTA) since its conception. However, ethical issues are still not frequently addressed explicitly in HTA. Several valuable reasons have been identified. The basis of the article is the claim that ethics is often not part of HTA for "epistemological reasons". Hence, the main aim of the contribution is to explore in more details and emphasize them by using the fact/value dichotomy. Our conclusion is that current HTA configuration is predominantly based on the comparison among objective and empirically testable "facts", whilst ethics is not empirically testable. In this sense, there is a sort of "epistemological gap", which can explain why it is so difficult to integrate ethics in HTA. We suggest that the epistemological differences among the various domains of HTA are addressed more explicitly.
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Affiliation(s)
- P Refolo
- Institute of Bioethics and Medical Humanities, "A. Gemelli" School of Medicine, Catholic University of the Sacred Heart, Rome, Italy.
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23
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Ghaeminia H, Perry J, Nienhuijs MEL, Toedtling V, Tummers M, Hoppenreijs TJM, Van der Sanden WJM, Mettes TG. Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth. Cochrane Database Syst Rev 2016:CD003879. [PMID: 27578151 DOI: 10.1002/14651858.cd003879.pub4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prophylactic removal of asymptomatic disease-free impacted wisdom teeth is surgical removal of wisdom teeth in the absence of symptoms and with no evidence of local disease. Impacted wisdom teeth may be associated with pathological changes, such as pericoronitis, root resorption, gum and alveolar bone disease (periodontitis), caries and the development of cysts and tumours. When surgical removal is carried out in older people, the risk of postoperative complications, pain and discomfort is increased. Other reasons to justify prophylactic removal of asymptomatic disease-free impacted third molars have included preventing late lower incisor crowding, preventing damage to adjacent structures such as the second molar or the inferior alveolar nerve, in preparation for orthognathic surgery, in preparation for radiotherapy or during procedures to treat people with trauma to the affected area. Removal of asymptomatic disease-free wisdom teeth is a common procedure, and researchers must determine whether evidence supports this practice. This review is an update of an existing review published in 2012. OBJECTIVES To evaluate the effects of removal compared with retention (conservative management) of asymptomatic disease-free impacted wisdom teeth in adolescents and adults. SEARCH METHODS We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 24 May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 4), MEDLINE Ovid (1946 to 24 May 2016) and Embase Ovid (1980 to 24 May 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing and unpublished studies to 24 May 2016. We imposed no restrictions on language or date of publication in our search of electronic databases. SELECTION CRITERIA Studies comparing removal (or absence) with retention (or presence) of asymptomatic disease-free impacted wisdom teeth in adolescents or adults. We included randomised controlled trials (RCTs) with no restriction on length of follow-up, if available. We considered quasi-RCTs and prospective cohort studies for inclusion if investigators measured outcomes with follow-up of five years or longer. DATA COLLECTION AND ANALYSIS Eight review authors screened search results and assessed the eligibility of studies for inclusion according to the review inclusion criteria. Eight review authors independently conducted risk of bias assessments in duplicate. When information was unclear, we contacted study authors for additional information. MAIN RESULTS This review includes two studies. The previous review included one RCT with a parallel-group design, which was conducted in a dental hospital setting in the United Kingdom; our new search for this update identified one prospective cohort study conducted in the private sector in the USA. Primary outcome No eligible studies in this review reported the effects of removal compared with retention of asymptomatic disease-free impacted wisdom teeth on health-related quality of life Secondary outcomes We found only low to very low quality evidence of the effects of removal compared with retention of asymptomatic disease-free impacted wisdom teeth for a limited number of secondary outcome measures.One prospective cohort study, reporting data from a subgroup of 416 healthy male participants, aged 24 to 84 years, compared the effect of the absence (previous removal or agenesis) against the presence of asymptomatic disease-free impacted wisdom teeth on periodontitis and caries associated with the distal of the adjacent second molar during a follow-up period of three to over 25 years. Very low quality evidence suggests that the presence of asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting the adjacent second molar in the long term. In the same study, which is at serious risk of bias, there is insufficient evidence to demonstrate a difference in caries risk associated with the presence or absence of impacted wisdom teeth.One RCT with 164 randomised and 77 analysed adolescent participants compared the effect of extraction with retention of asymptomatic disease-free impacted wisdom teeth on dimensional changes in the dental arch after five years. Participants (55% female) had previously undergone orthodontic treatment and had 'crowded' wisdom teeth. No evidence from this study, which was at high risk of bias, was found to suggest that removal of asymptomatic disease-free impacted wisdom teeth has a clinically significant effect on dimensional changes in the dental arch.The included studies did not measure our other secondary outcomes: costs, other adverse events associated with retention of asymptomatic disease-free impacted wisdom teeth (pericoronitis, root resorption, cyst formation, tumour formation, inflammation/infection) and adverse effects associated with their removal (alveolar osteitis/postoperative infection, nerve injury, damage to adjacent teeth during surgery, bleeding, osteonecrosis related to medication/radiotherapy, inflammation/infection). AUTHORS' CONCLUSIONS Insufficient evidence is available to determine whether or not asymptomatic disease-free impacted wisdom teeth should be removed. Although asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting adjacent second molars in the long term, the evidence is of very low quality. Well-designed RCTs investigating long-term and rare effects of retention and removal of asymptomatic disease-free impacted wisdom teeth, in a representative group of individuals, are unlikely to be feasible. In their continuing absence, high quality, long-term prospective cohort studies may provide valuable evidence in the future. Given the lack of available evidence, patient values should be considered and clinical expertise used to guide shared decision making with patients who have asymptomatic disease-free impacted wisdom teeth. If the decision is made to retain asymptomatic disease-free impacted wisdom teeth, clinical assessment at regular intervals to prevent undesirable outcomes is advisable.
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Affiliation(s)
- Hossein Ghaeminia
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 14, Nijmegen, Netherlands, 6525 GA
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24
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van Hoorn R, Kievit W, Booth A, Mozygemba K, Lysdahl KB, Refolo P, Sacchini D, Gerhardus A, van der Wilt GJ, Tummers M. The development of PubMed search strategies for patient preferences for treatment outcomes. BMC Med Res Methodol 2016; 16:88. [PMID: 27473226 PMCID: PMC4966584 DOI: 10.1186/s12874-016-0192-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The importance of respecting patients' preferences when making treatment decisions is increasingly recognized. Efficiently retrieving papers from the scientific literature reporting on the presence and nature of such preferences can help to achieve this goal. The objective of this study was to create a search filter for PubMed to help retrieve evidence on patient preferences for treatment outcomes. METHODS A total of 27 journals were hand-searched for articles on patient preferences for treatment outcomes published in 2011. Selected articles served as a reference set. To develop optimal search strategies to retrieve this set, all articles in the reference set were randomly split into a development and a validation set. MeSH-terms and keywords retrieved using PubReMiner were tested individually and as combinations in PubMed and evaluated for retrieval performance (e.g. sensitivity (Se) and specificity (Sp)). RESULTS Of 8238 articles, 22 were considered to report empirical evidence on patient preferences for specific treatment outcomes. The best search filters reached Se of 100 % [95 % CI 100-100] with Sp of 95 % [94-95 %] and Sp of 97 % [97-98 %] with 75 % Se [74-76 %]. In the validation set these queries reached values of Se of 90 % [89-91 %] with Sp 94 % [93-95 %] and Se of 80 % [79-81 %] with Sp of 97 % [96-96 %], respectively. CONCLUSIONS Narrow and broad search queries were developed which can help in retrieving literature on patient preferences for treatment outcomes. Identifying such evidence may in turn enhance the incorporation of patient preferences in clinical decision making and health technology assessment.
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Affiliation(s)
- Ralph van Hoorn
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Wietske Kievit
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrew Booth
- Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield Regent Court, Sheffield, United Kingdom
| | - Kati Mozygemba
- Department of Health Services Research, Institute for Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
| | | | - Pietro Refolo
- Institute of Bioethics and Medical Humanities, "A. Gemelli" School of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Sacchini
- Institute of Bioethics and Medical Humanities, "A. Gemelli" School of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ansgar Gerhardus
- Department of Health Services Research, Institute for Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Gert Jan van der Wilt
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcia Tummers
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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25
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Janse A, Wiborg JF, Bleijenberg G, Tummers M, Knoop H. The efficacy of guided self-instruction for patients with idiopathic chronic fatigue: A randomized controlled trial. J Consult Clin Psychol 2016; 84:377-88. [DOI: 10.1037/ccp0000085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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26
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Burger JPW, de Brouwer B, IntHout J, Wahab PJ, Tummers M, Drenth JPH. Systematic review with meta-analysis: Dietary adherence influences normalization of health-related quality of life in coeliac disease. Clin Nutr 2016; 36:399-406. [PMID: 27179800 DOI: 10.1016/j.clnu.2016.04.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/13/2016] [Accepted: 04/21/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND & AIMS Gluten-free diet is the keystone of coeliac disease treatment. Despite adherence, some patients continue to suffer from symptoms that negatively influence health-related quality of life (HRQoL). Therefore we performed a systematic review and meta-analysis to assess the effect of gluten-free diet on HRQoL in coeliac disease. We specifically sought for determinants that negatively influenced HRQoL. METHODS We systematically searched PubMed, EMBASE, CINAHL, PsycINFO and Cochrane Library for studies assessing HRQoL in untreated or treated adults using validated HRQoL-questionnaires from 1960 to September 2015, comparing HRQoL: (1) before and after gluten-free diet initiation or (2) in patients and non-coeliac controls. RESULTS We included eighteen studies and sixteen were suitable for meta-analysis. Gluten-free diet significantly improves HRQoL, for psychological general well-being (PGWB)-Total (mean difference (MD) 7.34, 95% confidence interval (CI) [1.96; 12.72]; p = 0.008), SF-36 Mental Component Score (MCS) (MD 7.37, 95% CI [1.84; 12.90]; p = 0.009) and SF-36 Physical Component Score (PCS) (MD 5.72, 95% CI [1.50; 9.95]; p = 0.008). Treated patients had similar HRQoL compared with controls for PGWB-Total (MD -0.72, 95% CI [-2.71; 1.27]; p = 0.48), but significantly lower levels for SF-36 MCS (MD -4.09, 95% CI [-6.17; -2.01]; p = 0.0001) and PCS (MD -4.57, 95% CI [-6.97; -2.17]; p = 0.0002). Symptom-detected gluten-free diet adhering patients have lower HRQoL compared with screening-detected patients (MD -3.73, 95% CI [-6.77;-0.69]; p = 0.02) Strict adhering patients have better HRQoL compared with non-strict adhering patients for SF-36 MCS (MD 7.70, 95% CI [4.61; 10.79]; p < 0.00001) and for SF-36 PCS (MD 3.23, 95% CI [1.33; 5.14]; p = 0.0009). CONCLUSIONS Gluten-free diet significantly improves but does not normalize HRQoL in adults with coeliac disease. Dietary adherence improves HRQoL. Better (self-reported) dietary adherence results in higher HRQoL.
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Affiliation(s)
- Jordy P W Burger
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands.
| | - Bart de Brouwer
- Department of Internal Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Joanna IntHout
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter J Wahab
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Marcia Tummers
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
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27
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Pietiläinen KH, Ismail K, Järvinen E, Heinonen S, Tummers M, Bollepalli S, Lyle R, Muniandy M, Moilanen E, Hakkarainen A, Lundbom J, Lundbom N, Rissanen A, Kaprio J, Ollikainen M. DNA methylation and gene expression patterns in adipose tissue differ significantly within young adult monozygotic BMI-discordant twin pairs. Int J Obes (Lond) 2015; 40:654-61. [PMID: 26499446 DOI: 10.1038/ijo.2015.221] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 08/29/2015] [Accepted: 09/21/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Little is known about epigenetic alterations associated with subcutaneous adipose tissue (SAT) in obesity. Our aim was to study genome-wide DNA methylation and gene expression differences in SAT in monozygotic (MZ) twin pairs who are discordant for body mass index (BMI). This design completely matches lean and obese groups for genetic background, age, gender and shared environment. METHODS 14We analyzed DNA methylome and gene expression from SAT, together with body composition (magnetic resonance imaging/spectroscopy) and glucose tolerance test, lipids and C-reactive protein from 26 rare BMI-discordant (intrapair difference in BMI ⩾3 kg m(-2)) MZ twin pairs identified from 10 birth cohorts of young adult Finnish twins. RESULTS We found 17 novel obesity-associated genes that were differentially methylated across the genome between heavy and lean co-twins. Nine of them were also differentially expressed. Pathway analyses indicated that dysregulation of SAT in obesity includes a paradoxical downregulation of lipo/adipogenesis and upregulation of inflammation and extracellular matrix remodeling. Furthermore, CpG sites whose methylation correlated with metabolically harmful fat depots (intra-abdominal and liver fat) also correlated with measures of insulin resistance, dyslipidemia and low-grade inflammation, thus suggesting that epigenetic alterations in SAT are associated with the development of unhealthy obesity. CONCLUSION This is the first study in BMI-discordant MZ twin pairs reporting genome-wide DNA methylation and expression profiles in SAT. We found a number of novel genes and pathways whose methylation and expression patterns differ within the twin pairs, suggesting that the pathological adaptation of SAT to obesity is, at least in part, epigenetically regulated.
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Affiliation(s)
- K H Pietiläinen
- Obesity Research Unit, Research Programs Unit, University of Helsinki, Helsinki, Finland.,Endocrinology, Abdominal Center, Helsinki University Central Hospital, and University of Helsinki, Helsinki, Finland.,Institute for Molecular Medicine FIMM, University of Helsinki, Helsinki, Finland
| | - K Ismail
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - E Järvinen
- Obesity Research Unit, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - S Heinonen
- Obesity Research Unit, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - M Tummers
- Obesity Research Unit, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - S Bollepalli
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - R Lyle
- Oslo University Hospital and University of Oslo, Department of Medical Genetics, Oslo, Norway
| | - M Muniandy
- Obesity Research Unit, Research Programs Unit, University of Helsinki, Helsinki, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - E Moilanen
- The Immunopharmacology Research Group, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
| | - A Hakkarainen
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J Lundbom
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research, Partner Düsseldorf, Düsseldorf, Germany
| | - N Lundbom
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Rissanen
- Obesity Research Unit, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - J Kaprio
- Institute for Molecular Medicine FIMM, University of Helsinki, Helsinki, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - M Ollikainen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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28
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Pfadenhauer LM, Mozygemba K, Gerhardus A, Hofmann B, Booth A, Lysdahl KB, Tummers M, Burns J, Rehfuess EA. Context and implementation: A concept analysis towards conceptual maturity. Z Evid Fortbild Qual Gesundhwes 2015; 109:103-14. [PMID: 26028447 DOI: 10.1016/j.zefq.2015.01.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/13/2015] [Accepted: 01/16/2015] [Indexed: 02/01/2023]
Abstract
Context and implementation of health interventions have received increasing attention over the past decade, in particular with respect to their influence on the effectiveness and reach of complex interventions. The underlying concepts are both considered partially mature, limiting their operationalization in research and practice. We conducted systematic literature searches and pragmatic utility (PU) concept analyses to provide a state-of-the-art assessment of the concepts of "context" and "implementation" in the health sciences to create a common understanding for their use within systematic reviews and HTA. We performed two separate searches, one for context (EMBASE, MEDLINE) and the other for implementation (Google Scholar) to identify relevant models, theories and frameworks. 17 publications on context and 35 articles on implementation met our inclusion criteria. PU concept analysis comprises three guiding principles: selection of the literature, organization and structuring of the literature, and asking analytic questions of the literature. Both concepts were analyzed according to four features of conceptual maturity, i.e., consensual definitions, clear characteristics, fully described preconditions and outcomes, and delineated boundaries. Context and implementation are highly intertwined, with both concepts influencing and interacting with each other. Context is defined as a set of characteristics and circumstances that surround the implementation effort. Implementation is conceptualized as a planned and deliberately initiated effort with the intention to put an intervention into practice. The concept of implementation presents largely consensual definitions and relatively well-defined boundaries, while distinguishing features, preconditions and outcomes are not yet fully articulated. In contrast, definitions of context vary widely, and boundaries with neighbouring concepts, such as setting and environment, are blurred; characteristics, preconditions and outcomes are ill-defined. Therefore, the maturity of both concepts should be further improved to facilitate operationalization in systematic reviews and HTAs.
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Affiliation(s)
- Lisa Maria Pfadenhauer
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany.
| | - Kati Mozygemba
- Institute of Public Health and Nursing Research, University of Bremen, Germany; Health Sciences Bremen, University of Bremen
| | - Ansgar Gerhardus
- Institute of Public Health and Nursing Research, University of Bremen, Germany; Health Sciences Bremen, University of Bremen
| | - Bjørn Hofmann
- Centre for Medical Ethics, University of Oslo, Norway
| | | | | | | | - Jacob Burns
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany
| | - Eva Annette Rehfuess
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany
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29
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van den Reek J, Tummers M, Zweegers J, Seyger M, van Lümig P, Driessen R, van de Kerkhof P, Kievit W, de Jong E. Predictors of adalimumab drug survival in psoriasis differ by reason for discontinuation: long-term results from the Bio-CAPTURE registry. J Eur Acad Dermatol Venereol 2014; 29:560-5. [DOI: 10.1111/jdv.12636] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/10/2014] [Indexed: 01/13/2023]
Affiliation(s)
- J.M.P.A. van den Reek
- Department of Dermatology; Radboud university medical center; Nijmegen the Netherlands
| | - M. Tummers
- Department for Health Evidence; Radboud university medical center; Nijmegen the Netherlands
| | - J. Zweegers
- Department of Dermatology; Radboud university medical center; Nijmegen the Netherlands
| | - M.M.B. Seyger
- Department of Dermatology; Radboud university medical center; Nijmegen the Netherlands
| | - P.P.M. van Lümig
- Department of Dermatology; Radboud university medical center; Nijmegen the Netherlands
| | - R.J.B. Driessen
- Department of Dermatology; Radboud university medical center; Nijmegen the Netherlands
| | - P.C.M. van de Kerkhof
- Department of Dermatology; Radboud university medical center; Nijmegen the Netherlands
| | - W. Kievit
- Department for Health Evidence; Radboud university medical center; Nijmegen the Netherlands
| | - E.M.G.J. de Jong
- Department of Dermatology; Radboud university medical center; Nijmegen the Netherlands
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Goedendorp MM, van der Werf SP, Bleijenberg G, Tummers M, Knoop H. Does neuropsychological test performance predict outcome of cognitive behavior therapy for Chronic Fatigue Syndrome and what is the role of underperformance? J Psychosom Res 2013; 75:242-8. [PMID: 23972413 DOI: 10.1016/j.jpsychores.2013.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 07/16/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE A subgroup of patients with Chronic Fatigue Syndrome (CFS) has cognitive impairments, reflected by deviant neuropsychological test performance. However, abnormal test scores can also be caused by suboptimal effort. We hypothesized that worse neuropsychological test performance and underperformance were related to each other and to a smaller reduction in fatigue, functional impairments, physical limitations and higher dropout rates following cognitive behavior therapy (CBT) for CFS. METHODS Data were drawn from a previous trial, in which CFS patients were randomized to two conditions; 1) guided self-instruction and additional CBT (n=84) or 2) waiting period followed by regular CBT for CFS (n=85). Underperformance was assessed using the Amsterdam Short Term Memory Test (<84). To test neuropsychological test performance, the Symbol Digit Modalities Task, a simple reaction time task and a choice reaction time task were used. Interaction effects were determined between underperformance and neuropsychological test performance on therapy outcomes. RESULTS Underperformance was associated to worse neuropsychological test performance, but there were no significant interaction effects of these two factors by therapy on fatigue severity, functional impairments and physical limitations, but there was a significant main effect of underperformance on functional impairments, physical limitations and dropout rates. CONCLUSION Underperformance or neuropsychological test performance was not related to the change in fatigue, functional impairments, and physical limitations following CBT for CFS. However, underperforming patients did drop out more often. Therapists should pay attention to beliefs and behavioral or environmental factors that might maintain underperformance and increase the risk of dropout.
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Affiliation(s)
- Martine M Goedendorp
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands.
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Tummers M, Knoop H, van Dam A, Bleijenberg G. Moderators of the treatment response to guided self-instruction for chronic fatigue syndrome. J Psychosom Res 2013; 74:373-7. [PMID: 23597323 DOI: 10.1016/j.jpsychores.2013.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 01/20/2013] [Accepted: 01/21/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The efficiency and efficacy of guided self-instruction for chronic fatigue syndrome (CFS) can be enhanced if it is known which patients will benefit from the intervention. This study aimed to identify moderators of treatment response. METHODS This study is a secondary analysis of two randomized controlled trials evaluating the efficacy of guided self-instruction for CFS. A sample of 261 patients fulfilling US Center for Disease Control and Prevention criteria for CFS was randomly allocated to guided self-instruction or a wait list. The following potential treatment moderators were selected from the literature: age, fatigue severity, level of physical functioning, pain, level of depressive symptoms, self-efficacy with respect to fatigue, somatic attributions, avoidance of activity, and focus on bodily symptoms. Logistic and linear regression analyses were used with interaction term between treatment response and the potential moderator. RESULTS Age, level of depression, and avoidance of activity moderated the response to guided self-instruction. Patients who were young, had low levels of depressive symptoms, and who had a low tendency to avoid activity benefited more from the intervention than older patients and patients with high levels of depressive symptoms and a strong tendency to avoid activity. CONCLUSION Guided self-instruction is exclusively aimed at cognitions and behaviours that perpetuate fatigue. Patients with severe depressive symptom may need more specific interventions aimed at the reduction of depressive symptoms to profit from the intervention. Therefore we suggest that patients with substantial depressive symptoms be directly referred to regular cognitive behaviour therapy.
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Affiliation(s)
- Marcia Tummers
- Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Tummers M, Lucassen PL, Wiborg JFW, Bleijenberg G. The challenge of diagnosing CFS in primary care. Int J Clin Pract 2013; 67:489. [PMID: 23574108 DOI: 10.1111/ijcp.12139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 01/24/2013] [Indexed: 11/30/2022] Open
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Wiborg JF, Wensing M, Tummers M, Knoop H, Bleijenberg G. Implementing evidence-based practice for patients with chronic fatigue syndrome. Clin Psychol Psychother 2012; 21:108-14. [PMID: 23229956 DOI: 10.1002/cpp.1827] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 11/01/2012] [Accepted: 11/02/2012] [Indexed: 11/06/2022]
Abstract
UNLABELLED The aim of our study was to explore whether community-based mental health care centres (MHCs) are able to implement and sustain cognitive behaviour therapy (CBT) for chronic fatigue syndrome (CFS) with the help of an implementation manual. We monitored the implementation process and treatment outcome data of three Dutch MHCs that implemented or sustained CBT for CFS, one in the context of a stepped care programme. We compared these data with findings of other treatment studies conducted in the context of CBT for CFS. All three MHCs included at least 40 patients with dropout rates between 15% and 35% from intention-to-treat to second assessment. Effect sizes ranged between 0.88 and 1.76 for changes in fatigue severity and 0.43 and 1.23 for changes in physical functioning. With one exception, these outcomes were within the range of our benchmark. Contrary to original expectations, we provided additional implementation support to the two MHCs new with CBT for CFS. We concluded that our implementation manual does not seem to substitute external support for team leaders and associated professions during initial implementation of CBT for CFS but may have the potential to make this assistance more efficient. Particular attention should be paid to challenges of implementing stepped care for CFS. KEY PRACTITIONERS MESSAGE Implementation of CBT for CFS in community-based MHCs was monitored. External support was provided in addition to an implementation manual during initial implementation of CBT for CFS. Participating MHCs were generally capable of successfully implementing and delivering CBT for CFS. Implementation of low-intensity interventions for CFS might better be postponed until therapists have sufficient experience with conventional CBT for CFS.
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Affiliation(s)
- Jan F Wiborg
- Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, The Netherlands; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf & Schön Klinik Hamburg-Eilbek, Hamburg, Germany
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Tummers M, Knoop H, van Dam A, Bleijenberg G. Implementing a minimal intervention for chronic fatigue syndrome in a mental health centre: a randomized controlled trial. Psychol Med 2012; 42:2205-2215. [PMID: 22354999 DOI: 10.1017/s0033291712000232] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cognitive behaviour therapy (CBT) for chronic fatigue syndrome (CFS) is an effective but intensive treatment, requiring trained therapists. A minimal intervention based on CBT for CFS, guided self-instruction, was shown to be an effective treatment when delivered in a tertiary treatment centre. Implementing this intervention in a community-based mental health centre (MHC) will increase the treatment capacity for CFS patients. This study evaluated the effectiveness of guided self-instruction for CFS implemented in an MHC, delivered by nurses. METHOD One hundred and twenty-three patients were randomly assigned to either guided self-instruction (n=62) or a waiting list (n=61). Randomization was computer generated, with allocation by numbered sealed envelopes. Group allocation was open to all those involved. Patients fulfilled US Centers for Disease Control and Prevention (CDC) criteria for CFS. Primary outcome variables were fatigue severity and physical and social functioning, measured with the Checklist Individual Strength (CIS) and the Medical Outcomes Survey Short Form-36 (SF-36) respectively. RESULTS After 6 months, patients who followed guided self-instruction reported a significantly larger decrease in fatigue compared to the waiting list [mean difference -8.1, 95% confidence interval (CI) -3.8 to -12.4, controlled effect size 0.70]. There was no significant difference in physical and social functioning. However, post-hoc analyses showed a significant decrease in fatigue and physical disabilities following the intervention in a subgroup of patients with physical disabilities at baseline (SF-36 physical functioning ⩽70). CONCLUSIONS Implementation of guided self-instruction in a community-based MHC was partially successful. The minimal intervention can be effectively implemented for CFS patients with physical impairments.
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Affiliation(s)
- M Tummers
- Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, The Netherlands.
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Tummers M, Knoop H, Bleijenberg G. Effectiveness of stepped care for chronic fatigue syndrome: a randomized noninferiority trial. J Consult Clin Psychol 2011; 78:724-31. [PMID: 20873907 DOI: 10.1037/a0020052] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In this randomized noninferiority study, the effectiveness and efficiency of stepped care for chronic fatigue syndrome (CFS) was compared to care as usual. Stepped care was formed by guided self-instruction, followed by cognitive behavior therapy (CBT) if the patient desired it. Care as usual encompassed CBT after a waiting period. METHOD A total of 171 CFS patients were randomly allocated to stepped care or care as usual. Patients in both conditions were assessed 3 times: at baseline, after guided self-instruction or the waiting period, and after CBT. The primary outcome variables were fatigue severity (Checklist Individual Strength) and disabilities (Sickness Impact Profile and Medical Outcomes Survey Short Form-36). RESULTS An intention to treat analysis showed that stepped care (N = 84) for CFS is noninferior to care as usual (N = 85). Both conditions were equivalent in reducing fatigue severity, reducing disabilities, and increasing physical functioning. The treatment results of both conditions were in accordance with those of previous randomized controlled trials testing the effectiveness of CBT for CFS. The total therapist time needed to treat a patient was significantly less in the stepped care condition. CONCLUSIONS Stepped care is as effective as CBT and is more time efficient for the therapist.
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Affiliation(s)
- Marcia Tummers
- Radboud University Nijmegen Medical Centre, Expert Centre for Chronic Fatigue, 4628, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Abstract
UNLABELLED GoPro49 is a recently identified, novel Golgi protein that is expressed in embryonic mesenchymal tissues, including dental follicle. In the present study, we have tested the hypothesis that the gene is a specific marker for the dental follicle, and examined its expression during the development of mouse incisors and molars. In situ hybridization showed that GoPro49 is expressed in dental follicles from bud to post-eruption stages. The expression is intense throughout the dental follicle during crown development, and persists in the root follicle during root development. In the forming periodontal ligament, GoPro49 expression is down-regulated upon differentiation of the follicle cells to cementoblasts and osteoblasts marked by Bsp1. In cultured dental follicle cells, the GoPro49 protein co-localizes with beta-COP, suggesting that GoPro49 may function in the secretory pathway. We conclude that GoPro49 is a novel, specific marker for the dental follicle and can be used to identify this tissue. ABBREVIATIONS Bsp1, bone sialoprotein 1; GoPro49, Golgi protein 49 kDa; E16, embryonic day 16; HERS, Hertwig's epithelial root sheath; PDL, periodontal ligament; dpn, day post-natal.
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Affiliation(s)
- M S Takatalo
- University of Helsinki, Department of Biological and Environmental Sciences, Division of Biochemistry, P.O. Box 56 (Viikinkaari 5D), University of Helsinki FIN-00014, Finland
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Abstract
Mouse molars are normally not capable of continuous growth. We hypothesized that the mouse molar has intrinsic potential to maintain the epithelial stem cell niche and assessed this potential by growth in vitro. Although the tooth germs flattened considerably, they developed a mineralized crown and a root. However, histologically, the root surface was composed of 3 structurally different regions affecting the fate of the dental epithelium. The anterior and posterior aspects maintained the morphological and molecular characteristics of the cervical loop of a continuously growing incisor, with a continuous layer of ameloblasts. The epithelium making contact with the supporting filter resembled Hertwig's epithelial root sheath. The top of the cultured molar exposed to air lacked epithelium altogether. We conclude that the fate of the epithelium is regulated by external cues influenced by culture conditions, and that the molar has the intrinsic capacity to grow continuously.
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Affiliation(s)
- M Tummers
- Developmental Biology Program, Institute of Biotechnology, Viikki Biocenter, PO Box 56, FIN-00014, Helsinki, Finland.
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Abstract
Notch signaling is an evolutionarily conserved pathway that controls the developmental choices made by individual cells. Cells communicate via Notch receptors and their ligands, which direct decisions on the fate of stem cells according to the states of their neighbors. In this study we explored Notch signaling after the pulp capping of adult first upper rat molars. The wound was capped with calcium hydroxide. In situ hybridization revealed an increased expression of Notch signaling genes on day 1, which showed a tendency to decrease on day 3. Notch1 increased in the subodontoblast zone and close to the lesion limited to a few cells. Notch2 increased in pulp stroma surrounded by coronal odontoblasts. Notch1 and, especially, Notch3 expression increased, corresponding to perivascular cell groups. A low increase of ligand expression was observed near the injury with Delta1 expression along the dentin wall and Jagged1 in the stroma. Expression of the downstream target, Hes1, was observed along the lesion and adjacent dentin walls. Hes5 expression was not observed. The results indicate that Notch signaling is activated in response to injury and associated with the differentiation of pulp cells into perivascular cells and odontoblasts. The findings are consistent with the concept that the Notch pathway controls stem cell fate during pulp regeneration.
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Affiliation(s)
- H Løvschall
- Department of Dental Pathology, Operative Dentistry and Endodontics, Royal Dental College, Faculty of Health Sciences, University of Aarhus, Denmark.
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Abstract
Like crown development, root formation is also regulated by interactions between epithelial and mesenchymml tissues. Bone morphogenetic proteins (BMPs), together with the transcription factors Msx1 and Msx2, play important roles in these interactions during early tooth morphogenesis. To investigate the involvement of this signaling pathway in root development, we analyzed the expression patterns of Bmp2, Bmp3, Bmp4, and Bmp7 as well as Msx1 and Msx2 in the roots of mouse molars. Bmp4 was expressed in the apical mesenchyme and Msx2 in the root sheath. However, Bmps were not detected in the root sheath epithelium, and Msx transcripts were absent from the underlying mesenchyme. These findings indicate that this Bmp signaling pathway, required for tooth initiation, does not regulate root development, but we suggest that root shape may be regulated by a mechanism similar to that regulating crown shape in cap-stage tooth germs. Msx2 expression continued in the epithelial cell rests of Malassez, and the nearby cementoblasts intensely expressed Bmp3, which may regulate some functions of the fragmented epithelium.
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Affiliation(s)
- T Yamashiro
- Developmental Biology Program, Institute of Biotechnology, Viikki Biocenter, PO Box 56, FIN-00014 University of Helsinki, Finland.
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