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Albarqouni L, Montori V, Jørgensen KJ, Ringsten M, Bulbeck H, Johansson M. Applying the time needed to treat to NICE guidelines on lifestyle interventions. BMJ Evid Based Med 2023; 28:354-355. [PMID: 37225391 DOI: 10.1136/bmjebm-2022-112225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Loai Albarqouni
- Global Center for Sustainable Healthcare, Global Center for Sustainable Healthcare, Uddevalla, Sweden
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Robina, Queensland, Australia
| | - Victor Montori
- Global Center for Sustainable Healthcare, Global Center for Sustainable Healthcare, Uddevalla, Sweden
- The Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Karsten Juhl Jørgensen
- Global Center for Sustainable Healthcare, Global Center for Sustainable Healthcare, Uddevalla, Sweden
- Department of Clinical Research, Cochrane Denmark and Centre for Evidence-Based Medicine Odense (CEBMO), University of Southern Denmark, Odense, Denmark
| | - Martin Ringsten
- Cochrane Sweden, Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Helen Bulbeck
- Cochrane Consumer Network Executive, Brainstrust, Cowes, UK
| | - Minna Johansson
- Global Center for Sustainable Healthcare, Global Center for Sustainable Healthcare, Uddevalla, Sweden
- General Practice, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Bailey S, Allwood D, Macklin N, Montori V, Bisognano M, Klaber B. Healthcare education needs radical reform to emphasise careful and kind care. BMJ 2023; 382:p1505. [PMID: 37402510 DOI: 10.1136/bmj.p1505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Affiliation(s)
| | - Dominique Allwood
- Imperial College Healthcare NHS Trust, UK
- Imperial College London, UK
| | - Nicki Macklin
- Faculty of Medicine and Health Sciences, University of Auckland, New Zealand
| | | | | | - Bob Klaber
- Imperial College Healthcare NHS Trust, UK
- Imperial College London, UK
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Patel Chavez CP, Godinez Leiva E, Bagautdinova D, Hidalgo J, Hartasanchez S, Barb D, Danan D, Dziegielewski P, Edwards C, Hughley B, Srihari A, Subbarayan S, Castro MR, Dean D, Morris J, Ryder M, Stan MN, Hargraves I, Shepel K, Brito JP, Bylund CL, Treise D, Montori V, Singh Ospina N. Patient feedback receiving care using a shared decision making tool for thyroid nodule evaluation-an observational study. Endocrine 2023; 80:124-133. [PMID: 36534326 PMCID: PMC10292116 DOI: 10.1007/s12020-022-03277-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To characterize the feedback of patients with thyroid nodules receiving care using a shared decision making (SDM) tool designed to improve conversations with their clinicians related to diagnostic options (e.g. thyroid biopsy, ultrasound surveillance). METHODS Investigators qualitatively analyzed post-encounter interviews with patients to characterize their feedback of a SDM tool used during their clinical visits. Additionally, investigators counted instances of diagnostic choice awareness and of patients' expression of a diagnostic management preference in recordings of clinical encounters of adult patients presenting for evaluation of thyroid nodules in which the SDM tool was used. RESULTS In total, 53 patients (42 (79%) women); median age 62 years were enrolled and had consultations supported by the SDM tool. Patients were favorable about the design of the SDM tool and its ability to convey information about options and support patient-clinician interactions. Patients identified opportunities to improve the tool through adding more content and improve its use in practice through training of clinicians in its use. There was evidence of diagnostic choice awareness in 52 (98%) of these visits and patients expressed a diagnostic management preference in 40 (76%). CONCLUSION User centered design including feedback from patients and real life observation supports the use of the SDM tool to facilitate collaboration between patients and clinicians.
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Affiliation(s)
| | - Eddison Godinez Leiva
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Diliara Bagautdinova
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Jessica Hidalgo
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
| | - Sandra Hartasanchez
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
| | - Diana Barb
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Deepa Danan
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | | | - Catherine Edwards
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Brian Hughley
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | - Ashok Srihari
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Sreevidya Subbarayan
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Diana Dean
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - John Morris
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Mabel Ryder
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Marius N Stan
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Ian Hargraves
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
| | - Kathryn Shepel
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Debbie Treise
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Victor Montori
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA.
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Affiliation(s)
- Minna Johansson
- Global Center for Sustainable Healthcare, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada
| | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, USA
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Montori V, Kunneman M. Caring without boundaries: delimiting shared decision-making. BMJ Evid Based Med 2022:bmjebm-2022-112184. [PMID: 36522137 DOI: 10.1136/bmjebm-2022-112184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Marleen Kunneman
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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Chavez CP, Hartasanchez S, Hidalgo J, Leiva EG, Bagautdinova D, Regina Castro M, Dean D, Morris JC, Ryder M, Stan M, Barb D, Danan D, Dziegielewski P, Edwards CM, Hughley B, Srihari A, Subbarayan S, Hargraves IG, Shepel K, Brito Campana JP, Carma B, Treise D, Montori V, Ospina NS. PSAT245 Feasibility of introducing a conversation aid for patients with thyroid nodules in clinical practice: Understanding the clinician experience. J Endocr Soc 2022. [DOI: 10.1210/jendso/bvac150.1666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
Background
To support the collaboration between patients with thyroid nodules and their clinician, we developed a Thyroid NOdule conversation aid (TNOC). TNOC includes a representation of thyroid cancer risk, alternative management options, and a print-out summary for patients. In a pilot study, the use of TNOC was associated with improvement in the quality of diagnostic conversations.
Research question: The aim of this study was to evaluate the feasibility of introducing TNOC into clinical encounters and understand clinicians’ experience with its use.
Methods
Prospective study conducted in two academic centers in the U.S. We included adult patients with thyroid nodules and their clinicians (endocrinologists and ear, nose, and throat specialists (ENT)). The feasibility of introducing TNOC was evaluated by the fidelity to which TNOC was used (12 item checklist of included components, such as: thyroid cancer risk presentation, management options) and the duration of clinical visits, evaluated through video recordings. Clinicians completed a post-visit survey to evaluate how helpful and easy to use TNOC was and the degree to which it supported collaboration with their patients. A qualitative analysis of semi-structured interviews was conducted after clinicians used TNOC in at least three visits. The interview guide was developed following constructs included in the Consolidated Framework for Implementation Research. Analysis was conducted using the constant comparative method.
Results
Twelve clinicians (9 endocrinologists and 3 ENT) were included and used TNOC with 53 patients. Most patients were women (N -42, 79%) with a median age of 62 years (Interquartile range, 53-70). The median size of the thyroid nodules was 2.3 cm (Interquartile range, 1.3, 3.0). The median clinical visit duration was 17 minutes (Interquartile range 10,28). The median fidelity score was 75% (interquartile range 58, 75), with thyroid cancer risk presentation being the most commonly used item (98%) and the printable summary the least used (15%). Clinicians agreed or strongly agreed that TNOC was helpful (N=34, 65%), easy to use (N=44, 85%), and supported collaboration with patients (N= 32, 62%).
In the qualitative analysis, clinicians reported that TNOC was organized and covered commonly discussed topics. Moreover, the use of TNOC could support the clinical interaction and be beneficial for patients by assuring the patient perspective was considered, creating space for questions, and improving how information was presented. Yet, the perceived benefit of using TNOC was expected to be different depending on the expertise of the clinician, as experts might benefit less. Clinicians highlighted the importance of familiarity with TNOC to ease its use and suggested modifications: additional visual content, improved navigation to support dynamic use and providing patient access before/after the visit.
Interpretation: Using TNOC to support thyroid nodule management conversations was feasible, helpful, easy to use, and supportive of patient-clinician collaboration.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
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Patel Chavez C, Leiva EG, Bagautdinova D, Hidalgo J, Hartasanchez S, Barb D, Danan D, Dziegielewski P, Edwards C, Hughley B, Srihari A, Subbarayan S, Regina C, Dean D, Morris J, Mabel R, Marius S, Hargraves I, Shepel K, Campana JB, Bylund C, Debbie T, Montori V, Ospina NS. PSAT246 Decision Making for Patients with Thyroid Nodules: Understanding the Patient's Experience. J Endocr Soc 2022. [PMCID: PMC9625195 DOI: 10.1210/jendso/bvac150.1667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background We recently developed a Thyroid NOdule conversation aid (TNOC), a conversation tool that supports communication about management options between patients with thyroid nodules and their clinicians. TNOC uses an interactive electronic interface to support conversations about thyroid cancer risk in patients with thyroid nodules and management options. In a pilot study, the use of TNOC in the clinical encounter was associated with improvement in the quality of diagnostic conversations. Research question: The aim of the study was to evaluate the patient's experience when receiving care using TNOC. Methods Prospective study conducted in two academic centers in the U.S. We included adult patients presenting for the evaluation of thyroid nodules and using TNOC in the encounters with their clinicians. Patients that were hyperthyroid, pregnant or had records of previous biopsy were excluded. Patient demographics and clinical features were obtained through electronic health record review. We conducted post-visit semi-structured interviews to assess patients’ experiences using TNOC. The semi-structured interview was developed following constructs included in the Consolidated Framework for Implementation Research. Qualitative analysis was conducted following the constant comparative method to identify emerging themes related to the patient experiences using TNOC. After an initial group of themes were identified, a final set of themes was derived based on prevalence and salience, following an iterative process by two coders. Results 53 patients were enrolled in the study and 49 completed the post-visit interview. Most patients were women (N -42, 79%) and white (N-47, 89%) with a median age of 62 years (Interquartile range, 53-70). The median size of the thyroid nodules was 2.3 cm (Interquartile range, 1.3, 3.0) and 45% were ACR-TIRADS 4 or 5 (N-24). Most nodules were found incidentally (N-37, 70%). In the qualitative assessment, the layman terms included in TNOC, the structured, step-wise and visual presentation of information were considered positively by patients. The language, visuals, and structure of TNOC supported knowledge transfer about thyroid nodules and their management options, helping them better understand their situation. Patients felt they worked together with their clinician by going through the conversation aid, making them feel comfortable asking questions. However, patients reported that the clinician's familiarity with TNOC and the learning needs of patients could affect the perceived benefit of the conversation aid. Patients suggested including more information and visuals in TNOC and providing access before/after the visit. Interpretation: Patients found that the use of TNOC in medical encounters was helpful to understand information, treatment options, and working with their clinicians. This information supports the implementation of TNOC in practice to support decision-making. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
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Mitra S, Boasquevisque DDS, Noorduyn S, Rodrigues M, Lawson DO, Thabane L, Montori V. A conversation on evidence-based medicine in the COVID-era, patient revolution, and academic career with Dr. Victor Montori. J Evid Based Med 2022; 15:187-191. [PMID: 35927962 PMCID: PMC9537952 DOI: 10.1111/jebm.12487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/21/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Souvik Mitra
- Departments of Pediatrics, Community Health & EpidemiologyDalhousie University and IWK HealthHalifaxNova ScotiaCanada
| | | | - Stephen Noorduyn
- Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Myanca Rodrigues
- Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Daeria O. Lawson
- Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteMcMaster UniversityHamiltonOntarioCanada
| | - Victor Montori
- Division of Endocrinology, Diabetes, Metabolism, Nutrition, Department of Internal Medicine, Mayo ClinicRochesterMinnesota
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Kunneman M, Hargraves IG, Sivly AL, Branda ME, LaVecchia CM, Labrie NHM, Brand-McCarthy S, Montori V. Co-creating sensible care plans using shared decision making: Patients' reflections and observations of encounters. Patient Educ Couns 2022; 105:1539-1544. [PMID: 34711446 DOI: 10.1016/j.pec.2021.10.003] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/13/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate how the use of a within-encounter SDM tool (compared to usual care in a randomized trial) contributes to care plans that make sense to patients with atrial fibrillation considering anticoagulation. METHODS In a planned subgroup of the trial, 123 patients rated post-encounter how much sense their decided-upon care plan made to them and explained why. We explored how sense ratings related to observed patient involvement (OPTION12), patient's decisional conflict, and adherence to their plan based on pharmacy records. We analyzed patient motives using Burke's pentad. RESULTS Plan sensibility was similarly high in both arms (Usual care n = 62: mean 9.4/10 (SD 1.0) vs SDM tool n = 61: 9.2/10 (SD 1.5); p = .8), significantly and weakly correlated to decisional conflict (rho=-0.28, p = .002), but not to OPTION12 or adherence. Plans made sense to most patients given their known efficacy, safety and what is involved in implementing them. CONCLUSION Adding an effective intervention to promote SDM did not affect how much, or why, care plans made sense to patients receiving usual care, nor patient adherence to them. PRACTICE IMPLICATIONS Evaluating the extent to which care plans make sense can improve SDM assessments, particularly when SDM extends beyond selecting from a menu of options.
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Affiliation(s)
- Marleen Kunneman
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.
| | - Ian G Hargraves
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
| | - Angela L Sivly
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
| | - Megan E Branda
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, USA; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
| | - Christina M LaVecchia
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; School of Arts and Sciences, Neumann University, Auston, PA, USA.
| | - Nanon H M Labrie
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | | | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
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Ospina NMS, Bagautdinova D, Hargraves I, Barb D, Subbarayan S, Srihari A, Wang S, Maraka S, Bylund C, Treise D, Montori V, Brito JP. Development and pilot testing of a conversation aid to support the evaluation of patients with thyroid nodules. Clin Endocrinol (Oxf) 2022; 96:627-636. [PMID: 34590734 PMCID: PMC8897203 DOI: 10.1111/cen.14599] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/25/2021] [Accepted: 09/09/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To support patient-centred care and the collaboration of patients and clinicians, we developed and pilot tested a conversation aid for patients with thyroid nodules. DESIGN, PATIENT AND MEASUREMENTS We developed a web-based Thyroid NOdule Conversation aid (TNOC) following a human-centred design. A proof of concept observational pre-post study was conducted (TNOC vs. usual care [UC]) to assess the impact of TNOC on the quality of conversations. Data sources included recordings of clinical visits, post-encounter surveys and review of electronic health records. Summary statistics and group comparisons are reported. RESULTS Sixty-five patients were analysed (32 in the UC and 33 in the TNOC cohort). Most patients were women (89%) with a median age of 57 years and were incidentally found to have a thyroid nodule (62%). Most thyroid nodules were at low risk for thyroid cancer (71%) and the median size was 1.4 cm. At baseline, the groups were similar except for higher numeracy in the TNOC cohort. The use of TNOC was associated with increased involvement of patients in the decision-making process, clinician satisfaction and discussion of relevant topics for decision making. In addition, decreased decisional conflict and fewer thyroid biopsies as the next management step were noted in the TNOC cohort. No differences in terms of knowledge transfer, length of consultation, thyroid cancer risk perception or concern for thyroid cancer diagnosis were found. CONCLUSION In this pilot observational study, using TNOC in clinical practice was feasible and seemed to help the collaboration of patients and clinicians.
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Affiliation(s)
- Naykky M Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL
| | | | - Ian Hargraves
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester MN, USA
| | - Diana Barb
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL
| | - Sreevidya Subbarayan
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL
| | - Ashok Srihari
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL
| | - Shu Wang
- University of Florida Health Cancer Center & Department of Biostatistics, University of Florida
| | - Spyridoula Maraka
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR
- Central Arkansas Veterans Healthcare System, Little Rock, AR
| | - Carma Bylund
- College of Journalism & Communications, University of Florida, Gainesville, FL
| | - Debbie Treise
- College of Journalism & Communications, University of Florida, Gainesville, FL
| | - Victor Montori
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN
| | - Juan P Brito
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN
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Riaz IB, Fuentes HE, Naqvi SAA, He H, Sipra QUAR, Tafur AJ, Padranos L, Wysokinski WE, Marshall AL, Vandvik PO, Montori V, Bryce AH, Liu H, Badgett RG, Murad MH, McBane RD. Direct Oral Anticoagulants Compared With Dalteparin for Treatment of Cancer-Associated Thrombosis: A Living, Interactive Systematic Review and Network Meta-analysis. Mayo Clin Proc 2022; 97:308-324. [PMID: 34172290 DOI: 10.1016/j.mayocp.2020.10.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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] [Received: 09/14/2020] [Revised: 10/05/2020] [Accepted: 10/26/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To maintain living, interactive evidence (LIvE) on the benefits and harms of different treatment options in adults with cancer-associated thrombosis (CAT). METHODS We have used a novel LIvE synthesis framework to maintain this living, interactive systematic review since September 19, 2018. Randomized controlled trials evaluating the efficacy and safety of direct oral anticoagulants (DOACs) compared with low-molecular-weight heparin for CAT are included in this analysis. Details of LIvE synthesis framework are available at the website https://cat.network-meta-analysis.com. RESULTS The results are constantly updated as new information becomes available (https://cat.network-meta-analysis.com/CAT.html). The living, interactive systematic review currently includes 4 randomized controlled trials (N=2894). Direct comparisons show that DOACs significantly decrease recurrent venous thromboembolism (VTE) events compared with dalteparin (odds ratio [OR], 0.59; 95% CI, 0.41 to 0.86; I2, 25%) without significantly increasing major bleeding (OR, 1.34; 95% CI, 0.83 to 2.18; I2, 28%). Mixed treatment comparisons show that apixaban (OR, 0.41; 95% credible interval [CrI], 0.16 to 0.95) and rivaroxaban (OR, 0.58; 95% CrI, 0.37 to 0.90) significantly decrease VTE recurrent events compared with dalteparin. Edoxaban significantly increases major bleeding compared with dalteparin (OR, 1.73; 95% CrI, 1.04 to 3.16), and rivaroxaban significantly increases clinically relevant nonmajor bleeding compared with dalteparin and other DOACs. There are no significant differences between DOACs in terms of VTE recurrences and major bleeding. CONCLUSION DOACs should be considered a standard of care for the treatment of CAT except in patients with a high risk of bleeding. Current evidence favors the use of apixaban for the treatment of CAT among other DOACs. REGISTRATION Open Science Framework (https://osf.io/dth86).
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Affiliation(s)
| | | | | | | | | | - Alfonso J Tafur
- Pritzker School of Medicine, University of Chicago, Chicago, IL
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Albarqouni L, Ringsten M, Montori V, Jørgensen KJ, Bulbeck H, Johansson M. Evaluation of evidence supporting NICE recommendations to change people's lifestyle in clinical practice: cross sectional survey. BMJ Med 2022; 1:e000130. [PMID: 36936567 PMCID: PMC9978760 DOI: 10.1136/bmjmed-2022-000130] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/14/2022] [Indexed: 01/21/2023]
Abstract
Objectives To assess whether recommendations of individually oriented lifestyle interventions (IOLIs) in guidelines from the National Institute for Health and Care Excellence (NICE) were underpinned by evidence of benefit, and whether harms and opportunity costs were considered. Design Cross sectional survey. Setting UK. Data sources NICE guidelines and supporting evidence. Eligibility criteria All NICE pathways for IOLI recommendations (ie, non-drug interventions that healthcare professionals administer to adults to achieve a healthier lifestyle and improve health) were searched systematically on 26 August 2020. One author screened all retrieved pathways for candidate guidelines, while a second author verified these judgments. Two authors independently and in duplicate screened all retrieved guidelines and recommendations for eligibility, extracted data, and evaluated the evidence cited and the outcomes considered. Disagreements were noted and resolved by consensus. Results Within 57 guidelines, 379 NICE recommendations were found for IOLIs; almost all (n=374; 99%) recommended the lifestyle intervention and five (1%) recommended against the intervention. Of the 379 recommendations, 13 (3%) were supported by moderate or high certainty evidence of a beneficial effect on patient relevant outcomes (n=7; 2%) or surrogate outcomes (n=13; 3%). 19 (5%) interventions considered psychosocial harms, 32 (8%) considered physical harms, and one (<1%) considered the opportunity costs of implementation. No intervention considered the burden placed on individuals by these recommendations. Conclusion Few NICE recommendations of lifestyle interventions are supported by reliable evidence. While this finding does not contest the beneficial effects of healthy habits, guidelines recommending clinicians to try to change people's lifestyle need to be reconsidered given the substantial uncertainty about the effectiveness, harms, and opportunity costs of such interventions.
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Affiliation(s)
- Loai Albarqouni
- Institute for Evidence-Based Healthcare, Bond University Faculty of Health Sciences and Medicine, Gold Coast, QLD, Australia
| | | | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, University of Southern Denmark, Odense, Denmark
| | - Helen Bulbeck
- Cochrane Consumer Network Executive, Brainstrust, Cowes, UK
| | - Minna Johansson
- Cochrane Sweden, Lund, Sweden
- Department of Public Health and Community Medicine, University of Gothenburg Institute of Medicine, Gothenburg, Sweden
- Global Center for Sustainable Healthcare, Uddevalla, Sweden
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Poplau S, Linzer M, Allwood D, Montori V, Armbruster R, Koka S. Designing the careful and kind clinic: an evidence-based approach. leader 2021; 6:87-91. [DOI: 10.1136/leader-2021-000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/28/2021] [Indexed: 11/04/2022]
Abstract
BackgroundThere is evidence that creating a ‘healthy workplace’ can be of profound importance for clinicians, team members and patients. Yet there have been few papers that have proposed mechanisms to take decades of research and translate this into a practical list of options for leaders and managers to take into account when structuring a clinic based on care and kindness to achieve optimal health.EvidenceWe bring together 20 years of scholarship linking care of the caregivers with outcomes for caregivers and patients. The data are used to support both structures and cultures that will result in satisfied and thriving healthcare team members, as well as satisfied and healthy patients.ResultsThe clinic based on care of the caregivers will be structured to address key aspects of worklife that are known to cause either satisfaction or burnout. Aspects of care, such as time pressure, chaotic environments and worker control of their workplace, will be taken into account in clinical design; organisational culture will be supportive and cohesive, emphasising quality, values and communication. Experiences based on gender and race will be measured and continuously improved; and performance will be evaluated in a new, human-centred manner.OutcomesThe careful and kind clinic will be a remarkable place to work; in contrast to industrialised healthcare, this will be an environment where health can indeed be optimised, for both workers and patients.
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Clark JE, Boehmer KR, Breslin M, Haider S, Pasciak W, Gravholt D, Sanchez BB, Hartasanchez SA, El Kawkgi OM, Montori V, Lipska KJ. Quality of life, burden of treatment, safety, and avoidance of future events (QBSAfe) protocol: a pilot study testing an intervention to shift the paradigm of diabetes care. Pilot Feasibility Stud 2021; 7:196. [PMID: 34749816 PMCID: PMC8572684 DOI: 10.1186/s40814-021-00935-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/15/2021] [Accepted: 10/22/2021] [Indexed: 01/22/2023] Open
Abstract
Background Diabetes care has been traditionally focused on targeting certain levels of glycemic control. This narrow emphasis may impose burdens on patients, including high treatment costs, illness-related work, or side effects from medications, while leaving other patient needs and goals under-addressed. The authors aim to shift the paradigm of care for people with diabetes, to focus on quality of life, burden of treatment, safety, and avoidance of future events: the QBSAfe domains. Methods We describe a single-arm pilot study to assess the feasibility and acceptability of using the QBSAfe agenda setting kit (ASK) during routine clinical visits. The set of 14 conversation aid cards was co-developed with patients, family caregivers, and clinicians. The ASK will be used in the context of a clinic visit, which will be recorded by members of the study team to identify patterns of clinician-patient conversations. Feasibility will be measured by the number of participants recruited, time to goal accrual, and completeness of data collection; acceptability will be assessed using post-visit surveys of patients and clinicians. A subgroup of patients will be invited to participate in post-visit qualitative semi-structured interviews for additional feedback. This study will be conducted across three medical centers in the Midwest and East Coast of the USA. Discussion Current healthcare infrastructure and associated demands and pressures on clinicians make changes in care difficult. However, this intervention has the potential to shift conversations during clinical encounters so they can address and directly respond to patient needs, symptoms, and capacity. As part of the QBSAfe ASK, the authors are also actively collaborating with a variety of stakeholders to create tools to help clinicians respond more effectively to patient concerns as they are raised during the clinical encounters. Additional insights about the use of the QBSAfe approach in the virtual space will be gathered during the process of our study due to restrictions imposed upon face to face visit during the COVID-19 pandemic. Trial registration ClinicalTrials.gov, NCT04514523. Registered 17 August 2020—retrospectively registered.
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Affiliation(s)
- Jennifer E Clark
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | | | - Shanzay Haider
- Section of Endocrinology, Yale University School of Medicine, PO Box 208020, New Haven, CT, 06520, USA
| | - Weronika Pasciak
- Frank H. Netter MD School of Medicine, Quinnipiac University, Hamden, CT, USA
| | - Derek Gravholt
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Brianna B Sanchez
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | | | - Omar M El Kawkgi
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Kasia J Lipska
- Section of Endocrinology, Yale University School of Medicine, PO Box 208020, New Haven, CT, 06520, USA.
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Hanlon P, Bryson I, Morrison H, Rafiq Q, Boehmer K, Gionfriddo MR, Gallacher K, May C, Montori V, Lewsey J, McAllister DA, Mair FS. Self-management interventions for Type 2 Diabetes: systematic review protocol focusing on patient workload and capacity support. Wellcome Open Res 2021; 6:257. [PMID: 35928807 PMCID: PMC9308000 DOI: 10.12688/wellcomeopenres.17238.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: People living with type 2 diabetes undertake a range of tasks to manage their condition, collectively referred to as self-management. Interventions designed to support self-management vary in their content, and efficacy. This systematic review will analyse self-management interventions for type 2 diabetes drawing on theoretical models of patient workload and capacity. Methods and analysis: Five electronic databases (Medline, Embase, CENTRAL, CINAHL and PsycINFO) will be searched from inception to 27th April 2021, supplemented by citation searching and hand-searching of reference lists. Two reviewers will independently review titles, abstracts and full texts. Inclusion criteria include Population: Adults with type 2 diabetes mellitus; Intervention: Randomised controlled trials of self-management support interventions; Comparison: Usual care; Outcomes: HbA1c (primary outcome) health-related quality of life (QOL), medication adherence, self-efficacy, treatment burden, healthcare utilization (e.g. number of appointment, hospital admissions), complications of type 2 diabetes (e.g. nephropathy, retinopathy, neuropathy, macrovascular disease) and mortality; Setting: Community. Study quality will be assessed using the Effective Practice and Organisation of Care (EPOC) risk of bias tool. Interventions will be classified according to the EPOC taxonomy and the PRISMS self-management taxonomy and grouped into similar interventions for analysis. Clinical and methodological heterogeneity will be assessed within subgroups, and random effects meta-analyses performed if appropriate. Otherwise, a narrative synthesis will be performed. Interventions will be graded on their likely impact on patient workload and support for patient capacity. The impact of these theoretical constructs on study outcomes will be explored using meta-regression. Conclusion This review will provide a broad overview of self-management interventions, analysed within the cumulative complexity model theoretical framework. Analyses will explore how the workload associated with self-management, and support for patient capacity, impact on outcomes of self-management interventions. Registration number: PROSPERO CRD42021236980.
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Affiliation(s)
- Peter Hanlon
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Iona Bryson
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Holly Morrison
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Qasim Rafiq
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kasey Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA
| | | | - Katie Gallacher
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Carl May
- London School of Hygiene and Tropical Medicine, London, UK
| | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA
| | - Jim Lewsey
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Frances S Mair
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
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Haider S, El Kawkgi O, Clark J, Breslin M, Boehmer KR, Montori V, Lipska K. Beyond hemoglobin A1c: a videographic analysis of conversations about quality of life and treatment burden during clinical encounters for diabetes care. Endocrine 2021; 73:573-579. [PMID: 34189680 PMCID: PMC8995128 DOI: 10.1007/s12020-021-02757-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Diabetes care has largely focused on reducing the risk of complications by achieving hemoglobin A1c (HbA1c) targets; yet, whole-person care may be more effective and desirable. We sought to determine the nature of discussions about quality of life, burden of treatment, hypoglycemia, sexual function, and social support during diabetes-focused clinical encounters. METHODS We analyzed 41 previously recorded clinical encounters with patients with type 2 diabetes from the control arms of practice-based trials of shared decision-making. Two coders evaluated videos for discussions about aspects of life with diabetes: quality of life, burden of treatment, hypoglycemia, sexual function, and social supports. When an aspect was raised, coders evaluated the nature of the conversation, clinician responses, and time spent on discussing the aspect. RESULTS Median length of the encounter was 15 min, 6 s (IQR: 11:16-20:23 min). Overall, 35 of 41 encounters (85.4%) included some discussion of quality of life (58.5%), burden of treatment (51.2%), social support (2.4%), or hypoglycemia (9.8%). Sexual function was not discussed. On average, 4.5% (1.4-5.5%) of the encounter time involved conversations about HbA1c, whereas 15.0% (0-25%) of the encounter time was spent on some aspect of quality of life, burden of treatment, social support, or hypoglycemia. If a topic related to quality of life was raised, clinicians most often responded by acknowledging patient's concern without providing a solution (45.8%). CONCLUSIONS A significant part of the patient-clinician encounter involves discussion of quality of life and burden of treatment, but clinicians rarely address these issues by providing solutions.
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Affiliation(s)
- Shanzay Haider
- Department of Internal Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, CT, USA
| | - Omar El Kawkgi
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Jennifer Clark
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Maggie Breslin
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Kasey R Boehmer
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Victor Montori
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Kasia Lipska
- Department of Internal Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, CT, USA.
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Torres Roldan VD, Ponce OJ, Urtecho M, Torres GF, Belluzzo T, Montori V, Liu C, Barrera F, Diaz A, Prokop L, Guyatt G, Montori VM. Understanding treatment-subgroup effect in primary and secondary prevention of cardiovascular disease: An exploration using meta-analyses of individual patient data. J Clin Epidemiol 2021; 139:160-166. [PMID: 34400257 DOI: 10.1016/j.jclinepi.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/02/2020] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Recommendations for preventing cardiovascular (CV) disease are currently separated into primary and secondary prevention. We hypothesize that relative effects of interventions for CV prevention are not different across primary and secondary prevention cohorts. Our aim was to test for differences in relative effects on CV events in common preventive CV interventions across primary and secondary prevention cohorts. METHODS AND RESULTS A systematic search was performed to identify individual patient data (IPD) meta-analyses that included both primary and secondary prevention populations. Eligibility assessment, data extraction, and risk of bias assessment were conducted independently and in duplicate. We extracted relative risks (RR) with 95% confidence intervals (95% CI) of the interventions over patient-important outcomes and estimated the ratio of RR for primary and secondary prevention populations. We identified five eligible IPDs representing 524,570 participants. Quality assessment resulted in overall low-to-moderate methodological quality. We found no subgroup effect across prevention categories in any of the outcomes assessed. CONCLUSION In the absence of significant treatment-subgroup interactions between primary and secondary CV prevention cohorts for common preventive interventions, clinical practice guidelines could offer recommendations tailored to individual estimates of CV risk without regard to membership to primary and secondary prevention cohorts. This would require the development of reliable ASCVD risk estimators that apply across both cohorts.
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Affiliation(s)
| | - Oscar J Ponce
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Meritxell Urtecho
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Gabriel F Torres
- School of Medicine, Cayetano Heredia Peruvian University, Lima, Peru
| | - Tereza Belluzzo
- Internal Medicine, Jablonec nad Nisou Hospital, Jablonec nad Nisou, Czech Republic
| | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Carolina Liu
- School of Medicine, Cayetano Heredia Peruvian University, Lima, Peru
| | - Francisco Barrera
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Alejandro Diaz
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Larry Prokop
- Department of Library-Public Services, Mayo Clinic, Rochester, MN, USA
| | | | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
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Oikonomidi T, Ravaud P, James A, Cosson E, Montori V, Tran VT. An International, Mixed-Methods Study of the Perceived Intrusiveness of Remote Digital Diabetes Monitoring. Mayo Clin Proc 2021; 96:1236-1247. [PMID: 33487438 DOI: 10.1016/j.mayocp.2020.07.040] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/06/2020] [Accepted: 07/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the relationship between remote digital monitoring (RDM) modalities for diabetes and intrusiveness in patients' lives. PATIENTS AND METHODS Online vignette-based survey (February 1 through July 1, 2019). Adults with diabetes (type 1, 2, or subtypes such as latent autoimmune diabetes of adulthood) assessed three randomly selected vignettes among 36 that combined different modalities for monitoring tools (three options: glucose- and physical activity [PA]-monitoring only, or glucose- and PA-monitoring with occasional or regular food monitoring), duration/feedback loops (six options: monitoring for a week before all vs before specific consultations with feedback given in consultation, vs monitoring permanently, with real-time feedback by one's physician vs by anoter caregiver, vs monitoring permanently, with real-time, artificial intelligence-generated treatment feedback vs treatment and lifestyle feedback), and data handling (two options: by the public vs private sector). We compared intrusiveness (assessed on a 5-point scale) across vignettes and used linear mixed models to identify intrusiveness determinants. We collected qualitative data to identify aspects that drove participants' perception of intrusiveness. RESULTS Overall, 1010 participants from 30 countries provided 2860 vignette-assessments (52% were type 1 diabetes). The monitoring modalities associated with increased intrusiveness were food monitoring compared with glucose- and PA-monitoring alone (β=0.34; 95% CI, 0.26 to 0.42; P<.001) and permanent monitoring with real-time physician-generated feedback compared with monitoring for a week with feedback in consultation (β=0.25; 95% CI, 0.16 to 0.34, P<.001). Public-sector data handling was associated with decreased intrusiveness as compared with private-sector (β=-0.15; 95% CI, -0.22 to -0.09; P<.001). Four drivers of intrusiveness emerged from the qualitative analysis: practical/psychosocial burden (eg, RDM attracting attention in public), control, data safety/misuse, and dehumanization of care. CONCLUSION RDM is intrusive when it includes food monitoring, real-time human feedback, and private-sector data handling.
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Affiliation(s)
- Theodora Oikonomidi
- Université de Paris, CRESS, INSERM, INRA, Paris, France; Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Philippe Ravaud
- Université de Paris, CRESS, INSERM, INRA, Paris, France; Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Arthur James
- Université de Paris, CRESS, INSERM, INRA, Paris, France; Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Cosson
- Sorbonne Paris Nord, Sorbonne Paris Cité, AP-HP, Avicenne Hospital, Department of Endocrinology, CRNH-IdF, CINFO, Bobigny, France; Sorbonne Paris Nord, CRESS, UMR 1153 INSERM/U1125 INRA/CNAM, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France
| | - Victor Montori
- Department of Health and Human Services, Center for Evidence and Practice Improvement of the Agency for Healthcare Research and Quality, Rockville, MD; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Viet-Thi Tran
- Université de Paris, CRESS, INSERM, INRA, Paris, France; Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Abstract
Atrial fibrillation is a common chronic disease seen in primary care offices, emergency departments, inpatient hospital services, and many subspecialty practices. Atrial fibrillation care is complicated and multifaceted, and, at various points, clinicians may see it as a consequence and cause of multi-morbidity, as a silent driver of stroke risk, as a bellwether of an acute medical illness, or as a primary rhythm disturbance that requires targeted treatment. Primary care physicians in particular must navigate these priorities, perspectives, and resources to meet the needs of individual patients. This includes judicious use of diagnostic testing, thoughtful use of novel therapeutic agents and procedures, and providing access to subspecialty expertise. This review explores the epidemiology, screening, and risk assessment of atrial fibrillation, as well as management of its symptoms (rate and various rhythm control options) and stroke risk (anticoagulation and other treatments), and offers a model for the integration of the components of atrial fibrillation care.
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Affiliation(s)
- Shiva P Ponamgi
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | | | - David R Rushlow
- Department of Family Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Victor Montori
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
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Affiliation(s)
- Marleen Kunneman
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
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Riaz IB, He H, Ryu AJ, Siddiqi R, Naqvi SAA, Yao Y, Husnain M, Maheswari D, Sipra QUAR, Montori V, Joseph RW, Liu H, Wang Z, Herasevich V, Singh P, Ho TH, Bryce AH, Pagliaro LC, Murad MH, Costello BA. A framework for living evidence synthesis in cancer: Living, interactive network meta-analysis for first-line treatment of metastatic renal cell carcinoma (mRCC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
335 Background: Systematic reviews are outdated quickly when the evidence is rapidly evolving as the process is laborious and there is little incentive for primary author team of an index SRMA to update the evidence. Consequently, there is an epidemic of redundant SRMAs performed by different teams—sometimes with conflicted results—for treatment of first line mRCC. Methods: We have created a living, interactive systematic review (LISR)and network meta-analysis(LINMA) for the treatment of first line mRCC using an Artificial intelligence (AI) assisted framework for evidence synthesis (Living, Interactive evidence synthesis framework) (LIvE) . The framework is implemented in five-layered architecture (application layer, shared module layer, core service layer, middleware layer, and storage layer) which work together to automate the identification of new studies and analysis and semi-automate the screening and data extraction. Dynamic features such as interactive tables, figures and evidence maps are enabled using Python and JavaScript programming languages. Results: We have maintained a living, interactive evidence profile for the first line treatment mRCC since September 2019 ( LIVING WEBSITE) . Living search strategy identifies new studies as they become available. As of October 13, 2020 LISR, includes data 14 clinical trials ( PRISMA ). Baseline characteristics are summarized in an interactive table ( TABLE) . Cabozantinib& Nivolumab (Cabo-Nivo) is the highest ranked drug for improving Overall Response (OR), Progression Free Survival (PFS) and Overall Survival (OS) whereas Ipilimumab in combination with Nivolumab (Ipi-Nivo) is highest ranked drug for achieving complete response (CR). Ipi-Nivo and Atezolizumab & Bevacizumab (Ate-Bev) ranked highest and Cabo-Nivo ranked lowest for treatment related Adverse events (TRAEs). Results of network meta-analysis are summarized as interactive tables and plots ( NMA ), summary of findings tables ( MULTIPLE COMAPRISONS ) and evidence maps ( MAP ). Conclusions: LISRs can potentially reduce redundancy, increase transparency, reproducibility, enable shared-decision making (at a guideline level, or in a patient-clinician dyad) and support living guidelines.
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Oikonomidi T, Ravaud P, Cosson E, Montori V, Tran VT. Evaluation of Patient Willingness to Adopt Remote Digital Monitoring for Diabetes Management. JAMA Netw Open 2021; 4:e2033115. [PMID: 33439263 PMCID: PMC7807289 DOI: 10.1001/jamanetworkopen.2020.33115] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/18/2020] [Indexed: 01/21/2023] Open
Abstract
Importance Patients will decide whether to adopt remote digital monitoring (RDM) for diabetes by weighing its health benefits against the inconvenience it may cause. Objective To identify the minimum effectiveness patients report they require to adopt 36 different RDM scenarios. Design, Setting, and Participants This survey study was conducted among adults with type 1 or type 2 diabetes living in 30 countries from February to July 2019. Exposures Survey participants assessed 3 randomly selected scenarios from a total of 36. Scenarios described different combinations of digital monitoring tools (glucose, physical activity, food monitoring), duration and feedback loops (feedback in consultation vs real-time telefeedback by a health care professional or by artificial intelligence), and data handling modalities (by a public vs private company), reflecting different degrees of RDM intrusiveness in patients' personal lives. Main Outcomes and Measures Participants assessed the minimum effectiveness for 2 diabetes-related outcomes (reducing hypoglycemic episodes and preventing ophthalmologic complications) for which they would adopt each RDM (from much less effective to much more effective than their current monitoring). Results Of 1577 individuals who consented to participate, 1010 (64%; 572 [57%] women, median [interquartile range] age, 51 [37-63] years, 524 [52%] with type 1 diabetes) assessed at least 1 vignette. Overall, 2860 vignette assessments were collected. In 1025 vignette assessments (36%), participants would adopt RDM only if it was much more effective at reducing hypoglycemic episodes compared with their current monitoring; in 1835 assessments (65%), participants would adopt RDM if was just as or somewhat more effective. The main factors associated with required effectiveness were food monitoring (β = 0.32; SE, 0.12; P = .009), real-time telefeedback by a health care professional (β = 0.49; SE, 0.15; P = .001), and perceived intrusiveness (β = 0.36; SE, 0.06; P < .001). Minimum required effectiveness varied among participants; 34 of 36 RDM scenarios (94%) were simultaneously required to be just as or less effective by at least 25% of participants and much more effective by at least 25% of participants. Results were similar for participant assessments of scenarios regarding the prevention of ophthalmologic complications. Conclusions and Relevance The findings of this study suggest that patients require greater health benefits to adopt more intrusive RDM modalities, food monitoring, and real-time feedback by a health care professional. Patient monitoring devices should be designed to be minimally intrusive. The variability in patients' requirements points to a need for shared decision-making.
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Affiliation(s)
- Theodora Oikonomidi
- Université de Paris, Centre of Research in Epidemiology and Statistics, French National Institute of Health and Medical Research, National Institute for Agricultural Research, Paris, France
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Philippe Ravaud
- Université de Paris, Centre of Research in Epidemiology and Statistics, French National Institute of Health and Medical Research, National Institute for Agricultural Research, Paris, France
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Emmanuel Cosson
- Sorbonne Paris Nord, Sorbonne Paris Cité, Assistance Publique–Hôpitaux de Paris, Avicenne Hospital, Department of Endocrinology, Research Centre in Human Nutrition–Ile de France, North Ile-de-France Integrated Obesity Centre, Bobigny, France
- Sorbonne Paris Nord, Centre of Research in Epidemiology and Statistics, Research Unit 1153, French National Institute of Health and Medical Research, U1125 National Institute for Agricultural Research, National Conservatory of Arts and Crafts, Bobigny, France
| | - Victor Montori
- Department of Health and Human Services, Center for Evidence and Practice Improvement of the Agency for Healthcare Research and Quality, Rockville, Maryland
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Viet Thi Tran
- Université de Paris, Centre of Research in Epidemiology and Statistics, French National Institute of Health and Medical Research, National Institute for Agricultural Research, Paris, France
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
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Oikonomidi T, Ravaud P, James A, Cosson E, Montori V, Tran VT. What makes digital health intrusive? Qualitative findings from an international study on diabetes. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Remote digital monitoring (RDM, i.e., using digital devices to monitor patients' health and behavior) is a novel care model that can improve health outcomes for people with chronic conditions. However, it could be intrusive to patients' lives. We sought to understand which aspects of RDM make it intrusive to patients and why.
Methods
We performed content analysis of qualitative data collected by using open-ended questions in an international, online survey with a convenience sample of adults with type 1 or 2 diabetes (February-July 2019). Participants were first shown scenarios describing possible RDM features (i.e. different RDM tools [for glucose or food monitoring], feedback loops [receiving feedback in consultation, or remotely by a physician, or by artificial intelligence], and data handling options [by the public or private sector]).
Results
We analyzed data from 709 participants from 24 countries (38% men, median age 38, 54% type 1). Participants found RDM burdensome (n = 468). Burden arose from RDM features that caused disruption in daily life (e.g., alerts), features that may invite undesirable attention in public (e.g., visible wearable sensors may invite questions about one's health), or from having to adapt one's life to fit in RDM (e.g., adapt one's mealtime routine around food monitoring). Participants wanted control, particularly over sharing food-monitoring data with health care professionals in real-time to receive feedback (n = 440). They felt RDM could expose a delicate topic to 'surveillance' by authority figures (i.e., their data may 'reveal' poor dietary habits, leading to criticism by physicians). Intrusion could take the form of RDM eroding the patient-physician relationship (n = 34), or fear of data misuse (n = 206), which was associated with private-sector financial interests.
Conclusions
Our findings offer directions for minimally intrusive RDM design and show that digital health may cause concerns about stigma and treatment burden.
Key messages
Remote digital monitoring is intrusive when it increases treatment burden and limits patients’ control over their own health. “Minimally intrusive” digital health design could increase patient acceptability and, ultimately, foster scalability.
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Affiliation(s)
- T Oikonomidi
- UMR 1153, Université de Paris, CRESS, INSERM, INRA, Paris, France
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - P Ravaud
- UMR 1153, Université de Paris, CRESS, INSERM, INRA, Paris, France
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, France
| | - A James
- UMR 1153, Université de Paris, CRESS, INSERM, INRA, Paris, France
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - E Cosson
- U 1125, Sorbonne Paris Nord, INRA/CNAM, Bobigny, France
- Department of Endocrinology, Sorbonne Paris Nord, Sorbonne Paris Cité, AP-HP, Avicenne Hospital, CRNH-IdF, CINFO, Bobigny, France
| | - V Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA
- Department of Health and Human Services, Center for Evidence and Practice Improvement of the Agency for Healthcare Research and Quality, Rockville, USA
| | - V T Tran
- UMR 1153, Université de Paris, CRESS, INSERM, INRA, Paris, France
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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26
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Abstract
Ray KK, Wright RS, Kallend D, et al. Two phase 3 trials of inclisiran in patients with elevated LDL cholesterol. N Engl J Med. 2020;382:1507-19. 32187462.
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Singh Ospina N, Toloza FJK, Barrera F, Bylund CL, Erwin PJ, Montori V. Educational programs to teach shared decision making to medical trainees: A systematic review. Patient Educ Couns 2020; 103:1082-1094. [PMID: 32005556 DOI: 10.1016/j.pec.2019.12.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 04/11/2019] [Revised: 11/06/2019] [Accepted: 12/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) is a process of collaboration between patients and clinicians. An increasing number of educational programs to teach SDM have been developed. We aimed to summarize and evaluate the body of evidence assessing the outcomes of these programs. METHODS We conducted a systematic review of studies that aimed to teach SDM to medical trainees. Reviewers worked independently and in duplicate to select studies, extract data and evaluate the risk of bias. RESULTS Eighteen studies were included. Most studies focused on residents/fellows (61 %) and combined a didactic component with a practical experience (50 % used a standardized patient). Overall, participants reported satisfaction with the courses. The effects on knowledge, attitudes/confidence and comfort with SDM were small; no clear improvement on SDM skills was noted. Evaluation of clinical behavior and outcomes was limited (3/18 studies). Studies had moderate risk of bias. CONCLUSION Very low quality evidence suggests that educational programs for teaching SDM to medical trainees are viewed as satisfactory and have a small impact on knowledge and comfort with SDM. Their impact on clinical skills, behaviors and patient outcomes is less clear. PRACTICAL IMPLICATIONS Integration of formal and systematic outcomes evaluation (effects on behavior/clinical practice) should be part of future programs.
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Affiliation(s)
| | - Freddy J K Toloza
- Division of Endocrinology, University of Arkansas for Medical Sciences, Little Rock, US; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, US
| | | | - Carma L Bylund
- College of Journalism and Communications, University of Florida, Gainesville, US
| | | | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, US; Division of Endocrinology, Mayo Clinic, Rochester, US
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28
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Riaz IB, Rawal SC, Siddiqi R, Asghar N, Islam M, Gajic O, Wang Z, Montori V, Herasevich V, Go RS, Baral C, Liu H, Vandvik PO, Haddad TC, Bryce AH, Rajkumar SV, Murad MH. Novel evidence synthesis system to support living systematic reviews and living guidelines for cancer immunotherapy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.2054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2054 Background: Systematic reviews that summarize the toxicity of Immune checkpoint inhibitors (ICIs) become outdated very soon after publication. Therefore, we reported results of a toxicity meta-analysis at 2019 ASCO meeting and informed the intent to create a living systematic review (LSR). LSRs combine human and machine effort and support rapid evidence synthesis and living clinical practice guidelines. Now, we report our experience maintaining a LSR on toxicity of ICIs. Methods: Steps include quarterly literature searches to identify new clinical trials reporting ICI-associated adverse events (AEs), AI-enabled screening of new citations which meet the inclusion criteria, automated cumulative meta-analysis and an online reporting platform. Standard data formats and protocols were designed for inputting text, tables and graphics. Software was written to interpret these data and output the information in the appropriate format, such as a forest plot and summary tables. Finally, a dynamic interface that enables user inputs and displays the associated output was designed. Results: The LSR is continuously updated incorporating toxicity data from new clinical trials as it becomes available. We have screened 8000 relevant citations and summarized the odds of Grade 3 or higher AEs and AEs of special interest in patient receiving ICIs. The results are updated on quarterly basis and are available online. The results are updated on quarterly basis and will be available on a website at the time of publication. Prototype with dummy data is available at this link . This interface can also be manipulated via user input to organize and sort data tables and forest plots by type of cancer, name or mechanism (PD-1 or PD-L1) of ICI agent, single agent or combination, type of control arm, line of treatment and several other clinically relevant filters. For example, a user can instantaneously generate a meta-analysis summarizing the risk of colitis or pneumonitis in metastatic lung cancer trials with pembrolizmuab. Conclusions: This LSR engine can prospectively synthesize toxicity data from ICI trials in an efficient manner providing accurate and timely information for advanced clinical decision support at point-of-care. Efforts are ongoing to improve efficiency of screening, improve AI-enabled processes for automated screening and data abstraction, and test across multiple clinical questions.
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Affiliation(s)
| | | | | | | | - Mahnoor Islam
- Dow University of Health Sciences, Karachi, Pakistan
| | | | | | | | | | | | | | | | - Per Olav Vandvik
- Department of Medicine, Innlandet Hospital Trust, Gjøvik, Norway
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29
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Tilburt JC, Pacyna JE, Petereit DG, Kaur JS, Rapkin BD, Grubb R, Chang GJ, Morris MJ, Kovac E, Sloan JA, Basch EM, Storrrick EM, Zahrieh D, Dueck AC, Paskett ED, Buckner JC, Montori V, Frosch DL, Volk RJ, Kim SP. Decision aids for localized prostate cancer: Initial outcomes from NCI Community Oncology Research Program Alliance Research Base Cancer Care Delivery Research (CCDR) Protocol - A191402CD - A Cluster-Randomized Trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e24176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24176 Background: Decision aids for prostate cancer treatment can improve knowledge, but the relative effect of pre-consultation and within-consultation DAs is not known. Methods: We conducted a parallel design, 2-by-2 factorial, 4-arm, cluster-RCT in urology practices affiliated with the NCI’s Alliance research base. We compared patient knowledge immediately after consultation (%12-item% correct) intervention arms compared to usual care. We used mixed effects regression modeling to assess effect of interventions on knowledge adjusting for site-clustering, race/ethnicity (non-Hispanic White; Other), age (years), clinical stage (T1-3), PSA, and Gleason score. Results: 15 of 21 randomized centers accrued 158 pts from Nov 2017 to June 2019. The arm delivering both DAs (n = 3 sites) recruited 25 pts. The pre-consultation DA arm (n = 4 sites) recruited 39 pts. The within-consultation DA arm (n = 4 sites) recruited 44 pts. The no DA arm (n = 4 sites) accrued 50 pts. Overall, mean age was 64; 54% were AA; 73% had T1 stage; median Gleason = 7; and median PSA = 7. The combined DAs group, followed by pre-consultation reported higher median knowledge (75% and 67%, respectively). The within-consultation and no DA arms both reported median knowledge scores (58%). Within arm, inter-site standard deviations in mean knowledge scores ranged from 0.164 in in the pre-consultation arm to 0.232 in the usual care arm. Neither pre-consultation nor within-consultation DAs had statistically significant effects (p = .15 and p = .99, respectively). Pre-specified adjusted difference [97.5% CIs], comparing the pre-consultation DA and the within-consultation DA with the control was 9.4% [-7.3%, 26.2%] and -0.4% [-16.9%, 16.1%], respectively. Intra-cluster correlation (ICC) coefficient was high (.24). No interaction effects were identified (p = .98). A post-hoc analysis comparing any DA vs usual care found a mean adjusted difference [95% CI] of 5.6% [-8.5%, 19.8%] (p = 0.40), 63.9% for any DA and 58.3% for usual care. Conclusions: Possible knowledge gains associated with some DAs for early prostate cancer were obscured by larger-than-expected intra-cluster correlation effects associated with the primary outcome. How interventions were used was not measured. Support:UG1CA189823; https://acknowledgments.alliancefound.org ; R01 MD008934-06. Clinical trial information: NCT03103321 .
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Affiliation(s)
| | | | | | | | - Bruce D. Rapkin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY
| | - Robert Grubb
- Medical University of South Carolina, Charleston, SC
| | - George J. Chang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Ethan M. Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | | | | | | | | | | | | | - Simon P. Kim
- University Hospitals Cleveland Medical Center, Cleveland, OH
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30
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Johansson M, Bero L, Bonfill X, Bruschettini M, Garner S, Glenton C, Harris R, Jørgensen KJ, Levinson W, Lotfi T, Montori V, Meng DM, Schünemann H, Vaz Carneiro A, Woloshin S, Moynihan R. Cochrane Sustainable Healthcare: evidence for action on too much medicine. Cochrane Database Syst Rev 2019; 12:ED000143. [PMID: 31808554 PMCID: PMC10284095 DOI: 10.1002/14651858.ed000143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Lisa Bero
- University of SydneyCochrane Public Health and Health SystemsAustralia
| | - Xavier Bonfill
- Universitat Autònoma de BarcelonaCochrane IberoaméricaSpain
| | | | | | - Claire Glenton
- Norwegian Institute of Public HealthCochrane NorwayNorway
| | | | | | | | - Tamara Lotfi
- American University of BeirutGlobal Evidence Synthesis InitiativeLebanon
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31
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Riaz IB, Rawal SC, Siddiqi R, Asghar N, Akhtar M, Gajic O, Wang Z, Montori V, Herasevich V, Go RS, Baral C, Rajkumar SV, Murad MH. Innovation in evidence synthesis: A living systematic review of immune checkpoint inhibitors in cancer patients. J Glob Oncol 2019. [DOI: 10.1200/jgo.2019.5.suppl.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
80 Background: Several previous systematic reviews and meta-analyses have attempted to summarize toxicity of Immune Checkpoint inhibitors (ICIs). However, very soon after each one of these reviews has been published, it became outdated. ICIs are currently used in 14 different cancers and data is rapidly evolving from new clinical trials. A living Systematic review, which is defined as a systematic review that is continually updated to incorporate relevant new evidence as it becomes available, is necessary in this situations. Methods: In order to dynamically display content -- including textual data, tables, charts, and graphs – standard data formats and protocols were designed for various components of the systematic reviews carried out by researchers. Given these standardized formats, software was written to interpret this data and output the information in the appropriate format, such as a forest plot or data table. Finally, a dynamic interface that enables user inputs (such as which aspect of the meta-analysis to view) and displays the associated output was designed. The overall living Systematic Review infrastructure includes monthly literature searches, cumulative meta-analysis, and an online reporting platform. Results: We have developed a Living Systematic Review engine that can take in standardized data and reflect this data in an interactive, intuitive manner in the form of text, tables, and plots. This interface can also be manipulated via user input to organize and sort data tables or omit/highlight specific pieces of data. Conclusions: We have initiated the first living systematic review in immune-oncology that will be continuously updated, incorporating relevant new evidence as it becomes available, and will provide accurate and up to date toxicity estimates to support clinical decision making. The Living Systematic Review interface allows users to easily and intuitively access the most recent available clinical evidence on toxicity of ICIs.
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Affiliation(s)
| | | | | | | | - Maheen Akhtar
- Dow University of Health Sciences, Karachi, Pakistan
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32
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Phillips KA, Singh Ospina N, Montori V. Physicians Interrupting Patients. J Gen Intern Med 2019; 34:1963. [PMID: 31289991 PMCID: PMC6816612 DOI: 10.1007/s11606-019-05141-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kari A Phillips
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Victor Montori
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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33
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Riaz IB, Siddiqi R, Asghar N, Cathcart-Rake EJ, Herasevich V, Montori V, Wang Z, Go RS, Rajkumar SV, Murad MH. Living systematic reviews: A novel mechanism for improving efficiency and quality of evidence synthesis in oncology. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
241 Background: In a rapidly moving field, such as cancer immunotherapy, where immune checkpoint inhibitors (ICIs) are used across 14 different tumor types, patients may receive suboptimal treatment or even be harmed if information on toxicity is not readily translated for use in clinical practice. Every single systematic review and meta-analysis which attempted to summarize toxicity of immune checkpoint inhibitors (ICIs) quickly became outdated. A living systematic review, which is defined as a systematic review that is continually updated to incorporate relevant new evidence as it becomes available, is necessary in this situation. Methods: The process of creating a living systematic review started with the creation of a comprehensive search designed by a librarian experienced in systematic reviews in collaboration with the study’s principle investigator. Search was constantly updated every 3 months and evidence is synthesized in a series of steps (microtasks) using a combination of human and augmented intelligence. A complete infrastructure is being developed and it includes automated cumulative meta-analysis and an online reporting platform which will constantly update information for clinicians and patients in a live manner. Results: We screened 6746 studies during Sep 2018-March 2019 and identified 6746 studies and we were able to successfully maintain up-to-date toxicity estimates for immune mediated adverse events over this period while maintaining the rigor of a conventional systematic review. Eventually, we will integrate the steps of LSR into one, user-friendly, semi-automated format which can independently provide accurate estimates and feed into and support a living guidelines platform through shared Application Programing Interface (APIs). Conclusions: LSRs are feasible, efficient, and when fully developed can reduce redundancy and waste in medical research, improve the quality of evidence, reduce human effort and support living and dynamic guidelines to facilitate truly informed shared decision making.
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34
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Riikonen JM, Guyatt GH, Kilpeläinen TP, Craigie S, Agarwal A, Agoritsas T, Couban R, Dahm P, Järvinen P, Montori V, Power N, Richard PO, Rutanen J, Santti H, Tailly T, Violette PD, Zhou Q, Tikkinen KAO. Decision Aids for Prostate Cancer Screening Choice: A Systematic Review and Meta-analysis. JAMA Intern Med 2019; 179:1072-1082. [PMID: 31233091 PMCID: PMC6593633 DOI: 10.1001/jamainternmed.2019.0763] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE US guidelines recommend that physicians engage in shared decision-making with men considering prostate cancer screening. OBJECTIVE To estimate the association of decision aids with decisional outcomes in prostate cancer screening. DATA SOURCES MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane CENTRAL were searched from inception through June 19, 2018. STUDY SELECTION Randomized trials comparing decision aids for prostate cancer screening with usual care. DATA EXTRACTION AND SYNTHESIS Independent duplicate assessment of eligibility and risk of bias, rating of quality of the decision aids, random-effects meta-analysis, and Grading of Recommendations, Assessment, Development and Evaluations rating of the quality of evidence. MAIN OUTCOMES AND MEASURES Knowledge, decisional conflict, screening discussion, and screening choice. RESULTS Of 19 eligible trials (12 781 men), 9 adequately concealed allocation and 8 blinded outcome assessment. Of 12 decision aids with available information, only 4 reported the likelihood of a true-negative test result, and 3 presented the likelihood of false-negative test results or the next step if the screening test result was negative. Decision aids are possibly associated with improvement in knowledge (risk ratio, 1.38; 95% CI, 1.09-1.73; I2 = 67%; risk difference, 12.1; low quality), are probably associated with a small decrease in decisional conflict (mean difference on a 100-point scale, -4.19; 95% CI, -7.06 to -1.33; I2 = 75%; moderate quality), and are possibly not associated with whether physicians and patients discuss prostate cancer screening (risk ratio, 1.12; 95% CI, 0.90-1.39; I2 = 60%; low quality) or with men's decision to undergo prostate cancer screening (risk ratio, 0.95; 95% CI, 0.88-1.03; I2 = 36%; low quality). CONCLUSIONS AND RELEVANCE The results of this study provide moderate-quality evidence that decision aids compared with usual care are associated with a small decrease in decisional conflict and low-quality evidence that they are associated with an increase in knowledge but not with whether physicians and patients discussed prostate cancer screening or with screening choice. Results suggest that further progress in facilitating effective shared decision-making may require decision aids that not only provide education to patients but are specifically targeted to promote shared decision-making in the patient-physician encounter.
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Affiliation(s)
- Jarno M Riikonen
- Department of Urology, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Life Science, University of Tampere, Tampere, Finland
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Tuomas P Kilpeläinen
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Samantha Craigie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Arnav Agarwal
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Division of General Internal Medicine, Department of Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Rachel Couban
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Philipp Dahm
- Urology Section, Minneapolis Veterans Administration Health Care System, Minneapolis, Minnesota.,Department of Urology, University of Minnesota, Minneapolis
| | - Petrus Järvinen
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Nicholas Power
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Patrick O Richard
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jarno Rutanen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Henrikki Santti
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Thomas Tailly
- Department of Urology, Ghent University Hospital, Gent, Belgium
| | - Philippe D Violette
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Surgery, Woodstock General Hospital, Woodstock, Ontario, Canada
| | - Qi Zhou
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kari A O Tikkinen
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
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35
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Riaz IB, Siddiqi R, Malik S, Cathcart-Rake EJ, Gajic O, Montori V, Wang Z, Herasevich V, Go RS, Rajkumar SV, Murad MH. A living systematic review of immune checkpoint inhibitors in cancer patients: A novel platform for evidence synthesis in oncology. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.6596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6596 Background: Several previous systematic reviews and meta-analyses have attempted to summarize toxicity of Immune checkpoint inhibitors (ICIs). However, very soon after each one of these reviews has been published, it became outdated. ICIs are currently used in 14 different cancers and data is rapidly evolving from new clinical trials. A living Systematic review, which is defined as a systematic review that is continually updated to incorporate relevant new evidence as it becomes available, is necessary in this situations. Therefore, we performed an updated systematic review and a meta-analysis which will serve as a foundation of a living Systematic review. Methods: MEDLINE, EMBASE and Cochrane were searched to identify phase 2 and 3 RCTs of PD-1/PD-L1 ICIs. Included studies compared either immunotherapy alone or combination with existing standard of care treatment and reported data for AE’s of interest. DerSimonian-Laird random effects Meta-Analysis was performed to derive pooled odds Ratio (OR) estimates for AE’s of interest. An infrastructure of a living systematic review is being developed and it includes monthly literature searches, cumulative meta-analysis and an online reporting platform. Results: We screened 6746 studies and 31 phase 3 and 2 phase 2 RCTs (n = 21,421) were included in the analysis. 22 RCTs used PD-1/PD-L1 ICIs as a single agent and 11 as a combination therapy. Selected toxicity estimates are summarized in a table. Conclusions: The meta-analysis updates previously published toxicity estimates and provides additional information about the risk of toxicities in single versus combination regimens. We have initiated the first living systematic review in oncology that will be continuously updated, incorporating relevant new evidence as it becomes available, and will provide accurate and up to date toxicity estimates to support clinical decision making. [Table: see text]
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36
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Tilburt J, Yost KJ, Lenz HJ, Zúñiga ML, O'Byrne T, Branda ME, Leppin AL, Kimball B, Fernandez C, Jatoi A, Barwise A, Kumbamu A, Montori V, Koenig BA, Geller G, Larson S, Roter DL. A Multicenter Comparison of Complementary and Alternative Medicine (CAM) Discussions in Oncology Care: The Role of Time, Patient-Centeredness, and Practice Context. Oncologist 2019; 24:e1180-e1189. [PMID: 31101701 DOI: 10.1634/theoncologist.2019-0093] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 01/31/2019] [Accepted: 04/10/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Little is known about how complementary and alternative medicine (CAM) is discussed in cancer care across varied settings in the U.S. METHODS In two practices affiliated with one academic medical center in southern California (SoCal), and one in the upper Midwest (UM), we audio-recorded patient-clinician interactions in medical oncology outpatient practices. We counted the frequency and duration of CAM-related conversations. We coded recordings using the Roter Interaction Analysis System. We used chi-square tests for bivariate analysis of categorical variables and generalized linear models for continuous variables to examine associations between dialogue characteristics, practice setting, and population characteristics with the occurrence of CAM discussion in each setting followed by multivariate models adjusting for clinician clustering. RESULTS Sixty-one clinicians and 529 patients participated. Sixty-two of 529 (12%) interactions included CAM discussions, with significantly more observed in the SoCal university practice than in the other settings. Visits that included CAM were on average 6 minutes longer, with CAM content lasting an average of 78 seconds. In bivariate tests of association, conversations containing CAM included more psychosocial statements from both clinicians and patients, higher patient-centeredness, more positive patient and clinician affect, and greater patient engagement. In a multivariable model including significant bivariate terms, conversations containing CAM were independently associated with higher patient-centeredness, slightly longer visits, and being at the SoCal university site. CONCLUSION The frequency of CAM-related discussion in oncology varied substantially across sites. Visits that included CAM discussion were longer and more patient centered. IMPLICATIONS FOR PRACTICE The Institute of Medicine and the American Society of Clinical Oncology have called for more open discussions of complementary and alternative medicine (CAM). But little is known about the role population characteristics and care contexts may play in the frequency and nature of those discussions. The present data characterizing actual conversations in practice complements a much larger literature based on patient and clinician self-report about CAM disclosure and use. It was found that CAM discussions in academic oncology visits varied significantly by practice context, that the majority were initiated by the patient, and that they may occur more when visit time exists for lifestyle, self-care, and psychosocial concerns.
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Affiliation(s)
- Jon Tilburt
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathleen J Yost
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Heinz-Josef Lenz
- Division of Medical Oncology, Keck School of Medicine, University of Southern California, Los Angeles California, USA
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, California, USA
| | - Thomas O'Byrne
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Biostatistics, Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Megan E Branda
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Biostatistics, Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron L Leppin
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Brittany Kimball
- Departments of Internal Medicine and Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cara Fernandez
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Aminah Jatoi
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Amelia Barwise
- Division of Critical Care, Mayo Clinic, Rochester, Minnesota, USA
| | - Ashok Kumbamu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor Montori
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Barbara A Koenig
- Program in Bioethics, University of California San Francisco, San Francisco, California, USA
| | - Gail Geller
- Berman Institute of Bioethics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan Larson
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Debra L Roter
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Toloza F, Singh Ospina N, Rodriguez-Gutierrez R, O'Keeffe D, Brito J, Montori V, Maraka S. MON-586 Practice Variation in the Management of Subclinical Hypothyroidism During Pregnancy: Results From a National Survey of Endocrinologists in the US. J Endocr Soc 2019. [PMCID: PMC6550686 DOI: 10.1210/js.2019-mon-586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 11/30/2022] Open
Abstract
Background: Evidence regarding subclinical hypothyroidism (SCH) effects on pregnancy and the benefits of levothyroxine (LT4) treatment is inconsistent. The American Thyroid Association (ATA) Guidelines for the management of thyroid diseases in pregnancy were published in 2017; the impact of these guidelines on clinical practice remains uncertain. Aim: To conduct a national survey among endocrinologists studying knowledge and perception regarding SCH diagnosis, treatment and impact on pregnancy. Methods: An online survey was sent by email invitation to endocrinologists who are active members of the Endocrine Society in the U.S. (n=5914). The questionnaire included demographic data and clinical scenarios with multiple choice questions to assess diagnostic evaluation, initiation of therapy, and follow up in pregnant women with SCH. Results: The survey was completed by 154 endocrinologists (9/5/18-10/31/18). On average each clinician had treated 5 (IQR 3-10) women with SCH in the past 6 months. The 2017 ATA guidelines were reviewed by 75% of whom 52% consider that these guidelines actually changed their clinical practice. Universal screening is done by 53%, 31% screens when there are associated risk factors for thyroid disease (e.g. clinical symptoms, family history, etc.) and 16% never screens. For the diagnosis of SCH, only 25% uses a TSH>4.0 mIU/L and 5.8% a population-based cutoff as recommended by ATA, while the most used cutoff was TSH>2.5 mIU/L (52%). Following ATA guidelines, 87% would immediately treat a woman with a 1st trimester TSH>4.0 mIU/L and TPO-Abs+ (strong recommendation) vs. 50% if TPO-Abs– (weak recommendation), followed by the option of repeating TSH within a month in 12% and 45% respectively. If a woman had TSH between 2.5-4.0 mIU/L, 58% would treat her if TPO-Abs+ (weak recommendation) vs. 17% if TPO-Abs- (no recommendation), followed by the option of repeating TSH within a month in 39% and 55% respectively. We found similar practices for the treatment of women in the 2nd trimester with the same clinical and laboratory characteristics. Clinicians reported considering the following factors for LT4 treatment decision: TSH level, TPO-Abs, history of miscarriages, and guidelines recommendations. Interestingly, 70-80% of the clinicians who would start LT4, consider treatment would have a small impact (10-20% reduction) or very small impact (<10% reduction) on maternofetal complications regardless the clinical scenario. Only 50% of the clinicians take into consideration the patient’s preferences and 19% the side effects related to LT4 use. Conclusions: Despite recently updated guidelines, there is still a wide variation in the clinical practice regarding the diagnosis and management of SCH in pregnancy. Although LT4 is frequently used as the treatment for SCH in pregnancy, the expected risk reduction is small, and patient’s preferences are often disregarded.
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Affiliation(s)
- Freddy Toloza
- Knowledge and Evaluation Research Unit in Endocrinology (KER-Endo), Mayo Clinic, Rochester, MN, USA. AND University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Naykky Singh Ospina
- Knowledge and Evaluation Research Unit in Endocrinology (KER-Endo), Mayo Clinic, Rochester, MN, USA AND University of Florida, Gainesville, FL, United States
| | - Rene Rodriguez-Gutierrez
- Endocrinology, University Hospital "Dr. Jose E. Gonzalez," Autonomous University of Nuevo León, Monterrey, Mexico AND Knowledge and Evaluation Research Unit in Endocrinology (KER-Endo), Mayo Clinic, Rochester, MN, USA AND Plataforma INVEST Medicina UANL-KER Unit, Monterrey, , Mexico
| | - Derek O'Keeffe
- Division of Endocrinology, Department of Medicine, National University of Ireland, Galway, , Ireland
| | - Juan Brito
- Endocrinology, Diabetes, Metabolism and Nutrition, Knowledge and Evaluation Research Unit in Endocrinology (KER-Endo), Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Victor Montori
- W 18A - Endo, Knowledge and Evaluation Research Unit in Endocrinology (KER-Endo), Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Spyridoula Maraka
- Knowledge and Evaluation Research Unit in Endocrinology (KER-Endo), Mayo Clinic, Rochester, MN, USA, AND University of Arkansas for Medical Sciences AND the Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
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Riikonen J, Guyatt G, Kilpeläinen TP, Craigie S, Agarwal A, Agoritsas T, Couban R, Dahm P, Järvinen P, Montori V, Power N, Richard PO, Rutanen J, Santti H, Tailly T, Violette PD, Zhou Q, Tikkinen KAO. MP57-03 DECISION AIDS FOR PROSTATE CANCER SCREENING: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Huang R, Song X, Zhang D, Xu J, Boehmer KR, Leppin AA, Gionfriddo M, Ting HH, Montori V. PREFERENCES AND ATTITUDES OF YOUNG CHINESE CLINICIANS ABOUT USING A SHARED DECISION MAKING TOOL FOR CARDIOVASCULAR RISK COMMUNICATION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)33181-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Chambers D, Simpson L, Neta G, Schwarz UVT, Percy-Laurry A, Aarons GA, Neta G, Brownson R, Vogel A, Stirman SW, Sherr K, Sturke R, Norton WE, Varley A, Chambers D, Vinson C, Klesges L, Heurtin-Roberts S, Massoud MR, Kimble L, Beck A, Neely C, Boggs J, Nichols C, Wan W, Staab E, Laiteerapong N, Moise N, Shah R, Essock S, Handley M, Jones A, Carruthers J, Davidson K, Peccoralo L, Sederer L, Molfenter T, Scudder A, Taber-Thomas S, Schaffner K, Herschell A, Woodward E, Pitcock J, Ritchie M, Kirchner J, Moore JE, Khan S, Rashid S, Park J, Courvoisier M, Straus S, Blonigen D, Rodriguez A, Manfredi L, Nevedal A, Rosenthal J, Smelson D, Timko C, Stadnick N, Regan J, Barnett M, Lau A, Brookman-Frazee L, Guerrero E, Fenwick K, Kong Y, Aarons G, Lengnick-Hall R, Fenwick K, Henwood B, Sayer N, Rosen C, Orazem R, Smith B, Rosen C, Zimmerman L, Lounsbury D, Rosen C, Kimerling R, Trafton JA, Lindley S, Bhargava R, Roberts H, Gibson L, Escobar GJ, Liu V, Turk B, Ragins A, Kipnis P, Gruszkowski AK, Kennedy MW, Drobek ER, Turgeman L, Milicevic AS, Hubert TL, Myaskovsky L, Tjader YC, Monte RJ, Sapnas KG, Ramly E, Lauver DR, Bartels CM, Elnahal S, Ippolito A, Peabody H, Clancy C, Cebul R, Love T, Einstadter D, Bolen S, Watts B, Yakovchenko V, Park A, Lukesh W, Miller DR, Thornton D, Drainoni ML, Gifford AL, Smith S, Kyle J, Bauer MS, Eisenberg D, Liebrecht C, Barbaresso M, Kilbourne A, Park E, Perez G, Ostroff J, Greene S, Parchman M, Austin B, Larson E, Ferreri S, Shea C, Smith M, Turner K, Bacci J, Bigham K, Curran G, Ferreri S, Frail C, Hamata C, Jankowski T, Lantaff W, McGivney MS, Snyder M, McCullough M, Gillespie C, Petrakis BA, Jones E, Park A, Lukas CV, Rose A, Shoemaker SJ, Curran G, Thomas J, Teeter B, Swan H, Teeter B, Thomas J, Curran G, Balamurugan A, Lane-Fall M, Beidas R, Di Taranti L, Buddai S, Hernandez ET, Watts J, Fleisher L, Barg F, Miake-Lye I, Olmos T, Chuang E, Rodriguez H, Kominski G, Yano B, Shortell S, Hook M, Fleisher L, Fiks A, Halkyard K, Gruver R, Sykes E, Vesco K, Beadle K, Bulkley J, Stoneburner A, Leo M, Clark A, Smith J, Smyser C, Wolf M, Trivedi S, Hackett B, Rao R, Cole FS, McGonigle R, Donze A, Proctor E, Mathur A, Sherr K, Gakidou E, Gloyd S, Audet C, Salato J, Vermund S, Amico R, Smith S, Nyirandagijimana B, Mukasakindi H, Rusangwa C, Franke M, Raviola G, Cummings M, Goldberg E, Mwaka S, Kabajaasi O, Cattamanchi A, Katamba A, Jacob S, Kenya-Mugisha N, Davis JL, Reed J, Ramaswamy R, Parry G, Sax S, Kaplan H, Huang KY, Cheng S, Yee S, Hoagwood K, McKay M, Shelley D, Ogedegbe G, Brotman LM, Kislov R, Humphreys J, Harvey G, Wilson P, Lieberthal R, Payton C, Sarfaty M, Valko G, Bolton R, Lukas CV, Hartmann C, Mueller N, Holmes SK, Bokhour B, Ono S, Crabtree B, Gordon L, Miller W, Balasubramanian B, Solberg L, Cohen D, McGraw K, Blatt A, Pittman D, McCullough M, Hartmann C, Kales H, Berlowitz D, Hudson T, Gillespie C, Helfrich C, Finley E, Garcia A, Rosen K, Tami C, McGeary D, Pugh MJ, Potter JS, Helfrich C, Stryczek K, Au D, Zeliadt S, Sayre G, Gillespie C, Leeman J, Myers A, Grant J, Wangen M, Queen T, Morshed A, Dodson E, Tabak R, Brownson RC, Sheldrick RC, Mackie T, Hyde J, Leslie L, Yanovitzky I, Weber M, Gesualdo N, Kristensen T, Stanick C, Halko H, Dorsey C, Powell B, Weiner B, Lewis C, Powell B, Weiner B, Stanick C, Halko H, Dorsey C, Lewis C, Weiner B, Dorsey C, Stanick C, Halko H, Powell B, Lewis C, Stirman SW, Carreno P, Mallard K, Masina T, Monson C, Swindle T, Curran G, Patterson Z, Whiteside-Mansell L, Hanson R, Saunders B, Schoenwald S, Moreland A, Birken S, Powell B, Presseau J, Miake-Lye I, Ganz D, Mittman B, Delevan D, Finley E, Hill JN, Locatelli S, Bokhour B, Fix G, Solomon J, Mueller N, Lavela SL, Scott V, Scaccia J, Alia K, Skiles B, Wandersman A, Wilson P, Sales A, Roberts M, Kennedy A, Chambers D, Khoury MJ, Sperber N, Orlando L, Carpenter J, Cavallari L, Denny J, Elsey A, Fitzhenry F, Guan Y, Horowitz C, Johnson J, Madden E, Pollin T, Pratt V, Rakhra-Burris T, Rosenman M, Voils C, Weitzel K, Wu R, Damschroder L, Lu C, Ceccarelli R, Mazor KM, Wu A, Rahm AK, Buchanan AH, Schwartz M, McCormick C, Manickam K, Williams MS, Murray MF, Escoffery NC, Lebow-Skelley E, Udelson H, Böing E, Fernandez ME, Wood RJ, Mullen PD, Parekh J, Caldas V, Stuart EA, Howard S, Thomas G, Jennings JM, Torres J, Markham C, Shegog R, Peskin M, Rushing SC, Gaston A, Gorman G, Jessen C, Williamson J, Ward D, Vaughn A, Morris E, Mazzucca S, Burney R, Ramanadhan S, Minsky S, Martinez-Dominguez V, Viswanath K, Barker M, Fahim M, Ebnahmady A, Dragonetti R, Selby P, Farrell M, Tompkins J, Norton W, Rapport K, Hargreaves M, Lee R, Ramanadhan S, Kruse G, Deutsch C, Lanier E, Gray A, Leppin A, Christiansen L, Schaepe K, Egginton J, Branda M, Gaw C, Dick S, Montori V, Shah N, Korn A, Hovmand P, Fullerton K, Zoellner N, Hennessy E, Tovar A, Hammond R, Economos C, Kay C, Gazmararian J, Vall E, Cheung P, Franks P, Barrett-Williams S, Weiss P, Kay C, Gazmararian J, Hamilton E, Cheung P, Kay C, Vall E, Gazmararian J, Marques L, Dixon L, Ahles E, Valentine S, Monson C, Shtasel D, Stirman SW, Parra-Cardona R, Northridge M, Kavathe R, Zanowiak J, Wyatt L, Singh H, Islam N, Monteban M, Freedman D, Bess K, Walsh C, Matlack K, Flocke S, Baily H, Harden S, Ramalingam N, Alia K, Scaccia J, Scott V, Ramaswamy R, Wandersman A, Gold R, Cottrell E, Hollombe C, Dambrun K, Bunce A, Middendorf M, Dearing M, Cowburn S, Mossman N, Melgar G, Hopfer S, Hecht M, Ray A, Miller-Day M, BeLue R, Zimet G, Nelson EL, Kuhlman S, Doolittle G, Krebill H, Spaulding A, Levin T, Sanchez M, Landau M, Escobar P, Minian N, Selby P, Noormohamed A, Zawertailo L, Baliunas D, Giesbrecht N, Le Foll B, Samokhvalov A, Meisel Z, Polsky D, Schackman B, Mitchell J, Sevarino K, Gimbel S, Mwanza M, Nisingizwe MP, Michel C, Hirschhorn L, Lane-Fall M, Beidas R, Di Taranti L, Choudhary M, Thonduparambil D, Fleisher L, Barg F, Meissner P, Pinnock H, Barwick M, Carpenter C, Eldridge S, Grandes-Odriozola G, Griffiths C, Rycroft-Malone J, Murray E, Patel A, Sheikh A, Taylor SJC, Mittman B, Guilliford M, Pearce G, Korngiebel D, West K, Burke W, Hannon P, Harris J, Hammerback K, Kohn M, Chan GKC, Mafune R, Parrish A, Helfrich C, Beresford S, Pike KJ, Shelton R, Jandorf L, Erwin D, Charles TA, Parchman M, Baldwin LM, Ike B, Fickel J, Lind J, Cowper D, Fleming M, Sadler A, Dye M, Katzburg J, Ong M, Tubbesing S, McCullough M, Simmons M, Yakovchenko V, Harnish A, Gabrielian S, McInnes K, Smith J, Smelson D, Ferrand J, Torres E, Green A, Aarons G, Bradbury AR, Patrick-Miller LJ, Egleston BL, Domchek SM, Olopade OI, Hall MJ, Daly MB, Fleisher L, Grana G, Ganschow P, Fetzer D, Brandt A, Chambers R, Clark DF, Forman A, Gaber RS, Gulden C, Horte J, Long J, Lucas T, Madaan S, Mattie K, McKenna D, Montgomery S, Nielsen S, Powers J, Rainey K, Rybak C, Seelaus C, Stoll J, Stopfer J, Yao XS, Savage M, Miech E, Damush T, Rattray N, Myers J, Homoya B, Winseck K, Klabunde C, Langer D, Aggarwal A, Neilson E, Gunderson L, Escobar GJ, Gardner M, O’Sulleabhain L, Kroenke C, Liu V, Kipnis P. Proceedings from the 9th annual conference on the science of dissemination and implementation. Implement Sci 2017. [PMCID: PMC5414666 DOI: 10.1186/s13012-017-0575-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ye S, Leppin A, Chan A, Chang N, Moise N, Montori V, Kronish I. THE IMPACT OF AN INFORMATICS INTERVENTION ON SHARED DECISION-MAKING FOR PRIMARY PREVENTION STATIN THERAPY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Singh Ospina N, Maraka S, Rodriguez-Gutierrez R, Espinosa de Ycaza AE, Jasim S, Gionfriddo M, Castaneda-Guarderas A, Brito JP, Al Nofal A, Erwin P, Wermers R, Montori V. Comparative efficacy of parathyroidectomy and active surveillance in patients with mild primary hyperparathyroidism: a systematic review and meta-analysis. Osteoporos Int 2016; 27:3395-3407. [PMID: 27562567 DOI: 10.1007/s00198-016-3715-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
Counseling for patients with primary hyperparathyroidism (PHPT) and mild hypercalcemia without indications for surgical intervention requires accurate estimates of the potential benefits of parathyroidectomy. We aim to summarize the available evidence regarding the benefits of parathyroidectomy that patients with mild PHPT without indications for surgery experience compared to observation. We searched multiple databases from inception to August 2015. We included randomized controlled trials (RCT) and observational studies that evaluated changes in bone health, quality of life or neuropsychiatric symptoms, or in the risk of nephrolithiasis, cardiovascular events, or death between patients undergoing parathyroidectomy or active surveillance. Eight studies were eligible. Risk differences were not significant, in part due to lack of events (fractures, nephrolithiasis, cardiovascular events, or deaths). No significant differences were observed across measures of bone health, quality of life, and neuropsychiatric symptoms. A single RCT evaluating bone mineral density (BMD) changes at 5 years found a small statistically significant effect favoring parathyroidectomy. Patients with mild PHPT without indications for surgery experience a limited number of adverse consequences during short-term follow-up limiting our ability to estimate the benefit of surgery during this timeframe. This information is helpful as these patients consider surgery versus active surveillance. Long-term data is warranted to determine who benefits in the long run from surgical intervention and the extent to which this benefit affects outcomes that matter to patients.
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Affiliation(s)
- N Singh Ospina
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Knowledge and Evaluation Research Unit, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - S Maraka
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Knowledge and Evaluation Research Unit, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - R Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
- Endocrinology Division, Department of Internal Medicine, University Hospital Dr. Jose E. Gonzalez, Monterrey, Mexico
| | - A E Espinosa de Ycaza
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Knowledge and Evaluation Research Unit, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA
| | - S Jasim
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Knowledge and Evaluation Research Unit, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA
| | - M Gionfriddo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
- Mayo Graduate School, Mayo Clinic, Rochester, MN, 55905, USA
| | - A Castaneda-Guarderas
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J P Brito
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Knowledge and Evaluation Research Unit, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - A Al Nofal
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
- Sanford Children's specialty Clinic, Sioux Falls, SD, USA
| | - P Erwin
- Mayo Medical Libraries, Mayo Clinic, Rochester, MN, 55905, USA
| | - R Wermers
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Knowledge and Evaluation Research Unit, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA
| | - V Montori
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Knowledge and Evaluation Research Unit, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA.
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
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Hopewell S, Boutron I, Altman DG, Barbour G, Moher D, Montori V, Schriger D, Cook J, Gerry S, Omar O, Dutton P, Roberts C, Frangou E, Clifton L, Chiocchia V, Rombach I, Wartolowska K, Ravaud P. Impact of a web-based tool (WebCONSORT) to improve the reporting of randomised trials: results of a randomised controlled trial. BMC Med 2016; 14:199. [PMID: 27894295 PMCID: PMC5126856 DOI: 10.1186/s12916-016-0736-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 10/28/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The CONSORT Statement is an evidence-informed guideline for reporting randomised controlled trials. A number of extensions have been developed that specify additional information to report for more complex trials. The aim of this study was to evaluate the impact of using a simple web-based tool (WebCONSORT, which incorporates a number of different CONSORT extensions) on the completeness of reporting of randomised trials published in biomedical publications. METHODS We conducted a parallel group randomised trial. Journals which endorsed the CONSORT Statement (i.e. referred to it in the Instruction to Authors) but do not actively implement it (i.e. require authors to submit a completed CONSORT checklist) were invited to participate. Authors of randomised trials were requested by the editor to use the web-based tool at the manuscript revision stage. Authors registering to use the tool were randomised (centralised computer generated) to WebCONSORT or control. In the WebCONSORT group, they had access to a tool allowing them to combine the different CONSORT extensions relevant to their trial and generate a customised checklist and flow diagram that they must submit to the editor. In the control group, authors had only access to a CONSORT flow diagram generator. Authors, journal editors, and outcome assessors were blinded to the allocation. The primary outcome was the proportion of CONSORT items (main and extensions) reported in each article post revision. RESULTS A total of 46 journals actively recruited authors into the trial (25 March 2013 to 22 September 2015); 324 author manuscripts were randomised (WebCONSORT n = 166; control n = 158), of which 197 were reports of randomised trials (n = 94; n = 103). Over a third (39%; n = 127) of registered manuscripts were excluded from the analysis, mainly because the reported study was not a randomised trial. Of those included in the analysis, the most common CONSORT extensions selected were non-pharmacologic (n = 43; n = 50), pragmatic (n = 20; n = 16) and cluster (n = 10; n = 9). In a quarter of manuscripts, authors either wrongly selected an extension or failed to select the right extension when registering their manuscript on the WebCONSORT study site. Overall, there was no important difference in the overall mean score between WebCONSORT (mean score 0.51) and control (0.47) in the proportion of CONSORT and CONSORT extension items reported pertaining to a given study (mean difference, 0.04; 95% CI -0.02 to 0.10). CONCLUSIONS This study failed to show a beneficial effect of a customised web-based CONSORT checklist to help authors prepare more complete trial reports. However, the exclusion of a large number of inappropriately registered manuscripts meant we had less precision than anticipated to detect a difference. Better education is needed, earlier in the publication process, for both authors and journal editorial staff on when and how to implement CONSORT and, in particular, CONSORT-related extensions. TRIAL REGISTRATION ClinicalTrials.gov: NCT01891448 [registered 24 May 2013].
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Affiliation(s)
- Sally Hopewell
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
- Centre d'Epidémiologie Clinique, Paris Descartes University, Paris, France.
| | - Isabelle Boutron
- Centre d'Epidémiologie Clinique, Paris Descartes University, Paris, France
- INSERM UMR 1153 equipe Methods, Paris Descartes University, Paris, France
| | - Douglas G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ginny Barbour
- Queensland University of Technology (QUT), Queensland, Australia
| | - David Moher
- Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Jonathan Cook
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Stephen Gerry
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Omar Omar
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Peter Dutton
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Corran Roberts
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Eleni Frangou
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lei Clifton
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Virginia Chiocchia
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ines Rombach
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Karolina Wartolowska
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Philippe Ravaud
- Centre d'Epidémiologie Clinique, Paris Descartes University, Paris, France
- INSERM UMR 1153 equipe Methods, Paris Descartes University, Paris, France
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Roter DL, Yost KJ, O'Byrne T, Branda M, Leppin A, Kimball B, Fernandez C, Jatoi A, Kumbamu A, Montori V, Koenig B, Geller G, Larson S, Tilburt J. Communication predictors and consequences of Complementary and Alternative Medicine (CAM) discussions in oncology visits. Patient Educ Couns 2016; 99:1519-25. [PMID: 27296081 PMCID: PMC5007180 DOI: 10.1016/j.pec.2016.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/07/2016] [Accepted: 06/02/2016] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Cancer patients use complementary and alternative medicine (CAM), but do not routinely talk about it with their clinicians. This study describes CAM discussions in oncology visits, the communication patterns that facilitate these discussions and their association with visit satisfaction. METHODS 327 patients (58% female; average age 61) and 37 clinicians were recorded during an oncology visit and completed post-visit questionnaires. All CAM discussions were tagged and the Roter Interaction Analysis System (RIAS) was used to code visit dialogue. RESULTS CAM was discussed in 36 of 327 visits; discussions were brief ( CONCLUSIONS CAM discussions do not occur at random; they take place in visits characterized by patient-centered communication and are associated with higher visit satisfaction. PRACTICE IMPLICATIONS CAM discussions are perceived positively by both patients and clinicians and are facilitated by patient-centered visit communication.
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Affiliation(s)
- Debra L Roter
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | | | - Barbara Koenig
- University of California San Francisco, San Francisco, CA, USA
| | - Gail Geller
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan Larson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Singh Ospina N, Maraka S, Montori V, Thompson GB, Young WF. When and how should patients with multiple endocrine neoplasia type 1 be screened for thymic and bronchial carcinoid tumours? Clin Endocrinol (Oxf) 2016; 84:13-6. [PMID: 26562483 DOI: 10.1111/cen.12972] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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] [Received: 09/28/2015] [Revised: 10/22/2015] [Accepted: 11/05/2015] [Indexed: 02/04/2023]
Abstract
Patients with multiple endocrine neoplasia type 1 (MEN1) are commonly evaluated for clinical manifestations of this syndrome with the rationale that early diagnosis and adequate treatment will result in improved survival and quality of life. Thymic and bronchial carcinoid tumours are uncommon but important manifestations of MEN1. Current practice guidelines recommend evaluation with computed tomography or magnetic resonance imaging scan of the chest every 1-2 years to detect these neoplasms. However, the certainty that patients will be better off (increased survival or quality of life) as a result of this case detection strategy is based on evidence at moderate-high risk of bias that yields only imprecise results of indirect relevance to these patients. In order to improve the care that patients with MEN1 receive, co-ordinated efforts from different stakeholders are required so that large, prospective, multicentre studies evaluating patient important outcomes are carried out.
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Affiliation(s)
- Naykky Singh Ospina
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Spyridoula Maraka
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Victor Montori
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - William F Young
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Barr PJ, O'Malley AJ, Tsulukidze M, Gionfriddo MR, Montori V, Elwyn G. The psychometric properties of Observer OPTION(5), an observer measure of shared decision making. Patient Educ Couns 2015; 98:970-976. [PMID: 25956069 DOI: 10.1016/j.pec.2015.04.010] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [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: 12/12/2014] [Revised: 04/15/2015] [Accepted: 04/18/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Observer OPTION(5) was designed as a more efficient version of OPTION(12), the most commonly used measure of shared decision making (SDM). The current paper assesses the psychometric properties of OPTION(5). METHODS Two raters used OPTION(5) to rate recordings of clinical encounters from two previous patient decision aid (PDA) trials (n=201; n=110). A subsample was re-rated two weeks later. We assessed discriminative validity, inter-rater reliability, intra-rater reliability, and concurrent validity. RESULTS OPTION(5) demonstrated discriminative validity, with increases in SDM between usual care and PDA arms. OPTION(5) also demonstrated concurrent validity with OPTION(12), r=0.61 (95%CI 0.54, 0.68) and intra-rater reliability, r=0.93 (0.83, 0.97). The mean difference in rater score was 8.89 (95% Credibility Interval, 7.5, 10.3), with intraclass correlation (ICC) of 0.67 (95% Credibility Interval, 0.51, 0.91) for the accuracy of rater scores and 0.70 (95% Credibility Interval, 0.56, 0.94) for the consistency of rater scores across encounters, indicating good inter-rater reliability. Raters reported lower cognitive burden when using OPTION(5) compared to OPTION(12). CONCLUSIONS OPTION(5) is a brief, theoretically grounded observer measure of SDM with promising psychometric properties in this sample and low burden on raters. PRACTICE IMPLICATIONS OPTION(5) has potential to provide reliable, valid assessment of SDM in clinical encounters.
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Affiliation(s)
- Paul J Barr
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, USA.
| | - Alistair James O'Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, USA. Alistair.J.O'
| | - Maka Tsulukidze
- The Dartmouth Center for Health Care Delivery Science, Hanover, USA.
| | - Michael R Gionfriddo
- Mayo Graduate School, Mayo Clinic, Rochester, USA; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA.
| | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA.
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, USA; The Dartmouth Center for Health Care Delivery Science, Hanover, USA.
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Violette PD, Agoritsas T, Alexander P, Riikonen J, Santti H, Agarwal A, Bhatnagar N, Dahm P, Montori V, Guyatt GH, Tikkinen KAO. Decision aids for localized prostate cancer treatment choice: Systematic review and meta-analysis. CA Cancer J Clin 2015; 65:239-51. [PMID: 25772796 DOI: 10.3322/caac.21272] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/08/2015] [Accepted: 02/12/2015] [Indexed: 12/21/2022] Open
Abstract
Patients who are diagnosed with localized prostate cancer need to make critical treatment decisions that are sensitive to their values and preferences. The role of decision aids in facilitating these decisions is unknown. The authors conducted a systematic review of randomized trials of decision aids for localized prostate cancer. Teams of 2 reviewers independently identified, selected, and abstracted data from 14 eligible trials (n = 3377 men), of which 10 were conducted in North America. Of these, 11 trials compared decision aids with usual care, and 3 trials compared decision aids with other decision aids. Two trials suggested a modest positive impact on decisional regret. Results across studies varied widely for decisional conflict (4 studies), satisfaction with decision (2 studies), and knowledge (2 studies). No impact on treatment choices was observed (6 studies). In conclusion, scant evidence at high risk of bias suggests the variable impact of existing decision aids on a limited set of decisional processes and outcomes. Because current decision aids provide information but do not directly facilitate shared decision making, subsequent efforts would benefit from user-centered design of decision aids that promote shared decision making.
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Affiliation(s)
- Philippe D Violette
- Endourology Fellow, Division of Urology, Department of Surgery, Western University, London, ON, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Woodstock General Hospital, Woodstock, ON, Canada
| | - Thomas Agoritsas
- Research Fellow, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada, Division of General Internal Medicine and Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Paul Alexander
- Doctoral Candidate, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Jarno Riikonen
- Consultant, Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Henrikki Santti
- Consultant, Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Arnav Agarwal
- Medical Student, Faculty of Medicine, University of Toronto, Toronto, ON, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Neera Bhatnagar
- Medical Librarian, Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - Philipp Dahm
- Professor, Department of Urology, University of Minnesota and Minneapolis Veterans Affairs Health Care System, Minneapolis, MN
| | - Victor Montori
- Professor, Knowledge and Evaluation Research Unit, Division of Endocrinology and Diabetes, Departments of Medicine and Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Gordon H Guyatt
- Distinguished Professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Kari A O Tikkinen
- Adjunct Professor, Departments of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Violette PD, Agoritsas T, Riikonen J, Santti H, Alexander P, Agarwal A, Bhatnagar N, Dahm P, Montori V, Guyatt GH, Tikkinen K. MP42-19 DECISION AIDS FOR LOCALIZED PROSTATE CANCER TREATMENT CHOICE: SYSTEMATIC REVIEW AND META-ANALYSIS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Miranda JJ, Bernabé-Ortiz A, Diez-Canseco F, Málaga G, Cardenas MK, Carrillo-Larco RM, Pesantes MA, Araya R, Boggio O, Checkley W, García PJ, León-Velarde F, Lescano AG, Montori V, Pan W, Rivera-Chira M, Sacksteder K, Smeeth L, García HH, Gilman RH. Building a platform for translational research in chronic noncommunicable diseases to address population health: lessons from NHLBI supported CRONICAS in Peru. Glob Heart 2015; 10:13-9. [PMID: 25754562 PMCID: PMC4356013 DOI: 10.1016/j.gheart.2014.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Heredia, was created in 2009 with support from the U.S. National Heart, Lung, and Blood Institute (NHLBI). The vision of CRONICAS is to build a globally recognized center of excellence conducting quality and innovative research and generating high-impact evidence for health. The center's identity is embedded in its core values: generosity, innovation, integrity, and quality. This review has been structured to describe the development of the CRONICAS Centre, with a focus on highlighting the ongoing translational research projects and capacity-building strategies. The CRONICAS Centre of Excellence is not a risk-averse organization: it benefits from past experiences, including past mistakes, and improves upon them and thus challenges traditional research approaches. This ethos and environment are key to fostering innovation in research.
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Affiliation(s)
- J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabé-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru,School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Francisco Diez-Canseco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Germán Málaga
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru,Division of Internal Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - María K. Cardenas
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rodrigo M. Carrillo-Larco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - M. Amalia Pesantes
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ricardo Araya
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oscar Boggio
- Division of Non-Communicable Diseases, Dirección General de Salud de las Personas, Ministerio de Salud, Lima, Peru
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patricia J. García
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Andrés G. Lescano
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru,Department of Parasitology, and Public Health Training Program, USA Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA,Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - William Pan
- Division of Environmental Science and Policy, Nicholas School of the Environment, Duke University, Durham, NC, USA
| | | | - Katherine Sacksteder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Program in Neuroscience and Cognitive Science, University of Maryland, Baltimore, MD, USA
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Héctor H. García
- School of Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru,Centre for Global Health – Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru,Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Robert H. Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Asociación Benéfica PRISMA, Lima, Peru
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50
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Wang Z, Asi N, Elraiyah TA, Abu Dabrh AM, Undavalli C, Glasziou P, Montori V, Murad MH. Dual computer monitors to increase efficiency of conducting systematic reviews. J Clin Epidemiol 2014; 67:1353-7. [DOI: 10.1016/j.jclinepi.2014.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 05/28/2014] [Accepted: 06/01/2014] [Indexed: 10/25/2022]
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