1
|
Grolleau F, Petit F, Gaudry S, Diard É, Quenot JP, Dreyfuss D, Tran VT, Porcher R. Personalizing renal replacement therapy initiation in the intensive care unit: a reinforcement learning-based strategy with external validation on the AKIKI randomized controlled trials. J Am Med Inform Assoc 2024; 31:1074-1083. [PMID: 38452293 PMCID: PMC11031229 DOI: 10.1093/jamia/ocae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/13/2023] [Accepted: 01/16/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE The timely initiation of renal replacement therapy (RRT) for acute kidney injury (AKI) requires sequential decision-making tailored to individuals' evolving characteristics. To learn and validate optimal strategies for RRT initiation, we used reinforcement learning on clinical data from routine care and randomized controlled trials. MATERIALS AND METHODS We used the MIMIC-III database for development and AKIKI trials for validation. Participants were adult ICU patients with severe AKI receiving mechanical ventilation or catecholamine infusion. We used a doubly robust estimator to learn when to start RRT after the occurrence of severe AKI for three days in a row. We developed a "crude strategy" maximizing the population-level hospital-free days at day 60 (HFD60) and a "stringent strategy" recommending RRT when there is significant evidence of benefit for an individual. For validation, we evaluated the causal effects of implementing our learned strategies versus following current best practices on HFD60. RESULTS We included 3748 patients in the development set and 1068 in the validation set. Through external validation, the crude and stringent strategies yielded an average difference of 13.7 [95% CI -5.3 to 35.7] and 14.9 [95% CI -3.2 to 39.2] HFD60, respectively, compared to current best practices. The stringent strategy led to initiating RRT within 3 days in 14% of patients versus 38% under best practices. DISCUSSION Implementing our strategies could improve the average number of days that ICU patients spend alive and outside the hospital while sparing RRT for many. CONCLUSION We developed and validated a practical and interpretable dynamic decision support system for RRT initiation in the ICU.
Collapse
Affiliation(s)
- François Grolleau
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, F-75004, France
- Centre d’Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, Paris, F-75004, France
| | - François Petit
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, F-75004, France
| | - Stéphane Gaudry
- Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Avicenne, Université Sorbonne Paris Nord, Bobigny, 93430, France
- Health Care Simulation Center, UFR SMBH, Sorbonne Paris Cité, Bobigny, 93017, France
- INSERM UMR S1155, Sorbonne Université, CORAKID, Hôpital Tenon, Paris, 75020, France
| | - Élise Diard
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, F-75004, France
- Centre d’Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, Paris, F-75004, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, 21000, France
- Lipness Team, INSERM Research Center, LNC-UMR1231 and LabEx LipSTIC, Dijon, 21000, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, 21000, France
| | - Didier Dreyfuss
- INSERM UMR S1155, Sorbonne Université, CORAKID, Hôpital Tenon, Paris, 75020, France
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Hôpital Louis Mourier, AP-HP, Université Paris-Cité, Paris, F-75018, France
| | - Viet-Thi Tran
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, F-75004, France
- Centre d’Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, Paris, F-75004, France
| | - Raphaël Porcher
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, F-75004, France
- Centre d’Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, Paris, F-75004, France
| |
Collapse
|
2
|
Fakih A, Tannous R, Lajnef M, Seneschal J, Andreu N, Tran VT, Ezzedine K. Stigma in vitiligo: associated factors and severity strata of the Patient Unique Stigmatization Holistic tool in Dermatology (PUSH-D) score. Br J Dermatol 2024; 190:712-717. [PMID: 38234050 DOI: 10.1093/bjd/ljae020] [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] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Vitiligo is the most common cause of skin depigmentation worldwide. Patients with vitiligo may experience stigma and this needs to be addressed. OBJECTIVES To evaluate stigma in patients with vitiligo, search for associated factors and establish severity strata for the Patient Unique Stigmatization Holistic tool in Dermatology (PUSH-D) for patients with vitiligo. METHODS We conducted a cross-sectional study in ComPaRe Vitiligo, an e-cohort of adult patients with vitiligo. Stigmatization was assessed using the PUSH-D, a recently validated dermatology-specific stigmatization assessment tool. We conducted univariate and multivariable linear regression to identify patient and disease factors associated with the stigmatization. We used an anchor-based approach to define severity strata for the PUSH-D. RESULTS In total, 318 patients participated (mean age 49.7 years; 73.9% women). Fitzpatrick skin phototype IV-VI, severe facial involvement (high Self-Assessment Vitiligo Extent Score of the face) and depression (high Patient Health Questionnaire-9 score) were positively -associated with a higher stigmatization score, although this association was weak [r = 0.24 (P < 0.001) and r = 0.30 (P < 0.001), respectively]. PUSH-D cutoff values that best discriminated patients with high and low stigma, as defined by the anchor question, were 13 and 23 (κ = 0.622, 95% confidence interval 0.53-0.71). CONCLUSIONS Our study is the first to use a skin-specific stigmatization tool to assess stigma in patients with vitiligo. Creating strata helps to better interpret the PUSH-D in daily practice and may facilitate its use in clinical trials.
Collapse
Affiliation(s)
- Ali Fakih
- Department of Dermatology, Hôpital Nord, Centre Hospitalier Universitaire, Université Jean Monnet, Saint Etienne, France
| | - Rim Tannous
- Department of Dermatology, Hôpital Henri Mondor, Université Paris-Est Créteil Val de Marne-Université Paris, Paris, France
| | - Mohamed Lajnef
- Inserm U955 IMRB, Translational Neuropsychiatry Laboratory and Paris-Est Créteil University, Créteil, France
| | - Julien Seneschal
- Department of Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint André, Bordeaux, France
| | - Nicolas Andreu
- Department of Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint André, Bordeaux, France
| | - Viet-Thi Tran
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France
- Centre de Recherche Épidémiologie et Statistiques (CRESS), Université de Paris, INSERM UMR1153, Paris, France
| | - Khaled Ezzedine
- Department of Dermatology, Hôpital Henri Mondor, Université Paris-Est Créteil Val de Marne-Université Paris, Paris, France
- EpidermE, Université Paris-Est Créteil (UPEC), Créteil, France
| |
Collapse
|
3
|
Alebouyeh F, Boutron I, Ravaud P, Tran VT. Psychometric Properties and Domains Covered by Patient-Reported Outcome Measures Used in Trials Assessing Interventions for Chronic Pain. J Clin Epidemiol 2024:111362. [PMID: 38615827 DOI: 10.1016/j.jclinepi.2024.111362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To identify the patient reported outcome measures (PROMs) used in clinical trials assessing interventions for chronic pain, describe their psychometric properties and the clinical domains they cover. STUDY DESIGN AND SETTING We identified phase 3 or 4 interventional trials on adult participants (age >18) registered in clinicaltrials.gov between January 1, 2021 to December 31, 2022 and which provided "chronic pain" as a keyword condition. We excluded diagnostic studies and phase 1 or 2 trials. In each trial, one reviewer extracted all outcomes registered and identified those captured using PROMs. For each PROM used in more than 1% of identified trials, two reviewers assessed whether it covered the six important clinical domains from the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT): pain, emotional functioning, physical functioning, Participant ratings of global improvement of global improvement, symptoms and adverse events, and participant disposition (e.g., adherence to medication). Second, reviewers searched PubMed for both the initial publication and latest review reporting the psychometric properties of each PROM and their content validity, structural validity, internal consistency, reliability, measurement error, hypotheses testing, criterion validity and responsiveness using published criteria from the literature. RESULTS In total, 596 trials assessing 4843 outcomes were included in the study (median sample size 60, interquartile range 40 to 100). Trials evaluated behavioral (22%), device-based (21%) and drug-based (10%) interventions. Of 495 unique PROMs, 55 were used in more than 1% trials (16 were generic pain measures; 8 were pain measures for specific diseases; 30 were measures of other symptoms or consequences of pain). About 50% PROMs had more than 50% of psychometric properties rated as sufficient. Scales often focused on a single clinical domain. Only 25% trials measured at least three clinical domains from IMMPACT. CONCLUSION Only half of PROMs used in trials for chronic pain had sufficient psychometric properties for more than 50% of criteria assessed. Few PROMs assess more than one important clinical domain. Only 25% of trials measure more than 3/6 clinical domains considered important by IMMPACT.
Collapse
Affiliation(s)
- Farzaneh Alebouyeh
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France
| | - Isabelle Boutron
- Université Paris Cité, CRESS, INSERM, INRAE, Paris, France; Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France
| | - Philippe Ravaud
- Université Paris Cité, CRESS, INSERM, INRAE, Paris, France; Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Viet-Thi Tran
- Université Paris Cité, CRESS, INSERM, INRAE, Paris, France; Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France.
| |
Collapse
|
4
|
Veal C, Tomlinson A, Cipriani A, Bulteau S, Henry C, Müh C, Touboul S, De Waal N, Levy-Soussan H, Furukawa TA, Fried EI, Tran VT, Chevance A. Heterogeneity of outcome measures in depression trials and the relevance of the content of outcome measures to patients: a systematic review. Lancet Psychiatry 2024; 11:285-294. [PMID: 38490761 DOI: 10.1016/s2215-0366(23)00438-8] [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: 10/17/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 03/17/2024]
Abstract
Research waste occurs when randomised controlled trial (RCT) outcomes are heterogeneous or overlook domains that matter to patients (eg, relating to symptoms or functions). In this systematic review, we reviewed the outcome measures used in 450 RCTs of adult unipolar and bipolar depression registered between 2018 and 2022 and identified 388 different measures. 40% of the RCTs used the same measure (Hamilton Depression Rating Scale [HAMD]). Patients and clinicians matched each item within the 25 most frequently used measures with 80 previously identified domains of depression that matter to patients. Seven (9%) domains were not covered by the 25 most frequently used outcome measures (eg, mental pain and irritability). The HAMD covered a maximum of 47 (59%) of the 80 domains that matter to patients. An interim solution to facilitate evidence synthesis before a core outcome set is developed would be to use the most common measures and choose complementary scales to optimise domain coverage. TRANSLATIONS: For the French and Dutch translations of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Christopher Veal
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM INRAE, Centre for Research in Epidemiology and Statistics, Paris, France; Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, Paris, France
| | | | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Samuel Bulteau
- UMR INSERM 1246, SPHERE, University of Nantes and University of Tours, Nantes, France; CHU Nantes, Department of Addictology, Psychiatry and Old Age Psychiatry, Nantes, France
| | - Chantal Henry
- Université Paris Cité, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie and Neurosciences, Paris, France
| | - Chlöé Müh
- Perception and Memory Unit, Institut Pasteur, UMR3571, CNRS, Paris, France; Université Paris Cité, Collège Doctoral, Paris, France
| | | | | | | | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Eiko I Fried
- Clinical Psychology Unit, Psychology Department, Leiden University, Leiden, Netherlands
| | - Viet-Thi Tran
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM INRAE, Centre for Research in Epidemiology and Statistics, Paris, France; Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, Paris, France
| | - Astrid Chevance
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM INRAE, Centre for Research in Epidemiology and Statistics, Paris, France; Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, Paris, France.
| |
Collapse
|
5
|
Blanc H, Rothier Bautzer E, Vellut N, Tran VT. Spread of awareness of COVID-19 between December 2019 and March 2020 in France. Sci Rep 2024; 14:6850. [PMID: 38514722 PMCID: PMC10958011 DOI: 10.1038/s41598-024-56423-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 03/06/2024] [Indexed: 03/23/2024] Open
Abstract
During the early phase of outbreaks, awareness of the presence of the disease plays an important role in transmission dynamics. To investigate the processes of how people become aware of a disease, we conducted two complementary investigations. First, we surveyed 868 academic researchers in France, on the time and circumstances when they became aware of COVID-19 as an important event. We found that 25% did so before February 18th (first death in France), 50% did so before March 10th (first presidential allocution) and 75% did so before March 16th (announcement of the lockdown). Awareness came from nine categories of circumstances: (1) decisions taken by the government (elicited by 35.7% participants); (2) information from media or social media (24.7%); (3) conversation with friends (22.4%); (4) observed changes in their personal lives (14.0%); (5) decisions taken by the employer (9.2%); (6) observed changes at work (9.9%); (7) suspected case of COVID-19 in their entourage (3.1%); (8) fear for oneself or their entourage (2.8%) and (9) self-appraisal of scientific reports (2.8%). Second, we appraised three general media in France (a television news show, a radio news show, and a newspaper) and showed that COVID-19 became a preeminent topic only after March 1st 2020 when the epidemic is present on national soil. Our results show that multiple intricated factors prompt the awareness of an emerging infectious disease. Awareness is not solely driven by general media as they begin to focus on the topic late.
Collapse
Affiliation(s)
- Horace Blanc
- Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, 75004, Paris, France
| | - Eliane Rothier Bautzer
- CNRS, INSERM, Centre for Research on Medicine, Science, Health, Mental Health, and Society (Cermes3), Université Paris Cité, 75004, Paris, France
| | - Natacha Vellut
- CNRS, INSERM, Centre for Research on Medicine, Science, Health, Mental Health, and Society (Cermes3), Université Paris Cité, 75004, Paris, France
| | - Viet-Thi Tran
- Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, 75004, Paris, France.
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique Hôpitaux de Paris, 75004, Paris, France.
| |
Collapse
|
6
|
Corre F, Albouys J, Tran VT, Lepilliez V, Ratone JP, Coron E, Lambin T, Rahmi G, Karsenti D, Canard JM, Chabrun E, Camus M, Wallenhorst T, Chevaux JB, Schaefer M, Gerard R, Rouquette A, Terris B, Coriat R, Jacques J, Barret M, Pioche M, Chaussade S, Cappelle E. Impact of surgery after endoscopically resected high-risk T1 colorectal cancer: results of an emulated target trial. Gastrointest Endosc 2024; 99:408-416.e2. [PMID: 37793506 DOI: 10.1016/j.gie.2023.09.027] [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: 05/05/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND AND AIMS We aimed to compare the long-term outcomes of patients with high-risk T1 colorectal cancer (CRC) resected endoscopically who received either additional surgery or surveillance. METHODS We used data from routine care to emulate a target trial aimed at comparing 2 strategies after endoscopic resection of high-risk T1 CRC: surgery with lymph node dissection (treatment group) versus surveillance alone (control group). All patients from 14 tertiary centers who underwent an endoscopic resection for high-risk T1 CRC between March 2012 and August 2019 were included. The primary outcome was a composite outcome of cancer recurrence or death at 48 months. RESULTS Of 197 patients included in the analysis, 107 were categorized in the treatment group and 90 were categorized in the control group. From baseline to 48 months, 4 of 107 patients (3.7%) died in the treatment group and 6 of 90 patients (6.7%) died in the control group. Four of 107 patients (3.7%) in the treatment group experienced a cancer recurrence and 4 of 90 patients (4.4%) in the control group experienced a cancer recurrence. After balancing the baseline covariates by inverse probability of treatment weighting, we found no significant difference in the rate of death and cancer recurrence between patients in the 2 groups (weighted hazard ratio, .95; 95% confidence interval, .52-1.75). CONCLUSIONS Our study suggests that patients with high-risk T1 CRC initially treated with endoscopic resection may not benefit from additional surgery.
Collapse
Affiliation(s)
- Félix Corre
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Cité University, Paris, France
| | - Jérémie Albouys
- Department of Gastroenterology and Endoscopy, Dupuytren University Hospital, Limoges, France
| | - Viet-Thi Tran
- Paris Cité University and Sorbonne Paris Nord University, INSERM, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | | | | | - Emmanuel Coron
- Department of Gastroenterology and Hepatology, University Hospital of Geneva, Geneva, Switzerland; Digestive Diseases Institute, University Hospital of Nantes, Nantes, France
| | - Thomas Lambin
- Department of Gastroenterology and Endoscopy, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Gabriel Rahmi
- Department of Gastroenterology and Endoscopy, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | - Marine Camus
- Department of Endoscopy, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Timothée Wallenhorst
- Department of Gastroenterology, Pontchaillou University Hospital, Rennes, France
| | | | - Marion Schaefer
- Department of Gastroenterology, Brabois University Hospital, Nancy, France
| | - Romain Gerard
- Department of Gastroenterology, Claude Huriez Hospital, Lille, France
| | - Alexandre Rouquette
- Paris Cité University, Paris, France; Department of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benoit Terris
- Paris Cité University, Paris, France; Department of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Coriat
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Cité University, Paris, France
| | - Jérémie Jacques
- Department of Gastroenterology and Endoscopy, Dupuytren University Hospital, Limoges, France
| | - Maximilien Barret
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Cité University, Paris, France
| | - Mathieu Pioche
- Department of Gastroenterology and Endoscopy, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Stanislas Chaussade
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Cité University, Paris, France
| | - Elisabeth Cappelle
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Cité University, Paris, France
| |
Collapse
|
7
|
Fertitta L, Bergqvist C, Sarin KY, Plotkin SR, Moertel C, Petersen AK, Cannon A, Berman Y, Pichard DC, Röhl C, Lessing A, Brizion B, Peiffer B, Ravaud P, Tran VT, Armand ML, Moryousef S, Ferkal S, Jannic A, Ezzedine K, Wolkenstein P. A core outcome domain set to assess cutaneous neurofibromas related to neurofibromatosis type 1 in clinical trials. Br J Dermatol 2024; 190:216-225. [PMID: 37877514 DOI: 10.1093/bjd/ljad397] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/19/2023] [Accepted: 10/14/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Cutaneous neurofibromas (cNF) are considered one of the highest burdens of neurofibromatosis type 1 (NF1). To date, no medical treatment can cure cNF or prevent their development. In that context, there is an urgent need to prepare and standardize the methodology of future trials targeting cNF. OBJECTIVES The objective was to develop a core outcome domain set suitable for all clinical trials targeting NF1-associated cNF. METHODS The validated approach of this work consisted of a three-phase methodology: (i) generating the domains [systematic literature review (SLR) and qualitative studies]; (ii) agreeing (three-round international e-Delphi consensus process and working groups); and (iii) voting. RESULTS (i) The SLR and the qualitative studies (three types of focus groups and a French e-survey with 234 participants) resulted in a preliminary list of 31 candidate items and their corresponding definitions. (ii) A total of 229 individuals from 29 countries participated in the first round of the e-Delphi process: 71 patients, relatives or representatives (31.0%), 130 healthcare professionals (HCPs, 56.8%) and 28 researchers, representatives of a drug regulatory authority, industry or pharmaceutical company representatives or journal editors (12.2%). The overall participation rate was 74%. After round 2, five candidate items were excluded. Between rounds 2 and 3, international workshops were held to better understand the disagreements among stakeholders. This phase led to the identification of 19 items as outcome subdomains. (iii) The items were fused to create four outcome domains ('clinical assessment', 'daily life impact', 'patient satisfaction' and 'perception of health') and prioritized. The seven items that did not reach consensus were marked for the research agenda. The final core outcome domain set reached 100% of the votes of the steering committee members. CONCLUSIONS Although numerous outcomes can be explored in studies related to cNF in NF1, the present study offers four outcome domains that should be reported in all trial studies, agreed on by international patients, relatives and representatives of patients; HCPs; researchers, representatives of drug regulatory authorities or pharmaceutical companies and journal editors. The next step will include the development of a set of core outcome measurement instruments to further standardize how these outcomes should be assessed.
Collapse
Affiliation(s)
- Laura Fertitta
- Department of Dermatology
- INSERM, Centre d'Investigation Clinique 1430; National Referral Center for Neurofibromatoses, -Henri-Mondor Hospital, Assistance Publique-Hôpitaux Paris (AP-HP) , 94010 Créteil, France
- INSERM U955 , 94010, Créteil, France
| | - Christina Bergqvist
- Department of Dermatology
- INSERM, Centre d'Investigation Clinique 1430; National Referral Center for Neurofibromatoses, -Henri-Mondor Hospital, Assistance Publique-Hôpitaux Paris (AP-HP) , 94010 Créteil, France
| | - Kavita Y Sarin
- Department of Dermatology, Stanford Medicine, Stanford University, Redwood City, CA, USA
| | - Scott R Plotkin
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - Andrea K Petersen
- Department of Rehabilitation and Development, Randall Children's Hospital at Legacy Emanuel Medical Center, Portland, OR, 97227, USA
| | - Ashley Cannon
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- InformedDNA, Inc., St Petersburg, FL, USA
| | - Yemima Berman
- Clinical Genetics, Royal North Shore Hospital, St Leonards, NSW, Australia and University of Sydney, Sydney, Australia
| | - Dominique C Pichard
- Dermatology Branch, National Institutes of Arthritis, Musculoskeletal, and Skin Diseases
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute; National Institutes of Health, Bethesda, MD, USA
| | - Class Röhl
- NF Patients United - Global Network of NF Support Groups, Vienna, Austria
| | | | | | | | - Philippe Ravaud
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France
- Université de Paris, CRESS, INSERM, INRA , F-75004 Paris, France
| | - Viet-Thi Tran
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France
- Université de Paris, CRESS, INSERM, INRA , F-75004 Paris, France
| | | | | | - Salah Ferkal
- Department of Dermatology
- INSERM, Centre d'Investigation Clinique 1430; National Referral Center for Neurofibromatoses, -Henri-Mondor Hospital, Assistance Publique-Hôpitaux Paris (AP-HP) , 94010 Créteil, France
| | | | - Khaled Ezzedine
- Department of Dermatology
- INSERM, Centre d'Investigation Clinique 1430; National Referral Center for Neurofibromatoses, -Henri-Mondor Hospital, Assistance Publique-Hôpitaux Paris (AP-HP) , 94010 Créteil, France
- Université Paris-Est Créteil (UPEC), 94010 Créteil, France
| | - Pierre Wolkenstein
- Department of Dermatology
- INSERM, Centre d'Investigation Clinique 1430; National Referral Center for Neurofibromatoses, -Henri-Mondor Hospital, Assistance Publique-Hôpitaux Paris (AP-HP) , 94010 Créteil, France
- INSERM U955, 94010, Créteil, France
- Université Paris-Est Créteil (UPEC), 94010 Créteil, France
| |
Collapse
|
8
|
Lenfant T, Ravaud P, Montori VM, Berntsen GR, Tran VT. Five principles for the development of minimally disruptive digital medicine. BMJ 2023; 383:2960. [PMID: 38114257 DOI: 10.1136/bmj.p2960] [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: 12/21/2023]
Affiliation(s)
- Tiphaine Lenfant
- Université Paris Cité, METHODS Team, CRESS, INSERM, INRAE, Paris, France
- Assistance Publique-Hôpitaux de Paris, Médecine Interne, Hôpital Européen Georges Pompidou, Paris, France
| | - Philippe Ravaud
- Université Paris Cité, METHODS Team, CRESS, INSERM, INRAE, Paris, France
- Assistance Publique-Hôpitaux de Paris, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, USA2 AP HEGP
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | - Gro R Berntsen
- Norwegian Center for e-healthresearch, University hospital of North Norway, Unit for Primary Care, Institute of Community Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Viet-Thi Tran
- Université Paris Cité, METHODS Team, CRESS, INSERM, INRAE, Paris, France
- Assistance Publique-Hôpitaux de Paris, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France
| |
Collapse
|
9
|
Fertitta L, Sarin KY, Bergqvist C, Patel E, Peiffer B, Moryousef S, Armand ML, Jannic A, Ferkal S, Ravaud P, Tran VT, Blakeley JO, Romo CG, Ezzedine K, Wolkenstein P. cNF-Skindex in Adults Living with Neurofibromatosis 1: Severity Strata in France and Validation in United States Adults. J Invest Dermatol 2023; 143:2226-2232.e1. [PMID: 37149083 DOI: 10.1016/j.jid.2023.04.014] [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] [Received: 02/01/2023] [Revised: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 05/08/2023]
Abstract
Cutaneous neurofibromas (cNF) contribute to the impairment of QOL in individuals with neurofibromatosis 1. The cNF-Skindex, validated in a French population, specifically assesses the cNF-related QOL. In this study, we first defined severity strata using an anchoring approach on the basis of patient's burden. In total, 209 patients answered the anchor question and the cNF-Skindex. We tested the agreement among the three strata, generated by all potential couples of cut-off values of the cNF-Skindex and the three strata defined in the anchor question. The cut-off values 12 and 49 provided the highest Kappa value (κ = 0.685, 95% confidence interval = 0.604-0.765). Second, we validated the score and the strata in a United States population using the answers provided by 220 French and 148 United States adults. In the multivariable linear regression analysis, the country of origin was not a factor associated with the score (P = 0.297). The number of cNF along the different severity strata was similar between the French and the United States populations. In conclusion, stratification constitutes a powerful tool to better interpret the cNF-Skindex in daily practice and in clinical trials. This study validates its use in two populations that together constitute a large cohort of patients willing to participate in clinical research.
Collapse
Affiliation(s)
- Laura Fertitta
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Clinical Investigation Center, Inserm 1430, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Inserm U955, Mondor Institute for Biomedical Research, Creteil, France.
| | - Kavita Y Sarin
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California, USA
| | - Christina Bergqvist
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Clinical Investigation Center, Inserm 1430, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France
| | - Ekshika Patel
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California, USA
| | - Bastien Peiffer
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France
| | - Sabine Moryousef
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Clinical Investigation Center, Inserm 1430, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France
| | - Marie-Laure Armand
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France
| | - Arnaud Jannic
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Clinical Investigation Center, Inserm 1430, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France
| | - Salah Ferkal
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Clinical Investigation Center, Inserm 1430, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France
| | - Philippe Ravaud
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and Statistics, Paris, France
| | - Viet-Thi Tran
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and Statistics, Paris, France
| | - Jaishri O Blakeley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carlos G Romo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Khaled Ezzedine
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Clinical Investigation Center, Inserm 1430, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Université Paris Est Créteil, Créteil, France
| | - Pierre Wolkenstein
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Clinical Investigation Center, Inserm 1430, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Inserm U955, Mondor Institute for Biomedical Research, Creteil, France; Université Paris Est Créteil, Créteil, France
| |
Collapse
|
10
|
Phi NTT, Oikonomidi T, Ravaud P, Tran VT. Assessment of US Food and Drug Administration-Approved Digital Medical Devices for Just-in-Time Interventions: A Systematic Review. JAMA Intern Med 2023; 183:858-869. [PMID: 37459057 DOI: 10.1001/jamainternmed.2023.2864] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Importance Just-in-time interventions (JITIs) are a type of digital therapeutic intervention that combines remote monitoring tools and algorithms to personalize the delivery of specific interventions at the right time. The US Food and Drug Administration (FDA) regulatory approval documents are often the only available source of information on the effectiveness of therapeutic interventions based on these devices. Objective To systematically review the publicly available information from the FDA on all recently approved medical devices used in JITIs to (1) assess how they operate to deliver JITIs and (2) appraise the evidence supporting their performance and clinical effectiveness. Evidence Review Two reviewers systematically searched the Premarket Notifications (510(k)), Premarket Approvals, De Novo, and Humanitarian Device Exemption databases from January 2019 to December 2021 for all entries associated with devices that monitored patients' data over time to personalize the delivery of interventions to treat, prevent, or mitigate health conditions or events. They assessed whether the product summaries (1) enabled an understanding of how the device operated to deliver a JITI (eg, the nature, type, and frequency of the monitoring, the nature of the decision algorithm, and the nature and intended receiver of the intervention); (2) informed about the performance and effectiveness of the JITI; and (3) included information on data security and ownership. Findings In total, 38 devices were included in this review. These were mainly intended for cardiac conditions (12 [31.6%]), diabetes (10 [26.3%]), and neurological diseases (4 [10.5%]). Monitoring devices ranged from wearable (18 of 28 [64.4%]; eg, smartwatches) to implanted sensors (6 of 28 [21.4%]; eg, inserted electrocardiographic sensors). Only 10 of 38 product summaries (26.3%) allowed a full understanding of how the device operated to deliver a JITI. Similarly, only 12 of 28 (42.9%), 12 of 36 (33.3%), and 5 of 38 (13.2%) reported the assessment of the performance of the monitoring device, assessment of the decision algorithm, and results of clinical studies assessing the effectiveness of the JITI, respectively. Finally, 14 of 36 product summaries (38.9%) included some information on data security, but none included information on data ownership. Conclusion and Relevance The results of this systematic review suggest that the information publicly available in the FDA databases on the performance and effectiveness of digital medical devices used in JITIs is heterogeneous.
Collapse
Affiliation(s)
- Ngan Thi Thuy Phi
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, INRAE, Center for Research in Epidemiology and Statistics (CRESS), F-75004 Paris, France
| | - Theodora Oikonomidi
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, INRAE, Center for Research in Epidemiology and Statistics (CRESS), F-75004 Paris, France
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, University of Manchester, Manchester, England
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, England
| | - Philippe Ravaud
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, INRAE, Center for Research in Epidemiology and Statistics (CRESS), F-75004 Paris, France
- Centre d'Epidemiologie clinique, AP-HP, Hôpital Hôtel Dieu, F-75004 Paris, France
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Viet-Thi Tran
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, INRAE, Center for Research in Epidemiology and Statistics (CRESS), F-75004 Paris, France
- Centre d'Epidemiologie clinique, AP-HP, Hôpital Hôtel Dieu, F-75004 Paris, France
| |
Collapse
|
11
|
Merhi S, Salameh P, Abboud M, Seneschal J, Eleftheriadou V, Pane I, Tran VT, Shourick J, Ezzedine K. Facial involvement is reflective of patients' global perception of vitiligo extent. Br J Dermatol 2023; 189:188-194. [PMID: 37002778 DOI: 10.1093/bjd/ljad109] [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] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND The involvement of visible areas in vitiligo has been found to be correlated with increased psychiatric morbidity. Although multiple tools have been developed to assess vitiligo, no cutoff for improvement or worsening of vitiligo from a patient's perspective has been established. OBJECTIVES To determine the minimal clinically important difference (MCID) of the Self-Assessment Vitiligo Extent Score (SA-VES) in patients with vitiligo and to evaluate, from the patient's perspective, the importance of the change in the involvement of visible areas (face and hands) in patients' overall perception of disease worsening or improving. METHODS This was a cross-sectional study in the context of the ComPaRe e-cohort. Adult patients with vitiligo were invited to answer online questionnaires. They completed the SA-VES twice, 1 year apart. In addition, patients answered a 5-point Likert anchor question aimed at assessing their perception of the evolution of the extent of their vitiligo. The MCID was calculated using distribution- and anchor-based approaches. Using ordinal logistic regression, the change of vitiliginous lesions on the face or hands was compared to the overall extent of vitiligo (patches on all body areas). RESULTS In total, 244 patients with vitiligo were included in the analyses; 20 (8%) were found to have an improvement in their vitiligo. The MCID in worsened patients was equal to a 1.3% body surface area [95% confidence interval (CI) 1.01-1.43] increase in the SA-VES. For participants with improved vitiligo, the MCID was equal to a decrease in total SA-VES of 1.3% (95% CI 0.867-1.697). Patients' perceptions of change in their vitiligo was increased sevenfold when it affected the face vs. the rest of the body. CONCLUSIONS Changes in the facial SA-VES were highly correlated with patients' impressions of the extent of vitiligo.
Collapse
Affiliation(s)
- Samar Merhi
- Université Paris-Est Créteil, EpiDermE - Epidemiology in Dermatology and Evaluation of Therapeutics, Creteil, France
- Faculty of Nursing and Health Sciences, Notre Dame University - Louaize (NDU), Zouk Mosbeh, Lebanon
| | - Pascale Salameh
- School of Medicine, Lebanese American University, Byblos, Lebanon
- Institut National de Santé Publique d'Épidémiologie Clinique et de Toxicologie-Liban (INSPECT-LB), Beirut, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | - Mounya Abboud
- Université Paris-Est Créteil, EpiDermE - Epidemiology in Dermatology and Evaluation of Therapeutics, Creteil, France
| | - Julien Seneschal
- University of Bordeaux, CNRS UMR5164, ImmunoConCept, Bordeaux, France
- Department of Dermatology, Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, Bordeaux, France
| | - Viktoria Eleftheriadou
- Walsall Healthcare NHS Trust and The Royal Wolverhampton NHS Trust, University of Birmingham, Birmingham, UK
| | - Isabelle Pane
- Centre de Recherche Épidémiologie et StatistiqueS (CRESS - Université Paris Cité, INSERM UMR1153), Paris, France
| | - Viet-Thi Tran
- Centre de Recherche Épidémiologie et StatistiqueS (CRESS - Université Paris Cité, INSERM UMR1153), Paris, France
- Centre d'Épidémiologie Clinique - Hôpital Hôtel-Dieu (AP-HP), Paris, France
| | - Jason Shourick
- Department of Epidemiology and Public Health, UMR 1027 INSERM, Toulouse University Hospital, Toulouse, France
| | - Khaled Ezzedine
- Université Paris-Est Créteil, EpiDermE - Epidemiology in Dermatology and Evaluation of Therapeutics, Creteil, France
- AP-HP, Hôpital Henri-Mondor, Service de Dermatologie, Créteil, France
| |
Collapse
|
12
|
Malmartel A, Ravaud P, Tran VT. A methodological framework allows the identification of personomic markers to consider when designing personalized interventions. J Clin Epidemiol 2023; 159:235-245. [PMID: 37311514 DOI: 10.1016/j.jclinepi.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/19/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To develop a methodological framework to identify and prioritize personomic markers (e.g., psychosocial situation, beliefs…) to consider for personalizing interventions and to test in smoking cessation interventions. STUDY DESIGN AND SETTING (1) We identified potential personomic markers considered in protocols of personalized interventions, in reviews of predictors of smoking cessation, and in interviews with general practitioners. (2) Physicians, and patient smokers or former smokers selected the markers they considered most relevant during online paired comparison experiments. Data were analyzed with Bradley Terry Luce models. RESULTS Thirty-six personomic markers were identified from research evidence. They were evaluated by 795 physicians (median age: 34, IQR [30-38]; 95% general practitioners) and 793 patients (median age: 54, IQR [42-64], 71.4% former smokers) during 11,963 paired comparisons. Physicians identified patients' motivation for quitting (e.g., Prochaska stages), patients' preferences, and patients' fears and beliefs (e.g., concerns about weight gain) as the most relevant elements to personalize smoking cessation. Patients considered their motivation for quitting, smoking behavior (e.g., smoking at home/at work), and tobacco dependence (e.g., Fagerström Test) as the most relevant elements to consider. CONCLUSION We provide a methodological framework to prioritize which personomic markers should be considered when developing smoking cessation interventions.
Collapse
Affiliation(s)
- Alexandre Malmartel
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004 Paris, France; Département de Médecine Générale, Université Paris Cité, F-75014 Paris, France.
| | - Philippe Ravaud
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004 Paris, France; Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel-Dieu, Paris, France
| | - Viet-Thi Tran
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004 Paris, France; Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel-Dieu, Paris, France
| |
Collapse
|
13
|
Servier C, Porcher R, Pane I, Ravaud P, Tran VT. Trajectories of the evolution of post COVID-19 condition, up to two years after symptoms onset. Int J Infect Dis 2023; 133:67-74. [PMID: 37182548 PMCID: PMC10176960 DOI: 10.1016/j.ijid.2023.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/04/2023] [Accepted: 05/07/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND We aimed to identify trajectories of the evolution of post COVID-19 condition, up to two years after symptom onset. METHODS The ComPaRe long COVID e-cohort is a prospective cohort of patients with symptoms lasting at least two months after SARS-CoV2 infection. We used trajectory modelling to identify different trajectories in the evolution of post COVID-19 condition, based on symptoms collected every 60 days using the long COVID Symptom Tool. FINDINGS A total of 2,197 patients were enrolled in the cohort between December 2020 and July 2022 when the Omicron variant was not dominant. Three trajectories of the evolution of post COVID-19 condition were identified: "high persistent symptoms" (4%), "rapidly decreasing symptoms" (5%), and "slowly decreasing symptoms" (91%). Participants with high persistent symptoms were older and more likely to report a history of systemic diseases. They often reported tachycardia, bradycardia, palpitations, and arrhythmia. Participants with rapidly decreasing symptoms were younger and more likely to report a confirmed infection. They often reported diarrhoea and back pain. Participants with slowly decreasing symptoms were more likely to have functional diseases. INTERPRETATION Most of patients with post COVID-19 condition improve slowly over time, while 5% have rapid improvement in the two years after symptom onset and 4% have a persistent condition. FUNDING The authors received no specific funding for this study.
Collapse
Affiliation(s)
- Clemence Servier
- Université Paris Cité, METHODS Team, CRESS, INSERM, INRA, F-75004 Paris, France
| | - Raphael Porcher
- Université Paris Cité, METHODS Team, CRESS, INSERM, INRA, F-75004 Paris, France; Centre d'Épidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôtel-Dieu, F-75004, Paris, France
| | - Isabelle Pane
- Université Paris Cité, METHODS Team, CRESS, INSERM, INRA, F-75004 Paris, France
| | - Philippe Ravaud
- Université Paris Cité, METHODS Team, CRESS, INSERM, INRA, F-75004 Paris, France; Centre d'Épidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôtel-Dieu, F-75004, Paris, France; Department of Epidemiology, Columbia University Mailman School of Public Health, 22 W 168th St, New York, NY, USA
| | - Viet-Thi Tran
- Université Paris Cité, METHODS Team, CRESS, INSERM, INRA, F-75004 Paris, France; Centre d'Épidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôtel-Dieu, F-75004, Paris, France.
| |
Collapse
|
14
|
Oikonomidi T, Ravaud P, LeBeau J, Tran VT. A systematic scoping review of just-in-time, adaptive interventions finds limited automation and incomplete reporting. J Clin Epidemiol 2023; 154:108-116. [PMID: 36521653 DOI: 10.1016/j.jclinepi.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 11/17/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To describe the degree of automation in just-in-time, adaptive interventions (JITAIs) assessed in randomized controlled trials (RCTs) in any medical specialty, and to assess the completeness of intervention reporting. STUDY DESIGN AND SETTING Systematic scoping review-we searched PubMed, PsycINFO, and Web of Science, from 1 January 2019 to 2 March 2021, for reports of RCTs assessing JITAIs. We assessed whether study reports included the minimum information required to replicate the interventions based on JITAI frameworks. We described JITAIs according to their automation level using an established framework (partially, highly, or fully automated), and care workload distribution (requiring work from patients, health care professionals [HCPs], both, or neither). RESULTS We included 88 JITAIs (62%, n = 55 supported chronic illness management and 12%, n = 11 supported health behavior change). Overall, 77% (n = 68) of JITAIs were missing some information required to replicate the intervention (e.g., n = 38, 43% inadequately reported the algorithm used to select intervention components). Only fifteen (17%) JITAIs were fully automated and did not require additional work from HCPs nor patients. Of the remaining JITAIs, 36% required work from both patients and HCPs, and 47% required work from either patients or HCPs. CONCLUSION Most JITAIs are not fully automated and require work from the HCPs and patients.
Collapse
Affiliation(s)
- Theodora Oikonomidi
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004 Paris, France; Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, (AP-HP), 75004 Paris, France.
| | - Philippe Ravaud
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004 Paris, France; Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, (AP-HP), 75004 Paris, France; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jonathan LeBeau
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004 Paris, France; Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, (AP-HP), 75004 Paris, France
| | - Viet-Thi Tran
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004 Paris, France; Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, (AP-HP), 75004 Paris, France
| |
Collapse
|
15
|
Skayem C, Fertitta L, Diaz E, Jannic A, Ferkal S, Ravaud P, Tran VT, Ezzedine K, Wolkenstein P. Neurofibromatosis type 1: Factors associated with flare-ups of cutaneous neurofibromas at puberty. J Eur Acad Dermatol Venereol 2023; 37:e158-e159. [PMID: 36226401 DOI: 10.1111/jdv.18652] [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] [Received: 03/17/2022] [Accepted: 10/06/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Charbel Skayem
- Assistance Publique des Hôpitaux de Paris (AP-HP), Dermatology Department, Henri Mondor Hospital, Créteil, France
| | - Laura Fertitta
- Assistance Publique des Hôpitaux de Paris (AP-HP), Dermatology Department, Henri Mondor Hospital, Créteil, France
| | - Emmanuelle Diaz
- Assistance Publique des Hôpitaux de Paris (AP-HP), Dermatology Department, Henri Mondor Hospital, Créteil, France.,Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) Université Paris Est Créteil (UPEC), Créteil, France
| | - Arnaud Jannic
- Assistance Publique des Hôpitaux de Paris (AP-HP), Dermatology Department, Henri Mondor Hospital, Créteil, France.,Dermatology Department, Referral Expert Center of Neurofibromatosis, Assistance Publique des Hôpitaux de Paris (APHP), Henri Mondor Hospital, Créteil, France
| | - Salah Ferkal
- Assistance Publique des Hôpitaux de Paris (AP-HP), Dermatology Department, Henri Mondor Hospital, Créteil, France.,Dermatology Department, Referral Expert Center of Neurofibromatosis, Assistance Publique des Hôpitaux de Paris (APHP), Henri Mondor Hospital, Créteil, France
| | - Philippe Ravaud
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France
| | - Viet-Thi Tran
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France
| | - Khaled Ezzedine
- Assistance Publique des Hôpitaux de Paris (AP-HP), Dermatology Department, Henri Mondor Hospital, Créteil, France.,Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) Université Paris Est Créteil (UPEC), Créteil, France.,Dermatology Department, Referral Expert Center of Neurofibromatosis, Assistance Publique des Hôpitaux de Paris (APHP), Henri Mondor Hospital, Créteil, France
| | - Pierre Wolkenstein
- Assistance Publique des Hôpitaux de Paris (AP-HP), Dermatology Department, Henri Mondor Hospital, Créteil, France.,Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) Université Paris Est Créteil (UPEC), Créteil, France.,Dermatology Department, Referral Expert Center of Neurofibromatosis, Assistance Publique des Hôpitaux de Paris (APHP), Henri Mondor Hospital, Créteil, France
| |
Collapse
|
16
|
Gouesbet S, Kvaskoff M, Riveros C, Diard É, Pane I, Goussé-Breton Z, Valenti M, Gabillet M, Garoche C, Ravaud P, Tran VT. Patients' Perspectives on How to Improve Endometriosis Care: A Large Qualitative Study Within the ComPaRe-Endometriosis e-Cohort. J Womens Health (Larchmt) 2023; 32:463-470. [PMID: 36656556 DOI: 10.1089/jwh.2022.0323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Endometriosis is a chronic gynecological condition that affects about 10% of women of reproductive age. Despite its prevalence, diagnosis is often delayed, misdiagnosis is common, and treatment options are poor. This study aimed at capturing ideas to improve endometriosis care from the patients' perspectives. Materials and Methods: We analyzed cross-sectional data from 1,000 adult patients in ComPaRe-Endometriosis (a French prospective e-cohort focused on endometriosis) who answered to the open-ended question: "If you had a magic wand, what would you change about your health care?". The free-text responses were analyzed by qualitative thematic analysis using an inductive approach. Results: Patients had a mean age of 34.1 years (standard deviation = 8.1); 56% and 42% had stage IV disease or deep endometriosis, respectively. They elicited 2,487 ideas to improve the management of endometriosis, which were categorized into 61 areas of improvement, further grouped into 14 themes. The top five areas of improvement were mentioned by >10% of the patients and were to (1) train caregivers to develop their knowledge on the disease, (2) provide better management of daily pain and pain attacks, (3) take patient-reported symptoms seriously, (4) standardize diagnostic processes to improve early detection, and (5) have caregivers listen more to the patients. Conclusions: We identified 61 areas for improvement in endometriosis care. These results reflect patients' expectations in terms of management of their disease and will be useful to design a better global care for endometriosis from the patients' perspectives.
Collapse
Affiliation(s)
- Solène Gouesbet
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, Villejuif, France.,Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Marina Kvaskoff
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, Villejuif, France
| | - Carolina Riveros
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Élise Diard
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Isabelle Pane
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Zélia Goussé-Breton
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, Villejuif, France
| | - Michelle Valenti
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, Villejuif, France
| | | | | | - Philippe Ravaud
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Université de Paris, CRESS, INSERM, INRA, Paris, France.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Viet-Thi Tran
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Université de Paris, CRESS, INSERM, INRA, Paris, France
| |
Collapse
|
17
|
Tran VT, Perrodeau E, Saldanha J, Pane I, Ravaud P. Efficacy of first dose of covid-19 vaccine versus no vaccination on symptoms of patients with long covid: target trial emulation based on ComPaRe e-cohort. BMJ Med 2023; 2:e000229. [PMID: 36910458 PMCID: PMC9978748 DOI: 10.1136/bmjmed-2022-000229] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 11/25/2022] [Indexed: 03/04/2023]
Abstract
Objective To evaluate the effect of covid-19 vaccination on the severity of symptoms in patients with long covid. Design Target trial emulation based on ComPaRe e-cohort. Data source ComPaRe long covid cohort, a nationwide e-cohort (ie, a cohort where recruitment and follow-up are performed online) of patients with long covid, in France. Methods Adult patients (aged ≥18 years) enrolled in the ComPaRe cohort before 1 May 2021 were included in the study if they reported a confirmed or suspected SARS-CoV-2 infection, symptoms persistent for >3 weeks after onset, and at least one symptom attributable to long covid at baseline. Patients who received a first covid-19 vaccine injection were matched with an unvaccinated control group in a 1:1 ratio according to their propensity scores. Number of long covid symptoms, rate of complete remission of long covid, and proportion of patients reporting an unacceptable symptom state at 120 days were recorded. Results 910 patients were included in the analyses (455 in the vaccinated group and 455 in the control group). By 120 days, vaccination had reduced the number of long covid symptoms (mean 13.0 (standard deviation 9.4) in the vaccinated group v 14.8 (9.8) in the control group; mean difference -1.8, 95% confidence interval -3.0 to -0.5) and doubled the rate of patients in remission (16.6% v 7.5%, hazard ratio 1.93, 95% confidence interval 1.18 to 3.14). Vaccination reduced the effect of long covid on patients' lives (mean score on the impact tool 24.3 (standard deviation 16.7) v 27.6 (16.7); mean difference -3.3, 95% confidence interval -5.7 to -1.0) and the proportion of patients with an unacceptable symptom state (38.9% v 46.4%, risk difference -7.4%, 95% confidence interval -14.5% to -0.3%). In the vaccinated group, two (0.4%) patients reported serious adverse events requiring admission to hospital. Conclusion In this study, covid-19 vaccination reduced the severity of symptoms and the effect of long covid on patients' social, professional, and family lives at 120 days in those with persistent symptoms of infection.
Collapse
Affiliation(s)
- Viet-Thi Tran
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004 Paris, France.,Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, F-75004 Paris, France
| | - Elodie Perrodeau
- Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, F-75004 Paris, France
| | | | - Isabelle Pane
- Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, F-75004 Paris, France
| | - Philippe Ravaud
- Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, F-75004 Paris, France.,Université Paris Cité, Paris, France.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| |
Collapse
|
18
|
Chevance A, Tomlinson A, Ravaud P, Touboul S, Henshall C, Tran VT, Cipriani A. Important adverse events to be evaluated in antidepressant trials and meta-analyses in depression: a large international preference study including patients and healthcare professionals. Evid Based Ment Health 2022; 25:e41-e48. [PMID: 35906006 PMCID: PMC9811084 DOI: 10.1136/ebmental-2021-300418] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/15/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Non-serious adverse events (NSAEs) should be captured and reported because they can have a significant negative impact on patients and treatment adherence. However, the reporting of NSAEs in randomised controlled trials (RCTs) is limited. OBJECTIVE To identify the most important NSAEs of antidepressants for patients and clinicians, to be evaluated in RCTs and meta-analyses. METHODS We conducted online international surveys in English, German and French, including (1) adults prescribed an antidepressant for a depressive episode and (2) healthcare professionals (HCPs) prescribing antidepressants. Participants ranked the 30 most frequent NSAEs reported in the scientific literature. We fitted logit models for sets of ranked items and calculated for each AE the probability to be ranked higher than the least important AE. We also identified additional patient-important AEs not included in the ranking task via open-ended questions. FINDINGS We included 1631 patients from 44 different countries (1290 (79.1%) women, mean age 39.4 (SD 13), 289 (37.1%) with severe depression (PHQ-9 score ≥20)) and 281 HCPs (224 (79.7%) psychiatrists). The most important NSAEs for patients were insomnia (95.9%, 95% CI 95.2% to 96.5%), anxiety (95.2%, 95% CI 94.3% to 95.9%) and fatigue (94.6%, 95% CI 93.6% to 95.4%). The most important NSAEs for HCPs were sexual dysfunction (99.2%, 95% CI 98.5% to 99.6%), weight gain (98.9%, 95% CI 97.7% to 99.4%) and erectile problems (98.8%, 95% CI 97.7% to 99.4%). Participants reported 66 additional NSAEs, including emotional numbing (8.6%), trouble with concentration (7.6%) and irritability (6%). CONCLUSIONS These most important NSAEs should be systematically reported in antidepressant trials. CLINICAL IMPLICATIONS The most important NSAEs should contribute to the core outcome set for harms in depression.
Collapse
Affiliation(s)
- Astrid Chevance
- CRESS, INSERM, INRA, F-75004 Paris, France, University of Paris, Paris, France
| | - Anneka Tomlinson
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Philippe Ravaud
- CRESS, INSERM, INRA, F-75004 Paris, France, University of Paris, Paris, France,Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, New York, USA
| | | | - Catherine Henshall
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK,Faculty of Health and Life Sciences, Oxford Brookes University Faculty of Health and Life Sciences, Oxford, UK
| | - Viet-Thi Tran
- CRESS, INSERM, INRA, F-75004 Paris, France, University of Paris, Paris, France
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| |
Collapse
|
19
|
James A, Ravaud P, Riveros C, Raux M, Tran VT. Completeness and Mismatch of Patient-Important Outcomes After Trauma. Ann Surg Open 2022; 3:e211. [PMID: 37600291 PMCID: PMC10406046 DOI: 10.1097/as9.0000000000000211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/25/2022] [Indexed: 11/09/2022] Open
Abstract
To assess the completeness of the collection of patient-important outcomes and the mismatch between outcomes measured in research and patients' important issues after trauma. Summary Background Data To date, severe trauma has mainly been assessed using in-hospital mortality. Yet, with 80 to 90% survivors discharged from hospital, it is critical to assess the collection of patient important long-term outcomes of trauma. Methods Mixed methods study combining a systematic review of outcomes and their comparison with domains elicited by patients during a qualitative study. We searched Medline, EMBASE and clinicaltrials.gov from January 1, 2014 to September 30, 2019 and extracted all outcomes from reports including severe trauma. We compared these outcomes with 97 domains that matter to trauma survivors identified in a previous qualitative study. We defined as patient-important outcome as the 10 most frequently elicited domains in the qualitative study. We assessed the number of domains captured in each report to illustrate the completeness of the collection of patient-important outcomes. We also assessed the mismatch between outcomes collected and what matters to patients. Findings Among the 116 reports included in the systematic review, we identified 403 outcomes collected with 154 unique measurements tools. Beside mortality, measurement tools most frequently used were the Glasgow Outcome Scale (31.0%, n=36), questions on patients' return to work (20,7%, n=24) and the EQ-5D (19.0%, n=22). The comparison between the outcomes identified in the systematic review and the domains from the qualitative study found that 10.3% (n=12) reports did not collect any patient-important domains and one collected all 10 patient-important domains. By examining each of the 10 patient-important domains, none was collected in more than 72% of reports and only five were among the ten most frequently measured domains in studies. Conclusion The completeness of the collection of the long-term patient-important outcomes after trauma can be improved. There was a mismatch between the domains used in the literature and those considered important by patients during a qualitative study.
Collapse
Affiliation(s)
- Arthur James
- Centre d’Epidémiologie Clinique, AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Hôtel Dieu, Paris, France
- Département d’Anesthésie Réanimation, Sorbonne Université, GRC 29, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
- Université de Paris, Centre of Research Epidemiology and Statistics (CRESS), INSERM U1153, Paris, France
| | - Philippe Ravaud
- Centre d’Epidémiologie Clinique, AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Hôtel Dieu, Paris, France
- Université de Paris, Centre of Research Epidemiology and Statistics (CRESS), INSERM U1153, Paris, France
| | - Carolina Riveros
- Centre d’Epidémiologie Clinique, AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Hôtel Dieu, Paris, France
| | - Mathieu Raux
- Département d’Anesthésie Réanimation, Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - Viet-Thi Tran
- Centre d’Epidémiologie Clinique, AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Hôtel Dieu, Paris, France
- Université de Paris, Centre of Research Epidemiology and Statistics (CRESS), INSERM U1153, Paris, France
| |
Collapse
|
20
|
Fertitta L, Bergqvist C, Armand ML, Moryousef S, Ferkal S, Jannic A, Ravaud P, Tran VT, Ezzedine K, Wolkenstein P. Quality of life in neurofibromatosis 1: development and validation of a tool dedicated to cutaneous neurofibromas in adults. J Eur Acad Dermatol Venereol 2022; 36:1359-1366. [PMID: 35412677 DOI: 10.1111/jdv.18140] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/10/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cutaneous neurofibromas (cNF), present in 95% of individuals with neurofibromatosis 1 (NF1), are considered as one of the greatest medical burden because of physical disfigurement. No specific score evaluates their impact on quality of life (QoL). OBJECTIVE To develop a specific score assessing cNF-related QoL. METHODS Through a multidisciplinary workshop including 10 patients, 3 expert-in-NF1 physicians, 3 health care workers (nurses and psychologist) and 1 methodologist, the French version of the Skindex-16 was modified by adding 3 items. The new cNF-Skindex was validated among patients with NF1 recruited in the ComPaRe online cohort, in France (N=284). Construct validity was assessed by comparing it with the EQ-5D-5L, its visual analog scale and the MYMOP2 and by assessing its association with patients' characteristics. Reliability was assessed by a test-retest. An English version of the tool was developed using a back forward translation. RESULTS A total of 228 individuals with NF1, with cNF answered the 19-item questionnaire. These items fitted into 3 domains: emotions, symptoms, functioning. One was dropped during analysis because >90% responders were not concerned. The cNF-Skindex significantly correlated with the EQ-5D-5L (N=193) and MYMOP2 (N=210) indicating good external validity: rs 0.38 (p<0.001), and 0.58 (p<0.001) respectively. Having >50 cNF was the only independent variable associated with the total score cNF-Skindex (β=15.88, 95%CI 6.96 - 24.81, p=0.001), and with the 3 sub-scores: "functioning" (β=2.65, 95%CI 0.71 - 4.59, p=0.008), "emotions" (β=17.03, 95%CI 4.11 - 29.96, p=0.010) and "symptoms" (β=3.90, 95%CI 1.95 - 5.85, p<0.001). Test-retest reliability (N=133) found an ICC at 0.96 demonstrating good reproducibility. CONCLUSION The cNF-Skindex demonstrated excellent psychometric properties. The global and sub-scores were increased with higher number of cNF arguing for its use in further trials aiming to reduce their number or prevent their development. Cross-cultural validation and evaluation of its responsiveness are the next steps.
Collapse
Affiliation(s)
- L Fertitta
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France
| | - C Bergqvist
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France
| | - M L Armand
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France
| | - S Moryousef
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France
| | - S Ferkal
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France.,INSERM, Centre d'Investigation Clinique 1430, National Referral Center for Neurofibromatoses, Henri-Mondor Hospital, Assistance Publique-Hôpitaux Paris (AP-HP), 94010, Créteil, France
| | - A Jannic
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France
| | - P Ravaud
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France.,Université de Paris, CRESS, INSERM, INRA, F-75004, Paris, France
| | - V T Tran
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France.,Université de Paris, CRESS, INSERM, INRA, F-75004, Paris, France
| | - K Ezzedine
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France.,Université Paris-Est Créteil (UPEC), 94010, Créteil, France
| | - P Wolkenstein
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France.,Université Paris-Est Créteil (UPEC), 94010, Créteil, France.,INSERM U955, 94010, Créteil, France
| |
Collapse
|
21
|
James A, Tran VT, Gauss T, Hamada S, Roquet F, Bitot V, Boutonnet M, Raux M, Ravaud P. Important Issues to Severe Trauma Survivors: A Qualitative Study. Ann Surg 2022; 275:189-195. [PMID: 32209913 DOI: 10.1097/sla.0000000000003879] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Identify issues that are important to severe trauma survivors up to 3 years after the trauma. BACKGROUND Severe trauma is the first cause of disability-adjusted life years worldwide, yet most attention has focused on acute care and the impact on long-term health is poorly evaluated. METHOD We conducted a large-scale qualitative study based on semi-structured phone interviews. Qualitative research methods involve the systematic collection, organization, and interpretation of conversations or textual data with patients to explore the meaning of a phenomenon experienced by individuals themselves. We randomly selected severe trauma survivors (abbreviated injury score ≥3 in at least 1 body region) who were receiving care in 6 urban academic level-I trauma centers in France between March 2015 and March 2018. We conducted double independent thematic analysis. Issues reported by patients were grouped into overarching domains by a panel of 5 experts in trauma care. Point of data saturation was estimated with a mathematical model. RESULTS We included 340 participants from 3 months to 3 years after the trauma [median age: 41 years (Q1-Q3 24-54), median injury severity score: 17 (Q1-Q3 11-22)]. We identified 97 common issues that we grouped into 5 overarching domains: body and neurological issues (29 issues elicited by 277 participants), biographical disruption (23 issues, 210 participants), psychological and personality issues (21 issues, 147 participants), burden of treatment (14 issues, 145 participants), and altered relationships (10 issues, 87 participants). Time elapsed because the trauma, injury location, or in-hospital trauma severity did not affect the distribution of these domains across participants' answers. CONCLUSIONS This qualitative study explored trauma survivors' experiences of the long-term effect of their injury and allowed for identifying a set of issues that they consider important, including dimensions that seem overlooked in trauma research. Our findings confirm that trauma is a chronic medical condition that demands new approaches to post-discharge and long-term care.
Collapse
Affiliation(s)
- Arthur James
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- Center d'épidémiologie clinique, Hôpital Hôtel Dieu, AP-HP, Paris, France AP-HP
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, Paris, France
- Sorbonne Université, Paris, France
| | - Viet-Thi Tran
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- Center d'épidémiologie clinique, Hôpital Hôtel Dieu, AP-HP, Paris, France AP-HP
| | - Tobias Gauss
- Department of Anaesthesia and Critical Care, Hôpital Beaujon, HUPNVS, AP-HP, Clichy, France
| | - Sophie Hamada
- Department of Anesthesiology and Critical Care, AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France
- CESP, INSERM, Université paris Sud, UVSQ, Université Paris-Saclay, Paris
| | - Florian Roquet
- Service d'Anesthésie-réanimation, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Service de Biostatistique et Informatique Médicale, Unité INSERM UMR 1153, Université Paris Diderot, Paris, France
| | - Valérie Bitot
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service d'anesthésie et des réanimations chirurgicales, Créteil Cedex, France
| | - Mathieu Boutonnet
- Department of Anesthesiology and Intensive Care, Percy Military Teaching Hospital, Clamart Cedex, France
| | - Mathieu Raux
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, Paris, France
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Philippe Ravaud
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, Paris, France
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| |
Collapse
|
22
|
Aguayo GA, Goetzinger C, Scibilia R, Fischer A, Seuring T, Tran VT, Ravaud P, Bereczky T, Huiart L, Fagherazzi G. Methods to Generate Innovative Research Ideas and Improve Patient and Public Involvement in Modern Epidemiological Research: Review, Patient Viewpoint, and Guidelines for Implementation of a Digital Cohort Study. J Med Internet Res 2021; 23:e25743. [PMID: 34941554 PMCID: PMC8738987 DOI: 10.2196/25743] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/16/2021] [Accepted: 10/08/2021] [Indexed: 01/20/2023] Open
Abstract
Background Patient and public involvement (PPI) in research aims to increase the quality and relevance of research by incorporating the perspective of those ultimately affected by the research. Despite these potential benefits, PPI is rarely included in epidemiology protocols. Objective The aim of this study is to provide an overview of methods used for PPI and offer practical recommendations for its efficient implementation in epidemiological research. Methods We conducted a review on PPI methods. We mirrored it with a patient advocate’s viewpoint about PPI. We then identified key steps to optimize PPI in epidemiological research based on our review and the viewpoint of the patient advocate, taking into account the identification of barriers to, and facilitators of, PPI. From these, we provided practical recommendations to launch a patient-centered cohort study. We used the implementation of a new digital cohort study as an exemplary use case. Results We analyzed data from 97 studies, of which 58 (60%) were performed in the United Kingdom. The most common methods were workshops (47/97, 48%); surveys (33/97, 34%); meetings, events, or conferences (28/97, 29%); focus groups (25/97, 26%); interviews (23/97, 24%); consensus techniques (8/97, 8%); James Lind Alliance consensus technique (7/97, 7%); social media analysis (6/97, 6%); and experience-based co-design (3/97, 3%). The viewpoint of a patient advocate showed a strong interest in participating in research. The most usual PPI modalities were research ideas (60/97, 62%), co-design (42/97, 43%), defining priorities (31/97, 32%), and participation in data analysis (25/97, 26%). We identified 9 general recommendations and 32 key PPI-related steps that can serve as guidelines to increase the relevance of epidemiological studies. Conclusions PPI is a project within a project that contributes to improving knowledge and increasing the relevance of research. PPI methods are mainly used for idea generation. On the basis of our review and case study, we recommend that PPI be included at an early stage and throughout the research cycle and that methods be combined for generation of new ideas. For e-cohorts, the use of digital tools is essential to scale up PPI. We encourage investigators to rely on our practical recommendations to extend PPI in future epidemiological studies.
Collapse
Affiliation(s)
- Gloria A Aguayo
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Catherine Goetzinger
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Renza Scibilia
- Diabetes Australia, Melbourne, Australia.,Diabetogenic, Melbourne, Australia
| | - Aurélie Fischer
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Till Seuring
- Luxembourg Institute of Socio-Economic Research, Esch/Alzette, Luxembourg
| | - Viet-Thi Tran
- Centre of Research in Epidemiology and Statistic Sorbonne Paris Cité, National Institute of Health and Medical Research (INSERM), French National Institute for Agricultural Research (INRA), Université de Paris, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Ravaud
- Centre of Research in Epidemiology and Statistic Sorbonne Paris Cité, National Institute of Health and Medical Research (INSERM), French National Institute for Agricultural Research (INRA), Université de Paris, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tamás Bereczky
- European Patients' Academy on Therapeutic Innovation, Brussels, Belgium
| | - Laetitia Huiart
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| |
Collapse
|
23
|
Abstract
IMPORTANCE The COVID-19 pandemic led to the implementation of alternative care modalities (eg, teleconsultations and task shifting) that will continue to be implemented in parallel to traditional care after the pandemic. An ideal balance between alternative and traditional care modalities is unknown. OBJECTIVES To quantify the ideal postpandemic balance between alternative and traditional care modalities among patients with chronic illness and to qualify the circumstances in which patients consider it appropriate to replace traditional care with alternative care. DESIGN, SETTING, AND PARTICIPANTS This survey study invited 5999 adults with chronic illness in ComPaRe, a French nationwide e-cohort of adults with chronic conditions who volunteer their time to participate in research projects, to participate in this study, which was performed from January 27 to February 23, 2021. MAIN OUTCOMES AND MEASURES Participants rated the ideal proportion at which they would use 3 alternative care modalities instead of the traditional care equivalent on a 0% to 100% scale (with 0% indicating using alternative care modalities for none of one's future care and 100% indicating using alternative care modalities for all of one's future care) of their overall future care: (1) teleconsultations, (2) online symptom-checkers to react to new symptoms, and (3) remote monitoring to adapt treatment outside consultations. The median ideal proportion of alternative care use was calculated. Perceived appropriate circumstances in which each alternative modality could replace traditional care were collected with open-ended questions. Analyses were performed on a weighted data set representative of patients with chronic illness in France. RESULTS Of the 5999 invited individuals, 1529 (mean [SD] age, 50.3 [14.7] years; 1072 [70.1%] female) agreed to participate (participation rate, 25.5%). Participants would choose teleconsultations for 50.0% of their future consultations (IQR, 11.0%-52.0%), online symptom-checkers over contacting their physician for 22.0% of new symptoms (IQR, 2.0%-50.0%), and remote monitoring instead of consultations for 52.3% of their treatment adaptations (IQR, 25.4%-85.4%). Participants reported 67 circumstances for which replacing traditional with alternative care modalities was considered appropriate, including 31 care activities (eg, prescription renewal and addressing acute or minor complaints), 25 patient characteristics (eg, stable chronic condition and established patient-physician relationship), and 11 required characteristics of the alternative care modalities (eg, quality assurance). CONCLUSIONS AND RELEVANCE Results of this survey study suggest that after the pandemic, patients would choose alternative over traditional care for 22% to 52% of the time across different care needs. Participants proposed 67 criteria to guide clinicians in replacing traditional care with alternative care. These findings provide a guide for redesigning care in collaboration with patients after the pandemic.
Collapse
Affiliation(s)
- Theodora Oikonomidi
- Université de Paris, Centre de Recherche Epidémiologie et StatistiqueS (CRESS), Institut National de la santé et de la recherche médicale (INSERM), Institut national de recherche pour l'agriculture, l'alimentation et l'environnement (INRAE), Paris, France
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Ravaud
- Université de Paris, Centre de Recherche Epidémiologie et StatistiqueS (CRESS), Institut National de la santé et de la recherche médicale (INSERM), Institut national de recherche pour l'agriculture, l'alimentation et l'environnement (INRAE), 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
| | - Diana Barger
- University of Bordeaux, ISPED, Inserm Bordeaux Population Health, Team EMOS, UMR 1219, Bordeaux, France
| | - Viet-Thi Tran
- Université de Paris, Centre de Recherche Epidémiologie et StatistiqueS (CRESS), Institut National de la santé et de la recherche médicale (INSERM), Institut national de recherche pour l'agriculture, l'alimentation et l'environnement (INRAE), Paris, France
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| |
Collapse
|
24
|
Gouesbet S, Kvaskoff M, Riveros C, Diard E, Pane I, Gabillet M, Garoche C, Ravaud P, Tran VT. P–327 Patients’ perspectives on how to improve the management of endometriosis in France: The ComPaRe-Endometriosis cohort. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.326] [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: 11/14/2022] Open
Abstract
Abstract
Study question
How should endometriosis management be improved from the patient’s point of view?
Summary answer
One thousand endometriosis patients proposed 2,587 ideas to improve the management of endometriosis that reflect three main themes: diagnosis, care, and information on the disease.
What is known already
Endometriosis is a gynecologic condition affecting 10% of reproductive-age women. The disease causes severe pelvic pain and has a dramatic impact on women’s quality of life. A mean delay of 7 years was described between onset of symptoms and diagnosis. There is an urgent need to reduce this delay and to rethink endometriosis care in order to adopt a more comprehensive and patient-centered approach, as women are often dissatisfied with the care they receive.
Study design, size, duration
This study was carried out in a random sample of endometriosis patients participating in ComPaRe (Community of Patients for Research), a prospective e-cohort of adult chronic disease patients who will be followed-up for 10 years. Participants complete monthly online questionnaires about their life with their disease(s). Recruitment began in January 2017 and is still ongoing, with currently 44,000 participants, including 10,000 endometriosis patients in the ComPaRe-Endometriosis sub-cohort.
Participants/materials, setting, methods
We selected a random sample of 1,000 participants in ComPaRe-Endometriosis, forming 3 equal groups of age (<25, 25–45, >45 years old) and education (<12, 12–14, >14 years). We conducted a qualitative study to gather their ideas for improving the management of their disease. Participants were asked: “If you had a magic wand, what would you change in your health care?”. One interviewer and two patients independently extracted ideas from the open-ended responses using thematic analysis.
Main results and the role of chance
Patients proposed a total of 2,587 ideas to improve the management of endometriosis, which we classified in three main themes: diagnosis, care, and information on the disease. To improve diagnosis, women proposed 724 ideas classified into 11 areas of improvement, including training of health professionals, taking symptoms seriously, improving the diagnosis process, and recognition of the disease by clinicians. To improve care, patients gave 1,677 ideas classified into 71 areas of improvement. For example, they asked for a better pain management, more listening from caregivers, the reimbursement of care or medical treatments, help in accessing clinicians that are expert in endometriosis, and reduced waiting times for medical appointments and exams. Finally, to improve information on the disease, participants suggested 186 ideas classified into 5 areas of improvement, covering more explanation about the disease, public recognition of endometriosis and general awareness, and more research and more explanation of research results.
Limitations, reasons for caution
The results were reviewed by three people in order to reduce the margin of interpretation in the analysis of this open-ended question, but some subjectivity remains. Generalizability may be difficult because the results are linked to the specificities of the French model of care.
Wider implications of the findings: Through the many ideas proposed by patients, we identified a total of 87 areas for improvement in endometriosis diagnosis, care, and information. These results reflect patients’ expectations in terms of management of their disease and will be useful to design a better global care for endometriosis from the patients’ perspective.
Trial registration number
Not applicable
Collapse
Affiliation(s)
- S Gouesbet
- Inserm U1018- Exposome and Heredity Team, Centre for Research in Epidemiology and Population Health CESP, Paris 15e Arrondissement, France
| | - M Kvaskoff
- Inserm U1018- Exposome and Heredity Team, Centre for Research in Epidemiology and Population Health CESP, Paris 15e Arrondissement, France
| | - C Riveros
- Assistance Publique-Hôpitaux de Paris AP-HP, Center for Clinical Epidemiology- Hôtel-Dieu Hospital, Paris, France
| | - E Diard
- Assistance Publique-Hôpitaux de Paris AP-HP, Center for Clinical Epidemiology- Hôtel-Dieu Hospital, Paris, France
| | - I Pane
- Assistance Publique-Hôpitaux de Paris AP-HP, Center for Clinical Epidemiology- Hôtel-Dieu Hospital, Paris, France
| | - M Gabillet
- ENDOmind France, Patient organization, Paris, France
| | - C Garoche
- The ComPaRe cohort, Volunteer patient, Gujan-Mestras, France
| | - P Ravaud
- Assistance Publique-Hôpitaux de Paris AP-HP, Center for Clinical Epidemiology- Hôtel-Dieu Hospital, Paris, France
| | - V T Tran
- Assistance Publique-Hôpitaux de Paris AP-HP, Center for Clinical Epidemiology- Hôtel-Dieu Hospital, Paris, France
| |
Collapse
|
25
|
Tran VT, Sidorkiewicz S, Péan C, Ravaud P. Impact of an interactive web tool on patients' intention to receive COVID-19 vaccination: a before-and-after impact study among patients with chronic conditions in France. BMC Med Inform Decis Mak 2021; 21:228. [PMID: 34332570 PMCID: PMC8325218 DOI: 10.1186/s12911-021-01594-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/12/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives In France, about 30% of the population refuses COVID-19 vaccination outright, and 9 to 40% are hesitant. We developed and evaluated an interactive web tool providing transparent and reliable information on the benefits and risks of COVID-19 vaccination.
Methods The most recent scientific data at the time of the study were implemented into an interactive web tool offering individualized information on the risks of COVID-19 infection-related events versus vaccination-related serious adverse events. The tool was evaluated during a before-and-after impact study nested in ComPaRe, a French e-cohort of adult patients with chronic conditions. Primary outcome was the proportion of patients intending to receive vaccination after using the tool, among those not intending to receive it at baseline.
Results Between January 8 and 14, 2021, we enrolled 3152 patients in the study [mean age 55.2 (SD: 16.9), 52.9% women and 63% with ≥ 2 chronic conditions]. Before consulting the tool, 961 (30.5%) refused to be vaccinated until further data on efficacy/safety was obtained and 239 (7.5%) outright refused vaccination. Among these 1200 patients, 96 (8.0%, number needed to treat: 12.5) changed their mind after consulting the tool and would subsequently accept vaccination.
Conclusions Our interactive web tool represents a scalable method to help increase the intent to receive COVID-19 vaccination among patients with chronic conditions and address vaccine hesitancy. Since April 2021, our tool has been embedded on the official webpage of the French Government for COVID-19 information. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01594-8.
Collapse
Affiliation(s)
- Viet-Thi Tran
- CRESS, INSERM, INRA, Université de Paris, 75004, Paris, France. .,Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, 75004, Paris, France.
| | - Stéphanie Sidorkiewicz
- CRESS, INSERM, INRA, Université de Paris, 75004, Paris, France.,Département de medecine generale, Université de Paris, 75014, Paris, France
| | - Clarisse Péan
- ASSOMAST French Patients' Organization, Paris, France
| | - Philippe Ravaud
- CRESS, INSERM, INRA, Université de Paris, 75004, Paris, France.,Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, 75004, Paris, France.,Department of Epidemiology, Columbia University Mailman School of Public Health, 22 W 168th St, New York, NY, USA
| |
Collapse
|
26
|
Taillé C, Roche N, Tesson F, Tardivon C, Tran VT, Couffignal C. Belief and adherence to COVID 19-lockdown restrictions in patients with asthma versus other chronic diseases: results from a cross-sectional survey nested in the ComPaRe e-cohort, in France. J Asthma 2021; 59:1491-1500. [PMID: 34111369 DOI: 10.1080/02770903.2021.1941091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Asthma patients are under-represented among patients with COVID-19. Their behavior during lockdown and associated restrictions is unknown, as well as whether it was influenced by coexistent cardiovascular conditions. METHODS We conducted a cross-sectional survey in May 2020, in France, nested in ComPaRe, an e-cohort of adults with chronic diseases. A self-administered questionnaire was mailed to 10,859 people; 3701 fully completed questionnaires. The prevalence of self-reported asthma was 7%. Patients were classified in 4 categories: asthma with (n = 106) or without (n = 149) cardiovascular disease and other diseases with (n = 1186) or without (n = 2260) cardiovascular disease. RESULT Adherence to movement restrictions during the lockdown was very strong: 89% of participants reported a frequency of outings of "less than once per week" and "once or twice per week" for errands and no family-related outings during the lockdown. This proportion and frequency of outings were similar whatever the chronic disease (p = 0.122). Most patients (96%) reported a high feeling of security during the lockdown, but 95% felt anxious or depressed, with no difference by disease. As compared with patients with controlled asthma, those with uncontrolled asthma more frequently reported complaints related to deteriorated medical follow-up, waived care, anxiety or depression. CONCLUSIONS Behaviors during the lockdown in France among the asthma population did not differ from patients with other chronic diseases in this cohort, which strengthens hypotheses for specific disease-related susceptibility to explain the low representation of asthmatics among COVID-19 cases. Special attention should be paid to the subgroup of patients with uncontrolled asthma during lockdowns.
Collapse
Affiliation(s)
- Camille Taillé
- Hôpital Bichat, Service de Pneumologie et Centre de Référence constitutif des Maladies Pulmonaires Rares, Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, Paris, France
| | - Nicolas Roche
- Hôpital Cochin, Service de Pneumologie, Groupe Hospitalier Universitaire AP-HP Centre-Université de Paris, Paris, France
| | - Florian Tesson
- Inserm, AP-HP Hôpital Bichat, Center for Clinical Investigation CIC-1425, Paris, France
| | - Coralie Tardivon
- Hôpital Bichat, Unité de recherche clinique PNVS, AP-HP, Paris, France
| | - Viet-Thi Tran
- CRESS, INSERM, INRA, Université de Paris, FranceParis.,AP-HP, Hôpital Hôtel-Dieu, Centre d'Epidémiologie Clinique, Paris, France
| | - Camille Couffignal
- Inserm, AP-HP Hôpital Bichat, Center for Clinical Investigation CIC-1425, Paris, France.,Hôpital Bichat, Unité de recherche clinique PNVS, AP-HP, Paris, France
| |
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Tran VT, Riveros C, Clepier B, Desvarieux M, Collet C, Yordanov Y, Ravaud P. Development and validation of the long covid symptom and impact tools, a set of patient-reported instruments constructed from patients' lived experience. Clin Infect Dis 2021; 74:278-287. [PMID: 33912905 PMCID: PMC8135558 DOI: 10.1093/cid/ciab352] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Indexed: 01/07/2023] Open
Abstract
Objectives To develop and validate patient-reported instruments, based on patients' lived experiences, for monitoring the symptoms and impact of long covid. Design The long covid Symptom and Impact Tools (ST and IT) were constructed from the answers to a survey with open-ended questions to 492 patients with long COVID. Validation of the tools involved adult patients with suspected or confirmed COVID-19 and symptoms extending over three weeks after onset. Construct validity was assessed by examining the relations of the ST and IT scores with health related quality of life (EQ-5D-5L), function (PCFS, post-COVID functional scale), and perceived health (MYMOP2). Reliability was determined by a test-retest. The "patient acceptable symptomatic state" (PASS) was determined by the percentile method. Results Validation involved 1022 participants (55% with confirmed COVID-19, 79% female, and 12.5% hospitalized for COVID-19). The long COVID ST and IT scores were strongly correlated with the EQ-5D-5L (rs = -0.45 and rs = -0.59 respectively), the PCFS (rs = -0.39 and rs = -0.55), and the MYMOP2 (rs = -0.40 and rs = -0.59). Reproducibility was excellent with an interclass correlation coefficient of 0.83 (95% confidence interval 0.80 to 0.86) for the ST score and 0.84 (0.80 to 0.87) for the IT score. In total, 793 (77.5%) patients reported an unacceptable symptomatic state, thereby setting the PASS for the long covid IT score at 30 (28 to 33). Conclusions The long covid ST and IT tools, constructed from patients’ lived experiences, provide the first validated and reliable instruments for monitoring the symptoms and impact of long covid.
Collapse
Affiliation(s)
- Viet-Thi Tran
- Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Caroline Riveros
- Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | | | - Moïse Desvarieux
- Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France.,Department of Epidemiology, Columbia University Mailman School of Public Health, 22 W 168th St, New York, NY, USA
| | | | - Youri Yordanov
- Service d'Accueil des Urgences, Hôpital Saint Antoine, AP-HP, Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, Paris, France
| | - Philippe Ravaud
- Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France.,Department of Epidemiology, Columbia University Mailman School of Public Health, 22 W 168th St, New York, NY, USA
| |
Collapse
|
29
|
Gallay L, Tran VT, Perrodeau E, Vignier N, Mahevas M, Bisio F, Forestier E, Lescure FX. Fourteen-day survival among older adults with severe infection with severe acute respiratory syndrome coronavirus 2 treated with corticosteroid: a cohort study. Clin Microbiol Infect 2021; 27:1145-1150. [PMID: 33819571 PMCID: PMC8016731 DOI: 10.1016/j.cmi.2021.03.021] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 12/15/2022]
Abstract
Objective To assess the effectiveness of corticosteroids among older adults with coronavirus disease 2019 (COVID-19) pneumonia requiring oxygen. Methods We used routine care data from 36 hospitals in France and Luxembourg to assess the effectiveness of corticosteroids with at least 0.4 mg/kg/day equivalent prednisone (treatment group) versus standard of care (control group). Participants were adults aged 80 years or older with PCR-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or CT scan images typical of COVID-19 pneumonia, requiring oxygen ≥3 L/min, and with an inflammatory syndrome (C-reactive protein ≥40 mg/L). The primary outcome was overall survival at day 14. In our main analysis, characteristics of patients at baseline (i.e. time when patients met all inclusion criteria) were balanced by using propensity-score inverse probability of treatment weighting. Results Among the 267 patients included in the analysis, 98 were assigned to the treatment group. Their median age was 86 years (interquartile range 83–90 years) and 95% had a SARS-CoV-2 PCR-confirmed diagnosis. In total, 43/98 (43.9%) patients in the treatment group and 84/166 (50.6%) in the control group died before day 14 (weighted hazard ratio 0.67, 95% CI 0.46–0.99). The treatment and control groups did not differ significantly for the proportion of patients discharged to home/rehabilitation at day 14 (weighted relative risk 1.12, 95% CI 0.68–1.82). Twenty-two (16.7%) patients receiving corticosteroids developed adverse events, but only 11 (6.4%) from the control group. Conclusions Corticosteroids were associated with a significant increase in the overall survival at day 14 of patients aged 80 years and older hospitalized for severe COVID-19.
Collapse
Affiliation(s)
- Laure Gallay
- Département de Médecine Interne et Immunologie Clinique, Centre Hospitalo-Universitaire Edouard Herriot, Hospices Civils de Lyon, Université Claude Bernard Lyon, Lyon, France
| | - Viet-Thi Tran
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris / Université de Paris, Centre de Recherche Epidémiologie et Statistiques (CRESS UMR 1153), Paris, France
| | - Elodie Perrodeau
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris / Université de Paris, Centre de Recherche Epidémiologie et Statistiques (CRESS UMR 1153), Paris, France
| | - Nicolas Vignier
- Groupe Hospitalier Sud Ile-de-France, Inserm CIC 1424 & Sorbonne Université, IPLESP, Inserm UMR 1136, Paris, France
| | - Matthieu Mahevas
- Service de Médecine Interne, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Francesca Bisio
- Département de Médecine, Centre Hospitalier de Vierzon, Vierzon, France
| | - Emmanuel Forestier
- Service de Maladies Infectieuses, Centre Hospitalier Métropole Savoie, Chambéry, France
| | - Francois-Xavier Lescure
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, Assistance Publique Hôpitaux de Paris / Université de Paris, IAME, Inserm UMR 1137, 75018, Paris, France.
| | | |
Collapse
|
30
|
Tran VT, Mahévas M, Bani-Sadr F, Robineau O, Perpoint T, Perrodeau E, Gallay L, Ravaud P, Goehringer F, Lescure FX. Corticosteroids in patients hospitalized for COVID-19 pneumonia who require oxygen: observational comparative study using routine care data. Clin Microbiol Infect 2021; 27:603-610. [PMID: 33301928 PMCID: PMC7722522 DOI: 10.1016/j.cmi.2020.11.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/20/2020] [Accepted: 11/28/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the effectiveness of corticosteroids on outcomes of patients with coronavirus disease 2019 (COVID-19) pneumonia requiring oxygen without mechanical ventilation. METHODS We used routine care data from 51 hospitals in France and Luxembourg to assess the effectiveness of corticosteroids at 0.8 mg/kg/day eq. prednisone (CTC group) versus standard of care (no-CTC group) among adults 18-80 years old with confirmed COVID-19 pneumonia requiring oxygen without mechanical ventilation. The primary outcome was intubation or death by day 28. In our main analysis, characteristics of patients at baseline (i.e. time when patients met all inclusion criteria) were balanced by using propensity-score inverse probability of treatment weighting. RESULTS Among the 891 patients included in the analysis, 203 were assigned to the CTC group. Use of corticosteroids was not significantly associated with risk of intubation or death by day 28 (weighted hazard ratio (wHR) 0.92, 95%CI 0.61-1.39) nor cumulative death rate (wHR 1.03, 95%CI 0.54-1.98). However, use of corticosteroids was associated with reduced risk of intubation or death by day 28 in the prespecified subgroups of patients requiring oxygen ≥3 L/min (wHR 0.50, 95%CI 0.30-0.85) or C-reactive protein level ≥100 mg/L (wHR 0.44, 95%CI 0.23-0.85). The number of hyperglycaemia events was higher for patients with corticosteroids than for those without, but the number of infections was similar. CONCLUSIONS We found no association between the use of corticosteroids and intubation or death in the broad population of patients 18-80 years old, with COVID-19, hospitalized in settings non intensive care units. However, the treatment was associated with a reduced risk of intubation or death for patients with ≥3 L/min oxygen or C-reactive protein level ≥100 mg/L at baseline. Further research is needed to confirm the right timing for corticosteroids in patients with COVID-19 requiring oxygen only.
Collapse
Affiliation(s)
- Viet-Thi Tran
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, 75004, Paris, France; Université de Paris, CRESS, INSERM, INRA, F-75004, Paris, France
| | - Matthieu Mahévas
- Service de Médecine Interne, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, 75000, Paris, France; Université Paris-Est Créteil, 94000, Créteil, France
| | - Firouze Bani-Sadr
- Service de Médecine Interne, Centre Hospitalier Universitaire de Reims, 51100, Reims, France
| | - Olivier Robineau
- Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier, Hôpital Guy Chatiliez, 59200, Tourcoing, France
| | - Thomas Perpoint
- Service des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, 69004, Lyon, France
| | - Elodie Perrodeau
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, 75004, Paris, France; Université de Paris, CRESS, INSERM, INRA, F-75004, Paris, France
| | - Laure Gallay
- Service de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69008, Lyon, France
| | - Philippe Ravaud
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, 75004, Paris, France; Université de Paris, CRESS, INSERM, INRA, F-75004, Paris, France
| | - François Goehringer
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire de Nancy, 54511, Vandoeuvre lès Nancy, France
| | - François-Xavier Lescure
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, 75018, Paris, France.
| |
Collapse
|
31
|
Condamina M, Shourick J, Seneschal J, Sbidian E, Andreu N, Pane I, Ravaud P, Tran VT, Ezzedine K. Factors associated with perceived stress in patients with vitiligo in the ComPaRe e-cohort. J Am Acad Dermatol 2021; 86:696-698. [PMID: 33684495 DOI: 10.1016/j.jaad.2021.02.083] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/20/2021] [Accepted: 02/27/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Morgane Condamina
- Service de Dermatologie-Vénéréologie, CHU Robert Debré, Reims, France
| | - Jason Shourick
- AP-HP, Hôpital Henri-Mondor, Service de Dermatologie, Créteil, France; Université Paris-Est Créteil, EpiDermE-Epidemiology in Dermatology and Evaluation of Therapeutics, Creteil, France
| | - Julien Seneschal
- Service de Dermatologie, Centre de Référence des Maladies Rares de la Peau, Hôpital Saint André, CHU de Bordeaux, Bordeaux, France; INSERM U1035 Biothérapie des Maladies Génétiques Inflammatoires et Cancers, Immuno-Dermatologie ATIP AVENIR, Université de Bordeaux, Bordeaux, France
| | - Emilie Sbidian
- AP-HP, Hôpital Henri-Mondor, Service de Dermatologie, Créteil, France; Université Paris-Est Créteil, EpiDermE-Epidemiology in Dermatology and Evaluation of Therapeutics, Creteil, France
| | - Nicolas Andreu
- Service de Dermatologie, Centre de Référence des Maladies Rares de la Peau, Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Isabelle Pane
- Centre de Recherche Épidémiologie et StatistiqueS (CRESS-Université de Paris, INSERM UMR1153), Paris, France; Centre d'épidémiologie clinique-Hôpital Hôtel-Dieu (AP-HP), Paris, France
| | - Philippe Ravaud
- Université Paris-Est Créteil, EpiDermE-Epidemiology in Dermatology and Evaluation of Therapeutics, Creteil, France; Centre d'épidémiologie clinique-Hôpital Hôtel-Dieu (AP-HP), Paris, France
| | - Viet-Thi Tran
- Centre de Recherche Épidémiologie et StatistiqueS (CRESS-Université de Paris, INSERM UMR1153), Paris, France; Centre d'épidémiologie clinique-Hôpital Hôtel-Dieu (AP-HP), Paris, France
| | - Khaled Ezzedine
- AP-HP, Hôpital Henri-Mondor, Service de Dermatologie, Créteil, France; Université Paris-Est Créteil, EpiDermE-Epidemiology in Dermatology and Evaluation of Therapeutics, Creteil, France.
| |
Collapse
|
32
|
Condamina M, Penso L, Tran VT, Hotz C, Guillem P, Villani AP, Perrot P, Bru MF, Jacquet E, Nassif A, Bachelez H, Wolkenstein P, Beylot-Barry M, Richard MA, Ravaud P, Viguier M, Sbidian E. Baseline Characteristics of a National French E-Cohort of Hidradenitis Suppurativa in ComPaRe and Comparison with Other Large Hidradenitis Suppurativa Cohorts. Dermatology 2021; 237:748-758. [PMID: 33503635 DOI: 10.1159/000513447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/29/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition substantially impacting patients' quality of life; the pathogenesis remains unclear, and treatment is complex and not yet standardized. Observational data are increasingly being used to evaluate therapeutics in "real-life" interventions, and the development of e-cohorts is offering new tools for epidemiological studies at the population level. OBJECTIVE The aim of this study was to describe the clinical characteristics and treatment history of HS participants in the Community of Patients for Research (ComPaRe) cohort and to compare these to other cohorts. METHODS We performed a cross-sectional study of the baseline data of HS participants in ComPaRe, an e-cohort of patients with chronic diseases. Data were collected using patient-reported questionnaires about clinical-dem-ographic aspects, quality of life, and treatment history. RESULTS A total of 396 participants (339 females, 57 males) were included (mean age 38 years); 83 (21%) had a family history of HS, 227 (57.3%) were current smokers, and 241 (60.9%) were overweight or obese. Most of the participants declared a Hurley stage II (n = 263, 66.4%) or III (n = 76, 20.3%). The breast was more frequently affected in women than men (37.5 vs. 5.3%, p < 0.0001), whereas the dorsal region was more frequently affected in men (39.5 vs. 10.9%, p < 0.0001). Increased disease stage was associated with obesity (25.9 vs. 33.8 vs. 51.3%, p = 0.02) and some HS localizations (genital [p < 0.005], pubis [p < 0.007], gluteal fold [p = 0.02], and groin [p < 0.0001]). The most frequently prescribed treatments were oral antibiotics (n = 362, 91.4%), especially amoxicillin-clavulanic acid and cyclins. Less than 10% of participants received biologics. Most of these results were consistent with previously published cohorts. CONCLUSION Recruitment of participants by such a web platform can be a faster way to get relevant scientific data for a wide variety of patients that could be used for epidemiological studies and to evaluate therapeutics in "real-life" interventions.
Collapse
Affiliation(s)
- Morgane Condamina
- Department of Dermatology-Venereology, Robert-Debré Hospital, Reims, France
| | - Laetitia Penso
- Paris-Est University, UPEC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Créteil, France
| | - Viet-Thi Tran
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France.,Centre de Recherche Épidémiologie et StatistiqueS (CRESS), Université de Paris, INSERM UMR1153, Paris, France
| | - Claire Hotz
- Department of Dermatology-Venereology, Henri Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France
| | - Philippe Guillem
- Department of Visceral and Digestive Surgery, Val d'Ouest Clinic, Écully, France.,RésoVerneuil, Paris, France.,European Hidradenitis Suppurativa Foundation, Dessau, Germany.,Groupe de Recherche en Proctologie de la Société Nationale Française de Coloproctologie, Paris, France
| | | | - Pierre Perrot
- Department of Plastic and Reconstructive Surgery, Hôtel-Dieu Hospital, Nantes, France
| | - Marie-France Bru
- Patient Member of the Scientific Committee of ComPaRe Verneuil Disease, Paris, France
| | - Eric Jacquet
- Department of Visceral Surgery, Beau Soleil Clinic, Montpellier, France
| | - Aude Nassif
- Medical Center, Institut Pasteur, Paris, France
| | - Hervé Bachelez
- Department of Dermatology-Venereology, Saint Louis Hospital (AP-HP), Sorbonne Paris Cité University Paris Diderot, Paris, France.,Laboratory of Genetics of Skin Diseases, INSERM U1163, Imagine Institute, Paris, France
| | - Pierre Wolkenstein
- Paris-Est University, UPEC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Créteil, France.,Department of Dermatology-Venereology, Henri Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France
| | - Marie Beylot-Barry
- Department of Dermatology, INSERM 1053, CHU Bordeaux, Bordeaux University, Bordeaux, France
| | - Marie-Aleth Richard
- CEReSS-EA 3279, Research Center in Health Services and Quality of Life, Aix Marseille University, Dermatology Department, University Hospital La Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Philippe Ravaud
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France.,Centre de Recherche Épidémiologie et StatistiqueS (CRESS), Université de Paris, INSERM UMR1153, Paris, France
| | - Manuelle Viguier
- Department of Dermatology-Venereology, Robert-Debré Hospital, Reims, France
| | - Emilie Sbidian
- Paris-Est University, UPEC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Créteil, France, .,Department of Dermatology-Venereology, Henri Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France, .,INSERM, Centre d'Investigation Clinique 1430, Créteil, France,
| |
Collapse
|
33
|
Malmartel A, Ravaud P, Ghosn L, Tran VT. A classification of methods used to personalize participative interventions revealed inadequate reporting in trial protocols. J Clin Epidemiol 2021; 133:80-93. [PMID: 33476767 DOI: 10.1016/j.jclinepi.2021.01.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/21/2020] [Accepted: 01/12/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The objective of the study was to develop a classification of methods used to personalize participative interventions in randomized controlled trials (RCTs). STUDY DESIGN AND SETTING We conducted a systematic review including protocols of RCTs assessing participative interventions in PubMed and ClinicalTrials.gov between June 2018 and May 2019. Data extraction was performed by two independent reviewers. We developed a precise classification of methods used to personalize interventions. Then, protocols were reviewed to determine whether personalization was sufficiently described to enable replication. RESULTS We included 109 protocols. The classification used four components and 13 subcomponents accounting for decision points (when interventions were personalized), tailoring variables (on what interventions were personalized), decision rules (how and by whom interventions were personalized), and nature of the subsequent tailoring (what was personalized in the interventions). In 95% of protocols, at least one component or subcomponent of our classification was not adequately reported to enable the replication of the intervention. Components the least well described were tailoring variables (72% of protocols insufficiently described) and the nature of the subsequent tailoring (46% of protocols). CONCLUSION This study provides the first detailed classification of methods used to personalize interventions. This is required to transparently implement personalization and improve reporting in RCTs.
Collapse
Affiliation(s)
- Alexandre Malmartel
- Université de Paris, METHODS Team, CRESS, INSERM, INRA, F-75004 Paris, France; Département de médecine générale, Université de Paris, F-75014 Paris, France.
| | - Philippe Ravaud
- Université de Paris, METHODS Team, CRESS, INSERM, INRA, F-75004 Paris, France; Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel-Dieu, Paris, France
| | - Lina Ghosn
- Université de Paris, METHODS Team, CRESS, INSERM, INRA, F-75004 Paris, France
| | - Viet-Thi Tran
- Université de Paris, METHODS Team, CRESS, INSERM, INRA, F-75004 Paris, France; Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel-Dieu, Paris, France
| |
Collapse
|
34
|
Graña Possamai C, Ravaud P, Ghosn L, Tran VT. Use of wearable biometric monitoring devices to measure outcomes in randomized clinical trials: a methodological systematic review. BMC Med 2020; 18:310. [PMID: 33153462 PMCID: PMC7646072 DOI: 10.1186/s12916-020-01773-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/01/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Wearable biometric monitoring devices (BMDs) have the potential to transform the conduct of randomized controlled trials (RCTs) by shifting the collection of outcome data from single measurements at predefined time points to dense continuous measurements. METHODS Methodological systematic review to understand how recent RCTs used BMDs to measure outcomes and to describe the reporting of these RCTs. Electronic search was performed in the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE and completed a page-by-page hand search in five leading medical journals between January 1, 2018, and December 31, 2018. Three reviewers independently extracted all primary and secondary outcomes collected using BMDs, and assessed (1) the definitions used to summarize BMD outcome data; (2) whether the validity, reliability, and responsiveness of sensors was reported; (3) the discrepancy with outcomes prespecified in public clinical trial registries; and (4) the methods used to manage missing and incomplete BMD outcome data. RESULTS Of the 4562 records screened, 75 RCTs were eligible. Among them, 24% tested a pharmacological intervention and 57% used an inertial measurement sensor to measure physical activity. Included trials involved 464 outcomes (average of 6 [SD = 8] outcomes per trial). In total, 35 trials used a BMD to measure a primary outcome. Several issues affected the value and transparency of trials using BMDs to measure outcomes. First, the definition of outcomes used in the trials was highly heterogeneous (e.g., 21 diabetes trials had 266 outcomes and 153 had different unique definitions to measure diabetes control), which limited the combination and comparison of results. Second, information on the validity, reliability, and responsiveness of sensors used was lacking in 74% of trials. Third, half (53%) of the outcomes measured with BMDs had not been prespecified, with a high risk of outcome reporting bias. Finally, reporting on the management of incomplete outcome data (e.g., due to suboptimal compliance with the BMD) was absent in 68% of RCTs. CONCLUSIONS Use of BMDs to measure outcomes is becoming the norm rather than the exception in many fields. Yet, trialists need to account for several methodological issues when specifying and conducting RCTs using these novel tools.
Collapse
Affiliation(s)
- Carolina Graña Possamai
- METHODS Team, Center for Research in Epidemiology and Statistics (CRESS), Université de Paris/INSERM (UMR 1153), 1 Place du Parvis Notre Dame, 75004, Paris, France
| | - Philippe Ravaud
- METHODS Team, Center for Research in Epidemiology and Statistics (CRESS), Université de Paris/INSERM (UMR 1153), 1 Place du Parvis Notre Dame, 75004, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu (AP-HP), 1 Place du Parvis Notre Dame, 75004, Paris, France.,Department of Epidemiology, Columbia University Mailman School of Public Health, 22 W 168th St, New York, NY, USA
| | - Lina Ghosn
- METHODS Team, Center for Research in Epidemiology and Statistics (CRESS), Université de Paris/INSERM (UMR 1153), 1 Place du Parvis Notre Dame, 75004, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu (AP-HP), 1 Place du Parvis Notre Dame, 75004, Paris, France
| | - Viet-Thi Tran
- METHODS Team, Center for Research in Epidemiology and Statistics (CRESS), Université de Paris/INSERM (UMR 1153), 1 Place du Parvis Notre Dame, 75004, Paris, France. .,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu (AP-HP), 1 Place du Parvis Notre Dame, 75004, Paris, France.
| |
Collapse
|
35
|
Perlmutter A, Benchoufi M, Ravaud P, Tran VT. Identification of Patient Perceptions That Can Affect the Uptake of Interventions Using Biometric Monitoring Devices: Systematic Review of Randomized Controlled Trials. J Med Internet Res 2020; 22:e18986. [PMID: 32915153 PMCID: PMC7519434 DOI: 10.2196/18986] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/23/2020] [Accepted: 07/26/2020] [Indexed: 12/24/2022] Open
Abstract
Background Biometric monitoring devices (BMDs) are wearable or environmental trackers and devices with embedded sensors that
can remotely collect high-frequency objective data on patients’ physiological, biological, behavioral, and environmental
contexts (for example, fitness trackers with accelerometer). The real-world effectiveness of interventions using biometric monitoring devices depends on patients’ perceptions of these interventions. Objective We aimed to systematically review whether and how recent randomized controlled trials (RCTs) evaluating interventions using BMDs assessed patients’ perceptions toward the intervention. Methods We systematically searched PubMed (MEDLINE) from January 1, 2017, to December 31, 2018, for RCTs evaluating interventions using BMDs. Two independent investigators extracted the following information: (1) whether the RCT collected information on patient perceptions toward the intervention using BMDs and (2) if so, what precisely was collected, based on items from questionnaires used and/or themes and subthemes identified from qualitative assessments. The two investigators then synthesized their findings in a schema of patient perceptions of interventions using BMDs. Results A total of 58 RCTs including 10,071 participants were included in the review (the median number of randomized participants was 60, IQR 37-133). BMDs used in interventions were accelerometers/pedometers (n=35, 60%), electrochemical biosensors (eg, continuous glucose monitoring; n=18, 31%), or ecological momentary assessment devices (eg, carbon monoxide monitors for smoking cessation; n=5, 9%). Overall, 26 (45%) trials collected information on patient perceptions toward the intervention using BMDs and allowed the identification of 76 unique aspects of patient perceptions that could affect the uptake of these interventions (eg, relevance of the information provided, alarm burden, privacy and data handling, impact on health outcomes, independence, interference with daily life). Patient perceptions were unevenly collected in trials. For example, only 5% (n=3) of trials assessed how patients felt about privacy and data handling aspects of the intervention using BMDs. Conclusions Our review showed that less than half of RCTs evaluating interventions using BMDs assessed patients’ perceptions toward interventions using BMDs. Trials that did assess perceptions often only assessed a fraction of them. This limits the extrapolation of the results of these RCTs to the real world. We thus provide a comprehensive schema of aspects of patient perceptions that may affect the uptake of interventions using BMDs and which should be considered in future trials. Trial Registration PROSPERO CRD42018115522; https://tinyurl.com/y5h8fjgx
Collapse
Affiliation(s)
- Alexander Perlmutter
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.,School of Global Public Health, New York University, New York, NY, United States
| | - Mehdi Benchoufi
- UMR1153 (METHODS team), Centre de Recherche en Epidemiologie et StatistiqueS, Institut national de la santé et de la recherche médicale, Paris, France
| | - Philippe Ravaud
- UMR1153 (METHODS team), Centre de Recherche en Epidemiologie et StatistiqueS, Institut national de la santé et de la recherche médicale, Paris, France
| | - Viet-Thi Tran
- UMR1153 (METHODS team), Centre de Recherche en Epidemiologie et StatistiqueS, Institut national de la santé et de la recherche médicale, Paris, France
| |
Collapse
|
36
|
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.
Collapse
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
| |
Collapse
|
37
|
Tran VT, Diard E, Ravaud P. Priorities to improve the care for chronic conditions and multimorbidity: a survey of patients and stakeholders nested within the ComPaRe e-cohort. BMJ Qual Saf 2020; 30:577-587. [PMID: 32839207 PMCID: PMC8237178 DOI: 10.1136/bmjqs-2020-011219] [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: 03/23/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 01/13/2023]
Abstract
Objective To set priorities to improve consultations, care structures and the healthcare system from the perspective of patients with chronic conditions, care professionals, hospital administrators and health policy makers. Methods Adult patients with chronic conditions recruited from the ComPaRe e-cohort in France ranked their 15 most important areas of improvement among 147 previously defined by patients. Priorities at a population level were obtained by using logit models for sets of ranked items in a data set calibrated to represent the French population of patients with chronic conditions. Care professionals, hospital managers and health policy makers rated the complexity involved in improving the areas identified. We calculated the number of patients who considered as a priority at least one of the areas considered easy to implement. Results Between September 2018 and May 2019, 3002 patients (84% women, 47% with multimorbidity) and 149 professionals (including 50 care professionals, 79 hospital directors, 11 health policy decision makers) were recruited. Patients’ top priorities were (1) Transforming care to be holistic and personalised, at a consultation level; (2) Smoothing patients' journey in the care system, increasing their knowledge of their own health and improving care coordination, at a care structure level (3) Training clinicians in better interpersonal skills and knowledge of specific conditions/treatments, reducing stigma and making care more affordable, at a healthcare system level. In total, 48%, 71% and 57% patients ranked in their top priorities one area considered easy to improve by professionals at consultation, care structure and health system levels, respectively. Conclusion This is the first comprehensive map of patients’ priorities to improve the management of chronic conditions. Implementing simple actions could benefit a large number of patients.
Collapse
Affiliation(s)
- Viet-Thi Tran
- METHODS Team, Université de Paris, CRESS, INSERM, INRA, Paris, France .,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Elise Diard
- METHODS Team, Université de Paris, CRESS, INSERM, INRA, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Philippe Ravaud
- METHODS Team, Université de Paris, CRESS, INSERM, INRA, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique - Hôpitaux de Paris, Paris, France
| |
Collapse
|
38
|
Tran VT, Ravaud P. COVID-19-related perceptions, context and attitudes of adults with chronic conditions: Results from a cross-sectional survey nested in the ComPaRe e-cohort. PLoS One 2020; 15:e0237296. [PMID: 32760127 PMCID: PMC7410193 DOI: 10.1371/journal.pone.0237296] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/23/2020] [Indexed: 12/23/2022] Open
Abstract
Background To avoid a surge of demand on the healthcare system due to the COVID-19 pandemic, we must reduce transmission to individuals with chronic conditions who are at risk of severe illness with COVID-19. We aimed at understanding the perceptions, context and attitudes of individuals with chronic conditions during the COVID-19 pandemic to clarify their potential risk of infection. Methods A cross-sectional survey was nested in ComPaRe, an e-cohort of adults with chronic conditions, in France. It assessed participants’ perception of their risk of severe illness with COVID-19; their context (i.e., work, household, contacts with external people); and their attitudes in situations involving frequent or occasional contacts with symptomatic or asymptomatic people. Data were collected from March 23 to April 2, 2020, during the lockdown in France. Analyses were weighted to represent the demographic characteristics of French patients with chronic conditions. The subgroup of participants at high risk according to the recommendations of the French High Council for Public Health was examined. Results Among the 7169 recruited participants, 63% patients felt at risk because of severe illness. About one quarter (23.7%) were at risk of infection because they worked outside home, had a household member working outside home or had regular visits from external contacts. Less than 20% participants refused contact with symptomatic people and <20% used masks when in contact with asymptomatic people. Among patients considered at high risk according to the recommendations of the French High Council for Public Health, 20% did not feel at risk, which led to incautious attitudes. Conclusion Individuals with chronic conditions have distorted perceptions of their risk of severe illness with COVID-19. In addition, they are exposed to COVID-19 due to their context or attitudes.
Collapse
Affiliation(s)
- Viet-Thi Tran
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- Centre d’Epidémiologie Clinique, AP-HP, Hôpital Hôtel-Dieu, Paris, France
- * E-mail:
| | - Philippe Ravaud
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- Centre d’Epidémiologie Clinique, AP-HP, Hôpital Hôtel-Dieu, Paris, France
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
| |
Collapse
|
39
|
Chevance A, Tran VT, Ravaud P. Controversy and Debate Series on Core Outcome Sets. Paper 7: Response to comments on the paper 2-6 re "Improving the generalizability and credibility of Core Outcome Sets (COSs) by involving large international sample of participants". J Clin Epidemiol 2020; 125:232-234. [PMID: 32565218 DOI: 10.1016/j.jclinepi.2020.06.019] [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] [Received: 05/29/2020] [Accepted: 06/14/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Astrid Chevance
- Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France.
| | - Viet-Thi Tran
- Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France
| | - Philippe Ravaud
- Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France; Department of Epidemiology, Columbia University Mailman School of Public Health, 22 W 168th St, New York, NY, USA
| |
Collapse
|
40
|
Pham NK, Sepehri A, Le TM, Tran VT. Re: Letter to the Editor of Public Health in response to 'Correlates of body mass index among primary schoolchildren in Ho Chi Minh City, Vietnam'. Public Health 2020; 185:405. [PMID: 32430138 DOI: 10.1016/j.puhe.2020.03.002] [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] [Received: 01/31/2020] [Accepted: 03/03/2020] [Indexed: 11/28/2022]
Affiliation(s)
- N K Pham
- Health Economics and Management, School of Economics, University of Economics Ho Chi Minh City, Ho Chi Minh City, Viet Nam.
| | - A Sepehri
- Department of Economics, University of Manitoba, Winnipeg, Manitoba, R3T 2N2, Canada.
| | - T M Le
- Development Economics, University of Economics Ho Chi Minh City, Viet Nam.
| | - V T Tran
- School of Economics, University of Economics Ho Chi Minh City, Viet Nam.
| |
Collapse
|
41
|
Mahévas M, Tran VT, Roumier M, Chabrol A, Paule R, Guillaud C, Fois E, Lepeule R, Szwebel TA, Lescure FX, Schlemmer F, Matignon M, Khellaf M, Crickx E, Terrier B, Morbieu C, Legendre P, Dang J, Schoindre Y, Pawlotsky JM, Michel M, Perrodeau E, Carlier N, Roche N, de Lastours V, Ourghanlian C, Kerneis S, Ménager P, Mouthon L, Audureau E, Ravaud P, Godeau B, Gallien S, Costedoat-Chalumeau N. Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data. BMJ 2020; 369:m1844. [PMID: 32409486 PMCID: PMC7221472 DOI: 10.1136/bmj.m1844] [Citation(s) in RCA: 268] [Impact Index Per Article: 67.0] [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] [Accepted: 05/05/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the effectiveness of hydroxychloroquine in patients admitted to hospital with coronavirus disease 2019 (covid-19) pneumonia who require oxygen. DESIGN Comparative observational study using data collected from routine care. SETTING Four French tertiary care centres providing care to patients with covid-19 pneumonia between 12 March and 31 March 2020. PARTICIPANTS 181 patients aged 18-80 years with documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia who required oxygen but not intensive care. INTERVENTIONS Hydroxychloroquine at a dose of 600 mg/day within 48 hours of admission to hospital (treatment group) versus standard care without hydroxychloroquine (control group). MAIN OUTCOME MEASURES The primary outcome was survival without transfer to the intensive care unit at day 21. Secondary outcomes were overall survival, survival without acute respiratory distress syndrome, weaning from oxygen, and discharge from hospital to home or rehabilitation (all at day 21). Analyses were adjusted for confounding factors by inverse probability of treatment weighting. RESULTS In the main analysis, 84 patients who received hydroxychloroquine within 48 hours of admission to hospital (treatment group) were compared with 89 patients who did not receive hydroxychloroquine (control group). Eight additional patients received hydroxychloroquine more than 48 hours after admission. In the weighted analyses, the survival rate without transfer to the intensive care unit at day 21 was 76% in the treatment group and 75% in the control group (weighted hazard ratio 0.9, 95% confidence interval 0.4 to 2.1). Overall survival at day 21 was 89% in the treatment group and 91% in the control group (1.2, 0.4 to 3.3). Survival without acute respiratory distress syndrome at day 21 was 69% in the treatment group compared with 74% in the control group (1.3, 0.7 to 2.6). At day 21, 82% of patients in the treatment group had been weaned from oxygen compared with 76% in the control group (weighted risk ratio 1.1, 95% confidence interval 0.9 to 1.3). Eight patients in the treatment group (10%) experienced electrocardiographic modifications that required discontinuation of treatment. CONCLUSIONS Hydroxychloroquine has received worldwide attention as a potential treatment for covid-19 because of positive results from small studies. However, the results of this study do not support its use in patients admitted to hospital with covid-19 who require oxygen.
Collapse
Affiliation(s)
- Matthieu Mahévas
- Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Viet-Thi Tran
- Centre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France
| | - Mathilde Roumier
- Department of Internal Medicine, Foch Hospital, Suresnes, France
| | - Amélie Chabrol
- Department of Infectious Diseases, Sud Francilien Hospital, Corbeil-Essonnes, France
| | - Romain Paule
- Department of Internal Medicine, Foch Hospital, Suresnes, France
| | - Constance Guillaud
- Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Elena Fois
- Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Raphael Lepeule
- Transversal Infections Treatment Unit, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France
| | - Tali-Anne Szwebel
- Department of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | | | - Frédéric Schlemmer
- Pulmonology Unit, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France
| | - Marie Matignon
- Department of Nephrology, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France
| | - Mehdi Khellaf
- Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Etienne Crickx
- Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Benjamin Terrier
- Department of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Caroline Morbieu
- Department of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Paul Legendre
- Department of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Julien Dang
- Centre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France
| | - Yoland Schoindre
- Department of Internal Medicine, Foch Hospital, Suresnes, France
| | - Jean-Michel Pawlotsky
- Department of Virology, Bacteriology-Hygiene, and Mycology-Parasitology Centre, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Michel
- Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Elodie Perrodeau
- Centre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France
| | - Nicolas Carlier
- Department of Pulmonology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Nicolas Roche
- Department of Pulmonology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Victoire de Lastours
- Department of Internal Medicine, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Clément Ourghanlian
- Pharmacy, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France
| | - Solen Kerneis
- Mobile Infectious Disease Team, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Philippe Ménager
- Pulmonology Unit, Sud Francilien Hospital, Corbeil-Essonnes, France
| | - Luc Mouthon
- Department of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Etienne Audureau
- Clinical Epidemiology and Aging Team, Mondor Institute for Biomedical Research (INSERM U955), Public Health Services, Henri-Mondor Hosptial, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France
| | - Philippe Ravaud
- Centre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France
| | - Bertrand Godeau
- Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Sébastien Gallien
- Department of Infectious Diseases, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Pari, Paris-Est Créteil University, Créteil, France
| | - Nathalie Costedoat-Chalumeau
- Centre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France
- Department of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| |
Collapse
|
42
|
Klimov AS, Bakeev IY, Oks EM, Tran VT, Zenin AA. Plasma electron source for generating a ribbon beam in the forevacuum pressure range. Rev Sci Instrum 2020; 91:043505. [PMID: 32357761 DOI: 10.1063/1.5130954] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 03/20/2020] [Indexed: 06/11/2023]
Abstract
We describe a plasma-cathode electron beam source based on a hollow cathode glow discharge and operating in the forevacuum pressure range that produces a steady-state ribbon beam. The electron beam is generated in the pressure range of 10-30 Pa. A multi-aperture electron extraction and beam formation system is used to provide beam stability and enhanced uniformity of beam current density, allowing the use of this kind of device for beam-plasma surface modification over relatively large areas.
Collapse
Affiliation(s)
- A S Klimov
- Physics Department, Tomsk State University of Control Systems and Radioelectronics, Tomsk 634050, Russia
| | - I Yu Bakeev
- Physics Department, Tomsk State University of Control Systems and Radioelectronics, Tomsk 634050, Russia
| | - E M Oks
- Physics Department, Tomsk State University of Control Systems and Radioelectronics, Tomsk 634050, Russia
| | - V T Tran
- Physics Department, Tomsk State University of Control Systems and Radioelectronics, Tomsk 634050, Russia
| | - A A Zenin
- Physics Department, Tomsk State University of Control Systems and Radioelectronics, Tomsk 634050, Russia
| |
Collapse
|
43
|
Wieringa TH, Sanchez-Herrera MF, Espinoza NR, Tran VT, Boehmer K. Crafting Care That Fits: Workload and Capacity Assessments Complementing Decision Aids in Implementing Shared Decision Making. J Particip Med 2020; 12:e13763. [PMID: 33064091 PMCID: PMC7434057 DOI: 10.2196/13763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 09/04/2019] [Accepted: 02/12/2020] [Indexed: 11/13/2022] Open
Abstract
About 42% of adults have one or more chronic conditions and 23% have multiple chronic conditions. The coordination and integration of services for the management of patients living with multimorbidity is important for care to be efficient, safe, and less burdensome. Minimally disruptive medicine may optimize this coordination and integration. It is a patient-centered approach to care that focuses on achieving patient goals for life and health by seeking care strategies that fit a patient’s context and are minimally disruptive and maximally supportive. The cumulative complexity model practically orients minimally disruptive medicine–based care. In this model, the patient workload-capacity imbalance is the central mechanism driving patient complexity. These elements should be accounted for when making decisions for patients with chronic conditions. Therefore, in addition to decision aids, which may guide shared decision making, we propose to discuss and clarify a potential workload-capacity imbalance.
Collapse
Affiliation(s)
- Thomas H Wieringa
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Nataly R Espinoza
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States
| | - Viet-Thi Tran
- METHODS Team, Centre of Research in Epidemiology and StatisticS, Université de Paris, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Kasey Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
44
|
Tran VT, Montori VM, Ravaud P. Is My Patient Overwhelmed?: Determining Thresholds for Acceptable Burden of Treatment Using Data From the ComPaRe e-Cohort. Mayo Clin Proc 2020; 95:504-512. [PMID: 31619365 DOI: 10.1016/j.mayocp.2019.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 07/31/2019] [Accepted: 09/04/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To estimate the highest burden of treatment beyond which patients with chronic conditions consider their current investments of time and effort in health care unsustainable. PATIENTS AND METHODS We used data collected between January 1, 2017 and October 1, 2018 in the Community of Patients for Research (ComPaRe), an ongoing e-cohort of adult patients with chronic conditions in France. We matched participants' answers to the Treatment Burden Questionnaire (TBQ) and to a Yes/No anchor question: "Think about all the things you do to care for yourself. Do you think you could continue investing the same amount of time, energy, and money in your health care lifelong?" We defined the Patient Acceptable Symptom State (PASS) for the burden of treatment as the TBQ score below which 75% of patients reported an acceptable burden state. RESULTS We analyzed data for 2413 patients (1781 [73.8%] women, 1248 [51.7%] multimorbid, median age: 48 (interquartile range, 36-59] years) enrolled in ComPaRe. Of these, 38% (917 of 2413) reported that they would be unable to continue the same investment of energy, time, and money in health care lifelong. The PASS for the burden of treatment was at 39% of the maximal score (ie, TBQ score = 59/150; 95% CI, 52-64) Using these results, clinicians can detect patients at risk for becoming overwhelmed by their medical care by identifying patients with TBQ scores of 59 or higher. CONCLUSION About 40% of patients with chronic conditions report being unable to sustain current investments of energy, time, and money in health care lifelong. The PASS for treatment burden provides a practical yardstick to help clinicians and researchers interpret scores for burden of treatment.
Collapse
Affiliation(s)
- Viet-Thi Tran
- Equipe METHODS, Centre de recherche en Epidémiologie et Statistiques (CRESS, Université de Paris, INSERM UMR 1153), France; Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, France.
| | - Victor M Montori
- Division of Health Care and Policy Research, Department of Health Sciences Research and Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Philippe Ravaud
- Equipe METHODS, Centre de recherche en Epidémiologie et Statistiques (CRESS, Université de Paris, INSERM UMR 1153), France; Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, France; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| |
Collapse
|
45
|
Pham NK, Sepehri A, Le TM, Tran VT. Correlates of body mass index among primary school children in Ho Chi Minh City, Vietnam. Public Health 2020; 181:65-72. [PMID: 31954871 DOI: 10.1016/j.puhe.2019.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To document the prevalence of overweight and obesity and examine associated risk factors. STUDY DESIGN A cross-sectional survey was conducted in 16 primary public schools in eight districts of Ho Chi Minh City in 2016. A multistage clustering sampling method was used to collect a sample of 1806 pupils attending the first, second, and third grades (7-9 years). METHODS Age- and sex-adjusted body mass index (BMI) status was defined using International Obesity Taskforce cut-offs. Ordered probit regression models were used to assess the association between child BMI and its socio-economic and demographic risk factors. The model was estimated separately for boys and girls to assess the extent to which the socio-economic gradients in BMI vary by gender. RESULTS The prevalence of obesity among boys was twice the rate for girls (24.7 vs 12.3%). The prevalence of overweight and obesity were also higher among pupils attending schools located in urban districts than in semi-rural districts. Gender, household wealth, the frequency of having breakfast at home, parental body weight, and school location were strong predictors of child BMI status. The protective effect of having breakfast more frequently at home against the risk of overweight/obesity was more pronounced in girls than in boys. Father's body weight and child BMI were more strongly associated with boys from poorer households than boys from wealthier households, while the differences were not significant for girls. CONCLUSIONS The high prevalence of childhood overweight and obesity indicates an urgent need for more gender-specific, effective intervention, and prevention programs.
Collapse
Affiliation(s)
- N K Pham
- School of Economics, University of Economics Ho Chi Minh City, Ho Chi Minh City, Viet Nam.
| | - A Sepehri
- Department of Economics, University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada.
| | - T M Le
- Development Economics, University of Economics, Ho Chi Minh City, Viet Nam.
| | - V T Tran
- School of Economics, University of Economics Ho Chi Minh City, Ho Chi Minh City, Viet Nam.
| |
Collapse
|
46
|
Oikonomidi T, Vivot A, Tran VT, Riveros C, Robin E, Ravaud P. A Methodologic Systematic Review of Mobile Health Behavior Change Randomized Trials. Am J Prev Med 2019; 57:836-843. [PMID: 31753266 DOI: 10.1016/j.amepre.2019.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 12/26/2022]
Abstract
CONTEXT Mobile health helps providers offer accessible, affordable, tailored behavior change interventions. However, research assessing mobile health interventions may feature methodologic shortcomings and poor reporting. This review aims to summarize the characteristics, methods, and intervention reporting of RCTs evaluating mobile health behavior change interventions. EVIDENCE ACQUISITION This was a methodologic systematic review of RCTs assessing mobile health behavior change interventions published in PubMed from January 1, 2014 to January 1, 2018, in journals with the upper half of Impact Factors (Clarivate Analytics). Three reviewers independently extracted sample characteristics. Primary outcomes were classified as patient-important or not using definitions from the literature. Any non-patient-important outcomes were then reclassified by a panel of 3 patients. Intervention reporting was assessed by the mobile health Evidence Reporting and Assessment checklist. Data were analyzed in December 2018. EVIDENCE SYNTHESIS Most of the 231 included RCTs assessed text messaging (51%) or smartphone app (28%) interventions aiming to change nutrition and physical activity (36%) or treatment adherence (25%). Only 8% of RCTs had a patient-important primary outcome, follow-up of ≥6 months, and intent-to-treat analysis. Most primary outcomes were behavioral measures (60%). Follow-up was <3 months in 29% of RCTs. Regarding reporting, 12 of the 16 checklist items were reported in less than half of RCTs (e.g., usability/content testing, 32%; data security, 13%). CONCLUSIONS Reports of RCTs assessing mobile health behavior change interventions lack information that would be useful for providers, including reporting of long-term intervention impact on patient-important primary outcomes and information needed for intervention replicability.
Collapse
Affiliation(s)
- Theodora Oikonomidi
- Clinical Epidemiology Unit, Hôtel Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, CRESS, INSERM, INRA, Paris, France
| | - Alexandre Vivot
- Clinical Epidemiology Unit, Hôtel Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, CRESS, INSERM, INRA, Paris, France.
| | - Viet-Thi Tran
- Clinical Epidemiology Unit, Hôtel Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, CRESS, INSERM, INRA, Paris, France
| | - Carolina Riveros
- Clinical Epidemiology Unit, Hôtel Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Philippe Ravaud
- Clinical Epidemiology Unit, Hôtel Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, CRESS, INSERM, INRA, Paris, France; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| |
Collapse
|
47
|
Porcher R, Tran VT, Blacher J, Ravaud P. Potential of Stratified Medicine for High Blood Pressure Management: A Modeling Study Using NHANES Survey Data. Hypertension 2019; 74:1420-1427. [PMID: 31679427 DOI: 10.1161/hypertensionaha.119.13749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The 2017 American College of Cardiology/American Heart Association hypertension guidelines lowered the thresholds for defining and treating hypertension. However, the SPRINT trial showed substantial heterogeneity in benefits and harms of intensive antihypertensive treatment depending on patients' characteristics. We aimed at illustrating the potential gains of personalizing intensive antihypertensive treatment. Using the US National Health and Nutrition Examination Survey 2011 to 2014 (n=2067), and prediction models derived from the SPRINT trial, we computed expected benefits and harms of intensive antihypertensive treatment for individuals aged 50 or more. We compared 2 interventions: (1) intensive antihypertensive treatment for all individuals meeting the 2017 American College of Cardiology/American Heart Association thresholds and (2) a stratified medicine strategy excluding from intensive treatment individuals with predicted unfavorable benefit-risk. Outcome measures were model-predicted 5-year risk of cardiovascular events or death (myocardial infarction, acute coronary, stroke, acute decompensated heart failure, and cardiovascular-related death), and severe adverse events (hypotension, syncope, electrolyte abnormalities, bradycardia, and acute kidney injury). Per 2017 American College of Cardiology/American Heart Association guidelines, 40.1 million (39.2%) US individuals aged 50 or more should initiate or intensify antihypertensive treatment, thereby preventing cardiovascular events for 795 000 individuals and inducing severe adverse events for 848 000 over 5 years. A stratified treatment strategy could decrease the number of individuals treated by 21.2 million (52.9%) and reduce the number of individuals with severe adverse events by 38.3%, with 11.7% fewer individuals with cardiovascular events prevented. Personalizing antihypertensive treatment according to predicted benefits and harms could spare treatment for more than half individuals while reducing harms 3× more than benefits.
Collapse
Affiliation(s)
- Raphaël Porcher
- From the Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Hôtel-Dieu, Center for Clinical Epidemiology, Paris, France (R.P., V.-T.T., P.R.).,INSERM, UMR1153 Epidemiology and Statistics Sorbonne Paris Cité Research Center (CRESS), Team METHODS, Paris, France (R.P., V.-T.T., P.R.).,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (R.P., J.B., P.R.)
| | - Viet-Thi Tran
- From the Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Hôtel-Dieu, Center for Clinical Epidemiology, Paris, France (R.P., V.-T.T., P.R.).,INSERM, UMR1153 Epidemiology and Statistics Sorbonne Paris Cité Research Center (CRESS), Team METHODS, Paris, France (R.P., V.-T.T., P.R.)
| | - Jacques Blacher
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (R.P., J.B., P.R.).,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Hôtel-Dieu, Centre de Diagnostic et de Thérapeutique, Paris, France (J.B.).,INSERM, UMR1153 Epidemiology and Statistics Sorbonne Paris Cité Research Center (CRESS), Team EREN, Bobigny, France (J.B.)
| | - Philippe Ravaud
- From the Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Hôtel-Dieu, Center for Clinical Epidemiology, Paris, France (R.P., V.-T.T., P.R.).,INSERM, UMR1153 Epidemiology and Statistics Sorbonne Paris Cité Research Center (CRESS), Team METHODS, Paris, France (R.P., V.-T.T., P.R.).,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (R.P., J.B., P.R.).,Columbia University, Mailman School of Public Health, Department of Epidemiology, NY (P.R.)
| |
Collapse
|
48
|
Mama Djima M, Ekouevi DK, Gregoire JP, Tchounga B, Coffie PA, Tran VT, Touré FY, Moisan J. Use of non-HIV medication among people living with HIV and receiving antiretroviral treatment in Côte d'Ivoire, West Africa: A cross-sectional study. PLoS One 2019; 14:e0221335. [PMID: 31525222 PMCID: PMC6746366 DOI: 10.1371/journal.pone.0221335] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 08/06/2019] [Indexed: 11/18/2022] Open
Abstract
Background In Côte d’Ivoire, people living with HIV (PLHIV) have free access to antiretroviral therapy (ART) and cotrimoxazole. Yet, they may use other medications to treat non-HIV diseases. Scarce data are available regarding the use of non-HIV medications in Africa. This study describes the use of non-HIV medications and identifies the factors associated with their use by PLHIV on ART in Côte d’Ivoire. Methods A cross-sectional study was conducted in six HIV clinics in 2016. HIV-1-infected adults receiving ART for at least one year were eligible. A standardized questionnaire was used to collect demographics, HIV characteristics and medication use data. Associated factors were identified using a multivariate adjusted Poisson regression. Results A total of 1,458 participants (74% women) were enrolled. The median age was 44 years, and the median duration of ART was 81 months. A total of 696 (48%) participants reported having used at least one non-HIV medication. Among the 1,519 non-HIV medications used, 550 (36%) had not been prescribed and 397 (26%) were from the nervous system class. Individuals who were more likely to report the use of at least one non-HIV medication included those who had been treated in an Abidjan HIV clinic, had a high school education level, had a monthly income between 152 and 304 euros, had a poor perceived health status, had WHO advanced clinical stage, had used traditional medicine products and had not used cotrimoxazole. Conclusion Almost half PLHIV on ART reported using non-HIV medication. Further research is needed to assess whether the use of non-HIV medication is appropriate given about a third of those medications are not being prescribed.
Collapse
Affiliation(s)
- Mariam Mama Djima
- PACCI, CHU Treichville, Abidjan, Côte d’Ivoire
- Institut Pasteur de Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Faculté de pharmacie, Université Laval, Québec, Canada
- * E-mail:
| | - Didier Koumavi Ekouevi
- PACCI, CHU Treichville, Abidjan, Côte d’Ivoire
- Centre Inserm U 1219, ISPED, Université Victor Segalen, Bordeaux, France
- Université de Lomé, Département de Santé Publique, Lomé, Togo
| | - Jean-Pierre Gregoire
- Faculté de pharmacie, Université Laval, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec–Université Laval, Québec, Canada
| | | | | | | | | | - Jocelyne Moisan
- Faculté de pharmacie, Université Laval, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec–Université Laval, Québec, Canada
| |
Collapse
|
49
|
Ysrraelit MC, Fiol MP, Peña FV, Vanotti S, Terrasa SA, Tran VT, Montori VM, Correale J. Adaptation and validation of a Spanish version of the treatment burden questionnaire in patients with multiple sclerosis. BMC Neurol 2019; 19:209. [PMID: 31455235 PMCID: PMC6710872 DOI: 10.1186/s12883-019-1441-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/21/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The Treatment Burden Questionnaire (TBQ) is a self-reported measure of the effect of treatment workload on patient wellbeing. We sought to validate the TBQ in Spanish and use it to estimate the burden of treatment in Argentinian patients with multiple sclerosis (MS). METHODS The TBQ was forward-backward translated into Spanish. Two focus groups and 25 semi-structured interviews focused on wording and possible item exclusion. Validation was performed in 2 steps. First, 162 patients across a range of MS severity completed the questionnaire. Confirmatory factor analysis assessed the dimensional structure of the TBQ. Construct validity was assessed by studying correlations with fatigue and quality of life (QoL). Then, in a second cohort of 171 patients, we evaluated the association between TBQ scores and patients' sex, age, education level, employment status, type of MS, disease duration, comorbidities, EDSS, pharmacological treatment and medication adherence. RESULTS The questionnaire presented a 3-factor structure in which burden was related to pharmacological treatment; comprehensive health assistance; and psycho-social-economic context. Composite reliability was > 0.8 for all factors. TBQ showed positive correlation with fatigue (rs = 0.467, p = 0.006), negative correlation with QoL (rs - 0.446, p = 0.009). For the second cohort, total TBQ score was 43 (SD 29). Lowest scores were observed on self-monitoring (0.53, SD 1.3) and highest for administrative load (4.2, SD 3.4). Inverse association was found between the TBQ score and medication adherence (r 0.243 p = 0.001). TBQ scores also correlated with daily patient pill/injection requirements (r 0.175 p = 0.020). Individuals receiving injectable treatment scored higher than patients on oral drugs (total TBQ 51 (SD 32) vs 39 (SD 27) p = 0.002). CONCLUSIONS The TBQ in Spanish is a reliable instrument and showed adequate correlation with QoL and adherence scales in MS patients. TBQ may benefit health resources allocation and provide tailor therapeutic interventions to construct a minimally disruptive care.
Collapse
Affiliation(s)
| | | | | | - Sandra Vanotti
- Multiple Sclerosis Clinic, INEBA - Neurosciences Institute of Buenos Aires, Buenos Aires, Argentina
| | | | - Viet-Thi Tran
- Centre of Research in Epidemiology and Statistics (CRESS – UMR 1153), Paris, France
| | - Victor M. Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905 USA
| | | |
Collapse
|
50
|
Tran VT, Riveros C, Ravaud P. Patients' views of wearable devices and AI in healthcare: findings from the ComPaRe e-cohort. NPJ Digit Med 2019; 2:53. [PMID: 31304399 PMCID: PMC6572821 DOI: 10.1038/s41746-019-0132-y] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/22/2019] [Indexed: 01/12/2023] Open
Abstract
Wearable biometric monitoring devices (BMDs) and artificial intelligence (AI) enable the remote measurement and analysis of patient data in real time. These technologies have generated a lot of "hype," but their real-world effectiveness will depend on patients' uptake. Our objective was to describe patients' perceptions of the use of BMDs and AI in healthcare. We recruited adult patients with chronic conditions in France from the "Community of Patients for Research" (ComPaRe). Participants (1) answered quantitative and open-ended questions about the potential benefits and dangers of using of these new technologies and (2) participated in a case-vignette experiment to assess their readiness for using BMDs and AI in healthcare. Vignettes covered the use of AI to screen for skin cancer, remote monitoring of chronic conditions to predict exacerbations, smart clothes to guide physical therapy, and AI chatbots to answer emergency calls. A total of 1183 patients (51% response rate) were enrolled between May and June 2018. Overall, 20% considered that the benefits of technology (e.g., improving the reactivity in care and reducing the burden of treatment) greatly outweighed the dangers. Only 3% of participants felt that negative aspects (inadequate replacement of human intelligence, risks of hacking and misuse of private patient data) greatly outweighed potential benefits. We found that 35% of patients would refuse to integrate at least one existing or soon-to-be available intervention using BMDs and AI-based tools in their care. Accounting for patients' perspectives will help make the most of technology without impairing the human aspects of care, generating a burden or intruding on patients' lives.
Collapse
Affiliation(s)
- Viet-Thi Tran
- METHODS Team, Center for Research in Epidemiology and StatisticS (CRESS) – Université Paris Descartes INSERM (UMR 1153), 1 Place du Parvis Notre Dame, 75004 Paris, France
- Paris Descartes University, 12 Rue de l’École de Médecine, 75006 Paris, France
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Place du Parvis Notre Dame, 75004 Paris, France
| | - Carolina Riveros
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Place du Parvis Notre Dame, 75004 Paris, France
| | - Philippe Ravaud
- METHODS Team, Center for Research in Epidemiology and StatisticS (CRESS) – Université Paris Descartes INSERM (UMR 1153), 1 Place du Parvis Notre Dame, 75004 Paris, France
- Paris Descartes University, 12 Rue de l’École de Médecine, 75006 Paris, France
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Place du Parvis Notre Dame, 75004 Paris, France
- Department of Epidemiology, Columbia University Mailman School of Public Health, 22W 168th St, New York, NY USA
| |
Collapse
|