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Yang ZJ, Liu Y, Liu YL, Qi B, Yuan X, Shi WX, Miao L. Osteoarthritis and hypertension: observational and Mendelian randomization analyses. Arthritis Res Ther 2024; 26:88. [PMID: 38632649 PMCID: PMC11022320 DOI: 10.1186/s13075-024-03321-w] [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: 02/05/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The association between osteoarthritis (OA) and hypertension is a subject of ongoing debate in observational research, and the underlying causal relationship between them remains elusive. METHODS This study retrospectively included 24,871 participants in the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2020. Weighted logistic regression was performed to investigate the connection between OA and hypertension. Additionally, Mendelian randomization (MR) analysis was conducted to explore the potential causal relationship between OA and hypertension. RESULTS In the NHANES data, after adjusting for multiple confounding factors, there was no significant relationship between OA and hypertension (OR 1.30, 95% CI, 0.97-1.73, P = 0.089). However, among males, OA appeared to be associated with a higher risk of hypertension (OR 2.25, 95% CI, 1.17-4.32, P = 0.019). Furthermore, MR results indicate no relationship between multiple OA phenotypes and hypertension: knee OA (IVW, OR 1.024, 95% CI: 0.931-1.126, P = 0.626), hip OA (IVW, OR 0.990, 95% CI: 0.941-1.042, P = 0.704), knee or hip OA (IVW, OR 1.005, 95% CI: 0.915-1.105, P = 0.911), and OA from UK Biobank (IVW, OR 0.796, 95% CI: 0.233-2.714, P = 0.715). Importantly, these findings remained consistent across different genders and in reverse MR. CONCLUSIONS Our study found that OA patients had a higher risk of hypertension only among males in the observational study. However, MR analysis did not uncover any causal relationship between OA and hypertension.
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Affiliation(s)
- Zhi-Jie Yang
- Departments of Cardiology, Liuzhou People's Hospital, 8 Wenchang Road, Liuzhou, Guangxi, 545006, People's Republic of China
| | - Yuan Liu
- Departments of Cardiology, Liuzhou People's Hospital, 8 Wenchang Road, Liuzhou, Guangxi, 545006, People's Republic of China
| | - Yan-Li Liu
- Departments of Cardiology, Liuzhou People's Hospital, 8 Wenchang Road, Liuzhou, Guangxi, 545006, People's Republic of China
| | - Bin Qi
- Departments of Cardiology, Liuzhou People's Hospital, 8 Wenchang Road, Liuzhou, Guangxi, 545006, People's Republic of China
| | - Xin Yuan
- Departments of Cardiology, Liuzhou People's Hospital, 8 Wenchang Road, Liuzhou, Guangxi, 545006, People's Republic of China
| | - Wan-Xin Shi
- Departments of Cardiology, Liuzhou People's Hospital, 8 Wenchang Road, Liuzhou, Guangxi, 545006, People's Republic of China
| | - Liu Miao
- Departments of Cardiology, Liuzhou People's Hospital, 8 Wenchang Road, Liuzhou, Guangxi, 545006, People's Republic of China.
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Park WY, Jeon K, Schmidt TS, Kondylakis H, Alkasab T, Dewey BE, You SC, Nagy P. Development of Medical Imaging Data Standardization for Imaging-Based Observational Research: OMOP Common Data Model Extension. J Imaging Inform Med 2024; 37:899-908. [PMID: 38315345 PMCID: PMC11031512 DOI: 10.1007/s10278-024-00982-6] [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] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 02/07/2024]
Abstract
The rapid growth of artificial intelligence (AI) and deep learning techniques require access to large inter-institutional cohorts of data to enable the development of robust models, e.g., targeting the identification of disease biomarkers and quantifying disease progression and treatment efficacy. The Observational Medical Outcomes Partnership Common Data Model (OMOP CDM) has been designed to accommodate a harmonized representation of observational healthcare data. This study proposes the Medical Imaging CDM (MI-CDM) extension, adding two new tables and two vocabularies to the OMOP CDM to address the structural and semantic requirements to support imaging research. The tables provide the capabilities of linking DICOM data sources as well as tracking the provenance of imaging features derived from those images. The implementation of the extension enables phenotype definitions using imaging features and expanding standardized computable imaging biomarkers. This proposal offers a comprehensive and unified approach for conducting imaging research and outcome studies utilizing imaging features.
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Affiliation(s)
- Woo Yeon Park
- Biomedical Informatics and Data Science, Johns Hopkins University, 855 N Wolfe St, Rangos 616, Baltimore, MD, USA.
| | - Kyulee Jeon
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Korea
| | - Teri Sippel Schmidt
- Biomedical Informatics and Data Science, Johns Hopkins University, 855 N Wolfe St, Rangos 616, Baltimore, MD, USA
| | - Haridimos Kondylakis
- Institute of Computer Science, Foundation of Research & Technology-Hellas (FORTH), Heraklion, Greece
| | - Tarik Alkasab
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Blake E Dewey
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Seng Chan You
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Korea
| | - Paul Nagy
- Biomedical Informatics and Data Science, Johns Hopkins University, 855 N Wolfe St, Rangos 616, Baltimore, MD, USA
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Karystianis G, Lukmanjaya W, Buchan I, Simpson P, Ginnivan N, Nenadic G, Butler T. An analysis of published study designs in PubMed prisoner health abstracts from 1963 to 2023: a text mining study. BMC Med Res Methodol 2024; 24:68. [PMID: 38494501 PMCID: PMC10944606 DOI: 10.1186/s12874-024-02186-6] [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: 08/28/2023] [Accepted: 02/20/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND The challenging nature of studies with incarcerated populations and other offender groups can impede the conduct of research, particularly that involving complex study designs such as randomised control trials and clinical interventions. Providing an overview of study designs employed in this area can offer insights into this issue and how research quality may impact on health and justice outcomes. METHODS We used a rule-based approach to extract study designs from a sample of 34,481 PubMed abstracts related to epidemiological criminology published between 1963 and 2023. The results were compared against an accepted hierarchy of scientific evidence. RESULTS We evaluated our method in a random sample of 100 PubMed abstracts. An F1-Score of 92.2% was returned. Of 34,481 study abstracts, almost 40.0% (13,671) had an extracted study design. The most common study design was observational (37.3%; 5101) while experimental research in the form of trials (randomised, non-randomised) was present in 16.9% (2319). Mapped against the current hierarchy of scientific evidence, 13.7% (1874) of extracted study designs could not be categorised. Among the remaining studies, most were observational (17.2%; 2343) followed by systematic reviews (10.5%; 1432) with randomised controlled trials accounting for 8.7% (1196) of studies and meta-analysis for 1.4% (190) of studies. CONCLUSIONS It is possible to extract epidemiological study designs from a large-scale PubMed sample computationally. However, the number of trials, systematic reviews, and meta-analysis is relatively small - just 1 in 5 articles. Despite an increase over time in the total number of articles, study design details in the abstracts were missing. Epidemiological criminology still lacks the experimental evidence needed to address the health needs of the marginalized and isolated population that is prisoners and offenders.
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Affiliation(s)
- George Karystianis
- School of Population Health, University of New South Wales, Sydney, Australia.
| | - Wilson Lukmanjaya
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Iain Buchan
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Paul Simpson
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Natasha Ginnivan
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Goran Nenadic
- School of Computer Science, University of Manchester, Manchester, UK
| | - Tony Butler
- School of Population Health, University of New South Wales, Sydney, Australia
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SCHUEMIE M, REPS J, BLACK A, DeFALCO F, EVANS L, FRIDGEIRSSON E, GILBERT JP, KNOLL C, LAVALLEE M, RAO GA, RIJNBEEK P, SADOWSKI K, SENA A, SWERDEL J, WILLIAMS RD, SUCHARD M. Health-Analytics Data to Evidence Suite (HADES): Open-Source Software for Observational Research. Stud Health Technol Inform 2024; 310:966-970. [PMID: 38269952 PMCID: PMC10868467 DOI: 10.3233/shti231108] [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] [Indexed: 01/26/2024]
Abstract
The Health-Analytics Data to Evidence Suite (HADES) is an open-source software collection developed by Observational Health Data Sciences and Informatics (OHDSI). It executes directly against healthcare data such as electronic health records and administrative claims, that have been converted to the Observational Medical Outcomes Partnership (OMOP) Common Data Model. Using advanced analytics, HADES performs characterization, population-level causal effect estimation, and patient-level prediction, potentially across a federated data network, allowing patient-level data to remain locally while only aggregated statistics are shared. Designed to run across a wide array of technical environments, including different operating systems and database platforms, HADES uses continuous integration with a large set of unit tests to maintain reliability. HADES implements OHDSI best practices, and is used in almost all published OHDSI studies, including some that have directly informed regulatory decisions.
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Affiliation(s)
- Martijn SCHUEMIE
- Observational Health Data Science and Informatics, New York, NY, USA
- Observational Health Data Analytics, Johnson & Johnson, Titusville, NJ, USA
- Department of Biostatistics, UCLA, Los Angeles, CA, USA
| | - Jenna REPS
- Observational Health Data Science and Informatics, New York, NY, USA
- Observational Health Data Analytics, Johnson & Johnson, Titusville, NJ, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Adam BLACK
- Observational Health Data Science and Informatics, New York, NY, USA
- Odysseus Data Services Inc., Cambridge, MA, USA
| | - Frank DeFALCO
- Observational Health Data Science and Informatics, New York, NY, USA
- Observational Health Data Analytics, Johnson & Johnson, Titusville, NJ, USA
| | - Lee EVANS
- Observational Health Data Science and Informatics, New York, NY, USA
- LTS Computing LLC, West Chester, PA, USA
| | - Egill FRIDGEIRSSON
- Observational Health Data Science and Informatics, New York, NY, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - James P. GILBERT
- Observational Health Data Science and Informatics, New York, NY, USA
- Observational Health Data Analytics, Johnson & Johnson, Titusville, NJ, USA
| | - Chris KNOLL
- Observational Health Data Science and Informatics, New York, NY, USA
- Observational Health Data Analytics, Johnson & Johnson, Titusville, NJ, USA
| | - Martin LAVALLEE
- Observational Health Data Science and Informatics, New York, NY, USA
- Virginia Commonwealth University, Richmond, VA, USA
| | - Gowtham A. RAO
- Observational Health Data Science and Informatics, New York, NY, USA
- Observational Health Data Analytics, Johnson & Johnson, Titusville, NJ, USA
| | - Peter RIJNBEEK
- Observational Health Data Science and Informatics, New York, NY, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Katy SADOWSKI
- Observational Health Data Science and Informatics, New York, NY, USA
- TrialSpark Inc., New York, NY, USA
| | - Anthony SENA
- Observational Health Data Science and Informatics, New York, NY, USA
- Observational Health Data Analytics, Johnson & Johnson, Titusville, NJ, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joel SWERDEL
- Observational Health Data Science and Informatics, New York, NY, USA
- Observational Health Data Analytics, Johnson & Johnson, Titusville, NJ, USA
| | - Ross D. WILLIAMS
- Observational Health Data Science and Informatics, New York, NY, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marc SUCHARD
- Observational Health Data Science and Informatics, New York, NY, USA
- Department of Biostatistics, UCLA, Los Angeles, CA, USA
- VA Informatics and Computing Infrastructure, Department of Veterans Affairs, Salt Lake City, UT, USA
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Abstract
Observational research designs enable clinicians to investigate topics for which randomized-controlled trials may be difficult to conduct. However, the lack of randomization in observational studies increases the likelihood of confounders introducing bias to study results. Analytical methods such as propensity score matching and regression analysis are employed to reduce the effects of such confounding, mainly by determining characteristics of patient groups and adjusting for measured confounders. Sensitivity analyses are subsequently applied to elucidate the extent to which study results could still be affected by unmeasured confounding. The E-value is one such approach. By presenting a value that quantifies the strength of unmeasured confounding necessary to negate the observed results, the E-value is a useful heuristic concept for assessing the robustness of observational studies. This article provides an introductory overview of how the E-value can be evaluated and presented in clinical research studies.
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Affiliation(s)
- William T Chung
- Clinical Research Assistant, Section of Plastic Surgery, Department of Surgery, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Kevin C Chung
- Professor of Surgery, Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.
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Prasad M, Batthish M, Beattie K, Berard R. A survey of Canadian adult rheumatologists' knowledge, comfort level, and barriers in assessing psychosocial needs of young adults with rheumatic diseases. Rheumatol Int 2023:10.1007/s00296-023-05337-y. [PMID: 37162528 PMCID: PMC10171159 DOI: 10.1007/s00296-023-05337-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/22/2023] [Indexed: 05/11/2023]
Abstract
To assess adult rheumatologists' comfort level, current practices, and barriers to provision of optimal care in supporting young adults with pediatric-onset rheumatic conditions in Canada. Survey questions were informed by literature review, a needs assessment, and using milestones listed by the Royal College of Physicians and Surgeons of Canada for the entrustable professional activities (EPAs) applicable to care for rheumatology patients transitioning to adult practice. The electronic survey was distributed to adult rheumatology members of the Canadian Rheumatology Association over 4 months. Four hundred and fifty-one rheumatologists received the survey, with a response rate of 15.2%. Most respondents were from Ontario and had been in practice ≥ 10 years. Three quarters reported a lack of training in transition care although the same proportion were interested in learning more about the same. Approximately 40% felt comfortable discussing psychosocial concerns such as gender identity, sexuality, contraception, drug and alcohol use, vaping, and mental health. Despite this, 45-50% reported not discussing vaping or gender identity at all. The most frequently reported barriers to providing transition care were lack of primary care providers, allied health support, and training in caring for this age group. Most adult rheumatologists lack formal training in transition care and view it as a barrier to providing care for this unique patient population. Future educational initiatives for adult rheumatology trainees should include issues pertaining to adolescents and young adults. More research is needed to assess the effectiveness of resources such as transition navigators in ensuring a successful transition process.
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Affiliation(s)
- Madhavi Prasad
- Department of Pediatrics, Western University, London, ON, Canada.
| | - Michelle Batthish
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Karen Beattie
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Roberta Berard
- Division of Rheumatology, Department of Pediatrics, Western University, London, ON, Canada
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Bertamini G, Perzolli S, Bentenuto A, Paolizzi E, Furlanello C, Venuti P. Child-therapist interaction features impact Autism treatment response trajectories. Res Dev Disabil 2023; 135:104452. [PMID: 36796270 DOI: 10.1016/j.ridd.2023.104452] [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] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Identifying mechanisms of change in Autism treatment may help explain response variability and maximize efficacy. For this, the child-therapist interaction could have a key role as stressed by developmental models of intervention, but still remains under-investigated. AIMS The longitudinal study of treatment response trajectories considering both baseline and child-therapist interaction features by means of predictive modeling. METHODS AND PROCEDURES N = 25 preschool children were monitored for one year during Naturalistic Developmental Behavioral Intervention. N = 100 video-recorded sessions were annotated with an observational coding system at four time points, to extract quantitative interaction features. OUTCOMES AND RESULTS Baseline and interaction variables were combined to predict response trajectories at one year, and achieved the best predictive performance. The baseline developmental gap, therapist's efficacy in child engagement, respecting children's timing after fast behavioral synchronization, and modulating the interplay to prevent child withdrawal emerged as key factors. Further, changes in interaction patterns in the early phase of the intervention were predictive of the overall response to treatment. CONCLUSIONS AND IMPLICATIONS Clinical implications are discussed, stressing the importance of promoting emotional self-regulation during intervention and the possible relevance of the first period of intervention for later response.
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Affiliation(s)
- Giulio Bertamini
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy; Department of Child and Adolescent Psychiatry, Pitie-Salpetriere University Hospital, Sorbonne University, 75013 Paris, France; Data Science for Health (DSH), Bruno Kessler Foundation, 38123 Trento, Italy; Institute for Ingelligent Systems and Robotics (ISIR), Sorbonne University, 75005 Paris, France.
| | - Silvia Perzolli
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Arianna Bentenuto
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Eleonora Paolizzi
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Cesare Furlanello
- Orobix Life Sciences, 24121 Bergamo, Italy; HK3Lab, 38068 Rovereto, Italy
| | - Paola Venuti
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
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Yan F, Yan S, Wang J, Cui Y, Chen F, Fang F, Cui W. Association between triglyceride glucose index and risk of cerebrovascular disease: systematic review and meta-analysis. Cardiovasc Diabetol 2022; 21:226. [PMID: 36324146 PMCID: PMC9632026 DOI: 10.1186/s12933-022-01664-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/12/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The triglyceride glucose (TyG) index, which is a new surrogate indicator of insulin resistance (IR), is thought to be associated with many diseases, such as cardiovascular disease, but its relationship with cerebrovascular disease is still controversial. METHODS The PubMed, EMBASE, Cochrane Library, Web of Science and Medline databases were searched until March 2022 to evaluate the association between the TyG index and cerebrovascular disease risk. A random‒effects model was used to calculate the effect estimates and 95% confidence intervals (CIs). RESULTS A total of 19 cohort studies and 10 case‒control/cross‒sectional studies were included in our study, which included 11,944,688 participants. Compared with a low TyG index, a higher TyG index increased the risk of cerebrovascular disease (RR/HR = 1.22, 95% CI [1.14, 1.30], P< 0.001; OR = 1.15, 95% CI [1.07, 1.23], P< 0.001). Furthermore, the results of the dose-response analysis of the cohort study demonstrated that the risk of cerebrovascular disease increased by 1.19 times per 1 mg/dl increment of the TyG index (relative risk = 1.19, 95% CI [1.13,1.25], P< 0.001). CONCLUSION TyG index is related to cerebrovascular disease. More data and basic research are needed to confirm the association.
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Affiliation(s)
- Feifei Yan
- grid.64924.3d0000 0004 1760 5735Department of Nutrition and Food Hygiene, School of Public Health, Jilin University, 1163 Xinmin Avenue, 130021 Changchun, P. R. China
| | - Shoumeng Yan
- grid.64924.3d0000 0004 1760 5735School of Nursing, Jilin University, 130021 Changchun, P. R. China
| | - Jing Wang
- grid.64924.3d0000 0004 1760 5735Department of Nutrition and Food Hygiene, School of Public Health, Jilin University, 1163 Xinmin Avenue, 130021 Changchun, P. R. China
| | - Yani Cui
- grid.64924.3d0000 0004 1760 5735Department of Nutrition and Food Hygiene, School of Public Health, Jilin University, 1163 Xinmin Avenue, 130021 Changchun, P. R. China
| | - Feinan Chen
- grid.64924.3d0000 0004 1760 5735Department of Nutrition and Food Hygiene, School of Public Health, Jilin University, 1163 Xinmin Avenue, 130021 Changchun, P. R. China
| | - Fang Fang
- grid.64924.3d0000 0004 1760 5735Department of Nutrition and Food Hygiene, School of Public Health, Jilin University, 1163 Xinmin Avenue, 130021 Changchun, P. R. China
| | - Weiwei Cui
- grid.64924.3d0000 0004 1760 5735Department of Nutrition and Food Hygiene, School of Public Health, Jilin University, 1163 Xinmin Avenue, 130021 Changchun, P. R. China
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Suissa S, Dell'Aniello S, Ernst P. Comparing initial LABA-ICS inhalers in COPD: Real-world effectiveness and safety. Respir Med 2021; 189:106645. [PMID: 34757243 DOI: 10.1016/j.rmed.2021.106645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Guidelines for the treatment of chronic obstructive pulmonary disease (COPD) patients with multiple exacerbations and eosinophilia recommend a long-acting beta2-agonist (LABA) and inhaled corticosteroid (ICS) combined inhaler, with no distinction between different agents. We compared the effectiveness and safety of budesonide-formoterol versus fluticasone-salmeterol on the incidence of exacerbations and pneumonia in a real-world clinical practice setting of COPD, particularly considering eosinophilia, an important marker for ICS effectiveness. METHODS We identified a cohort of patients with COPD, new users of a LABA-ICS during 2002-2018, age 50 or older, from the UK's CPRD database, and followed for one year. The hazard ratio (HR) of exacerbation and of pneumonia was estimated using the Cox regression model, weighted by fine stratification of the propensity score of treatment initiation. RESULTS The cohort included 24,973 of budesonide-formoterol and 61,251 initiators of fluticasone-salmeterol. The adjusted HR of a first moderate or severe exacerbation with budesonide-formoterol relative to fluticasone-salmeterol was 0.98 (95% CI: 0.95-1.01), while for severe exacerbation it was 0.92 (95% CI: 0.85-0.99). The HR of severe pneumonia with budesonide-formoterol was 0.76 (95% CI: 0.70-0.83), and was particularly decreased with higher blood eosinophil count, dropping to 0.62 (95% CI: 0.51-0.77) at >300 cells/μL. CONCLUSION In a real-world clinical setting of COPD treatment, a budesonide-formoterol inhaler was generally as effective at reducing the incidence of moderate-severe exacerbations as fluticasone-salmeterol. However, budesonide-formoterol was more effective than fluticasone-salmeterol at reducing the incidence of severe exacerbation and the risk of severe pneumonia, particularly in patients with higher blood eosinophil counts.
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Karlgren K, Dahlström A, Birkestam A, Drevstam Norling A, Forss G, Andersson Franko M, Cooper S, Leijon T, Paulsson C. The TEAM instrument for measuring emergency team performance: validation of the Swedish version at two emergency departments. Scand J Trauma Resusc Emerg Med 2021; 29:139. [PMID: 34544459 PMCID: PMC8454124 DOI: 10.1186/s13049-021-00952-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/08/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The Team Emergency Assessment Measure (TEAM) questionnaire is designed for rating the non-technical performance of emergency medical teams during emergencies, e.g., resuscitation or trauma management. Originally developed in Australia it has today been translated and validated into eleven languages, but a Swedish version is lacking. The aim was therefore to cross-culturally translate and evaluate the reliability and validity of the TEAM questionnaire in a Swedish health care setting. METHODS The instrument was forward and backward translated and adapted into a Swedish context according to established guidelines for cross-cultural adaptation of survey-based measures. The translated version was tested through 78 pairwise assessments of 39 high-priority codes at the emergency departments of two major hospitals. The raters observed the teams at work in real time and filled in the questionnaires immediately afterwards independently of each other. Psychometric properties of the instrument were evaluated. RESULTS The original instrument was translated by pairs of translators independently of each other and reviewed by an expert committee of researchers, nurses and physicians from different specialties, a linguist and one of the original developers of the tool. A few adaptations were needed for the Swedish context. A principal component factor analysis confirmed a single 'teamwork' construct in line with the original instrument. The Swedish version showed excellent reliability with a Cronbach's alpha of 0.955 and a mean inter-item correlation of 0.691. The mean item-scale correlation of 0.82 indicated high internal consistency reliability. Inter-rater reliability was measured by intraclass correlation and was 0.74 for the global score indicating good reliability. Individual items ranged between 0.52 and 0.88. No floor effects but ceiling effects were noted. Finally, teams displaying clear closed-loop communication had higher TEAM scores than teams with less clear communication. CONCLUSIONS Real time observations of authentic, high priority cases at two emergency departments show that the Swedish version of the TEAM instrument has good psychometric properties for evaluating team performance. The TEAM instrument is thus a welcome tool for assessing non-technical skills of emergency medical teams.
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Affiliation(s)
- Klas Karlgren
- Department of Research, Education, Development and Innovation, Södersjukhuset, 118 83 Stockholm, Sweden
- MINT, Department Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, 5063 Bergen, Norway
| | - Anders Dahlström
- Department of Research, Education, Development and Innovation, Södersjukhuset, 118 83 Stockholm, Sweden
- Department of Neonatology, Sachs’ Children and Youth Hospital, Stockholm, Sweden
| | - Anderz Birkestam
- Department of Emergency, 118 83 Södersjukhuset, Stockholm, Sweden
| | | | - Gustav Forss
- Department of Emergency, 118 83 Södersjukhuset, Stockholm, Sweden
| | - Mikael Andersson Franko
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Södersjukhuset, 118 83 Stockholm, Sweden
| | - Simon Cooper
- Health Innovation and Transformation Centre (HITC), School of Health, Federation University Australia, Room 113, Building 1, Berwick Campus, Clyde Road, Berwick, VIC 3922 Australia
| | - Thomas Leijon
- Department of Emergency Medicine,
Capio S:t Göran’s Hospital
, 112 81 Stockholm, Sweden
| | - Charlotta Paulsson
- Department of Emergency Medicine,
Capio S:t Göran’s Hospital
, 112 81 Stockholm, Sweden
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11
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Abstract
Several observational studies report decreased incidence of mortality and of exacerbations with aspirin use in patients with chronic obstructive pulmonary disease (COPD), with calls for a large randomized trial. Aspirin does have local and systemic pulmonary mechanisms of action that could make this drug beneficial in the treatment of COPD. However, the potential for biases in the observational studies has not been examined. We searched the literature for all observational studies reporting on the effect of aspirin in COPD patients on exacerbation and mortality. We reviewed the studies for the presence of time-related and other biases. We identified eight observational studies reporting an overall reduction in all-cause mortality or exacerbation with aspirin use of 21% (pooled rate ratio (RR) 0.79; 95% CI 0.71-0.86). We found two studies affected by immortal time bias (pooled RR 0.81; 95% CI 0.74-0.89), three studies affected by collider-stratification bias (pooled RR 0.66; 95% CI 0.55-0.79) and three that involved some exposure misclassification (pooled RR 0.85; 95% CI 0.78-0.92). Moreover, while adjusting for cardiovascular factors, six of the eight studies did not adjust for important markers of COPD severity and thus remain susceptible to confounding bias. In conclusion, all observational studies reporting on the effectiveness of aspirin on major outcomes of COPD are affected by biases known to exaggerate the effectiveness of a drug. As these studies cannot be used to support a beneficial effect for aspirin in COPD, it would be premature to consider a randomized trial to investigate this question until methodologically rigorous studies are available.
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Affiliation(s)
- Anirudh Bakshi
- Centre for Clinical Epidemiology, Lady Davis Institute-Jewish General Hospital; Departments of Epidemiology and Biostatistics, and Medicine, McGill University, Montreal, Quebec, Canada
| | - Samy Suissa
- Centre for Clinical Epidemiology, Lady Davis Institute-Jewish General Hospital; Departments of Epidemiology and Biostatistics, and Medicine, McGill University, Montreal, Quebec, Canada
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12
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Maarseveen TD, Maurits MP, Niemantsverdriet E, van der Helm-van Mil AHM, Huizinga TWJ, Knevel R. Handwork vs machine: a comparison of rheumatoid arthritis patient populations as identified from EHR free-text by diagnosis extraction through machine-learning or traditional criteria-based chart review. Arthritis Res Ther 2021; 23:174. [PMID: 34158089 PMCID: PMC8218515 DOI: 10.1186/s13075-021-02553-4] [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: 03/30/2021] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Electronic health records (EHRs) offer a wealth of observational data. Machine-learning (ML) methods are efficient at data extraction, capable of processing the information-rich free-text physician notes in EHRs. The clinical diagnosis contained therein represents physician expert opinion and is more consistently recorded than classification criteria components. Objectives To investigate the overlap and differences between rheumatoid arthritis patients as identified either from EHR free-text through the extraction of the rheumatologist diagnosis using machine-learning (ML) or through manual chart-review applying the 1987 and 2010 RA classification criteria. Methods Since EHR initiation, 17,662 patients have visited the Leiden rheumatology outpatient clinic. For ML, we used a support vector machine (SVM) model to identify those who were diagnosed with RA by their rheumatologist. We trained and validated the model on a random selection of 2000 patients, balancing PPV and sensitivity to define a cutoff, and assessed performance on a separate 1000 patients. We then deployed the model on our entire patient selection (including the 3000). Of those, 1127 patients had both a 1987 and 2010 EULAR/ACR criteria status at 1 year after inclusion into the local prospective arthritis cohort. In these 1127 patients, we compared the patient characteristics of RA cases identified with ML and those fulfilling the classification criteria. Results The ML model performed very well in the independent test set (sensitivity=0.85, specificity=0.99, PPV=0.86, NPV=0.99). In our selection of patients with both EHR and classification information, 373 were recognized as RA by ML and 357 and 426 fulfilled the 1987 or 2010 criteria, respectively. Eighty percent of the ML-identified cases fulfilled at least one of the criteria sets. Both demographic and clinical parameters did not differ between the ML extracted cases and those identified with EULAR/ACR classification criteria. Conclusions With ML methods, we enable fast patient extraction from the huge EHR resource. Our ML algorithm accurately identifies patients diagnosed with RA by their rheumatologist. This resulting group of RA patients had a strong overlap with patients identified using the 1987 or 2010 classification criteria and the baseline (disease) characteristics were comparable. ML-assisted case labeling enables high-throughput creation of inclusive patient selections for research purposes. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02553-4.
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Affiliation(s)
- T D Maarseveen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - M P Maurits
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - E Niemantsverdriet
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - T W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - R Knevel
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
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13
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Sivesind TE, Runion T, Branda M, Schilling LM, Dellavalle RP. Dermatologic Research Potential of the Observational Health Data Sciences and Informatics (OHDSI) Network. Dermatology 2021; 238:44-52. [PMID: 33735862 DOI: 10.1159/000514536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Observational Health Data Sciences and Informatics (OHDSI) network enables access to billions of deidentified, standardized health records and built-in analytics software for observational health research, with numerous potential applications to dermatology. While the use of the OHDSI has increased steadily over the past several years, review of the literature reveals few studies utilizing OHDSI in dermatology. To our knowledge, the University of Colorado School of Medicine is unique in its use of OHDSI for dermatology big data research. SUMMARY A PubMed search was conducted in August 2020, followed by a literature review, with 24 of the 72 screened articles selected for inclusion. In this review, we discuss the ways OHDSI has been used to compile and analyze data, improve prediction and estimation capabilities, and inform treatment guidelines across specialties. We also discuss the potential for OHDSI in dermatology - specifically, ways that it could reveal adherence to available guidelines, establish standardized protocols, and ensure health equity. Key Messages: OHDSI has demonstrated broad utility in medicine. Adoption of OHDSI by the field of dermatology would facilitate big data research, allow for examination of current prescribing and treatment patterns without clear best practice guidelines, improve the dermatologic knowledge base and, by extension, improve patient outcomes.
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Affiliation(s)
- Torunn Elise Sivesind
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado, USA,
| | - Taylor Runion
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, USA
| | - Megan Branda
- Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lisa M Schilling
- Department of Medicine, Data Science to Patient Value Program Aurora, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Quinn TJ, Burton JK, Carter B, Cooper N, Dwan K, Field R, Freeman SC, Geue C, Hsieh PH, McGill K, Nevill CR, Rana D, Sutton A, Rowan MT, Xin Y. Following the science? Comparison of methodological and reporting quality of covid-19 and other research from the first wave of the pandemic. BMC Med 2021; 19:46. [PMID: 33618741 PMCID: PMC7899793 DOI: 10.1186/s12916-021-01920-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/19/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Following the initial identification of the 2019 coronavirus disease (covid-19), the subsequent months saw substantial increases in published biomedical research. Concerns have been raised in both scientific and lay press around the quality of some of this research. We assessed clinical research from major clinical journals, comparing methodological and reporting quality of covid-19 papers published in the first wave (here defined as December 2019 to May 2020 inclusive) of the viral pandemic with non-covid papers published at the same time. METHODS We reviewed research publications (print and online) from The BMJ, Journal of the American Medical Association (JAMA), The Lancet, and New England Journal of Medicine, from first publication of a covid-19 research paper (February 2020) to May 2020 inclusive. Paired reviewers were randomly allocated to extract data on methodological quality (risk of bias) and reporting quality (adherence to reporting guidance) from each paper using validated assessment tools. A random 10% of papers were assessed by a third, independent rater. Overall methodological quality for each paper was rated high, low or unclear. Reporting quality was described as percentage of total items reported. RESULTS From 168 research papers, 165 were eligible, including 54 (33%) papers with a covid-19 focus. For methodological quality, 18 (33%) covid-19 papers and 83 (73%) non-covid papers were rated as low risk of bias, OR 6.32 (95%CI 2.85 to 14.00). The difference in quality was maintained after adjusting for publication date, results, funding, study design, journal and raters (OR 6.09 (95%CI 2.09 to 17.72)). For reporting quality, adherence to reporting guidelines was poorer for covid-19 papers, mean percentage of total items reported 72% (95%CI:66 to 77) for covid-19 papers and 84% (95%CI:81 to 87) for non-covid. CONCLUSIONS Across various measures, we have demonstrated that covid-19 research from the first wave of the pandemic was potentially of lower quality than contemporaneous non-covid research. While some differences may be an inevitable consequence of conducting research during a viral pandemic, poor reporting should not be accepted.
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Affiliation(s)
- Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, New Lister Building Campus, Alexandra Parade, Glasgow, G31 2ER, UK.
| | - Jennifer K Burton
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ben Carter
- Institute of Psychiatry, Psychology and Neuroscience Kings College London, London, UK
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kerry Dwan
- Cochrane Methods Support Unit, Cochrane, UK, Oxford, UK
| | - Ryan Field
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Suzanne C Freeman
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Claudia Geue
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Ping-Hsuan Hsieh
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK.,Tri-Service General Hospital, National Defence Medical Center, Taipei, Taiwan
| | - Kris McGill
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Clareece R Nevill
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Dikshyanta Rana
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Alex Sutton
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Martin Taylor Rowan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Yiqiao Xin
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
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15
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Abrahami D, Hudson M, Suissa S. Statins and lower mortality in rheumatic diseases: An effect of immortal time bias? Semin Arthritis Rheum 2020; 51:211-218. [PMID: 33385861 DOI: 10.1016/j.semarthrit.2020.11.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/26/2020] [Accepted: 11/12/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Randomized controlled trials of the effectiveness of statins on rheumatic disease outcomes have shown limited or no benefit. On the other hand, observational studies have reported remarkable effectiveness of statins at reducing mortality in patients with rheumatic diseases. We evaluated these observational studies for the presence of immortal time bias, which tends to exaggerate the effectiveness of drugs by creating a survival advantage for exposed patients. METHODS We searched PubMed for observational studies investigating the impact of statins in patients with common rheumatic diseases, including rheumatoid arthritis, osteoarthritis, lupus, ankylosing spondylitis, gout and systemic autoimmune diseases. Studies were included if estimates for all-cause mortality among statin users compared to non-users were reported. We evaluated each study for the presence of immortal time bias and estimated the impact of the bias on the published results. RESULTS We found eight observational studies investigating the impact of statins on mortality among patients with rheumatic diseases. Four studies were affected by the classical variant of immortal time bias, while the others introduced immortal time into the comparator via random-calendar date assignment. The studies with the classical form of immortal time bias, which tends to exaggerate drug effectiveness, reported protective effects of statins on mortality ranging from 13% to 57% reductions. In contrast, immortal time bias through random-calendar date assignment, which tends to play down the effectiveness by introducing immortal time in the comparator, reported 16% to 37% reductions in mortality. CONCLUSION Bias in observational studies may explain the discrepancy in findings with randomized controlled trials on the effectiveness of statins in patients with rheumatic diseases. Future observational studies will need to rely on incident and prevalent new-user designs that emulate randomized trials and avoid immortal time bias.
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Affiliation(s)
- Devin Abrahami
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Marie Hudson
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada; Division of Rheumatology, Jewish General Hospital, Montreal, Canada; Department of Medicine, McGill University, Montréal, Canada
| | - Samy Suissa
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Department of Medicine, McGill University, Montréal, Canada.
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16
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Lohse B, Satter E. Use of an Observational Comparative Strategy Demonstrated Construct Validity of a Measure to Assess Adherence to the Satter Division of Responsibility in Feeding. J Acad Nutr Diet 2021; 121:1143-1156.e6. [PMID: 33349573 DOI: 10.1016/j.jand.2020.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 10/30/2020] [Accepted: 11/11/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Currently developed parent feeding measures do not exclusively measure behaviors compatible with theoretical underpinnings of the Satter Division of Responsibility in Feeding for Children Aged 2 to 6 Years (sDOR.2-6y). A measure of adherence to sDOR.2-6y has been constructed and shown to have translational validity. OBJECTIVE To examine the construct validity of the 15 sDOR.2-6y items. DESIGN Observations from in-home mealtime video-capture in a household with a child aged 2 to 6 years were compared with parent sDOR.2-6y responses. One sDOR.2-6y item about mealtime regularity was compared with mealtime data provided in the Automated Self-Administered 24-Hour Dietary Assessment Tool that had been completed by a larger sample of parents that included the smaller sample of video-capture participants. PARTICIPANTS/SETTING Parents of preschool children aged 2 to 6 years in central Pennsylvania participated in Automated Self-Administered 24-Hour Dietary Assessment Tool online dietary assessment (n = 61) from May to November 2013 or in-home mealtime video-capture (n = 20) during October 2013 or both (n = 16). MAIN OUTCOME MEASURES Consensus of three trained sDOR coders of plausible parent sDOR.2-6y item responses after video viewing, parent responses to sDOR.2-6y items, and mealtime regularity from three Automated Self-Administered 24-Hour Dietary Assessment Tool recalls. STATISTICAL ANALYSIS Data analysis included identification of codeable 5-minute segments, coding by three sDOR experts, intraclass correlation coefficient, and determination of coder congruence to establish plausible sDOR.2-6y responses and comparison between coder-observed and parent sDOR.2-6y responses. RESULTS Video-capture participants were mostly women, White, and overweight with a mean ± standard deviation age of 35.3 ± 6.4 years. Postvideo debriefing supported the observed meal as typical in location, timing, and composition. Of 273 coding decisions, coder congruence was inadequate or dissonant for 3.7% and intraclass correlation coefficient was 0.81 (0.77 to 0.84; P < 0.001). Parent and congruent coder responses were in agreement for nearly 70% of the possible comparisons. Of the original 15 items, three were deemed not valid, nine of the remaining 12 were considered valid, and three could not be invalidated. CONCLUSIONS Congruence between observed and self-reported behaviors supported additional validation and scoring studies with the 12-item sDOR.2-6y to assess adherence of parents to sDOR.
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17
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Tingley K, Lamoureux M, Pugliese M, Geraghty MT, Kronick JB, Potter BK, Coyle D, Wilson K, Kowalski M, Austin V, Brunel-Guitton C, Buhas D, Chan AKJ, Dyack S, Feigenbaum A, Giezen A, Goobie S, Greenberg CR, Ghai SJ, Inbar-Feigenberg M, Karp N, Kozenko M, Langley E, Lines M, Little J, MacKenzie J, Maranda B, Mercimek-Andrews S, Mohan C, Mhanni A, Mitchell G, Mitchell JJ, Nagy L, Napier M, Pender A, Potter M, Prasad C, Ratko S, Salvarinova R, Schulze A, Siriwardena K, Sondheimer N, Sparkes R, Stockler-Ipsiroglu S, Trakadis Y, Turner L, Van Karnebeek C, Vallance H, Vandersteen A, Walia J, Wilson A, Wilson BJ, Yu AC, Yuskiv N, Chakraborty P. Evaluation of the quality of clinical data collection for a pan-Canadian cohort of children affected by inherited metabolic diseases: lessons learned from the Canadian Inherited Metabolic Diseases Research Network. Orphanet J Rare Dis 2020; 15:89. [PMID: 32276663 PMCID: PMC7149838 DOI: 10.1186/s13023-020-01358-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/09/2019] [Accepted: 03/17/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The Canadian Inherited Metabolic Diseases Research Network (CIMDRN) is a pan-Canadian practice-based research network of 14 Hereditary Metabolic Disease Treatment Centres and over 50 investigators. CIMDRN aims to develop evidence to improve health outcomes for children with inherited metabolic diseases (IMD). We describe the development of our clinical data collection platform, discuss our data quality management plan, and present the findings to date from our data quality assessment, highlighting key lessons that can serve as a resource for future clinical research initiatives relating to rare diseases. METHODS At participating centres, children born from 2006 to 2015 who were diagnosed with one of 31 targeted IMD were eligible to participate in CIMDRN's clinical research stream. For all participants, we collected a minimum data set that includes information about demographics and diagnosis. For children with five prioritized IMD, we collected longitudinal data including interventions, clinical outcomes, and indicators of disease management. The data quality management plan included: design of user-friendly and intuitive clinical data collection forms; validation measures at point of data entry, designed to minimize data entry errors; regular communications with each CIMDRN site; and routine review of aggregate data. RESULTS As of June 2019, CIMDRN has enrolled 798 participants of whom 764 (96%) have complete minimum data set information. Results from our data quality assessment revealed that potential data quality issues were related to interpretation of definitions of some variables, participants who transferred care across institutions, and the organization of information within the patient charts (e.g., neuropsychological test results). Little information was missing regarding disease ascertainment and diagnosis (e.g., ascertainment method - 0% missing). DISCUSSION Using several data quality management strategies, we have established a comprehensive clinical database that provides information about care and outcomes for Canadian children affected by IMD. We describe quality issues and lessons for consideration in future clinical research initiatives for rare diseases, including accurately accommodating different clinic workflows and balancing comprehensiveness of data collection with available resources. Integrating data collection within clinical care, leveraging electronic medical records, and implementing core outcome sets will be essential for achieving sustainability.
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Affiliation(s)
| | - Monica Lamoureux
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | | | - Michael T Geraghty
- University of Ottawa, Ottawa, Ontario, Canada
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Jonathan B Kronick
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Doug Coyle
- University of Ottawa, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Michael Kowalski
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Valerie Austin
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Daniela Buhas
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Alicia K J Chan
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah Dyack
- IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Annette Feigenbaum
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Alette Giezen
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharan Goobie
- IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Cheryl R Greenberg
- Health Sciences Centre Winnipeg, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shailly Jain Ghai
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | | | - Natalya Karp
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Mariya Kozenko
- Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Erica Langley
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Matthew Lines
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | | | - Jennifer MacKenzie
- Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Bruno Maranda
- Le centre hospitalier universitaire Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Connie Mohan
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Aizeddin Mhanni
- Health Sciences Centre Winnipeg, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Grant Mitchell
- Le centre hospitalier universitaire Ste-Justine, Montreal, Quebec, Canada
| | - John J Mitchell
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Laura Nagy
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Napier
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Amy Pender
- Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Murray Potter
- Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Chitra Prasad
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Suzanne Ratko
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Ramona Salvarinova
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andreas Schulze
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Komudi Siriwardena
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Neal Sondheimer
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Sparkes
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | | | - Yannis Trakadis
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Lesley Turner
- Janeway Children's Hospital, Memorial University, St John's, NL, Canada
| | - Clara Van Karnebeek
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hilary Vallance
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jagdeep Walia
- Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Ashley Wilson
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Brenda J Wilson
- Janeway Children's Hospital, Memorial University, St John's, NL, Canada
| | - Andrea C Yu
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Nataliya Yuskiv
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pranesh Chakraborty
- University of Ottawa, Ottawa, Ontario, Canada.
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.
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18
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Hodson J, Garros C, Jensen J, Duff JP, Garcia Guerra G, Joffe AR. Parental opinions regarding consent for observational research of no or minimal risk in the pediatric intensive care unit. J Intensive Care 2019; 7:60. [PMID: 31890222 PMCID: PMC6916229 DOI: 10.1186/s40560-019-0411-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/31/2019] [Indexed: 11/24/2022] Open
Abstract
Background The aim of the study was to determine opinions and knowledge regarding the process of obtaining informed consent to participate in observational research in pediatric intensive care. Methods Survey 1 asked decision makers what model(s) of consent was acceptable for each type of observational research both before and after background information. Survey 2 asked decision makers about the experience of being asked for consent to observational research, and knowledge regarding the consent process both before and after background information. Results Cooperation rate was 100/117 (85%). The proportion in favor of any of the offered alternatives to signed informed consent for observational research, after receiving all the background information, was 74-80%, lowest for observational prospective research with a minimal risk intervention 37/50 (74%; 95% CI 60–84%). The proportion who agreed they felt overwhelmed by being approached for consent to observational research was 26 (52%; 95% CI 39-65%). Most respondents (from 60 to 74%) felt they understood the concepts regarding observational research; however, after reading background information, most (from 60 to 74%) felt their understanding had improved “a great deal”. Conclusion Understanding of risk, practical difficulties, consent bias, and Research Ethics Board safeguards was poor. Future study is needed to confirm our finding that most agreed with alternative methods of consent for observational research.
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Affiliation(s)
- Jessica Hodson
- 1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stollery Children's Hospital and University of Alberta, Edmonton, Alberta Canada
| | - Christiana Garros
- 1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stollery Children's Hospital and University of Alberta, Edmonton, Alberta Canada
| | - Jodie Jensen
- 1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stollery Children's Hospital and University of Alberta, Edmonton, Alberta Canada
| | - Jonathan P Duff
- 1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stollery Children's Hospital and University of Alberta, Edmonton, Alberta Canada
| | - Gonzalo Garcia Guerra
- 1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stollery Children's Hospital and University of Alberta, Edmonton, Alberta Canada
| | - Ari R Joffe
- 1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stollery Children's Hospital and University of Alberta, Edmonton, Alberta Canada.,4-546 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada.,3John Dossetor Health Ethics Center, University of Alberta, Edmonton, Alberta Canada
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19
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Nicholson BD, Aveyard P, Bankhead CR, Hamilton W, Hobbs FDR, Lay-Flurrie S. Determinants and extent of weight recording in UK primary care: an analysis of 5 million adults' electronic health records from 2000 to 2017. BMC Med 2019; 17:222. [PMID: 31783757 PMCID: PMC6883613 DOI: 10.1186/s12916-019-1446-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/02/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Excess weight and unexpected weight loss are associated with multiple disease states and increased morbidity and mortality, but weight measurement is not routine in many primary care settings. The aim of this study was to characterise who has had their weight recorded in UK primary care, how frequently, by whom and in relation to which clinical events, symptoms and diagnoses. METHODS A longitudinal analysis of UK primary care electronic health records (EHR) data from 2000 to 2017. Descriptive statistics were used to summarise weight recording in terms of patient sociodemographic characteristics, health professional encounters, clinical events, symptoms and diagnoses. Negative binomial regression was used to model the likelihood of having a weight record each year, and Cox regression to the likelihood of repeated weight recording. RESULTS A total of 14,049,871 weight records were identified in the EHR of 4,918,746 patients during the study period, representing 26,998,591 person-years of observation. Around a third of patients had a weight record each year. Forty-nine percent of weight records were repeated within a year with an average time to a repeat weight record of 1.92 years. Weight records were most often taken by nursing staff (38-42%) and GPs (37-39%) as part of a routine clinical care, such as chronic disease reviews (16%), medication reviews (6-8%) and health checks (6-7%), or were associated with consultations for contraception (5-8%), respiratory disease (5%) and obesity (1%). Patient characteristics independently associated with an increased likelihood of weight recording were as follows: female sex, younger and older adults, non-drinkers, ex-smokers, low or high BMI, being more deprived, diagnosed with a greater number of comorbidities and consulting more frequently. The effect of policy-level incentives to record weight did not appear to be sustained after they were removed. CONCLUSION Weight recording is not a routine activity in UK primary care. It is recorded for around a third of patients each year and is repeated on average every 2 years for these patients. It is more common in females with higher BMI and in those with comorbidity. Incentive payments and their removal appear to be associated with increases and decreases in weight recording.
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Affiliation(s)
- B D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK.
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
| | - C R Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
| | - W Hamilton
- Medical School, University of Exeter, Exeter, UK
| | - F D R Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
| | - S Lay-Flurrie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
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20
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Abstract
Objective: The objective was to characterize psoriasis treatment patterns, including estimating persistence and describing subsequent events (i.e. switching and restarting) for all systemic therapies. Methods: This retrospective cohort study utilized Truven MarketScan databases from 1 January 2014 to 31 December 2016 to investigate persistence, switching and restarting in new users of systemic psoriasis medications. Descriptive statistics, time-to-event analyses and a Cox proportional hazards regression were conducted. Results: A total of 5205 patients met inclusion criteria. Regardless of treatment type, >50% lost persistence by 12 months. Patients newly initiating acitretin or non-TNF biologic experienced the highest loss of persistence (85.2%, 73.8%, respectively). Patients initiating a TNF-α inhibitor or apremilast experienced the lowest loss (51.8%, 56.4% respectively). Treatment type had a statistically significant effect on persistence loss (adjusted hazard ratio: 0.86, 95% CI: 0.81, 0.91). Restarting was the most commonly observed event for patients on an oral or biologic (60.2%, 79.9%, respectively). The most common switch from an oral was to a TNF-α inhibitor, while apremilast often followed biologics. Conclusion: Most patients lost persistence on initial treatment by 12 months, and the majority restarted treatment. This may indicate poor compliance or the cyclical nature of psoriasis. More patients switched from an oral to biologic than vice versa, likely due to formulary design and preference for orals. Studies are needed to investigate underlying reasons and patient characteristics that differentiate treatment utilization.
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Affiliation(s)
- Sara Higa
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington , Seattle , WA , USA
- Allergan Inc. , Irvine , CA , USA
| | - Beth Devine
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington , Seattle , WA , USA
| | | | | | | | - Aasthaa Bansal
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington , Seattle , WA , USA
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21
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Affiliation(s)
- Annamaria Iorio
- Cardiovascular Center, University Hospital and Health Services, Trieste, Italy; Cardiology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Gianfranco Sinagra
- Cardiovascular Center, University Hospital and Health Services, Trieste, Italy.
| | - Andrea Di Lenarda
- Cardiovascular Center, University Hospital and Health Services, Trieste, Italy.
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22
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Layton JB, Butler AM, Brookhart MA, Panozzo CA. Variation in rotavirus vaccination coding in state US Medicaid data. Vaccine 2019; 37:2892-2895. [PMID: 30876721 PMCID: PMC6510625 DOI: 10.1016/j.vaccine.2019.02.074] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/13/2019] [Accepted: 02/25/2019] [Indexed: 11/26/2022]
Abstract
Differences in state Medicaid policies and practices may result in variation in the recording of individual-level vaccination claims, which may present challenges for vaccination research using state Medicaid data. We describe differences in procedure coding for rotavirus vaccination in four states' Medicaid programs by identifying rotavirus vaccine-specific codes and oral vaccine administration codes. The proportion of vaccinated children with vaccine-specific and oral vaccine administration codes differed substantially across states: two states used vaccine-specific codes almost exclusively (95.9% and 99.0%); one had exclusively oral vaccine administration codes (>99.9%); another had a mixture (32.1% vaccine-specific codes, 40.0% oral vaccine administration codes, and 27.9% both). Depending on the research question, studies using Medicaid data in states without (or with incomplete) vaccine-specific coding may be infeasible. Prior to initiating research, investigators should carefully evaluate state Medicaid policies and patterns of vaccination uptake, as vaccine reimbursement policies and availability of vaccine claims may vary.
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Affiliation(s)
- J Bradley Layton
- RTI Health Solutions, Research Triangle Park, NC, USA; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Anne M Butler
- Departments of Medicine and Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
| | - M Alan Brookhart
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Catherine A Panozzo
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA.
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23
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Abstract
In the past, vitamins and minerals were used to cure deficiency diseases. Supplements nowadays are used with the aim of reducing the risk of chronic diseases of which the origins are complex. Dietary supplement use has increased in the UK over recent decades, contributing to the nutrient intake in the population, but not necessarily the proportion of the population that is sub-optimally nourished; therefore, not reducing the proportion below the estimated average requirement and potentially increasing the number at risk of an intake above the safety limits. The supplement nutrient intake may be objectively monitored using circulation biomarkers. The influence of the researcher in how the supplements are grouped and how the nutrient intakes are quantified may however result in different conclusions regarding their nutrient contribution, the associations with biomarkers, in general, and dose-response associations specifically. The diet might be sufficient in micronutrients, but lacking in a balanced food intake. Since public-health nutrition guidelines are expressed in terms of foods, there is potentially a discrepancy between the nutrient-orientated supplement and the quality of the dietary pattern. To promote health, current public-health messages only advocate supplements in specific circumstances, but not in optimally nourished populations.
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Mueller S, Gottschalk F, Groth A, Meeraus W, Driessen M, Kohlmann T, Wilke T. Primary data, claims data, and linked data in observational research: the case of COPD in Germany. Respir Res 2018; 19:161. [PMID: 30165860 DOI: 10.1186/s12931-018-0865-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/15/2018] [Indexed: 01/23/2023] Open
Abstract
Background Real-world evidence (RWE) can inform patient management decisions, but RWE studies are associated with limitations. Linkage of different RWE data types could address such limitations by enriching data and improving scientific quality. Using the example of chronic obstructive pulmonary disease (COPD) in Germany, this study assessed the value of data linkage between primary and secondary data sources for RWE. Methods Post hoc analysis of data from an observational RWE study, which used prospectively collected data and data from an insurance claims database to assess treatment adherence and persistence in patients with COPD in Germany. Patient-level primary data were collected from the prospective observational study (primary dataset, N = 636), and claims data from the sickness fund AOK Nordost (claims dataset, N = 74,916). Primary and claims data were linked at a patient level using insurance numbers (linked dataset). Patients in the linked dataset were indexed at date of study inclusion for primary data and matched calendar date for claims data. Agreement between primary and claims data was examined for patients in the linked dataset based on comparisons between recorded sociodemographic data at index, comorbidities (primary: any recorded; claims: pre-index), prescriptions for COPD therapies (type and date) and exacerbations in the 12-month post-index period. Results The linked dataset included primary and claims data for 536 patients. Fewer comorbid patients were reported in primary data compared with claims data (p < 0.001), with overall agreement between 63.6% (hypertension) and 90.5% (osteoporosis). Number of prescriptions for COPD therapies per patient was lower in primary versus claims data (3.7 vs 10.3 prescriptions, respectively), with only 24.5% of prescriptions recorded in both datasets. Only 11.5% of exacerbations (moderate or severe) were recorded in both datasets, with 15.5% recorded only in primary data and 73.0% recorded only in claims data. Conclusion Our study highlighted discrepancies between primary and claims data capture for this population of German patients with COPD, with lower reporting of comorbidities, COPD therapy prescriptions and exacerbations in primary versus claims data. Study findings suggest that data linkage of primary and claims data could provide enrichment and be useful in fully describing COPD endpoints. Electronic supplementary material The online version of this article (10.1186/s12931-018-0865-1) contains supplementary material, which is available to authorized users.
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Abstract
OBJECTIVE To demonstrate regression to the mean bias introduced by matching on preperiod variables in difference-in-differences studies. DATA SOURCES Simulated data. STUDY DESIGN We performed a Monte Carlo simulation to estimate the effect of a placebo intervention on simulated longitudinal data for units in treatment and control groups using unmatched and matched difference-in-differences analyses. We varied the preperiod level and trend differences between the treatment and control groups, and the serial correlation of the matching variables. We assessed estimator bias as the mean absolute deviation of estimated program effects from the true value of zero. PRINCIPAL FINDINGS When preperiod outcome level is correlated with treatment assignment, an unmatched analysis is unbiased, but matching units on preperiod outcome levels produces biased estimates. The bias increases with greater preperiod level differences and weaker serial correlation in the outcome. This problem extends to matching on preperiod level of a time-varying covariate. When treatment assignment is correlated with preperiod trend only, the unmatched analysis is biased, and matching units on preperiod level or trend does not introduce additional bias. CONCLUSIONS Researchers should be aware of the threat of regression to the mean when constructing matched samples for difference-in-differences. We provide guidance on when to incorporate matching in this study design.
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Affiliation(s)
- Jamie R Daw
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Laura A Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, MA
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26
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Affiliation(s)
- Axel Finckh
- Département des spécialités de médecine interne, service de rhumatologie, hôpitaux universitaires de Genève (HUG), 26, avenue Beau-Séjour, 1211 Geneva 14, Switzerland.
| | - Delphine Courvoisier
- Département des spécialités de médecine interne, service de rhumatologie, hôpitaux universitaires de Genève (HUG), 26, avenue Beau-Séjour, 1211 Geneva 14, Switzerland
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Vertosick EA, Assel M, Vickers AJ. A systematic review of instrumental variable analyses using geographic region as an instrument. Cancer Epidemiol 2017; 51:49-55. [PMID: 29035744 DOI: 10.1016/j.canep.2017.10.005] [Citation(s) in RCA: 2] [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: 04/04/2017] [Revised: 09/12/2017] [Accepted: 10/07/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Instrumental variables analysis is a methodology to mitigate the effects of measured and unmeasured confounding in observational studies of treatment effects. Geographic area is increasingly used as an instrument. METHODS We conducted a literature review to determine the properties of geographic area in studies of cancer treatments. We identified cancer studies performed in the United States which incorporated instrumental variable analysis with area-wide treatment rate within a geographic region as the instrument. We assessed the degree of treatment variability between geographic regions, assessed balance of measured confounders afforded by geographic area and compared the results of instrumental variable analysis to those of multivariable methods. RESULTS Geographic region as an instrument was relatively common, with 22 eligible studies identified, many of which were published in high-impact journals. Treatment rates did not vary greatly by geographic region. Covariates were not balanced by the instrument in the majority of studies. Eight out of eleven studies found statistically significant effects of treatment on multivariable analysis but not for instrumental variables, with the central estimates of the instrumental variables analysis generally being closer to the null. CONCLUSIONS We recommend caution and an investigation of IV assumptions when considering the use of geographic region as an instrument in observational studies of cancer treatments. The value of geographic region as an instrument should be critically evaluated in other areas of medicine.
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Affiliation(s)
- Emily A Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY 10017, United States.
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY 10017, United States.
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY 10017, United States.
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28
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Crispin V, Bugge C, Stoddart K. Sufficiency and relevance of information for inpatients in general ward settings: A qualitative exploration of information exchange between patients and nurses. Int J Nurs Stud 2017; 75:112-122. [PMID: 28783488 DOI: 10.1016/j.ijnurstu.2017.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 05/24/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Information exchange as part of shared decision-making is widely discussed in research and policy literature as a means of improving patient involvement in treatment and care. To date information exchange between patients and nurses has not been explored in ward contexts. OBJECTIVE To explore the sufficiency of, and intentions behind, information exchanged by patients and nurses in surgical and medical ward settings using a recognised model of shared decision-making. DESIGN A multiple-case study design was used. Data were collected from 19 cases. Each case comprised one patient, the nurses interacting with that patient, the interactions between them, and their perceptions about the interactions. SETTINGS The study was undertaken across six surgical, six medical and one rehabilitation ward in a large teaching hospital in the United Kingdom. PARTICIPANTS Purposive sampling was used to first recruit nurses and then patients. Inclusion criteria included nurses registered with the Nursing and Midwifery Council, and patients who had been in hospital for more than 24h and who could consent to participating. Twenty-two nurses and 19 patients participated. METHODS Interactions from 19 cases were observed and audio-recorded. Individual interviews with patients and nurses followed, and were related to, the observed interactions. RESULTS Patients and nurses perceived they had exchanged sufficient information for their own needs including patient involvement, due to: information being shared previously and on an ongoing basis; having asked all their questions; therapeutic patient/nurse relationships; and, nurses speaking in lay terms. In contrast, the observational data suggested that insufficient information was exchanged between patients and nurses due to: lost opportunities for sharing information; paternalistic practice; and withholding information. CONCLUSION The elements of information exchange within a recognised model of shared decision-making do not adequately fit with patient/nurse interactions in ward settings. Participants generally perceived they had given and received enough information for their own needs. Therefore, the ways in which patients and nurses currently interact, could remain as they are. Policymakers should be aware of the varying contexts where healthcare staff work, and should promote information exchange and shared decision-making more strategically. Due to the complexities of patient/nurse interactions, consideration should be given to situation and context when applying these findings to practice.
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Affiliation(s)
- Vivianne Crispin
- University of Stirling, Bridge of Allan, Stirling, Scotland, FK9 4LA, UK.
| | - Carol Bugge
- University of Stirling, Bridge of Allan, Stirling, Scotland, FK9 4LA, UK
| | - Kathleen Stoddart
- University of Stirling, Bridge of Allan, Stirling, Scotland, FK9 4LA, UK
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29
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Duke JD, Ryan PB, Suchard MA, Hripcsak G, Jin P, Reich C, Schwalm MS, Khoma Y, Wu Y, Xu H, Shah NH, Banda JM, Schuemie MJ. Risk of angioedema associated with levetiracetam compared with phenytoin: Findings of the observational health data sciences and informatics research network. Epilepsia 2017; 58:e101-e106. [PMID: 28681416 DOI: 10.1111/epi.13828] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2017] [Indexed: 11/28/2022]
Abstract
Recent adverse event reports have raised the question of increased angioedema risk associated with exposure to levetiracetam. To help address this question, the Observational Health Data Sciences and Informatics research network conducted a retrospective observational new-user cohort study of seizure patients exposed to levetiracetam (n = 276,665) across 10 databases. With phenytoin users (n = 74,682) as a comparator group, propensity score-matching was conducted and hazard ratios computed for angioedema events by per-protocol and intent-to-treat analyses. Angioedema events were rare in both the levetiracetam and phenytoin groups (54 vs. 71 in per-protocol and 248 vs. 435 in intent-to-treat). No significant increase in angioedema risk with levetiracetam was seen in any individual database (hazard ratios ranging from 0.43 to 1.31). Meta-analysis showed a summary hazard ratio of 0.72 (95% confidence interval [CI] 0.39-1.31) and 0.64 (95% CI 0.52-0.79) for the per-protocol and intent-to-treat analyses, respectively. The results suggest that levetiracetam has the same or lower risk for angioedema than phenytoin, which does not currently carry a labeled warning for angioedema. Further studies are warranted to evaluate angioedema risk across all antiepileptic drugs.
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Affiliation(s)
- Jon D Duke
- Observational Health Data Sciences and Informatics (OHDSI) Collaborative.,Georgia Tech Research Institute, Atlanta, Georgia, U.S.A
| | - Patrick B Ryan
- Observational Health Data Sciences and Informatics (OHDSI) Collaborative.,Janssen Research and Development, Raritan, New Jersey, U.S.A.,Columbia University, New York, New York, U.S.A
| | - Marc A Suchard
- Observational Health Data Sciences and Informatics (OHDSI) Collaborative.,University of California Los Angeles, Los Angeles, California, U.S.A
| | - George Hripcsak
- Observational Health Data Sciences and Informatics (OHDSI) Collaborative.,Columbia University, New York, New York, U.S.A
| | - Peng Jin
- Observational Health Data Sciences and Informatics (OHDSI) Collaborative.,Columbia University, New York, New York, U.S.A
| | - Christian Reich
- Observational Health Data Sciences and Informatics (OHDSI) Collaborative.,Quintiles-IMS, Cambridge, Massachusetts, U.S.A
| | - Marie-Sophie Schwalm
- Observational Health Data Sciences and Informatics (OHDSI) Collaborative.,Quintiles-IMS, Cambridge, Massachusetts, U.S.A
| | - Yuriy Khoma
- Observational Health Data Sciences and Informatics (OHDSI) Collaborative.,Odysseus Data Services Inc, Cambridge, Massachusetts U.S.A.,Lviv Polytechnic National University, Lviv, Ukraine
| | - Yonghui Wu
- Observational Health Data Sciences and Informatics (OHDSI) Collaborative.,The University of Texas Health Science Center at Houston, Houston, Texas, U.S.A
| | - Hua Xu
- Observational Health Data Sciences and Informatics (OHDSI) Collaborative.,The University of Texas Health Science Center at Houston, Houston, Texas, U.S.A
| | - Nigam H Shah
- Observational Health Data Sciences and Informatics (OHDSI) Collaborative.,Center for Biomedical Informatics Research, Stanford University, Stanford, California, U.S.A
| | - Juan M Banda
- Observational Health Data Sciences and Informatics (OHDSI) Collaborative.,Center for Biomedical Informatics Research, Stanford University, Stanford, California, U.S.A
| | - Martijn J Schuemie
- Observational Health Data Sciences and Informatics (OHDSI) Collaborative.,Janssen Research and Development, Raritan, New Jersey, U.S.A
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30
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Abstract
This study utilized observational and self-report data from 64 maritally satisfied and stable older couples to explore if there were meaningful differences in how couples approached marital disagreements. Using a typology approach to classify couples based on their behaviors in a 15-minute problem-solving interaction, findings revealed four types of couples: (1) problem solvers (characterized by both spouses' higher problem-solving skills and warmth), (2) supporters (characterized by both spouses' notable warmth), (3) even couples (characterized by both spouses' moderate problem-solving skills and warmth), and (4) cool couples (characterized by both spouses' greater negativity and lower problem-solving skills and warmth). Despite the differences in these behaviors, all couples had relatively high marital satisfaction and functioning. However, across nearly all indices, spouses in the cool couple cluster reported poorer marital functioning, particularly when compared to the problem solvers and supporters. These findings suggest that even modest doses of negativity (e.g., eye roll) may be problematic for some satisfied couples later in life. The implications of these typologies are discussed as they pertain to practitioners' efforts to tailor their approaches to a wider swath of the population.
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Affiliation(s)
- Amy Rauer
- Human Development and Family Studies, Auburn University, Auburn, AL
| | - Leah Williams
- Human Development and Family Studies, Auburn University, Auburn, AL
| | - Jakob Jensen
- Child Development and Family Relations, East Carolina University, Greenville, NC
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31
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Droste N, Miller P, Pennay A, Zinkiewicz L, Lubman DI. Environmental contexts of combined alcohol and energy drink use: Associations with intoxication in licensed venues. Int J Drug Policy 2016; 36:58-66. [PMID: 27497238 DOI: 10.1016/j.drugpo.2016.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 05/21/2016] [Accepted: 06/30/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Environmental factors inside licensed venues have been found to influence the intoxication levels and consumption practices of patrons. The consumption of alcohol mixed with energy drinks (AmED) occurs primarily at or prior to attending licensed venues, however there is a lack of in situ research investigating AmED use in these contexts. Given that AmED use has been linked with increased alcohol consumption, intoxication, illicit substance use, and risk taking behaviours, this paper explores the environmental correlates and levels of intoxication associated with AmED use in licensed venues. METHODS Structured observations were undertaken in five Australian cities on Friday and Saturday nights. Covert teams spent 4-5h in venues and recorded hourly observations on patron, venue, and staff characteristics, alcohol, illicit drug and AmED consumption patterns and intoxication levels. RESULTS 898 hourly observations were recorded across 68 venues. All but one venue served energy drinks, and patron AmED use was observed during 34.9% of hourly records. AmED use was more prevalent after 12am and in nightclub venues compared to bars and pubs, and was positively associated with high intoxication levels, illicit drug use, and younger crowds. After controlling for environmental factors (i.e. venue crowding, service practices, venue characteristics, patron demographics and behaviour) AmED use did not predict high intoxication at a venue level in multivariable models. CONCLUSION AmED consumption is ubiquitous in the licensed venues of Australian night-time entertainment districts, particularly busy nightclub venues where intoxication and risky consumption are heightened. However, AmED use was not associated with high patron intoxication when environmental factors were considered.
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Affiliation(s)
- Nicolas Droste
- School of Psychology, Deakin University, Level 3, 27 Brougham St, Geelong, Victoria, Australia.
| | - Peter Miller
- School of Psychology, Deakin University, Level 3, 27 Brougham St, Geelong, Victoria, Australia
| | - Amy Pennay
- Centre for Alcohol Policy Research, La Trobe University, 215 Franklin Street, Melbourne, VIC 3000, Australia
| | - Lucy Zinkiewicz
- School of Psychology, Deakin University, Level 3, 27 Brougham St, Geelong, Victoria, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, 54-62 Gertrude St, Fitzroy, Victoria 3065, Australia; Eastern Health Clinical School, Monash University, Clayton, Victoria 3168, Australia
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Peters BJM, Janssen VEMT, Schramel FM, van de Garde EMW. Quantitative and qualitative assessment of real world data comparative effectiveness research of systemic therapies in lung oncology: A systematic review. Cancer Epidemiol 2016; 44:5-15. [PMID: 27449577 DOI: 10.1016/j.canep.2016.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/15/2016] [Accepted: 07/11/2016] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The growing interest in comparative effectiveness research (CER) based on data from routine clinical practice also extends towards lung oncology. Although CER studies using real world data (RWD) have the potential to assist clinical decision-making, concerns about the quality and validity of studies with observational data subsist. The primary objective of the present study is to assess the current status of observational CER in the field of lung oncology, both quantitatively as qualitatively. METHODS We performed a systematic electronic literature database search in MEDLINE and EMBASE (up to 1 July 2015). The quality of all selected studies was assessed according to the Good ReseArch for Comparative Effectiveness (GRACE) checklist. RESULTS The first selection included 657 publications. After screening the corresponding abstracts and full-text papers, 38 studies remained. A total of 36 studies included patients with advanced NSCLC. The comparison of the effectiveness of gefitinib versus erlotinib was the main objective in 22% of the studies. The median number of patients per study was 202 (range 21-10064). The number of publications increased over the years whereas the quality score remained stable over the years with several common shortcomings (checklist items M5, D1, D4, D6). DISCUSSION The growing interest in clinical oncology CER studies using RWD is reflected in an increasing number of publications in the recent years. The studies have several common methodological shortcomings possibly limiting their applicability in clinical decision-making. To fulfil the promise of RWD CER in lung oncology effort should be continued to overcome these shortcomings.
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Affiliation(s)
- Bas J M Peters
- Department of Clinical Pharmacy, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands; Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands.
| | - Vivi E M T Janssen
- Department of Clinical Pharmacy, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
| | - Franz M Schramel
- Department of Pulmonary Diseases, St Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
| | - Ewoudt M W van de Garde
- Department of Clinical Pharmacy, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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Datt J, Baldock L, Pull E, Webber B. The management and outcomes of fingolimod first dose cardiac monitoring in UK patients with relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2015; 5:40-6. [PMID: 26856942 DOI: 10.1016/j.msard.2015.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 07/27/2015] [Revised: 09/29/2015] [Accepted: 10/23/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients initiated on Gilenya (fingolimod) require cardiovascular monitoring for 6h after the first dose. Novartis has engaged an independent provider (Regent's Park Heart Clinics [RPHC]) to provide a first dose observation (FDO) service to UK neurologists. OBJECTIVES To describe routinely-documented clinical observations (heart rate [HR], blood pressure [BP], cardiac rhythm [CR]) and outcomes from the RPHC fingolimod FDO service. METHODS Pseudonymised data (clinical observations pre-dose and for 6h after the first dose and any requirement for extended monitoring) were collected retrospectively from RPHC records for the first 850 RPHC FDO episodes (undertaken Jul-2012 to Jan-2015). All episodes involved patients with relapsing-remitting MS who were initiated on fingolimod in routine National Health Service (NHS) clinical practice. RESULTS In 78% of FDO episodes the patient was female. Mean age at date of episode was 40.1 years. Mean HR was 72.7 bpm (beats per minute) pre-dose, 64.3 bpm at 5h (the lowest recorded HR) and 66.1 bpm at 6h post-dose. New-onset heart block was observed in 2% of episodes (1.5% first-degree; 0.5% second-degree). The patient was discharged at 6 hours post-dose in 97% of episodes and required extended monitoring in 3%. In 5 episodes overnight monitoring was required. There were no episodes in which the patient required pharmacological intervention or temporary cardiac pacing. CONCLUSIONS In this real-world UK population fingolimod initiation was predominantly uneventful; clinical observations were similar to previous clinical trials.
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Affiliation(s)
- Joe Datt
- Novartis Pharmaceuticals, Frimley Business Park, Frimley, Camberley, United Kingdom.
| | - Laura Baldock
- pH Associates Ltd, Derwent House, Dedmere Road, Marlow, United Kingdom.
| | - Emily Pull
- Novartis Pharmaceuticals, Frimley Business Park, Frimley, Camberley, United Kingdom.
| | - Bryn Webber
- Regent's Park Heart Clinics (RPHC), 52 Brook Street, Mayfair, London, United Kingdom.
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Dasenbrook EC, Konstan MW, VanDevanter DR. Association between the introduction of a new cystic fibrosis inhaled antibiotic class and change in prevalence of patients receiving multiple inhaled antibiotic classes. J Cyst Fibros 2014; 14:370-5. [PMID: 25496726 DOI: 10.1016/j.jcf.2014.11.005] [Citation(s) in RCA: 17] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/16/2014] [Accepted: 11/14/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND In 2010, aztreonam for inhalation solution joined aminoglycosides and colistimethate as a new cystic fibrosis (CF) chronic inhaled antimicrobial therapy. We studied how the introduction of this new inhaled antibiotic class changed the management of US CF patients. METHODS The use of inhaled aminoglycosides, colistimethate, and aztreonam among patients followed in the CF Foundation Patient Registry was analyzed by age group, lung disease stage, and microbiologic status both annually, and at individual visits between 2009 and 2012. RESULTS The overall prevalence of inhaled antibiotic use did not change during the period, but the prevalence of annual and any visit treatment with >1 inhaled antibiotic class more than doubled. Adults, those with advanced lung disease, and those with >1 Pseudomonas aeruginosa respiratory culture were more likely to receive >1 antibiotic class. CONCLUSIONS Inhaled antibiotic management of US CF patients has dramatically changed in association with the introduction of a third inhaled antibiotic class.
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Affiliation(s)
- Elliott C Dasenbrook
- Case Western Reserve University School of Medicine, Cleveland, OH, United States; Rainbow Babies and Children's Hospital, Cleveland, OH, United States.
| | - Michael W Konstan
- Case Western Reserve University School of Medicine, Cleveland, OH, United States; Rainbow Babies and Children's Hospital, Cleveland, OH, United States.
| | - Donald R VanDevanter
- Case Western Reserve University School of Medicine, Cleveland, OH, United States; Rainbow Babies and Children's Hospital, Cleveland, OH, United States.
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Abstract
We review traits of reusable clinical data and offer a typology of clinical repositories with a range of known examples. Sources of clinical data suitable for research can be classified into types reflecting the data's institutional origin, original purpose, level of integration and governance. Primary data nearly always come from research studies and electronic medical records. Registries collect data on focused populations primarily to track outcomes, often using observational research methods. Warehouses are institutional information utilities repackaging clinical care data. Collections organize data from more organizations than a data warehouse, and more original data sources than a registry. Therefore even if they are heavily curated, their level of internal integration, and thus ease of use, can be less than other types. Federations are like collections except that physical control over data is distributed among donor organizations. Federations sometimes federate, giving a second level of organization. While the size, in number of patients, varies widely within each type of data source, populations over 10 K are relatively numerous, and much larger populations can be seen in warehouses and federations. One imagined ideal structure for research progress has been called an "Information Commons". It would have longitudinal, multi-leveled (environmental through molecular) data on a large population of identified, consenting individuals. These are qualities whose achievement would require long term commitment on the part of many data donors, including a willingness to make their data public.
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Affiliation(s)
- Ted D Wade
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206-2761 USA
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Hoefeler H, Duran I, Hechmati G, Garzon Rodriguez C, Lüftner D, Ashcroft J, Bahl A, Atchison C, Wei R, Thomas E, Lorusso V. Health resource utilization associated with skeletal-related events in patients with bone metastases: Results from a multinational retrospective - prospective observational study - a cohort from 4 European countries. J Bone Oncol 2014; 3:40-8. [PMID: 26909296 DOI: 10.1016/j.jbo.2014.04.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 11/21/2022] Open
Abstract
Background Skeletal-related events (SREs; pathologic fracture, radiation or surgery to bone, spinal cord compression) frequently occur in patients with advanced cancer with bone metastases/lesions. Limited data on the associated patient and economic burden are available to aid in resource planning and evaluating treatment options. Methods Patients with bone metastases/lesions secondary to breast, lung or prostate cancer or multiple myeloma; with at least one SRE within 97 days prior to enrollment; life expectancy of at least 6 months; and Eastern Cooperative Oncology Group performance status 0, 1 or 2 were recruited. Information on health resource utilization (HRU; including number/duration of hospitalizations, outpatient visits, procedures), attributed by investigators to be associated with a SRE, was collected retrospectively for up to 97 days prior to enrollment and prospectively for up to 18–21 months. Results A total of 631 patients contributing 1282 SREs, were enrolled across Germany, Italy, Spain and the United Kingdom. Approximately a third of all SREs required an inpatient stay. Mean duration of inpatient stay for patients with SREs requiring one ranged from 8.4 to 41.1 days across all countries and SRE types. Conclusion All types of SREs are associated with substantial HRU burden. Preventing SREs by using the best therapeutic options available may help to reduce the burden to patients and healthcare systems. Patients with bone metastases frequently experience skeletal-related events (SREs). We used prospective and retrospective data to examine health resource utilization. All types of SREs required substantial resource use. Therapies that prevent SREs could reduce the burden on healthcare systems.
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