1
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Bharmal M, Katsoulis I, Chang J, Graham A, Stavropoulou A, Jhingran P, Pashos CL. Real-world evidence in the reassessment of oncology therapies: payer perceptions from five countries. Future Oncol 2024. [PMID: 38573230 DOI: 10.2217/fon-2023-1004] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Aim: This study explored the perceived value of real-world evidence (RWE) in the reassessment of oncology therapies by collecting the perspectives of health technology assessment/payer decision-makers. Materials & methods: A web-based survey was conducted using the Market Access Transformation Rapid Payer Response online portal. 30 participants from France, Germany, Spain, the UK and the USA were recruited based on their expertise. Results: Participants agreed that the most common uses of RWE are to confirm efficacy and safety results from randomized controlled trials and to reevaluate the projected utilization of an oncology therapy. We found variability in other reported uses of RWE. Conclusion: The organizations developing RWE should ensure that their plans recognize the heterogeneity in payer perceptions.
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Affiliation(s)
- Murtuza Bharmal
- Global Evidence & Value Development Oncology, EMD Serono, Inc., Rockland, MA 02370, USA, an affiliate of Merck KGaA
| | | | - Jane Chang
- Value & Evidence, Pfizer, New York, NY 10001-2192, USA
| | - Alex Graham
- Market Access Transformation, Fleet, GU51 2UJ, UK
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2
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Lee SC, Babchishin KM, Mularczyk KP, Hanson RK. Dynamic Risk Scales Degrade Over Time: Evidence for Reassessments. Assessment 2024; 31:698-714. [PMID: 37264628 DOI: 10.1177/10731911231177227] [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] [Indexed: 06/03/2023]
Abstract
Risk tools containing dynamic (potentially changeable) factors are routinely used to evaluate the recidivism risk of justice-involved individuals. Although frequent reassessments are recommended, there is little research on how the predictive accuracy of dynamic risk assessments changes over time. This study examined the extent to which predictive accuracy decreases over time for the ACUTE-2007 and the STABLE-2007 sexual recidivism risk tools. We used two independent samples of men on community supervision (NStudy 1 = 795; NStudy 2 = 4,221). For all outcomes (sexual, violent, and any recidivism [including technical violations]), reassessments improved predictive accuracy, with the largest effects found for the most recent assessment (i.e., those closest in time prior to the recidivism event). Based on these results, we recommend that ACUTE-2007 assessments occur at least every 30 days and that the STABLE-2007 assessments occur every 6 months or after significant life changes (e.g., successful completion of treatment).
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Affiliation(s)
- Seung C Lee
- Public Safety Canada, Ottawa, Ontario, Canada
- Carleton University, Ottawa, Ontario, Canada
| | | | - Kimberly P Mularczyk
- Carleton University, Ottawa, Ontario, Canada
- BC Corrections, Victoria, British Columbia, Canada
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3
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de Roos MS, Lloyd CD, Serin RC. General Criminal Dynamic Risk and Strength Factors Predict Short-Term General Recidivism Outcomes Among People Convicted of Sexual Crime During Community Supervision. Sex Abuse 2023; 35:981-1008. [PMID: 36527310 PMCID: PMC10647907 DOI: 10.1177/10790632221146499] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
There are clinical practice and operational reasons why it may be appropriate to primarily focus on general risk factors when supervising people convicted of sexual crime in the community. General risk domains may be particularly relevant when supervision officers engage in frequent reassessment of acute dynamic risk factors. We tested the ability of a case management tool, the Dynamic Risk Assessment for Offender Re-entry, to discriminate community based, short-term general (all outcome) recidivism versus nonrecidivism among people convicted of sexual crime (n = 562). We tested the predictive discrimination validity of each DRAOR item and then subscale scores in univariate and multivariate models (also controlling for general static risk). DRAOR scores were associated with general recidivism outcomes and effect sizes were generally similar or stronger compared to models with people convicted of nonsexual crime (n = 2854). DRAOR Acute scores were consistently and incrementally related to general recidivism outcomes beyond other scores. In practice, case managers should remain aware that people convicted of sexual crime are at risk for nonsexual recidivism outcomes and assess problematic functioning broadly alongside problems in sexual domains. Clinically, interconnection among domains potentially provides multiple avenues for effective intervention.
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Affiliation(s)
- Melissa S. de Roos
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Caleb D. Lloyd
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Alphington, VIC, Australia
| | - Ralph C. Serin
- Department of Psychology, Carleton University, Ottawa, ON, Canada
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4
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Baud F, Ladjouzi N, Ben Hassen J, El Omeiri N, Raveloson H, Brondin L, Ben Rahal C, Ould Ouali C, Zouloumis G, Schlatter J. Paracetamol prescriptions in older people hospitalized in a French geriatric hospital. Health Sci Rep 2023; 6:e1565. [PMID: 37732103 PMCID: PMC10507803 DOI: 10.1002/hsr2.1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- Frederic Baud
- Médecine gériatrique aigue, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
| | - Nadia Ladjouzi
- Médecine gériatrique aigue, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
| | - Jihène Ben Hassen
- Médecine gériatrique aigue, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
| | - Nesrine El Omeiri
- Médecine gériatrique aigue, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
| | - Hendriniainia Raveloson
- Médecine gériatrique aigue, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
| | - Lucile Brondin
- Médecine gériatrique aigue, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
| | - Camille Ben Rahal
- Médecine gériatrique aigue, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
| | - Cid Ould Ouali
- Service de soins et réadaptation, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
| | - Georges Zouloumis
- Service de long séjour, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
| | - Joël Schlatter
- Pharmacie, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
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5
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Elrobaa IH, Elmaasarawi A. Can Hot Weather Cause Non-ST Elevation Myocardial Infarction in Young Athletic Male Runners? Cureus 2023; 15:e42936. [PMID: 37565175 PMCID: PMC10411488 DOI: 10.7759/cureus.42936] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 08/12/2023] Open
Abstract
Athletes are a group of people who have good activity, regular muscular exercise, an almost standard lifestyle, and should be in good condition with low rates of medical, particularly cardiovascular, complications. However, cardiac attacks, sudden cardiac deaths, and fatal arrhythmogenic syndromes have been reported in athletes with low incidences. We can determine external and internal factors that lead to cardiac attacks in athletes. The former include abnormal cardiac structures and genetics, while the latter include environmental conditions like extreme temperatures, smoking, and drug abuse. Here, we report a case of a cardiac attack with non-ST elevation myocardial infarction (NSTEMI) in a young athlete who was a non-smoker, did not have any abnormal heart structures or a history of drug abuse, and did not have a family history of cardiac disease or arrest. High humidity levels and temperatures were the main causes of the cardiac attack, which occurred during a sports exercise at high temperatures with high humidity levels. We hope to prevent the recurrence of such a case. We need to understand when and where sports exercises can be performed without the risk of medical complications.
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Affiliation(s)
- Islam H Elrobaa
- College of Medicine, Qatar University, Doha, QAT
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
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6
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Graili P, Guertin JR, Chan KKW, Tadrous M. Integration of real-world evidence from different data sources in health technology assessment. J Pharm Pharm Sci 2023; 26:11460. [PMID: 37529633 PMCID: PMC10387532 DOI: 10.3389/jpps.2023.11460] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Abstract
Real-world evidence (RWE) is being increasingly used by a wide range of stakeholders involved in the therapeutic product lifecycle but remains underutilized in the health technology assessment (HTA) process. RWE aims to fill the current evidence gaps, reduce the uncertainty around the benefits of medical technologies, and better understand the long-term impact of health technologies in real-world conditions. Despite the minimal use of RWE in some elements of HTA, there has been a larger push to further utilize RWE in the HTA processes. HTA bodies, as other stakeholders, work towards developing more robust means to leverage RWE from various data sources in the HTA processes. However, these agencies need to overcome important challenges before the broader incorporation of RWE into their routine practice. This paper aims to explore the extensive integration of RWE utilizing diverse sources of RWD. We discuss the utilization of RWE in HTA processes, considering aspects such as when, where, and how RWE can be effectively applied. Additionally, we seek the potential challenges and barriers associated with the utilization of different data sources.
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Affiliation(s)
- Pooyeh Graili
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Quality HTA, Oakville, ON, Canada
| | - Jason R. Guertin
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec-Université Laval, Laval, QC, Canada
- Department of Social and Preventive Medicine, Université Laval, Laval, QC, Canada
- Tissue Engineering Laboratory (LOEX), Université Laval, Laval, QC, Canada
| | - Kelvin K. W. Chan
- Sunnybrook Health Science Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
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7
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Ball G, Levine MAH, Thabane L, Tarride JE. Health Technology Reassessment: Addressing Uncertainty in Economic Evaluations of Oncology Drugs at Time of Reimbursement Using Long-Term Clinical Trial Data. Curr Oncol 2023; 30:6596-6608. [PMID: 37504344 PMCID: PMC10378704 DOI: 10.3390/curroncol30070484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023] Open
Abstract
The evidence base to support reimbursement decision making for oncology drugs is often based on short-term follow-up trial data, and attempts to address this uncertainty are not typically undertaken once a reimbursement decision is made. To address this gap, we sought to conduct a reassessment of an oncology drug (pembrolizumab) for patients with advanced melanoma which was approved based on interim data with a median 7.9 months of follow-up and for which long-term data have since been published. We developed a three-health-state partitioned survival model based on the phase 3 KEYNOTE-006 clinical trial data using patient-level data reconstruction techniques based on an interim analysis. We used a standard survival analysis and parametric curve fitting techniques to extrapolate beyond the trial follow-up time, and the model structure and inputs were derived from the literature. Five-year long-term follow-up data from the trial were then used to re-evaluate the cost-effectiveness of pembrolizumab versus ipilimumab for treatment of advanced melanoma. The best fitting parametric curves and corresponding survival extrapolations for reconstructed interim data and long-term data reconstructed from KEYNOTE-006 were different. An analysis of the 5 year long-term follow-up data generated a base case incremental cost-effectiveness ratio (ICER) that was 28% higher than the ICER based on interim trial data. Our findings suggest that there may be a trade-off between certainty and the ICER. Conducting health technology re-assessments of certain oncology products on the basis of longer-term data availability, especially for those health technology adoption decisions made based on immature clinical data, may be of value to decision makers.
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Affiliation(s)
- Graeme Ball
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Mitchell A H Levine
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada
- The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada
- The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada
- The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
- McMaster Chair in Health Technology Management, McMaster University, Hamilton, ON L8S 4L8, Canada
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8
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Badji S, Kavanagh A, Petrie D. The impact of Disability Insurance reassessment on healthcare use. Health Econ 2023; 32:1581-1602. [PMID: 37002833 PMCID: PMC10947330 DOI: 10.1002/hec.4680] [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] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/16/2023] [Accepted: 03/12/2023] [Indexed: 06/04/2023]
Abstract
Several Organisation for Economic Co-operation and Development countries have constrained Disability Income Insurance (DI) eligibility and reassessed those on DI to encourage workforce participation. But these policies can also have unintended consequences. While receiving less income can directly worsen physical and mental health, the stress related to reassessment and the possibility of losing DI may also adversely affect mental health. This paper uses Australian population-wide administrative data to explore how a 2014 policy - where DI recipients under 35 were reassessed under stricter criteria - affected healthcare use. We exploit this age targeting using a difference-in-difference regression design and find that the policy increased nervous system drug prescriptions (which includes antidepressants). Our findings suggest that the reassessment of DI recipients, even without income loss, may have had a significant negative impact on their mental health. DI reassessment policies may have the unintended consequence of worsening mental health and this needs be considered when deciding if reassessment is worthwhile.
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Affiliation(s)
- Samia Badji
- Centre for Health EconomicsMonash UniversityCaulfield EastVictoriaAustralia
| | - Anne Kavanagh
- Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Dennis Petrie
- Centre for Health EconomicsMonash UniversityCaulfield EastVictoriaAustralia
- Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
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9
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Fodor M, Woerdehoff A, Peter W, Esser H, Oberhuber R, Margreiter C, Maglione M, Cardini B, Resch T, Weissenbacher A, Sucher R, Zoller H, Tilg H, Öfner D, Schneeberger S. Reassessment of Relevance and Predictive Value of Parameters Indicating Early Graft Dysfunction in Liver Transplantation: AST Is a Weak, but Bilirubin and INR Strong Predictors of Mortality. Front Surg 2021; 8:693288. [PMID: 34869549 PMCID: PMC8634944 DOI: 10.3389/fsurg.2021.693288] [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: 04/10/2021] [Accepted: 10/27/2021] [Indexed: 01/14/2023] Open
Abstract
Introduction: Early graft dysfunction (EAD) complicates liver transplantation (LT). The aim of this analysis was to discriminate between the weight of each variable as for its predictive value toward patient and graft survival. Methods: We reviewed all LT performed at the Medical University of Innsbruck between 2007 and 2018. EAD was recorded when one of the following criteria was present: (i) aspartate aminotransferase (AST) levels >2,000 IU/L within the first 7 days, (ii) bilirubin levels ≥10mg/dL or (iii) international normalized ratio (INR) ≥1.6 on postoperative day 7. Results: Of 616 LT, 30.7% developed EAD. Patient survival did not differ significantly (P = 0.092; log rank-test = 2.87), graft survival was significantly higher in non-EAD patients (P = 0.008; log rank-test = 7.13). Bilirubin and INR on postoperative day 7 were identified as strong mortality predictors (Bilirubin HR = 1.71 [1.34, 2.16]; INR HR = 2.69 [0.51, 14.31]), in contrast to AST (HR = 0.91 [0.75, 1.10]). Similar results were achieved for graft loss estimation. A comparison with the Model for Early Allograft Function (MEAF) and the Liver Graft Assessment Following Transplantation (L-GrAFT) score identified a superior discrimination potential but lower specificity. Conclusion: Contrarily to AST, bilirubin and INR have strong predictive capacity for patient and graft survival. This fits well with the understanding, that bile duct injury and deprivation of synthetic function rather than hepatocyte injury are key factors in LT.
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Affiliation(s)
- Margot Fodor
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Adriana Woerdehoff
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Peter
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Hannah Esser
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Rupert Oberhuber
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Margreiter
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Manuel Maglione
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Benno Cardini
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Resch
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Annemarie Weissenbacher
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Robert Sucher
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University of Leipzig, Leipzig, Germany
| | - Heinz Zoller
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Tilg
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Öfner
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Schneeberger
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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10
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Dai WF, Craig E, Fraser B, Chambers A, Mai H, Brown MB, Earle CC, Evans WK, Geirnaert M, Taylor M, Trudeau M, Sperber D, Beca JM, Denburg A, Mercer RE, Parmar A, Tadrous M, Takhar P, Chan KKW. Building a National Reassessment Process for Oncology Drugs: Lessons Learned by the Canadian Real-World Evidence for Value of Cancer Drugs (CanREValue) Collaboration through a Simulated Reassessment Exercise. Curr Oncol 2021; 28:4645-4654. [PMID: 34898572 PMCID: PMC8628679 DOI: 10.3390/curroncol28060392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
The CanREValue Collaboration established the Reassessment & Uptake Working Group to develop a preliminary process to reassess funded cancer drugs in Canada. A simulated exercise was conducted to evaluate the proposed reassessment process using a real-world case. We invited 32 attendees including representatives from Health Canada and Health Technology Assessment (HTA) agencies, along with payers, clinicians, academics, and patient representatives. A case was developed using a real-world study on a publicly funded cancer drug. In facilitated group sessions, participants were asked to deliberate upon the evidence presented in the case to issue reassessment recommendations. Several themes were identified through the deliberation discussions. While the generalizability of real-world evidence (RWE) is perceived as a strength, trust in the RWE depends largely on the source of the real-world data. The attendees suggested several improvements to the proposed reassessment process including evidence requirement for reassessment, recommendation categories, and a priori study protocols. This exercise generated important insights on the evidence required for conducting reassessment and considerations for improvements of the proposed reassessment process. Building upon lessons from this exercise, future work would continue to refine the reassessment process as part of the overall CanREValue framework.
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Affiliation(s)
- Wei Fang Dai
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada;
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
| | - Erica Craig
- New Brunswick Cancer Network, Fredericton, NB E3B 5G8, Canada;
| | - Brent Fraser
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON K1S 5S8, Canada; (B.F.); (A.C.); (H.M.)
| | - Alex Chambers
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON K1S 5S8, Canada; (B.F.); (A.C.); (H.M.)
| | - Helen Mai
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON K1S 5S8, Canada; (B.F.); (A.C.); (H.M.)
| | - M. Bryson Brown
- Philosophy Department, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada;
| | - Craig C. Earle
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (C.C.E.); (M.T.); (A.P.)
| | - William K. Evans
- Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada;
- Ontario Health (CCO), Toronto, ON M5G 2L3, Canada;
| | | | | | - Maureen Trudeau
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (C.C.E.); (M.T.); (A.P.)
| | - Daniel Sperber
- Pan-Canadian Pharmaceutical Alliance, Toronto, ON M5S 2B1, Canada;
| | - Jaclyn M. Beca
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
- Ontario Health (CCO), Toronto, ON M5G 2L3, Canada;
| | - Avram Denburg
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Rebecca E. Mercer
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
- Ontario Health (CCO), Toronto, ON M5G 2L3, Canada;
| | - Ambica Parmar
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (C.C.E.); (M.T.); (A.P.)
| | - Mina Tadrous
- Women’s College Hospital, Toronto, ON M53 1B2, Canada;
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M53 3M2, Canada
| | - Pam Takhar
- Ontario Health (CCO), Toronto, ON M5G 2L3, Canada;
| | - Kelvin K. W. Chan
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada;
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
- Ontario Health (CCO), Toronto, ON M5G 2L3, Canada;
- Correspondence: ; Tel.: +1-416-480-4928
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11
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Dai WF, Arciero V, Craig E, Fraser B, Arias J, Boehm D, Bosnic N, Caetano P, Chambers C, Jones B, Lungu E, Mitera G, Potashnik T, Reiman A, Ritcher T, Beca JM, Denburg A, Mercer RE, Parmar A, Tadrous M, Takhar P, Chan KKW. Considerations for Developing a Reassessment Process: Report from the Canadian Real-World Evidence for Value of Cancer Drugs (CanREValue) Collaboration's Reassessment and Uptake Working Group. Curr Oncol 2021; 28:4174-4183. [PMID: 34677272 PMCID: PMC8534602 DOI: 10.3390/curroncol28050354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
The Canadian Real-world Evidence for Value in Cancer Drugs (CanREValue) Collaboration was established to develop a framework for generating and using real-world evidence (RWE) to inform the reassessment of cancer drugs following initial health technology assessment (HTA). The Reassessment and Uptake Working Group (RWG) is one of the five established CanREValue Working Groups. The RWG aims to develop considerations for incorporating RWE for HTA reassessment and strategies for using RWE to reassess drug funding decisions. Between February 2018 and December 2019, the RWG attended four teleconferences (with follow-up surveys) and two in-person meetings to discuss recommendations for the development of a reassessment process and potential barriers and facilitators. Modified Delphi methods were used to gather input. A draft report of recommendations (to December 2018) was shared for public consultation (December 2019 to January 2020). Initial considerations for developing a reassessment process were proposed. Specifically, reassessment can be initiated by diverse stakeholders, including decision makers from public drug plans or industry stakeholders. The reassessment process should be modelled after existing deliberation and recommendation frameworks used by HTA agencies. Proposed reassessment outcome categories include maintaining status quo, revisiting funding criteria, renegotiating price, or disinvesting. Overall, these initial considerations will serve as the basis for future advancements by the Collaboration.
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Affiliation(s)
- Wei Fang Dai
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (W.F.D.); (V.A.)
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
| | - Vanessa Arciero
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (W.F.D.); (V.A.)
| | - Erica Craig
- New Brunswick Cancer Network, Saint John, NB E2J 3S4, Canada;
| | - Brent Fraser
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON K1S 5S8, Canada; (B.F.); (T.R.)
| | - Jessica Arias
- Ontario Health (CCO), Toronto, ON M5G 2L7, Canada; (J.A.); (P.T.)
| | - Darryl Boehm
- Saskatchewan Cancer Agency, Regina, SK S4W 0G3, Canada;
| | - Nevzeta Bosnic
- Patented Medicine Prices Review Board, Ottawa, ON K1P 1C1, Canada; (N.B.); (E.L.); (T.P.)
| | | | | | | | - Elena Lungu
- Patented Medicine Prices Review Board, Ottawa, ON K1P 1C1, Canada; (N.B.); (E.L.); (T.P.)
| | - Gunita Mitera
- Canadian Association of Provincial Cancer Agencies, Toronto, ON M5H 1J9, Canada;
| | - Tanya Potashnik
- Patented Medicine Prices Review Board, Ottawa, ON K1P 1C1, Canada; (N.B.); (E.L.); (T.P.)
| | - Anthony Reiman
- Department of Medicine, Dalhousie University, Halifax, NS B3H 2Y9, Canada;
- Department of Biology, University of New Brunswick, Fredericton, NB E3B 5A3, Canada
- Department of Oncology, Saint John Regional Hospital, Saint John, NB E2L 42L, Canada
| | - Trevor Ritcher
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON K1S 5S8, Canada; (B.F.); (T.R.)
| | - Jaclyn M. Beca
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
- Ontario Health (CCO), Toronto, ON M5G 2L7, Canada; (J.A.); (P.T.)
| | - Avram Denburg
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Rebecca E. Mercer
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
- Ontario Health (CCO), Toronto, ON M5G 2L7, Canada; (J.A.); (P.T.)
| | - Ambica Parmar
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada;
| | - Mina Tadrous
- Women’s College Hospital, Toronto, ON M5S 1B2, Canada;
| | - Pam Takhar
- Ontario Health (CCO), Toronto, ON M5G 2L7, Canada; (J.A.); (P.T.)
| | - Kelvin K. W. Chan
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (W.F.D.); (V.A.)
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada;
- Correspondence:
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Bezabhe WM, Bereznicki LR, Radford J, Wimmer BC, Salahudeen MS, Garrahy E, Bindoff I, Peterson GM. Stroke risk reassessment and oral anticoagulant initiation in primary care patients with atrial fibrillation: A ten-year follow-up. Eur J Clin Invest 2021; 51:e13489. [PMID: 33426646 DOI: 10.1111/eci.13489] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/21/2020] [Accepted: 01/07/2021] [Indexed: 12/25/2022]
Abstract
AIM To examine the change in stroke risk over time and determine the proportion of patients with atrial fibrillation (AF) who were initiated on an oral anticoagulant (OAC) as their stroke risk increased from low/moderate to high, using the Australian general practice data set, MedicineInsight. METHODS A total of 2296 patients diagnosed with AF between 1 January 2007 and 31 December 2008, aged 18 years or older and not initiated on an OAC before 2009, were included. We assessed the change in stroke risk and the proportion of patients who had a recorded prescription of an OAC, each year from 1 January 2009 to 31 December 2018. RESULTS At baseline, 23.9%, 22.9% and 53.2% were categorised as being at low (score = 0), moderate (score = 1) and high stroke risk (score ≥ 2), respectively, using the sexless CHA2 DS2 -VASc (CHA2 DS2 -VA) score. Overall, the CHA2 DS2 -VA score increased by a mean of 1.34 (95% confidence interval, 1.29-1.39) points over the study period. Nearly two-thirds of patients (65%, 412/632) whose stroke risk changed from baseline low/moderate to high were subsequently prescribed an OAC. The median (interquartile range) lag time from becoming high stroke risk to having OAC initiation was 2 (5) years. CONCLUSIONS Nearly one-third of patients reclassified as being at high risk of stroke during the study period were not prescribed OAC therapy. Furthermore, the delay in OAC initiation following classification as being at high risk was a median of 2 years, suggesting that more frequent stroke reassessment is needed.
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Affiliation(s)
| | - Luke R Bereznicki
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Jan Radford
- Launceston Clinical School, Tasmanian School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Barbara C Wimmer
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Mohammed S Salahudeen
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Edward Garrahy
- Launceston Clinical School, Tasmanian School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Ivan Bindoff
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
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Pekacka-Egli AM, Kazmierski R, Lutz D, Pekacka-Falkowska K, Maszczyk A, Windisch W, Spielmanns M. Reassessment of Poststroke Dysphagia in Rehabilitation Facility Results in Reduction in Diet Restrictions. J Clin Med 2021; 10:1714. [PMID: 33921185 DOI: 10.3390/jcm10081714] [Citation(s) in RCA: 2] [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: 01/30/2021] [Revised: 03/28/2021] [Accepted: 04/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Dysphagia assessment in postacute stroke patients can decrease the incidence of complications like malnutrition, dehydration, and aspiration pneumonia. It also helps to avoid unnecessary diet restrictions. The aim of this study is to verify if regular reassessment of dysphagia would change the diet management of postacute stroke patients in rehabilitation settings. Methods: This single-center retrospective study included 63 patients referred to an inpatient neurological rehabilitation center between 2018–2019. A standardized clinical swallowing evaluation and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) were performed. Diet level according to Functional Oral Intake Scale (FOIS) was evaluated. As the primary endpoint, the FOIS values based on diagnostic procedures were assessed at hospital discharge, rehabilitation admission, and after FEES. Results: 19 women (30%) and 44 men (70%), with a mean age of 75 y (SD ± 10.08), were enrolled. The intergroup ANOVA revealed significant differences (p < 0.001) between dietary prescriptions in an acute care setting and following clinical and endoscopic reassessment in the rehabilitation center. Diet recommendations changed in 41 of 63 (65%) enrolled patients (p < 0.001). Conclusion: Instrumental diagnostic by FEES during the early convalescence period of stroke patients leads to clinically relevant changes to diet restrictions and lower rates of pneumonia. Our findings underline the need for regular and qualitative dysphagia diagnostics in stroke patients participating in neurological rehabilitation.
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Davies ST, Lloyd CD, Polaschek DLL. Does Reassessment Enhance the Prediction of Imminent Criminal Recidivism? Replicating Lloyd et al. (2020) With High-Risk Parolees. Assessment 2021; 29:962-980. [PMID: 33631949 DOI: 10.1177/1073191121993216] [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] [Indexed: 11/15/2022]
Abstract
Lloyd et al. (2020) proposed and tested a novel three-step framework for examining the extent to which reassessment of dynamic risk and protective factors enhances the prediction of imminent criminal recidivism. We conducted a conceptual replication of Lloyd et al.'s study. We used the same dynamic risk assessment measure in the same jurisdiction but, unlike Lloyd et al., our sample comprised solely high-risk men on parole in New Zealand (N = 966), the individuals who are most frequently reassessed in the community and most likely to imminently reoffend. The results of the previous study were largely reproduced: reassessment consistently enhanced prediction, with the most pronounced effects observed for a scale derived from theoretically acute dynamic risk factors. These findings indicate reassessment effects are robust to sample selection based on a narrower range of risk levels and remain robust across years of practice in applied contexts, despite potential organizational drift from initial training and reassessment fatigue. The findings also provide further support for the practice of ongoing risk reassessment in community supervision and suggest that the method proposed by Lloyd et al. is a replicable approach for testing the essential criteria for defining dynamic risk and protective factors.
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Affiliation(s)
| | - Caleb D Lloyd
- Swinburne University of Technology and Forensicare, Alphington, Victoria, Australia
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15
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Hofmann B. Internal barriers to efficiency: why disinvestments are so difficult. Identifying and addressing internal barriers to disinvestment of health technologies. Health Econ Policy Law 2021; 16:473-88. [PMID: 33563362 DOI: 10.1017/S1744133121000037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Although efficiency is a core concept in health economics, its impact on health care practice still is modest. Despite an increased pressure on resource allocation, a widespread use of low-value care is identified. Nonetheless, disinvestments are rare. Why is this so? This is the key question of this paper: why are disinvestments not more prevalent and improving the efficiency of the health care system, given their sound foundation in health economics, their morally important rationale, the significant evidence for a long list of low-value care and available alternatives? Although several external barriers to disinvestments have been identified, this paper looks inside us for mental mechanisms that hamper rational assessment, implementation, use and disinvestment of health technologies. Critically identifying and assessing internal inclinations, such as cognitive biases, affective biases and imperatives, is the first step toward a more rational handling of health technologies. In order to provide accountable and efficient care we must engage in the quest against the figments of our minds; to disinvest in low-value care in order to provide high-value health care.
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Song MH, Kong TH, Shim DB. Optimal reassessment time for treatment response in posterior canal benign paroxysmal positional vertigo. Laryngoscope 2019; 130:496-499. [PMID: 30982972 DOI: 10.1002/lary.28005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/20/2019] [Accepted: 03/28/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS The present study aimed to evaluate the optimal reassessment time for treatment response in posterior canal benign paroxysmal positional vertigo (PC-BPPV) following the initial Epley maneuver. STUDY DESIGN Prospective, single-blinded, randomized study. METHODS One hundred eight patients with PC-BPPV agreed to participate. These patients received a single modified Epley maneuver (recommended by the 2008 American Academy of Otolaryngology-Head and Neck Surgery guidelines) daily until positional nystagmus disappeared during the Dix-Hallpike maneuver 24 hours after the treatment. Repeated Dix-Hallpike testing to reassess the treatment response was performed at 1 hour (post-1 hour), every 24 hours (post-24 hours) until the positional nystagmus resolved, 1 week (post-1 week), and 1 month (post-1 month) following the therapeutic maneuver. The difference in the resolution rates at post-1 hour and post-24 hours reassessment was analyzed, and the recurrence rates at post-1 week and post-1 month were evaluated. RESULTS The resolution rate was 67.6% at post-1 hour, which increased to 79.6% at post-24 hours reassessment. There was a statistically significant difference in the results of the Dix-Hallpike test between post-1 hour and post-24 hours follow-up. After complete resolution, nine out of 108 patients (8.3%) demonstrated recurrence within 1 month. CONCLUSIONS Reassessment after 24 hours following the initial Epley maneuver is more advantageous than a 1-hour follow-up in patients with PC-BPPV. This information may be helpful for clinicians in deciding the appropriate follow-up period after treatment for PC-BPPV. LEVEL OF EVIDENCE 1b Laryngoscope, 130:496-499, 2020.
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Affiliation(s)
- Mee Hyun Song
- Department of Otorhinolaryngology, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Tae Hoon Kong
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Dae Bo Shim
- Department of Otorhinolaryngology, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
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Schmitz DC, Ivancie RA, Rhee KE, Pierce HC, Cantu AO, Fisher ES. Imperative Instruction for Pressurized Metered-Dose Inhalers: Provider Perspectives. Respir Care 2018; 64:292-298. [PMID: 30254041 DOI: 10.4187/respcare.06302] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND Reports show that many patients do not use their pressurized metered-dose inhalers (pMDIs) effectively. The National Heart, Lung, and Blood Institute recommends that health-care providers educate and assess patients' pMDI technique at each opportunity. However, limited data exist regarding how often pediatric primary care providers perform assessments and which methods they use. We sought to (1) identify instructional methods used to teach pMDI use, (2) describe how pMDI use is reassessed at follow-up visits, and (3) describe primary care provider attitudes and barriers to in-office pMDI instruction. METHODS A 34-item electronic survey was distributed from August to December 2016 via E-mail to local pediatric primary care providers. Descriptive statistics were used for analysis. RESULTS Sixty two of 223 potential primary care providers (28%) responded. Physicians and nurse practitioners were identified most often as the providers of pMDI education (53%). When first prescribing a pMDI, only 10% reported having the patient practice inhaler use in the office and receive feedback. Only 19% "always" reassessed the technique, even for patients with poorly controlled asthma. Among those who reassessed the technique, most (76%) did so verbally, and only 42% asked the patients to demonstrate pMDI use. Only 32% reported that typical patient education in their setting was adequate to ensure proper pMDI use. Commonly cited barriers included time (84%) and access to demo pMDIs (67%). Provider solutions included video tutorials and access to demo inhalers. CONCLUSIONS Many pediatric primary care providers did not demonstrate or have patients practice pMDI use when teaching or assessing pMDI technique, and the reassessment rate was low even for patients with poorly controlled asthma. Identifying and training a consistent pMDI educator and obtaining demo pMDIs may abate some barriers. Respiratory therapists could appropriately fulfill this educator role. Brief, repeated pMDI practice for motor learning could promote more stable pMDI mastery.
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Affiliation(s)
- Daniel C Schmitz
- University of California San Diego School of Medicine, La Jolla, California
| | - Rebecca A Ivancie
- Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Kyung E Rhee
- Division of Academic General Pediatrics, Child Development, and Community Health, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California
| | - Heather C Pierce
- Rady Children's Hospital and Health Centers, Division of Hospital Medicine, Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California
| | - Alicia O Cantu
- Rady Children's Hospital and Health Centers, Division of Hospital Medicine, Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California
| | - Erin S Fisher
- Rady Children's Hospital and Health Centers, Division of Hospital Medicine, Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California.
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Reiss CA, Mechelen JBV, Goubitz K, Peschar R. Reassessment of paracetamol orthorhombic Form III and determination of a novel low-temperature monoclinic Form III-m from powder diffraction data. Acta Crystallogr C Struct Chem 2018; 74:392-399. [PMID: 29504571 DOI: 10.1107/s2053229618002619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 02/13/2018] [Indexed: 11/11/2022]
Abstract
Paracetamol [N-(4-hydroxyphenyl)acetamide, C8H9NO2] has several polymorphs, just like many other drugs. The most stable polymorphs, denoted Forms I and II, can be obtained easily and their crystal structures are known. Crystals of the orthorhombic, less stable, room-temperature Form III are difficult to grow; they need a special recipe to crystallize and suffer from severe preferred orientation. A crystal structure model of Form III has been proposed and solved from a combination of structure prediction and powder X-ray diffraction (PXRD) [Perrin et al. (2009). Chem. Commun. 22, 3181-3183]. The final Rwp value of 0.138 and the corresponding considerable residual trace were reasons to check its validity. A new structure determination of Form III using new high-resolution PXRD data led to a final Rwp value of 0.042 and an improvement of the earlier proposed model. In addition, a reversible phase transition was found at 170-220 K between the orthorhombic Form III and a novel monoclinic Form III-m. The crystal structure of Form III-m has been determined and refined from PXRD data to a final Rwp value of 0.059.
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Affiliation(s)
| | | | - Kees Goubitz
- Technical University Delft, Faculty of Applied Sciences, Department of Radiation Science and Technology-Fundamental Aspects of Materials and Energy (FAME), Mekelweg 15, 2629JB Delft, The Netherlands
| | - René Peschar
- University of Amsterdam, Faculty of Humanities, Conservation and Restoration of Cultural Heritage, Johannes Vermeerplein 1, 1071DV Amsterdam, The Netherlands
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Abstract
PURPOSE The purpose of this study was to determine differences in pediatric pain management by unit type in hospitals across the United States. The aims were to (a) compare unit-type rates of assessment, intervention, and reassessment (AIR), and (b) describe differences in assessment tools and intervention use by unit type. DESIGN The study used a cross-sectional design. A secondary analysis of 2013 data from the National Database of Nursing Quality Indicators (NDNQI®) pain AIR cycle indicator was conducted. The sample included 984 pediatric units in 390 hospitals. METHODS Data were gathered via retrospective chart review on the pain assessment tool used, presence of pain, interventions, and reassessment. Descriptive statistics and the Kruskal-Wallis one-way analysis of variance test were conducted. Post-hoc analyses included the Wilcoxon-rank sum test with Bonferroni correction. FINDINGS Across all units the mean unit-level percentage of patients assessed for pain was 99.6%. Of those patients assessed, surgical units had the highest average unit-level percentage of patients with pain, while Level 4 neonatal intensive care units (NICUs) had the lowest. The most commonly used assessment tool among all units was the Faces, Legs, Activity, Crying, and Consolability (FLACC) Scale. The Neonatal Pain, Agitation, and Sedation Scale (N-PASS) and Neonatal Infant Pain Scale (NIPS) specifically developed for infants were more commonly used across NICU unit types. The mean unit-level percentage of patients with pain receiving an intervention was 89.4%, and reassessment was 83.6%. Overall, pharmacologic methods were the most common pain intervention, while music was the least common. CONCLUSIONS Assessments were performed routinely, yet interventions and reassessments were not. Pain AIR cycle completion varied by unit type. Pain was also widely present across many unit types, and pharmacologic methods were most frequently used. CLINICAL RELEVANCE Frontline nurses are instrumental to pain management and have the ability to improve patient care and outcomes by effectively managing pain. A comprehensive understanding of it provides valuable insight into improving our practice to produce the best outcomes for pediatric patients.
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Affiliation(s)
- Kelsea O'Neal
- Delta, Staff Nurse, Children's Mercy Hospitals and Clinics, Children's Mercy Hospital, Kansas City, MO, USA
| | - Danielle Olds
- Alpha Mu, and Delta, Research Assistant Professor, University of Kansas School of Nursing, Kansas City, KS, USA
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Abstract
Community acquired pneumonia (CAP) is a relevant public health problem, constituting an important cause of morbidity and mortality. It accounts for a significant number of adult hospital admissions and a large number of those patients ultimately die, especially the population who needed mechanical ventilation or vasopressor support. Thus, early identification of CAP patients and its rapid and appropriate treatment are important features with impact on hospital resource consumption and overall mortality. Although CAP diagnosis may sometimes be straightforward, the diagnostic criteria commonly used are highly sensitive but largely unspecific. Biomarkers and microbiological documentation may be useful but have important limitations. Evaluation of clinical response is also critical especially to identify patients who fail to respond to initial treatment since these patients have a high risk of in-hospital death. However, the criteria of definition of non-response in CAP are largely empirical and frequently markedly diverse between different studies. In this review, we aim to identify criteria defining nonresponse in CAP and the pitfalls associated with this diagnosis. We also aim to overview the main causes of treatment failure especially in severe CAP and the possible strategies to identify and reassess non-responders trying to change the dismal prognosis associated with this condition.
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Affiliation(s)
- João Gonçalves-Pereira
- Unidade de Cuidados Intensivos Polivalente, Hospital de Sao Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005 Lisboa, Portugal
| | - Catarina Conceição
- Polyvalent Intensive Care Unit, Sao Francisco Xavier Hospital, CHLO, Lisbon, Portugal
| | - Pedro Póvoa
- Polyvalent Intensive Care Unit, Sao Francisco Xavier Hospital, CHLO, Lisbon and CEDOC, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal
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Ogawa Y, Nakata Y, Tominaga T. Post-purchase reassessment and improvement of neuroendoscope holder: importance of physician-manufacturer communication. Technol Health Care 2014; 22:297-301. [PMID: 24576811 DOI: 10.3233/thc-140781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Modern medical management requires constant quality improvement of the various instruments used for surgical procedures. Higher quality, less complicated handling, and reduced maintenance are all desirable qualities. However, any improvements in instrumentation require that surgeons must clearly understand the application of the device by adherence to the manufacturer's instructions. The weakness of this one-way information flow depends on the low interest among medical personnel for post-purchase reassessment. OBJECTIVE Service industries have research departments to investigate the post-purchase behavior of customers, and service recovery is considered essential to retain customers after service failure. All service providers can suffer service failures, and even the best providers may make errors in delivering service. Such an approach has been increasingly adopted in the risk management at medical institutions. METHODS We report our clinical trials of the post-purchase reassessment and product improvement of surgical instrumentation. Medical personnel reassessed the use of a newly developed endoscope holder based on the manufacturer's manual and made recommendations for possible improvements, which were examined by the manufacturer. RESULTS Simple but important improvement was achieved for reducing the instability and uncertainty of instrument fixation. CONCLUSION This bi-directional post-purchase communication between medical personnel and manufacturers can improve risk management in medical institutions.
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Affiliation(s)
- Yoshikazu Ogawa
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Yusuke Nakata
- R&D Division, Mitaka Kohki, Co., Ltd., Mitaka, Tokyo, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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