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Curtis R, Wu J, Iorio A, Frick N, Nichol M, Noone D, O'Mahony B, Page D, Stonebraker J, Kucher A, Clearfield E, Skinner MW, Germini F. Test-retest reliability of a mobile application of the patient reported outcomes burdens and experiences (PROBE) study. Haemophilia 2024; 30:702-708. [PMID: 38439137 DOI: 10.1111/hae.14969] [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: 10/11/2023] [Revised: 12/15/2023] [Accepted: 02/01/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION The Patient Reported Outcomes, Burdens, and Experiences (PROBE) questionnaire is a patient-reported outcome tool that assesses quality of life and disease burden in people with haemophilia (PWH). AIM To assesses the test-retest reliability of PROBE when completed using the mobile phone application. METHODS We recruited PWH, including carriers, and individuals with no bleeding disorders who attended haemophilia-related workshops or via social media. Participants completed PROBE three times (twice on the app: T1 and T2, and once on the web, T3). Test-retest reliability was analysed for T1 versus T2 (app to app, time period one) and T2 versus T3 (app to web, time period two). RESULTS We enrolled 48 participants (median age = 56 [range 27-78] years). Eighteen participants (37.5%) were PWH and seven (14.6%) were carriers. On general health domain questions, we found almost perfect agreement, except for a question on the frequency of use of pain medication in the last 12 months [Kappa coefficient (κ) .72 and .37 for time period one and two, respectively] and any use of pain medications (κ .75) for time period two. For haemophilia-related questions, we found substantial to perfect agreement, except for the questions on the number of joint bleeds in the previous 6 months for time period one (κ .49) and the number of bleeds in the previous two weeks for time period two (κ .34). CONCLUSIONS The results demonstrate the reliability of the PROBE app. The app can be used interchangeably with the paper and web platforms for PROBE administration.
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Affiliation(s)
| | - Joanne Wu
- Sol Price School of Public Policy, University of Southern California, Los Angeles, USA
| | - Alfonso Iorio
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Neil Frick
- National Hemophilia Foundation, New York, USA
| | - Michael Nichol
- Sol Price School of Public Policy, University of Southern California, Los Angeles, USA
| | | | - Brian O'Mahony
- Irish Haemophilia Society, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - David Page
- Canadian Hemophilia Society, Montreal, Canada
| | | | - Alexandra Kucher
- Patient Outcomes Research Group Ltd, Washington, District of Columbia, USA
| | | | - Mark W Skinner
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Institute for Policy Development Ltd, Washington, District of Columbia, USA
| | - Federico Germini
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Clinical Epidemiology and Research Center (CERC), IRCCS Humanitas Research Hospital, Milan, Italy
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Germini F, Al-Haimus F, Hu Y, Mondoux S, Ibrahim Q, Chan N, Ikesaka R, Klyn J, Clayton N, Thabane L, de Wit K. Implementation, Clinical Benefit and Safety of a D-Dimer-Focused Pulmonary Embolism Testing Pathway in the Emergency Department. Ann Emerg Med 2024:S0196-0644(24)00156-2. [PMID: 38661619 DOI: 10.1016/j.annemergmed.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 04/26/2024]
Abstract
STUDY OBJECTIVE Computed tomography pulmonary angiogram (CTPA) is overused during pulmonary embolism (PE) testing in the emergency department (ED), whereas prediction rules and D-dimer are underused. We report the adherence, clinical benefit, and safety of a D-dimer-only strategy to guide need for PE imaging in the ED. METHODS This was a prospective multicenter implementation study in 2 EDs with historical and external controls. Patients with suspected PE underwent D-dimer testing and imaging (CTPA or ventilation-perfusion scan) when D-dimer levels were 500 ng/mL or more. PE was ruled out if D-dimer was less than 500 ng/mL or with negative imaging. The primary implementation outcome was the proportion of patients tested for PE in adherence with the pathway. The primary clinical benefit outcome was the proportion of patients tested for PE who received pulmonary imaging. The primary safety outcome was diagnosis of PE in the 30 days following negative PE testing postimplementation. RESULTS Between January 2018 and June 2021, 16,155 patients were tested for PE, including 33.4% postimplementation, 30.7% preimplementation, and 35.9% in an external control site. Adherence with the D-dimer-only pathway was 97.6% (adjusted odds ratio (aOR) post- versus preimplementation 5.26 (95% confidence interval 1.70 to 16.26). There was no effect on the proportion undergoing PE imaging. Imaging yield increased aOR 4.89 (1.17 to 20.53). Two cases of PE (0.04%; 0.01% to 0.16%) were diagnosed within 30 days. CONCLUSION In this Canadian ED study, the uptake of a D-dimer-only PE testing strategy was high. Implementation was associated with higher imaging yield and a D-dimer level of less than 500 ng/mL safely excluded PE.
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Affiliation(s)
- Federico Germini
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Fayad Al-Haimus
- Division of Emergency Medicine, Department of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Yang Hu
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shawn Mondoux
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Quazi Ibrahim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Noel Chan
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Rick Ikesaka
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Joshua Klyn
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Natasha Clayton
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Schools of Nursing and Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada; Departments of Surgery and Family Medicine, McMaster University, Hamilton, ON, Canada; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada; Departments of Paediatrics and Anaesthesia, McMaster University, Hamilton, ON, Canada; Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Kerstin de Wit
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Emergency Medicine, Queen's University, Kingston, ON, Canada.
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Matino D, Germini F, Chan AKC, Decker K, Iserman E, Chelle P, Edginton AN, Oladoyinbo O, Trinari E, Keepanasseril A, Iorio A. Canadian clinical experience on switching from standard half-life recombinant factor VIII (rFVIII), octocog alfa, to extended half-life rFVIII, damoctocog alfa pegol, in persons with haemophilia A ≥ 12 years followed in a Comprehensive Hemophilia Care Program in Canada. Haemophilia 2024; 30:345-354. [PMID: 38379181 DOI: 10.1111/hae.14960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Damoctocog alfa pegol (BAY 94-9027, Jivi®) is an extended half-life recombinant factor (F)VIII replacement, indicated for the treatment of haemophilia A in patients aged ≥12 years. Following introduction of damoctocog alfa pegol in Canada in 2020, there have been no reports on routine clinical effectiveness and satisfaction, when switching from a previous FVIII product in Canada. AIM To report changes in pharmacokinetics, effectiveness, utilization and patient satisfaction when switching to damoctocog alfa pegol prophylaxis from previous standard half-life octocog alfa (BAY 81-8973, Kovaltry®) treatment. METHODS A single-centre, intra-patient comparison of pharmacokinetics and clinical outcomes was performed. Blood samples drawn once pre-dose and ≥2 times post-dose were measured by a one-stage assay to assess pharmacokinetic parameters including area under the curve (AUC, primary endpoint). Patient-reported outcomes data were collected using the Patient-Reported Outcomes, Burdens and Experiences questionnaire (PROBE). Clinical outcomes included annualized bleeding rate (ABR) and factor utilization. RESULTS Dose-normalized AUC was significantly increased after switch to damoctocog alfa pegol from octocog alfa. Median (quartile [Q]1; Q3) annualized bleeding rates were 0.67 (0.00; 1.33) with damoctocog alfa pegol and 1.33 (0.00; 2.67) with octocog alfa. Half of the patients receiving damoctocog alfa pegol prophylaxis experienced zero bleeds (n = 9, 50.0%) versus 38.9% (n = 7) of patients treated with octocog alfa. Patients' good quality of life was maintained. CONCLUSION This study provides routine clinical evidence supporting the benefits of switching from octocog alfa to damoctocog alfa pegol for patients with severe haemophilia A.
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Affiliation(s)
- Davide Matino
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Federico Germini
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Anthony K C Chan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Kay Decker
- Hamilton Health Sciences, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Emma Iserman
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Pierre Chelle
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrea N Edginton
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Elisabetta Trinari
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Arun Keepanasseril
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alfonso Iorio
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Germini F, Chan NC. Patterns and Persistence of Anticoagulant Use in the Treatment of Venous Thromboembolism: Insights from South Korea. Thromb Haemost 2024; 124:163-165. [PMID: 37463605 DOI: 10.1055/a-2131-7066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Federico Germini
- Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Noel C Chan
- Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Mannucci PM, Kessler CM, Germini F, Nissen F, Ofori-Asenso R, Brocchieri C, Bendinelli S, Iorio A. Bleeding events in people with congenital haemophilia A without factor VIII inhibitors receiving prophylactic factor VIII treatment: A systematic literature review. Haemophilia 2023. [PMID: 37289855 DOI: 10.1111/hae.14803] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/28/2023] [Accepted: 05/14/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Evidence on bleeding rates in people with congenital haemophilia A (PwcHA) without inhibitors on factor VIII (FVIII) replacement products is inconsistent. AIM This systematic literature review assessed bleeding outcomes in PwcHA using FVIII-containing products as prophylactic treatment. METHODS A search was conducted using the bibliographic databases Medline, Embase and Cochrane Central Register of Controlled Trials on the Ovid platform. The search involved a bibliographic review of clinical trial studies, routine clinical care studies and registries and a search of ClinicalTrials.gov, EU Clinical Trials Register and conference abstracts. RESULTS The search yielded 5548 citations. A total of 58 publications were included for analysis. In 48 interventional studies, the pooled estimated mean (95% confidence interval [CI]) annualized bleeding rate (ABR), annualized joint bleeding rate (AJBR) and proportion of participants with zero bleeding events were 3.4 (3.0-3.7), 2.0 (1.6-2.5), and 38.5% (33.1-43.9), respectively. In 10 observational studies, the pooled estimated mean (95% CI) ABR, AJBR and proportion of participants with zero bleeding events were 4.8 (4.0-5.5), 2.6 (2.1-3.2), and 21.8% (19.9-47.5), respectively. A large variation in mean effect size for ABR, AJBR and zero bleeding event data across cohorts and cohort types was observed. Funnel plots indicated potential reporting bias for publications incorporating ABR and AJBR data across both interventional and observational studies. CONCLUSION This meta-analysis shows that PwcHA without inhibitors still have bleeds despite FVIII prophylaxis. Improved standardization on capturing and reporting bleeding outcomes is needed so that effective comparisons between treatments can be made.
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Affiliation(s)
- Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi, Hemophilia and Thrombosis Center, Milan, Italy
| | - Craig M Kessler
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington District of Columbia, USA
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Lokker C, Bagheri E, Abdelkader W, Parrish R, Afzal M, Navarro T, Cotoi C, Germini F, Linkins L, Brian Haynes R, Chu L, Iorio A. Deep Learning to Refine the Identification of High-Quality Clinical Research Articles from the Biomedical Literature: Performance Evaluation. J Biomed Inform 2023; 142:104384. [PMID: 37164244 DOI: 10.1016/j.jbi.2023.104384] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/24/2023] [Accepted: 05/03/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Identifying practice-ready evidence-based journal articles in medicine is a challenge due to the sheer volume of biomedical research publications. Newer approaches to support evidence discovery apply deep learning techniques to improve the efficiency and accuracy of classifying sound evidence. OBJECTIVE To determine how well deep learning models using variants of Bidirectional Encoder Representations from Transformers (BERT) identify high-quality evidence with high clinical relevance from the biomedical literature for consideration in clinical practice. METHODS We fine-tuned variations of BERT models (BERTBASE, BioBERT, BlueBERT, and PubMedBERT) and compared their performance in classifying articles based on methodological quality criteria. The dataset used for fine-tuning models included titles and abstracts of >160,000 PubMed records from 2012-2020 that were of interest to human health which had been manually labeled based on meeting established critical appraisal criteria for methodological rigor. The data was randomly divided into 80:10:10 sets for training, validating, and testing. In addition to using the full unbalanced set, the training data was randomly undersampled into four balanced datasets to assess performance and select the best performing model. For each of the four sets, one model that maintained sensitivity (recall) at ≥99% was selected and were ensembled. The best performing model was evaluated in a prospective, blinded test and applied to an established reference standard, the Clinical Hedges dataset. RESULTS In training, three of the four selected best performing models were trained using BioBERTBASE. The ensembled model did not boost performance compared with the best individual model. Hence a solo BioBERT-based model (named DL-PLUS) was selected for further testing as it was computationally more efficient. The model had high recall (>99%) and 60% to 77% specificity in a prospective evaluation conducted with blinded research associates and saved >60% of the work required to identify high quality articles. CONCLUSIONS Deep learning using pretrained language models and a large dataset of classified articles produced models with improved specificity while maintaining >99% recall. The resulting DL-PLUS model identifies high-quality, clinically relevant articles from PubMed at the time of publication. The model improves the efficiency of a literature surveillance program, which allows for faster dissemination of appraised research.
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Affiliation(s)
- Cynthia Lokker
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Elham Bagheri
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Wael Abdelkader
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rick Parrish
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Muhammad Afzal
- Department of Computing, Birmingham City University, Birmingham, UK
| | - Tamara Navarro
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Chris Cotoi
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Federico Germini
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lori Linkins
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - R Brian Haynes
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lingyang Chu
- Department of Computing and Software, McMaster University, Hamilton, Ontario, Canada
| | - Alfonso Iorio
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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de Wit K, Al-Haimus F, Hu Y, Ikesaka R, Chan N, Ibrahim Q, Klyn J, Clayton N, Germini F. Comparison of YEARS and Adjust-Unlikely D-dimer Testing for Pulmonary Embolism in the Emergency Department. Ann Emerg Med 2023; 81:558-565. [PMID: 36371248 DOI: 10.1016/j.annemergmed.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/05/2022] [Accepted: 09/19/2022] [Indexed: 11/12/2022]
Abstract
STUDY OBJECTIVE We prospectively assessed the diagnostic accuracy of YEARS and a modified age-adjusted clinical decision rule ("Adjust-Unlikely") for pulmonary embolism (PE) testing in the emergency department. METHODS This study was conducted in tertiary care Canadian emergency departments. When the D-dimer was <500 ng/ml, PE was excluded. Pulmonary imaging for PE was performed when the D-dimer was ≥500 ng/ml. Patients were followed for 30 days, and PE outcomes were independently adjudicated. Physicians systematically recorded the presence or absence of YEARS items (PE most likely, hemoptysis, signs of deep venous thrombosis) prior to D-dimer testing and imaging. We analyzed the diagnostic accuracy of YEARS and the "Adjust-Unlikely" rule. Age adjustment (age x 10 in those >50 years old) was applied in patients where PE was not the most likely diagnosis and 500 ng/ml threshold when PE was most likely. RESULTS One thousand seven hundred three patients were included, median age 62 (50, 74), 58% female, PE prevalence 8.0%. YEARS sensitivity for PE diagnosis was 92.6% (87.0, 96.0%) and specificity 45.0% (42.5, 47.5%). Adjust-Unlikely sensitivity was 100.0% (97.2, 100.0%) and specificity 32.4% (30.1, 34.8%). Posttest probability of PE in the group of patients with PE excluded by D-dimer between 500 ng/ml and the adjusted limit was 2.8% (1.6, 5.1%) for YEARS and 0.0% (0.0, 2.6%) for the "Adjust-Unlikely" rule. CONCLUSION The "Adjust-Unlikely" rule would modestly reduce imaging and identify all cases of PE. YEARS would substantially reduce imaging but miss 1 in 14 cases of PE.
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Affiliation(s)
- Kerstin de Wit
- Department of Emergency Medicine and Medicine, Queens University, Kingston, and Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
| | - Fayad Al-Haimus
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Yang Hu
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Rick Ikesaka
- Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Noel Chan
- Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Quazi Ibrahim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Joshua Klyn
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Natasha Clayton
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Emergency Department, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Federico Germini
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada
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de Wit K, Ikesaka R, Chan N, Germini F. In reply. Ann Emerg Med 2023; 81:517-518. [PMID: 36948692 DOI: 10.1016/j.annemergmed.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 03/24/2023]
Affiliation(s)
- Kerstin de Wit
- Departments of Emergency Medicine and Medicine, Queens University, Kingston, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rick Ikesaka
- Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Noel Chan
- Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Federico Germini
- Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Marrero MC, Bonfini Petraccone J, Guida S, Montesi A, Fanti A, Gigliola G, Scalingi S, Aucone R, Russo FT, Lovetro D, Facente F, Germini F, Del Prete J, Ierardi T, Zagaria N, Gerbasi G, Brandimarte MA, Parente P, Di Rosa E, Paglione L. Responding to a school SARS-CoV-2 outbreak: Insights and policy implications emerging from the pandemic. Ann Ig 2023; 35:178-187. [PMID: 35532051 DOI: 10.7416/ai.2022.2522] [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] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background The SARS-CoV-2 pandemic has affected also the school environment. Prolonged closures and the weakness of available data prevent a definitive answer to the question of school transmission. We report our experience of responding to COVID-19 cases in the school setting, presenting a case study of the management of an outbreak in a large school. Methods The LHA/ASL Roma 1 has organized the School Units with a structure firmly rooted in the territory. At the local level, the District Unit mainly manages the relationship with schools, while the Hygiene and Public Health Service of the Prevention Department holds a coordinating and facilitating role. The HPHS carries out contact tracing activities facilitated by the schools, through the figure of the COVID-19 Contact Person, who is specifically trained to manage the preliminary stages of the reports. Results Following several reports of COVID-19 suspect cases from two schools and, after a complex phase of contact tracing, it was possible to identify the major transmission chains. Furthermore, we performed a population-based screening on the entire school. Beyond the known transmission chains, for which quarantine was already in place, only five additional cases emerged, all asymptomatic, out of 1,231 swabs tested with RT-PCR. Conclusions Our experience confirms that an active interaction between the school and the School Unit made it possible to quickly control a potentially dangerous outbreak. The large-scale screening test demonstrated the substantial absence of collateral transmission chains. Effective contact tracing allowed to set forth a successful response. Our model of intervention can be used to support public health protocols regarding school outbreaks.
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Affiliation(s)
- M C Marrero
- Department of Prevention, ASL Roma 1, Rome, Italy
| | | | - S Guida
- Department of Prevention, ASL Roma 1, Rome, Italy
| | - A Montesi
- Department of Prevention, ASL Roma 1, Rome, Italy
| | - A Fanti
- Department of Prevention, ASL Roma 1, Rome, Italy
| | - G Gigliola
- Department of Prevention, ASL Roma 1, Rome, Italy
| | - S Scalingi
- Department of Prevention, ASL Roma 1, Rome, Italy
| | - R Aucone
- Department of Prevention, ASL Roma 1, Rome, Italy
| | - F T Russo
- Department of Prevention, ASL Roma 1, Rome, Italy
| | - D Lovetro
- Department of Prevention, ASL Roma 1, Rome, Italy
| | - F Facente
- Department of Prevention, ASL Roma 1, Rome, Italy
| | - F Germini
- District II, ASL Roma 1, Rome, Italy
| | | | - T Ierardi
- District II, ASL Roma 1, Rome, Italy
| | - N Zagaria
- District II, ASL Roma 1, Rome, Italy
| | - G Gerbasi
- District XV, ASL Roma 1, Rome, Italy
| | | | - P Parente
- Health Management, ASL Roma 1, Rome, Italy
| | - E Di Rosa
- Department of Prevention, ASL Roma 1, Rome, Italy
| | - L Paglione
- Department of Prevention, ASL Roma 1, Rome, Italy
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Iorio A, MacDonald V, Caillaud A, Luckevich MD, Christoffersen P, Matino D, Keepanasseril A, Iserman E, Germini F, Bentley A, Poon MC. Treatment switch to nonacog beta pegol (N9-GP) factor IX (FIX) in hemophilia B: a Canadian cost-consequence analysis based on real-world FIX consumption and clinical outcomes. Res Pract Thromb Haemost 2023; 7:100106. [PMID: 37065846 PMCID: PMC10099317 DOI: 10.1016/j.rpth.2023.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/23/2023] [Accepted: 02/13/2023] [Indexed: 03/12/2023] Open
Abstract
Background The Canadian Bleeding Disorders Registry (CBDR) is a source of real-world data for Canadian patients with hemophilia B. Nonacog beta pegol (N9-GP), an extended half-life (EHL) recombinant factor IX (FIX) concentrate, was awarded a Canadian Blood Services contract in 2018 and subsequently made available across Canada (except Québec) to adult patients. For most patients already on another EHL FIX treatment, a switch to N9-GP occurred. Objectives This study estimates the impact on treatment costs of a switch from a prior FIX to N9-GP based on annualized bleed rates and FIX consumption volumes before and after N9-GP switch from the CBDR. Methods Real-world data from the CBDR for total FIX consumption and annualized bleed rates were used to inform a deterministic 1-year cost-consequence model. The model considered that the EHL to N9-GP switches were from eftrenonacog alfa and the standard half-life switches were from nonacog alfa. Because FIX prices are confidential in Canada, the model assumed cost parity for annual prophylaxis with each FIX based on the product monograph recommended dosing regimen to calculate an estimated price per international unit for each product. Results The switch to N9-GP resulted in improvements in real-world annualized bleed rates and therefore reductions in annual breakthrough bleed treatment costs. Switching to N9-GP also resulted in reduced real-world annual FIX consumption for prophylaxis. Overall, annual treatment costs were 9.4% and 10.5% lower after the switch to N9-GP from nonacog alfa and eftrenonacog alfa, respectively. Conclusion N9-GP improves clinical outcomes and may be cost-saving vs nonacog alfa and eftrenonacog alfa.
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Affiliation(s)
- Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- Correspondence Alfonso Iorio, McMaster University, 1280 Main Street West, Hamilton, L8S 4L8, Ontario, Canada.
| | | | | | | | | | - Davide Matino
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Arun Keepanasseril
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Emma Iserman
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Federico Germini
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | | | - Man-Chiu Poon
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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11
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Hirt J, Schönenberger CM, Ewald H, Lawson DO, Papola D, Rohner R, Suter K, Lin S, Germini F, Zeng L, Shahabinezhad A, Chowdhury SR, Gao Y, Bhattacharjee A, Lima JP, Marusic A, Buljan I, Agarwal A, Guyatt GH, Briel M, Schandelmaier S. Introducing the Library of Guidance for Health Scientists (LIGHTS): A Living Database for Methods Guidance. JAMA Netw Open 2023; 6:e2253198. [PMID: 36787138 DOI: 10.1001/jamanetworkopen.2022.53198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
IMPORTANCE Improving methodological quality is a priority in the health research community. Finding appropriate methods guidance can be challenging due to heterogeneous terminology, poor indexing in medical databases, and variation in formats. The Library of Guidance for Health Scientists (LIGHTS) is a new searchable database for methods guidance articles. OBSERVATIONS Journal articles that aim to provide guidance for performing (including planning, design, conduct, analysis, and interpretation), reporting, and assessing the quality of health-related research involving humans or human populations (ie, excluding basic and animal research) are eligible for LIGHTS. A team of health researchers, information specialists, and methodologists continuously identifies and manually indexes eligible guidance documents. The search strategy includes focused searches of specific journals, specialized databases, and suggestions from researchers. A current limitation is that a keyword-based search of MEDLINE (and other general databases) and manual screening of records were not feasible because of the large number of hits (n = 915 523). As of September 20, 2022, LIGHTS included 1246 articles (336 reporting guidelines, 80 quality assessment tools, and 830 other methods guidance articles). The LIGHTS website provides a user-oriented search interface including filters for study type, specific methodological topic, research context, guidance type, and development process of the guidance. Automated matching of alternative methodological expressions (eg, enter loss to follow-up and find articles indexed with missing data) enhances search queries. CONCLUSIONS AND RELEVANCE LIGHTS is a peer-supported initiative that is intended to increase access to and use of methods guidance relevant to health researchers, statisticians, methods consultants, methods developers, ethics boards, peer reviewers, journal editors, and funding bodies.
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Affiliation(s)
- Julian Hirt
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute of Nursing Science, Department of Health, Eastern Switzerland University of Applied Sciences, St. Gallen
| | - Christof Manuel Schönenberger
- CLEAR (Clinical Research Empirical Assessment and Recommendations) Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Hannah Ewald
- University Medical Library, University of Basel, Basel, Switzerland
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Ramon Rohner
- CLEAR (Clinical Research Empirical Assessment and Recommendations) Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Katja Suter
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Shanshan Lin
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Federico Germini
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Linan Zeng
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Pharmacy Department/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ali Shahabinezhad
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Saifur Rahman Chowdhury
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ya Gao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Arunima Bhattacharjee
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Swiss TPH (Tropical and Public Health Institute), University of Basel, Basel, Switzerland
| | - João Pedro Lima
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ana Marusic
- Department of Research in Biomedicine and Health, Center for Evidence-Based Medicine, University of Split School of Medicine, Split, Croatia
| | - Ivan Buljan
- Department of Research in Biomedicine and Health, Center for Evidence-Based Medicine, University of Split School of Medicine, Split, Croatia
| | - Arnav Agarwal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matthias Briel
- CLEAR (Clinical Research Empirical Assessment and Recommendations) Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Stefan Schandelmaier
- CLEAR (Clinical Research Empirical Assessment and Recommendations) Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
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12
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Rufini P, Cumbo S, Caccavale AR, Azzari C, Germini F, L'Erario M, Ricci Z. Reversed ultrasound-guided dorsal penile nerve block in children: A retrospective study. Paediatr Anaesth 2022; 32:1076-1077. [PMID: 35639440 DOI: 10.1111/pan.14502] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 05/16/2022] [Accepted: 05/29/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Paolo Rufini
- Department of Pediatric Anesthesia and Intensive Care, Meyer Children's Hospital, Florence, Italy
| | - Silvia Cumbo
- Department of Pediatric Anesthesia and Intensive Care, Meyer Children's Hospital, Florence, Italy
| | - Angela Rosaria Caccavale
- Department of Pediatric Anesthesia and Intensive Care, Meyer Children's Hospital, Florence, Italy
| | | | - Federico Germini
- Department of Health Research Methods, Evidence & Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Manuela L'Erario
- Department of Pediatric Anesthesia and Intensive Care, Meyer Children's Hospital, Florence, Italy
| | - Zaccaria Ricci
- Department of Pediatric Anesthesia and Intensive Care, Meyer Children's Hospital, Florence, Italy.,University of Florence, Florence, Italy
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13
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Germini F, Noronha N, Abraham Philip B, Olasupo O, Pete D, Navarro T, Keepanasseril A, Matino D, de Wit K, Parpia S, Iorio A. Risk factors for bleeding in people living with hemophilia A and B treated with regular prophylaxis: A systematic review of the literature. J Thromb Haemost 2022; 20:1364-1375. [PMID: 35395700 DOI: 10.1111/jth.15723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/01/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Knowledge about the risk for bleeding in patients with hemophilia (PWH) would be relevant for patients, stakeholders, and policy makers. OBJECTIVES To perform a systematic review of the literature on risk assessment models (RAMs) and risk factors for bleeding in PWH on regular prophylaxis. METHODS We searched Medline, Embase, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from inception through August 2019. In duplicate, reviewers screened the articles for inclusion, extracted data, and assessed the risk for bias using the Quality in Prognostic Studies (QUIPS) tool. A qualitative synthesis of the results was not performed due to high heterogeneity in risk factors, outcomes definition and measurement, and statistical analysis of the results. RESULTS From 1843 search results, 10 studies met the inclusion criteria. No RAM for the risk for bleeding in PWH was found. Most studies included only PWH A or both PWH A and B and were conducted in North America or Europe. Only one study had a low risk for bias in all the domains. Eight categories of risk factors were identified. The risk for bleeding was increased when factor levels were lower and in people with a significant history of bleeding or who engaged in physical activities involving contact. CONCLUSIONS Our findings suggest that plasma factor levels, history of bleeds, and physical activity should be considered for the derivation analysis when building a RAM for bleeding in PWH, and the role of other risk factors, including antithrombotic treatment and obesity, should be explored.
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Affiliation(s)
- Federico Germini
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Noella Noronha
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Binu Abraham Philip
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Omotola Olasupo
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Drashti Pete
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Tamara Navarro
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Arun Keepanasseril
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Davide Matino
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kerstin de Wit
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Sameer Parpia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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14
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Matino D, Iorio A, Keepanasseril A, Germini F, Caillaud A, Carcao M, Hews‐Girard J, Iserman E, James P, Lee A, Phua CW, Sun H(L, Teitel J, Poon M. Switching to nonacog beta pegol in hemophilia B: Outcomes from a Canadian real‐world, multicenter, retrospective study. Res Pract Thromb Haemost 2022; 6:e12661. [PMID: 35386274 PMCID: PMC8971162 DOI: 10.1002/rth2.12661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background The Canadian Bleeding Disorders Registry (CBDR) captures data from 24 hemophilia treatment centers and patients directly. Nonacog beta pegol (N9‐GP) was approved in Canada in 2018. Objectives To assess treatment outcomes following switching to N9‐GP in a real‐world setting. Methods CBDR data for Canadian male patients (aged 7–72 years) with hemophilia B receiving prophylactic N9‐GP for ≥6 months as of March 31, 2021, were included. To allow comparison with the previously used products, only patients for whom data were available in the CBDR for at least 6 months before the switch to N9‐GP were included in this retrospective analysis. Results Forty‐two patients were included in the analysis (total observation period: 148.0 patient‐years). The distribution of disease severity was 62% severe, 36% moderate, 2% mild, with 62% of patients previously receiving recombinant factor IX‐Fc‐fusion protein (rFIXFc) and 38% previously receiving standard half‐life (SHL) recombinant factor IX (rFIX). During a median follow‐up period of 2.3 years on N9‐GP prophylaxis, 232 bleeds were reported in 30 patients, 29% of patients reported zero bleeds. The median overall annualized bleeding rate on N9‐GP was 0.73 for patients switching from rFIXFc (previously 1.44) and 2.10 for patients switching from SHL rFIX (previously 6.06). Median total annualized factor consumption (IU/kg) was lower with N9‐GP than with previous SHL rFIX (2152 vs 3018) and previous rFIXFc (1766 vs 2278). Conclusions Results from this first real‐world study of N9‐GP in patients with hemophilia B suggest optimal bleeding control with low factor consumption after switching to N9‐GP, irrespective of the previous product.
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Affiliation(s)
| | | | | | | | | | - Manuel Carcao
- The Hospital for Sick Children University of Toronto Toronto ON Canada
| | | | | | | | | | | | | | - Jerome Teitel
- St Michael's Hospital University of Toronto Toronto ON Canada
| | - Man‐Chiu Poon
- Cumming School of Medicine University of Calgary Calgary AB Canada
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15
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Marcucci M, Etxeandia-Ikobaltzeta I, Yang S, Germini F, Gupta S, Agarwal A, Ventresca M, Tang S, Morgano GP, Wang M, Ahmed MM, Neumann I, Izcovich A, Criniti J, Popoff F, Devereaux PJ, Dahm P, Anderson D, Lavikainen LI, Tikkinen KAO, Guyatt GH, Schünemann HJ, Violette PD. Benefits and harms of direct oral anticoagulation and low molecular weight heparin for thromboprophylaxis in patients undergoing non-cardiac surgery: systematic review and network meta-analysis of randomised trials. BMJ 2022; 376:e066785. [PMID: 35264372 PMCID: PMC8905353 DOI: 10.1136/bmj-2021-066785] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To systematically compare the effect of direct oral anticoagulants and low molecular weight heparin for thromboprophylaxis on the benefits and harms to patients undergoing non-cardiac surgery. DESIGN Systematic review and network meta-analysis of randomised controlled trials. DATA SOURCES Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL), up to August 2021. REVIEW METHODS Randomised controlled trials in adults undergoing non-cardiac surgery were selected, comparing low molecular weight heparin (prophylactic (low) or higher dose) with direct oral anticoagulants or with no active treatment. Main outcomes were symptomatic venous thromboembolism, symptomatic pulmonary embolism, and major bleeding. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for network meta-analyses. Abstracts and full texts were screened independently in duplicate. Data were abstracted on study participants, interventions, and outcomes, and risk of bias was assessed independently in duplicate. Frequentist network meta-analysis with multivariate random effects models provided odds ratios with 95% confidence intervals, and GRADE (grading of recommendations, assessment, development, and evaluation) assessments indicated the certainty of the evidence. RESULTS 68 randomised controlled trials were included (51 orthopaedic, 10 general, four gynaecological, two thoracic, and one urological surgery), involving 45 445 patients. Low dose (odds ratio 0.33, 95% confidence interval 0.16 to 0.67) and high dose (0.19, 0.07 to 0.54) low molecular weight heparin, and direct oral anticoagulants (0.17, 0.07 to 0.41) reduced symptomatic venous thromboembolism compared with no active treatment, with absolute risk differences of 1-100 per 1000 patients, depending on baseline risks (certainty of evidence, moderate to high). None of the active agents reduced symptomatic pulmonary embolism (certainty of evidence, low to moderate). Direct oral anticoagulants and low molecular weight heparin were associated with a 2-3-fold increase in the odds of major bleeding compared with no active treatment (certainty of evidence, moderate to high), with absolute risk differences as high as 50 per 1000 in patients at high risk. Compared with low dose low molecular weight heparin, high dose low molecular weight heparin did not reduce symptomatic venous thromboembolism (0.57, 0.26 to 1.27) but increased major bleeding (1.87, 1.06 to 3.31); direct oral anticoagulants reduced symptomatic venous thromboembolism (0.53, 0.32 to 0.89) and did not increase major bleeding (1.23, 0.89 to 1.69). CONCLUSIONS Direct oral anticoagulants and low molecular weight heparin reduced venous thromboembolism compared with no active treatment but probably increased major bleeding to a similar extent. Direct oral anticoagulants probably prevent symptomatic venous thromboembolism to a greater extent than prophylactic low molecular weight heparin. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018106181.
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Affiliation(s)
- Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | | | - Stephen Yang
- Department of Anaesthesia, Jewish General Hospital, Montreal, QC, Canada
| | - Federico Germini
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shyla Gupta
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Arnav Agarwal
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthew Ventresca
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Shaowen Tang
- Department of Epidemiology, Nanjing Medical University, Nanjing, China
| | - Gian Paolo Morgano
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Mengxiao Wang
- Department of Science, McMaster University, Hamilton, ON, Canada
- Department of Mathematics, University of Waterloo, Waterloo, ON, Canada
| | | | - Ignacio Neumann
- Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Ariel Izcovich
- Department of Internal Medicine, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Criniti
- Department of Internal Medicine, Hospital Alemán, Buenos Aires, Argentina
| | - Federico Popoff
- Department of Internal Medicine, Hospital Alemán, Buenos Aires, Argentina
| | - P J Devereaux
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Philipp Dahm
- Minneapolis Veterans Affair Health Care System, Urology Section, Minneapolis, MN, USA
- University of Minnesota, Department of Urology, Minneapolis, MN, USA
| | - David Anderson
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Michael DeGroote Cochrane Canada Centre-Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Philippe D Violette
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
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16
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Germini F, Borg Debono V, Page D, Zuk V, Kucher A, Cotoi C, Hobson N, Sevestre M, Skinner MW, Iorio A. User-Centered Development and Testing of the Online Patient-Reported Outcomes, Burdens, and Experiences (PROBE) Survey and the myPROBE App and Integration With the Canadian Bleeding Disorder Registry: Mixed Methods Study. JMIR Hum Factors 2022; 9:e30797. [PMID: 35234648 PMCID: PMC8928049 DOI: 10.2196/30797] [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] [Received: 05/28/2021] [Revised: 10/25/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background The Patient-Reported Outcomes, Burdens, and Experiences (PROBE) questionnaire is a tool for assessing the quality of life and disease burden in people living with hemophilia. Objective The objectives of our study were (1) to assess the needs of relevant stakeholders involved in the use of PROBE, (2) to develop the software infrastructure needed to meet these needs, and (3) to test the usability of the final product. Methods We conducted a series of semistructured interviews of relevant stakeholders, including PROBE investigators, people with hemophilia, and representatives of the sponsor. Based on these, we developed an online survey and a mobile app for iOS and Android. A user group evaluated the final product using the System Usability Scale (SUS) and an open feedback framework. Results The online survey was updated, and the myPROBE app for mobile devices and a new application programming interface were developed. The app was tested and modified according to user feedback over multiple cycles. The final version of the app was released in July 2019. Seventeen users aged 23 to 67 years evaluated the final version of the app using the SUS. The median (first, third quartile) SUS score for the app was 85 (68, 88) out of 100. The newly introduced functionalities were as follows: (1) capability to longitudinally track repeated fillings of the questionnaire at different time points by the same participant (as opposed to anonymous completion); (2) linking of the questionnaire with hemophilia registries, starting with the Canadian Bleeding Disorders Registry as a proof of concept; (3) removing or adding questions as needed; and (4) sending notifications to the users (eg, reminders). A new secure database was built for securely storing personal information separately from the questionnaire data. The PROBE online survey is currently available in 96 countries and 34 languages. Conclusions The online survey was updated successfully, and the myPROBE app was developed, with a SUS score of 85 (out of 100). The app has been released in 81 countries and 34 languages. This will facilitate data collection for research and advocacy purposes, and the use of this tool in everyday clinical practice.
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Affiliation(s)
- Federico Germini
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Victoria Borg Debono
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - David Page
- Canadian Hemophilia Society, Montreal, QC, Canada
| | - Victoria Zuk
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Alexandra Kucher
- Patient Outcomes Research Group Ltd, Washington, DC, United States
| | - Chris Cotoi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Nicholas Hobson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Mark W Skinner
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Institute for Policy Advancement Ltd, Washington, DC, United States
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | -
- see Acknowledgments, Hamilton, ON, Canada
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17
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Germini F, Noronha N, Borg Debono V, Abraham Philip B, Pete D, Navarro T, Keepanasseril A, Parpia S, de Wit K, Iorio A. Accuracy and Acceptability of Wrist-Wearable Activity-Tracking Devices: Systematic Review of the Literature. J Med Internet Res 2022; 24:e30791. [PMID: 35060915 PMCID: PMC8817215 DOI: 10.2196/30791] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/24/2021] [Accepted: 12/06/2021] [Indexed: 01/19/2023] Open
Abstract
Background Numerous wrist-wearable devices to measure physical activity are currently available, but there is a need to unify the evidence on how they compare in terms of acceptability and accuracy. Objective The aim of this study is to perform a systematic review of the literature to assess the accuracy and acceptability (willingness to use the device for the task it is designed to support) of wrist-wearable activity trackers. Methods We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and SPORTDiscus for studies measuring physical activity in the general population using wrist-wearable activity trackers. We screened articles for inclusion and, for the included studies, reported data on the studies’ setting and population, outcome measured, and risk of bias. Results A total of 65 articles were included in our review. Accuracy was assessed for 14 different outcomes, which can be classified in the following categories: count of specific activities (including step counts), time spent being active, intensity of physical activity (including energy expenditure), heart rate, distance, and speed. Substantial clinical heterogeneity did not allow us to perform a meta-analysis of the results. The outcomes assessed most frequently were step counts, heart rate, and energy expenditure. For step counts, the Fitbit Charge (or the Fitbit Charge HR) had a mean absolute percentage error (MAPE) <25% across 20 studies. For heart rate, the Apple Watch had a MAPE <10% in 2 studies. For energy expenditure, the MAPE was >30% for all the brands, showing poor accuracy across devices. Acceptability was most frequently measured through data availability and wearing time. Data availability was ≥75% for the Fitbit Charge HR, Fitbit Flex 2, and Garmin Vivofit. The wearing time was 89% for both the GENEActiv and Nike FuelBand. Conclusions The Fitbit Charge and Fitbit Charge HR were consistently shown to have a good accuracy for step counts and the Apple Watch for measuring heart rate. None of the tested devices proved to be accurate in measuring energy expenditure. Efforts should be made to reduce the heterogeneity among studies.
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Affiliation(s)
- Federico Germini
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Noella Noronha
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- School of Interdisciplinary Sciences, McMaster University, Hamilton, ON, Canada
| | - Victoria Borg Debono
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Binu Abraham Philip
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Drashti Pete
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Tamara Navarro
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Arun Keepanasseril
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sameer Parpia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Kerstin de Wit
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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Abdelkader W, Navarro T, Parrish R, Cotoi C, Germini F, Linkins LA, Iorio A, Haynes RB, Ananiadou S, Chu L, Lokker C. A Deep Learning Approach to Refine the Identification of High-Quality Clinical Research Articles From the Biomedical Literature: Protocol for Algorithm Development and Validation. JMIR Res Protoc 2021; 10:e29398. [PMID: 34847061 PMCID: PMC8669577 DOI: 10.2196/29398] [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: 04/07/2021] [Revised: 08/24/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background A barrier to practicing evidence-based medicine is the rapidly increasing body of biomedical literature. Use of method terms to limit the search can help reduce the burden of screening articles for clinical relevance; however, such terms are limited by their partial dependence on indexing terms and usually produce low precision, especially when high sensitivity is required. Machine learning has been applied to the identification of high-quality literature with the potential to achieve high precision without sacrificing sensitivity. The use of artificial intelligence has shown promise to improve the efficiency of identifying sound evidence. Objective The primary objective of this research is to derive and validate deep learning machine models using iterations of Bidirectional Encoder Representations from Transformers (BERT) to retrieve high-quality, high-relevance evidence for clinical consideration from the biomedical literature. Methods Using the HuggingFace Transformers library, we will experiment with variations of BERT models, including BERT, BioBERT, BlueBERT, and PubMedBERT, to determine which have the best performance in article identification based on quality criteria. Our experiments will utilize a large data set of over 150,000 PubMed citations from 2012 to 2020 that have been manually labeled based on their methodological rigor for clinical use. We will evaluate and report on the performance of the classifiers in categorizing articles based on their likelihood of meeting quality criteria. We will report fine-tuning hyperparameters for each model, as well as their performance metrics, including recall (sensitivity), specificity, precision, accuracy, F-score, the number of articles that need to be read before finding one that is positive (meets criteria), and classification probability scores. Results Initial model development is underway, with further development planned for early 2022. Performance testing is expected to star in February 2022. Results will be published in 2022. Conclusions The experiments will aim to improve the precision of retrieving high-quality articles by applying a machine learning classifier to PubMed searching. International Registered Report Identifier (IRRID) DERR1-10.2196/29398
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Affiliation(s)
- Wael Abdelkader
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Tamara Navarro
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Rick Parrish
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Chris Cotoi
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Federico Germini
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lori-Ann Linkins
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Alfonso Iorio
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - R Brian Haynes
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sophia Ananiadou
- Department of Computer Science, University of Manchester, Manchester, United Kingdom.,The Alan Turing Institute, London, United Kingdom
| | - Lingyang Chu
- Department of Computing and Software, Faculty of Engineering, McMaster University, Hamilton, ON, Canada
| | - Cynthia Lokker
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Germini F, Chai-Adisaksopha C, Pete D, Curtis R, Frick N, Nichol MB, Noone D, O'Mahony B, Page D, Stonebraker JS, Thabane L, Crowther MA, Skinner MW, Iorio A. Evaluation of the sexual health in people living with hemophilia. Haemophilia 2021; 27:993-1001. [PMID: 34538001 DOI: 10.1111/hae.14410] [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: 07/18/2018] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Knowledge about sexual health, difficulty with sexual activity and intimacy (sexual difficulty), in people with hemophilia is little understood. OBJECTIVES The objectives were to determine the prevalence of sexual difficulty in people living with hemophilia (PWH) compared to people with no bleeding disorders (PWNoBD), and to determine factors associated with it. METHODS This was an analysis of the PROBE study. We recruited individuals who had hemophilia A or B (PWH) and PWNoBD who were 18 years old or older. We calculated proportions of participants with sexual difficulty and odds ratios (ORs) adjusted for sex and age with 95% confidence intervals. RESULTS There were 2007 PWH and 1972 PWNoBD. Mean (standard deviation) age was 41 (15) years in PWH and 42 (13) years in PWNoBD. Sexual difficulty was reported in 302 (15.1%) PWH and 79 (4.0%) PWNoBD. The odds of sexual difficulty were significantly higher in PWH (OR 3.82, 95% CI 2.85, 5.11). Among PWH, older age, experiencing acute or chronic pain in the past 12 months, bleeds within the past two weeks, ≥3 spontaneous joint bleeds (past six months), limitation of range of motion of any joints, and any life- or limb-threatening bleeds in the past 12 months were associated with sexual difficulty. CONCLUSIONS Sexual difficulty is more prevalent in people living with hemophilia and associated with markers of disease severity. Sexual health issues should be incorporated in comprehensive hemophilia care, future research, and hemophilia related health policy.
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Affiliation(s)
- Federico Germini
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of HEI, McMaster University, Hamilton, ON, Canada
| | - Chatree Chai-Adisaksopha
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of HEI, McMaster University, Hamilton, ON, Canada
| | - Drashti Pete
- Department of HEI, McMaster University, Hamilton, ON, Canada
| | | | - Neil Frick
- National Hemophilia Foundation, New York, USA
| | - Michael B Nichol
- Sol Price School of Public Policy, University of Southern California, Los Angeles, USA
| | | | - Brian O'Mahony
- Irish Haemophilia Society, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland
| | - David Page
- Canadian Hemophilia Society, Montreal, Canada
| | | | - Lehana Thabane
- Department of HEI, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, St Joseph's Healthcare, Hamilton, Canada
| | - Mark A Crowther
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of HEI, McMaster University, Hamilton, ON, Canada
| | - Mark W Skinner
- Department of HEI, McMaster University, Hamilton, ON, Canada.,Institute for Policy Development Ltd, Washington, USA
| | - Alfonso Iorio
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of HEI, McMaster University, Hamilton, ON, Canada
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20
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Abdelkader W, Navarro T, Parrish R, Cotoi C, Germini F, Iorio A, Haynes RB, Lokker C. Machine Learning Approaches to Retrieve High-Quality, Clinically Relevant Evidence From the Biomedical Literature: Systematic Review. JMIR Med Inform 2021; 9:e30401. [PMID: 34499041 PMCID: PMC8461527 DOI: 10.2196/30401] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/15/2021] [Accepted: 07/25/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The rapid growth of the biomedical literature makes identifying strong evidence a time-consuming task. Applying machine learning to the process could be a viable solution that limits effort while maintaining accuracy. OBJECTIVE The goal of the research was to summarize the nature and comparative performance of machine learning approaches that have been applied to retrieve high-quality evidence for clinical consideration from the biomedical literature. METHODS We conducted a systematic review of studies that applied machine learning techniques to identify high-quality clinical articles in the biomedical literature. Multiple databases were searched to July 2020. Extracted data focused on the applied machine learning model, steps in the development of the models, and model performance. RESULTS From 3918 retrieved studies, 10 met our inclusion criteria. All followed a supervised machine learning approach and applied, from a limited range of options, a high-quality standard for the training of their model. The results show that machine learning can achieve a sensitivity of 95% while maintaining a high precision of 86%. CONCLUSIONS Machine learning approaches perform well in retrieving high-quality clinical studies. Performance may improve by applying more sophisticated approaches such as active learning and unsupervised machine learning approaches.
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Affiliation(s)
- Wael Abdelkader
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Tamara Navarro
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Rick Parrish
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Chris Cotoi
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Federico Germini
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Alfonso Iorio
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - R Brian Haynes
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Cynthia Lokker
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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21
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Versloot O, Iserman E, Chelle P, Germini F, Edginton AN, Schutgens REG, Iorio A, Fischer K. Terminal half-life of FVIII and FIX according to age, blood group and concentrate type: Data from the WAPPS database. J Thromb Haemost 2021; 19:1896-1906. [PMID: 34013558 PMCID: PMC8361743 DOI: 10.1111/jth.15395] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/26/2021] [Accepted: 05/11/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Real-life data on pharmacokinetics of factor (F) VIII/IX concentrates, especially extended half-life (EHL), concentrates in large cohorts of persons with hemophilia are currently lacking. OBJECTIVES This cross-sectional study aimed to establish reference values for terminal half-life (THL) for FVIII/IX concentrates according to concentrate type, age, blood group and inhibitor history. PATIENTS/METHODS Data were extracted from the Web-Accessible Population Pharmacokinetics Service database. Groups were compared by nonparametric tests. THL was modelled according to patient characteristics and concentrate type. RESULTS Infusion data (n = 8022) were collected from 4832 subjects (including 2222 children) with severe hemophilia (age: 1 month-85 years; 89% hemophilia A; 34% using EHL concentrates, 9.8% with history of inhibitors). THL of FVIII-EHL was longer than of FVIII standard half-life (SHL; median 15.1 vs. 11.1 h). FVIII-THL was dependent on age, concentrate type, blood group, and inhibitor history. THL of FIX-EHL was longer than of FIX-SHL (median 106.9 vs. 36.5 h). FIX-THL increased with age until 30 years and remained stable thereafter. FVIII-THL was shorter in subjects with blood group O. THL was decreased by 1.3 h for FVIII and 22 h for FIX in subjects with a positive inhibitor history. CONCLUSIONS We established reference values for FVIII/IX concentrates according to patient characteristics and concentrate type in a large database of hemophilia patients. These reference values may inform clinical practice (e.g., assessment of immune tolerance success), economic implications of procurement processes and value attribution of novel treatments (e.g., mimetics, gene therapy).
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Affiliation(s)
- Olav Versloot
- Van CreveldkliniekUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Emma Iserman
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonONCanada
| | - Pierre Chelle
- School of PharmacyUniversity of WaterlooWaterlooONCanada
| | - Federico Germini
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonONCanada
- Department of MedicineMcMaster UniversityHamiltonONCanada
| | | | | | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonONCanada
- Department of MedicineMcMaster UniversityHamiltonONCanada
- McMaster‐Bayer Endowed Research Chair in Clinical Epidemiology of Congenital bleeding DisordersDepartment of MedicineMcMasterHamiltonONCanada
| | - Kathelijn Fischer
- Van CreveldkliniekUniversity Medical Centre UtrechtUtrechtThe Netherlands
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22
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Aquino CC, Borg Debono V, Germini F, Pete D, Kempton CL, Young G, Sidonio R, Croteau SE, Dunn AL, Key NS, Iorio A. Outcomes for studies assessing the efficacy of hemostatic therapies in persons with congenital bleeding disorders. Haemophilia 2021; 27:211-220. [PMID: 33550614 DOI: 10.1111/hae.14247] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Management strategies and hemostatic treatments to achieve control of bleeding are relevant across many disease areas. Identification of primary outcomes for studies assessing hemostatic intervention was the objective of a National Heart, Lung and Blood Institute (NHLBI) sponsored multidisciplinary initiative. The aim of this report is to summarize the evidence reviewed, and the outcomes identified by the subgroup tasked to assess outcomes for inherited bleeding disorders. METHODS The subgroup decided to focus on haemophilia, the prototypal congenital bleeding disorder and the one with the largest available body of evidence. MEDLINE, EMBASE and PsycINFO, The Cochrane Review, CINAHL, and Web of Science were searched for systematic and narrative reviews on outcomes used in haemophilia clinical trials. Three different clinical goals were identified as typical objectives of future research. RESULTS Out of 1322 unique citations, 24 reviews published in the period 2002-2019 were included. We identified 113 outcome measures, categorized in 6 domains: health-related quality of life (HRQoL), comorbidities and mortality, overall physical functioning and participation, bleeding and hemostasis, joint health, and costs and resource use. Three different clinical goals were identified as typical objectives of future research: Episodic 'on demand' replacement therapy, prevention of bleeding (Prophylaxis), and long-term and overall impact of bleeding. For each of these scenarios, specific outcomes were recommended. CONCLUSIONS Primary outcomes for clinical trials assessing the efficacy of hemostatic treatment in achieving control, prevention and limiting long-term consequences of bleeding in inherited bleeding disorders are suggested, and their strength and limitations discussed.
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Affiliation(s)
- Camila C Aquino
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, Calgary, Canada
| | - Victoria Borg Debono
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.,Department of Anesthesiology, McMaster University, Hamilton, ON, Canada.,Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - Federico Germini
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Drashti Pete
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Christine L Kempton
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA, USA
| | - Guy Young
- Hemostasis and Thrombosis Center, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Robert Sidonio
- Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders, Atlanta, GA, USA
| | - Stacy E Croteau
- Boston Children's Hospital, Boston Hemophilia Center, Harvard Medical School, Boston, MA, USA
| | - Amy L Dunn
- Hemophilia Treatment Center, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Nigel S Key
- Division of Hematology and Blood Research Center, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Alfonso Iorio
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
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23
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Germini F, Hu Y, Afzal S, Al-Haimus F, Puttagunta SA, Niaz S, Chan T, Clayton N, Mondoux S, Thabane L, de Wit K. Feasibility of a quality improvement project to increase adherence to evidence-based pulmonary embolism diagnosis in the emergency department. Pilot Feasibility Stud 2021; 7:4. [PMID: 33390190 PMCID: PMC7779326 DOI: 10.1186/s40814-020-00741-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/03/2020] [Indexed: 11/11/2022] Open
Abstract
Background Many evidence-based clinical decision tools are available for the diagnosis of pulmonary embolism (PE). However, these clinical decision tools have had suboptimal uptake in the everyday clinical practice in emergency departments (EDs), despite numerous implementation efforts. We aimed to test the feasibility of a multi-faceted intervention to implement an evidence-based PE diagnosis protocol. Methods We conducted an interrupted time series study in three EDs in Ontario, Canada. We enrolled consecutive adult patients accessing the ED with suspected PE from January 1, 2018, to February 28, 2020. Components of the intervention were as follows: clinical leadership endorsement, a new pathway for PE testing, physician education, personalized confidential physician feedback, and collection of patient outcome information. The intervention was implemented in November 2019. We identified six criteria for defining the feasibility outcome: successful implementation of the intervention in at least two of the three sites, capturing data on ≥ 80% of all CTPAs ordered in the EDs, timely access to electronic data, rapid manual data extraction with feedback preparation before the end of the month ≥ 80% of the time, and time required for manual data extraction and feedback preparation ≤ 2 days per week in total. Results The intervention was successfully implemented in two out of three sites. A total of 5094 and 899 patients were tested for PE in the period before and after the intervention, respectively. We captured data from 90% of CTPAs ordered in the EDs, and we accessed the required electronic data. The manual data extraction and individual emergency physician audit and feedback were consistently finalized before the end of each month. The time required for manual data extraction and feedback preparation was ≤ 2 days per week (14 h). Conclusions We proved the feasibility of implementing an evidence-based PE diagnosis protocol in two EDs. We were not successful implementing the protocol in the third ED. Registration The study was not registered.
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Affiliation(s)
- Federico Germini
- Department of Health Research Methods, Evidence, and Impact, Health Information Research Unit (HIRU), Communication Research Laboratory (CRL), McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. .,Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Yang Hu
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sarah Afzal
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Fayad Al-Haimus
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Saghar Niaz
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Teresa Chan
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Natasha Clayton
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shawn Mondoux
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Emergency Medicine, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, Health Information Research Unit (HIRU), Communication Research Laboratory (CRL), McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.,Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada.,Departments of Paediatrics and Anaesthesia, McMaster University, Hamilton, ON, Canada.,Centre for Evaluation of Medicine, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Kerstin de Wit
- Department of Health Research Methods, Evidence, and Impact, Health Information Research Unit (HIRU), Communication Research Laboratory (CRL), McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
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24
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Germini F, Zarabi S, Eventov M, Turcotte M, Li M, de Wit K. Pulmonary embolism prevalence among emergency department cohorts: A systematic review and meta-analysis by country of study. J Thromb Haemost 2021; 19:173-185. [PMID: 33048461 DOI: 10.1111/jth.15124] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/08/2020] [Accepted: 09/28/2020] [Indexed: 12/30/2022]
Abstract
Essentials The threshold to test for pulmonary embolism (PE) might be lower in North America than Europe. We compared the PE prevalence and positive yield of imaging in Europe and North America. More patients tested in Europe are diagnosed with PE, and imaging is more often positive. Our systematic review supports the hypothesis of overtesting for PE in North America. ABSTRACT: Background There is an impression that North American emergency department (ED) patients tested for pulmonary embolism (PE) differ from European ones. Objectives We compared the PE prevalence, frequency of use, and positive yield of imaging among ED patients tested for PE in Europe and North America. Methods We searched for studies reporting consecutive ED patients tested for PE. Two authors screened full texts, performed risk of bias assessment, and data extraction. We conducted a meta-analysis of proportions for each outcome and a multiple meta-regression. Results From 3109 publications, 44 were included in the systematic review. The prevalence of PE in Europe was 23% (95% confidence interval [CI], 21-26) and in North America 8% (95% CI, 6-9). The adjusted mean difference (aMD) in the prevalence of PE in the European compared with North American studies, was 15% (95% CI, 10-20). Computed tomography pulmonary angiography (CTPA) was used in 60% (95% CI, 52%-68) of European and 38% (95% CI, 24-51) of North American patients tested for PE (aMD, 23% [95% CI, 7-39]). The CTPA diagnostic yield was 29% (95% CI, 26-32) in Europe and 13% (95% CI, 9-17) in North America (aMD, 15% [95% CI, 8-21]). Conclusion Compared with North America, European ED studies have a higher prevalence of PE and diagnostic yield from CTPA, despite a higher frequency of CTPA use among patients tested for PE. This supports the hypothesis that those tested for PE in North American EDs have a lower risk of PE compared with Europe.
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Affiliation(s)
- Federico Germini
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Canada
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
| | - Sahar Zarabi
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Canada
| | - Michelle Eventov
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Canada
| | - Michelle Turcotte
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Canada
| | - Meirui Li
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Canada
| | - Kerstin de Wit
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Canada
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Chai-Adisaksopha C, Noone D, Curtis R, Frick N, Nichol MB, Germini F, O'Mahony B, Page D, Stonebraker JS, Skinner MW, Iorio A. Non-severe haemophilia: Is it benign? - Insights from the PROBE study. Haemophilia 2020; 27 Suppl 1:17-24. [PMID: 32870546 DOI: 10.1111/hae.14105] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/15/2020] [Accepted: 06/22/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION There are limited data on the impact of haemophilia on health status and health-related quality of life (HRQL) in people with non-severe (mild and moderate) haemophilia. AIM To evaluate the health status of people living with mild or moderate haemophilia. METHODS Data on respondents with no bleeding disorder (NoBD), mild and moderate haemophilia patients were drawn from the PROBE study. Respondents were enrolled using network patient organizations. This analysis was performed as a cross-sectional study. Primary outcomes were reported bleeding, acute and chronic pain, activities of daily living and HRQL. RESULTS A total of 862 respondents with NoBD (n = 173), mild (n = 102) and moderate (n = 134) haemophilia were eligible, with a median age of 33, 42 and 43, respectively. In relation to haemophilia-related sequalae, 53% of male and 29% of female patients with mild and 83% of males with moderate haemophilia had more than 2-3 bleeds in the last 12 months. Reporting of acute and chronic pain is less in those with NoBD compared to the mild and moderate cohorts for both genders. Multivariate analysis demonstrates significant reductions in quality of life using VAS, EQ-5D-5L and PROBE for males with mild and moderate haemophilia (P ≤ .001) with only PROBE indicating a significant reduction for females with mild (P = .002). CONCLUSION People affected by mild or moderate haemophilia report a significant HRQL impact due to haemophilia-related bleeding. Future research is needed to identify the optimal care management of patients with mild and moderate haemophilia.
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Affiliation(s)
- Chatree Chai-Adisaksopha
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Declan Noone
- Health Decisions Consultants, Dublin, Ireland.,European Haemophilia Consortium, Brussels, Belgium
| | | | - Neil Frick
- National Hemophilia Foundation, New York, NY, USA
| | - Michael B Nichol
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Federico Germini
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Brian O'Mahony
- Trinity College Dublin, Dublin, Ireland.,Irish Haemophilia Society, Dublin, Ireland
| | - David Page
- Canadian Hemophilia Society, Montreal, QC, Canada
| | | | - Mark W Skinner
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Institute for Policy Advancement Ltd, Washington, DC, USA
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,McMaster-Bayer Endowed Research Chair in Clinical Epidemiology of Congenital Bleeding Disorders, Department of Medicine, McMaster, Hamilton, ON, Canada
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26
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Borges FK, Sheth T, Patel A, Marcucci M, Yung T, Langer T, Alboim C, Polanczyk CA, Germini F, Azeredo-da-Silva AF, Sloan E, Kaila K, Ree R, Bertoletti A, Vedovati MC, Galzerano A, Spence J, Devereaux PJ. Accuracy of Physicians in Differentiating Type 1 and Type 2 Myocardial Infarction Based on Clinical Information. CJC Open 2020; 2:577-584. [PMID: 33305218 PMCID: PMC7711010 DOI: 10.1016/j.cjco.2020.07.009] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/13/2020] [Indexed: 12/31/2022] Open
Abstract
Background Physicians commonly judge whether a myocardial infarction (MI) is type 1 (thrombotic) vs type 2 (supply/demand mismatch) based on clinical information. Little is known about the accuracy of physicians’ clinical judgement in this regard. We aimed to determine the accuracy of physicians’ judgement in the classification of type 1 vs type 2 MI in perioperative and nonoperative settings. Methods We performed an online survey using cases from the Optical Coherence Tomographic Imaging of Thrombus (OPTIMUS) Study, which investigated the prevalence of a culprit lesion thrombus based on intracoronary optical coherence tomography (OCT) in patients experiencing MI. Four MI cases, 2 perioperative and 2 nonoperative, were selected randomly, stratified by etiology. Physicians were provided with the patient’s medical history, laboratory parameters, and electrocardiograms. Physicians did not have access to intracoronary OCT results. The primary outcome was the accuracy of physicians' judgement of MI etiology, measured as raw agreement between physicians and intracoronary OCT findings. Fleiss’ kappa and Gwet’s AC1 were calculated to correct for chance. Results The response rate was 57% (308 of 536). Respondents were 62% male; median age was 45 years (standard deviation ± 11); 45% had been in practice for > 15 years. Respondents’ overall accuracy for MI etiology was 60% (95% confidence interval [CI] 57%-63%), including 63% (95% CI 60%-68%) for nonoperative cases, and 56% (95% CI 52%-60%) for perioperative cases. Overall chance-corrected agreement was poor (kappa = 0.05), consistent across specialties and clinical scenarios. Conclusions Physician accuracy in determining MI etiology based on clinical information is poor. Physicians should consider results from other testing, such as invasive coronary angiography, when determining MI etiology.
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Affiliation(s)
- Flavia K Borges
- Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Tej Sheth
- Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ameen Patel
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Maura Marcucci
- Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Terence Yung
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Langer
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carolina Alboim
- Post-graduate Program of Cardiology and Cardiovacular Sciences, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Department of Anesthesia, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Carisi Anne Polanczyk
- Graduate Program in Cardiology and Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Department of Internal Medicine, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Federico Germini
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Erin Sloan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kendeep Kaila
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ron Ree
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alessandra Bertoletti
- Department of Cardiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Antonio Galzerano
- Intensive Care Unit, Santa Maria of Misericordia Hospital, Univerity of Perugia, Perugia, Italy
| | - Jessica Spence
- Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada
| | - P J Devereaux
- Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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Germini F, Marcucci M, Fedele M, Galli MG, Heath T, Mbuagbaw L, Salvatori V, Veronese G, Worster A, Thabane L. Quality of reporting in abstracts of RCTs published in emergency medicine journals: a systematic survey of the literature suggests we can do better. Emerg Med J 2019; 37:660-665. [PMID: 31694858 DOI: 10.1136/emermed-2019-208629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/26/2019] [Accepted: 08/02/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We investigated the association between the publication of the Consolidated Standards of Reporting Trials extension for abstracts (CONSORT-EA) and other variables of interest on the quality of reporting of abstracts of randomised controlled trials (RCTs) published in emergency medicine (EM) journals. METHODS We performed a survey of the literature, comparing the quality of reporting before (2005-2007) with after (2014-2015) the publication of the dedicated CONSORT-EA in 2008. The quality of reporting was measured as the sum of items of the CONSORT-EA checklist reported in each abstract, ranging from 0 to 15. The main explanatory variable was the period of publication: pre-CONSORT-EA versus post-CONSORT-EA public. Other explanatory variables were journal's endorsement of the CONSORT statement, number of centres participating in the study, study's sample size, type of intervention, significance of results, source of funding and study setting. We analysed the data using generalised estimation equations, performing a univariate and a multivariable analysis. RESULTS We retrieved 844 articles, and randomly selected 60 per period for review, after stratifying for journal. The mean (SD) number of items reported was 6.4 (1.9) in the period before and 6.9 (1.8) in the period after the publication of the CONSORT-EA, with an adjusted mean difference (aMD) of 0.47 (95% CI -0.13 to 1.06). Abstracts of trials of pharmacological interventions had a significantly larger mean number of reported items than those of trials of non-pharmacological interventions (aMD 1.59; 95% CI 0.94 to 2.24). CONCLUSIONS The quality of reporting in abstracts of RCTs published in EM journals is low and was not significantly impacted by the publication of a dedicated CONSORT-EA.
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Affiliation(s)
- Federico Germini
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
| | - Maura Marcucci
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Marta Fedele
- Unità Operativa Complessa di Medicina e Chirurgia d'Accettazione e d'Urgenza, Ospedale Renzetti, Asl Lanciano Vasto Chieti, Lanciano, Italy
| | - Maria Giulia Galli
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Tevin Heath
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Valentina Salvatori
- General Practitioner Course, Regione Marche - Servizio Sanità, Ancona, Italy
| | - Giacomo Veronese
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Andrew Worster
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Departments of Paediatrics and Anaesthesia, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicine, St Joseph's Healthcare, Hamilton, Ontario, Canada
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Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, Vollenbroek-Hutten M, Germini F, D'Avanzo B, Gwyther H, Holland C. Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: a systematic review. ACTA ACUST UNITED AC 2019; 16:140-232. [PMID: 29324562 PMCID: PMC5771690 DOI: 10.11124/jbisrir-2017-003382] [Citation(s) in RCA: 273] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To summarize the best available evidence regarding the effectiveness of interventions for preventing frailty progression in older adults. INTRODUCTION Frailty is an age-related state of decreased physiological reserves characterized by an increased risk of poor clinical outcomes. Evidence supporting the malleability of frailty, its prevention and treatment, has been presented. INCLUSION CRITERIA The review considered studies on older adults aged 65 and over, explicitly identified as pre-frail or frail, who had been undergoing interventions focusing on the prevention of frailty progression. Participants selected on the basis of specific illness or with a terminal diagnosis were excluded. The comparator was usual care, alternative therapeutic interventions or no intervention. The primary outcome was frailty. Secondary outcomes included: (i) cognition, quality of life, activities of daily living, caregiver burden, functional capacity, depression and other mental health-related outcomes, self-perceived health and social engagement; (ii) drugs and prescriptions, analytical parameters, adverse outcomes and comorbidities; (iii) costs, and/or costs relative to benefits and/or savings associated with implementing the interventions for frailty. Experimental study designs, cost effectiveness, cost benefit, cost minimization and cost utility studies were considered for inclusion. METHODS Databases for published and unpublished studies, available in English, Portuguese, Spanish, Italian and Dutch, from January 2001 to November 2015, were searched. Critical appraisal was conducted using standardized instruments from the Joanna Briggs Institute. Data was extracted using the standardized tools designed for quantitative and economic studies. Data was presented in a narrative form due to the heterogeneity of included studies. RESULTS Twenty-one studies, all randomized controlled trials, with a total of 5275 older adults and describing 33 interventions, met the criteria for inclusion. Economic analyses were conducted in two studies. Physical exercise programs were shown to be generally effective for reducing or postponing frailty but only when conducted in groups. Favorable effects on frailty indicators were also observed after the interventions, based on physical exercise with supplementation, supplementation alone, cognitive training and combined treatment. Group meetings and home visits were not found to be universally effective. Lack of efficacy was evidenced for physical exercise performed individually or delivered one-to-one, hormone supplementation and problem solving therapy. Individually tailored management programs for clinical conditions had inconsistent effects on frailty prevalence. Economic studies demonstrated that this type of intervention, as compared to usual care, provided better value for money, particularly for very frail community-dwelling participants, and had favorable effects in some of the frailty-related outcomes in inpatient and outpatient management, without increasing costs. CONCLUSIONS This review found mixed results regarding the effectiveness of frailty interventions. However, there is clear evidence on the usefulness of such interventions in carefully chosen evidence-based circumstances, both for frailty itself and for secondary outcomes, supporting clinical investment of resources in frailty intervention. Further research is required to reinforce current evidence and examine the impact of the initial level of frailty on the benefits of different interventions. There is also a need for economic evaluation of frailty interventions.
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Affiliation(s)
- João Apóstolo
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
| | - Richard Cooke
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, United Kingdom
| | - Elzbieta Bobrowicz-Campos
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
| | - Silvina Santana
- Department of Economics, Management and Industrial Engineering, University of Aveiro, Aveiro, Portugal
| | - Maura Marcucci
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department. of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Antonio Cano
- Department of Paediatrics, Obstetrics and Gynaecology, Universitat de Valência, Valência, Spain
| | | | - Federico Germini
- Department. of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Barbara D'Avanzo
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Holly Gwyther
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, United Kingdom
| | - Carol Holland
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, United Kingdom
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Marcucci M, Damanti S, Germini F, Apostolo J, Bobrowicz-Campos E, Gwyther H, Holland C, Kurpas D, Bujnowska-Fedak M, Szwamel K, Santana S, Nobili A, D'Avanzo B, Cano A. Interventions to prevent, delay or reverse frailty in older people: a journey towards clinical guidelines. BMC Med 2019; 17:193. [PMID: 31660959 PMCID: PMC6819620 DOI: 10.1186/s12916-019-1434-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/26/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Age-related frailty is a multidimensional dynamic condition associated with adverse patient outcomes and high costs for health systems. Several interventions have been proposed to tackle frailty. This correspondence article describes the journey through the development of evidence- and consensus-based guidelines on interventions aimed at preventing, delaying or reversing frailty in the context of the FOCUS (Frailty Management Optimisation through EIP-AHA Commitments and Utilisation of Stakeholders Input) project (664367-FOCUS-HP-PJ-2014). The rationale, framework, processes and content of the guidelines are described. MAIN TEXT The guidelines were framed into four questions - one general and three on specific groups of interventions - all including frailty as the primary outcome of interest. Quantitative and qualitative studies and reviews conducted in the context of the FOCUS project represented the evidence base. We followed the GRADE Evidence-to-Decision frameworks based on assessment of whether the problem is a priority, the magnitude of the desirable and undesirable effects, the certainty of the evidence, stakeholders' values, the balance between desirable and undesirable effects, the resource use, and other factors like acceptability and feasibility. Experts in the FOCUS consortium acted as panellists in the consensus process. Overall, we eventually recommended interventions intended to affect frailty as well as its course and related outcomes. Specifically, we recommended (1) physical activity programmes or nutritional interventions or a combination of both; (2) interventions based on tailored care and/or geriatric evaluation and management; and (3) interventions based on cognitive training (alone or in combination with exercise and nutritional supplementation). The panel did not support interventions based on hormone treatments or problem-solving therapy. However, all our recommendations were weak (provisional) due to the limited available evidence and based on heterogeneous studies of limited quality. Furthermore, they are conditional to the consideration of participant-, organisational- and contextual/cultural-related facilitators or barriers. There is insufficient evidence in favour of or against other types of interventions. CONCLUSIONS We provided guidelines based on quantitative and qualitative evidence, adopting methodological standards, and integrating relevant stakeholders' inputs and perspectives. We identified the need for further studies of a higher methodological quality to explore interventions with the potential to affect frailty.
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Affiliation(s)
- Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Sarah Damanti
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Nutritional Sciences Doctorate, Università degli Studi di Milano, Milan, Italy
| | - Federico Germini
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Joao Apostolo
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence Based Practice - a Joanna Briggs Institute Centre of Excellence, Coimbra, Portugal
| | - Elzbieta Bobrowicz-Campos
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence Based Practice - a Joanna Briggs Institute Centre of Excellence, Coimbra, Portugal
| | - Holly Gwyther
- The Centre for Ageing Research, Lancaster University, Lancaster, UK
| | - Carol Holland
- The Centre for Ageing Research, Lancaster University, Lancaster, UK
| | - Donata Kurpas
- Family Medicine Department, Wroclaw Medical University, Wroclaw, Poland
| | | | - Katarzyna Szwamel
- Family Medicine Department, Wroclaw Medical University, Wroclaw, Poland
- Faculty of Medical Science, Opole Medical School, Opole, Poland
| | - Silvina Santana
- Department of Economics, Management and Industrial Engineering, University of Aveiro, Aveiro, Portugal
| | - Alessandro Nobili
- Laboratory of Quality Assessment of Geriatric Therapies and Services, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Barbara D'Avanzo
- Laboratory of Quality Assessment of Geriatric Therapies and Services, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Antonio Cano
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
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Iorio A, Stonebraker JS, Chambost H, Makris M, Coffin D, Herr C, Germini F. Establishing the Prevalence and Prevalence at Birth of Hemophilia in Males: A Meta-analytic Approach Using National Registries. Ann Intern Med 2019; 171:540-546. [PMID: 31499529 DOI: 10.7326/m19-1208] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The large observed variability in hemophilia prevalence prevents robust estimation of burden of disease. OBJECTIVE To estimate the prevalence and prevalence at birth of hemophilia and the associated life expectancy disadvantage. DESIGN Random-effects meta-analysis of registry data. SETTING Australia, Canada, France, Italy, New Zealand, and the United Kingdom. PARTICIPANTS Male patients with hemophilia A or B. MEASUREMENTS Prevalence of hemophilia as a proportion of cases to the male population, prevalence of hemophilia at birth as a proportion of cases to live male births by year of birth, life expectancy disadvantage as a 1 - ratio of prevalence to prevalence at birth, and expected number of patients worldwide based on prevalence in high-income countries and prevalence at birth. RESULTS Prevalence (per 100 000 males) is 17.1 cases for all severities of hemophilia A, 6.0 cases for severe hemophilia A, 3.8 cases for all severities of hemophilia B, and 1.1 cases for severe hemophilia B. Prevalence at birth (per 100 000 males) is 24.6 cases for all severities of hemophilia A, 9.5 cases for severe hemophilia A, 5.0 cases for all severities of hemophilia B, and 1.5 cases for severe hemophilia B. The life expectancy disadvantage for high-income countries is 30% for hemophilia A, 37% for severe hemophilia A, 24% for hemophilia B, and 27% for severe hemophilia B. The expected number of patients with hemophilia worldwide is 1 125 000, of whom 418 000 should have severe hemophilia. LIMITATION Details were insufficient to adjust for comorbid conditions and ethnicity. CONCLUSION The prevalence of hemophilia is higher than previously estimated. Patients with hemophilia still have a life expectancy disadvantage. Establishing prevalence at birth is a milestone toward assessing years of life lost, years of life with disability, and burden of disease. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Alfonso Iorio
- McMaster University, Hamilton, Ontario, Canada (A.I., F.G.)
| | - Jeffrey S Stonebraker
- Poole College of Management at North Carolina State University, Raleigh, North Carolina (J.S.S.)
| | - Hervé Chambost
- La Timone Hospital of Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, Institut National de la Santé et de la Recherche Médicale, and Institut National de la Recherche Agronomique, Marseille, France (H.C.)
| | - Michael Makris
- University of Sheffield, Sheffield, United Kingdom (M.M.)
| | - Donna Coffin
- World Federation of Hemophilia, Montréal, Québec, Canada (D.C., C.H.)
| | - Christine Herr
- World Federation of Hemophilia, Montréal, Québec, Canada (D.C., C.H.)
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Germini F, Zarabi S, Eventov M, Turcotte M, Rigg K, Li M, De Wit K. P4. Abstract Title: Prevalence of Pulmonary Embolism in Patients Accessing the Emergency Department, Reported by Country of Study: A Systematic Review and Meta-Analysis. Thromb Res 2019. [DOI: 10.1016/j.thromres.2019.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Causada-Calo N, Germini F, Yuan Y, Eikelboom JW, Moayyedi P. Proton-pump inhibitors for the prevention of upper gastrointestinal bleeding in adults receiving antithrombotic therapy. Hippokratia 2019. [DOI: 10.1002/14651858.cd013415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Natalia Causada-Calo
- St. Michael's Hospital; Department of Medicine, Division of Gastroenterology; 30 Bond St. Therapeutic Endoscopy Unit, 16th floor, Cardinal Carter North Toronto ON Canada M5B 1W8
| | - Federico Germini
- McMaster University; Department of Health Research Methods, Evidence, and Impact; Hamilton ON Canada
| | - Yuhong Yuan
- McMaster University; Department of Medicine, Division of Gastroenterology; 1280 Main Street West Room HSC 3N51 Hamilton ON Canada L8S 4K1
| | - John W Eikelboom
- McMaster Clinic; Thrombosis Service; HHS - General Hospital 237 Barton Street East Hamilton ON Canada L8L 2X2
| | - Paul Moayyedi
- McMaster University; Department of Medicine, Division of Gastroenterology; 1280 Main Street West Room HSC 3N51 Hamilton ON Canada L8S 4K1
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Germini F, Veronese G, Marcucci M, Coen D, Ardemagni D, Montano N, Fabbri A. Validation of the BAP-65 score for prediction of in-hospital death or use of mechanical ventilation in patients presenting to the emergency department with an acute exacerbation of COPD: a retrospective multi-center study from the Italian Society of Emergency Medicine (SIMEU). Eur J Intern Med 2019; 61:62-68. [PMID: 30391167 DOI: 10.1016/j.ejim.2018.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/07/2018] [Accepted: 10/24/2018] [Indexed: 11/24/2022]
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPDE) frequently require hospitalizations, may necessitate of invasive mechanical ventilation (IMV), and are associated with a remarkable in-hospital mortality. The BAP-65 score is a risk assessment model (RAM) based on simple variables, that has been proposed for the prediction of these adverse outcomes in patients with COPDE. If showed to be accurate, the BAP-65 RAM might be used to guide the patients management, in terms of destination and treatment. We conducted a retrospective, multicentre, chart-review study, on patients attending the ED for a COPDE during 2014. The aim of the study was the validation of the BAP-65 RAM for the prediction of in-hospital death or use of IMV (composite primary outcome). We assessed the discrimination and the prognostic performance of the BAP-65 RAM. We enrolled 2908 patients from 20 centres across Italy. The mean (standard deviation) age was 76 (11) years, and 38% of patients were female. The composite outcome occurred in 5.3% of patients. The AUROC of BAP-65 for the composite outcome was 0.64 (95%CI 0.59-0.68). The sensitivity of BAP-65 score ≥ 4 to predict in-hospital mortality was 44% (95% CI 34%-55%), the specificity was 84% (95% CI 82%-85%), the positive predictive value was 9% (95% CI 6%-12%), and the negative predictive value was 98% (95% CI 97%-98%). CONCLUSIONS: In patients attending Italian EDs with a COPDE, we found that the BAP-65 score did not have sufficient accuracy to stratify patients upon their risk of severe in-hospital outcomes.
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Affiliation(s)
- Federico Germini
- Department of Health Research Methods, Evidence, and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, ON, Canada; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy; Emergency Department, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giacomo Veronese
- Department of Emergency Medicine, Grande Ospedale Metropolitano Niguarda Ca' Granda, Università di Milano-Bicocca, Milan, Italy
| | - Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, ON, Canada
| | - Daniele Coen
- Department of Emergency Medicine, Grande Ospedale Metropolitano Niguarda Ca' Granda, Università di Milano-Bicocca, Milan, Italy
| | - Deborah Ardemagni
- Geriatric Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Nicola Montano
- Emergency Department, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Andrea Fabbri
- Department of Emergency Medicine, Ospedale Morgagni-Pierantoni, Forlì, Italy
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Stemberger M, Kallenbach F, Schmit E, McEneny-King A, Germini F, Yeung CHT, Edginton AN, von Mackensen S, Kurnik K, Iorio A. Impact of Adopting Population Pharmacokinetics for Tailoring Prophylaxis in Haemophilia A Patients: A Historically Controlled Observational Study. Thromb Haemost 2019; 119:368-376. [PMID: 30685872 DOI: 10.1055/s-0039-1677700] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Performing individual pharmacokinetics (PK) studies in clinical practice can be simplified by adopting population PK-based profiling on limited post-infusion samples. The objective of this study was to assess the impact of population PK in tailoring prophylaxis in patients with haemophilia A. PATIENTS AND METHODS Individual weekly treatment plans were developed considering predicted plasma factor activity levels and patients' lifestyle. Patients were trained using a visual traffic-light scheme to help modulate their level of physical activity with respect to factor infusions timing. Annualized joint bleeding rate (ABJR), haemophilia-specific quality of life questionnaire for adults (Haemo-QoL-A) and factor utilization were measured for 12 months before and after tailoring, compared within patients and analysed separately for those previously on prophylaxis (P), situational prophylaxis (SP) or on-demand (OD). RESULTS Sixteen patients previously on P, 10 on SP and 10 on OD were enrolled in the study. The median (lower, upper quartile) ABJR changed from 2.0 (0, 4.0) to 0 (0, 1.6) for P (p = 0.003), from 2.0 (2.0, 13.6) to 3.0 (1.4, 7.2) for SP (p = 0.183) and from 16.0 (13.0, 25.0) to 2.3 (0, 5.0) for OD (p = 0.003). The Haemo-QoL-A total score improved for 58% of P, 50% of SP and 29% of OD patients. Factor utilization (IU/kg/patient/year) increased by 2,400 (121; 2,586) for P, 1,052 (308; 1,578) for SP and 2,086 (1,498; 2,576) for OD. One of 138 measurements demonstrated a factor activity level below the critical threshold of 0.03 IU/mL while the predicted level was above the threshold. CONCLUSION Implementing tailored prophylaxis using a Bayesian forecasting approach in a routine clinical practice setting may improve haemophilia clinical outcomes.
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Affiliation(s)
- Michaela Stemberger
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany.,Abteilung für Transfusionsmedizin, Zelltherapeutika und Hämostaseologie, Klinikum der Universität München, Munich, Germany
| | - Felix Kallenbach
- Abteilung für Transfusionsmedizin, Zelltherapeutika und Hämostaseologie, Klinikum der Universität München, Munich, Germany
| | - Elisabeth Schmit
- Abteilung für Transfusionsmedizin, Zelltherapeutika und Hämostaseologie, Klinikum der Universität München, Munich, Germany
| | | | - Federico Germini
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Cindy H T Yeung
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrea N Edginton
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Sylvia von Mackensen
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Kurnik
- Zentrum für Pädiatrische Hämostaseologie, Dr. von Haunersches Kinderspital, Klinikum der Universität München, Munich, Germany
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,McMaster-Bayer Chair for Clinical Epidemiology Research in Bleeding Disorders, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Nagao A, Yeung CH, Germini F, Suzuki T. Clinical outcomes in hemophilia A patients undergoing tailoring of prophylaxis based on population-based pharmacokinetic dosing. Thromb Res 2019; 173:79-84. [DOI: 10.1016/j.thromres.2018.11.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/09/2018] [Accepted: 11/15/2018] [Indexed: 01/19/2023]
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Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, Vollenbroek-Hutten M, Germini F, Holland C. Predicting risk and outcomes for frail older adults: an umbrella review of frailty screening tools. ACTA ACUST UNITED AC 2018; 15:1154-1208. [PMID: 28398987 PMCID: PMC5457829 DOI: 10.11124/jbisrir-2016-003018] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND A scoping search identified systematic reviews on diagnostic accuracy and predictive ability of frailty measures in older adults. In most cases, research was confined to specific assessment measures related to a specific clinical model. OBJECTIVES To summarize the best available evidence from systematic reviews in relation to reliability, validity, diagnostic accuracy and predictive ability of frailty measures in older adults. INCLUSION CRITERIA POPULATION Older adults aged 60 years or older recruited from community, primary care, long-term residential care and hospitals. INDEX TEST Available frailty measures in older adults. REFERENCE TEST Cardiovascular Health Study phenotype model, the Canadian Study of Health and Aging cumulative deficit model, Comprehensive Geriatric Assessment or other reference tests. DIAGNOSIS OF INTEREST Frailty defined as an age-related state of decreased physiological reserves characterized by an increased risk of poor clinical outcomes. TYPES OF STUDIES Quantitative systematic reviews. SEARCH STRATEGY A three-step search strategy was utilized to find systematic reviews, available in English, published between January 2001 and October 2015. METHODOLOGICAL QUALITY Assessed by two independent reviewers using the Joanna Briggs Institute critical appraisal checklist for systematic reviews and research synthesis. DATA EXTRACTION Two independent reviewers extracted data using the standardized data extraction tool designed for umbrella reviews. DATA SYNTHESIS Data were only presented in a narrative form due to the heterogeneity of included reviews. RESULTS Five reviews with a total of 227,381 participants were included in this umbrella review. Two reviews focused on reliability, validity and diagnostic accuracy; two examined predictive ability for adverse health outcomes; and one investigated validity, diagnostic accuracy and predictive ability. In total, 26 questionnaires and brief assessments and eight frailty indicators were analyzed, most of which were applied to community-dwelling older people. The Frailty Index was examined in almost all these dimensions, with the exception of reliability, and its diagnostic and predictive characteristics were shown to be satisfactory. Gait speed showed high sensitivity, but only moderate specificity, and excellent predictive ability for future disability in activities of daily living. The Tilburg Frailty Indicator was shown to be a reliable and valid measure for frailty screening, but its diagnostic accuracy was not evaluated. Screening Letter, Timed-up-and-go test and PRISMA 7 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) demonstrated high sensitivity and moderate specificity for identifying frailty. In general, low physical activity, variously measured, was one of the most powerful predictors of future decline in activities of daily living. CONCLUSION Only a few frailty measures seem to be demonstrably valid, reliable and diagnostically accurate, and have good predictive ability. Among them, the Frailty Index and gait speed emerged as the most useful in routine care and community settings. However, none of the included systematic reviews provided responses that met all of our research questions on their own and there is a need for studies that could fill this gap, covering all these issues within the same study. Nevertheless, it was clear that no suitable tool for assessing frailty appropriately in emergency departments was identified.
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Affiliation(s)
- João Apóstolo
- 1Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence-Based Practice: a Joanna Briggs Institute Centre of Excellence 2Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, United Kingdom 3Department of Economics, Management and Industrial Engineering, University of Aveiro, Aveiro, Portugal 4Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy 5Department of Clinical Science and Community Health, University of Milan, Milan, Italy 6Department of Paediatrics, Obstetrics and Gynaecology, Universitat de Valência, Valência, Spain 7Roessingh Research and Development, The Netherlands
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Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, Vollenbroek-Hutten M, Germini F, D'Avanzo B, Gwyther H, Holland C. Corrigendum: Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: a systematic review. ACTA ACUST UNITED AC 2018; 16:1282-1283. [PMID: 29762317 DOI: 10.11124/jbisrir-2017-003761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- João Apóstolo
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
| | - Richard Cooke
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, United Kingdom
| | - Elzbieta Bobrowicz-Campos
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
| | - Silvina Santana
- Department of Economics, Management and Industrial Engineering, University of Aveiro, Averio, Portugal
| | - Maura Marcucci
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Antonio Cano
- Department of Paediatrics, Obstetrics and Gynaecology, Universitat de Valência, Valência, Spain
| | | | - Federico Germini
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Barbara D'Avanzo
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Holly Gwyther
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, United Kingdom
| | - Carol Holland
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, United Kingdom
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Germini F, Veronese G, Marcucci M, Coen D, Ardemagni D, Montano N, Fabbri A. COPD exacerbations in the emergency department: Epidemiology and related costs. A retrospective cohort multicentre study from the Italian Society of Emergency Medicine (SIMEU). Eur J Intern Med 2018; 51:74-79. [PMID: 29371059 DOI: 10.1016/j.ejim.2018.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/31/2017] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
Abstract
UNLABELLED Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) frequently cause patients with COPD to access the emergency department and have a negative impact on the course of the disease. The objectives of our study were: 1) describing the socio-demographic and clinical characteristics, and the clinical management, of patients with AECOPD, when they present to the emergency department; and 2) estimating the costs related to the management of these patients. We conducted a retrospective cohort study in Italy, collecting data on 4396 patients, from 34 centres. Patients had a mean (SD) age of 76,6 (10.6) years, and 61.2% of them where males. >70% of the patients had a moderate to very high comorbidity burden, and heart failure was present in 26.4% of the cohort. The 64.6% of patients were admitted to hospital wards, with a mean (SD) length of stay of 10.8 (9.8) days. The estimated cost per patient was 2617 €. CONCLUSIONS Patients attending the ED for an AECOPD are old and present important comorbidities. The rate of admission is high, and costs are remarkable.
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Affiliation(s)
- Federico Germini
- Department of Health Research Methods, Evidence, and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, ON, Canada,; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy; Emergency Department, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giacomo Veronese
- Department of Emergency Medicine, Grande Ospedale Metropolitano Niguarda Ca' Granda, Università di Milano-Bicocca, Milan, Italy
| | - Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, ON, Canada
| | - Daniele Coen
- Department of Emergency Medicine, Grande Ospedale Metropolitano Niguarda Ca' Granda, Università di Milano-Bicocca, Milan, Italy
| | - Deborah Ardemagni
- Geriatric Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Nicola Montano
- Emergency Department, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Andrea Fabbri
- Department of Emergency Medicine, Ospedale Morgagni-Pierantoni, Forlì, Italy
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Germini F, Coerezza A, Andreinetti L, Nobili A, Rossi PD, Mari D, Guyatt G, Marcucci M. N-of-1 Randomized Trials of Ultra-Micronized Palmitoylethanolamide in Older Patients with Chronic Pain. Drugs Aging 2018; 34:941-952. [PMID: 29210011 DOI: 10.1007/s40266-017-0506-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Ultra-micronized palmitoylethanolamide (um-PEA) represents an attractive option for chronic pain control in complex older patients at higher risk of adverse effects with traditional analgesics. OBJECTIVE The aim of this study was to determine the effectiveness of um-PEA versus placebo on chronic pain intensity and function in individual geriatric patients. DESIGN We performed randomized, blinded N-of-1 trials with two 3-week um-PEA versus placebo comparisons, separated by 2-week washout periods. PARTICIPANTS The study included outpatients aged ≥ 65 years with chronic, non-cancer, non-ischemic pain in the back, joints, or limbs. INTERVENTION Patients were randomized to Um-PEA 600 mg or placebo twice daily. MEASUREMENTS Pain intensity was measured using an 11-point visual numeric scale. Functional impairment was measured using a Back Pain Functional Scale. Impact of each N-of-1 trial was measured on the clinician's intention to treat and confidence. RESULTS Ten of 11 eligible patients consented over 7 months [all female, mean age 83.2 years (SD 4.6)]. Three patients interrupted the trial: one had diarrhea (under placebo), one for low adherence, and one for intercurrent pneumonia. A small statistically significant effect in favor of um-PEA was seen at the mixed method analyses in two patients (effect size equal to 8% of the baseline pain). A statistically significant impact on function was found in one patient. After the trial, um-PEA was prescribed to four patients; in two patients the clinician changed their pre-trial intention to treat; the clinician confidence in the treatment plan either increased (5) or remained the same (2). CONCLUSIONS Our experience confirmed that N-of-1 trials may help make personalized evidence-based decisions in complex older patients, with special feasibility considerations. CLINICALTRIALS.GOV: NCT02699281.
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Affiliation(s)
- Federico Germini
- Geriatric Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
- Department of Health Research Methods, Evidence, and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, 1280 Main St. W, Hamilton, ON, L8S 4K1, Canada
| | - Anna Coerezza
- Geriatric Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Luca Andreinetti
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Nobili
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Paolo Dionigi Rossi
- Geriatric Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Mari
- Geriatric Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, 1280 Main St. W, Hamilton, ON, L8S 4K1, Canada
| | - Maura Marcucci
- Geriatric Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Health Research Methods, Evidence, and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, 1280 Main St. W, Hamilton, ON, L8S 4K1, Canada.
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
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Germini F, Marcucci M, Fedele M, Galli MG, Mbuagbaw L, Salvatori V, Veronese G, Worster A, Thabane L. Quality of reporting in abstracts of RCTs published in emergency medicine journals: a protocol for a systematic survey of the literature. BMJ Open 2017; 7:e014981. [PMID: 28450467 PMCID: PMC5566942 DOI: 10.1136/bmjopen-2016-014981] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The quality of reporting of abstracts of randomised controlled trials (RCTs) in major general medical journals and in some category-specific journals was shown to be poor before the publication of the ConsolidatedStandards of ReportingTrials (CONSORT) extension for abstracts in 2008, and an improvement in the quality of reporting of abstracts was observed after its publication. The effect of the publication of the CONSORT extension for abstracts on the quality of reporting of RCTs in emergency medicine journals has not been studied. In this paper, we present the protocol of a systematic survey of the literature, aimed at assessing the quality of reporting in abstracts of RCTs published in emergency medicine journals and at evaluating the effect of the publication of the CONSORT extension for abstracts on the quality of reporting. METHODS AND ANALYSIS The Medline database will be searched for RCTs published in the years 2005-2007 and 2014-2015 in the top 10 emergency medicine journals, according to their impact factor. Candidate studies will be screened for inclusion in the review. Exclusion criteria will be the following: the abstract is not available, they are published only as abstracts, still recruiting, or duplicate publications. The study outcomes will be the overall quality of reporting (number of items reported) according to the CONSORT extension and the compliance with its individual items. Two independent reviewers will screen each article for inclusion and will extract data on the CONSORT items and on other variables, which can possibly affect the quality of reporting. ETHICS AND DISSEMINATION This is a library-based study and therefore exempt from research ethics board review. The review results will be disseminated through abstract submission to conferences and publication in a peer-reviewed biomedical journal.
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Affiliation(s)
- Federico Germini
- Department of Emergency, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milano, Italy
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
| | - Maura Marcucci
- Geriatric Unit, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milano, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Marta Fedele
- Department of Emergency, Area Nord, Azienda Unita Sanitaria Locale di Bologna, Bologna, Italy
| | - Maria Giulia Galli
- Department of Clinical and Experimental Medicine, Università degli Studi di Parma, Parma, Italy
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Centre, St Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Valentina Salvatori
- General Practitioner Course, Regione Marche – Servizio Sanità, Ancona, Italy
| | - Giacomo Veronese
- Department of Emergency Medicine, Ospedale Niguarda Ca’ Granda, Milano, Italy
| | - Andrew Worster
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Centre, St Joseph’s Healthcare, Hamilton, Ontario, Canada
- Departments of Paediatrics and Anaesthesia, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicine, St Joseph’s Healthcare, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
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Veronese G, Germini F, Ingrassia S, Cutuli O, Donati V, Bonacchini L, Marcucci M, Fabbri A. Emergency physician accuracy in interpreting electrocardiograms with potential ST-segment elevation myocardial infarction: Is it enough? ACTA ACUST UNITED AC 2016; 18:7-10. [DOI: 10.1080/17482941.2016.1234058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Giacomo Veronese
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, University of Milano-Bicocca, Milan, Italy
| | - Federico Germini
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stella Ingrassia
- Department of Emergency Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Ombretta Cutuli
- Department of Emergency Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino—IST, Genova, Italy
| | - Valeria Donati
- Department of Emergency Medicine, Ospedale San Donato, Arezzo, Italy
| | - Luca Bonacchini
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, University of Milano-Bicocca, Milan, Italy
| | - Maura Marcucci
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea Fabbri
- Department of Emergency Medicine, Ospedale Morgagni-Pierantoni, Forlì, Italy
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Marcucci M, Germini F, Coerezza A, Andreinetti L, Bellintani L, Nobili A, Rossi PD, Mari D. Efficacy of ultra-micronized palmitoylethanolamide (um-PEA) in geriatric patients with chronic pain: study protocol for a series of N-of-1 randomized trials. Trials 2016; 17:369. [PMID: 27473188 PMCID: PMC4966710 DOI: 10.1186/s13063-016-1496-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 07/02/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Chronic pain in older people is highly prevalent, often underestimated, and associated with adverse outcomes. Most available analgesic drugs are often either ineffective or not tolerated, with many side effects. Palmitoylethanolamide (PEA) is an endogenous widely distributed N-acylethanolamina involved in neuroinflammation and pain-generating processes. Formulations containing ultra-micronized palmitoylethanolamide (um-PEA) are available but their effectiveness on chronic pain in highly heterogeneous geriatric patients is not clear and probably not generalizable. We planned to adopt the N-of-1 trial approach to test the effectiveness of um-PEA objectively at the individual level in our older outpatients. METHODS/DESIGN Persons 65 years or older referring to the Geriatric Unit of the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan complaining of noncancer chronic pain of any origin will be eligible. Each trial will be a placebo-controlled randomized crossover trial including two um-PEA (600 mg twice a day) and placebo treatment pairs. The um-PEA or placebo 3-week periods will be separated by 2-week washout intervals to overcome possible carryover effects. Pain intensity, need of on-demand analgesic medications, and impact on daily activities will be evaluated. Cognitively impaired patients will be eligible as long as an expression of pain can be recognized and its frequency assessed by a caregiver. Trial results will be discussed with the patient or caregiver and the treating physician to decide whether to continue the treatment. The impact of the N-of-1 approach on the physician's management plan and confidence will be assessed. We will secondarily meta-analyze the performed N-of-1 trials to obtain an estimate of the average effect of um-PEA compared with placebo using a frequentist and Bayesian approach. DISCUSSION While pursuing an ultimate clinical objective, i.e. to empirically and objectively decide the best treatment choice for an individual older patient with chronic pain, these series of geriatric N-of-1 trials on PEA will bring the principles of evidence-based medicine into the care of patients not usually represented in conventional randomized controlled trials, and realize a patient-centered outcome approach necessary to improve appropriate prescribing in elderly patients with multimorbidity and polypharmacy. TRIAL REGISTRATION ClinicalTrials.gov NCT02699281 . Registered on 3 March 2016.
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Affiliation(s)
- Maura Marcucci
- Geriatric Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy. .,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, via Francesco Sforza 35, 20122, Milan, Italy.
| | - Federico Germini
- Geriatric Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - Anna Coerezza
- Geriatric Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, via Francesco Sforza 35, 20122, Milan, Italy
| | - Luca Andreinetti
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, via Francesco Sforza 35, 20122, Milan, Italy
| | - Lorenzo Bellintani
- Geriatric Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, via Francesco Sforza 35, 20122, Milan, Italy
| | - Alessandro Nobili
- Laboratory for Quality Assessment of Geriatric Therapies and Services, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via Giuseppe La Masa 19, 20156, Milan, Italy
| | - Paolo Dionigi Rossi
- Geriatric Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - Daniela Mari
- Geriatric Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, via Francesco Sforza 35, 20122, Milan, Italy
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Vedovati MC, Germini F, Agnelli G, Becattini C. Direct oral anticoagulants in patients with VTE and cancer: a systematic review and meta-analysis. Chest 2015; 147:475-483. [PMID: 25211264 DOI: 10.1378/chest.14-0402] [Citation(s) in RCA: 219] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Direct oral anticoagulants (DOAs) have been shown to be as effective and at least as safe as conventional anticoagulation for the prevention of recurrences in patients with VTE. Whether this is the case in patients with cancer-associated VTE remains undefined. METHODS We performed a meta-analysis of randomized controlled trials with the aim of assessing the efficacy and safety of DOAs in patients with VTE and cancer. MEDLINE, EMBASE, and CENTRAL were searched up to December 2013 with no language restriction. The primary outcome of the analysis was recurrent VTE. Data on major bleeding (MB) and clinically relevant nonmajor bleeding were analyzed. Data were pooled and compared by ORs and 95% CIs. RESULTS Overall, 10 studies comparing DOAs with conventional anticoagulation for treatment of VTE including patients with cancer were included in the review. Six studies were included in the meta-analysis (two with dabigatran, two with rivaroxaban, one with edoxaban, and one with apixaban), accounting for a total of 1,132 patients. VTE recurred in 23 of 595 (3.9%) and in 32 of 537 (6.0%) patients with cancer treated with DOAs and conventional treatment, respectively (OR, 0.63; 95% CI, 0.37-1.10; I2, 0%). MB occurred in 3.2% and 4.2% of patients receiving DOAs and conventional treatment, respectively (OR, 0.77; 95% CI, 0.41-1.44; I2, 0%). CONCLUSIONS DOAs seem to be as effective and safe as conventional treatment for the prevention of VTE in patients with cancer. Further clinical trials in patients with cancer-associated VTE should be performed to confirm these results.
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Affiliation(s)
| | - Federico Germini
- Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Perugia, Italy
| | - Giancarlo Agnelli
- Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Perugia, Italy
| | - Cecilia Becattini
- Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Perugia, Italy
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Abstract
The aim of this study was to evaluate whether right ventricle dilation at computed tomography (CT) angiography can be used to assess the risk of death in patients with acute pulmonary embolism. Medline and EMBASE were searched up to April 30, 2013. Studies reporting on the association between right ventricle dilation (right-to-left ventricle diameter) or dysfunction (inter-ventricular septal bowing) at CT angiography and death at 30 days, as well as at 3 months in patients with acute pulmonary embolism, were included in a systematic review and meta-analysis. CT-detected right ventricle dilation was associated with an increased 30 day-mortality in all-comers with pulmonary embolism (OR 2.08 (95% CI 1.63-2.66); p<0.00001) and in haemodynamically stable patients (OR 1.64 (95% CI 1.06-2.52); p=0.03), as well as with death due to pulmonary embolism (OR 7.35 (95% CI 3.59-15.09); p<0.00001). An association between right ventricle dilation and 3-month mortality was also observed (OR 4.65 (95% CI 1.79-12.07); p=0.002). Right-to-left ventricle dilation as assessed by CT angiography can be used to evaluate risk of death in all-comers with pulmonary embolism and in haemodynamically stable patients.
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Affiliation(s)
- Cecilia Becattini
- Internal and Cardiovascular Medicine and Stroke Unit, University of Perugia, Perugia, Italy
| | - Giancarlo Agnelli
- Internal and Cardiovascular Medicine and Stroke Unit, University of Perugia, Perugia, Italy
| | - Federico Germini
- Internal and Cardiovascular Medicine and Stroke Unit, University of Perugia, Perugia, Italy
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Vedovati MC, Germini F, Agnelli G, Becattini C. Prognostic role of embolic burden assessed at computed tomography angiography in patients with acute pulmonary embolism: systematic review and meta-analysis. J Thromb Haemost 2013; 11:2092-102. [PMID: 24134450 DOI: 10.1111/jth.12429] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND In patients with acute pulmonary embolism (PE), risk stratification is indicated for tailoring of both diagnostic strategies and acute treatment. Whether embolic burden assessed at computed tomography (CT) angiography has a role in risk stratification in these patients is debated. OBJECTIVE To systematically review and perform a meta-analysis to evaluate the role of CT-assessed burden associated with embolic obstruction and embolic localization in the prognostic stratification of patients with acute PE. METHODS We performed a systematic search in EMBASE and MEDLINE up until 30 June 2013. Studies reporting on the 30-day outcome of patients with confirmed PE and CT-assessed embolic burden were included. The study outcome was death. RESULTS Thirty studies reporting on the prognostic value of CT-assessed embolic burden met the inclusion criteria for this systematic review; of these, 19 were included in the meta-analysis. Five studies (2215 patients) were included in the analysis of localization: an association between embolus localization in the central arteries and 30-day mortality was found after heterogeneity was resolved (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.29-3.89, I(2) = 0%). No correlation was observed between obstruction index (according to the Qanadli scoring system) and 30-day mortality after heterogeneity was reduced (16 studies, 3884 patients, OR 1.22, 95% CI 0.99-1.51, I(2) = 27%). CONCLUSION Localization of emboli assessed at CT angiography can be used for risk stratification in patients with acute PE. Moreover, no correlation was observed between obstruction index and prognosis.
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Affiliation(s)
- M C Vedovati
- Department of Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Perugia, Italy
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Palmer S, Ruospo M, Pellgrini F, Strippoli GFM, Palmer S, Ruospo M, Natale P, Saglimbene V, Pellegrini F, Craig JC, Hegbrant J, Strippoli GFM, Ferraresi M, Pereno A, Castelluccia N, Clari R, Moro I, Colombi N, Di Giorgio G, Barbero S, Piccoli GB, Krishnan M, Bond TC, Brunelli S, Nissenson A, Kara B, Palmer S, Wong G, Craig JC, Strippoli GFM, Hanafusa N, Wakai K, Iseki K, Tsubakihara Y, Ogata S, Bikbov B, Tomilina N, Suleymanlar G, Altiparmak MR, Seyahi N, Trabulus S, Serdengecti K, Huang ST, Shu KH, Kao CH, Palmer S, Ruospo M, Natale P, Johnson DW, Craig JC, Gargano L, Saglimbene V, Pellegrini F, Strippoli GFM, Bernasconi AR, Waisman R, Lapidus A, Montoya P, Heguilen R, Suzuki A, Shoji T, Tsubakihara Y, Hayashi T, Tomida K, Guinsburg A, Thijssen S, Usvyat L, Xiao Q, van der Sande F, Marelli C, Etter M, Marcelli D, Levin N, Wang Y, Kotanko P, Kooman J, Schiller A, Schiller O, Andrei C, Mihaescu A, Olariu N, Anton C, Ivacson Z, Roman V, Berca S, Bansal V, Hwang SJ, Lee JJ, Lin MY, Chang JS, Okamura K, Kishi T, Miyazono M, Ikeda Y, Fukumitsu T, Sanai T, Reyes-Bahamonde J, Raimann J, Usvyat LA, Thijssen S, Van der Sande F, Kooman J, Levin N, Kotanko P, Allehbi AM, Bunani AD, Noor A, Laplante S, Rutherford P, Kulcsar I, Szegedi J, Ladanyi E, Torok M, Reusz G, Kiss I, Sparacino V, Agnello V, Di Gaetano P, Guaiana V, Almasio P, Rainone F, Merlino L, Ritchie JP, Marcatti M, Kalra PA, Toprak O, Quintaliani G, Ranocchia D, Germini F, Notargiacomo A, Ariete ML, Palmer S, Ruospo M, Pellegrini F, Strippoli GFM, Bunani AD, Bunani ED, Herrero Berron JC, Mon C, Ortiz M, Hinostroza J, Cobo G, Gallar P, Ortega O, Rodriguez Villarreal I, Oliet A, Digiogia C, Vigil A, Trigka K, Douzdampanis P, Aggelakou-Vaitsi M, Vaitsis N, Fourtounas K, Vigotti FN, Apostu AL, Boscolo M, Chegui LK, Ferrero S, Gallicchio M, Garassino G, Ionescu A, Portonero I, Tarea CA, Valentino E, Piccoli GB, Sikole A, Trajceska L, Gelev S, Dzekova P, Selim G, Amitov V, Borg Cauchi A, Buhagiar L, Calleja N, Demarco D, Nikitidou O, Liakopoulos V, Michalaki A, Demirtzi P, Christidou F, Papagianni A, Daskalopoulou E, Nikolaidis P, Dombros N, Vassallo DM, Chinnadurai R, Robinson H, Middleton R, Donne R, Saralegui I, Garcia O, Robledo C, Gabilondo E, Ortalda VVO, Tomei PPT, Yabarek TTY, Spatola LLS, Dalla Gassa AADG, Lupo AAL, Barril G, Quiroga JA, Arenas D, Cigarran S, Garcia N, Glez Parra E, Martin A, Bartolome J, Castillo I, Carreno V, Baamonde E, Bosch E, Perez G, Ramirez I, Checa MD, Palmer S, Ruospo M, Pellegrini F, Strippoli GFM, Shifris I, Dudar I, Rudenko A, Gonchar I, Mademtzoglou S, Tsikliras NC, Balaskas EV, Montalto G, Lupica R, Fazio MR, Aloisi C, Donato V, Lucisano S, Buemi M, Trimboli D, Cernaro V, Donia A, Denewar A, Khil M, Dudar I, Khil V, Shifris I. Epidemiology CKD 5D - A. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Trancanelli V, Natalini G, Germini F, Grilli P, Burardi F, Castori AC, Leone De Magistris C, Gerli P, Mercati U. [Perforated duodenal ulcer. Personal experience]. MINERVA CHIR 1980; 35:1645-7. [PMID: 7454061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Reference is made to personal experience in affirming that the treatment of perforated duodenal ulcer should set out to resolve both the perforation and the ulcer at the same time. Troncular vagotomy combined with pyroloplasty is put forward as an effective way of achieving this, and long-term results on a par with those obtained electively are described.
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