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"You don't put it down to arthritis": A qualitative study of the first symptoms recalled by individuals with knee osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100428. [PMID: 38229918 PMCID: PMC10790080 DOI: 10.1016/j.ocarto.2023.100428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024] Open
Abstract
Objective As part of the first phase of the OARSI Early-stage Symptomatic Knee Osteoarthritis (EsSKOA) initiative, we explored the first symptoms and experiences recalled by individuals with knee osteoarthritis (OA). Design This qualitative study, informed by qualitative description, was a secondary analysis of focus groups (n = 17 groups) and one-on-one interviews (n = 3) conducted in 91 individuals living with knee OA as part of an international study to better understand the OA pain experience. In each focus group or interview, participants were asked to describe their first symptoms of knee OA. We inductively coded these transcripts and conducted thematic analysis. Results Mean age of participants was 70 years (range 47-92) and 68 % were female. We developed four overarching themes: Insidious and Episodic Onset, Diverse Early Symptoms, Must be Something Else, and Adjustments. Participants described the gradual and intermittent way in which symptoms of knee OA developed over many years; many could not identify a specific starting point. Participants described diverse initial knee symptoms, including activity-exacerbated joint pain, stiffness and crepitus. Most participants dismissed early symptoms or rationalized their presence, employing various strategies to enable continued participation in recreational and daily activities. Few sought medical attention until physical functioning was demonstrably impacted. Conclusions The earliest symptoms of knee OA are frequently insidious in onset, episodic and present long before individuals present to health professionals. These results highlight challenges to identifying people with knee OA early and support the development of specific classification criteria for EsSKOA to capture individuals at an early stage.
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On the estimation of the effect of weight change on a health outcome using observational data, by utilising the target trial emulation framework. Int J Obes (Lond) 2023; 47:1309-1317. [PMID: 37884665 PMCID: PMC10663146 DOI: 10.1038/s41366-023-01396-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 09/17/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND/OBJECTIVES When studying the effect of weight change between two time points on a health outcome using observational data, two main problems arise initially (i) 'when is time zero?' and (ii) 'which confounders should we account for?' From the baseline date or the 1st follow-up (when the weight change can be measured)? Different methods have been previously used in the literature that carry different sources of bias and hence produce different results. METHODS We utilised the target trial emulation framework and considered weight change as a hypothetical intervention. First, we used a simplified example from a hypothetical randomised trial where no modelling is required. Then we simulated data from an observational study where modelling is needed. We demonstrate the problems of each of these methods and suggest a strategy. INTERVENTIONS weight loss/gain vs maintenance. RESULTS The recommended method defines time-zero at enrolment, but adjustment for confounders (or exclusion of individuals based on levels of confounders) should be performed both at enrolment and the 1st follow-up. CONCLUSIONS The implementation of our suggested method [adjusting for (or excluding based on) confounders measured both at baseline and the 1st follow-up] can help researchers attenuate bias by avoiding some common pitfalls. Other methods that have been widely used in the past to estimate the effect of weight change on a health outcome are more biased. However, two issues remain (i) the exposure is not well-defined as there are different ways of changing weight (however we tried to reduce this problem by excluding individuals who develop a chronic disease); and (ii) immortal time bias, which may be small if the time to first follow up is short.
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The impact of having a carer on adult health and social care utilisation across five settings of care: A matched cohort study. Health Policy 2023; 129:104705. [PMID: 36639309 DOI: 10.1016/j.healthpol.2022.104705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 03/10/2021] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION An estimated 6.8 million people are (informal) carers in the UK. The economic value of annual carer contributions is an estimated .·132bn. Reliance on carers appears to be increasing. There is mixed evidence on whether carers are substitutes for formal care. This study investigated the association between having a carer and service use patterns across five care settings when compared to a matched cohort without a carer. MATERIALS AND METHODS A matched case-control group analysis using person-level data in Barking and Dagenham (B&D), a London borough in the U.K., to assess the impact of having a carer in terms of the differences in cost-weighted utilisation relative to a matched control group. RESULTS In 2016/17, for adult residents of B&D, having a carer (n = 1,295) was associated with 27% increased cost-weighted utilisation (mean difference of £2,662, CI £1,595, £3,729, p<0.001) compared to a matched cohort without a carer. 39% of the cost difference was social care. CONCLUSIONS Findings suggest additional service use induced by carers may dominate any substitution effect. Having a carer may be a key element in enabling access to services. As such, there may be wider inequalities in service access for people without a carer. For an ageing society with projections suggesting there will be more people without carers in the future, these inequalities need to be addressed.
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SURVIVAL INDEPENDENT PREDICTIVE VALUE OF INTERIM FDG
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‐PET IN NEWLY DIAGNOSED DIFFUSE LARGE B CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.94_2881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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DIFFUSE LARGE B‐CELL LYMPHOMA IN ELDERLY PATIENTS: OUTCOME IN REAL‐WORLD CLINICAL PRACTICE. Hematol Oncol 2021. [DOI: 10.1002/hon.63_2881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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CLINICAL RISK SCORES IN DIFFUSE LARGE B CELL LYMPHOMA ‐ IS THERE STILL ROOM FOR IMPROVEMENT? Hematol Oncol 2021. [DOI: 10.1002/hon.54_2881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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PROGNOSTIC IMPACT OF NUTRITIONAL STATUS ON DLBCL PATIENTS. Hematol Oncol 2021. [DOI: 10.1002/hon.50_2881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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BONE MARROW INFILTRATION ASSESSMENT BY FDG
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‐PET: CAN THIS IMAGING TEST REPLACE BONE MARROW TREPHINE BIOPSY IN DIFFUSE LARGE B CELL LYMPHOMA STAGING? Hematol Oncol 2021. [DOI: 10.1002/hon.84_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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NEUTROPHIL/LYMPHOCYTE RATIO AND MONOCYTE/LYMPHOCYTE RATIO – PROMISING PROGNOSTIC BIOMARKERS IN DIFFUSE LARGE B‐CELL LYMPHOMA? Hematol Oncol 2021. [DOI: 10.1002/hon.52_2881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Application of blood microsampling in cynomolgus monkey and demonstration of equivalent monoclonal antibody PK parameters compared to conventional sampling. Pharm Res 2021; 38:819-830. [PMID: 33982224 DOI: 10.1007/s11095-021-03044-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/12/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the suitability of whole blood microsampling procedures in non-human primate (NHP) to support toxicokinetic assessments of biotherapeutics in non-human primates. METHOD A one-month single dose intravenous pharmacokinetic (PK) study was performed in male cynomolgus monkeys with a human IgG1 control monoclonal antibody (mAb) as a surrogate monoclonal antibody biotherapeutic. In this study, both serum samples (conventional sample collection) and microsampling samples were collected. Microsampling samples were collected from two sites on cynomolgus monkey, with each site using two different devices for the whole blood collection. The drug concentrations from all sample types were determined using a quantitative ligand binding assay (LBA). The PK parameters obtained from microsampling samples and serum samples were examined using a standard PK analysis method. The comparability of key PK parameters from both sample types were analyzed statistically. RESULTS Similar profiles of drug concentrations versus timepoints from all sampling procedures were observed. The correlations of PK concentration data obtained from serum and microsampling samples were ≥ 0.97 using Brand Alman Plot analysis. The key PK parameters obtained from microsampling samples were comparable to those obtained from serum samples (the % differences of mean PK parameters obtained from both sample types were within ±25%). CONCLUSION This study confirmed that PK parameters obtained from samples using microsampling were comparable to that of serum samples in cynomolgus monkeys. Therefore, the microsampling procedure described can be used as a substitute for conventional sampling procedure to support PK/TK studies of biotherapeutics in non-clinical product developments.
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M2 macrophage exosomes regulate hematopoiesis & resolve inflammation in atherosclerosis via microrna cargo. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Consensus recommendations for optimizing biomarker testing to identify and treat advanced EGFR-mutated non-small-cell lung cancer. Curr Oncol 2020; 27:321-329. [PMID: 33380864 PMCID: PMC7755440 DOI: 10.3747/co.27.7297] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The advent of personalized therapy for non-small-cell lung carcinoma (nsclc) has improved patient outcomes. Selection of appropriate targeted therapy for patients with nsclc now involves testing for multiple biomarkers, including EGFR. EGFR mutation status is required to optimally treat patients with nsclc, and thus timely and accurate biomarker testing is necessary. However, in Canada, there are currently no standardized processes or methods in place to ensure consistent testing implementation. That lack creates challenges in ensuring that all appropriate biomarkers are tested for each patient and that the medical oncologist receives the results for making informed treatment decisions in a timely way. An expert multidisciplinary working group was convened to create consensus recommendations about biomarker testing in advanced nsclc in Canada, with a primary focus on EGFR testing. Recognizing that there are biomarkers beyond EGFR that require timely identification, the expert multidisciplinary working group considered EGFR testing in the broader context of integration into complex lung biomarker testing. Primarily, the panel of experts recommends that all patients with nonsquamous nsclc, regardless of stage, should undergo comprehensive reflex biomarker testing at diagnosis with targeted next-generation sequencing. The panel also considered the EGFR testing algorithm and the challenges associated with the pre-analytic, analytic, and post-analytic elements of testing. Strategies for funding testing by reducing silos of single biomarker testing for EGFR and for optimally implementing the recommendations presented here and educating oncology professionals about them are also discussed.
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Relationship between country income, socioeconomic factors and control of cardiovascular disease risk factors in patients with type 2 Diabetes: insights from the global DISCOVER registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In patients with type 2 diabetes (T2D), optimal management of cardiovascular (CV) risk factors is critical for primary prevention of CV disease.
Purpose
To describe the association of country income and patient socioeconomic factors with risk factor control in patients with T2D.
Methods
DISCOVER is a 37-country, prospective, observational study of 15,983 patients with T2D enrolled between January 2016 and December 2018 at initiation of 2nd-line glucose-lowering therapy and followed for 3 years. In patients without known CV disease with sub-optimally controlled risk factors at baseline, we examined achievement of risk factor control (HbA1c <7%, BP <140/90 mmHg, appropriate statin) at the 3 year follow-up. Countries were stratified by gross national income (GNI)/capita, per World Bank report. We explored variability across countries in risk factor control achievement using hierarchical logistic regression models and examined the association of country- and patient-level economic factors with risk factor control.
Results
Among 9,613 patients with T2D but without CV disease (mean age 57.2 years, 47.9% women), 83.1%, 37.5%, and 66.3% did not have optimal control of glucose, BP, and statins, respectively, at baseline. Of these, 40.8%, 55.5%, and 28.6% achieved optimal control at 3 years of follow-up. There was substantial variability in achievement of risk factor control across countries (Figure) but no association of country GNI/capita on achievement of risk factor control (Table). Insurance status, which differed substantially by GNI group, was strongly associated with glycemic control, with no insurance and public insurance associated with lower odds of patients achieving HbA1c <7%.
Conclusions
In a global cohort of patients with T2D, a substantial proportion do not achieve risk factor control even after 3 years of follow-up. The variability across countries in risk factor control is not explained by the GNI/capita of the country.
Proportion of patients at goal
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): The DISCOVER study is funded by AstraZeneca
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The use of geospatial tools to study the evolution of TB incidence in North Portugal between 2008-18. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Tuberculosis continues to be a significant global health problem. Portugal isn't an exception to this health problem, being considered by the ECDC a high incidence country. According to the SDG target 3.3, the world must end the epidemics of tuberculosis by 2030. However, several parishes in Portugal continue to observe extremely high values of TB, taking into account the WHO goal for pre-elimination of 10 TB cases per million people.
Methods
A cross-sectional study was conducted with data from the Surveillance System of the National Program against Tuberculosis. Descriptive and regression analyses were carried out using R 3.6.1 and Rstudio 1.2.5033. The geospatial analysis was carried out with ArcMap 10.7.1 using a five-year average of TB incidence. Animations and videos were made with Microsoft Office365 PowerPoint v2002.
Results
In the period 2008-2012, 55,7% of parishes had registered cases of tuberculosis. That value decreased to 50,6% parishes in the period 2014-2018. For the period of 2014-18, 30,3% of parishes had a five-year average incidence above 20/100.000 people (value defined as high-incidence by the ECDC) and 45,0% parishes an incidence above 10/100.000 people. With ArcMap HotSpot analysis was possible to observe the existence of a significant cluster of TB in the southwest of North Portugal. With animation analysis, it was also possible to see the global spatial reduction of TB cases between 2008 and 2018, and the ongoing problem of a high incidence of TB in specific regions of North Portugal.
Conclusions
TB continues to be a significant health problem in North Portugal. The spatial analysis pointed to a specific area of North Portugal that needs priority action. Videos produced by the Department of Public Health may guide health professionals and policymakers for future strategies to be implemented to reach SDG3.
Key messages
The importance of desegregated spatial data for TB elimination. The elimination efforts must be scaled up in specific areas to achieve SDG3.
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0804 Sleep Bruxism, Awake Bruxism and Sleep Related Breathing Disorders in Adults With Down Syndrome. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
To our knowledge, no studies have accessed theawake bruxism (AB) and stage by stage sleep bruxism (SB) in adults with Down syndrome. Recent works have shown that portable PSG systems are accurate for SB assessment even in the absence of audio-video recording. We aimed to evaluate the prevalence of awake bruxism, stage-by-stage sleep bruxism and Sleep Related Breathing Disorders (SRBD) in adults with Down syndrome.
Methods
Twenty-three adults with Down Syndrome (DS) were enrolled in this study. General health, dental status, parafunctional habits and temporomandibular symptoms were assessed. The history of SB/AB was taken from a questionnaire to the caregivers. A portable PSG type II system (Embla Embletta MPR+PG ST+Proxy, Natus, California-USA) was used to perform a full-sleep study at patients’ home. RMMA activity was defined as low (>1 and <2 episodes/h of sleep), moderate (>2 and <4 episodes/h of sleep), or high (>4 episodes/h of sleep). PSG diagnose of SB was assumed if RMMA index was >2 episodes/h of sleep.
Results
According to caregiver’s report, AB was present in all patients whereas only 13.1% had SB. PSG records showed a SB prevalence of 91.3%, with a mean RMMA index 40.0±30.0/h. Only 2 (8,7%) showed RMMA index of 0.0/h. SB episodes were predominant in N3 and REM sleep stage in 14 and 9 patients, respectively. All but one (95,7%) patient (isolated snoring) presented with OSA (AHI=32.8±28.6). A unique TMD symptom (pain on palpation) was present in 8,7% of the global sample.
Conclusion
The high prevalence of “definitive SB” together with the high prevalence of OSA and snoring point in favor to the recommendation of routine PSG in adults with DS. Furthermore, the low sensitivity of parent-oriented questionnaires reinforces the need of more accurate assessment tools in order to get a better standard of care in this particular group of patients.
Support
State of Sao Paulo Research Support Foundation - FAPESP grant number: 2017/06835-8
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0657 Impact of Treatment With Mandibular Advancement Oral Appliance on Respiratory Parameters, Sleep and Cardiometabolic Risk Factors of CPAP Non-Adherent Patients With Severe Obstructive Sleep Apnea. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Obstructive sleep apnea (OSA) may trigger systemic changes linked to important cardiometabolic risk factors such as hypertension, stroke and diabetes II. As a life-threatening, multifactorial disorder, OSA demands a multiprofessional approach. The most common worldwide treatments are Continuous Positive Airway Pressure (CPAP) and Mandibular Advancement Oral Appliance (OAm). The aim of this study was to evaluate the impact of OAm treatment on CPAP non-adherent patients with severe OSA, comparing objective and subjective data between baseline and follow up.
Methods
A prospective study was carried out including non-adherent severe OSA patients, which were referred to OAm therapy evaluation. Patients presenting with snoring, gasping/choking during sleep, fatigue and daily sleepiness were evaluated by a sleep medicine specialist and the diagnosis of severe OSA with a basal polysomnography (PSG). All the patients were treated with a standard OAm (PMPositioner®). Baseline and Follow up (6 months) sleep parameters (PSG and Epworth Sleepiness Scale - ESS) were compared to assess treatment efficacy.
Results
Seventeen patients (9 with hypertension and 8 with hypertension + diabetes) met the inclusion criteria and 13 finished the protocol. After treatment with OAm the following parameters improved significantly: OSA severity (44.5±13.5 to 9.0±4.3, p≤0.001), ODI (46.8±11.6 to 12.1±9.1(p<0.05)), REM (18.4± 4.8 to 21.5± 2.9 (p<0.05)) and SaO2nadir (75.7± 9.4 to 87.0±3.6, p<0.001), ESS (p<0.005). Ten patients (58%) reported a reduction either in systolic and diastolic blood pressure with 3 of them (30%) reduced the hypertensive drug dose.
Conclusion
Our findings show that OAm is a safe and effective treatment option to CPAP non-adherent severe OSA patients. Furthermore OAm therapy had also a positive impact on cardiometabolic risk factors which are particularly relevant outcomes in OSA patients.
Support
State of Sao Paulo Research Support Foundation (FAPESP).
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Preliminary Data from Famidem Survey: Can we assume who is at Risk Regarding Informal Caregiving in Dementia? Eur Psychiatry 2020. [DOI: 10.1016/s0924-9338(09)71333-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background and aims:In meridional European countries such as Portugal, informal caregivers are almost always close relatives, either key-relatives (those more involved) or not. There are few systematic comparisons between the experience of key-relatives/primary caregivers (PC) and other/secondary caregivers (SC) in psychogeriatrics. We present some preliminary data from the FAMIDEM (Families of People with Dementia) survey.Methods:Non-randomised cross-sectional study comparing two related samples of caregivers (PC versus SC) of 41 patients with DSM-IV dementia from outpatient practices in Lisbon (Portugal). Caregivers’ assessments included: Zarit Burden Interview, Caregiver Activity Survey (CAS), Positive Aspects of Caregiving, GHQ-12, Social Network Questionnaire and Dementia Knowledge Questionnaire.Results:Patients’ mean age was 78,7 years (SD 7,9). 24 (58,5%) were women and 58,5% had Alzheimer disease.PC were older than SC (p=0,000) and tended to live with the patient (p=0,000). They reported less emocional support (p=0,021) but higher objective burden-CAS (p=0,002). Regarding all other outcome variables, significant differences between groups were not found. Within the global sample, comparing spousals (n=23) and adult children/other relatives (n=59) yielded interestingly different preliminary results, eg higher GHQ-12 levels (p=0,010).Conclusions:The experience of caregiving is possibly different regarding PC and SC, but further research is warranted in order to define who really is at risk. Being a spouse may be much more determinant, although most spouses are PC as well. for the moment, it seems prudent not to exclude SC from risk assessments. the final FAMIDEM results, even lacking generalizability, will probably provide interesting clues.
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P3816Cost-effectiveness of ventricular tachycardia catheter ablation: limitations in the current trial evidence base. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Randomised clinical trials (RCTs) have suffered from criticisms including a lack of generalisability as well as a lack of cost-effectiveness analysis of the different interventions being studied. Such analyses are used by organisations including the UK's National institute for Health and Care Excellence (NICE) to inform system-level decisions regarding which treatments are funded. There is the potential for a growing chasm to exist between what is the latest innovation in cardiology and what can be afforded.
Purpose
To evaluate the cost-effectiveness of ventricular tachycardia (VT) catheter ablation versus anti-arrhythmic drug (AAD) therapy in ischemic heart disease.
Methods
A decision-analytic Markov model was used to calculate the costs and health outcomes of catheter ablation or AAD treatment of VT for a hypothetical cohort of patients with ischaemic cardiomyopathy andan implantable cardioverter defibrillator (ICD). Model inputs where informed using RCT-level evidence [Table 1] wherever possible. Costs were calculated from a UK perspective.
Results
Catheter ablation vs. AAD therapy had an incremental cost-effectiveness ratio (ICER) of £144,150 (€161,448) per quality adjusted life year (QALY) gained, over a five-year time horizon. The ICER for a ten-year time horizon was £75,074 (€84,083) and £69,986 (€78,384) over the cohort's lifetime. Using probabilistic sensitivity analyses to account for model parameter uncertainty, the likelihood of catheter ablation being cost-effective was only 11%, assuming a willingness to pay threshold of £30,000 used by the NICE [Figure 1].
Table 1. Summary of RCT level source data used to inform Markov model inputs Name of trial SMASH VT VTACH SMS CALYPSO VANISH VISTA Sample size 128 110 111 27 259 118 Mean age 67 66 67 64 68 66 Control AAD AAD AAD AAD AAD Clinical ablation Intervention Ablation Ablation Ablation Ablation Ablation Substrate ablation Length of follow up 22 months 24 months 28 months 6 months 28 months 12 months Mortality (%) 11% [AAD] 7% [AAD] 19% [AAD] 14% [AAD] 28% [AAD] 15% [C-ablation] vs. vs. vs. vs. vs. vs. 9% [Ablation] 10% [Ablation] 17% [Ablation] 15% [Ablation] 27% [Ablation] 9% [S-Ablation] Readmission (%) 19% [AAD] 55% [AAD] 44% [AAD] 50% [AAD] 31% [AAD] 32% [C-ablation] vs. vs. vs. vs. vs. vs. 12% [S-ablation] 6% [Ablation] 33% [Ablation] 39% [Ablation] 38% [Ablation] 25% [Ablation]
Cost-effectiveness acceptability curve
Conclusion
Catheter ablation of VT is unlikely to be cost-effective compared with AAD therapy alone in patients with ischaemic cardiomyopathy implanted with an ICD based on pooled trial evidence. However, better designed studies incorporating detailed and more frequent quality of life assessment are needed to advise health policy in this field and to provide more informed cost-effectiveness analyses.
Acknowledgement/Funding
NIHR Academic Clinical Fellowship
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MIPI as a superior prognostic tool in mantle cell lymphoma compared to monocyte-lymphocyte, neutrophil-lymphocyte and platelet-lymphocyte ratios. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz251.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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HIV screening of tuberculosis patients in Portugal: what are we missing? Int J Tuberc Lung Dis 2019; 22:1216-1219. [PMID: 30236191 DOI: 10.5588/ijtld.17.0846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knowledge of human immunodeficiency virus (HIV) status is essential to effectively manage both tuberculosis (TB) and HIV infection. This is why the World Health Organization (WHO) recommends routine HIV testing in all TB patients. OBJECTIVE To determine the number of TB patients with unknown HIV status in Portugal and to identify the factors associated with unknown HIV status. METHODS A retrospective study of all TB notifications from 2008 to 2014 in Portugal was conducted. A multiple logistic regression model was used to evaluate the association of sociodemographic and clinical factors with unknown HIV status. RESULTS We examined the records of 18 445 patients with TB notification, 2402 of whom (13%) had unknown HIV status. Unknown HIV status was positively associated with age 65 years (adjusted odds ratio [aOR] 1.208, 95%CI 1.037-1.408) and extra-pulmonary TB (aOR 1.381, 95%CI 1.252-1.523), but negatively associated with unemployment (aOR 0.755, 95%CI 0.637-0.895), alcohol dependence (aOR 0.809, 95%CI 0.682-0.959) and drug dependence (aOR 0.566, 95%CI 0.449-0.713). CONCLUSION Risk perception is the most important barrier to complete knowledge of HIV status in TB patients in Portugal. Given the importance of HIV screening in TB patients, every effort should be made to ensure that all TB patients undergo HIV screening.
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Analyse thématique de l’expérience des soins socioesthétiques des patients hospitalisés à domicile en oncologie. PSYCHO-ONCOLOGIE 2019. [DOI: 10.3166/pson-2019-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : Décrire l’expérience des soins socioesthétiques (SE) des patients hospitalisés à domicile dans le cadre d’une pathologie cancéreuse.
Matériel et méthodes : Sept participantes décrivent leurs expériences grâce à un entretien semi-directif, enregistré par un dictaphone.
Résultats : Les participantes expriment que les soins SE ont un effet sur « la dimension sociale et relationnelle », « la restauration de l’image de soi », « le remaniement du mode de vie » et « la transformation du vécu de la maladie ».
Conclusion : Ce soin de support est perçu par les participantes comme un privilège utile et bénéfique pour elles.
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Electron scattering from 1-butanol at intermediate impact energies: Total cross sections. J Chem Phys 2019; 150:194307. [PMID: 31117791 DOI: 10.1063/1.5096211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report experimental measurements of the absolute total cross sections (TCSs) for electron scattering from 1-butanol at impact energies in the range 80-400 eV. Those measurements were conducted by considering the attenuation of a collimated electron beam, at a given energy, through a gas cell containing 1-butanol, at a given pressure, and through application of the Beer-Lambert law to derive the required TCS. We also report theoretical results using the Independent-Atom Model with Screening Corrected Additivity Rule and Interference approach. Those results include the TCS, the elastic integral cross section (ICS), the ionization total ICS, and the sum over all excitation process ICSs with agreement at the TCS level between our measured and calculated results being encouraging.
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Abstract P5-09-21: Not presented. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-09-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was not presented at the conference.
Citation Format: Servais L, Gardner A, Gomes M, Zimmer AD, Silvestrini A, Siqueira de Abreu e Lima R. Not presented [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-09-21.
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Metabolomics Analysis in Chronic Thromboembolic Pulmonary Hypertension. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Fistula Size and Hemodynamics: An Experimental Model in Canine Femoral Arteriovenous Fistulas. J Vasc Access 2018. [DOI: 10.1177/112972980700800107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose The objective was to evaluate the impact of anastomosis diameter on blood flow in an arteriovenous fistula (AVF), comparing two different anastomosis sizes with a modified side-to-side technique in canine femoral arteries. Methods Ten mongrel dogs were subjected to two AVFs each, both using a modified side-to-side technique. On one side, the anastomosis diameter was 1.5 times the arterial diameter and on the other side 3.0 times the arterial diameter. Mean proximal and caudal blood flow and mean venous flow were measured using an electronic flowmeter 15, 20 and 25 min after surgery. The Mann-Whitney, Friedman and Wilcoxon non-parametric tests were used for data analysis (α ≤ 0.05). Results Femoral artery flow cranial to the fistula became 5.6 times greater in the 1.5 arterial diameter group, and 8.4 times greater in the 3.0 arterial diameter group, when compared to initial arterial flow. The mean flow in the cranial vein was greater in the 3.0 group (10.09 times greater vs. 6.46 times greater in the 1.5 group). Both in the proximal artery and in the vein there was a significantly greater flow in the group with the larger anastomosis diameter (Wilcoxon test). In the femoral artery caudal to the fistula, the flow in most of the animals was reversed: 3.5 times greater in the 1.5 group and 1.2 times greater in the 3.0 group, without statistical difference. Conclusions These results suggest that 3.0 times the arterial diameter for the AVF size in dogs leads to greater venous flow than with 1.5 times the arterial diameter, without increasing the reversed flow.
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Abstract
BACKGROUND Although the incidence rates of non-tuberculous mycobacteria (NTM) have been increasing in many countries, the basic epidemiology of NTM remains to be fully understood. OBJECTIVE To assess the incidence, clinical relevance and geographical distribution of NTM disease in Portugal and to identify demographic and clinical characteristics associated with Mycobacterium avium complex (MAC) disease. METHODS Information stored in an electronic database of all NTM cases reported over an 11-year period was retrospectively reviewed. Significant demographic and clinical characteristics of MAC disease (vs. having any other NTM disease) were determined using multiple logistic regression models. RESULTS We identified 632 patients, mostly male, native Portuguese, with pulmonary disease, predominantly from Lisbon and Porto. The annual incidence of NTM disease was 0.54 per 100 000 population. The annual number of NTM cases increased throughout the study period. MAC was most frequently isolated. MAC disease was positively (and significantly) associated with being female, age >45 years and human immunodeficiency virus infection. CONCLUSIONS The increasing incidence of NTM over the study period emphasises the importance of NTM as a public health issue. This study provides important information for health care professionals and a basis for further study of NTM in Portugal.
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Abstract
BACKGROUND Tuberculosis (TB) is a major concern among high-risk populations such as the homeless. OBJECTIVES To evaluate TB incidence and treatment outcomes among homeless patients in Portugal and to identify predictors of unsuccessful TB treatment outcomes among the homeless. DESIGN This was a retrospective cohort study of all TB patients notified in Portugal from 2008 to 2014. Characteristics of homeless TB patients were assessed and predictors of unsuccessful TB treatment were determined using logistic regression. RESULTS TB incidence among the homeless was 122/100,000 homeless persons and was positively correlated with TB incidence among non-homeless persons. Homeless TB patients had a higher prevalence of alcohol and/or drug use, human immunodeficiency virus (HIV) co-infection, cavitary TB and smear positivity. The rate of unsuccessful treatment outcomes among the homeless was 28.6%, and was significantly associated with increased age, injection drug use (IDU) and HIV co-infection. CONCLUSION TB incidence among homeless persons was five times that among the non-homeless, and higher in regions with greater TB incidence among non-homeless persons. The successful treatment outcome rate was lower. Predictors of unsuccessful treatment were age, IDU and HIV co-infection. Integrated TB programmes targeting homeless and non-homeless patients, with measures targeting specific characteristics, may contribute to TB elimination in Portugal.
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Longitudinal clustering of tuberculosis incidence and predictors for the time profiles: the impact of HIV. Int J Tuberc Lung Dis 2018; 20:1027-32. [PMID: 27393535 DOI: 10.5588/ijtld.15.0522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Portugal remains the country with the highest tuberculosis (TB) incidence in Western Europe. OBJECTIVES To identify longitudinal trends in TB incidence in Portugal from 2002 to 2012 and investigate the longitudinal effect of sociodemographic and health-related predictors among the resident population on the TB incidence rate. METHODS We used data from the National Tuberculosis Surveillance System and other national institutions. K-means longitudinal clustering algorithm was performed on TB incidence time profiles from districts of Portugal. RESULTS Three longitudinal profiles for the TB incidence rate of Portugal were identified. In all of them, TB incidence decreased over time. Among all studied sociodemographic and health-related predictors, human immunodeficiency virus (HIV) notification rate and unemployment were shown to have (positive) significant effects on TB incidence. In particular, the greatest effects were found for the HIV notification rate. CONCLUSIONS Our study supports the view that combined TB-HIV strategies and the improvement of social determinants can contribute to decreases in TB incidence.
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Total cross sections for electron scattering by 1-propanol at impact energies in the range 40-500 eV. J Chem Phys 2017; 147:194307. [PMID: 29166110 DOI: 10.1063/1.5008621] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Absolute total cross section (TCS) measurements for electron scattering from 1-propanol molecules are reported for impact energies from 40 to 500 eV. These measurements were obtained using a new apparatus developed at Juiz de Fora Federal University-Brazil, which is based on the measurement of the attenuation of a collimated electron beam through a gas cell containing the molecules to be studied at a given pressure. Besides these experimental measurements, we have also calculated TCS using the Independent-Atom Model with Screening Corrected Additivity Rule and Interference (IAM-SCAR+I) approach with the level of agreement between them being typically found to be very good.
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Major compounds of the anti-dengue active leaf methanol extracts from Faramea hyacinthina and Faramea truncata (Rubiaceae). Am J Transl Res 2017. [DOI: 10.1055/s-0037-1608063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nosocomial tuberculosis prevention in Portuguese hospitals: a cross-sectional evaluation. Int J Tuberc Lung Dis 2017; 21:930-934. [PMID: 28786802 DOI: 10.5588/ijtld.16.0835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Measures to control tuberculous infection are crucial to prevent nosocomial transmission and protect health care workers (HCWs). In Portugal, the extent of implementation of tuberculosis (TB) control measures in hospitals is not known. OBJECTIVE To determine the current implementation of preventive measures for tuberculous infection at administrative, environmental and personal levels in Portuguese hospitals. DESIGN A cross-sectional evaluation was performed using two anonymous questionnaires: one sent to all the hospital infection control (IC) committees and the other sent to all pulmonologists and physicians specialising in infectious disease. RESULTS Fourteen IC committees and 72 physicians responded. According to the IC committees, 92% of hospitals had a written TB control plan, but only 37% of the physicians said there was always/almost always a fast track for diagnosing suspected pulmonary TB cases. The majority of the hospitals had an isolation policy (85%) and these patients were always/almost always admitted in separate rooms, according to 70% of physicians. Both HCWs and TB patients used respiratory protection equipment (92%). CONCLUSION These findings indicate that the most basic TB IC measures had been undertaken, but some TB IC measures were not fully implemented at all hospitals. An institutional effort should be made to solve this problem and strengthen TB prevention activities.
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Abstract
BACKGROUND Tuberculosis (TB) is a major global health problem, and during the last 20 years, industrialised countries have shown similar patterns in TB notifications: decreasing TB incidence in native populations and increasing incidence in foreign-born populations. OBJECTIVES To characterise risk factors associated with TB among native- and foreign-born TB patients in Portugal and identify barriers to the management of foreign cases. METHODS Analysis of the data from the national tuberculosis surveillance system and data from an online survey of physicians managing TB cases in the country. RESULTS Risk factors in the two populations differed. Foreign-born patients were younger, less likely to use drugs or alcohol and had fewer comorbidities. They were also more likely to be human immunodeficiency virus positive, to be employed and to be homeless/living in shelters. The outcome of the disease and the time to diagnosis were not significantly different between the two populations. The most important barriers to the management of foreign-born TB cases were language and fear of deportation. CONCLUSIONS As there are significant differences between the two populations, different TB control strategies should be implemented in the two populations.
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Differential Diagnosis of Neoplastic-like Lesions in Wild Animals. J Comp Pathol 2017. [DOI: 10.1016/j.jcpa.2016.11.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Economic evaluation of Peek (Portable Eye Examination Kit) for diabetic retinopathy screening. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw164.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Innate immune cell activation in symptomatic and asymptomatic atherosclerosis in humans in vivo. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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090 Essential role of polarity protein Par3 for epidermal homeostasis through regulation of barrier function, keratinocyte differentiation and stem cell maintenance. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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An evaluation of the clinical and cost-effectiveness of alternative care locations for critically ill adult patients with acute traumatic brain injury. Br J Neurosurg 2016; 30:388-96. [PMID: 27188663 DOI: 10.3109/02688697.2016.1161166] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND For critically ill adult patients with acute traumatic brain injury (TBI), we assessed the clinical and cost-effectiveness of: (a) Management in dedicated neurocritical care units versus combined neuro/general critical care units within neuroscience centres. (b) 'Early' transfer to a neuroscience centre versus 'no or late' transfer for those who present at a non-neuroscience centre. METHODS The Risk Adjustment In Neurocritical care (RAIN) Study included prospective admissions following acute TBI to 67 UK adult critical care units during 2009-11. Data were collected on baseline case-mix, mortality, resource use, and at six months, Glasgow Outcome Scale Extended (GOSE), and quality of life (QOL) (EuroQol 5D-3L). We report incremental effectiveness, costs and cost per Quality-Adjusted Life Year (QALY) of the alternative care locations, adjusting for baseline differences with validated risk prediction models. We tested the robustness of results in sensitivity analyses. FINDINGS Dedicated neurocritical care unit patients (N = 1324) had similar six-month mortality, higher QOL (mean gain 0.048, 95% CI -0.002 to 0.099) and increased average costs compared with those managed in combined neuro/general units (N = 1341), with a lifetime cost per QALY gained of £14,000. 'Early' transfer to a neuroscience centre (N = 584) was associated with lower mortality (odds ratio 0.52, 0.34-0.80), higher QOL for survivors (mean gain 0.13, 0.032-0.225), but positive incremental costs (£15,001, £11,123 to £18,880) compared with 'late or no transfer' (N = 263). The lifetime cost per QALY gained for 'early' transfer was £11,000. CONCLUSIONS For critically ill adult patients with acute TBI, within neuroscience centres management in dedicated neurocritical care units versus combined neuro/general units led to improved QoL and higher costs, on average, but these differences were not statistically significant. This study finds that 'early' transfer to a neuroscience centre is associated with reduced mortality, improvement in QOL and is cost-effective.
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Multiple imputation methods for bivariate outcomes in cluster randomised trials. Stat Med 2016; 35:3482-96. [PMID: 26990655 PMCID: PMC4981911 DOI: 10.1002/sim.6935] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 02/15/2016] [Accepted: 02/18/2016] [Indexed: 01/03/2023]
Abstract
Missing observations are common in cluster randomised trials. The problem is exacerbated when modelling bivariate outcomes jointly, as the proportion of complete cases is often considerably smaller than the proportion having either of the outcomes fully observed. Approaches taken to handling such missing data include the following: complete case analysis, single‐level multiple imputation that ignores the clustering, multiple imputation with a fixed effect for each cluster and multilevel multiple imputation. We contrasted the alternative approaches to handling missing data in a cost‐effectiveness analysis that uses data from a cluster randomised trial to evaluate an exercise intervention for care home residents. We then conducted a simulation study to assess the performance of these approaches on bivariate continuous outcomes, in terms of confidence interval coverage and empirical bias in the estimated treatment effects. Missing‐at‐random clustered data scenarios were simulated following a full‐factorial design. Across all the missing data mechanisms considered, the multiple imputation methods provided estimators with negligible bias, while complete case analysis resulted in biased treatment effect estimates in scenarios where the randomised treatment arm was associated with missingness. Confidence interval coverage was generally in excess of nominal levels (up to 99.8%) following fixed‐effects multiple imputation and too low following single‐level multiple imputation. Multilevel multiple imputation led to coverage levels of approximately 95% throughout. © 2016 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.
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Social profile of the highest tuberculosis incidence areas in Portugal. REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 22:50-2. [PMID: 26515935 DOI: 10.1016/j.rppnen.2015.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/19/2015] [Accepted: 08/21/2015] [Indexed: 11/25/2022] Open
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Antineoplastic occupational exposure: Is exposure to mixtures being considered in the risk assessment process? Toxicol Lett 2015. [DOI: 10.1016/j.toxlet.2015.08.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Sheep and goats are widely infected by oncogenic retroviruses, namely Jaagsiekte Sheep RetroVirus (JSRV) and Enzootic Nasal Tumour Virus (ENTV). Under field conditions, these viruses induce transformation of differentiated epithelial cells in the lungs for Jaagsiekte Sheep RetroVirus or the nasal cavities for Enzootic Nasal Tumour Virus. As in other vertebrates, a family of endogenous retroviruses named endogenous Jaagsiekte Sheep RetroVirus (enJSRV) and closely related to exogenous Jaagsiekte Sheep RetroVirus is present in domestic and wild small ruminants. Interestingly, Jaagsiekte Sheep RetroVirus and Enzootic Nasal Tumour Virus are able to promote cell transformation, leading to cancer through their envelope glycoproteins. In vitro, it has been demonstrated that the envelope is able to deregulate some of the important signaling pathways that control cell proliferation. The role of the retroviral envelope in cell transformation has attracted considerable attention in the past years, but it appears to be highly dependent of the nature and origin of the cells used. Aside from its health impact in animals, it has been reported for many years that the Jaagsiekte Sheep RetroVirus-induced lung cancer is analogous to a rare, peculiar form of lung adenocarcinoma in humans, namely lepidic pulmonary adenocarcinoma. The implication of a retrovirus related to Jaagsiekte Sheep RetroVirus is still controversial and under investigation, but the identification of an infectious agent associated with the development of lepidic pulmonary adenocarcinomas might help us to understand cancer development. This review explores the mechanisms of induction of respiratory cancers in small ruminants and the possible link between retrovirus and lepidic pulmonary adenocarcinomas in humans.
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CYP2D6*4 polymorphism: A new marker of response to hormonotherapy in male breast cancer? Breast 2015; 24:481-6. [DOI: 10.1016/j.breast.2015.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 04/13/2015] [Accepted: 04/19/2015] [Indexed: 12/01/2022] Open
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Influence of
N
‐Acetylcysteine on Apoptosis in White‐Gastrocnemius Muscle of Rats With Chronic Heart Failure. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.lb710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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EP-1358: Hemoptysis due to fungus ball after tuberculosis: natural history and role of radiotherapy. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41350-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Population pharmacokinetics of intravenous artesunate: a pooled analysis of individual data from patients with severe malaria. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2014; 3:e145. [PMID: 25372510 PMCID: PMC4259998 DOI: 10.1038/psp.2014.43] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 08/28/2014] [Indexed: 11/09/2022]
Abstract
There are ~660,000 deaths from severe malaria each year. Intravenous artesunate (i.v. ARS) is the first-line treatment in adults and children. To optimize the dosing regimen of i.v. ARS, the largest pooled population pharmacokinetic study to date of the active metabolite dihydroartemisinin (DHA) was performed. The pooled dataset consisted of 71 adults and 195 children with severe malaria, with a mixture of sparse and rich sampling within the first 12 h after drug administration. A one-compartment model described the population pharmacokinetics of DHA adequately. Body weight had the greatest impact on DHA pharmacokinetics, resulting in lower DHA exposure for smaller children (6–10 kg) than adults. Post hoc estimates of DHA exposure were not significantly associated with parasitological outcomes. Comparable DHA exposure in smaller children and adults after i.v. ARS was achieved under a dose modification for intramuscular ARS proposed in a separate analysis of children.
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