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Wongtangman K, Semczuk P, Freda J, Smith RV, Pushparaj V, Beckham D, Aasman B, Rudolph MI, Salloum E, Kiyatkin M, Anand P, Ganz-Lord FA, Himes C, Fassbender P, Eikermann M. The effect of a bundle intervention for ambulatory otorhinolaryngology procedures on same-day case cancellation rate and associated costs. Anaesthesia 2024; 79:593-602. [PMID: 38353045 DOI: 10.1111/anae.16247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 05/12/2024]
Abstract
Cancellations within 24 h of planned elective surgical procedures reduce operating theatre efficiency, add unnecessary costs and negatively affect patient experience. We implemented a bundle intervention that aimed to reduce same-day case cancellations. This consisted of communication tools to improve patient engagement and new screening instruments (automated estimation of ASA physical status and case cancellation risk score plus four screening questions) to identify patients in advance (ideally before case booking) who needed comprehensive pre-operative risk stratification. We studied patients scheduled for ambulatory surgery with the otorhinolaryngology service at a single centre from April 2021 to December 2022. Multivariable logistic regression and interrupted time-series analyses were used to analyse the effects of this intervention on case cancellations within 24 h and costs. We analysed 1548 consecutive scheduled cases. Cancellation within 24 h occurred in 114 of 929 (12.3%) cases pre-intervention and 52 of 619 (8.4%) cases post-intervention. The cancellation rate decreased by 2.7% (95%CI 1.6-3.7%, p < 0.01) during the first month, followed by a monthly decrease of 0.2% (95%CI 0.1-0.4%, p < 0.01). This resulted in an estimated $150,200 (£118,755; €138,370) or 35.3% cost saving (p < 0.01). Median (IQR [range]) number of days between case scheduling and day of surgery decreased from 34 (21-61 [0-288]) pre-intervention to 31 (20-51 [1-250]) post-intervention (p < 0.01). Patient engagement via the electronic health record patient portal or text messaging increased from 75.9% at baseline to 90.8% (p < 0.01) post-intervention. The primary reason for case cancellation was patients' missed appointment on the day of surgery, which decreased from 7.2% pre-intervention to 4.5% post-intervention (p = 0.03). An anaesthetist-driven, clinical informatics-based bundle intervention decreases same-day case cancellation rate and associated costs in patients scheduled for ambulatory otorhinolaryngology surgery.
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Affiliation(s)
- K Wongtangman
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - P Semczuk
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - J Freda
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - R V Smith
- Department of Otorhinolaryngology/Head and Neck Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - V Pushparaj
- Faculty Practice Operations, Montefiore Health System, Bronx, NY, USA
| | - D Beckham
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - B Aasman
- Center for Health Data Innovations, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - M I Rudolph
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - E Salloum
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - M Kiyatkin
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - P Anand
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - F A Ganz-Lord
- Network Performance Group, and Staff Physician, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - C Himes
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - P Fassbender
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
- Klinik für Anästhesiologie, Operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Herne, Germany
| | - M Eikermann
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
- Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Essen, Germany
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Latronico N, Eikermann M, Ely EW, Needham DM. Improving management of ARDS: uniting acute management and long-term recovery. Crit Care 2024; 28:58. [PMID: 38395902 PMCID: PMC10893724 DOI: 10.1186/s13054-024-04810-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/12/2024] [Indexed: 02/25/2024] Open
Abstract
Acute Respiratory Distress Syndrome (ARDS) is an important global health issue with high in-hospital mortality. Importantly, the impact of ARDS extends beyond the acute phase, with increased mortality and disability for months to years after hospitalization. These findings underscore the importance of extended follow-up to assess and address the Post-Intensive Care Syndrome (PICS), characterized by persistent impairments in physical, cognitive, and/or mental health status that impair quality of life over the long-term. Persistent muscle weakness is a common physical problem for ARDS survivors, affecting mobility and activities of daily living. Critical illness and related interventions, including prolonged bed rest and overuse of sedatives and neuromuscular blocking agents during mechanical ventilation, are important risk factors for ICU-acquired weakness. Deep sedation also increases the risk of delirium in the ICU, and long-term cognitive impairment. Corticosteroids also may be used during management of ARDS, particularly in the setting of COVID-19. Corticosteroids can be associated with myopathy and muscle weakness, as well as prolonged delirium that increases the risk of long-term cognitive impairment. The optimal duration and dosage of corticosteroids remain uncertain, and there's limited long-term data on their effects on muscle weakness and cognition in ARDS survivors. In addition to physical and cognitive issues, mental health challenges, such as depression, anxiety, and post-traumatic stress disorder, are common in ARDS survivors. Strategies to address these complications emphasize the need for consistent implementation of the evidence-based ABCDEF bundle, which includes daily management of analgesia in concert with early cessation of sedatives, avoidance of benzodiazepines, daily delirium monitoring and management, early mobilization, and incorporation of family at the bedside. In conclusion, ARDS is a complex global health challenge with consequences extending beyond the acute phase. Understanding the links between critical care management and long-term consequences is vital for developing effective therapeutic strategies and improving the quality of life for ARDS survivors.
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Affiliation(s)
- Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
- Department of Emergency, Spedali Civili University Hospital, Piazzale Ospedali Civili, 1, 25123, Brescia, Italy.
- "Alessandra BONO" Interdepartmental University Research Center on Long-Term Outcome (LOTO) in Critical Illness Survivors, University of Brescia, Brescia, Italy.
| | - M Eikermann
- Department of Anesthesiology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, USA
- Klinik fur Anästhesiologie und Intensivmedizin, Universitaet Duisburg-Essen, Essen, Germany
| | - E W Ely
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - D M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
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Becker M, Hansen U, Eikermann M. [Are the assessments of individual out-of-pocket health services of the IGeL-Monitor in line with clinical guidelines?]. Gesundheitswesen 2023; 85:1192-1199. [PMID: 38081174 PMCID: PMC10713336 DOI: 10.1055/a-2158-8869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVES The IGeL-Monitor of the Federal Medical Advisory Service in Germany evaluates the benefits and harms of individual out-of-pocket health services (in German: Individuelle Gesundheitsleistungen / IGeL). The aim of the analysis was to systematically compare IGeL-assessements with the recommendations from evidence-based guidelines. METHOD To identify guidelines, we conducted searches in guidelines databases (AWMF, Guidelines International Network and Trip database) and the websites of guideline organisations (February/March 2022). We included guidelines that were not older than 5 years. The methodological quality of the guidelines was assessed using the AGREE II instrument. We compared the recommendations with the IGeL-assessments in terms of content and grade of recommendation. RESULTS We identified 41 guidelines covering 24 IGeL-assessements. 19 (79%) assessments (nearly) were in agreement with the guideline recommendations. No comparison was possible for 5 IGeL-assessements, because, for example, the recommendations were more specific. Ten of the 13 IGeL that were rated (tendentially) negatively were also not recommended in the guidelines. CONCLUSION Overall, the IGeL-assessments were consistent with the recommendations of current guidelines. Accordingly, guideline groups seem to assess the evidence similarly to the IGeL-Monitor team. Insured persons should be informed honestly about the evidence, particularly for the (tendentially) negatively evaluated IGeL that are not recommended even in guidelines.
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Affiliation(s)
- Monika Becker
- Bereich Evidenzbasierte Medizin, Medizinischer Dienst Bund, Essen,
Germany
| | - Ute Hansen
- Bereich Evidenzbasierte Medizin, Medizinischer Dienst Bund, Essen,
Germany
| | - Michaela Eikermann
- Bereich Evidenzbasierte Medizin, Medizinischer Dienst Bund, Essen,
Germany
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Suleiman A, Munoz-Acuna R, Azimaraghi O, Houle TT, Chen G, Rupp S, Witt AS, Azizi BA, Ahrens E, Shay D, Wongtangman K, Wachtendorf LJ, Tartler TM, Eikermann M, Schaefer MS. The effects of sugammadex vs. neostigmine on postoperative respiratory complications and advanced healthcare utilisation: a multicentre retrospective cohort study. Anaesthesia 2023; 78:294-302. [PMID: 36562202 DOI: 10.1111/anae.15940] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
Reversing neuromuscular blockade with sugammadex can eliminate residual paralysis, which has been associated with postoperative respiratory complications. There are equivocal data on whether sugammadex reduces these when compared with neostigmine. We investigated the association of the choice of reversal drug with postoperative respiratory complications and advanced healthcare utilisation. We included adult patients who underwent surgery and received general anaesthesia with sugammadex or neostigmine reversal at two academic healthcare networks between January 2016 and June 2021. The primary outcome was postoperative respiratory complications, defined as post-extubation oxygen saturation < 90%, respiratory failure requiring non-invasive ventilation, or tracheal re-intubation within 7 days. Our main secondary outcome was advanced healthcare utilisation, a composite outcome including: 7-day unplanned intensive care unit admission; 30-day hospital readmission; or non-home discharge. In total, 5746 (6.9%) of 83,250 included patients experienced postoperative respiratory complications. This was not associated with the reversal drug (adjusted OR (95%CI) 1.01 (0.94-1.08); p = 0.76). After excluding patients admitted from skilled nursing facilities, 8372 (10.5%) patients required advanced healthcare utilisation, which was not associated with the choice of reversal (adjusted OR (95%CI) 0.95 (0.89-1.01); p = 0.11). Equivalence testing supported an equivalent effect size of sugammadex and neostigmine on both outcomes, and neostigmine was non-inferior to sugammadex with regard to postoperative respiratory complications or advanced healthcare utilisation. Finally, there was no association between the reversal drug and major adverse cardiovascular events (adjusted OR 1.07 (0.94-1.21); p = 0.32). Compared with neostigmine, reversal of neuromuscular blockade with sugammadex was not associated with a reduction in postoperative respiratory complications or post-procedural advanced healthcare utilisation.
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Affiliation(s)
- A Suleiman
- Department of Anesthesia, Critical Care and Pain Medicine, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, MA, Boston, USA
| | - R Munoz-Acuna
- Department of Anesthesia, Critical Care and Pain Medicine, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, MA, Boston, USA
| | - O Azimaraghi
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, NY, Bronx, USA
| | - T T Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, MA, Boston, USA
| | - G Chen
- Department of Anesthesia, Critical Care and Pain Medicine, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, MA, Boston, USA
| | - S Rupp
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, NY, Bronx, USA
| | - A S Witt
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, NY, Bronx, USA
| | - B A Azizi
- Department of Anesthesia, Critical Care and Pain Medicine, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, MA, Boston, USA
| | - E Ahrens
- Department of Anesthesia, Critical Care and Pain Medicine, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, MA, Boston, USA
| | - D Shay
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, MA, Boston, USA
| | - K Wongtangman
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, NY, Bronx, USA
| | - L J Wachtendorf
- Department of Anesthesia, Critical Care and Pain Medicine, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, MA, Boston, USA
| | - T M Tartler
- Department of Anesthesia, Critical Care and Pain Medicine, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, MA, Boston, USA
| | - M Eikermann
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, NY, Bronx, USA
| | - M S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, MA, Boston, USA
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Abstract
OBJECTIVES To investigate authors' awareness and use of authorship guidelines, and to assess their perceptions of the fairness of authorship decisions. DESIGN A cross-sectional online survey. SETTING AND PARTICIPANTS Corresponding authors of research papers submitted in 2014 to 18 BMJ journals. RESULTS 3859/12 646 (31%) researchers responded. They worked in 93 countries and varied in research experience. Of these, 1326 (34%) reported their institution had an authorship policy providing criteria for authorship; 2871 (74%) were 'very familiar' with the International Committee of Medical Journal Editors' authorship criteria and 3358 (87%) reported that guidelines were beneficial when preparing manuscripts. Furthermore, 2609 (68%) reported that their use was 'sometimes' or 'frequently' encouraged in their research setting. However, 2859 respondents (74%) reported that they had been involved in a study at least once where someone was added as an author who had not contributed substantially (honorary authorship), and 1305 (34%) where someone was not listed as an author but had contributed substantially (ghost authorship). Only 740 (19%) reported that they had never experienced either honorary or ghost authorship; 1115 (29%) reported that they had experienced both at least once. There was no clear pattern in experience of authorship misappropriation by continent. For their last coauthored article, 2187 (57%) reported that explicit authorship criteria had been used to determine eligibility, and 3088 (80%) felt that the decision made was fair. When institutions frequently encouraged use of authorship guidelines, authorship eligibility was more likely to be discussed early (817 of 1410, 58%) and perceived as fairer (1273 of 1410, 90%) compared with infrequent encouragement (974 of 2449, 40%, and 1891 of 2449, 74%). CONCLUSIONS Despite a high level of awareness of authorship guidelines and criteria, these are not so widely used; more explicit encouragement of their use by institutions may result in more favourable use of guidelines by authors.
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Affiliation(s)
| | - Ilaria Montagni
- Bordeaux Population Health Research Center UMR129, University of Bordeaux-Inserm, Bordeaux, France
| | - Elizabeth Loder
- BMJ Publishing Group, London, UK
- Division of Headache, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - M Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Elke Schäffner
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Sandini M, Ruscic KJ, Ferrone CR, Qadan M, Eikermann M, Warshaw AL, Lillemoe KD, Castillo CFD. Major Complications Independently Increase Long-Term Mortality After Pancreatoduodenectomy for Cancer. J Gastrointest Surg 2019; 23:1984-1990. [PMID: 30225794 DOI: 10.1007/s11605-018-3939-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 08/17/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Postoperative major morbidity has been associated with worse survival gastrointestinal tumors. This association remains controversial in pancreatic cancer (PC). We analyzed whether major complications after surgical resection affect long-term survival. METHODS Records of all PC patients resected from 2007 to 2015 were reviewed. Major morbidity was defined as any grade-3 or higher 30-day complications, per the Clavien-Dindo Classification. Patients who died within 90 days after surgery were excluded from survival analysis. RESULTS Of 616 patients, 81.7% underwent pancreatoduodenectomy (PD) and 18.3% distal pancreatectomy (DP). Major complications occurred in 19.1% after PD and 15.9% after DP. In patients who survived > 90 days, the likelihood of receiving adjuvant treatment was 43.9% if major complications had occurred, vs. 68.5% if not (p < 0.001), and those who received it started the treatment median 10 days later compared with uncomplicated patients (median 60 days (50-72) vs. 50 days (41-61), p = 0.001). By univariate analysis, in addition to the conventional pathology-related prognostic determinants and the receipt of adjuvant treatment, major complications worsened long-term survival after PD (median OS 26 months vs. 15, p = 0.008). A difference was also seen after DP, but it did not reach statistical significance, likely related to the small sample size (median OS 33 months vs. 18, p = 0.189). At multivariate analysis for PD, major postoperative complications remained independently associated with worse survival [HR 1.37, 95%CI (1.01-1.86)]. CONCLUSIONS Major surgical complications after pancreaticoduodenectomy are associated with worse long-term survival in pancreatic cancer. This effect is independent of the receipt of adjuvant treatment.
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Affiliation(s)
- M Sandini
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman ST, Boston, MA, 02114-02115, USA
| | - K J Ruscic
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - C R Ferrone
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman ST, Boston, MA, 02114-02115, USA
| | - M Qadan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman ST, Boston, MA, 02114-02115, USA
| | - M Eikermann
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - A L Warshaw
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman ST, Boston, MA, 02114-02115, USA
| | - K D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman ST, Boston, MA, 02114-02115, USA
| | - Carlos Fernández-Del Castillo
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman ST, Boston, MA, 02114-02115, USA.
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Abstract
BACKGROUND Pay-for-Performance (P4P) is a payment model that rewards health care providers for meeting pre-defined targets for quality indicators or efficacy parameters to increase the quality or efficacy of care. OBJECTIVES Our objective was to assess the impact of P4P for in-hospital delivered health care on the quality of care, resource use and equity. Our objective was not only to answer the question whether P4P works in general (simple perspective) but to provide a comprehensive and detailed overview of P4P with a focus on analyzing the intervention components, the context factors and their interrelation (more complex perspective). SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases and two trial registers on 27 June 2018. In addition, we searched conference proceedings, gray literature and web pages of relevant health care institutions, contacted experts in the field, conducted cited reference searches and performed cross-checks of included references and systematic reviews on the same topic. SELECTION CRITERIA We included randomized trials, cluster randomized trials, non-randomized clustered trials, controlled before-after studies, interrupted time series and repeated measures studies that analyzed hospitals, hospital units or groups of hospitals and that compared any kind of P4P to a basic payment scheme (e.g. capitation) without P4P. Studies had to analyze at least one of the following outcomes to be eligible: patient outcomes; quality of care; utilization, coverage or access; resource use, costs and cost shifting; healthcare provider outcomes; equity; adverse effects or harms. DATA COLLECTION AND ANALYSIS Two review authors independently screened all citations for inclusion, extracted study data and assessed risk of bias for each included study. Study characteristics were extracted by one reviewer and verified by a second.We did not perform meta-analysis because the included studies were too heterogenous regarding hospital characteristics, the design of the P4P programs and study design. Instead we present a structured narrative synthesis considering the complexity as well as the context/setting of the intervention. We assessed the certainty of evidence using the GRADE approach and present the results narratively in 'Summary of findings' tables. MAIN RESULTS We included 27 studies (20 CBA, 7 ITS) on six different P4P programs. Studies analyzed between 10 and 4267 centers. All P4P programs targeted acute or emergency physical conditions and compared a capitation-based payment scheme without P4P to the same capitation-based payment scheme combined with a P4P add-on. Two P4P program used rewards or penalties; one used first rewards and than penalties; two used penalties only and one used rewards only. Four P4P programs were established and evaluated in the USA, one in England and one in France.Most studies showed no difference or a very small effect in favor of the P4P program. The impact of each P4P program was as follows.Premier Hospital Quality Incentive Demonstration Program: It is uncertain whether this program, which used rewards for some hospitals and penalties for others, has an impact on mortality, adverse clinical events, quality of care, equity or resource use as the certainty of the evidence was very low.Value-Based Purchasing Program: It is uncertain whether this program, which used rewards for some hospitals and penalties for others, has an impact on mortality, adverse clinical events or quality of care as the certainty of the evidence was very low. Equity and resource use outcomes were not reported in the studies, which evaluated this program.Non-payment for Hospital-Acquired Conditions Program: It is uncertain whether this penalty-based program has an impact on adverse clinical events as the certainty of the evidence was very low. Mortality, quality of care, equity and resource use outcomes were not reported in the studies, which evaluated this program.Hospital Readmissions Reduction Program: None of the studies that examined this penalty-based program reported mortality, adverse clinical events, quality of care (process quality score), equity or resource use outcomes.Advancing Quality Program: It is uncertain whether this reward-/penalty-based program has an impact on mortality as the certainty of the evidence was very low. Adverse clinical events, quality of care, equity and resource use outcomes were not reported in any study.Financial Incentive to Quality Improvement Program: It is uncertain whether this reward-based program has an impact on quality of care, as the certainty of the evidence was very low. Mortality, adverse clinical events, equity and resource use outcomes were not reported in any study.Subgroup analysis (analysis of modifying design and context factors)Analysis of P4P design factors provides some hints that non-payments compared to additional payments and payments for quality attainment (e.g. falling below specified mortality threshold) compared to quality improvement (e.g. reduction of mortality by specified percent points within one year) may have a stronger impact on performance. AUTHORS' CONCLUSIONS It is uncertain whether P4P, compared to capitation-based payments without P4P for hospitals, has an impact on patient outcomes, quality of care, equity or resource use as the certainty of the evidence was very low (or we found no studies on the outcome) for all P4P programs. The effects on patient outcomes of P4P in hospitals were at most small, regardless of design factors and context/setting. It seems that with additional payments only small short-term but non-sustainable effects can be achieved. Non-payments seem to be slightly more effective than bonuses and payments for quality attainment seem to be slightly more effective than payments for quality improvement.
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Affiliation(s)
- Tim Mathes
- University Witten/HerdeckeInstitute for Research in Operative Medicine (IFOM) ‐ Department for Evidence‐based Health Services ResearchOstmerheimer Str. 200 (House 38)CologneGermany51109
| | - Dawid Pieper
- University Witten/HerdeckeInstitute for Research in Operative Medicine (IFOM) ‐ Department for Evidence‐based Health Services ResearchOstmerheimer Str. 200 (House 38)CologneGermany51109
| | - Johannes Morche
- Federal Joint CommitteeMedical Consultancy DepartmentWegelystraße 8BerlinGermany
| | - Stephanie Polus
- University Witten/HerdeckeInstitute for Research in Operative Medicine (IFOM) ‐ Department for Evidence‐based Health Services ResearchOstmerheimer Str. 200 (House 38)CologneGermany51109
| | - Thomas Jaschinski
- University Witten/HerdeckeInstitute for Research in Operative Medicine (IFOM) ‐ Department for Evidence‐based Health Services ResearchOstmerheimer Str. 200 (House 38)CologneGermany51109
| | - Michaela Eikermann
- Medical advisory service of social health insurance (MDS)Department of Evidence‐based medicineTheodor‐Althoff‐Straße 47EssenNorth Rhine WestphaliaGermany51109
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8
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Lukannek C, Shaefi S, Platzbecker K, Raub D, Santer P, Nabel S, Lecamwasam HS, Houle TT, Eikermann M. The development and validation of the Score for the Prediction of Postoperative Respiratory Complications (SPORC-2) to predict the requirement for early postoperative tracheal re-intubation: a hospital registry study. Anaesthesia 2019; 74:1165-1174. [PMID: 31222727 DOI: 10.1111/anae.14742] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2019] [Indexed: 01/24/2023]
Abstract
Postoperative pulmonary complications are associated with an increase in mortality, morbidity and healthcare utilisation. The Agency for Healthcare Research and Quality recommends risk assessment for postoperative respiratory complications in patients undergoing surgery. In this hospital registry study of adult patients undergoing non-cardiac surgery between 2005 and 2017 at two independent healthcare networks, a prediction instrument for early postoperative tracheal re-intubation was developed and externally validated. This was based on the development of the Score for Prediction Of Postoperative Respiratory Complications. For predictor selection, stepwise backward logistic regression and bootstrap resampling were applied. Development and validation cohorts were represented by 90,893 patients at Partners Healthcare and 67,046 patients at Beth Israel Deaconess Medical Center, of whom 699 (0.8%) and 587 (0.9%) patients, respectively, had their tracheas re-intubated. In addition to five pre-operative predictors identified in the Score for Prediction Of Postoperative Respiratory Complications, the final model included seven additional intra-operative predictors: early post-tracheal intubation desaturation; prolonged duration of surgery; high fraction of inspired oxygen; high vasopressor dose; blood transfusion; the absence of volatile anaesthetic use; and the absence of lung-protective ventilation. The area under the receiver operating characteristic curve for the new score was significantly greater than that of the original Score for Prediction Of Postoperative Respiratory Complications (0.84 [95%CI 0.82-0.85] vs. 0.76 [95%CI 0.75-0.78], respectively; p < 0.001). This may allow clinicians to develop and implement strategies to decrease the risk of early postoperative tracheal re-intubation.
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Affiliation(s)
- C Lukannek
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Anesthesia Information Systems, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - S Shaefi
- Anesthesia Information Systems, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - K Platzbecker
- Anesthesia Information Systems, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - D Raub
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Anesthesia Information Systems, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - P Santer
- Anesthesia Information Systems, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - S Nabel
- Anesthesia Information Systems, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - H S Lecamwasam
- Department of Anesthesia, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI, USA.,Talis Clinical, LLC, USA
| | - T T Houle
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - M Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.,Duisburg-Essen University, Essen, Germany
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9
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Friedrich S, Raub D, Teja BJ, Neves SE, Thevathasan T, Houle TT, Eikermann M. Effects of low-dose intraoperative fentanyl on postoperative respiratory complication rate: a pre-specified, retrospective analysis. Br J Anaesth 2019; 122:e180-e188. [PMID: 30982564 DOI: 10.1016/j.bja.2019.03.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 11/07/2018] [Revised: 02/24/2019] [Accepted: 03/15/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Fentanyl is one of the most frequently administered intraoperative drugs and may increase the risk of postoperative respiratory complications (PRCs). METHODS We performed a pre-specified analysis of 145 735 adult non-cardiac surgical cases under general anaesthesia. Using multivariable logistic regression, we evaluated the association of intraoperative fentanyl dose and PRCs within 3 days after surgery (defined as reintubation, respiratory failure, pneumonia, pulmonary oedema, or atelectasis). We examined effect modification by patient characteristics, surgical site, and anaesthetics used. RESULTS PRCs within 3 days after surgery occurred in 18 839 (12.9%) patients. In comparison with high intraoperative fentanyl doses [median: 3.85; inter-quartile range (IQR): 3.42-4.50 μg kg-1, quartile 4 (Q4)], low intraoperative fentanyl dose [median: 0.80, IQR: 0.00-1.14 μg kg-1, quartile 1 (Q1)] was significantly associated with lower odds of PRCs [Q1 vs Q4: 10.9% vs 16.2%; adjusted odds ratio (aOR) 0.79; 95% confidence intervals (CI) 0.75-0.84; P<0.001; adjusted absolute risk difference (aARD) -1.7%]. This effect was augmented by thoracic surgery (P for interaction <0.001; aARD -6.2%), high doses of inhalation anaesthetics (P for interaction=0.016; aARD -2.2%) and neuromuscular blocking agents (NMBAs) (P for interaction=0.001; aARD -3.4%). Exploratory analysis demonstrated that compared with no fentanyl, low-dose fentanyl was associated with lower rates of PRCs (decile 2 vs decile 1: aOR 0.82, CI 0.75-0.89, P<0.001). CONCLUSIONS Intraoperative low-dose fentanyl (about 60-120 μg for a 70 kg patient) was associated with lower risk of postoperative respiratory complications compared with both no fentanyl and high-dose fentanyl. Beneficial effects of low-dose fentanyl were magnified in specific patient subgroups. CLINICAL TRIAL REGISTRATION NCT03198208.
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Affiliation(s)
- S Friedrich
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - D Raub
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - B J Teja
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S E Neves
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - T Thevathasan
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - T T Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - M Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Universitätsklinikum Essen, Essen, Germany.
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10
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Kent NB, Liang SS, Phillips S, Smith NA, Khandkar C, Eikermann M, Stewart PA. Therapeutic doses of neostigmine, depolarising neuromuscular blockade and muscle weakness in awake volunteers: a double-blind, placebo-controlled, randomised volunteer study. Anaesthesia 2019; 73:1079-1089. [PMID: 30132821 DOI: 10.1111/anae.14386] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2018] [Indexed: 11/28/2022]
Abstract
Neostigmine reverses non-depolarising neuromuscular blockade, but may cause muscle weakness when administered after full recovery of neuromuscular function. We hypothesised that neostigmine in therapeutic doses impairs muscle strength and respiratory function in awake healthy volunteers. Twenty-one volunteers were randomised to receive two doses of either intravenous (i.v.) neostigmine 2.5 mg with glycopyrrolate 450 μg (neostigmine group, n = 14) or normal saline 0.9% (placebo group, n = 7). The first dose was administered immediately after obtaining baseline measurements, and the second dose was administered 15 min later. All 14 volunteers in the neostigmine group received the first dose, mean (SD) 35 (5.8) μg.kg-1 , but only nine of these volunteers agreed to receive the second dose, 34 (3.5) ?g.kg-1 . The primary outcome was hand grip strength. Secondary outcomes were train-of-four ratio, single twitch height, forced expiratory volume in 1 s, forced vital capacity, forced expiratory volume in 1 s/forced vital capacity ratio, oxygen saturation, heart rate and mean arterial pressure. The first dose of intravenous neostigmine with glycopyrrolate resulted in reduced grip strength compared with placebo, -20 (20) % vs. +4.3 (9.9) %, p = 0.0016; depolarising neuromuscular blockade with decreased single twitch height, -14 (11) % vs. -3.8 (5.6) %, p = 0.0077; a restrictive spirometry pattern with decreased predicted forced expiratory volume in 1 s, -15 (12) % vs. -0.47 (3.4) %, p = 0.0011; and predicted forced vital capacity, -20 (12) % vs. -0.59 (3.2) %, p < 0.0001 at 5 min after administration. The second dose of neostigmine with glycopyrrolate further decreased grip strength mean (SD) -41 (23) % vs. +1.0 (15) %, p = 0.0004; single twitch height -25 (15) % vs. -2.5 (6.6) %, p = 0.0030; predicted forced expiratory volume in 1 s -23 (24) % vs. -0.7 (4.4) %, p = 0.0063; and predicted forced vital capacity, -27.1 (22.0) % vs. -0.66 (3.9) %, p = 0.0010. Train-of-four ratio remained unchanged (p = 0.22). In healthy volunteers, therapeutic doses of neostigmine induced significant and dose-dependent muscle weakness, demonstrated by a decrease in maximum voluntary hand grip strength and a restrictive spirometry pattern secondary to depolarising neuromuscular blockade.
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Affiliation(s)
- N B Kent
- Department of Anaesthesia, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - S S Liang
- Department of Anaesthesia, Westmead Hospital, Westmead, NSW, Australia
| | - S Phillips
- Department of Anaesthesia, The University of Sydney, Sydney Adventist Hospital Clinical School, Sydney, NSW, Australia
| | - N A Smith
- Department of Anaesthesia, Wollongong Hospital, Wollongong, NSW, Australia
| | - C Khandkar
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - M Eikermann
- Department of Anaesthesia, Harvard Medical School, Boston, MA, USA.,Department of Anaesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Centre, Boston, MA, USA
| | - P A Stewart
- Department of Anaesthesia, The University of Sydney, Sydney Adventist Hospital Clinical School, Sydney, NSW, Australia
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11
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Rudolph MI, Houle TT, Eikermann M. Statistical concerns about implementing a peri-operative neuromuscular blockade management strategy - a reply. Anaesthesia 2019; 74:399. [PMID: 30734950 DOI: 10.1111/anae.14600] [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] [Indexed: 11/30/2022]
Affiliation(s)
- M I Rudolph
- Massachusetts General Hospital, Boston, MA, USA
| | - T T Houle
- Massachusetts General Hospital, Boston, MA, USA
| | - M Eikermann
- Beth Israel Deaconess Medical Center, Boston, MA, USA
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12
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Affiliation(s)
- P M Fuller
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - M Eikermann
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
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13
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Rostin P, Teja BJ, Friedrich S, Shaefi S, Murugappan KR, Ramachandran SK, Houle TT, Eikermann M. The association of early postoperative desaturation in the operating theatre with hospital discharge to a skilled nursing or long-term care facility. Anaesthesia 2019; 74:457-467. [DOI: 10.1111/anae.14517] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2018] [Indexed: 12/17/2022]
Affiliation(s)
- P. Rostin
- Department of Anesthesia, Critical Care, and Pain Medicine; Massachusetts General Hospital and Harvard Medical School; Boston MA USA
- Department of Anaesthesiology and Intensive Care Medicine; University Duisburg-Essen; Essen Germany
| | - B. J. Teja
- Department of Anesthesia, Critical Care and Pain Medicine; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
| | - S. Friedrich
- Department of Anesthesia, Critical Care, and Pain Medicine; Massachusetts General Hospital and Harvard Medical School; Boston MA USA
- Department of Anesthesia, Critical Care and Pain Medicine; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
| | - S. Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
| | - K. R. Murugappan
- Department of Anesthesia, Critical Care and Pain Medicine; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
| | - S. K. Ramachandran
- Department of Anesthesia, Critical Care and Pain Medicine; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
| | - T. T. Houle
- Department of Anesthesia, Critical Care, and Pain Medicine; Massachusetts General Hospital and Harvard Medical School; Boston MA USA
| | - M. Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
- Department of Anaesthesiology and Intensive Care Medicine; University Duisburg-Essen; Essen Germany
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14
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Staehr-Rye AK, Meyhoff CS, Scheffenbichler FT, Vidal Melo MF, Gätke MR, Walsh JL, Ladha KS, Grabitz SD, Nikolov MI, Kurth T, Rasmussen LS, Eikermann M. High intraoperative inspiratory oxygen fraction and risk of major respiratory complications. Br J Anaesth 2018; 119:140-149. [PMID: 28974067 DOI: 10.1093/bja/aex128] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 11/14/2022] Open
Abstract
Background High inspiratory oxygen fraction ( FIO2 ) may improve tissue oxygenation but also impair pulmonary function. We aimed to assess whether the use of high intraoperative FIO2 increases the risk of major respiratory complications. Methods We studied patients undergoing non-cardiothoracic surgery involving mechanical ventilation in this hospital-based registry study. The cases were divided into five groups based on the median FIO2 between intubation and extubation. The primary outcome was a composite of major respiratory complications (re-intubation, respiratory failure, pulmonary oedema, and pneumonia) developed within 7 days after surgery. Secondary outcomes included 30-day mortality. Several predefined covariates were included in a multivariate logistic regression model. Results The primary analysis included 73 922 cases, of whom 3035 (4.1%) developed a major respiratory complication within 7 days of surgery. For patients in the high- and low-oxygen groups, the median FIO2 was 0.79 [range 0.64-1.00] and 0.31 [0.16-0.34], respectively. Multivariate logistic regression analysis revealed that the median FIO2 was associated in a dose-dependent manner with increased risk of respiratory complications (adjusted odds ratio for high vs low FIO2 1.99, 95% confidence interval [1.72-2.31], P -value for trend <0.001). This finding was robust in a series of sensitivity analyses including adjustment for intraoperative oxygenation. High median FIO2 was also associated with 30-day mortality (odds ratio for high vs low FIO2 1.97, 95% confidence interval [1.30-2.99], P -value for trend <0.001). Conclusions In this analysis of administrative data on file, high intraoperative FIO2 was associated in a dose-dependent manner with major respiratory complications and with 30-day mortality. The effect remained stable in a sensitivity analysis controlled for oxygenation. Clinical trial registration NCT02399878.
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Affiliation(s)
- A K Staehr-Rye
- Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.,Department of Anaesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - C S Meyhoff
- Department of Anaesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark.,Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark
| | - F T Scheffenbichler
- Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - M F Vidal Melo
- Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - M R Gätke
- Department of Anaesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - J L Walsh
- Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - K S Ladha
- Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - S D Grabitz
- Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - M I Nikolov
- Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - T Kurth
- Institute of Public Health, Charité Universitätzmedizin Berlin, Germany
| | - L S Rasmussen
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Denmark
| | - M Eikermann
- Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.,Klinik für Anaesthesie und Intensivmedizin, Universitaetsklinikum Essen, Essen, Germany
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15
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Abstract
BACKGROUND The removal of the acute appendix is one of the most frequently performed surgical procedures. Open surgery associated with therapeutic efficacy has been the treatment of choice for acute appendicitis. However, in consequence of the evolution of endoscopic surgery, the operation can also be performed with minimally invasive surgery. Due to smaller incisions, the laparoscopic approach may be associated with reduced postoperative pain, reduced wound infection rate, and shorter time until return to normal activity.This is an update of the review published in 2010. OBJECTIVES To compare the effects of laparoscopic appendectomy (LA) and open appendectomy (OA) with regard to benefits and harms. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE and Embase (9 February 2018). We identified proposed and ongoing studies from World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov and EU Clinical Trials Register (9 February 2018). We handsearched reference lists of identified studies and the congress proceedings of endoscopic surgical societies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing LA versus OA in adults or children. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed the risk of bias, and extracted data. We performed the meta-analyses using Review Manager 5. We calculated the Peto odds ratio (OR) for very rare outcomes, and the mean difference (MD) for continuous outcomes (or standardised mean differences (SMD) if researchers used different scales such as quality of life) with 95% confidence intervals (CI). We used GRADE to rate the quality of the evidence. MAIN RESULTS We identified 85 studies involving 9765 participants. Seventy-five trials included 8520 adults and 10 trials included 1245 children. Most studies had risk of bias issues, with attrition bias being the largest source across studies due to incomplete outcome data.In adults, pain intensity on day one was reduced by 0.75 cm on a 10 cm VAS after LA (MD -0.75, 95% CI -1.04 to -0.45; 20 RCTs; 2421 participants; low-quality evidence). Wound infections were less likely after LA (Peto OR 0.42, 95% CI 0.35 to 0.51; 63 RCTs; 7612 participants; moderate-quality evidence), but the incidence of intra-abdominal abscesses was increased following LA (Peto OR 1.65, 95% CI 1.12 to 2.43; 53 RCTs; 6677 participants; moderate-quality evidence).The length of hospital stay was shortened by one day after LA (MD -0.96, 95% CI -1.23 to -0.70; 46 RCTs; 5127 participant; low-quality evidence). The time until return to normal activity occurred five days earlier after LA than after OA (MD -4.97, 95% CI -6.77 to -3.16; 17 RCTs; 1653 participants; low-quality evidence). Two studies showed better quality of life scores following LA, but used different scales, and therefore no pooled estimates were presented. One used the SF-36 questionnaire two weeks after surgery and the other used the Gastro-intestinal Quality of Life Index six weeks and six months after surgery (both low-quality evidence).In children, we found no differences in pain intensity on day one (MD -0.80, 95% CI -1.65 to 0.05; 1 RCT; 61 participants; low-quality evidence), intra-abdominal abscesses after LA (Peto OR 0.54, 95% CI 0.24 to 1.22; 9 RCTs; 1185 participants; low-quality evidence) or time until return to normal activity (MD -0.50, 95% CI -1.30 to 0.30; 1 RCT; 383 participants; moderate-quality evidence). However, wound infections were less likely after LA (Peto OR 0.25, 95% CI 0.15 to 0.42; 10 RCTs; 1245 participants; moderate-quality evidence) and the length of hospital stay was shortened by 0.8 days after LA (MD -0.81, 95% CI -1.01 to -0.62; 6 RCTs; 316 participants; low-quality evidence). Quality of life was not reported in any of the included studies. AUTHORS' CONCLUSIONS Except for a higher rate of intra-abdominal abscesses after LA in adults, LA showed advantages over OA in pain intensity on day one, wound infections, length of hospital stay and time until return to normal activity in adults. In contrast, LA showed advantages over OA in wound infections and length of hospital stay in children. Two studies reported better quality of life scores in adults. No study reported this outcome in children. However, the quality of evidence ranged from very low to moderate and some of the clinical effects of LA were small and of limited clinical relevance. Future studies with low risk of bias should investigate, in particular, the quality of life in children.
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Affiliation(s)
- Thomas Jaschinski
- University Witten/HerdeckeInstitute for Research in Operative Medicine (IFOM) ‐ Department for Evidence‐based Health Services ResearchOstmerheimer Str. 200 (Building 38)CologneGermany51109
| | - Christoph G Mosch
- University Witten/HerdeckeInstitute for Research in Operative Medicine (IFOM) ‐ Department for Evidence‐based Health Services ResearchOstmerheimer Str. 200 (Building 38)CologneGermany51109
| | - Michaela Eikermann
- Medical advisory service of social health insurance (MDS)Department of Evidence‐based medicineTheodor‐Althoff‐Straße 47EssenNorth Rhine WestphaliaGermany51109
| | - Edmund AM Neugebauer
- Brandenburg Medical School Theodor Fontane 3Fehrbelliner Str 38NeuruppinBrandenburgGermany16816
| | - Stefan Sauerland
- Institute for Quality and Efficiency in Health Care (IQWiG)Department of Non‐Drug InterventionsIm Mediapark 8CologneGermany50670
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16
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Long DR, Friedrich S, Eikermann M. High intraoperative opioid dose increases readmission risk in patients undergoing ambulatory surgery. Br J Anaesth 2018; 121:1179-1180. [PMID: 30336864 DOI: 10.1016/j.bja.2018.07.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 11/19/2022] Open
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17
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Rudolph MI, Chitilian HV, Ng PY, Timm FP, Agarwala AV, Doney AB, Ramachandran SK, Houle TT, Eikermann M. Implementation of a new strategy to improve the peri-operative management of neuromuscular blockade and its effects on postoperative pulmonary complications. Anaesthesia 2018; 73:1067-1078. [DOI: 10.1111/anae.14326] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 12/14/2022]
Affiliation(s)
- M. I. Rudolph
- Department of Anesthesia, Critical Care and Pain Medicine; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - H. V. Chitilian
- Department of Anesthesia, Critical Care and Pain Medicine; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - P. Y. Ng
- Department of Anesthesia, Critical Care and Pain Medicine; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
- Adult Intensive Care Unit; Queen Mary Hospital; The University of Hong Kong; Pok Fu Lam Hong Kong
| | - F. P. Timm
- Department of Anesthesia, Critical Care and Pain Medicine; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - A. V. Agarwala
- Department of Anesthesia, Critical Care and Pain Medicine; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - A. B. Doney
- Department of Anesthesia, Critical Care and Pain Medicine; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - S. K. Ramachandran
- Department of Anesthesia, Critical Care and Pain Medicine; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - T. T. Houle
- Department of Anesthesia, Critical Care, and Pain Medicine; Beth Israel Deaconess Medical Center; Harvard Medical School; Boston MA USA
| | - M. Eikermann
- Klinik für Anästhesiologie und Intensivmedizin; Universitätsklinikum Essen; Germany
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18
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Budde A, Parsons C, Eikermann M. Uvula necrosis after fibreoptic intubation. Br J Anaesth 2018; 120:1139-1140. [DOI: 10.1016/j.bja.2018.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 10/17/2022] Open
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19
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Long D, Lihn A, Friedrich S, Scheffenbichler F, Safavi K, Burns S, Schneider J, Grabitz S, Houle T, Eikermann M. Association between intraoperative opioid administration and 30-day readmission: a pre-specified analysis of registry data from a healthcare network in New England. Br J Anaesth 2018; 120:1090-1102. [DOI: 10.1016/j.bja.2017.12.044] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 12/06/2017] [Accepted: 01/25/2018] [Indexed: 11/17/2022] Open
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20
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Hoffmann-Eßer W, Siering U, Neugebauer EA, Lampert U, Eikermann M. Systematic review of current guideline appraisals performed with the Appraisal of Guidelines for Research & Evaluation II instrument—a third of AGREE II users apply a cut-off for guideline quality. J Clin Epidemiol 2018; 95:120-127. [DOI: 10.1016/j.jclinepi.2017.12.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 11/29/2017] [Accepted: 12/20/2017] [Indexed: 12/20/2022]
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21
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Hoffmann-Eßer W, Siering U, Neugebauer EAM, Brockhaus AC, McGauran N, Eikermann M. Guideline appraisal with AGREE II: online survey of the potential influence of AGREE II items on overall assessment of guideline quality and recommendation for use. BMC Health Serv Res 2018; 18:143. [PMID: 29482555 PMCID: PMC5828401 DOI: 10.1186/s12913-018-2954-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [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: 07/16/2017] [Accepted: 02/21/2018] [Indexed: 11/17/2022] Open
Abstract
Background The AGREE II instrument is the most commonly used guideline appraisal tool. It includes 23 appraisal criteria (items) organized within six domains. AGREE II also includes two overall assessments (overall guideline quality, recommendation for use). Our aim was to investigate how strongly the 23 AGREE II items influence the two overall assessments. Methods An online survey of authors of publications on guideline appraisals with AGREE II and guideline users from a German scientific network was conducted between 10th February 2015 and 30th March 2015. Participants were asked to rate the influence of the AGREE II items on a Likert scale (0 = no influence to 5 = very strong influence). The frequencies of responses and their dispersion were presented descriptively. Results Fifty-eight of the 376 persons contacted (15.4%) participated in the survey and the data of the 51 respondents with prior knowledge of AGREE II were analysed. Items 7–12 of Domain 3 (rigour of development) and both items of Domain 6 (editorial independence) had the strongest influence on the two overall assessments. In addition, Items 15–17 (clarity of presentation) had a strong influence on the recommendation for use. Great variations were shown for the other items. The main limitation of the survey is the low response rate. Conclusions In guideline appraisals using AGREE II, items representing rigour of guideline development and editorial independence seem to have the strongest influence on the two overall assessments. In order to ensure a transparent approach to reaching the overall assessments, we suggest the inclusion of a recommendation in the AGREE II user manual on how to consider item and domain scores. For instance, the manual could include an a-priori weighting of those items and domains that should have the strongest influence on the two overall assessments. The relevance of these assessments within AGREE II could thereby be further specified. Electronic supplementary material The online version of this article (10.1186/s12913-018-2954-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wiebke Hoffmann-Eßer
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670, Cologne, Germany. .,Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Campus Cologne, Cologne, Germany.
| | - Ulrich Siering
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670, Cologne, Germany
| | - Edmund A M Neugebauer
- Senior Professor for Health Services Research, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Anne Catharina Brockhaus
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670, Cologne, Germany
| | - Natalie McGauran
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670, Cologne, Germany
| | - Michaela Eikermann
- Medical Advisory Service of the German Social Health Insurance (MDS), Theodor-Althoff-Straße 47, 45133, Essen, Germany
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Shaefi S, Eikermann M. Analysing tidal volumes early after a positive end-expiratory pressure increase: a new way to determine optimal PEEP in the operating theatre? Br J Anaesth 2018; 120:623-626. [PMID: 29576103 DOI: 10.1016/j.bja.2018.01.017] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/01/2018] [Accepted: 01/22/2018] [Indexed: 11/16/2022] Open
Affiliation(s)
- S Shaefi
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - M Eikermann
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Affiliation(s)
| | - M. Eikermann
- Beth Israel Deaconess Medical Center; Boston MA USA
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Thevathasan T, Ruscic KJ, Eikermann M. Evolution of observational research and implementation science in neuromuscular pharmacology to improve the value of care. Br J Anaesth 2018; 120:605-606. [PMID: 29452822 DOI: 10.1016/j.bja.2017.12.022] [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] [Indexed: 11/27/2022] Open
Affiliation(s)
- T Thevathasan
- Department of Anaesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA
| | - K J Ruscic
- Department of Anaesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA
| | - M Eikermann
- Department of Anaesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA.
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Affiliation(s)
- A Bagchi
- Massachusetts General Hospital, Boston, MA, USA
| | - M I Rudolph
- Massachusetts General Hospital, Boston, MA, USA
| | - M Eikermann
- Beth Israel Deaconess Medical Center, Boston, MA, USA
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Becker M, Jaschinski T, Eikermann M, Mathes T, Bühn S, Koppert W, Leffler A, Neugebauer E, Pieper D. A systematic decision-making process on the need for updating clinical practice guidelines proved to be feasible in a pilot study. J Clin Epidemiol 2017; 96:101-109. [PMID: 29289763 DOI: 10.1016/j.jclinepi.2017.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 11/27/2017] [Accepted: 12/11/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The objective of this study was to test and evaluate a new decision-making process on the need for updating within the update of a German clinical practice guideline (CPG). STUDY DESIGN AND SETTING The pilot study comprised (1) limited searches in Pubmed to identify new potentially relevant evidence, (2) an online survey among the members of the CPG group to assess the need for update, and (3) a consensus conference for determination and prioritization of guideline sections with a high need for update. Subsequently, we conducted a second online survey to evaluate the procedure. RESULTS The searches resulted in 902 abstracts that were graded as new potentially relevant evidence. Twenty five of 39 members of the CPG group (64%) participated in the online survey. Seventy six percent of those took part in the second online survey. The evaluation study found on average a grade of support of the procedure regarding the determination of the need for update of 3.65 (standard deviation: 0.76) on a likert scale with 1 = "no support" to 5 = "very strong support." CONCLUSION The conducted procedure presents a systematic approach for assessing whether and to what extent a CPG requires updating and enables setting priorities for which particular guideline section to update within a CPG.
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Affiliation(s)
- Monika Becker
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany.
| | - Thomas Jaschinski
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany
| | - Michaela Eikermann
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany; Department of Evidence Based Medicine, Medical Advisory Service of Social Health Insurance (MDS), Theodor-Althoff-Straße 47, 45133 Essen, Germany
| | - Tim Mathes
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany
| | - Stefanie Bühn
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany
| | - Wolfgang Koppert
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Andreas Leffler
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Edmund Neugebauer
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany; Brandenburg Medical School-Theodor Fontane, Fehrbelliner Str.38, 16816 Neuruppin, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany
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Rath A, Salamon V, Peixoto S, Hivert V, Laville M, Segrestin B, Neugebauer EAM, Eikermann M, Bertele V, Garattini S, Wetterslev J, Banzi R, Jakobsen JC, Djurisic S, Kubiak C, Demotes-Mainard J, Gluud C. A systematic literature review of evidence-based clinical practice for rare diseases: what are the perceived and real barriers for improving the evidence and how can they be overcome? Trials 2017; 18:556. [PMID: 29166947 PMCID: PMC5700662 DOI: 10.1186/s13063-017-2287-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 10/05/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Evidence-based clinical practice is challenging in all fields, but poses special barriers in the field of rare diseases. The present paper summarises the main barriers faced by clinical research in rare diseases, and highlights opportunities for improvement. METHODS Systematic literature searches without meta-analyses and internal European Clinical Research Infrastructure Network (ECRIN) communications during face-to-face meetings and telephone conferences from 2013 to 2017 within the context of the ECRIN Integrating Activity (ECRIN-IA) project. RESULTS Barriers specific to rare diseases comprise the difficulty to recruit participants because of rarity, scattering of patients, limited knowledge on natural history of diseases, difficulties to achieve accurate diagnosis and identify patients in health information systems, and difficulties choosing clinically relevant outcomes. CONCLUSIONS Evidence-based clinical practice for rare diseases should start by collecting clinical data in databases and registries; defining measurable patient-centred outcomes; and selecting appropriate study designs adapted to small study populations. Rare diseases constitute one of the most paradigmatic fields in which multi-stakeholder engagement, especially from patients, is needed for success. Clinical research infrastructures and expertise networks offer opportunities for establishing evidence-based clinical practice within rare diseases.
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Affiliation(s)
- Ana Rath
- Orphanet, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Valérie Salamon
- Orphanet, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Sandra Peixoto
- Orphanet, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Virginie Hivert
- EURORDIS – European Organisation for Rare Diseases, Paris, France
| | - Martine Laville
- Centre de Recherche en Nutrition Humaine Rhone-Alpes, Université de Lyon 1, Hospices Civils de Lyon, Groupement Hospitaler Sud, Pierre Benite, France
| | - Berenice Segrestin
- Centre de Recherche en Nutrition Humaine Rhone-Alpes, Université de Lyon 1, Hospices Civils de Lyon, Groupement Hospitaler Sud, Pierre Benite, France
| | | | - Michaela Eikermann
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten and Brandenburg Medical School, Neuruppin, Germany
| | - Vittorio Bertele
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Silvio Garattini
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Jørn Wetterslev
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rita Banzi
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Janus C. Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Holbæk Hospital, Holbæek, Denmark
| | - Snezana Djurisic
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christine Kubiak
- European Clinical Research Infrastructure Network (ECRIN), Paris, France
| | | | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Thevathasan T, Shih S, Safavi K, Berger D, Burns S, Grabitz S, Glidden R, Zafonte R, Eikermann M, Schneider J. Association between intraoperative non-depolarising neuromuscular blocking agent dose and 30-day readmission after abdominal surgery. Br J Anaesth 2017; 119:595-605. [DOI: 10.1093/bja/aex240] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2017] [Indexed: 01/16/2023] Open
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Neugebauer EAM, Rath A, Antoine SL, Eikermann M, Seidel D, Koenen C, Jacobs E, Pieper D, Laville M, Pitel S, Martinho C, Djurisic S, Demotes-Mainard J, Kubiak C, Bertele V, Jakobsen JC, Garattini S, Gluud C. Specific barriers to the conduct of randomised clinical trials on medical devices. Trials 2017; 18:427. [PMID: 28903769 PMCID: PMC5597993 DOI: 10.1186/s13063-017-2168-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [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: 03/24/2017] [Accepted: 08/30/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Medical devices play an important role in the diagnosis, prevention, treatment and care of diseases. However, compared to pharmaceuticals, there is no rigorous formal regulation for demonstration of benefits and exclusion of harms to patients. The medical device industry argues that the classical evidence hierarchy cannot be applied for medical devices, as randomised clinical trials are impossible to perform. This article aims to identify the barriers for randomised clinical trials on medical devices. METHODS Systematic literature searches without meta-analysis and internal European Clinical Research Infrastructure Network (ECRIN) communications taking place during face-to-face meetings and telephone conferences from 2013 to 2017 within the context of the ECRIN Integrating Activity (ECRIN-IA) project. RESULTS In addition to the barriers that exist for all trials, we identified three major barriers for randomised clinical trials on medical devices, namely: (1) randomisation, including timing of assessment, acceptability, blinding, choice of the comparator group and considerations on the learning curve; (2) difficulties in determining appropriate outcomes; and (3) the lack of scientific advice, regulations and transparency. CONCLUSIONS The present review offers potential solutions to break down the barriers identified, and argues for applying the randomised clinical trial design when assessing the benefits and harms of medical devices.
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Affiliation(s)
- Edmund A M Neugebauer
- Brandenburg Medical School Theodor Fontane & Health Services Research Witten/Herdecke University, Campus Neuruppin, Neuruppin, Germany
| | - Ana Rath
- Orphanet, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Sunya-Lee Antoine
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Michaela Eikermann
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Doerthe Seidel
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Carsten Koenen
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Esther Jacobs
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Martine Laville
- Centre de Recherche en Nutrition Humaine Rhone-Alpes, Université de Lyon 1, Hospices Civils de Lyon, Groupement Hospitaler Sud, Pierre Benite, France
| | | | | | - Snezana Djurisic
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | | | - Christine Kubiak
- European Clinical Research Infrastructure Network (ECRIN), Paris, France
| | - Vittorio Bertele
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Cardiology, Holbæk Hospital, Holbæk, Denmark
| | - Silvio Garattini
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Bagchi A, Rudolph MI, Ng PY, Timm FP, Long DR, Shaefi S, Ladha K, Vidal Melo MF, Eikermann M. The association of postoperative pulmonary complications in 109,360 patients with pressure-controlled or volume-controlled ventilation. Anaesthesia 2017; 72:1334-1343. [PMID: 28891046 DOI: 10.1111/anae.14039] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2017] [Indexed: 12/20/2022]
Abstract
We thought that the rate of postoperative pulmonary complications might be higher after pressure-controlled ventilation than after volume-controlled ventilation. We analysed peri-operative data recorded for 109,360 adults, whose lungs were mechanically ventilated during surgery at three hospitals in Massachusetts, USA. We used multivariable regression and propensity score matching. Postoperative pulmonary complications were more common after pressure-controlled ventilation, odds ratio (95%CI) 1.29 (1.21-1.37), p < 0.001. Tidal volumes and driving pressures were more varied with pressure-controlled ventilation compared with volume-controlled ventilation: mean (SD) variance from the median 1.61 (1.36) ml.kg-1 vs. 1.23 (1.11) ml.kg-1 , p < 0.001; and 3.91 (3.47) cmH2 O vs. 3.40 (2.69) cmH2 O, p < 0.001. The odds ratio (95%CI) of pulmonary complications after pressure-controlled ventilation compared with volume-controlled ventilation at positive end-expiratory pressures < 5 cmH2 O was 1.40 (1.26-1.55) and 1.20 (1.11-1.31) when ≥ 5 cmH2 O, both p < 0.001, a relative risk ratio of 1.17 (1.03-1.33), p = 0.023. The odds ratio (95%CI) of pulmonary complications after pressure-controlled ventilation compared with volume-controlled ventilation at driving pressures of < 19 cmH2 O was 1.37 (1.27-1.48), p < 0.001, and 1.16 (1.04-1.30) when ≥ 19 cmH2 O, p = 0.011, a relative risk ratio of 1.18 (1.07-1.30), p = 0.016. Our data support volume-controlled ventilation during surgery, particularly for patients more likely to suffer postoperative pulmonary complications.
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Affiliation(s)
- A Bagchi
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - M I Rudolph
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - P Y Ng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - F P Timm
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - D R Long
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - S Shaefi
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - K Ladha
- Department of Anesthesia and Pain Medicine, University of Toronto and Toronto General Hospital, Toronto, ON, Canada
| | - M F Vidal Melo
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - M Eikermann
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Essen, Germany
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Kim SC, Choudhry N, Franklin JM, Bykov K, Eikermann M, Lii J, Fischer MA, Bateman BT. Patterns and predictors of persistent opioid use following hip or knee arthroplasty. Osteoarthritis Cartilage 2017; 25:1399-1406. [PMID: 28433815 PMCID: PMC5565694 DOI: 10.1016/j.joca.2017.04.002] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 04/06/2017] [Accepted: 04/11/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The relationship between arthroplasty and long-term opioid use in patients with knee or hip osteoarthritis is not well studied. We examined the prevalence, patterns and predictors of persistent opioid use after hip or knee arthroplasty. METHOD Using claims data (2004-2013) from a US commercial health plan, we identified adults who underwent hip or knee arthroplasty and filled ≥1 opioid prescription within 30 days after the surgery. We defined persistent opioid users as patients who filled ≥1 opioid prescription every month during the 1-year postoperative period based on group-based trajectory models. Multivariable logistic regression was used to determine preoperative predictors of persistent opioid use after surgery. RESULTS We identified 57,545 patients who underwent hip or knee arthroplasty. The mean ± SD age was 61.5 ± 7.8 years and 87.1% had any opioid use preoperatively. Overall, 7.6% persistently used opioids after the surgery. Among patients who used opioids in 80% of the time for ≥4 months preoperatively (n = 3023), 72.1% became persistent users. In multivariable analysis, knee arthroplasty vs hip, a longer hospitalization stay, discharge to a rehabilitation facility, preoperative opioid use (e.g., a longer duration and greater dosage and frequency), a higher comorbidity score, back pain, rheumatoid arthritis, fibromyalgia, migraine and smoking, and benzodiazepine use at baseline were strong predictors for persistent opioid use (C-statistic = 0.917). CONCLUSION Over 7% of patients persistently used opioids in the year after hip or knee arthroplasty. Given the adverse health effects of persistent opioid use, strategies need to be developed to prevent persistent opioid use after this common surgery.
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Affiliation(s)
- S C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - N Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J M Franklin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - K Bykov
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - M Eikermann
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J Lii
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - M A Fischer
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - B T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Prengel P, Kotte N, Antoine SL, Eikermann M, Neugebauer EAM, Stahl K, Pieper D. [Patients are Satisfied with the Physician-Patient Communication: A Pilot Study Applying the "Individual Clinician Feedback" Questionnaire]. Gesundheitswesen 2017; 80:882-887. [PMID: 28586941 DOI: 10.1055/s-0043-104690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM OF THE STUDY Patient-centeredness as an essential aspect of quality of patient care is becoming increasingly important. The aim of the pilot study is to gain insight into the physician-patient communication from the patient's perspective. A German questionnaire in a maximum care hospital was tested. METHODS The German "Individual Clinician Feedback" questionnaire (ICF) was tested in a pilot study in the special consultation in a voluntary cohort of surgeons. In the survey period from June to August 2015, the questionnaire was given to the patient. The physicians received their assessment results as a compressed score. They were rated on a scale of 1-10 on which 10 is "very good". RESULTS 12 physicians were recruited from five departments. There was a high response rate of 46% (n=219). The patients evaluated the communication as very good (on average over all items and physicians 8.5 to 9.5 points). 89% of the patients had the feeling that the doctor took adequate time for them, while 50% of the patients had a consultation time of 11-20 min. 12% of the patients had still open questions after treatment that they did not ask. 19% and 21% of patients reported that the physician has not asked them if they had any questions, or that they just forgot about it at the end of treatment. CONCLUSION The results of the pilot study are associated with a good response rate and patients were mostly very satisfied with the physician-patient communication. However, a selection bias among participating physicians is likely.
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Affiliation(s)
- Peggy Prengel
- Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Köln
| | - Nina Kotte
- Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Köln
| | - Sunya-Lee Antoine
- Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Köln
| | - Michaela Eikermann
- Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Köln
| | - Edmund A M Neugebauer
- Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Köln
| | - Katja Stahl
- Produktentwicklung & Forschung, Picker Institut Deutschland GmbH, Hamburg
| | - Dawid Pieper
- Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Köln
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Marx G, Schindler AW, Mosch C, Albers J, Bauer M, Gnass I, Hobohm C, Janssens U, Kluge S, Kranke P, Maurer T, Merz W, Neugebauer E, Quintel M, Senninger N, Trampisch HJ, Waydhas C, Wildenauer R, Zacharowski K, Eikermann M. Intravascular volume therapy in adults: Guidelines from the Association of the Scientific Medical Societies in Germany. Eur J Anaesthesiol 2016; 33:488-521. [PMID: 27043493 PMCID: PMC4890839 DOI: 10.1097/eja.0000000000000447] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Gernot Marx
- From the Department of Cardiothoracic and Vascular Surgery, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz (JA); Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena (MB); Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne (ME); Institute of Nursing Science and Practice, Paracelsus Private Medical University, Salzburg, Austria (IG); Department of Internal Medicine, Neurology and Dermatology, Leipzig University Hospital, Leibzig (CH); Department of Cardiology, St Antonius Hospital, Eschweiler (UJ); Centre for Intensive Care Medicine, Universitätsklinikum, Hamburg-Eppendorf (SK); Department of Anaesthesia and Critical Care, University Hospital of Würzburg, Würzburg (PK); Department of Intensive and Intermediate Care Medicine, University Hospital of RWTH Aachen, Aachen (GM); Urological Unit and Outpatient Clinic, University Hospital rechts der Isar, Munich (TM); Department of Obstetrics and Gynaecology, Bonn University Hospital, Bonn (WM); Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne (CM, EN); Department of Anaesthesiology, University Medical Centre Göttingen, Göttingen (MQ); Department of Intensive and Intermediate Care Medicine, University Hospital of RWTH Aachen, Aachen (AWS); Department of General and Visceral Surgery, Münster University Hospital, Münster (NS); Department of Health Informatics, Biometry and Epidemiology, Ruhr-Universität Bochum, Bochum (HJT); Department of Trauma Surgery, Essen University Hospital, Essen (CW); Department of General Surgery, University Hospital of Würzburg, Würzburg (RW); and Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany (KZ)
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Garattini S, Jakobsen JC, Wetterslev J, Bertelé V, Banzi R, Rath A, Neugebauer EAM, Laville M, Masson Y, Hivert V, Eikermann M, Aydin B, Ngwabyt S, Martinho C, Gerardi C, Szmigielski CA, Demotes-Mainard J, Gluud C. Evidence-based clinical practice: Overview of threats to the validity of evidence and how to minimise them. Eur J Intern Med 2016; 32:13-21. [PMID: 27160381 DOI: 10.1016/j.ejim.2016.03.020] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [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: 03/15/2016] [Accepted: 03/22/2016] [Indexed: 12/14/2022]
Abstract
Using the best quality of clinical research evidence is essential for choosing the right treatment for patients. How to identify the best research evidence is, however, difficult. In this narrative review we summarise these threats and describe how to minimise them. Pertinent literature was considered through literature searches combined with personal files. Treatments should generally not be chosen based only on evidence from observational studies or single randomised clinical trials. Systematic reviews with meta-analysis of all identifiable randomised clinical trials with Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment represent the highest level of evidence. Even though systematic reviews are trust worthier than other types of evidence, all levels of the evidence hierarchy are under threats from systematic errors (bias); design errors (abuse of surrogate outcomes, composite outcomes, etc.); and random errors (play of chance). Clinical research infrastructures may help in providing larger and better conducted trials. Trial Sequential Analysis may help in deciding when there is sufficient evidence in meta-analyses. If threats to the validity of clinical research are carefully considered and minimised, research results will be more valid and this will benefit patients and heath care systems.
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Affiliation(s)
- Silvio Garattini
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
| | - Janus C Jakobsen
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Holbæk Hospital, Holbæk, Denmark.
| | - Jørn Wetterslev
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Vittorio Bertelé
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
| | - Rita Banzi
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
| | - Ana Rath
- Orphanet, Institut National de la Santé et de la Recherche Médicale US14, Paris, France.
| | - Edmund A M Neugebauer
- Faculty of Health, School of Medicine, Witten/Herdecke University, Campus Cologne, Germany.
| | - Martine Laville
- Centre de Recherche en Nutrition Humaine, Rhône-Alpes, Univ de Lyon, Lyon, France.
| | - Yvonne Masson
- Centre de Recherche en Nutrition Humaine, Rhône-Alpes, Univ de Lyon, Lyon, France.
| | - Virginie Hivert
- Centre de Recherche en Nutrition Humaine, Rhône-Alpes, Univ de Lyon, Lyon, France.
| | - Michaela Eikermann
- Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Cologne, Germany.
| | - Burc Aydin
- Department of Medical Pharmacology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Sandra Ngwabyt
- Orphanet, Institut National de la Santé et de la Recherche Médicale US14, Paris, France.
| | - Cecilia Martinho
- Palliative Care Service, Portuguese Institute of Oncology, Porto, Portugal.
| | - Chiara Gerardi
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
| | - Cezary A Szmigielski
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland.
| | | | - Christian Gluud
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Eikermann M, Houle TT. Antagonism of neuromuscular block: all things are poison; only the dose makes a thing not a poison. Br J Anaesth 2016; 116:157-9. [PMID: 26787785 DOI: 10.1093/bja/aev448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Eikermann
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA Universitaet Duisburg-Essen, Klinik für Anesthesiologie und Intensivmedizin, Essen, Germany
| | - T T Houle
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
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Brueckmann B, Sasaki N, Grobara P, Li MK, Woo T, de Bie J, Maktabi M, Lee J, Kwo J, Pino R, Sabouri AS, McGovern F, Staehr-Rye AK, Eikermann M. Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study. Br J Anaesth 2015; 115:743-51. [PMID: 25935840 DOI: 10.1093/bja/aev104] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [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] [Accepted: 02/11/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study aimed to investigate whether reversal of rocuronium-induced neuromuscular blockade with sugammadex reduced the incidence of residual blockade and facilitated operating room discharge readiness. METHODS Adult patients undergoing abdominal surgery received rocuronium, followed by randomized allocation to sugammadex (2 or 4 mg kg(-1)) or usual care (neostigmine/glycopyrrolate, dosing per usual care practice) for reversal of neuromuscular blockade. Timing of reversal agent administration was based on the providers' clinical judgement. Primary endpoint was the presence of residual neuromuscular blockade at PACU admission, defined as a train-of-four (TOF) ratio <0.9, using TOF-Watch® SX. Key secondary endpoint was time between reversal agent administration and operating room discharge-readiness; analysed with analysis of covariance. RESULTS Of 154 patients randomized, 150 had a TOF value measured at PACU entry. Zero out of 74 sugammadex patients and 33 out of 76 (43.4%) usual care patients had TOF-Watch SX-assessed residual neuromuscular blockade at PACU admission (odds ratio 0.0, 95% CI [0-0.06], P<0.0001). Of these 33 usual care patients, 2 also had clinical evidence of partial paralysis. Time between reversal agent administration and operating room discharge-readiness was shorter for sugammadex vs usual care (14.7 vs. 18.6 min respectively; P=0.02). CONCLUSIONS After abdominal surgery, sugammadex reversal eliminated residual neuromuscular blockade in the PACU, and shortened the time from start of study medication administration to the time the patient was ready for discharge from the operating room. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov:NCT01479764.
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Affiliation(s)
- B Brueckmann
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA
| | - N Sasaki
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA
| | - P Grobara
- Biostatistics and Research Decision Sciences, MSD, Oss, The Netherlands
| | - M K Li
- Clinical Research, Merck Sharp & Dohme Corp, Whitehouse Station, NJ, USA
| | - T Woo
- Clinical Research, Merck Sharp & Dohme Corp, Whitehouse Station, NJ, USA
| | - J de Bie
- Clinical Research, Merck Sharp & Dohme Corp, Whitehouse Station, NJ, USA
| | - M Maktabi
- Trauma, Emergency Surgery, Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J Lee
- Trauma, Emergency Surgery, Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J Kwo
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA Harvard Medical School, Boston, MA, USA
| | - R Pino
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA Harvard Medical School, Boston, MA, USA
| | - A S Sabouri
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA
| | - F McGovern
- Harvard Medical School, Boston, MA, USA Department of Urology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - A K Staehr-Rye
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA Department of Anesthesiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - M Eikermann
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA Harvard Medical School, Boston, MA, USA Essen-Duisburg University, Essen, Germany
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Merkel S, Eikermann M, Neugebauer EA, von Bandemer S. The transcatheter aortic valve implementation (TAVI)--a qualitative approach to the implementation and diffusion of a minimally invasive surgical procedure. Implement Sci 2015; 10:140. [PMID: 26444275 PMCID: PMC4596312 DOI: 10.1186/s13012-015-0330-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 09/28/2015] [Indexed: 11/10/2022] Open
Abstract
Background The transcatheter aortic valve implantation (TAVI), a minimally invasive surgical procedure to treat patients with severe symptomatic aortic stenosis, showed a rapid diffusion in Germany compared to the international level. The aim of this study is to identify and analyze factors affecting the implementation and diffusion of the procedure in hospitals using a qualitative application of the diffusion of innovations theory. Methods We conducted problem-centered interviews with cardiologists and cardiac surgeons working in German hospitals. The multi-level model “diffusion of innovations in health services organizations” developed by Greenhalgh et al. was used to guide the research. Data was analyzed using content and a thematic analysis. Results Among the ten participants who were interviewed, we found both barriers and facilitators related to the innovation itself, system readiness and antecedents, communication and influence, and the outer context. Key issues were the collaboration between cardiologists and cardiac surgeons, reimbursement policies, requirements needed to conduct the procedure, and medical advantages of the method. Conclusions The findings show that there are multiple factors influencing the diffusion of TAVI that go beyond the reimbursement and cost issues. The diffusion of innovations model proved to be helpful in understanding the different aspects of the uptake of the procedure. A central theme that affected the implementation of TAVI was the collaboration and competition between involved medical departments: cardiology and cardiac surgery. Against this background, it seems especially important to moderate and coordinate the cooperation of the different medical disciplines.
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Affiliation(s)
- Sebastian Merkel
- Institute for Work and Technology (IAT), Munscheidstr. 14, 45886, Gelsenkirchen, Germany.
| | - Michaela Eikermann
- Institute for Research in Operative Medicine (IFOM), Ostmerheimer Str. 200 Haus 38, 51109, Köln, Germany
| | - Edmund A Neugebauer
- Institute for Research in Operative Medicine (IFOM), Ostmerheimer Str. 200 Haus 38, 51109, Köln, Germany
| | - Stephan von Bandemer
- Institute for Work and Technology (IAT), Munscheidstr. 14, 45886, Gelsenkirchen, Germany
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Pieper D, Jülich F, Antoine SL, Bächle C, Chernyak N, Genz J, Eikermann M, Icks A. Studies analysing the need for health-related information in Germany - a systematic review. BMC Health Serv Res 2015; 15:407. [PMID: 26399759 PMCID: PMC4579794 DOI: 10.1186/s12913-015-1076-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 09/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exploring health-related information needs is necessary to better tailor information. However, there is a lack of systematic knowledge on how and in which groups information needs has been assessed, and which information needs have been identified. We aimed to assess the methodology of studies used to assess information needs, as well as the topics and extent of health-related information needs and associated factors in Germany. METHODS A systematic search was performed in Medline, Embase, Psycinfo, and all databases of the Cochrane Library. All studies investigating health-related information needs in patients, relatives, and the general population in Germany that were published between 2000 and 2012 in German or English were included. Descriptive content analysis was based on predefined categories. RESULTS We identified 19 studies. Most studies addressed cancer or rheumatic disease. Methods used were highly heterogeneous. Apart from common topics such as treatment, diagnosis, prevention and health promotion, etiology and prognosis, high interest ratings were also found in more specific topics such as complementary and alternative medicine or nutrition. Information needs were notable in all surveyed patient groups, relatives, and samples of the general population. Younger age, shorter duration of illness, poorer health status and higher anxiety and depression scores appeared to be associated with higher information needs. CONCLUSION Knowledge about information needs is still scarce. Assuming the importance of comprehensive information to enable people to participate in health-related decisions, further systematic research is required.
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Affiliation(s)
- Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, D- 51109, Cologne, Germany.
| | - Fabian Jülich
- Institute for Biometrics and Epidemiology, German Diabetes Center at the Heinrich-Heine University, Leibniz-Center for Diabetes Research, Düsseldorf, Germany.
- Public Health Unit, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraße 5, D-40225, Düsseldorf, Germany.
| | - Sunya-Lee Antoine
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, D- 51109, Cologne, Germany.
| | - Christina Bächle
- Institute for Biometrics and Epidemiology, German Diabetes Center at the Heinrich-Heine University, Leibniz-Center for Diabetes Research, Düsseldorf, Germany.
- , Auf'm Hennekamp 65, D-40225, Düsseldorf, Germany.
| | - Nadja Chernyak
- Institute for Biometrics and Epidemiology, German Diabetes Center at the Heinrich-Heine University, Leibniz-Center for Diabetes Research, Düsseldorf, Germany.
- Public Health Unit, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraße 5, D-40225, Düsseldorf, Germany.
| | - Jutta Genz
- Institute for Biometrics and Epidemiology, German Diabetes Center at the Heinrich-Heine University, Leibniz-Center for Diabetes Research, Düsseldorf, Germany.
- , Auf'm Hennekamp 65, D-40225, Düsseldorf, Germany.
| | - Michaela Eikermann
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, D- 51109, Cologne, Germany.
| | - Andrea Icks
- Institute for Biometrics and Epidemiology, German Diabetes Center at the Heinrich-Heine University, Leibniz-Center for Diabetes Research, Düsseldorf, Germany.
- Public Health Unit, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraße 5, D-40225, Düsseldorf, Germany.
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Baumüller E, Schaller S, Chiquito Lama Y, Frick C, Bauhofer T, Eikermann M, Fink H, Blobner M. Postoperative impairment of motor function at train-of-four ratio ≥0.9 cannot be improved by sugammadex (1 mg kg −1 ). Br J Anaesth 2015; 114:785-93. [DOI: 10.1093/bja/aeu453] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2014] [Indexed: 12/17/2022] Open
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Jaschinski T, Mosch C, Eikermann M, Neugebauer EAM. Laparoscopic versus open appendectomy in patients with suspected appendicitis: a systematic review of meta-analyses of randomised controlled trials. BMC Gastroenterol 2015; 15:48. [PMID: 25884671 PMCID: PMC4399217 DOI: 10.1186/s12876-015-0277-3] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/30/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Several systematic reviews (SRs) of randomised controlled trials (RCTs) comparing laparoscopic versus open appendectomy have been published, but there has been no overview of SRs of these two interventions. This overview (review of review) aims to summarise the results of such SRs in order to provide the most up to date evidence, and to highlight discordant results. METHODS Medline, Embase, Cinahl, the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects were searched for SRs published up to August 2014. Study selection and quality assessment using the AMSTAR tool were carried out independently by two reviewers. We used standardised forms to extract data that were analysed descriptively. RESULTS Nine SRs met the inclusion criteria. All were of moderate to high quality. The number of randomized controlled trials (RCTs) they included ranged from eight to 67. The duration of surgery pooled by eight reviews was 7.6 to 18.3 minutes shorter using the open approach. Pain scores on the first postoperative day were lower after laparoscopic appendectomy in two out of three reviews. The risk of abdominal abscesses was higher for laparoscopic surgery in half of six meta-analyses. The occurrence of wound infections pooled by all reviews was lower after laparoscopic appendectomy. One review showed no difference in mortality. The laparoscopic approach shortened hospital stay from 0.16 to 1.13 days in seven out of eight meta-analyses, though the strength of the evidence was affected by strong heterogeneity. CONCLUSION Laparoscopic and open appendectomy are both safe and effective procedures for the treatment of acute appendicitis. This overview shows discordant results with respect to the magnitude of the effect but not to the direction of the effect. The evidence from this overview may prove useful for the development of clinical guidelines and protocols.
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Affiliation(s)
- Thomas Jaschinski
- Department for Evidence-based health services research, Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200 (building 38), 51109, Cologne, Germany.
| | - Christoph Mosch
- Department for Evidence-based health services research, Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200 (building 38), 51109, Cologne, Germany.
| | - Michaela Eikermann
- Department for Evidence-based health services research, Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200 (building 38), 51109, Cologne, Germany.
| | - Edmund A M Neugebauer
- Department for Evidence-based health services research, Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200 (building 38), 51109, Cologne, Germany.
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Mosch C, Eikermann M. [Role of evidence-based medicine in intensive care]. Med Klin Intensivmed Notfmed 2015; 110:159-65; quiz 166-7. [PMID: 25809311 DOI: 10.1007/s00063-015-0008-0] [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: 12/11/2014] [Revised: 01/23/2015] [Accepted: 01/27/2015] [Indexed: 11/30/2022]
Abstract
Evidence-based medicine (EBM) plays an important role in intensive care. Along with the individual expertise of the attending physician and the preferences of the respective patient, recent study evidence is an important decision criterion when choosing the appropriate diagnostic and therapeutic procedures. Both a target-orientated literature search and adequate evaluation of the risk of bias as well as interpretation of the depicted outcomes are necessary to be able to draw the right conclusions from study results. Furthermore, proper publication formats might facilitate the synopsis of the available evidence and support the implementation of this knowledge in routine clinical work.
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Affiliation(s)
- C Mosch
- Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Ostmerheimer Str. 200 (Haus 38), 51109, Köln, Deutschland,
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Walgenbach M, Mathes T, Siegel R, Eikermann M. Mesh fixation techniques in primary ventral or incisional hernia repair. Cochrane Database of Systematic Reviews 2015. [DOI: 10.1002/14651858.cd011563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Maren Walgenbach
- University Witten/Herdecke; Institute for Research in Operative Medicine (IFOM) - Department for Evidence-based Health Services Research; Ostmerheimer Str. 200 (Building 38) Cologne Germany 51109
| | - Tim Mathes
- University Witten/Herdecke; Institute for Research in Operative Medicine (IFOM) - Department for Evidence-based Health Services Research; Ostmerheimer Str. 200 (Building 38) Cologne Germany 51109
| | - Robert Siegel
- HELIOS Klinikum Berlin-Buch and Faculty of Health - Witten/Herdecke University; Department of General, Visceral and Cancer Surgery; Schwanebecker Chaussee 50 Berlin Germany 13125
| | - Michaela Eikermann
- University Witten/Herdecke; Institute for Research in Operative Medicine (IFOM) - Department for Evidence-based Health Services Research; Ostmerheimer Str. 200 (Building 38) Cologne Germany 51109
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Pieper D, Buechter RB, Li L, Prediger B, Eikermann M. Systematic review found AMSTAR, but not R(evised)-AMSTAR, to have good measurement properties. J Clin Epidemiol 2014; 68:574-83. [PMID: 25638457 DOI: 10.1016/j.jclinepi.2014.12.009] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 11/25/2014] [Accepted: 12/23/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To summarize all available evidence on measurement properties in terms of reliability, validity, and feasibility of the Assessment of Multiple Systematic Reviews (AMSTAR) tool, including R(evised)-AMSTAR. STUDY DESIGN AND SETTING MEDLINE, EMBASE, Psycinfo, and CINAHL were searched for studies containing information on measurement properties of the tools in October 2013. We extracted data on study characteristics and measurement properties. These data were analyzed following measurement criteria. RESULTS We included 13 studies, four of them were labeled as validation studies. Nine articles dealt with AMSTAR, two articles dealt with R-AMSTAR, and one article dealt with both instruments. In terms of interrater reliability, most items showed a substantial agreement (>0.6). The median intraclass correlation coefficient (ICC) for the overall score of AMSTAR was 0.83 (range 0.60-0.98), indicating a high agreement. In terms of validity, ICCs were very high with all but one ICC lower than 0.8 when the AMSTAR score was compared with scores from other tools. Scoring AMSTAR takes between 10 and 20 minutes. CONCLUSION AMSTAR seems to be reliable and valid. Further investigations for systematic reviews of other study designs than randomized controlled trials are needed. R-AMSTAR should be further investigated as evidence for its use is limited and its measurement properties have not been studied sufficiently. In general, test-retest reliability should be investigated in future studies.
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Affiliation(s)
- Dawid Pieper
- Institute for Research in Operative Medicine, Department for Evidence-based health services research, Ostmerheimer Str. 200 (building 38), 51109 Cologne, Witten/Herdecke University, Germany.
| | - Roland Brian Buechter
- Institute for Quality and Efficiency in Health Care (IQWiG), Department for Health Information, Mediapark 8 (KölnTurm), 50670 Cologne, Germany
| | - Lun Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 199 Donggang West Road, Lanzhou, Gansu 730000, China
| | - Barbara Prediger
- Institute for Research in Operative Medicine, Department for Evidence-based health services research, Ostmerheimer Str. 200 (building 38), 51109 Cologne, Witten/Herdecke University, Germany
| | - Michaela Eikermann
- Institute for Research in Operative Medicine, Department for Evidence-based health services research, Ostmerheimer Str. 200 (building 38), 51109 Cologne, Witten/Herdecke University, Germany
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Eikermann M, Holzmann N, Siering U, Rüther A. Tools for assessing the content of guidelines are needed to enable their effective use--a systematic comparison. BMC Res Notes 2014; 7:853. [PMID: 25427972 PMCID: PMC4258382 DOI: 10.1186/1756-0500-7-853] [Citation(s) in RCA: 15] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 11/18/2014] [Indexed: 01/08/2023] Open
Abstract
Background To ensure that clinical practice guidelines (CPGs) form a sound basis for decision-making in health care, it is necessary to be able to reliably assess and ensure their quality. This results in the need to assess the content of guidelines systematically, particularly with regard to the validity of their recommendations. The aim of the present analysis was to determine the suitability and applicability of frequently used assessment tools for evidence syntheses with regard to the assessment of guideline content. Methods We conducted a systematic comparison and analysis of established tools for the assessment of evidence syntheses (guidelines, systematic reviews, health technology assessments). The tools analyzed were: ADAPTE, AGREE II, AMSTAR, GLIA and the INAHTA checklist. We analyzed methodological steps related to the assessment of the reliability and validity of guideline recommendations. Data were extracted and analyzed by two persons independently of one another. Results Widely used tools for the methodological assessment of evidence syntheses are not suitable for a comprehensive content-related assessment. They remain mostly at the level of assessment of the documentation of processes. Some tools assess selected content-related aspects, but operationalization is either unspecific or lacking. Conclusion None of the tools analyzed enables the structured and comprehensive assessment of the content of guideline recommendations with special regard to their reliability and validity. All tools contribute towards the judicious use of evidence syntheses by supporting their systematic development or assessment. However, further progress is needed, particularly with regard to the assessment of content quality. This includes comprehensive operationalization and documentation of the assessment process to ensure reliability and validity, and therefore to enable the effective use of trustworthy guidelines in the health care system. Electronic supplementary material The online version of this article (doi:10.1186/1756-0500-7-853) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michaela Eikermann
- Department Evidence-based Health Services Research, Faculty of Health, Department of Medicine, Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Str, 200, Building 38, 51109 Cologne, Germany.
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Jaschinski T, Pieper D, Eikermann M, Steinhausen S, Linke C, Heitmann T, Pani M, Neugebauer E. [Current status of total hip and knee replacements in Germany - results of a nation-wide survey]. Z Orthop Unfall 2014; 152:455-61. [PMID: 25313700 DOI: 10.1055/s-0034-1383023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Total hip and knee replacements are very frequently performed operative procedures in German hospitals. Despite the high number of cases, only few data on treatment procedures of the clinical routine and their impact on postoperative length of stay and clinical outcome are available. The aim of our survey was to gain detailed insights of the treatment procedures in patients scheduled for elective hip or knee replacement in order to extract recommendations for improving patient care. METHODS In a nation-wide survey, we asked leading physicians of 694 trauma surgery and orthopaedic surgery departments and their corresponding colleagues in the departments of anaesthesia for treatment procedures including the process of patient admission, surgical techniques, postoperative analgesia, discharge management and follow-up. We used a multiple linear regression for analysing variables impacting on the postoperative length of stay. RESULTS Altogether, 303 replies representing 31.8 % of the contacted hospitals could be evaluated. For hip arthroplasty, the anterolateral approach was most commonly chosen. For knee arthroplasty, the parapatellar approach was most frequently used. Tourniquet and wound drainage (mostly removed on the second postoperative day) were widely used with more than 90 %. The avoidance of wound drainage was associated with a lower postoperative length of stay for patients following total hip or knee replacement. Only 70 % of the German departments followed up their patients after discharge checking especially the range of motion of the artificial joint replacement. CONCLUSION The treatment procedures for elective hip and knee replacement are very heterogeneous in German hospitals. The quality of the clinical outcome cannot be related to a single procedure; in fact the choice and complementary interaction of interventions are essential for improving patient care. These results provide first important evidence to which extent organisational structures and treatment procedures affect patient care and length of stay. Therefore, the analyses show relevant indications for an optimised standard in patient care.
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Affiliation(s)
- T Jaschinski
- Lehrstuhl für Chirurgische Forschung, Institut für Forschung in der Operativen Medizin (IFOM), Köln
| | - D Pieper
- Lehrstuhl für Chirurgische Forschung, Institut für Forschung in der Operativen Medizin (IFOM), Köln
| | - M Eikermann
- Lehrstuhl für Chirurgische Forschung, Institut für Forschung in der Operativen Medizin (IFOM), Köln
| | - S Steinhausen
- Lehrstuhl für Chirurgische Forschung, Institut für Forschung in der Operativen Medizin (IFOM), Köln
| | - C Linke
- Biomet Deutschland GmbH, Berlin
| | | | - M Pani
- Biomet Deutschland GmbH, Berlin
| | - E Neugebauer
- Lehrstuhl für Chirurgische Forschung, Institut für Forschung in der Operativen Medizin (IFOM), Köln
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Pieper D, Antoine SL, Neugebauer EAM, Eikermann M. Up-to-dateness of reviews is often neglected in overviews: a systematic review. J Clin Epidemiol 2014; 67:1302-8. [PMID: 25281222 DOI: 10.1016/j.jclinepi.2014.08.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 06/27/2014] [Accepted: 08/25/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVE As systematic reviews may run out of date, it might be necessary to update them. Out-of-date reviews may jeopardize the comparability when used in the context of overviews (review of reviews). METHODS Seven electronic databases were searched for overviews up to November 2012. We first aimed to analyze whether the authors of overviews additionally searched for primary studies or alternatively explained why they did not. Second, we sought to analyze the actual publication lag (publication date of the overview - publication date of the review) in overviews and to develop recommendations for authors of overviews. RESULTS We included 147 overviews. The mean publication lag in overviews was more than 5 years. A median of 36% of the reviews were published more than 6 years ago. Only one in four reviews considered up-to-dateness. The methods for updating reviews were heterogeneous. We found no overview that systematically investigated whether an update was necessary. CONCLUSION The issue of up-to-dateness when conducting overviews seems to be neglected by most authors of overviews. Authors should assess the quality of evidence, based on their included reviews first.
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Affiliation(s)
- Dawid Pieper
- Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, D-51109 Cologne, Germany.
| | - Sunya-Lee Antoine
- Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, D-51109 Cologne, Germany
| | - Edmund A M Neugebauer
- Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, D-51109 Cologne, Germany
| | - Michaela Eikermann
- Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, D-51109 Cologne, Germany
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Pieper D, Mathes T, Eikermann M. Can AMSTAR also be applied to systematic reviews of non-randomized studies? BMC Res Notes 2014; 7:609. [PMID: 25193554 PMCID: PMC4167129 DOI: 10.1186/1756-0500-7-609] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 09/04/2014] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There is a lack of an instrument to evaluate systematic reviews of non-randomized studies in epidemiological research. The Assessment of Multiple Systematic Reviews (AMSTAR) is widely used to evaluate the scientific quality of systematic reviews, but it has not been validated for SRs of non-randomized studies. The objective of this paper is to report our experience in applying AMSTAR to systematic reviews of non-randomized studies in terms of applicability, reliability and feasibility. Thus, we applied AMSTAR to a recently published review of 32 systematic reviews of non-randomized studies investigating the hospital volume-outcome relationship in surgery. RESULTS The inter-rater reliability was high (0.76), albeit items 8 (scientific quality used in formulating conclusions), 9 (appropriate method to combine studies), and 11 (conflicts of interest) scored moderate (≤0.58). However, there was a high heterogeneity between the two pairs of reviewers. In terms of feasibility, AMSTAR proved easy to apply to systematic reviews of non-randomized studies, each review taking 5-10 minutes to complete. We faced problems in applying three items, mainly related to scientific quality of the included studies. CONCLUSIONS AMSTAR showed good psychometric properties, comparable to prior findings in systematic reviews of randomized controlled trials. AMSTAR can be applied to systematic reviews of non-randomized studies, although there are some item specific issues users should be aware of. Revisions and extensions of AMSTAR might be helpful.
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Affiliation(s)
- Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str, 200, Building 38, D-51109 Cologne, Germany.
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Mosch CG, Jaschinski T, Eikermann M. Impact of epithelial ovarian cancer screening on patient-relevant outcomes in average-risk postmenopausal women. Hippokratia 2014. [DOI: 10.1002/14651858.cd011210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Christoph G Mosch
- University Witten/Herdecke; Institute for Research in Operative Medicine (IFOM) - Department for Evidence-based Health Services Research; Ostmerheimer Str. 200 (Building 38) Cologne Germany 51109
| | - Thomas Jaschinski
- University Witten/Herdecke; Institute for Research in Operative Medicine (IFOM) - Department for Evidence-based Health Services Research; Ostmerheimer Str. 200 (Building 38) Cologne Germany 51109
| | - Michaela Eikermann
- Medical advisory service of social health insurance (MDS); Department of Evidence-based medicine; Theodor-Althoff-Straße 47 Essen North Rhine Westphalia Germany 51109
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Antoine SL, Pieper D, Mathes T, Eikermann M. Improving the adherence of type 2 diabetes mellitus patients with pharmacy care: a systematic review of randomized controlled trials. BMC Endocr Disord 2014; 14:53. [PMID: 25001374 PMCID: PMC4105396 DOI: 10.1186/1472-6823-14-53] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [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] [Received: 04/28/2014] [Accepted: 06/30/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Oral medication for patients with type 2 diabetes mellitus plays an important role in diabetes care and is associated with a high level self-care behavior and self-management. However, poor adherence to diabetes treatment is common which causes severe health complications and increased mortality. Barriers to adherence may consist of complex treatment regimens often along with long-term multi-therapies, side effects due to the medication as well as insufficient, incomprehensible or confusing information or instructions provided by the health care provider. Multidisciplinary approaches can support adherence success and can enable a more effective management of diabetes care. One approach in diabetes care can be the involvement of a pharmacist. The aim was to analyze the effectiveness of adherence-enhancing pharmacist interventions for oral medication in type 2 diabetes mellitus. METHODS A systematic review of randomized controlled trials. The study quality was assessed with the Cochrane risk of bias tool. RESULTS Of 491 hits, six publications were included. Two studies mainly examining educational interventions showed a significant improvement in adherence. Moreover, the quality of the included studies was deficient. CONCLUSION Although pharmacist interventions might potentially improve adherence to type 2 diabetes mellitus medication, high-quality studies are needed to assess effectiveness.
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Affiliation(s)
- Sunya-Lee Antoine
- Institute for Research in Operative Medicine, Faculty of Health - School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, D- 51109 Cologne, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Faculty of Health - School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, D- 51109 Cologne, Germany
| | - Tim Mathes
- Institute for Research in Operative Medicine, Faculty of Health - School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, D- 51109 Cologne, Germany
| | - Michaela Eikermann
- Institute for Research in Operative Medicine, Faculty of Health - School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, D- 51109 Cologne, Germany
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