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Wang X, Yang P, Yuan SS, Wang WWB. Application of estimand framework in ICH E9 (R1) to safety evaluation. J Biopharm Stat 2023:1-12. [PMID: 36951445 DOI: 10.1080/10543406.2023.2189452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Defining the right question of interest is important to a clinical study. ICH E9 (R1) introduces the framework of an estimand and its five attributes, which provide a basis for connecting different components of a study with its clinical questions. Most of the applications of the estimand framework focus on efficacy instead of safety assessment. In this paper, we expand the estimand framework into the safety evaluation and compare/contrast the similarity and differences between safety and efficacy estimand. Furthermore, we present and discuss applications of a safety estimand to oncology trials and pooled data analyses. At last, we also discuss the potential usage of safety estimand to handle the impacts of COVID-19 pandemic on safety assessment.
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Affiliation(s)
| | - Ping Yang
- BARDS, MSD China Holding Co, Ltd, Shanghai, China
| | - Shuai S Yuan
- Oncology Statistics, GSK, Collegeville, Pennsylvania, USA
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2
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Bragazzi NL, Kong JD, Mahroum N, Tsigalou C, Khamisy-Farah R, Converti M, Wu J. Epidemiological trends and clinical features of the ongoing monkeypox epidemic: A preliminary pooled data analysis and literature review. J Med Virol 2023; 95:e27931. [PMID: 35692117 DOI: 10.1002/jmv.27931] [Citation(s) in RCA: 122] [Impact Index Per Article: 122.0] [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: 06/04/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 01/11/2023]
Abstract
An emerging outbreak of monkeypox infection is quickly spreading worldwide, being currently reported in more than 30 countries, with slightly less than 1000 cases. In the present preliminary report, we collected and synthesized early data concerning epidemiological trends and clinical features of the ongoing outbreak and we compared them with those of previous outbreaks. Data were pooled from six clusters in Italy, Australia, the Czech Republic, Portugal, and the United Kingdom, totaling 124 cases (for 35 of which it was possible to retrieve detailed information). The ongoing epidemic differs from previous outbreaks in terms of age (54.29% of individuals in their thirties), sex/gender (most cases being males), risk factors, and transmission route, with sexual transmission being highly likely. Also, the clinical presentation is atypical and unusual, being characterized by anogenital lesions and rashes that relatively spare the face and extremities. The most prevalent sign/symptom reported was fever (in 54.29% of cases) followed by inguinal lymphadenopathy (45.71%) and exanthema (40.00%). Asthenia, fatigue, and headache were described in 22.86% and 25.71% of the subjects, respectively. Myalgia was present in 17.14% of the cases. Both genital and anal lesions (ulcers and vesicles) were reported in 31.43% of the cases. Finally, cervical lymphadenopathy was described in 11.43% of the sample, while the least commonly reported symptoms were diarrhea and axillary lymphadenopathy (5.71% of the case series for both symptoms). Some preliminary risk factors can be identified (being a young male, having sex with other men, engaging in risky behaviors and activities, including condomless sex, human immunodeficiency virus positivity (54.29% of the sample analyzed), and a story of previous sexually transmitted infections, including syphilis). On the other hand, being fully virally suppressed and undetectable may protect against a more severe infectious course. However, further research in the field is urgently needed.
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Affiliation(s)
- Nicola L Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
| | - Jude D Kong
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
| | - Naim Mahroum
- Department of Internal Medicine, International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Christina Tsigalou
- Laboratory of Microbiology, Department of Medicine, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Rola Khamisy-Farah
- Clalit Health Services, Akko, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | | | - Jianhong Wu
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
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3
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Mantua J, Bessey AF, Mickelson CA, Choynowski JJ, Noble JJ, Burke TM, McKeon AB, Sowden WJ. Sleep and high-risk behavior in military service members: a mega-analysis of four diverse U.S. Army units. Sleep 2021; 44:5944093. [PMID: 33125489 DOI: 10.1093/sleep/zsaa221] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/29/2020] [Indexed: 11/14/2022] Open
Abstract
Experimental sleep restriction and deprivation lead to risky decision-making. Further, in naturalistic settings, short sleep duration and poor sleep quality have been linked to real-world high-risk behaviors (HRB), such as reckless driving or substance use. Military populations, in general, tend to sleep less and have poorer sleep quality than nonmilitary populations due to a number of occupational, cultural, and psychosocial factors (e.g. continuous operations, stress, and trauma). Consequently, it is possible that insufficient sleep in this population is linked to HRB. To investigate this question, we combined data from four diverse United States Army samples and conducted a mega-analysis by aggregating raw, individual-level data (n = 2,296, age 24.7 ± 5.3). A negative binomial regression and a logistic regression were used to determine whether subjective sleep quality (Pittsburgh Sleep Quality Index [PSQI], Insomnia Severity Index [ISI], and duration [h]) predicted instances of military-specific HRB and the commission of any HRB (yes/no), respectively. Poor sleep quality slightly elevated the risk for committing HRBs (PSQI Exp(B): 1.12 and ISI Exp(B): 1.07), and longer duration reduced the risk for HRBs to a greater extent (Exp(B): 0.78), even when controlling for a number of relevant demographic factors. Longer sleep duration also predicted a decreased risk for commission of any HRB behaviors (Exp(B): 0.71). These findings demonstrate that sleep quality and duration (the latter factor, in particular) could be targets for reducing excessive HRB in military populations. These findings could therefore lead to unit-wide or military-wide policy changes regarding sleep and HRB.
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Affiliation(s)
- Janna Mantua
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | | | - Carolyn A Mickelson
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Jake J Choynowski
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | | | - Tina M Burke
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Ashlee B McKeon
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Walter J Sowden
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD.,Tripler Army Medical Center, Honolulu, HI
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Sasaki M, Miyake M, Fujiwara K, Nanba H, Akiyama M, Yanagi Y, Harada S, Tabara Y, Yasuda M, Yamashita H, Kayama T, Tsubota K, Matsuda F, Hashimoto S, Ueda E, Ninomiya T, Takebayashi T, Tsujikawa A, Sonoda KH, Kawasaki R. Cohort Profile: The Ganka-Ekigaku Network (GEN), a Network of Japanese Ophthalmological Epidemiology Studies. Ophthalmic Epidemiol 2020; 28:237-243. [PMID: 32924732 DOI: 10.1080/09286586.2020.1815803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Japan has been known as a super-aged society, and ageing is a well-known risk factor for blinding eye diseases. However, epidemiological studies in ophthalmology are still scarce in Japan, and the sizes of the cohorts are relatively small. "Ganka-Ekigaku Network" (GEN, an acronym for the epidemiological network in ophthalmology in Japanese) is established to develop a capacity to boost each epidemiological study and enrich a potential inter-study collaboration to identify risk factors of visual impairment in aged society. METHODS We reviewed cohort studies in Japan with the inclusion criteria as: (1) at least n = 1000 at baseline, (2) multiple modalities of ophthalmic data, and (3) diagnosis reviewed by ophthalmologist(s), and (4) ophthalmologists are involved in the investigators group. As of January 2020, GEN includes 4 individual Japanese epidemiological studies namely, Hisayama study, Yamagata Study (Funagata), Tsuruoka Metabolomics Cohort study, and the Nagahama Prospective Genome Cohort for Comprehensive Human Bioscience. RESULTS GEN includes approximately 25,000 Japanese participants. The baseline surveys started from 1998 to 2012, and since then the data has been prospectively collected approximately every 5 years. A variety of ophthalmic measurements and other factors have been collected in each study in GEN: ophthalmic measurements (fundus photography, optical coherence tomography, etc.), systemic conditions (laboratory data, etc.), and others (DNA, etc.). CONCLUSION GEN is an open platform for observational ophthalmic epidemiological studies to share standardized methodologies. While each study in GEN pursues specific and original research questions, standardization of the methods will enable us to conduct reliable meta-analysis/pooled data analyses.
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Affiliation(s)
- Mariko Sasaki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.,Department of Ophthalmology, Tachikawa Hospital, Tokyo, Japan.,National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan
| | - Masahiro Miyake
- Department of Ophthalmology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kohta Fujiwara
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Nanba
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masato Akiyama
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Ocular Pathology and Imaging Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuo Yanagi
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Sei Harada
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Miho Yasuda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidetoshi Yamashita
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takamasa Kayama
- Department of Advanced Medicine, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sawako Hashimoto
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Emi Ueda
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryo Kawasaki
- Department of Vision Informatics, Osaka University Graduate School of Medicine, Osaka, Japan
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He Y, Jia S, Sun G, Cao L, Wang X, Zhang H, Jia X, Ma X, Xiong J, Liu X, Guo W. Fenestrated/Branched Endovascular Repair for Postdissection Thoracoabdominal Aneurysms: A Systematic Review with Pooled Data Analysis. Vasc Endovascular Surg 2020; 54:510-518. [PMID: 32436464 DOI: 10.1177/1538574420927131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Patients who have survived an acute aortic dissection remain at risk for postdissection thoracoabdominal aortic aneurysms (PD-TAAAs). Fenestrated/branched endovascular repair for PD-TAAA is increasingly used in some high-volume centers, but outcomes are still limited because of the additional challenges compared to atherosclerotic thoracoabdominal aneurysms. This study was performed to evaluate the literature on fenestrated/branched endovascular repair for PD-TAAAs. METHODS PubMed, Embase, and the Cochrane Database were searched for relevant studies published until September 2019. Outcome data were extracted to evaluate the technical success, 30-day mortality, later survival, major complications, endoleaks, target vessel patency, and reintervention. Studies were analyzed in a pooled proportion meta-analysis. RESULTS In total, 143 patients from 4 studies were identified for the pooled data analysis. The pooled technical success rate was 98% (95% CI: 86%-100%). After the treatment, the overall estimated 30-day mortality rate was 3% (95% CI: 1%-8%), early spinal cord ischemia rate was 10% (95% CI: 4%-21%), early renal injury rate was 5% (95% CI: 1%-19%), endoleak rate was 33% (95% CI: 22%-47%), reintervention rate at a median follow-up of 22.5 months was 34% (95% CI: 27%-42%), and all-cause mortality rate was 12% (95% CI: 6%-24%). CONCLUSIONS The use of fenestrated/branched stent grafts for the treatment of PD-TAAA appears generally feasible based on the limited literature, but endoleaks and reinterventions are frequent.
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Affiliation(s)
- Yuan He
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
| | - Senhao Jia
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
| | - Guoyi Sun
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
| | - Long Cao
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China.,Department of General Surgery, Chinese PLA No. 983 Hospital, Hebei District, Tianjin, People's Republic of China
| | - Xinhao Wang
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
| | - Hongpeng Zhang
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
| | - Xin Jia
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
| | - Xiaohui Ma
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
| | - Jiang Xiong
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
| | - Xiaoping Liu
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
| | - Wei Guo
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
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6
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Teuschl Y, Ihle-Hansen H, Matz K, Dachenhausen A, Ratajczak P, Tuomilehto J, Ursin MH, Hagberg G, Thommessen B, Øksengård AR, Brainin M. Multidomain intervention for the prevention of cognitive decline after stroke - a pooled patient-level data analysis. Eur J Neurol 2018; 25:1182-1188. [PMID: 29782693 PMCID: PMC6099341 DOI: 10.1111/ene.13684] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 05/03/2018] [Indexed: 12/16/2022]
Abstract
Background and purpose The aim of this pooled patient‐level data analysis was to test if multidomain interventions, addressing several modifiable vascular risk factors simultaneously, are more effective than usual post‐stroke care for the prevention of cognitive decline after stroke. Methods This pooled patient‐level data analysis included two randomized controlled trials using a multidomain approach to target vascular risk factors in stroke patients and cognition as primary outcome. Changes from baseline to 12 months in the trail making test (TMT)‐A, TMT‐B and 10‐words test were analysed using stepwise backward linear mixed models with study as random factor. Two analyses were based on the intention‐to‐treat (ITT) principle using different imputation approaches and one was based on complete cases. Results Data from 322 patients (157 assigned to multidomain intervention and 165 to standard care) were analysed. Differences between randomization groups for TMT‐A scores were found in one ITT model (P = 0.014) and approached significance in the second ITT model (P = 0.087) and for complete cases (P = 0.091). No significant intervention effects were found for any of the other cognitive variables. Conclusion We found indications that multidomain interventions compared with standard care can improve the scores in TMT‐A at 1 year after stroke but not those for TMT‐B or the 10‐words test. These results have to be interpreted with caution due to the small number of patients.
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Affiliation(s)
- Y Teuschl
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
| | - H Ihle-Hansen
- Department of Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Drammen, Norway
| | - K Matz
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria.,Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Neurology, University Hospital Tulln, Tulln, Austria
| | - A Dachenhausen
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
| | - P Ratajczak
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
| | - J Tuomilehto
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria.,Dasman Diabetes Center, Dasman, Kuwait
| | - M H Ursin
- Department of Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Drammen, Norway
| | - G Hagberg
- Department of Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Drammen, Norway
| | - B Thommessen
- Department of Neurology, Akershus University Hospital, Oslo, Norway
| | - A R Øksengård
- Department of Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Drammen, Norway
| | - M Brainin
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
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Abstract
Previous placebo-controlled experimental studies have shown that a single dose of MDMA can increase emotional empathy in the multifaceted empathy test (MET) without affecting cognitive empathy. Although sufficiently powered to detect main effects of MDMA, these studies were generally underpowered to also validly assess contributions of additional parameters, such as sex, drug use history, trait empathy and MDMA or oxytocin plasma concentrations. The present study examined the robustness of the MDMA effect on empathy and investigated the moderating role of these additional parameters. Participants ( n = 118) from six placebo-controlled within-subject studies and two laboratories were included in the present pooled analysis. Empathy (MET), MDMA and oxytocin plasma concentrations were assessed after oral administration of MDMA (single dose, 75 or 125 mg). Trait empathy was assessed using the interpersonal reactivity index. We confirmed that MDMA increased emotional empathy at both doses without affecting cognitive empathy. This MDMA-related increase in empathy was most pronounced during presentation of positive emotions as compared with negative emotions. MDMA-induced empathy enhancement was positively related to MDMA blood concentrations measured before the test, but independent of sex, drug use history and trait empathy. Oxytocin concentrations increased after MDMA administration but were not associated with behavioral effects. The MDMA effects on emotional empathy were stable across laboratories and doses. Sex did not play a moderating role in this effect, and oxytocin levels, trait empathy and drug use history were also unrelated. Acute drug exposure was of significant relevance in the MDMA-induced emotional empathy elevation.
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Affiliation(s)
- Kim PC Kuypers
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, the Netherlands,Kim PC Kuypers, Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, Maastricht, 6200 MD, the Netherlands.
| | - Patrick C Dolder
- Psychopharmacology Research, Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel and University of Basel, Switzerland
| | - Johannes G Ramaekers
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, the Netherlands
| | - Matthias E Liechti
- Psychopharmacology Research, Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel and University of Basel, Switzerland
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