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Morrell W, Gelinas L, Zarin D, Bierer BE. Ensuring the Scientific Value and Feasibility of Clinical Trials: A Qualitative Interview Study. AJOB Empir Bioeth 2023; 14:99-110. [PMID: 36599052 DOI: 10.1080/23294515.2022.2160510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Ethical and scientific principles require that clinical trials address an important question and have the resources needed to complete the study. However, there are no clear standards for review that would ensure that these principles are upheld. METHODS We conducted semi-structured interviews with a convenience sample of nineteen experts in clinical trial design, conduct, and/or oversight to elucidate current practice and identify areas of need with respect to ensuring the scientific value and feasibility of clinical trials prior to initiation and while ongoing. We used a priori and grounded theory to analyze the data and constant comparative method to induce higher order themes. RESULTS Interviewees perceived determination of scientific value as the responsibility of the investigator and, secondarily, other parties who review or oversee research. Interviewees reported that ongoing trials are rarely reevaluated due to emerging evidence from external sources, evaluation is complex, and there would be value in the development of standards for monitoring and evaluating evidence systematically. Investigators, IRBs, and/or data monitoring committees (DMCs) could undertake these responsibilities. Feasibility assessments are performed but are typically inadequate; potential solutions are unclear. CONCLUSIONS There are three domains where current approaches are suboptimal and in which further guidance is needed. First, who has the responsibility for conducting scientific review, whether it be the investigator, IRB, and/or DMC is often unclear. Second, the standards for scientific review (e.g., appropriate search terms, data sources, and analytic plan) should be defined. Third, guidance is needed on the evaluation of ongoing studies in light of potentially new and evolving evidence, with particular reference to evidence from outside the trial itself.
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Affiliation(s)
- Walker Morrell
- Multi-Regional Clinical Trials Center, Brigham & Women's Hospital and Harvard, Cambridge, MA, USA
| | - Luke Gelinas
- Multi-Regional Clinical Trials Center, Brigham & Women's Hospital and Harvard, Cambridge, MA, USA.,Advarra IRB, Columbia, MD, USA
| | - Deborah Zarin
- Multi-Regional Clinical Trials Center, Brigham & Women's Hospital and Harvard, Cambridge, MA, USA
| | - Barbara E Bierer
- Multi-Regional Clinical Trials Center, Brigham & Women's Hospital and Harvard, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA.,Brigham & Women's Hospital, Boston, MA, USA
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Bitterman R, Koppel F, Mussini C, Geffen Y, Chowers M, Rahav G, Nesher L, Ben-Ami R, Turjeman A, Huberman Samuel M, Cheng MP, Lee TC, Leibovici L, Yahav D, Paul M. Piperacillin-tazobactam versus meropenem for treatment of bloodstream infections caused by third-generation cephalosporin-resistant Enterobacteriaceae: a study protocol for a non-inferiority open-label randomised controlled trial (PeterPen). BMJ Open 2021; 11:e040210. [PMID: 33558347 PMCID: PMC7871690 DOI: 10.1136/bmjopen-2020-040210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/26/2020] [Accepted: 11/19/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION The optimal treatment for extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae bloodstream infections has yet to be defined. Retrospective studies have shown conflicting results, with most data suggesting the non-inferiority of beta-lactam-beta-lactamase inhibitor combinations compared with carbapenems. However, the recently published MERINO trial failed to demonstrate the non-inferiority of piperacillin-tazobactam to meropenem. The potential implications of the MERINO trial are profound, as widespread adoption of carbapenem treatment will have detrimental effects on antimicrobial stewardship in areas endemic for ESBL and carbapenem-resistant bacteria. Therefore, we believe that it is justified to re-examine the comparison in a second randomised controlled trial prior to changing clinical practice. METHODS AND ANALYSIS PeterPen is a multicentre, investigator-initiated, open-label, randomised controlled non-inferiority trial, comparing piperacillin-tazobactam with meropenem for third-generation cephalosporin-resistant Escherichia coli and Klebsiella bloodstream infections. The study is currently being conducted in six centres in Israel and one in Canada with other centres from Israel, Italy and Canada expected to join. The two primary outcomes are all-cause mortality at day 30 from enrolment and treatment failure at day seven (death, fever above 38°C in the last 48 hours, continuous symptoms, increasing Sequential Organ Failure Assessment Score or persistent blood cultures with the index pathogen). A sample size of 1084 patients was calculated for the mortality endpoint assuming a 12.5% mortality rate in the control group with a 5% non-inferiority margin and assuming 100% follow-up for this outcome. ETHICS AND DISSEMINATION The study is approved by local and national ethics committees as required. Results will be published, and trial data will be made available. TRIAL REGISTRATION NUMBERS ClinicalTrials.gov Registry (NCT03671967); Israeli Ministry of Health Trials Registry (MOH_2018-12-25_004857).
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Affiliation(s)
- Roni Bitterman
- Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Haifa, Israel
| | - Fidi Koppel
- Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Cristina Mussini
- Infectious Diseases Clinics, University Hospital Modena, Modena, Emilia-Romagna, Italy
| | - Yuval Geffen
- Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel
| | - Michal Chowers
- Infectious Diseases Unit, Meir Medical Center, Kfar Saba, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Galia Rahav
- Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Nesher
- Infectious Diseases Unit, Soroka Medical Center, Beer Sheva, Israel
- Ben-Gurion University of the Negev Faculty of Health Sciences, Beer Sheva, Israel
| | - Ronen Ben-Ami
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adi Turjeman
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
- Internal Medicine E, Rabin Medical Center, Petah Tikva, Israel
| | | | - Matthew P Cheng
- Division of Infectious Diseases, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Todd C Lee
- Division of Infectious Diseases, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Leonard Leibovici
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
- Internal Medicine E, Rabin Medical Center, Petah Tikva, Israel
| | - Dafna Yahav
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
- Infectious Diseases Unit, Rabin Medical Center, Petah Tikva, Israel
| | - Mical Paul
- Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Haifa, Israel
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Kurian SJ, Wahood W, Alvi MA, Yolcu YU, Zreik J, Bydon M. Assessing the Effects of Publication Bias on Reported Outcomes of Cervical Disc Replacement and Anterior Cervical Discectomy and Fusion: A Meta-Epidemiologic Study. World Neurosurg 2020; 137:443-450.e13. [PMID: 31926357 DOI: 10.1016/j.wneu.2019.12.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND There have been several clinical trials as well as observational studies that have compared the outcomes of different cervical disc replacement (CDR) devices with anterior cervical disc replacement and fusion (ACDF). Although the results of these studies have provided sufficient evidence for the safety of CDR, there is still a lack of consensus in terms of longer-term outcomes, with studies providing equivocal results for the 2 procedures. In the current study, we used a novel methodology, a meta-epidemiologic study, to investigate the impact of study characteristics on the observed effects in the literature on CDR and ACDF. METHODS Data were abstracted from available meta-analyses regarding author, study author, year, intervention events, control events, and sample size, as well as year and geographic location of each study within the meta-analyses. We grouped the studies based on median year of publication as well as the region of the submitting author(s). Odds ratios, 95% confidence intervals (CIs), and standard errors of individual studies were calculated based on the number of events and sample size for each arm (ACDF or CDR). Further, results of outcomes from individual studies were pooled and a meta-analysis was conducted. Ratio of odds ratio (ROR) was used to assess the impact of each of these factors on estimates of the study for CDR versus ACDF. RESULTS A total of 13 meta-analyses were analyzed after exclusions. Using the results from 10 meta-analyses, we found that studies published before 2012 reported significantly lower odds of a reoperation after CDR (vs. ACDF), compared with studies published after 2012 (ROR, 0.51; 95% CI, 0.38-0.67; P < 0.001). We did not observe a significant impact of study year on difference in estimates between CDR and ACDF for adjacent segment disease (ROR, 0.99; 95% CI, 0.64-1.55; P = 0.465). The region of submitting author was also found to have no impact on results of published studies. CONCLUSIONS These results indicate that there may be a publication bias regarding the year of publication, with earlier studies reporting lower reoperation rates for CDR compared with ACDF.
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Affiliation(s)
- Shyam Joshua Kurian
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, Mayo Clinic, Rochester, Minnesota, USA
| | - Waseem Wahood
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammed Ali Alvi
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Yagiz Ugur Yolcu
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jad Zreik
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome-More Research Is Needed. Crit Care Med 2019; 47:118-120. [PMID: 30334820 DOI: 10.1097/ccm.0000000000003502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Walter S, Guyatt G, Bassler D, Briel M, Ramsay T, Han H. Randomised trials with provision for early stopping for benefit (or harm): The impact on the estimated treatment effect. Stat Med 2019; 38:2524-2543. [DOI: 10.1002/sim.8142] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/26/2019] [Accepted: 02/20/2019] [Indexed: 11/08/2022]
Affiliation(s)
- S.D. Walter
- Department of Health Research Methods, Evidence, and ImpactMcMaster University Hamilton Canada
| | - G.H. Guyatt
- Department of Health Research Methods, Evidence, and ImpactMcMaster University Hamilton Canada
| | - D. Bassler
- Department of Neonatology, University Hospital ZurichUniversity of Zurich Zürich Switzerland
| | - M. Briel
- Department of Health Research Methods, Evidence, and ImpactMcMaster University Hamilton Canada
- Basel Institute for Clinical Epidemiology and BiostatisticsUniversity Hospital Basel Basel Switzerland
| | - T. Ramsay
- Ottawa Hospital Research InstituteUniversity of Ottawa Ottawa Canada
| | - H.D. Han
- Mount Sinai Hospital Toronto Canada
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Ekhaguere OA, Mairami AB, Kirpalani H. Risk and benefits of Bubble Continuous Positive Airway Pressure for neonatal and childhood respiratory diseases in Low- and Middle-Income countries. Paediatr Respir Rev 2019; 29:31-36. [PMID: 29907334 DOI: 10.1016/j.prrv.2018.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
Over 80% of the global burden of childhood deaths occur in Low- and Middle-Income Countries (LMIC). Of the leading causes of death, respiratory failure is common to the top three. Bubble Continuous Positive Airway Pressure (bCPAP) is a standard therapy considered safe and cost effective in high resource settings. Although high-quality trials from LMIC are few, pooled available trial data considered alongside studies from high-income countries suggest that bCPAP: (i) reduces mortality; (ii) reduces the need for mechanical ventilation; and (iii) prevents extubation failure. Wider availability and optimal use at all levels of the health care system in LMIC are important steps to improve childhood survival. Studies aimed at effectively implementing, and sustaining safe use of bCPAP in the resource limited setting of LMIC are required.
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Affiliation(s)
- Osayame A Ekhaguere
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | - Amsa B Mairami
- Neonatal Unit, National Hospital Abuja, Federal Capital Territory, Nigeria
| | - Haresh Kirpalani
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Murad MH, Wang Z. Guidelines for reporting meta-epidemiological methodology research. ACTA ACUST UNITED AC 2017; 22:139-142. [PMID: 28701372 PMCID: PMC5537553 DOI: 10.1136/ebmed-2017-110713] [Citation(s) in RCA: 241] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 12/15/2022]
Abstract
Published research should be reported to evidence users with clarity and transparency that facilitate optimal appraisal and use of evidence and allow replication by other researchers. Guidelines for such reporting are available for several types of studies but not for meta-epidemiological methodology studies. Meta-epidemiological studies adopt a systematic review or meta-analysis approach to examine the impact of certain characteristics of clinical studies on the observed effect and provide empirical evidence for hypothesised associations. The unit of analysis in meta-epidemiological studies is a study, not a patient. The outcomes of meta-epidemiological studies are usually not clinical outcomes. In this guideline, we adapt items from the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) to fit the context of meta-epidemiological studies.
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Affiliation(s)
| | - Zhen Wang
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
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