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McKechnie T, Kazi T, Wang A, Zhang S, Thabane A, Nanji K, Doumouras AG, Eskicioglu C, Thabane L, Parpia S, Bhandari M. REporting quality of PilOt randomised controlled trials in surgery (REPORTS): a methodological survey protocol. BMJ Open 2024; 14:e085293. [PMID: 38658008 PMCID: PMC11043721 DOI: 10.1136/bmjopen-2024-085293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/15/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION The aim of this methodological review is to evaluate the completeness of reporting of surgical pilot and feasibility randomised trials as per the Consolidated Standards of Reporting Trials (CONSORT) extension to randomised pilot and feasibility trials. Moreover, we aim to assess for the presence of spin reporting and inconsistency between abstract and main text reporting in surgical pilot and feasibility randomised trials. METHODS AND ANALYSIS A comprehensive, electronic search strategy will be used to identify studies indexed in Medline, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Studies will be included if they are pilot or feasibility randomised trials of surgical interventions. The primary outcome will be overall CONSORT statement extension to randomised pilot and feasibility trials checklist completeness. This will be defined as trials reporting each of the 40 items in the CONSORT statement extension to randomised pilot and feasibility trials checklist. Secondary outcomes will include the reporting of individual studies as per the CONSORT extension to randomised pilot and feasibility trials, the use of spin reporting strategies, trial factors associated with reporting quality and spin strategy use, and consistency between abstract and main text reporting. Poisson and logistic regressions will be performed to explore the association between trial factors and completeness of reporting as measured by the number of reported CONSORT items. ETHICS AND DISSEMINATION This is a methodological survey that has been registered a priori on the International Prospective Register for Systematic Reviews (PROSPERO) (CRD42023475512). Local ethics approval is not required. We plan to disseminate study results through peer-reviewed publication and conference presentations.
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Affiliation(s)
- Tyler McKechnie
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Tania Kazi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Austine Wang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sophia Zhang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alex Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Keean Nanji
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Aristithes G Doumouras
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Sameer Parpia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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McKechnie T, Kazi T, Wang A, Zhang S, Thabane A, Nanji K, Staibano P, Park LJ, Doumouras A, Eskicioglu C, Thabane L, Parpia S, Bhandari M. Pilot and feasibility trials in surgery are incompletely reported according to the CONSORT checklist: a meta-research study. J Clin Epidemiol 2024; 170:111335. [PMID: 38548230 DOI: 10.1016/j.jclinepi.2024.111335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/17/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES Given the key role that pilot and feasibility (PAF) trials play in addressing the challenges of surgical trials, adequate reporting completeness is essential. Our aim was to assess completeness of reporting and evaluate if the items of the Consolidated Standards of Reporting Trials (CONSORT) extension for PAF trials have been reported in surgical PAF trials. STUDY DESIGN This is a metaresearch study reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they were pilot or feasibility randomized trials evaluating a surgical intervention. The primary outcome was overall adherence to the CONSORT statement extension to randomized PAF trials checklist. A Poisson regression was performed to explore the association between research factors and reporting completeness. SETTING MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched from January 1-December 31, 2011 and 2021. RESULTS After screening 1991 citations, 38 studies from 2011 to 34 studies from 2021 were included. The mean CONSORT reporting score across all included studies was 21.5 (standard deviation 6.3). After excluding items that were not applicable to all studies, a mean of 20.1 (standard deviation 6.1) of 34 items (0.59) were reported. Studies published in 2021 (vs 2011) did not have a greater number of CONSORT items reported (incidence rate ratio [IRR] 1.01, 95% confidence interval [CI] 0.89-1.15). Studies registered in a clinical trial registry (IRR 1.29, 95% CI 1.12-1.48) and randomizing more than 50 patients (IRR 1.16, 95% CI 1.04-1.30) were associated with more CONSORT items reported. CONCLUSION The reporting completeness of surgical PAF trials is poor and has not improved after the publication of the CONSORT extension.
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Affiliation(s)
- Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Tania Kazi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Austine Wang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sophia Zhang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alex Thabane
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Keean Nanji
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Phillip Staibano
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Division of Otolaryngology Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lily J Park
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Aristithes Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Sameer Parpia
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Ravani LV, Gewehr DM, Calomeni P, Gauza MDM, Pereira J, Cardoso R, Ribeiro HB, Bocchi E. Angiotensin Receptor-Neprilysin Inhibitor Effects on Atherosclerotic Cardiovascular Disease Events: A Meta-Analysis of Randomized Controlled Trials. Am J Cardiol 2023; 205:259-268. [PMID: 37619492 DOI: 10.1016/j.amjcard.2023.07.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/21/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023]
Abstract
Sacubitril-valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI) associated with a decreased risk of death and hospitalization for selected patients with heart failure (HF). However, its association with improved atherosclerotic cardiovascular disease (ASCVD) events remains unclear. We performed a meta-analysis to evaluate the association of ARNI with ASCVD events in patients with HF. We systematically searched PubMed, Embase, Cochrane, and ClinicalTrials.gov for studies comparing ARNIs with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in terms of myocardial infarction, stroke, angina pectoris, peripheral artery disease, and the composite end point in patients with HF. A total of 8 randomized controlled trials were included, with 17,541 patients assigned to either the ARNI (8,764 patients) or ACEi/ARB (8,777 patients) groups. The incidence of composite end point (risk ratio [RR] 1.03, 95% confidence interval [CI] 0.93 to 1.13, p = 0.63), myocardial infarction (RR 1.02, 95% CI 0.81 to 1.30, p = 0.85), angina pectoris (RR 0.96, 95% CI 0.80 to 1.17, p = 0.70), and stroke (RR 0.99, 95% CI 0.85 to 1.16, p = 0.93) were not statistically different between the ARNI and ACEi/ARB groups. However, ARNI was associated with a higher incidence of peripheral artery disease (RR 1.63, 95% CI 1.05 to 2.52, p = 0.03). In conclusion, this meta-analysis found no association between ARNI therapy and improved ASCVD events in patients with HF.
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Affiliation(s)
- Lis Victoria Ravani
- Department of Medicine, University of São Paulo Medical School, São Paulo, Brazil.
| | - Douglas Mesadri Gewehr
- Curitiba Heart Institute (INCOR Curitiba) and Denton Cooley Institute of Research Science and Technology,Curitiba, Paraná, Brazil
| | - Pedro Calomeni
- Department of Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Mateus de Miranda Gauza
- Department of Medicine, Universidade da Região de Joinville, Joinville, Santa Catarina, Brazill
| | | | - Rhanderson Cardoso
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Henrique Barbosa Ribeiro
- Department of Medicine, Universidade da Região de Joinville, Joinville, Santa Catarina, Brazill; Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Edimar Bocchi
- Department of Medicine, Universidade da Região de Joinville, Joinville, Santa Catarina, Brazill; Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Sardana D, Lee J, Yiu CK, Li KY. EFFECTIVENESS OF PHENTOLAMINE MESYLATE IN REVERSAL OF LOCAL ANESTHESIA: SYSTEMATIC REVIEW AND META-ANALYSIS. J Evid Based Dent Pract 2023; 23:101861. [PMID: 37689448 DOI: 10.1016/j.jebdp.2023.101861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/10/2023] [Accepted: 03/24/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND The aim of the present paper is to summarize the effectiveness of Phentolamine mesylate on the reversal of local anesthesia (LA). METHODOLOGY Seven electronic databases were searched for randomized clinical trials in patients who received LA (population) and either received a Phentolamine injection (intervention) after LA compared to placebo or sham (control) to cause a return of normal sensation (outcome). Risk of bias assessment was performed using Cochrane risk of bias assessment tool 2.0. The hazard ratio (HR) was calculated as the event (time to return to the normal sensation) was a time-dependent event, as well as the weighted mean difference (WMD), was computed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the certainty of the evidence. RESULTS Ten studies met our inclusion criteria and were included in this review. After pooling the results quantitatively, the value of the HR in the tongue was 0.56 (95% CI: 0.41-0.75, P<.001); in lower lip, the value was 0.56 (95% CI: 0.38-0.83, P = .004) and for upper lip, the value was 0.50 (95% CI: 0.31-0.80, P = .004). The WMD for the time to return for normal sensation was -47.71 min for the tongue (95% CI: -73.63 to -21.80 min, P<.001), -73.29 min for lower lip (95% CI: -88.41 to -58.16 min, P<.001) and -86.86 min for upper lip (95% CI: -101.16 to -72.57 min, P<.001). There is a high certainty of evidence that patients who have been administered local anesthesia may achieve faster recovery of normal sensation in tongue, and moderate certainty of evidence for return of normal sensation in lower lip and upper lip, if Phentolamine was administered after the local anesthesia. The adverse effects were reported in a few studies and were minor, not necessitating any medical intervention. CONCLUSIONS Phentolamine might be a useful adjunct in patients who desire an earlier return of normal sensation and function after local anesthesia. Future research should be directed to study the cost-effectiveness or dental patient-reported outcomes of Phentolamine after local anesthetic injections.
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Affiliation(s)
- Divesh Sardana
- Division of Pediatric Dentistry, Department of Developmental Sciences, Oklahoma University Health Sciences Center (OUHSC) College of Dentistry, Oklahoma City, OK, United States of America.
| | - Johyun Lee
- The University of Hong Kong, Hong Kong SAR, China
| | | | - Kar Yan Li
- The University of Hong Kong, Hong Kong SAR, China
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Burke C, Rossitch SS, Bejarano G, Knisely M, Ford CG, Allen KD, Ma J, Blalock DV, Ear B, Cantrell S, Gordon AM, Van Voorhees E, Goldstein KM, Williams JW, Gierisch JM. Videoconferencing of Movement-Based and Psychologically Informed Interventions for Chronic Pain: A Systematic Review and Horizon Scan. Telemed J E Health 2023; 29:1275-1288. [PMID: 36787486 DOI: 10.1089/tmj.2022.0308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Introduction: With the coronavirus disease 2019 (COVID-19) pandemic, use of telehealth technology increased dramatically. Nonpharmacological approaches to pain management may be well suited for virtual care. Yet, it is not widely understood if this treatment modality is effective when delivered via videoconferencing. This review examines the effectiveness of movement-based and psychologically informed chronic pain management interventions delivered via videoconferencing compared to in-person care. Methods: Searches of MEDLINE® (via Ovid®), Embase (via Elsevier), CINAHL Complete (via EBSCO), and Cochrane Central Register of Controlled Trials (via Ovid) were performed from inception to June 10, 2021. All articles meeting eligibility criteria were included for data abstraction. Results: Eight thousand two hundred fifty-two citations were identified, and after removing duplicates, 4,661 citations remained. One study investigating acceptance and commitment therapy met eligibility criteria. The noninferiority randomized trial found no statistically significant difference in outcomes between delivery modalities. A horizon scan was conducted to assess planned or recent studies. Horizon scan results yielded six protocols in trial databases, one pilot study, and three published protocols for ongoing studies. Discussion: Findings from this study indicate that virtually delivered pain management is a possible substitute for in-person care. Given the paucity of evidence on this topic, further comparative and adequately powered studies that assess the impact of movement-based and psychologically informed pain management delivered via videoconferencing are needed. Conclusions: Research is needed to understand patient preferences of such interventions within a variety of settings. Such evaluations will be needed to guide clinical and operations practice to optimize equitable deployment and access to high-quality health care delivered via videoconferencing.
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Affiliation(s)
- Colleen Burke
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Stephanie Salcedo Rossitch
- Mental and Behavioral Health Service Line, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Geronimo Bejarano
- Department of Epidemiology, The University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, USA
| | - Mitchell Knisely
- Healthcare in Adult Populations Division of the Duke University School of Nursing, Durham, North Carolina, USA
| | - Christopher Graham Ford
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Kelli D Allen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Jessica Ma
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
- Geriatrics Research Education and Clinical Center, Durham VA Health Care System, Durham, NC
| | - Dan V Blalock
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Belinda Ear
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Sarah Cantrell
- Duke University Medical Center Library and Archives, Duke University School of Medicine, Durham, North Carolina, USA
| | - Adelaide M Gordon
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Elizabeth Van Voorhees
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VISN-6 Mental Ilness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Karen M Goldstein
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - John W Williams
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Jennifer M Gierisch
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
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Green MD, Dalmage MR, Lusk JB, Kadhim EF, Skalla LA, O'Brien EC. Public reporting of black participation in anti-hypertensive drug clinical trials. Am Heart J 2023; 258:129-139. [PMID: 36640861 DOI: 10.1016/j.ahj.2023.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/05/2022] [Accepted: 01/04/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Non-Hispanic Black people in the United States have the highest prevalence of essential hypertension. Unfortunately, clinical trials often underrepresent Black patients. We aim to understand whether trial sponsorship type is associated with representation of Black participants in anti-hypertensive drug clinical trials. Then, we contextualize our findings amongst current efforts to improve diversity in clinical research populations. METHODS We searched ClinicalTrials.gov in May 2022 for antihypertensive drug trials. Of n = 408 trials in our initial search, n = 97 (23.77%) met inclusion criteria and were stratified by sponsorship type (industry vs non-industry). Standardized tests of difference were employed to compare characteristics of these trials, and linear regression was used to model change over time. RESULTS Of 97 trials reporting results from 2010 to 2020, there were minimal differences in the percent of Black patients enrolled in anti-hypertensive clinical trials by sponsorship type. Both industry and non-industry sponsored studies had high rates of non-reporting, with slightly more non-reporting for industry (73.2%) vs non-industry (66.67%) studies. Industry funded studies reported results to ClinicalTrials.gov within 23.3 ± 15.0 months from completing studies, while non-industry funded trials reported within 18.9 ± 10.8 months. CONCLUSIONS Despite Black Americans carrying the highest burden of disease for essential hypertension, they are underrepresented in anti-hypertension clinical trials and their overall participation has decreased between 2010 and 2020. In addition, there is major underreporting of trial participant race. We implore researchers and funders to establish clear, meaningful targets for anti-hypertensive drug trial diversity, and improve transparency in reporting of study characteristics.
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Affiliation(s)
- Michael D Green
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America; Duke University Medical Center Library & Archives, Duke University School of Medicine, Durham, NC, United States of America.
| | - Mahalia R Dalmage
- Division of Biological Sciences, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States of America
| | - Jay B Lusk
- Department of Neurology, Duke University School of Medicine, Durham, NC, United States of America; Fuqua School of Business, Duke University, Durham, NC, United States of America
| | - Emilie F Kadhim
- Social & Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lesley A Skalla
- Duke University Medical Center Library & Archives, Duke University School of Medicine, Durham, NC, United States of America
| | - Emily C O'Brien
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America
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Home-built environment interventions and inflammation biomarkers: a systematic review and meta-analysis protocol. BJGP Open 2022; 6:BJGPO.2022.0104. [PMID: 36137647 PMCID: PMC9904785 DOI: 10.3399/bjgpo.2022.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Inflammation control is a fundamental part of chronic care in patients with a history of cancer and comorbidity. As the risk-benefit profile of anti-inflammatory drugs is unclear in survivors of cancer, GPs and patients could benefit from alternative non-pharmacological treatment options for dysregulated inflammation. There is a potential for home-built environment (H-BE) interventions to modulate inflammation; however, discrepancies exist between studies. AIM To evaluate the effectiveness of H-BE interventions on cancer-associated inflammation biomarkers. DESIGN & SETTING A systematic review and meta-analysis of randomised and non-randomised trials in community-dwelling adults. METHOD PubMed and MEDLINE, Embase, Web of Science, and Google Scholar will be searched for clinical trials published in January 2000 onwards. The study will include H-BE interventions modifying air quality, thermal comfort, non-ionising radiation, noise, nature, and water. No restrictions to study population will be applied to allow deriving expectations for effects of the interventions in cancer survivors from available source populations. Outcome measures will be inflammatory biomarkers clinically and physiologically relevant to cancer. The first reviewer will independently screen articles together with GPs and extract data that will be verified by a second reviewer. The quality of studies will be assessed using the Cochrane risk-of-bias tools. Depending on the clinical and methodological homogeneity of populations, interventions, and outcomes, a meta-analysis will be conducted using random-effects models. CONCLUSION Findings will determine the effectiveness of H-BE interventions on inflammatory parameters, guide future directions for its provision in community-dwelling survivors of cancer and support GPs with safer anti-inflammatory treatment options in high-risk patients for clinical complications.
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Wang S, Xiong F, Gao Y, Lei M, Zhang X. Characteristics of clinical trials related to hip fractures and factors associated with completion. BMC Musculoskelet Disord 2022; 23:781. [PMID: 35974342 PMCID: PMC9380385 DOI: 10.1186/s12891-022-05714-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed at investigating the characteristics of clinical trials related to hip fractures that were registered at ClinicalTrials.gov. It also aimed to identify potential risk factors associated with completion. MAIN BODY We obtained 733 clinical studies related to hip fractures from the ClinicalTrials.gov database and included 470 studies in the analysis. These clinical trials were divided into behavioral, drug/biological, device, procedure, and other categories based on intervention types. Clinical trials investigating drugs or biologics were categorized based on the specific agents administered in each trial. Multiple logistic and Cox regression models were used to test the ability of 24 potential risk factors in predicting recruitment status and completion time, respectively. Among the included clinical trials, 44.89% (211/470) had complete recruitment status. The overall median completion time was 931.00 days (95% confidence interval [CI]: 822.56-1039.44 days). The results of only 8.94% (42/470) of clinical trials were presented on the ClinicalTrials.gov website. Bupivacaine (a local anesthetic) was most commonly investigated (in 25 clinical trials); this was followed by ropivacaine (another local anesthetic, 23 clinical trials) and tranexamic acid (a hemostatic, 21 clinical trials). Multivariate analysis showed that trials including children (P = 0.03) and having National Institutes of Health funds (P < 0.01) had significantly higher rates of complete recruitment. Higher enrollment (P < 0.01), National Institutes of Health funding (P < 0.01), location in the United States (P = 0.04), and location in Europe (P = 0.03) predisposed to longer completion time, while studies involving drugs/biologics (P < 0.01) had shorter completion times. CONCLUSIONS A considerable proportion of clinical trials related to hip fractures were completed, but the results of only a small fraction were presented on the ClinicalTrials.gov website. The commonly investigated drugs focused on anesthesia, pain relief, and hemostasis. Several independent risk factors that affect recruitment status and completion time were identified. These factors may guide the design of clinical trials relating to hip fractures.
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Affiliation(s)
- Shengjie Wang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Yishan Road 600#, Shanghai, 200233, China
| | - Fan Xiong
- Department of Orthopedic Surgery, People's Hospital of Macheng City, Huang Gang, 438399, China
| | - Yanzheng Gao
- Department of Orthopaedic Surgery, Henan Provincial People's Hospital, Zhengzhou, 450003, China
| | - Mingxing Lei
- Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China. .,Department of Orthopedic Surgery, Hainan Hospital of PLA General Hospital, Sanya, China. .,The National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, PLA General Hospital, Beijing, China.
| | - Xianlong Zhang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Yishan Road 600#, Shanghai, 200233, China.
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Mathebula L, Runeyi S, Wiysonge C, Ndwandwe D. Clinical trial registration during COVID-19 and beyond in the African context: what have we learned? Trials 2022; 23:460. [PMID: 35668437 PMCID: PMC9167898 DOI: 10.1186/s13063-022-06412-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/18/2022] [Indexed: 11/28/2022] Open
Abstract
Since the outbreak of COVID-19, many lives have been impacted especially on the African continent which is already fighting the burden of multiple diseases of poverty. However, clinical research has offered hope for treatment and prevention options for this infectious disease. Despite many COVID-19 clinical trials conducted globally, three countries in Africa account for more than 80% of all trials from the continent registered trials in clinical trial registries. This indicates geographic disparity among COVID-19 research in Africa. From the perspective of clinical trial registration, transparency in clinical research and the availability of data became important for making informed decisions to manage the pandemic. Registries serve as a source of planned, ongoing, and completed trials while allowing efficient funding allocation for research that would not duplicate efforts. Additionally, research gaps can be identified, which provide opportunities for collaboration among researchers. Therefore, a critical lesson learnt during this pandemic is that clinical trial registration is important in facilitating the process of tracking changes made to protocols and minimizing publication bias, thereby promoting and advocating for clinical research transparency. Moreover, registration in a clinical trial registry is a condition for publication and allows for trial summary results to be publicly available. Adhering to the principle of results sharing is especially important for the rapidly growing clinical research activities racing to find evidence-based interventions to end the COVID-19 pandemic.
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Affiliation(s)
- Lindi Mathebula
- Cochrane South Africa, South African Medical Research Council, Tygerberg, 7505, South Africa.
| | - Sinazo Runeyi
- Cochrane South Africa, South African Medical Research Council, Tygerberg, 7505, South Africa
| | - Charles Wiysonge
- Cochrane South Africa, South African Medical Research Council, Tygerberg, 7505, South Africa.,HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Tygerberg, 7505, South Africa.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, 7505, South Africa.,School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Tygerberg, 7505, South Africa
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10
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Smalheiser NR, Holt AW. A web-based tool for automatically linking clinical trials to their publications. J Am Med Inform Assoc 2022; 29:822-830. [PMID: 35020887 PMCID: PMC9006700 DOI: 10.1093/jamia/ocab290] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Evidence synthesis teams, physicians, policy makers, and patients and their families all have an interest in following the outcomes of clinical trials and would benefit from being able to evaluate both the results posted in trial registries and in the publications that arise from them. Manual searching for publications arising from a given trial is a laborious and uncertain process. We sought to create a statistical model to automatically identify PubMed articles likely to report clinical outcome results from each registered trial in ClinicalTrials.gov. MATERIALS AND METHODS A machine learning-based model was trained on pairs (publications known to be linked to specific registered trials). Multiple features were constructed based on the degree of matching between the PubMed article metadata and specific fields of the trial registry, as well as matching with the set of publications already known to be linked to that trial. RESULTS Evaluation of the model using known linked articles as gold standard showed that they tend to be top ranked (median best rank = 1.0), and 91% of them are ranked in the top 10. DISCUSSION Based on this model, we have created a free, public web-based tool that, given any registered trial in ClinicalTrials.gov, presents a ranked list of the PubMed articles in order of estimated probability that they report clinical outcome data from that trial. The tool should greatly facilitate studies of trial outcome results and their relation to the original trial designs.
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Affiliation(s)
- Neil R Smalheiser
- Corresponding Author: Neil R. Smalheiser, MD, PhD, Department of Psychiatry, University of Illinois College of Medicine, 1601 W. Taylor Street, MC912, Chicago, IL 60612, USA;
| | - Arthur W Holt
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, Illinois, USA
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11
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Siontis GCM, Sweda R, Noseworthy PA, Friedman PA, Siontis KC, Patel CJ. Development and validation pathways of artificial intelligence tools evaluated in randomised clinical trials. BMJ Health Care Inform 2022; 28:bmjhci-2021-100466. [PMID: 34969668 PMCID: PMC8718483 DOI: 10.1136/bmjhci-2021-100466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/04/2021] [Indexed: 12/20/2022] Open
Abstract
Objective Given the complexities of testing the translational capability of new artificial intelligence (AI) tools, we aimed to map the pathways of training/validation/testing in development process and external validation of AI tools evaluated in dedicated randomised controlled trials (AI-RCTs). Methods We searched for peer-reviewed protocols and completed AI-RCTs evaluating the clinical effectiveness of AI tools and identified development and validation studies of AI tools. We collected detailed information, and evaluated patterns of development and external validation of AI tools. Results We found 23 AI-RCTs evaluating the clinical impact of 18 unique AI tools (2009–2021). Standard-of-care interventions were used in the control arms in all but one AI-RCT. Investigators did not provide access to the software code of the AI tool in any of the studies. Considering the primary outcome, the results were in favour of the AI intervention in 82% of the completed AI-RCTs (14 out of 17). We identified significant variation in the patterns of development, external validation and clinical evaluation approaches among different AI tools. A published development study was found only for 10 of the 18 AI tools. Median time from the publication of a development study to the respective AI-RCT was 1.4 years (IQR 0.2–2.2). Conclusions We found significant variation in the patterns of development and validation for AI tools before their evaluation in dedicated AI-RCTs. Published peer-reviewed protocols and completed AI-RCTs were also heterogeneous in design and reporting. Upcoming guidelines providing guidance for the development and clinical translation process aim to improve these aspects.
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Affiliation(s)
- George C M Siontis
- Department of Cardiology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Romy Sweda
- Department of Cardiology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Chirag J Patel
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
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12
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Huang A, Komukai S, Friede T, Hattori S. Using clinical trial registries to inform Copas selection model for publication bias in meta-analysis. Res Synth Methods 2021; 12:658-673. [PMID: 34169657 DOI: 10.1002/jrsm.1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/02/2021] [Accepted: 06/01/2021] [Indexed: 11/10/2022]
Abstract
Prospective registration of study protocols in clinical trial registries is a useful way to minimize the risk of publication bias in meta-analysis, and several clinical trial registries are available nowadays. However, they are mainly used as a tool for searching studies and information submitted to the registries has not been utilized as efficiently as it could. In addressing publication bias in meta-analyses, sensitivity analysis with the Copas selection model is a more objective alternative to widely-used graphical methods such as the funnel-plot and the trim-and-fill method. Despite its ability to quantify the potential impact of publication bias, the Copas selection model relies on sensitivity analyses, in which some parameters are varied across a certain range. This may result in some difficulty in interpreting the results. In this paper, we propose an alternative inference procedure for the Copas selection model by utilizing information from clinical trial registries. Our method provides a simple and accurate way to estimate all unknown parameters of the Copas selection model. A simulation study revealed that our proposed method resulted in smaller biases and more accurate confidence intervals than existing methods. Furthermore, three published meta-analyses were re-analyzed to demonstrate how to implement the proposed method in practice.
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Affiliation(s)
- Ao Huang
- Department of Biomedical Statistics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Sho Komukai
- Department of Biomedical Statistics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Satoshi Hattori
- Department of Biomedical Statistics, Graduate School of Medicine, Osaka University, Osaka, Japan.,Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Osaka, Japan
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13
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van Biesen W, Van Der Straeten C, Sterckx S, Steen J, Diependaele L, Decruyenaere J. The concept of justifiable healthcare and how big data can help us to achieve it. BMC Med Inform Decis Mak 2021; 21:87. [PMID: 33676513 PMCID: PMC7937275 DOI: 10.1186/s12911-021-01444-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 02/16/2021] [Indexed: 01/08/2023] Open
Abstract
Over the last decades, the face of health care has changed dramatically, with big improvements in what is technically feasible. However, there are indicators that the current approach to evaluating evidence in health care is not holistic and hence in the long run, health care will not be sustainable. New conceptual and normative frameworks for the evaluation of health care need to be developed and investigated. The current paper presents a novel framework of justifiable health care and explores how the use of artificial intelligence and big data can contribute to achieving the goals of this framework.
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Affiliation(s)
- Wim van Biesen
- Renal Division, 0K12 IA, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium. .,Consortium for Justifiable Healthcare, Ghent University Hospital, Ghent, Belgium.
| | | | - Sigrid Sterckx
- Consortium for Justifiable Healthcare, Ghent University Hospital, Ghent, Belgium.,Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| | - Johan Steen
- Renal Division, 0K12 IA, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium.,Consortium for Justifiable Healthcare, Ghent University Hospital, Ghent, Belgium
| | - Lisa Diependaele
- Consortium for Justifiable Healthcare, Ghent University Hospital, Ghent, Belgium.,Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| | - Johan Decruyenaere
- Consortium for Justifiable Healthcare, Ghent University Hospital, Ghent, Belgium.,Department of Intensive Care, Ghent University Hospital, Ghent, Belgium
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14
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Gulden C, Blasini R, Nassirian A, Stein A, Altun FB, Kirchner M, Prokosch HU, Boeker M. Prototypical Clinical Trial Registry Based on Fast Healthcare Interoperability Resources (FHIR): Design and Implementation Study. JMIR Med Inform 2021; 9:e20470. [PMID: 33433393 PMCID: PMC7837997 DOI: 10.2196/20470] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/23/2020] [Accepted: 12/05/2020] [Indexed: 11/29/2022] Open
Abstract
Background Clinical trial registries increase transparency in medical research by making information and results of planned, ongoing, and completed studies publicly available. However, the registration of clinical trials remains a time-consuming manual task complicated by the fact that the same studies often need to be registered in different registries with different data entry requirements and interfaces. Objective This study investigates how Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) may be used as a standardized format for exchanging and storing clinical trial records. Methods We designed and prototypically implemented an open-source central trial registry containing records from university hospitals, which are automatically exported and updated by local study management systems. Results We provided an architecture and implementation of a multisite clinical trials registry based on HL7 FHIR as a data storage and exchange format. Conclusions The results show that FHIR resources establish a harmonized view of study information from heterogeneous sources by enabling automated data exchange between trial centers and central study registries.
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Affiliation(s)
- Christian Gulden
- Chair of Medical Informatics, Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Romina Blasini
- Institute of Medical Informatics, Justus-Liebig-University Gießen, Gießen, Germany
| | - Azadeh Nassirian
- Carl Gustav Carus Faculty of Medicine, Center for Medical Informatics, Institute for Medical Informatics and Biometry, Dresden University of Technology, Dresden, Germany
| | - Alexandra Stein
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Fatma Betül Altun
- Medical Informatics Group, University Hospital Frankfurt, Frankfurt, Germany
| | - Melanie Kirchner
- Medical Center for Information and Communication Technology, University Hospital Erlangen, Erlangen, Germany
| | - Hans-Ulrich Prokosch
- Chair of Medical Informatics, Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Medical Center for Information and Communication Technology, University Hospital Erlangen, Erlangen, Germany
| | - Martin Boeker
- Institute of Medical Biometry and Statistics, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
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15
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Varghese J, Fujarski M, Dugas M. StudyPortal - Geovisualization of Study Research Networks. J Med Syst 2019; 44:22. [PMID: 31823031 PMCID: PMC6904404 DOI: 10.1007/s10916-019-1493-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 10/31/2019] [Indexed: 11/29/2022]
Abstract
StudyPortal was implemented as the first multilingual search platform for geographic visualization of clinical trials and scientific articles. The platform queries information from ClinicalTrials.gov, PubMed, a geodatabase and geographic maps to enable geospatial study search and real-time rendering of study locations or research networks on a map. Thus, disease-specific clinical studies or whole research networks can be shown in a geographic proximity. Moreover, a semantic layer enables multilingual disease input and autosuggestion of medical terms based on the Unified Medical Language System. The portal is accessible on https://studyportal.uni-muenster.de. This paper presents details on implementation of the novel search platform, its search evaluation and future work.
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Affiliation(s)
- Julian Varghese
- Institute of Medical Informatics, University of Münster, Albert-Schweitzer-Campus 1, Gebäude A11, 48149, Münster, Germany.
| | - Michael Fujarski
- Institute of Medical Informatics, University of Münster, Albert-Schweitzer-Campus 1, Gebäude A11, 48149, Münster, Germany
| | - Martin Dugas
- Institute of Medical Informatics, University of Münster, Albert-Schweitzer-Campus 1, Gebäude A11, 48149, Münster, Germany
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16
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Zarin DA, Fain KM, Dobbins HD, Tse T, Williams RJ. 10-Year Update on Study Results Submitted to ClinicalTrials.gov. N Engl J Med 2019; 381:1966-1974. [PMID: 31722160 PMCID: PMC8591666 DOI: 10.1056/nejmsr1907644] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Deborah A Zarin
- From the National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD
| | - Kevin M Fain
- From the National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD
| | - Heather D Dobbins
- From the National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD
| | - Tony Tse
- From the National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD
| | - Rebecca J Williams
- From the National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD
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