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Ghandour LA, Anouti S, Lotfi T, Meho L, Kashash R, Al-Akkawi A, Majed A, Akl E, Afifi RA. Parenting a High and Growing Population of Youth in the Arab Region: A Scoping Review for an Evidence-Informed Research Agenda. J Adolesc Health 2024:S1054-139X(24)00125-3. [PMID: 38597843 DOI: 10.1016/j.jadohealth.2024.02.033] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 04/11/2024]
Abstract
The Arab region is experiencing the largest youth cohort in its history. Parental influence is a clear factor in the well-being of this demographic. This scoping review serves as the first consolidated synthesis of existing research on parenting in the Arab world, aimed at identifying research gaps and informing future research agendas. Searches of 18 databases resulted in 4,758 records (1995-2018) in all languages. Using Arksey and O'Malley's methodological framework, eligible studies (n = 152) underwent duplicate data abstraction. An evidence gap map was developed using 3i.e.'s platform. Studies were mostly published in English (88%), and lead authors' affiliations were mostly from Arab institutions. Included studies were mostly cross-sectional (89%), quantitative (96%), conducted in a school/university (83%), and surveyed children and adolescents (70%). Most studies (79%) examined parenting influences on youth outcomes. Fewer examined parenting measurement (30%) or evaluated interventions (1%). Mental health and school performance were the most commonly investigated outcomes. The evidence gap map allows researchers who study youth in the Arab world to efficiently and visually delineate the gaps and strategically prioritize research needs. Future studies should employ robust mixed methods study designs, focus on evaluation and psychometric research, engage youth in the research process and explore a more diverse set of outcomes.
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Affiliation(s)
- Lilian A Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, Beirut, Lebanon
| | - Sirine Anouti
- Department of Epidemiology and Population Health, Faculty of Health Sciences, Beirut, Lebanon
| | - Tamara Lotfi
- Global Evidence Synthesis Initiative (GESI) Secretariat, American University of Beirut, Beirut, Lebanon
| | - Lokman Meho
- University Libraries, American University of Beirut, Beirut, Lebanon
| | - Rima Kashash
- Global Evidence Synthesis Initiative (GESI) Secretariat, American University of Beirut, Beirut, Lebanon; Public Health Monitoring Evaluation Accountability and Learning Coordinator, Mercy Corps, Beirut, Lebanon
| | - Alaa Al-Akkawi
- Department of Epidemiology and Population Health, Faculty of Health Sciences, Beirut, Lebanon
| | - AlZahraa Majed
- Department of Epidemiology and Population Health, Faculty of Health Sciences, Beirut, Lebanon
| | - Elie Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Rima A Afifi
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa.
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2
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Marsh K, Akl E, Achan J, Alzahrani M, Baird JK, Bousema T, Gamboa D, Lacerda M, Mendis K, Penny M, Schapira A, Sovannaroth S, Wongsrichanalai C, Tiffany A, Li X, Shutes E, Schellenberg D, Alonso P, Lindblade KA. Development of WHO Recommendations for the Final Phase of Elimination and Prevention of Re-Establishment of Malaria. Am J Trop Med Hyg 2024; 110:3-10. [PMID: 38118172 PMCID: PMC10993787 DOI: 10.4269/ajtmh.22-0768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 06/02/2023] [Indexed: 12/22/2023] Open
Abstract
The WHO recommends that all affected countries work toward the elimination of malaria, even those still experiencing a high burden of disease. However, malaria programs in the final phase of elimination or those working to prevent re-establishment of transmission after elimination could benefit from specific evidence-based recommendations for these settings as part of comprehensive and quality-controlled malaria guidelines. The WHO convened an external guideline development group to formulate recommendations for interventions to reduce or prevent malaria transmission in areas with very low- to low-transmission levels and those that have eliminated malaria. In addition, several interventions that could be deployed in higher burden areas to accelerate elimination, such as mass drug administration, were reviewed. Systematic reviews were conducted that synthesized and evaluated evidence for the benefits and harms of public health interventions and summarized critical contextual factors from a health systems perspective. A total of 12 recommendations were developed, with five related to mass interventions that could be deployed at higher transmission levels and seven that would be most appropriate for programs in areas close to elimination or those working to prevent re-establishment of transmission. Four chemoprevention, two active case detection, and one vector control interventions were positively recommended, whereas two chemoprevention and three active case detection interventions were not recommended by the WHO. None of the recommendations were classified as strong given the limited and low-quality evidence base. Approaches to conducting higher quality research in very low- to low-transmission settings to improve the strength of WHO recommendations are discussed.
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Affiliation(s)
- Kevin Marsh
- Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom
| | - Elie Akl
- Department of Internal Medicine, American University of Beirut, Lebanon
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Jane Achan
- Malaria Consortium, London, United Kingdom
| | | | - J. Kevin Baird
- Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom
- Oxford University Clinical Research Unit, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Center, Radboud, the Netherlands
| | - Dionicia Gamboa
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marcus Lacerda
- Tropical Medicine Foundation Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Kamini Mendis
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Melissa Penny
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Allan Schapira
- Bicol University College of Medicine, Legazpi City, Philippines
| | - Siv Sovannaroth
- National Malaria Program, Ministry of Health, Phnom Penh, Cambodia
| | | | | | - Xiaohong Li
- Global Malaria Programme, WHO, Geneva, Switzerland
| | - Erin Shutes
- Global Malaria Programme, WHO, Geneva, Switzerland
| | | | - Pedro Alonso
- Global Malaria Programme, WHO, Geneva, Switzerland
| | - The WHO Malaria Elimination Steering Group
- Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom
- Department of Internal Medicine, American University of Beirut, Lebanon
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Malaria Consortium, London, United Kingdom
- Public Health Agency, Ministry of Health, Makkah, Saudi Arabia
- Oxford University Clinical Research Unit, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Department of Medical Microbiology, Radboud University Medical Center, Radboud, the Netherlands
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Tropical Medicine Foundation Dr Heitor Vieira Dourado, Manaus, Brazil
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Bicol University College of Medicine, Legazpi City, Philippines
- National Malaria Program, Ministry of Health, Phnom Penh, Cambodia
- Independent Consultant, Bangkok, Thailand
- Global Malaria Programme, WHO, Geneva, Switzerland
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3
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Akl E, Sahami N, Labos C, Genest J, Zgheib A, Piazza N, Jolly S. Meta-Analysis of Randomized Trials: Efficacy and Safety of Colchicine for Secondary Prevention of Cardiovascular Disease. J Interv Cardiol 2024; 2024:8646351. [PMID: 38505729 PMCID: PMC10950412 DOI: 10.1155/2024/8646351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 12/28/2023] [Accepted: 02/22/2024] [Indexed: 03/21/2024] Open
Abstract
Background Colchicine has shown potential cardioprotective effects owing to its broad anti-inflammatory properties. We performed a meta-analysis to assess its safety and efficacy in secondary prevention in patients with established coronary artery disease (CAD). Methods We searched Ovid Healthstar, MEDLINE, and Embase (inception to May 2022) for randomized controlled trials (RCTs) evaluating the cardiovascular effects of colchicine compared with placebo or usual care in patients with CAD. Study-level data on efficacy and safety outcomes were pooled using the Peto method. The primary outcome was the composite of cardiovascular (CV) death, myocardial infarction (MI), or stroke. Results A total of 8 RCTs were included with a follow-up duration of ≥1 month, comprising a total of 12,151 patients. Compared with placebo or usual care, colchicine was associated with a significant risk reduction in the primary outcome (odds ratio (OR) 0.70, 95% CI 0.60 to 0.83, P < 0.0001; I2 = 52%). Risks of MI (OR 0.75, 95% CI 0.62 to 0.91, P = 0.003; I2 = 33%), stroke (OR 0.47, 95% CI 0.30 to 0.74, P = 0.001; I2 = 0%), and unplanned coronary revascularization (OR 0.67, 95% CI 0.55 to 0.82, P = 0.0001; I2 = 58%) were all reduced in the colchicine group. Rates of CV and all-cause mortality did not differ between the two groups, but there was an increase in noncardiac deaths with colchicine (OR 1.54, 95% CI 1.10 to 2.15, P = 0.01; I2 = 51%). The occurrence of all other adverse events was similar between the two groups, including GI reactions (OR 1.06, 95% CI 0.94 to 1.20, P = 0.35; I2 = 42%) and infections (OR 1.04, 95% CI 0.84 to 1.28, P = 0.74; I2 = 53%). Conclusions Colchicine therapy may reduce the risk of future cardiovascular events in patients with established CAD; however, there remains a concern about non-CV mortality. Further trials are underway that will shed light on non-CV mortality and colchicine NCT03048825, and NCT02898610.
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Affiliation(s)
- Elie Akl
- McGill University, Montreal, Canada
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Zgheib AZ, Jdaidani J, Akl E, Khalil S, Chaabo O, Piazza N, Sawaya FJ, Rebeiz AG. Percutaneous Coronary Intervention with Procedural Unfractionated Heparin without Activated Clotting Time Guidance: A Unique Opportunity to Assess Thrombotic and Bleeding Events. Int J Clin Pract 2024; 2024:6219301. [PMID: 38390376 PMCID: PMC10883739 DOI: 10.1155/2024/6219301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/11/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Background Rates of major bleeding and intraprocedural thrombotic events (IPTE) in the setting of percutaneous coronary intervention (PCI) using weight-adjusted unfractionated heparin (UFH) without activated clotting time (ACT) monitoring are not known. Methods We reviewed 2,748 consecutive patients who underwent coronary angiography at our tertiary care university hospital between January 2017 and December 2020. All patients who underwent PCI with weight-adjusted UFH without ACT guidance were considered for further analysis. Major bleeding complications occurring within 48 hours of PCI were collected from patients' medical records. IPTE were collected independently by two interventional cardiologists after review of coronary angiograms. Results There were 718 patients included in the analysis (65.4 ± 12.2 years old; 81.3% male). In total, 45 patients (7.8%) experienced a major bleed or IPTE. The most common IPTE were slow/no reflow (1.5%) and coronary artery dissection with decreased flow (1.1%). Other IPTE occurred in <1% of cases. Major bleeding occurred in 11 patients (1.5%), of whom 8 required blood transfusion and 3 required vascular intervention. Bleeding complications were more common with femoral compared with radial access (6.6% vs. 0.2%, P < 0.001). Conclusion Weight-adjusted UFH use during PCI without ACT monitoring was related to low rates of major bleeding or IPTE.
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Affiliation(s)
- Ali Z. Zgheib
- American University of Beirut Medical Center, Division of Cardiology, Beirut, Lebanon
- McGill University Health Centre, Division of Cardiology, Montreal, Canada
| | - Jennifer Jdaidani
- American University of Beirut Medical Center, Division of Cardiology, Beirut, Lebanon
| | - Elie Akl
- McGill University Health Centre, Division of Cardiology, Montreal, Canada
| | - Suzan Khalil
- University of California at Los Angeles, Division of Cardiology, Los Angeles, California, USA
| | - Omar Chaabo
- American University of Beirut Medical Center, Division of Cardiology, Beirut, Lebanon
- McGill University Health Centre, Division of Cardiology, Montreal, Canada
| | - Nicolo Piazza
- McGill University Health Centre, Division of Cardiology, Montreal, Canada
| | - Fadi J. Sawaya
- American University of Beirut Medical Center, Division of Cardiology, Beirut, Lebanon
| | - Abdallah G. Rebeiz
- American University of Beirut Medical Center, Division of Cardiology, Beirut, Lebanon
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5
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Gartlehner G, Nussbaumer-Streit B, Devane D, Kahwati L, Viswanathan M, King VJ, Qaseem A, Akl E, Schuenemann HJ. Rapid reviews methods series: Guidance on assessing the certainty of evidence. BMJ Evid Based Med 2024; 29:50-54. [PMID: 37076264 PMCID: PMC10850678 DOI: 10.1136/bmjebm-2022-112111] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 04/21/2023]
Abstract
This paper is part of a series of methodological guidance from the Cochrane Rapid Reviews Methods Group. Rapid reviews (RRs) use modified systematic review methods to accelerate the review process while maintaining systematic, transparent and reproducible methods. This paper addresses considerations for rating the certainty of evidence (COE) in RRs. We recommend the full implementation of GRADE (Grading of Recommendations, Assessment, Development and Evaluation) for Cochrane RRs if time and resources allow.If time or other resources do not permit the full implementation of GRADE, the following recommendations can be considered: (1) limit rating COE to the main intervention and comparator and limit the number of outcomes to critical benefits and harms; (2) if a literature review or a Delphi approach to rate the importance of outcomes is not feasible, rely on informal judgements of knowledge users, topic experts or team members; (3) replace independent rating of the COE by two reviewers with single-reviewer rating and verification by a second reviewer and (4) if effect estimates of a well-conducted systematic review are incorporated into an RR, use existing COE grades from such a review. We advise against changing the definition of COE or the domains considered part of the GRADE approach for RRs.
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Affiliation(s)
- Gerald Gartlehner
- Department for Evidence-based Medicine and Evaluation & Cochrane Austria, University of Krems, Krems, Austria
- RTI-UNC Evidence-based Practice Center, RTI International, Research Triangle Park, North Carolina, USA
| | - Barbara Nussbaumer-Streit
- Department for Evidence-based Medicine and Evaluation & Cochrane Austria, University of Krems, Krems, Austria
| | - Declan Devane
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland & Cochrane Ireland, University of Galway, Galway, Ireland
| | - Leila Kahwati
- RTI-UNC Evidence-based Practice Center, RTI International, Research Triangle Park, North Carolina, USA
| | - Meera Viswanathan
- RTI-UNC Evidence-based Practice Center, RTI International, Research Triangle Park, North Carolina, USA
| | - Valerie J King
- Center for Evidence-based Policy, Oregon Health and Science University, Portland, Oregon, USA
| | - Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania, USA
| | - Elie Akl
- American University of Beirut, Beirut, Lebanon
| | - Holger J Schuenemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Biomedical Sciences, Humanitas University, Humanitas University, Pieve Emanuele, Italy
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6
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Chehab O, Akl E, Abdollahi A, Zeitoun R, Ambale-Venkatesh B, Wu C, Tracy R, Blumenthal RS, Post WS, Lima JAC, Rodriguez A. Higher HDL cholesterol levels are associated with increased markers of interstitial myocardial fibrosis in the MultiEthnic Study of Atherosclerosis (MESA). Sci Rep 2023; 13:20115. [PMID: 37978334 PMCID: PMC10656454 DOI: 10.1038/s41598-023-46811-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
Emerging research indicates that high HDL-C levels might not be cardioprotective, potentially worsening cardiovascular disease (CVD) outcomes. Yet, there is no data on HDL-C's association with other CVD risk factors like myocardial fibrosis, a key aspect of cardiac remodeling predicting negative outcomes. We therefore aimed to study the association between HDL-C levels with interstitial myocardial fibrosis (IMF) and myocardial scar measured by CMR T1-mapping and late-gadolinium enhancement (LGE), respectively. There were 1863 participants (mean age of 69 years) who had both serum HDL-C measurements and underwent CMR. Analysis was done among those with available indices of interstitial fibrosis (extracellular volume fraction [ECV]; N = 1172 and native-T1; N = 1863) and replacement fibrosis by LGE (N = 1172). HDL-C was analyzed as both logarithmically-transformed and categorized into < 40 (low),40-59 (normal), and ≥ 60mg/dL (high). Multivariable linear and logistic regression models were constructed to assess the associations of HDL-C with CMR-obtained measures of IMF, ECV% and native-T1 time, and myocardial scar, respectively. In the fully adjusted model, each 1-SD increment of log HDL-C was associated with a 1% increment in ECV% (p = 0.01) and an 18-ms increment in native-T1 (p < 0.001). When stratified by HDL-C categories, those with high HDL-C (≥ 60mg/dL) had significantly higher ECV (β = 0.5%, p = 0.01) and native-T1 (β = 7 ms, p = 0.01) compared with those with normal HDL-C levels. Those with low HDL-C were not associated with IMF. Results remained unchanged after excluding individuals with a history of myocardial infarction. Neither increasing levels of HDL-C nor any HDL-C category was associated with the prevalence of myocardial scar. Increasing levels of HDL-C were associated with increased markers of IMF, with those with high levels of HDL-C being linked to subclinical fibrosis in a community-based setting.
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Affiliation(s)
- Omar Chehab
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Elie Akl
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ashkan Abdollahi
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ralph Zeitoun
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Colin Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Russell Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT, USA
| | - Roger S Blumenthal
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Annabelle Rodriguez
- Center for Vascular Biology, University of Connecticut Health, Farmington, CT, USA.
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7
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Chehab O, Akl E, Abdollahi A, Zeitoun R, Ambale-Venkatesh B, Wu C, Tracy R, Blumenthal R, Post W, Lima J, Rodriguez A. Higher HDL Cholesterol Levels Are Associated with Increased Markers of Interstitial Myocardial Fibrosis: Insights from The Multi-Ethnic Study of Atherosclerosis. Res Sq 2023:rs.3.rs-3299344. [PMID: 37790448 PMCID: PMC10543254 DOI: 10.21203/rs.3.rs-3299344/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Emerging research indicates that high HDL-C levels might not be cardioprotective, potentially worsening cardiovascular disease(CVD)outcomes. Yet, there's no data on HDL-C's association with other CVD risk factors like myocardial fibrosis, a key aspect of cardiac remodeling predicting negative outcomes. We therefore aimed to study the association between HDL-C levels with interstitial myocardial fibrosis (IMF) and myocardial scar measured by CMR T1-mapping and late-gadolinium enhancement(LGE), respectively. Methods There were 1,863 participants (mean age of 69-years) who had both serum HDL-C measurements and underwent CMR. Analysis was done among those with available indices of interstitial fibrosis (extracellular volume fraction[ECV];N=1,172 and native-T1;N=1,863) and replacement fibrosis by LGE(N=1,172). HDL-C was analyzed as both logarithmically-transformed and categorized into <40 (low), 40-59 (normal), and ≥60mg/dL (high). Multivariable linear and logistic regression models were constructed to assess the associations of HDL-C with CMR-obtained measures of IMF, ECV% and native-T1 time, and myocardial scar, respectively. Results In the fully adjusted model, each 1-SD increment of log HDL-C was associated with a 1% increment in ECV%(p=0.01) and an 18-ms increment in native-T1(p<0.001). When stratified by HDL-C categories, those with high HDL-C(≥60mg/dL) had significantly higher ECV(β=0.5%,p=0.01) and native-T1(β =7ms,p=0.01) compared with those with normal HDL-C levels. Those with low HDL-C were not associated with IMF. Results remained unchanged after excluding individuals with a history of myocardial infarction. Neither increasing levels of HDL-C nor any HDL-C category was associated with the prevalence of myocardial scar. Conclusions Increasing levels of HDL-C were associated with increased markers of IMF, with those with high levels of HDL-C being linked to subclinical fibrosis in a community-based setting.
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Affiliation(s)
| | | | | | | | | | - Colin Wu
- National Heart Lung and Blood Institute
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8
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Akl E, Sniderman AD. Cholesterol, Coronary Calcification, and Cardiovascular Prevention: Lessons We Can Learn From the Western Denmark Heart Registry. Circulation 2023; 147:1064-1066. [PMID: 37011071 DOI: 10.1161/circulationaha.123.063658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Affiliation(s)
- Elie Akl
- Mike and Valeria Rosenbloom Centre for Cardiovascular Prevention, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Allan D Sniderman
- Mike and Valeria Rosenbloom Centre for Cardiovascular Prevention, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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9
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d'Entremont MA, Alrashidi S, Alansari O, Brochu B, Heenan L, Skuriat E, Tyrwhitt J, Raco M, Tsang M, Valettas N, Velianou JL, Sheth TN, Sibbald M, Mehta SR, Pinilla-Echeverri N, Schwalm JD, Natarajan MK, Kelly A, Akl E, Tawadros S, Camargo M, Faidi W, Bauer J, Moxham R, Nkurunziza J, Dutra G, Winter J, Jolly SS. Ultrasound-guided femoral access in patients with vascular closure devices: a prespecified analysis of the randomised UNIVERSAL trial. EUROINTERVENTION 2023; 19:73-79. [PMID: 36876864 PMCID: PMC10174184 DOI: 10.4244/eij-d-22-01130] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Whether ultrasound (US)-guided femoral access compared to femoral access without US guidance decreases access site complications in patients receiving a vascular closure device (VCD) is unclear. AIMS We aimed to compare the safety of VCD in patients undergoing US-guided versus non-US-guided femoral arterial access for coronary procedures. METHODS We performed a prespecified subgroup analysis of the UNIVERSAL trial, a multicentre randomised controlled trial of 1:1 US-guided femoral access versus non-US-guided femoral access, stratified for planned VCD use, for coronary procedures on a background of fluoroscopic landmarking. The primary endpoint was a composite of major Bleeding Academic Research Consortium 2, 3 or 5 bleeding and vascular complications at 30 days. RESULTS Of 621 patients, 328 (52.8%) received a VCD (86% ANGIO-SEAL, 14% ProGlide). In patients who received a VCD, those randomised to US-guided femoral access compared to non-US-guided femoral access experienced a reduction in major bleeding or vascular complications (20/170 [11.8%] vs 37/158 [23.4%], odds ratio [OR] 0.44, 95% confidence interval [CI]: 0.23-0.82). In patients who did not receive a VCD, there was no difference between the US- and non-US-guided femoral access groups, respectively (20/141 [14.2%] vs 13/152 [8.6%], OR 1.76, 95% CI: 0.80-4.03; interaction p=0.004). CONCLUSIONS In patients receiving a VCD after coronary procedures, US-guided femoral access was associated with fewer bleeding and vascular complications compared to femoral access without US guidance. US guidance for femoral access may be particularly beneficial when VCD are used.
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Affiliation(s)
- Marc-André d'Entremont
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada.,Population Health Research Institute, Hamilton, ON, Canada
| | - Sulaiman Alrashidi
- McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada.,Niagara Health, St. Catharines, ON, Canada
| | - Omar Alansari
- McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada.,Niagara Health, St. Catharines, ON, Canada
| | - Bradley Brochu
- CK Hui Heart Centre, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Laura Heenan
- Population Health Research Institute, Hamilton, ON, Canada
| | | | | | - Micheal Raco
- McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada.,Niagara Health, St. Catharines, ON, Canada
| | - Micheal Tsang
- McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada.,Niagara Health, St. Catharines, ON, Canada
| | - Nicholas Valettas
- McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada.,Niagara Health, St. Catharines, ON, Canada
| | - James L Velianou
- McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada.,Niagara Health, St. Catharines, ON, Canada
| | - Tej N Sheth
- Population Health Research Institute, Hamilton, ON, Canada.,McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada.,Niagara Health, St. Catharines, ON, Canada
| | - Matthew Sibbald
- McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada.,Niagara Health, St. Catharines, ON, Canada
| | - Shamir R Mehta
- Population Health Research Institute, Hamilton, ON, Canada.,McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada.,Niagara Health, St. Catharines, ON, Canada
| | - Natalia Pinilla-Echeverri
- Population Health Research Institute, Hamilton, ON, Canada.,McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada.,Niagara Health, St. Catharines, ON, Canada
| | - Jon David Schwalm
- Population Health Research Institute, Hamilton, ON, Canada.,McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada.,Niagara Health, St. Catharines, ON, Canada
| | - Madhu K Natarajan
- Population Health Research Institute, Hamilton, ON, Canada.,McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada.,Niagara Health, St. Catharines, ON, Canada
| | - Andrew Kelly
- McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada.,Niagara Health, St. Catharines, ON, Canada
| | - Elie Akl
- McGill University Faculty of Medicine and Health Sciences, Montreal, QC, Canada
| | | | | | - Walaa Faidi
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - John Bauer
- Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - James Nkurunziza
- McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada.,Niagara Health, St. Catharines, ON, Canada
| | - Gustavo Dutra
- McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jose Winter
- Clinica Alemana De Santiago, Universidad de Desarrollo, Santiago, Chile
| | - Sanjit S Jolly
- Population Health Research Institute, Hamilton, ON, Canada.,McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada.,Niagara Health, St. Catharines, ON, Canada
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10
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Antoniou SA, Florez ID, Markar S, Logullo P, López-Cano M, Silecchia G, Antoniou GA, Tsokani S, Mavridis D, Brouwers M, Bertolaccini L, Alonso-Coello P, Akl E, Chand M, Como JJ, de Borst GJ, Di Saverio S, Emile S, Eom BW, Gorter R, Hanna G, Immonen K, Lai Q, Lumen N, Mathew JL, Montendori A, Moya M, Pellino G, Sanabria A, Saratzis A, Smart N, Stefanidis D, Zaninotto G. Author Correction: AGREE-S: AGREE II extension for surgical interventions: appraisal instrument. Surg Endosc 2023; 37:780. [PMID: 36414872 DOI: 10.1007/s00464-022-09770-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Stavros A Antoniou
- Department of Surgery, Mediterranean Hospital of Cyprus, Limassol, Cyprus. .,European University Cyprus, Nicosia, Cyprus.
| | - Ivan D Florez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, University of Antioquia, Medellin, Colombia
| | - Sheraz Markar
- Nuffield Department of Surgery, University of Oxford, Oxford, UK.,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Patricia Logullo
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Manuel López-Cano
- Abdominal Wall Surgery Unit, Val d' Hebrón University Hospital, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Gianfranco Silecchia
- Department of Medico-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Cardiovascular Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Sofia Tsokani
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Dimitrios Mavridis
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.,Paris Descartes University, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Melissa Brouwers
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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11
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Jolly SS, AlRashidi S, d’Entremont MA, Alansari O, Brochu B, Heenan L, Skuriat E, Tyrwhitt J, Raco M, Tsang M, Valettas N, Velianou JL, Sheth T, Sibbald M, Mehta SR, Pinilla-Echeverri N, Schwalm JD, Natarajan MK, Kelly A, Akl E, Tawadros S, Camargo M, Faidi W, Bauer J, Moxham R, Nkurunziza J, Dutra G, Winter J. Routine Ultrasonography Guidance for Femoral Vascular Access for Cardiac Procedures: The UNIVERSAL Randomized Clinical Trial. JAMA Cardiol 2022; 7:1110-1118. [PMID: 36116089 PMCID: PMC9483833 DOI: 10.1001/jamacardio.2022.3399] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/19/2022] [Indexed: 12/15/2022]
Abstract
Importance A significant limitation of femoral artery access for cardiac interventions is the increased risk of vascular complications and bleeding compared with radial access. Strategies to make femoral access safer are needed. Objective To determine whether routinely using ultrasonography guidance for femoral arterial access for coronary angiography/intervention reduces bleeding or vascular complications. Design, Setting, and Participants The Routine Ultrasound Guidance for Vascular Access for Cardiac Procedures (UNIVERSAL) randomized clinical trial is a multicenter, prospective, open-label trial of ultrasonography-guided femoral access vs no ultrasonography for coronary angiography or intervention with planned femoral access. Patients were randomized from June 26, 2018, to April 26, 2022. Patients with ST-elevation myocardial infarction were not eligible. Interventions Ultrasonography guidance vs no ultrasonography guidance for femoral arterial access on a background of fluoroscopic landmarking. Main Outcomes and Measures The primary composite outcome is the composite of major bleeding based on the Bleeding Academic Research Consortium 2, 3, or 5 criteria or major vascular complications within 30 days. Results A total of 621 patients were randomized at 2 centers in Canada (mean [SD] age, 71 [10.24] years; 158 [25.4%] female). The primary outcome occurred in 40 of 311 patients (12.9%) in the ultrasonography group vs 50 of 310 patients (16.1%) without ultrasonography (odds ratio, 0.77 [95% CI, 0.49-1.20]; P = .25). The rates of Bleeding Academic Research Consortium 2, 3, or 5 bleeding were 10.0% (31 of 311) vs 10.7% (33 of 310) (odds ratio, 0.93 [95% CI, 0.55-1.56]; P = .78). The rates of major vascular complications were 6.4% (20 of 311) vs 9.4% (29 of 310) (odds ratio, 0.67 [95% CI, 0.37-1.20]; P = .18). Ultrasonography improved first-pass success (277 of 311 [86.6%] vs 222 of 310 [70.0%]; odds ratio, 2.76 [95% CI, 1.85-4.12]; P < .001) and reduced the number of arterial puncture attempts (mean [SD], 1.2 [0.5] vs 1.4 [0.8]; mean difference, -0.26 [95% CI, -0.37 to -0.16]; P < .001) and venipuncture (10 of 311 [3.1%] vs 37 of 310 [11.7%]; odds ratio, 0.24 [95% CI, 0.12-0.50]; P < .001) with similar times to access (mean [SD], 114 [185] vs 129 [206] seconds; mean difference, -15.1 [95% CI, -45.9 to 15.8]; P = .34). All prerandomization prespecified subgroups were consistent with the overall finding. Conclusions and Relevance In this randomized clinical trial, use of ultrasonography for femoral access did not reduce bleeding or vascular complications. However, ultrasonography did reduce the risk of venipuncture and number of attempts. Larger trials may be required to demonstrate additional potential benefits of ultrasonography-guided access. Trial Registration ClinicalTrials.gov Identifier: NCT03537118.
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Affiliation(s)
- Sanjit S. Jolly
- Population Health Research Institute, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St Catherines, Ontario, Canada
| | - Sulaiman AlRashidi
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St Catherines, Ontario, Canada
| | - Marc-André d’Entremont
- Population Health Research Institute, Hamilton, Ontario, Canada
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
| | - Omar Alansari
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St Catherines, Ontario, Canada
| | - Bradley Brochu
- CK Hui Heart Centre, Royal Alexandra Hospital Edmonton, Edmonton, Alberta, Canada
| | - Laura Heenan
- Population Health Research Institute, Hamilton, Ontario, Canada
| | | | | | - Michael Raco
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St Catherines, Ontario, Canada
| | - Michael Tsang
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St Catherines, Ontario, Canada
| | - Nicholas Valettas
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St Catherines, Ontario, Canada
| | - James L. Velianou
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St Catherines, Ontario, Canada
| | - Tej Sheth
- Population Health Research Institute, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St Catherines, Ontario, Canada
| | - Matthew Sibbald
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St Catherines, Ontario, Canada
| | - Shamir R. Mehta
- Population Health Research Institute, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St Catherines, Ontario, Canada
| | - Natalia Pinilla-Echeverri
- Population Health Research Institute, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St Catherines, Ontario, Canada
| | - Jon David Schwalm
- Population Health Research Institute, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St Catherines, Ontario, Canada
| | - Madhu K. Natarajan
- Population Health Research Institute, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St Catherines, Ontario, Canada
| | - Andrew Kelly
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St Catherines, Ontario, Canada
| | - Elie Akl
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | | | | | - Walaa Faidi
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - John Bauer
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - James Nkurunziza
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St Catherines, Ontario, Canada
| | - Gustavo Dutra
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Jose Winter
- Departamento de enfermedades cardiovasculares, Clínica Alemana De Santiago, Universidad del Desarrollo, Chile
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12
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Alrashidi S, d’Entremont MA, Alansari O, Winter J, Brochu B, Heenan L, Skuriat E, Tyrwhitt J, Raco M, Tsang MB, Valettas N, Velianou J, Sheth T, Sibbald M, Mehta SR, Pinilla-Echeverri N, Schwalm JD, Natarajan MK, Kelly A, Akl E, Tawadros S, Camargo M, Faidi W, Dutra G, Jolly SS. Design and Rationale of Routine Ultrasou Nd Gu Idance for Vascular Acc Ess fo R Cardiac Procedure s: A Randomized Tria L (UNIVERSAL). CJC Open 2022; 4:1074-1080. [PMID: 36562014 PMCID: PMC9764117 DOI: 10.1016/j.cjco.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/22/2022] [Indexed: 12/25/2022] Open
Abstract
Background A significant limitation of femoral artery access for cardiac interventions is the increased risk of vascular complications and bleeding compared to radial access. Ultrasound (US)-guided femoral access may reduce major vascular complications and bleeding. We aim to determine whether routinely using US guidance for femoral arterial access for coronary angiography or intervention will reduce Bleeding Academic Research Consortium (BARC) 2, 3, or 5 bleeding or major vascular complications. Methods The Ultrasound Guidance for Vascular Access for Cardiac Procedures: A Randomized Trial (UNIVERSAL) is a multicentre, prospective, open-label, randomized trial with blinded outcomes assessment. Patients undergoing coronary angiography with or without intervention via a femoral approach with fluoroscopic guidance will be randomized 1:1 to US-guided femoral access, compared to no US. The primary outcome is the composite of major bleeding based on the BARC 2, 3, or 5 criteria or major vascular complications within 30 days. The trial is designed to have 80% power and a 2-sided alpha level of 5% to detect a 50% relative risk reduction for the primary outcome based on a control event rate of 14%. Results We completed enrollment on April 29, 2022, with 621 randomized patients. The patients had a mean age of 71 years (25.4% female), with a high rate of comorbidities, as follows: 45% had a prior percutaneous coronary intervention; 57% had previous coronary artery bypass surgery; and 18% had peripheral vascular disease. Conclusions The UNIVERSAL trial will be one of the largest randomized trials of US-guided femoral access and has the potential to change guidelines and increase US uptake for coronary procedures worldwide.
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Affiliation(s)
- Sulaiman Alrashidi
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada
| | - Marc-André d’Entremont
- Population Health Research Institute, Hamilton, Ontario, Canada,Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
| | - Omar Alansari
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada
| | - Jose Winter
- Clinica Alemana de Santiago, Santiago, Chile
| | - Bradley Brochu
- CK Hui Heart Centre, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Laura Heenan
- Population Health Research Institute, Hamilton, Ontario, Canada
| | | | | | - Michael Raco
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada
| | - Michael B. Tsang
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada
| | - Nicholas Valettas
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada
| | - James Velianou
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada
| | - Tej Sheth
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Matthew Sibbald
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada
| | - Shamir R. Mehta
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Natalia Pinilla-Echeverri
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jon David Schwalm
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Madhu K. Natarajan
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Andrew Kelly
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada
| | - Elie Akl
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Walaa Faidi
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Gustavo Dutra
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Sanjit S. Jolly
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada,Population Health Research Institute, Hamilton, Ontario, Canada,Corresponding author: Dr Sanjit S. Jolly, Population Health Research Institute, Hamilton General Hospital, 237 Barton St. East, Hamilton, Ontario L8L 2X2, Canada. Tel.: +1-905-521-2100 ext. 40309.
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13
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Gédéon T, Akl E, D'Souza R, Altit G, Rowe H, Flannery A, Siriki P, Bhatia K, Thorne S, Malhamé I. Acute Myocardial Infarction in Pregnancy. Curr Probl Cardiol 2022; 47:101327. [PMID: 35901856 DOI: 10.1016/j.cpcardiol.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/17/2022] [Indexed: 11/03/2022]
Abstract
Cardiovascular disease, and particularly ischemic heart disease, is a leading cause of maternal morbidity and mortality in high-income countries. The incidence of acute myocardial infarction (AMI) has been rising over the past two decades due to increasing maternal age and a higher prevalence of cardiovascular risk factors in the pregnant population. Causes of AMI in pregnancy are diverse and may require specific considerations for their diagnosis and management. In this narrative review, we provide an overview of physiologic changes, risk factors, and etiologies leading to AMI in pregnancy, as well as diagnostic tools, reperfusion strategies, and pharmacological treatments for this complex population. In addition, we outline considerations for labor and delivery planning and long-term follow-up of patients with AMI in pregnancy.
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Affiliation(s)
- Tara Gédéon
- Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Elie Akl
- Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Rohan D'Souza
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Gabriel Altit
- Department of Paediatrics, McGill University Health Centre, Montreal, Canada
| | - Hilary Rowe
- Department of Pharmacy, Nanaimo Regional General Hospital, Island Health, Nanaimo, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Alexandria Flannery
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | | | - Kailash Bhatia
- Department of Anaesthesia, Manchester University Hospitals and St Mary's Hospital, University of Manchester, Manchester, United Kingdom
| | - Sara Thorne
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Isabelle Malhamé
- Department of Medicine, McGill University Health Centre, Montreal, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada.
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14
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Akl E, Pinilla-Echeverri N, Garcia-Garcia HM, Mehta SR, Dan K, Kuku KO, Courtney BK, Sheth T. First in-human evaluation of a novel intravascular ultrasound and optical coherence tomography system for intracoronary imaging. Catheter Cardiovasc Interv 2021; 99:686-698. [PMID: 34792273 DOI: 10.1002/ccd.30001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/17/2021] [Accepted: 10/19/2021] [Indexed: 11/07/2022]
Abstract
AIMS We evaluated the first in-human performance of a novel hybrid imaging catheter that permits simultaneous and co-registered acquisition of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) images. METHODS AND RESULTS A total of 17 patients undergoing planned percutaneous coronary intervention (PCI) were imaged between August 2018 and August 2019. Eleven patients with both pre- and post-PCI IVUS and OCT images were included in the offline image analysis. IVUS and OCT images were analyzed separately then together with co-registered images for pre-stent findings, and only separately for post-stent findings. A total of 926 frames were analyzed (218 pre-PCI, 708 post-PCI). There was substantial agreement to detect calcific plaque between co-registered IVUS-OCT and standalone IVUS (Kappa 0.72 [0.65-0.79]) and standalone OCT (Kappa 0.75 [0.68-0.81]) while standalone imaging modalities showed lower agreement to detect lipidic and fibrotic plaques compared with co-registered IVUS-OCT. There were more frames with stent underexpansion on IVUS than OCT [72 (28.7%) vs. 58 (23.1%), respectively, p = 0.039]. Detection rates of incomplete stent apposition (present on 20 OCT frames vs. 2 IVUS frames, p < 0.001) and tissue protrusion (40 vs. 27 frames, p < 0.001) were higher on OCT than IVUS. One stent edge dissection was detected in the image analysis and was seen on OCT but not IVUS. All 177 frames with image artifacts contained at least one co-registered imaging modality with interpretable diagnostic content. There were no study device-related adverse events. CONCLUSIONS Hybrid image acquisition was safe. The availability of both IVUS and OCT changed image interpretation compared to either modality alone, suggesting a complementary role of these two techniques.
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Affiliation(s)
- Elie Akl
- Department of Medicine, Division of Cardiology, McGill University, Montreal, Canada
| | - Natalia Pinilla-Echeverri
- Department of Medicine, Division of Cardiology, McMaster University, Hamilton, Ontario, Canada.,Department of Cardiology, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Hector M Garcia-Garcia
- Department of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Shamir R Mehta
- Department of Medicine, Division of Cardiology, McMaster University, Hamilton, Ontario, Canada.,Department of Cardiology, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Kazuhiro Dan
- Department of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Kayode O Kuku
- Department of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Brian K Courtney
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Conavi Medical Inc., Toronto, Ontario, Canada
| | - Tej Sheth
- Department of Medicine, Division of Cardiology, McMaster University, Hamilton, Ontario, Canada.,Department of Cardiology, Population Health Research Institute, Hamilton, Ontario, Canada
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15
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Chu D, Khamis A, Akl E, Neumann I, Solo K, Schunemann H. Revisiting the evidence for physical distancing, face masks, and eye protection - Authors' reply. Lancet 2021; 398:663-664. [PMID: 34419202 PMCID: PMC8426154 DOI: 10.1016/s0140-6736(21)01734-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/22/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Derek Chu
- McMaster University, Hamilton, ON L8S 4L8, Canada
| | | | - Elie Akl
- American University of Beirut, Beirut, Lebanon
| | | | - Karla Solo
- McMaster University, Hamilton, ON L8S 4L8, Canada
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16
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Jolly S, Akl E. Should we use the transradial approach in cardiogenic shock? Pol Arch Intern Med 2021; 131:409-410. [PMID: 34034465 DOI: 10.20452/pamw.16008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sanjit Jolly
- Division of Cardiology, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada.
| | - Elie Akl
- Division of Cardiology, McGill University, Montreal, Quebec, Canada
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17
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Nassar A, Adib E, Abou Alaiwi S, Akl E, El Zarif T, Nuzzo PV, Mouhieddine TH, El-Khoury H, Groha S, Sonpavde GP, Haddad RI, Mouw KW, Giannakis M, Ananda G, Freedman ML, Kwiatkowski DJ, MacConaill LE, Choueiri TK, Gusev A. Genetic ancestry and clinical outcomes to immune checkpoint inhibitors among seven common cancers. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.10536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10536 Background: Prior studies and clinical trials report associations between self-reported race and clinical outcomes to Immune Checkpoint Inhibitors (ICIs). However, comprehensive studies of ancestry-associated differences in clinical outcomes have not been performed. We derived genetic ancestry scores and assessed clinical outcomes in 1341 patients with cancer treated with ICIs. Methods: Patients at the Dana-Farber Cancer Institute treated with ICIs only and with relevant cancer types and targeted exome sequencing data (Oncopanel) were included. Relevant cancer types included colorectal adenocarcinoma (CRC), esophagogastric adenocarcinoma (EGC), head and neck squamous cell carcinoma (HNSCC), melanoma, non-small cell lung cancer (NSCLC), renal cell carcinoma (RCC), and urothelial carcinoma (UC). We developed a bioinformatics pipeline to infer fine-scale genetic ancestry for each patient (n=1341) directly from tumor sequencing data by leveraging off and on-target sequenced reads and external ancestry reference panels. Three ancestry scores were determined (African, East Asian, European). Overall survival (OS) and time-to-treatment failure (TTF) were compared by Cox logistic regression between ancestral populations. Hazard ratio (HR) was derived using multivariable analysis, adjusted for single versus combination therapy, prior lines of therapy, and tumor mutational burden (TMB, as percentiles). Results: Median follow-up was 37.8 months (m; interquartile range: 35.7-39.5m). Common cancer types included CRC (n=52), EGC (n=114), HNSCC (n=88), melanoma (n=274), NSCLC (n=571), RCC (n=99), and UC (n=143). A higher East Asian ancestry (EAS) was significantly associated with worse OS ( p=0.03) and TTF ( p=0.002) in patients with RCC, independent of the histologic subtype (Table). There was no significant association between any of the three ancestral populations and clinical outcomes in the other 6 cancer types. Conclusions: We described clinical outcomes to ICIs across three global populations in 7 cancers. As the medical field re-evaluates the use of self-reported race in clinical decision-making, we utilize a novel ancestry pipeline that can be readily applied to tumor-only sequencing panels and better characterize non-white populations. We find no ancestry differences in clinical outcomes except in patients with RCC treated with ICIs which will require future validation. We plan to analyze genomic correlates of response by ancestry in each of the cancer types to better understand these diverge clinical behaviors.[Table: see text]
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Affiliation(s)
| | - Elio Adib
- The Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Sarah Abou Alaiwi
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Elie Akl
- Brigham and Women's Hospital, Boston, MA
| | | | | | | | | | | | - Guru P. Sonpavde
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Robert I. Haddad
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | | | - Matthew L. Freedman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Laura E MacConaill
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - Toni K. Choueiri
- Dana-Farber Cancer Institute, The Lank Center for Genitourinary Oncology, Boston, MA
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Adib E, Akl E, Nassar A, El Zarif T, Abou Alaiwi S, Kwiatkowski DJ. Genomic landscape of malignnant mesothelioma by site and histology. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.8559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8559 Background: Malignnant mesothelioma (MM) is a highly lethal tumor that can develop in the pleura, the peritoneum, the pericardium or the testes. While the genomic features of pleural MM have been well-described overall, less is known about the distribution of genetic alterations (GAs) according to histology. In addition, few reports comparing genetic features according to disease site are available. Methods: We identified patients with pleural or peritoneal mesothelioma with mutational analysis through the GENIE registry. Patient tumor genetic data were provided by Memorial Sloan-Kettering Cancer Center (MSK)-IMPACT and Dana-Farber Cancer Institute (DFCI)-Oncopanel NGS initiatives. Patients with more than one sequenced sample were excluded. We limited our analysis to genes common to all versions of both panels and that were significantly mutated in the TCGA mesothelioma cohort. Mutation and copy number variant (CNV), collectively called GAs, were determined, and were compared using the Fisher’s Exact test and Kruskal-Wallis Test. Comparisons were made both by disease site (pleural vs. peritoneal) and histology for the pleural samples (epithelioid vs. biphasic vs. sarcomatoid). Nominal p-values were obtained, and FDR correction was employed (q<0.1). Results: We identified 439 patients with MM in the GENIE registry who fit the inclusion criteria. The median age was 70.5 years for pleural MM and 60 years for peritoneal MM (Wilcoxon-rank sum test p-value = 3e-9). 72% of patients were male. CDKN2A/CDKN2B GAs (97% and 100% being deletions in CDKN2A and CDKN2B respectively), a described prognostic marker in MM, were more common in pleural than in peritoneal MM. Among pleural MMs, tumors of epithelioid histology had less NF2 GAs than biphasic or sarcomatoid tumors, whereas sarcomatoid tumors had the lowest frequency of BAP1 GAs (Table). Conclusions: Malignnant mesotheliomas of different disease sites and/or histologies display distinct patterns of GAs. These findings may contribute in part to differences in response to treatment and survival among these subsets of MM.[Table: see text]
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Affiliation(s)
- Elio Adib
- The Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Elie Akl
- Brigham and Women's Hospital, Boston, MA
| | | | | | - Sarah Abou Alaiwi
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
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Adib E, Nassar A, Akl E, Abou Alaiwi S, El Zarif T, El-Khoury H, Ananda G, Choueiri TK, Gusev A. Improving tumor mutational burden calibration in non-European patients. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.1559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1559 Background: Tumor mutational burden (TMB), has been recently granted FDA approval as a biomarker for ICI treatment in tumors with a high mutation load (≥ 10/MB). To leverage this biomarker in the clinical setting, it is necessary to evaluate its application in diverse patient populations. In particular, tumor-only sequencing may overestimate TMB in non-EUR populations for which reference panels are small or unavailable, and thus have poorer predictive performance. Herein, we investigate the effect of TMB overestimation in non-EURs on patient diagnosis and clinical outcomes in a real world patient cohort. Methods: TMB was computed using a tumor-only NGS platform (Oncopanel) for 8349 cancer patients (pts) of 7 cancer types (Table). Genetic ancestry was inferred directly from tumor sequencing data and confirmed for a subset of pts using germline SNP arrays. TMB was compared using Wilcoxon rank-sum test between European (EUR) and non-EUR pts. TMB percentile rank by ancestral group (East Asian, African, European) and tumor histology was computed. In non-EUR pts, TMB was calibrated by reassigning its value to the corresponding percentile rank in EUR pts having the same cancer (AH-TMB). Tumors with raw TMB ≥ 10/MB were assigned as TMB-high (TMBH; with the rest referred to as TMBL for TMB-low) and those with calibrated AH-TMB ≥ 10/MB as AH-TMBH. A subset of pts treated with ICIs at DFCI and of EUR ancestry were analyzed. TMB was intentionally mis-calibrated in EURs (MC-TMB), to mimic the TMB overestimation observed in non-EURs. Associations between TMBH status and overall survival (OS) was assessed using Cox regression. Results: Uncalibrated TMB was significantly higher in tumors from non-EUR pts overall (p <0.0001, Table) as anticipated, whereas this difference was not observed in tumors with matched germline filtering. We reassigned non-EUR pts into low/high groups using calibrated AH-TMB, which changed the assignment of 67/670 non-EURs, most of which (65/67) were downgraded from TMBH to AH-TMBL. In the ICI-treated cohort, there was a strong association between TMBH status and OS (p = 2e-11, HR = 0.6) whereas MC-TMBH (mimicking the miscalibration in non-EUR samples) had a weaker association with OS (p = 0.0013, HR = 0.8). Importantly, pts assigned to TMB-H due to miscalibration (90 TMB-L/MC-TMBH pts) had shorter OS compared to the true TMBH group (p = 3e-6, HR = 1.9). Conclusions: In this analysis, we showed that tumor-only sequencing platforms can overestimate TMB in non-EUR pts, impacting treatment decisions and outcomes. Replacing raw TMB counts with an ancestry-adjusted measure could optimize TMB application in the clinical setting when germline sequencing is not available. Accurate ancestry inference can be performed using tumor-only sequencing.[Table: see text]
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Affiliation(s)
- Elio Adib
- The Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | | | - Elie Akl
- Brigham and Women's Hospital, Boston, MA
| | - Sarah Abou Alaiwi
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | - Toni K. Choueiri
- Dana-Farber Cancer Institute, The Lank Center for Genitourinary Oncology, Boston, MA
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Moxham R, Džavík V, Cairns J, Natarajan MK, Bainey KR, Akl E, Tsang MB, Lavi S, Cantor WJ, Madan M, Liu YY, Jolly SS. Association of Thrombus Aspiration With Time and Mortality Among Patients With ST-Segment Elevation Myocardial Infarction: A Post Hoc Analysis of the Randomized TOTAL Trial. JAMA Netw Open 2021; 4:e213505. [PMID: 33769510 PMCID: PMC7998077 DOI: 10.1001/jamanetworkopen.2021.3505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Patients with shorter ischemic times have a greater viable myocardium and may derive greater benefit from thrombus aspiration. OBJECTIVE To study the association of thrombus aspiration with outcomes among patients presenting with ST-segment elevation myocardial infarction (STEMI) based on time. DESIGN, SETTING, AND PARTICIPANTS The TOTAL (Thrombectomy With PCI vs PCI Alone in Patients with STEMI) trial was an international randomized clinical trial of 10 732 patients with STEMI undergoing primary percutaneous coronary intervention (PCI) within 12 hours of symptom onset. Patients were recruited between August 5, 2010, and July 25, 2014, and were followed up for 1 year. Data analysis was performed from February 22, 2019, to January 5, 2021. INTERVENTIONS Thrombus aspiration vs PCI alone. MAIN OUTCOMES AND MEASURES Post hoc subgroup analyses were performed for total ischemic time and first medical contact (FMC)-to-device time for the primary outcomes (cardiovascular [CV] mortality, myocardial Infarction [MI], cardiogenic shock, and New York Heart Association class IV heart failure) and angiographically determined distal embolization. In addition, a multivariable analysis was performed to assess the association of total ischemic time and FMC-to-device time with CV mortality at 1 year. RESULTS The study randomized 10 732 patients, and 9986 underwent primary PCI and had time data available (7737 men [77.5%]; mean [SD] age, 61.0 [12.0] years). For the randomized comparison of thrombus aspiration, there was a reduction in angiographic distal embolization with thrombus aspiration that was more pronounced in patients with short ischemic times (<2 hours: odds ratio [OR], 0.23 [95% CI, 0.09-0.62]; 2-6 hours: OR, 0.54 [95% CI, 0.39-0.73]; >6 hours: OR, 0.70 [95% CI, 0.33-1.50]; P = .12 for interaction). However, for the primary composite outcome, there was no benefit based on (1) total ischemic time (<2 hours: hazard ratio [HR], 0.77 [95% CI, 0.46-1.28]; 2-6 hours: HR, 1.03 [95% CI, 0.85-1.25]; >6 hours: HR, 0.87 [95% CI, 0.60-1.27]; P = .46 for interaction) or (2) FMC-to-device time (<60 minutes: HR, 1.14 [95% CI, 0.66-1.95]; 60-90 minutes: HR, 0.94 [95% CI, 0.67-1.32]; >90-120 minutes: HR, 1.19 [95% CI, 0.85-1.67]; >120 minutes: HR, 0.89 [95% CI, 0.70-1.14]; P = .54 for interaction). In a multivariable analysis, both total ischemic time (>2 hours: HR, 1.26 [95% CI, 1.00-1.58) and FMC-to-device time (>120 minutes: HR, 1.45 [95% CI, 1.18-1.79]) were independently associated with CV mortality. CONCLUSIONS AND RELEVANCE This analysis suggests that thrombus aspiration does not appear to be associated with an improvement in clinical outcomes regardless of ischemic time. In the current STEMI era, both total ischemic time and FMC-to-device times continue to be important factors associated with mortality. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01149044.
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Affiliation(s)
- Rachel Moxham
- McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Vladimír Džavík
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - John Cairns
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Madhu K. Natarajan
- McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Kevin R. Bainey
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Elie Akl
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael B. Tsang
- McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Shahar Lavi
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Warren J. Cantor
- Southlake Regional Health Center, University of Toronto, Toronto, Ontario, Canada
| | - Mina Madan
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Yan Yun Liu
- McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Sanjit S. Jolly
- McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
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21
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Abraham GM, Obley AJ, Humphrey LL, Qaseem A, Centor RM, Akl E, Forceia MA, Haeme R, Hamilton PG, Hood GA, Jokela JA, Kansagara DL, Levine MA, Mason JR, Marcucci M. World Health Organization Guidelines on Treatment of Hepatitis C Virus Infection: Best Practice Advice From the American College of Physicians. Ann Intern Med 2021; 174:98-100. [PMID: 33017566 DOI: 10.7326/m19-3860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Affiliation(s)
- George M Abraham
- University of Massachusetts Medical School and Saint Vincent Hospital, Worcester, Massachusetts (G.M.A.)
| | - Adam J Obley
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
| | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
| | - Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
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Santesso N, Akl E, Bhandari M, Busse JW, Cook DJ, Greenhalgh T, Muti P, Schünemann H, Guyatt G. A practical guide for using a survey about attitudes and behaviors to inform health care decisions. J Clin Epidemiol 2020; 128:93-100. [PMID: 32987165 DOI: 10.1016/j.jclinepi.2019.11.020] [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] [Received: 06/10/2019] [Revised: 10/21/2019] [Accepted: 11/06/2019] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Surveys can provide important information about what people think or do. There is little guidance about how to use surveys in decision-making. This article provides guidance for how to appraise and use a survey to answer health care questions. STUDY DESIGN AND SETTING A guidance article about the use a survey of a selected sample of people, who completed a self-report tool about their knowledge, beliefs and opinions, behaviors and experiences, or personal attributes. We use survey examples, one scenario, and a specific survey for illustration. RESULTS Decision makers should consider the credibility and applicability of the results of a survey. Key threats to credibility depend on the representativeness of the population and likelihood that it provides an accurate picture of the population's knowledge, attitudes, or self-reported practices. If survey investigators do not use rigorous strategies to develop or pretest questions, there is a greater risk that results will be misleading. Decision makers may want to consider the precision of estimates and whether it would change their decisions. Finally, they need to decide how similar the surveyed population is to their specific population before applying results. CONCLUSIONS Decision makers can follow this guidance to critically appraise, interpret, and apply the results of surveys to health care questions.
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Affiliation(s)
- Nancy Santesso
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Elie Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | | | - Paola Muti
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Holger Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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23
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Oqab Z, Akl E, Mehta SR. Novel approaches to guide complete revascularisation in patients with STEMI and multivessel coronary artery disease. EUROINTERVENTION 2020; 15:e1558-e1559. [PMID: 32234687 DOI: 10.4244/eijv15i18a284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Zardasht Oqab
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
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24
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Abou Alaiwi S, Nassar A, Adib E, Akl E, Groha S, Esplin ED, Nielsen S, Yang S, McGregor BA, Pomerantz M, Gusev A, Rana HQ, Sonpavde G, Garber JE, Freedman ML, Choueiri TK. Prevalence of pathogenic germline risk variants (PVs) in 1,829 renal cell carcinoma (RCC) patients (pts). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
659 Background: Hereditary RCCs account for 3-5% of all RCC cases. The prevalence and significance of germline PVs of RCC have not been fully characterized. Methods: We evaluated the frequency of pathogenic and likely pathogenic variants, referred to as PVs, in 1829 high-risk RCC pts who underwent targeted clinical germline testing (1-134 genes) at a commercial laboratory. PVs, including single nucleotide variants/indels/ copy number variants, were confirmed using orthogonal technology in accordance with Invitae’s standard operating practices. Actionable genes were defined as established cancer-predisposition genes that confer a higher risk for any cancer phenotype and for which enhanced screening and family genetic testing are recommended by the National Comprehensive Cancer Network. We focused our analysis on genes tested in more than 100 pts (n=93). Results: Among 1892 pts, 54.9% were male, and 68.9% were Caucasians, with median age 50 (range:1-87) years at RCC diagnosis. 11.8% (n=215) of pts had at least 2 primary RCCs, and 30.7% (n= 561) had a personal history of another cancer. The cumulative frequency of pts with PVs was 17.7%. PVs in known RCC susceptibility genes such as FH, FLCN, and SDHB were detected in 1.8% (29/1622), 1.22% (120/1634) and 0.64% (11/1727) of pts respectively. PVs in other cancer-associated genes were most frequently reported in CHEK2 (loss-of-function variants, 30/1276, 2.4%), MUTYH (19/1124, 1.7%), and BRCA2 (17/1276, 1.33%). PVs in DNA-damage repair genes (DRG) accounted for 71.8% of PVs and, overall, were detected in 12.7% of pts. Among the DRG, PVs in the homologous recombination pathway (ATM, BARD1, BLM, BRCA1, BRCA2, BRIP1, CHEK2, NBN, PALB2, RECQL4, WRN) were the most prevalent (7.8%) whereas the mismatch repair pathway (MLH1, MSH2, MSH6, PMS2) was altered in only 0.7% of pts. Of the examined cohort, 9.7% of pts had ≥1 actionable PV. In non-Caucasians, BRCA2 PVs were the most common (6/273, 2.20%). Conclusions: PVs were identified in 17.7% of RCC subjects, most of which (71.8%) were in DRG, with »10% of pts having actionable variants. Our work is concordant with known RCC susceptibility genes and potentially highlights novel risk genes that should be validated in future studies.
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Affiliation(s)
- Sarah Abou Alaiwi
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Elio Adib
- Dana Farber Cancer Institute, Boston, MA
| | - Elie Akl
- Brigham and Women's Hospital, Boston, MA
| | | | | | | | | | | | - Mark Pomerantz
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Huma Q. Rana
- Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA
| | | | - Judy Ellen Garber
- Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA
| | - Matthew L. Freedman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Toni K. Choueiri
- Dana-Farber Cancer Institute/Brigham and Women’s Hospital and Harvard University School of Medicine, Boston, MA
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Abstract
Considerable evidence supports transradial angiography and intervention in patients with acute coronary syndrome, with an emphasis on decreasing major bleeding and access site vascular complications. Patients undergoing invasive treatment are at greatest risk of bleeding and have the most to gain. The radial advantage has consistently been shown to translate into reduced mortality in pooled data analyses. The benefits of transradial access have been demonstrated across the acute coronary syndrome spectrum and in both sexes. A radial-first strategy should be the default approach and continuous efforts should be made to increase operator expertise of transradial access in these patients.
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Affiliation(s)
- Elie Akl
- Department of Medicine, Division of Cardiology, McMaster University, Room C3-118, DBCVSRI Building, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Mohammed K Rashid
- Department of Medicine, Division of Cardiology, McMaster University, Room C3-118, DBCVSRI Building, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Ahmad Alshatti
- Department of Medicine, Division of Cardiology, McMaster University, Room C3-118, DBCVSRI Building, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Sanjit S Jolly
- Department of Medicine, Division of Cardiology, McMaster University, Room C3-118, DBCVSRI Building, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada; Population Health Research Institute, Hamilton, Ontario, Canada.
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Akl E, Dzavik V, Cairns J, Lavi S, Mehta S, Cantor W, Sibbald M, Cheema A, Welsh R, Sheth T, Bertrand O, Liu Y, Jolly S. HEART FAILURE IN ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION, PREDICTORS AND PROGNOSTIC IMPACT: INSIGHTS FROM THE TOTAL TRIAL. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Akl E, Dzavik V, Cairns J, Lavi S, Mehta S, Cantor W, Sibbald M, Cheema A, Welsh R, Sheth T, Bertrand O, Rao S, Moreno R, Liu YY, Jolly S. TCT-487 Heart Failure in ST-Segment Elevation Myocardial Infarction, Predictors and Prognostic Impact: Insights From the TOTAL Trial. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Moxham R, Dzavik V, Cairns J, Natarajan M, Bainey K, Akl E, Tsang M, Lavi S, Cantor W, Liu Y, Jolly S. TIME AND MORTALITY IN ST ELEVATION MYOCARDIAL INFARCTION: INSIGHTS FROM THE TOTAL TRIAL. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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El Khoury J, Noufi P, Ahmad A, Akl E, El Hayek S. Attitudes, beliefs, and knowledge of substance use amongst youth in the Eastern Mediterranean region: A systematic review. Drug Alcohol Depend 2019; 196:71-78. [PMID: 30716567 DOI: 10.1016/j.drugalcdep.2018.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/06/2018] [Accepted: 12/21/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Substance use has a tremendous impact on the burden of disease. This is particularly true in the Eastern Mediterranean region (EMR), where many countries serve as suppliers of drugs. As risk perception and frequency of use are inversely correlated, targeting perception during adolescence becomes essential for prevention. In this study, we systematically reviewed the literature on attitudes, beliefs, and knowledge of substance use amongst youth in the EMR. METHODS We reviewed quantitative articles addressing attitudes, beliefs, and knowledge of youth aged between 13 and 25 years towards substance use in the EMR. We searched MEDLINE, PubMed, Cochrane, PsycInfo, and PsycArticles then applied a duplicate independent method for study selection and screening. Two reviewers completed data abstraction and a narrative summary of findings. RESULTS Our search generated 12,810 articles. Five cross-sectional studies were eligible (two analytic and three descriptive). The analytic studies described a significant correlation between intention to use and both attitudes and subjective norms. The descriptive studies portrayed a negative attitude towards use with a low threshold for considering it as serious. Beliefs pertaining to reasons for use included stress and sleeping, whereas thoughts on treatment were restricted to traditional methods based on personal resilience and religious support. Knowledge about substance use symptoms, withdrawal, and treatment was low. CONCLUSION Our review ascertains the role of sociocultural moral prohibition and awareness of mental health as major influencers in shaping the perception of substance use. Further research is needed to elaborate culturally-tailored survey tools.
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Affiliation(s)
- Joseph El Khoury
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Paul Noufi
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Amanda Ahmad
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Elie Akl
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Samer El Hayek
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon.
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Rosenbaum SE, Moberg J, Glenton C, Schünemann HJ, Lewin S, Akl E, Mustafa RA, Morelli A, Vogel JP, Alonso‐Coello P, Rada G, Vásquez J, Parmelli E, Gülmezoglu AM, Flottorp SA, Oxman AD. Developing Evidence to Decision Frameworks and an Interactive Evidence to Decision Tool for Making and Using Decisions and Recommendations in Health Care. Glob Chall 2018; 2:1700081. [PMID: 31565348 PMCID: PMC6607226 DOI: 10.1002/gch2.201700081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/16/2017] [Indexed: 05/08/2023]
Abstract
Evidence-informed health care decisions and recommendations need to be made systematically and transparently. Mediating technology can help manage boundaries between groups making decisions and target audiences, enhancing salience, credibility, and legitimacy for all. This article describes the development of the Evidence to Decision (EtD) framework and an interactive tool to create and use frameworks (iEtD) to support communication in decision making. Methods: Using a human-centered design approach, we created prototypes employing a broad range of methods to iteratively develop EtD framework content and iEtD tool functionality. Results: We developed tailored EtD frameworks for making evidence-informed decisions and recommendations about clinical practice interventions, diagnostic and screening tests, coverage, and health system and public health options. The iEtD tool provides functionality for preparing frameworks, using them in group discussions, and publishing output for implementation or adaption. EtD and iEtD are intuitive and useful for producers and users of frameworks, and flexible for use across different types of topics, decisions, and organizations. They bring valued structure to panel discussions and transparency to published output. Conclusion: EtD and iEtD can resolve some of the challenges inherent in multicriteria, multistakeholder decision systems. They are freely available online for all to use at https://ietd.epistemonikos.org/ and https://gradepro.org.
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Affiliation(s)
- Sarah E. Rosenbaum
- Centre for Informed Health ChoicesNorwegian Institute of Public HealthPostboks 4404 Nydalen,N‐0403OsloNorway
| | - Jenny Moberg
- Centre for Informed Health ChoicesNorwegian Institute of Public HealthPostboks 4404 Nydalen,N‐0403OsloNorway
| | - Claire Glenton
- Global Health UnitNorwegian Institute of Public HealthPO Box 4404, Nydalen,N‐0403OsloNorway
| | - Holger J. Schünemann
- Department of Health Research MethodsEvidence, and Impact (formerly “Clinical Epidemiology and Biostatistics”)McMaster University1280 Main Street WHamiltonON L8S 4K1Canada
| | - Simon Lewin
- Norwegian Institute of Public Health, andSouth African Medical Research Council, Health Systems Research UnitPO Box 19070,7505TygerbergSouth Africa
| | - Elie Akl
- Department of Internal MedicineAmerican University of Beirut Medical CenterP.O. Box: 11‐0236, Riad‐El‐Solh Beirut,1107 2020BeirutLebanon
| | - Reem A. Mustafa
- Division of Nephrology and HypertensionOutcomes and Implementation ResearchUniversity of Kansas Medical Center3901 Rainbow Blvd, MS3002Kansas CityKS 66160USA
| | - Angela Morelli
- InfoDesignLab ‐ SentralenØvre Slottsgate 3N‐0157OsloNorway
| | - Joshua P. Vogel
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of ResearchDevelopment and Research Training in Human Reproduction (HRP)Department of Reproductive Health and Research, World Health Organization20 Avenue Appia,CH‐1211GenevaSwitzerland
| | - Pablo Alonso‐Coello
- Iberoamerican Cochrane CenterIIB Sant Pau‐CIBERESPSant Antoni Maria Claret 167,08025BarcelonaSpain
| | - Gabriel Rada
- Evidence CentrePontificia Universidad Católica de ChileSantiagoChile
- Department of Internal MedicineFaculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
- Epistemonikos FoundationDiagonal Paraguay 362SantiagoChile
| | - Juan Vásquez
- Epistemonikos FoundationArrayán 2735, ProvidenciaSantiago7510069Chile
| | - Elena Parmelli
- Department of Epidemiology of the Lazio Region – ASL Roma 1Via Cristoforo Colombo 112,00147RomeItaly
| | - A. Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of ResearchDevelopment and Research Training in Human Reproduction (HRP)Department of Reproductive Health and Research, World Health Organization20 Avenue Appia,CH‐1211GenevaSwitzerland
| | - Signe A. Flottorp
- Norwegian Institute of Public HealthInstitute of Health and Society, University of OsloPostboks 4404 Nydalen,N‐0403OsloNorway
| | - Andrew D. Oxman
- Centre for Informed Health ChoicesNorwegian Institute of Public HealthPostboks 4404 Nydalen,N‐0403OsloNorway
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Jawad M, Lotfi T, Darzi A, Singh N, Hawkins B, Nakkash R, Akl E. Towards understanding the features of the waterpipe tobacco industry: findings from two consecutive visits to the International Hookah Fair. Tob Induc Dis 2018. [DOI: 10.18332/tid/84427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Thaler KJ, Ukety TO, Mahlknecht P, Akl E, Norris SL, Biswas G, Engels D, Gartlehner G. Using GRADE to develop the WHO guideline on verifying elimination of human onchocerciasis. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw171.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Akl E, Irani A, Zhao W. P020 Fatal eosinophilic myocarditis in a 15-year-old female with dress without peripheral blood eosinophilia. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lotfi T, Bou-Karroum L, Darzi A, Hajjar R, El Rahyel A, El Eid J, Itani M, Brax H, Akik C, Osman M, Hassan G, El-Jardali F, Akl E. Coordinating the Provision of Health Services in Humanitarian Crises: a Systematic Review of Suggested Models. PLoS Curr 2016; 8:ecurrents.dis.95e78d5a93bbf99fca68be64826575fa. [PMID: 27617167 PMCID: PMC4999356 DOI: 10.1371/currents.dis.95e78d5a93bbf99fca68be64826575fa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Our objective was to identify published models of coordination between entities funding or delivering health services in humanitarian crises, whether the coordination took place during or after the crises. METHODS We included reports describing models of coordination in sufficient detail to allow reproducibility. We also included reports describing implementation of identified models, as case studies. We searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and the WHO Global Health Library. We also searched websites of relevant organizations. We followed standard systematic review methodology. RESULTS Our search captured 14,309 citations. The screening process identified 34 eligible papers describing five models of coordination of delivering health services: the "Cluster Approach" (with 16 case studies), the 4Ws "Who is Where, When, doing What" mapping tool (with four case studies), the "Sphere Project" (with two case studies), the "5x5" model (with one case study), and the "model of information coordination" (with one case study). The 4Ws and the 5x5 focus on coordination of services for mental health, the remaining models do not focus on a specific health topic. The Cluster approach appears to be the most widely used. One case study was a mixed implementation of the Cluster approach and the Sphere model. We identified no model of coordination for funding of health service. CONCLUSION This systematic review identified five proposed coordination models that have been implemented by entities funding or delivering health service in humanitarian crises. There is a need to compare the effect of these different models on outcomes such as availability of and access to health services.
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Affiliation(s)
- Tamara Lotfi
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Lama Bou-Karroum
- Health Management and Policy, American University of Beirut, Beirut, Lebanon
| | - Andrea Darzi
- AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | | | | | - Jamale El Eid
- Human Research Protection Program, American University of Beirut, Beirut, Lebanon
| | - Mira Itani
- Biology, Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Hneine Brax
- Medicine Faculty, Saint Joseph University, Beirut, Lebanon
| | - Chaza Akik
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Mona Osman
- Department of Family Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Fadi El-Jardali
- Health Management and Policy, American University of Beirut, Beirut, Lebanon
| | - Elie Akl
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Lebanon
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Neumann I, Brignardello-Petersen R, Wiercioch W, Carrasco-Labra A, Cuello C, Akl E, Mustafa RA, Al-Hazzani W, Etxeandia-Ikobaltzeta I, Rojas MX, Falavigna M, Santesso N, Brozek J, Iorio A, Alonso-Coello P, Schünemann HJ. The GRADE evidence-to-decision framework: a report of its testing and application in 15 international guideline panels. Implement Sci 2016; 11:93. [PMID: 27417219 PMCID: PMC4946225 DOI: 10.1186/s13012-016-0462-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 06/20/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Judgments underlying guideline recommendations are seldom recorded and presented in a systematic fashion. The GRADE Evidence-to-Decision Framework (EtD) offers a transparent way to record and report guideline developers' judgments. In this paper, we report the experiences with the EtD frameworks in 15 real guideline panels. METHODS Following the guideline panel meetings, we asked methodologists participating in the panel to provide feedback regarding the EtD framework. They were instructed to consider their own experience and the feedback collected from the rest of the panel. Two investigators independently summarized the responses and jointly interpreted the data using pre-specified domains as coding system. We asked methodologists to review the results and provide further input to improve the structure of the EtDs iteratively. RESULTS The EtD framework was well received, and the comments were generally positive. Methodologists felt that in a real guideline panel, the EtD framework helps structuring a complex process through relatively simple steps in an explicit and transparent way. However, some sections (e.g., "values and preferences" and "balance between benefits and harms") required further development and clarification that were considered in the current version of the EtD framework. CONCLUSIONS The use of an EtD framework in guideline development offers a structured and explicit way to record and report the judgments and discussion of guideline panels during the formulation of recommendations. In addition, it facilitates the formulation of recommendations, assessment of their strength, and identifying gaps in research.
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Affiliation(s)
- Ignacio Neumann
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
- Department of Internal Medicine, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Romina Brignardello-Petersen
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
- Evidence-Based Dentistry Unit, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Wojtek Wiercioch
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Alonso Carrasco-Labra
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
- Evidence-Based Dentistry Unit, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Carlos Cuello
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Elie Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Reem A. Mustafa
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
- Department of Medicine/Nephrology and Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, Missouri USA
| | - Waleed Al-Hazzani
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Itziar Etxeandia-Ikobaltzeta
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
- Basque Office for Health Technology Assessment-OSTEBA—Directorate for Health Research and Innovation, Ministry for Health Basque Government, Vitoria-Gasteiz, Spain
| | - Maria Ximena Rojas
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Maicon Falavigna
- Institute for Education and Research, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Nancy Santesso
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Jan Brozek
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Alfonso Iorio
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Pablo Alonso-Coello
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Holger J. Schünemann
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
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Schünemann HJ, Ståhl E, Austin P, Akl E, Armstrong D, Guyatt GH. A Comparison of Narrative and Table Formats for Presenting Hypothetical Health States to Patients with Gastrointestinal or Pulmonary Disease. Med Decis Making 2016; 24:53-60. [PMID: 15005954 DOI: 10.1177/0272989x03261566] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traditionally, quality-of-life researchers describe states of health for patients to rate either in narrative form or in table form, but evidence about which format patients prefer is limited. The authors performed 2 randomized studies to test whether patients prefer the table or narrative format and whether the format of presentation influences how patients rate health states. Approximately three-fourths of patients with gastrointestinal disease or chronic airflow limitation preferred the table format. There were no differences in patients’ ratings of 3 described health states or of their own health. Investigators should consider using the table presentation for describing health states to subjects who are not familiar with these states of health.
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Affiliation(s)
- Holger J Schünemann
- McMaster University Health Sciences Centre, Room 2C12, Hamilton, Ontario, L8N 3Z5, Canada.
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Pai M, Iorio A, Meerpohl J, Taruscio D, Laricchiuta P, Mincarone P, Morciano C, Leo CG, Sabina S, Akl E, Treweek S, Djulbegovic B, Schunemann H. Developing methodology for the creation of clinical practice guidelines for rare diseases: A report from RARE-Bestpractices. Rare Dis 2015. [PMCID: PMC4590012 DOI: 10.1080/21675511.2015.1058463] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Rare diseases are a global public health priority; they can cause significant morbidity and mortality, can gravely affect quality of life, and can confer a social and economic burden on families and communities. These conditions are, by their nature, encountered very infrequently by clinicians. Thus, clinical practice guidelines are potentially very helpful in supporting clinical decisions, health policy and resource allocation. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system is a structured and transparent approach to developing and presenting summaries of evidence, grading its quality, and then transparently interpreting the available evidence to make recommendations in health care. GRADE has been adopted widely. However, its use in creating guidelines for rare diseases – which are often plagued by a paucity of high quality evidence – has not yet been explored. RARE-Bestpractices is a project to create and populate a platform for sharing best practices for management of rare diseases. A major aim of this project is to ensure that European Union countries have the capacity to produce high quality clinical practice guidelines for rare diseases. On February 12, 2013 at the Istituto Superiore di Sanità, in Rome, Italy, the RARE-Bestpractices group held the first of a series of 2 workshops to discuss methodology for creating clinical practice guidelines, and explore issues specific to rare diseases. This paper summarizes key results of the first workshop, and explores how the current GRADE approach might (or might not) work for rare diseases. Avenues for future research are also identified.
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Affiliation(s)
- Menaka Pai
- McMaster University; Hamilton, Canada
- Hamilton Regional Laboratory Medicine Program; Hamilton, Canada
| | | | | | - Domenica Taruscio
- National Center for Rare Diseases; Istituto Superiore di Sanità; Rome, Italy
| | - Paola Laricchiuta
- National Center for Rare Diseases; Istituto Superiore di Sanità; Rome, Italy
| | - Pierpaolo Mincarone
- National Research Council; Institute for Research on Population and Social Policies; Rome, Italy
| | - Cristina Morciano
- National Center for Rare Diseases; Istituto Superiore di Sanità; Rome, Italy
| | - Carlo Giacomo Leo
- National Research Council; Institute of Clinical Physiology; Lecce, Italy
- Tufts Medical Center; Boston, MA USA
| | | | - Elie Akl
- American University of Beirut; Beirut, Lebanon
| | | | | | - Holger Schunemann
- McMaster University; Hamilton, Canada
- Universitaetsklinikum; Freiburg, Germany
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Brozek J, Akl E, Falck-Ytter Y, Kunstman P, Meerpohl J, Mustafa R, Nowak A, Oxman A, Santesso N, Wiercioch W, Schünemann H. P307 Guideline Development Tool (GDT) – Web-Based Solution For Guideline Developers And Authors Of Systematic Reviews. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ebrahim S, Akl E, Mustafa R, Sun X, Walter S, Heels-Ansdell D, Alonso-Coello P, Johnston B, Guyatt G. 056 Addressing Continuous Data For Participants Excluded From Trial Analysis: A Guide. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Schünemann H, Tugwell P, Reeves B, Akl E, Santesso N, Spencer F, Shea B, Wells G, Helfand M. 059 Nonrandomised Studies as a Source of Complementary, Sequential or Replacement Evidence for Randomised Controlled Trials in Systematic Reviews and Guidelines. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Vandvik P, Brandt L, Kristiansen A, Alonso P, Agoritsas T, Akl E, Guyatt G. 028 How Do Clinicians Like and Understand Trustworthy Guidelines? Randomised Controlled Trial Using Clickers in Educational Sessions. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Brandt L, Elde T, Agoritsas T, Guyatt G, Kristiansen A, Alonso-Coello P, Akl E, Meerpohl J, Vandvik P. 084 PLUGGED-IN (Providing Likeable and Understandable Guidelines using GRADE in the EMR with Direct links to Individual patient data) Phase 2. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Agoritsas T, Brandt L, Heen AA, Kristiansen A, Alonso-Coello P, Akl E, Neumann I, Tikkinen K, Montor V, Guyatt G, Vandvik P. 051 Can We Automatically Produce Generic Decision Aids for the Clinical Encounter Directly from GRADE Guideline Recommendations? Experience from the Share-It Project. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Brandt L, McCallum S, Kristiansen A, Agoritsas T, Akl E, Vandvik P, Montori V. P352 Game-It (Games For Improving Treatment-Recommendations). BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Neumann I, Karl R, Rajpal A, Akl E, Guyatt G. P084 Experiences With The Novel Policy For Managing Conflicts Of Interest Implemented In The 9th Edition Of The American College Of Chest Physicians Antithrombotic Guidelines (At9). BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Akl E, Johnston B, Alonso-Coello P, Neumann I, Ebrahim S, Briel M, Cook D, Guyatt G. 057 Handling Trial Participants with Missing Data in Meta-Analyses Of Dichotomous Outcomes: Guidance for Systematic Reviewers. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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47
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Brozek J, Akl E, Falck-Ytter Y, Kunstman P, Meerpohl J, Mustafa R, Nowak A, Oxman A, Santesso N, Wiercioch W, Schünemann H. 046 Guideline Development Tool (GDT) – Web-Based Solution for Guideline Developers and Authors of Systematic Reviews. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Akl E, El-Hachem P, Abou-Haidar H, Guyatt G. P236 Documentation Of Intellectual Conflicts Of Interests Proved Critical In A Clinical Practice Guideline. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Guyatt G, Eikelboom J, Crowther M, Akl E, Francis C, Garcia D, Gould M, Hylek E, Kahn S, Kunz R, Quinlan D, Vandvik P, Hirsh J. A response to--there's madness in their methods. J Thromb Haemost 2013; 11:785-6. [PMID: 23406024 DOI: 10.1111/jth.12142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 01/08/2013] [Indexed: 11/29/2022]
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Falck-Ytter Y, Kearon C, Akl E, Francis C. Are Asymptomatic DVTs Relevant?: Response. Chest 2013; 143:874-875. [DOI: 10.1378/chest.12-2717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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