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Beukers NGFM, Su N, van der Heijden GJMG, Loos BG. Periodontitis is associated with multimorbidity in a large dental school population. J Clin Periodontol 2023; 50:1621-1632. [PMID: 37658672 DOI: 10.1111/jcpe.13870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 09/03/2023]
Abstract
AIM To investigate whether and which diseases co-occur with periodontitis (PD) to assess the prevalence of comorbidities and multimorbidity and to identify patterns and profiles of comorbidity and multimorbidity and the influence of demographic and lifestyle factors to identify distinct groups of multimorbid patients. MATERIALS AND METHODS A database from the Academic Centre of Dentistry Amsterdam (ACTA) with 37,801 adult individuals containing information about demographic (age, sex, socio-economic position [SEP]) and lifestyle factors (smoking, alcohol use and addictive substance use) and PD and systemic diseases was constructed. PD assessment was based on clinical information by the use of claim codes and systemic diseases data were derived from self-reported medical history. For analyses, univariable and multivariable (adjusted for age, sex, SEP, smoking, alcohol use and addictive substance use) logistic regression analyses and cluster analysis were used. RESULTS Individuals with PD more often had one or multiple diseases. The adjusted odds ratio (OR) for PD patients having up to four systemic diseases ranged from 1.46 to 1.20. Co-occurrence of PD with several systemic diseases and a higher prevalence of multimorbidity was found (adjusted OR comorbidity = 1.36; 95% confidence interval (CI): 1.30-1.43; multimorbidity = 1.18; 95% CI: 1.11-1.25). Four clusters existed: cluster 1 was defined as a periodontal and systemically healthy group and cluster 4 as burdened with PD but not containing any systemic diseases. Individuals in cluster 1 were of the lowest age (44.9 [SD: 15.5]) and had the lowest prevalence of the lifestyle factors of smoking (13.6%) and alcohol use (3.9%). Clusters 2 and 3 contained both PD and had several systemic diseases but were different from each other. Cluster 2 contained 34.5% of PD individuals and had mainly respiratory tract, immune system and digestive system diseases. Cluster 3 contained 45.9% of PD individuals and had mainly cardiometabolic diseases. Cluster 2 had the highest prevalence of females (63.1%) and the highest prevalence of smokers (23.8%) and addictive substance users (8.9%). Cluster 3 included individuals of the highest age (63.5 [SD: 11.9]), and had highest prevalence of alcohol users (17.7%) and lowest prevalence of addictive substance users (3.8%). CONCLUSIONS This study shows that individuals with PD are more often burdened with comorbidity and multimorbidity. Presence of distinct clusters suggests overlap in pathophysiology between certain types of PD and specific systemic diseases. Therefore, PD can be considered as part of multimorbidity, as one of the systemic diseases co-occurring in certain groups of individuals.
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Affiliation(s)
- Nicky G F M Beukers
- Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Naichuan Su
- Department of Oral Public Health, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Geert J M G van der Heijden
- Department of Oral Public Health, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bruno G Loos
- Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Su N, Harroui S, Rozema F, Listl S, Lange JD, Heijden GJMGVD. What do we know about uncommon complications associated with third molar extractions? A scoping review of case reports and case series. J Korean Assoc Oral Maxillofac Surg 2023; 49:2-12. [PMID: 36859370 PMCID: PMC9985997 DOI: 10.5125/jkaoms.2023.49.1.2] [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: 07/14/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 03/03/2023] Open
Abstract
The current study aimed to explore the types and frequencies of uncommon complications associated with third molar extractions based on a scoping review of case reports and case series. The study used an electronic literature search based on PubMed and Embase up to March 31, 2020, with an update performed on October 22, 2021. Any case reports and case series that reported complications associated with third molar extractions were included. The types of complications were grouped and the main symptoms of each type of complication were summarized. A total of 51 types of uncommon complications were identified in 248 patients from 186 studies. Most types of complications were post-operative. In the craniofacial and cervical regions, the most frequent complications included iatrogenic displacement of the molars or root fragments in the craniofacial area, late mandibular fracture, and subcutaneous emphysema. In other regions, the most frequent complications include pneumomediastinum, pneumorrhachis, pneumothorax, and pneumopericardium. Of the patients, 37 patients had life-threatening uncommon complications and 20 patients had long-term/irreversible uncommon complications associated with third molar extractions. In conclusion, a variety of uncommon complications associated with third molar extractions were identified. Most complications occurred in the craniofacial and cervical regions and were mild and transient.
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Affiliation(s)
- Naichuan Su
- Department of Oral Public Health, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam
| | - Sana Harroui
- Department of Oral Public Health, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam
| | - Fred Rozema
- Department of Oral Medicine, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam.,Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (UMC), Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam
| | - Stefan Listl
- Radboud Institute for Health Sciences, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.,Department of Conservative Dentistry, Section for Translational Health Economics, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (UMC), Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam
| | - Geert J M G van der Heijden
- Department of Oral Public Health, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam
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van Spreuwel PCJM, Munk-Overkamp MLC, Smit LC, Ziesemer KA, van Loveren C, van der Heijden GJMG, Bruers JJM, Jerković-Ćosić K. Exploring the development, evaluation and implementation of complex health interventions to prevent early childhood caries in preschool children: A scoping review protocol. PLoS One 2022; 17:e0275501. [PMID: 36215315 PMCID: PMC9550072 DOI: 10.1371/journal.pone.0275501] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022] Open
Abstract
Objective This scoping review aims to identify complex health interventions (CHI’s) to prevent early childhood caries (ECC), explore the level of complexity of the identified CHI’s, and explore the details of their development, evaluation, and implementation. Introduction Many interventions to prevent ECC have multiple interacting components and can be seen as CHI’s. Recent reviews on these interventions have found inconclusive effects, which may be due to differences in the development, evaluation, and implementation of CHI’s. Inclusion criteria This scoping review will consider clinical trials reporting CHI’s to prevent ECC that starts during pregnancy or in the first year of life. Studies in the English language will be included regardless of the country of origin, sociocultural setting, or context. Methods This review will follow the Joanna Briggs Institute methodology for scoping reviews. An initial search of PubMed identified keywords and Medical Subject Headings terms. A second search of PubMed, Embase, Clarivate Analytics/Web of Science Core Collection, ClinicalTrials.gov, and the Wiley/Cochrane Library will follow. Two independent reviewers will perform title and abstract screening, retrieve and review full-text studies, and extract data. The reference lists of all included sources will be screened for additional CHI’s or relevant publications about a specific CHI. Data charting will be utilised based on study characteristics and intervention complexity. A 39-item instrument will be used to explore the details in the description of the CHI’s development, evaluation, and implementation. The results will be presented in tables, visual outputs, and a narrative summary in response to the review questions. Discussion The proposed review will generate evidence which may provide a direction for the future design of studies on CHI’s to prevent ECC and more complete information for those who want to adopt successful interventions to prevent ECC.
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Affiliation(s)
- Peggy C. J. M. van Spreuwel
- HU University of Applied Science, Research group Innovation in Preventive Healthcare, Utrecht, The Netherlands
- Oral Public Health Department, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Milou L. C. Munk-Overkamp
- Oral Public Health Department, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Royal Dutch Dental Association (KNMT), Utrecht, The Netherlands
| | - Linda C. Smit
- HU University of Applied Science, Research Centre for Healthy and Sustainable Living, Utrecht, The Netherlands
| | | | - Cor van Loveren
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Geert J. M. G. van der Heijden
- Oral Public Health Department, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Josef J. M. Bruers
- Oral Public Health Department, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Royal Dutch Dental Association (KNMT), Utrecht, The Netherlands
| | - Katarina Jerković-Ćosić
- HU University of Applied Science, Research group Innovation in Preventive Healthcare, Utrecht, The Netherlands
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van Spreuwel PCJM, Jerković-Ćosić K, van Loveren C, van der Heijden GJMG. Oral Health Coaches at Well-Baby Clinics to Promote Oral Health in Preschool Children From the First Erupted Tooth: Protocol for a Multisite, Pragmatic Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e39683. [PMID: 36044251 PMCID: PMC9475409 DOI: 10.2196/39683] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Early childhood caries is considered one of the most prevalent diseases in childhood, affecting almost half of preschool-age children globally. In the Netherlands, approximately one-third of children aged 5 years already have dental caries, and dental care providers experience problems reaching out to these children. Objective Within the proposed trial, we aim to test the hypothesis that, compared to children who receive usual care, children who receive the Toddler Oral Health Intervention as add-on care will have a reduced cumulative caries incidence and caries incidence density at the age of 48 months. Methods This pragmatic, 2-arm, individually randomized controlled trial is being conducted in the Netherlands and has been approved by the Medical Ethics Research Board of University Medical Center Utrecht. Parents with children aged 6 to 12 months attending 1 of the 9 selected well-baby clinics are invited to participate. Only healthy children (ie, not requiring any form of specialized health care) with parents that have sufficient command of the Dutch language and have no plans to move outside the well-baby clinic region are eligible. Both groups receive conventional oral health education in well-baby clinics during regular well-baby clinic visits between the ages of 6 to 48 months. After concealed random allocation of interventions, the intervention group also receives the Toddler Oral Health Intervention from an oral health coach. The Toddler Oral Health Intervention combines behavioral interventions of proven effectiveness in caries prevention. Data are collected at baseline, at 24 months, and at 48 months. The primary study endpoint is cumulative caries incidence for children aged 48 months, and will be analyzed according to the intention-to-treat principle. For children aged 48 months, the balance between costs and effects of the Toddler Oral Health Intervention will be evaluated, and for children aged 24 months, the effects of the Toddler Oral Health Intervention on behavioral determinants, alongside cumulative caries incidence, will be compared. Results The first parent-child dyads were enrolled in June 2017, and recruitment was finished in June 2019. We enrolled 402 parent-child dyads. Conclusions All follow-up interventions and data collection will be completed by the end of 2022, and the trial results are expected soon thereafter. Results will be shared at international conferences and via peer-reviewed publication. Trial Registration Netherlands Trial Register NL8737; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8737 International Registered Report Identifier (IRRID) DERR1-10.2196/39683
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Affiliation(s)
- Peggy C J M van Spreuwel
- Research Group Innovation in Preventive Care, Hogeschool Utrecht University of Applied Science, Utrecht, Netherlands.,Oral Public Health Department, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
| | - Katarina Jerković-Ćosić
- Research Group Innovation in Preventive Care, Hogeschool Utrecht University of Applied Science, Utrecht, Netherlands
| | - Cor van Loveren
- Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
| | - Geert J M G van der Heijden
- Oral Public Health Department, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
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van der Wouden P, Shemesh H, van der Heijden GJMG. Research priorities for oral healthcare: agenda setting from the practitioners' perspective. Acta Odontol Scand 2021; 79:451-457. [PMID: 33650460 DOI: 10.1080/00016357.2021.1887929] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this study was to develop a research agenda based on the most important information needs concerning the effects and outcomes of oral healthcare provided by oral healthcare professionals (OHPs). METHODS A two-stage survey study was used to identify and prioritise topics for future research. The first survey generated topics based on information needs by OHPs. Topics were clustered thematically and overlapping topics were merged in 84 research themes. In the second survey, respondents selected their top 5 from the 84 research themes. Themes were sorted by the rank number based on rank sum. RESULTS In the first survey, 937 topics were suggested. Almost half (n = 430, 46%) were identified as topics related to endodontology, cariology, oral medicine/surgery or tooth restoration. Topics were grouped in 84 research themes, covering 10 research domains. These were prioritised by 235 OHPs. Behaviour change for oral health and oral healthcare for geriatric patients ranked as most important. CONCLUSIONS Consultation of OHPs has resulted in a research agenda, which can be used to inform programming future oral health research. The highest prioritised research themes have an interdisciplinary nature, mainly concern oral disease prevention and are under-represented in the current oral healthcare research portfolio.
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Affiliation(s)
- Puck van der Wouden
- Department of Social Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Hagay Shemesh
- Department of Endodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Geert J. M. G. van der Heijden
- Department of Social Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Institute, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
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6
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Hilverda F, van der Wouden P, van der Heijden GJMG, Pittens CACM. A research agenda on oral health care as a boundary object that unites the perspectives of patients and practitioners. Health Expect 2021; 24:1701-1712. [PMID: 34312967 PMCID: PMC8483215 DOI: 10.1111/hex.13310] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 06/14/2021] [Accepted: 06/19/2021] [Indexed: 11/26/2022] Open
Abstract
Context A research agenda for oral health care was established in the Netherlands using the Dialogue Model. This project served as a case study in which we applied boundary‐work theory as a framework to understand boundaries (ie demarcations) between and within groups, and how these boundaries can be overcome. Objective To gain insights into the boundaries encountered when setting a research agenda, we analysed how this agenda served as a boundary object (ie circumstances, situations or material that connect actor groups and allow boundary crossing) that facilitated crossing boundaries and uniting the perspectives of patients and practitioners. Methods We used a thematic approach to analyse researchers' observations, meeting materials, emails, interviews with patients (n = 11) and a survey among patients and practitioners (n = 18). Results Setting the research agenda helped to cross boundaries in oral health care, which demonstrates its role as a boundary object. First, this made it possible to integrate research topics representing the perspectives and priorities of all patients and also to unite those perspectives. It was essential to involve practitioners at an early stage of the project so that they could better accept the patients' perspectives. This resulted in support for an integrated research agenda, which facilitated the crossing of boundaries. Conclusions The research agenda‐setting project was found to serve as a boundary object in uniting the perspectives and priorities of patients and practitioners. Patient contribution Patient involvement in this case study was structured in the process of research agenda setting using the Dialogue Model.
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Affiliation(s)
- Femke Hilverda
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands.,Department of Socio-Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Puck van der Wouden
- Department of Oral Public Health, Academic Centre for Dentistry Amsterdam, VU University Amsterdam, Amsterdam and University of Amsterdam, Amsterdam, The Netherlands
| | - Geert J M G van der Heijden
- Department of Oral Public Health, Academic Centre for Dentistry Amsterdam, VU University Amsterdam, Amsterdam and University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Carina A C M Pittens
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
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Schandelmaier S, Briel M, Varadhan R, Schmid CH, Devasenapathy N, Hayward RA, Gagnier J, Borenstein M, van der Heijden GJMG, Dahabreh IJ, Sun X, Sauerbrei W, Walsh M, Ioannidis JPA, Thabane L, Guyatt GH. Development of the Instrument to assess the Credibility of Effect Modification Analyses (ICEMAN) in randomized controlled trials and meta-analyses. CMAJ 2021; 192:E901-E906. [PMID: 32778601 DOI: 10.1503/cmaj.200077] [Citation(s) in RCA: 240] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Most randomized controlled trials (RCTs) and meta-analyses of RCTs examine effect modification (also called a subgroup effect or interaction), in which the effect of an intervention varies by another variable (e.g., age or disease severity). Assessing the credibility of an apparent effect modification presents challenges; therefore, we developed the Instrument for assessing the Credibility of Effect Modification Analyses (ICEMAN). METHODS To develop ICEMAN, we established a detailed concept; identified candidate credibility considerations in a systematic survey of the literature; together with experts, performed a consensus study to identify key considerations and develop them into instrument items; and refined the instrument based on feedback from trial investigators, systematic review authors and journal editors, who applied drafts of ICEMAN to published claims of effect modification. RESULTS The final instrument consists of a set of preliminary considerations, core questions (5 for RCTs, 8 for meta-analyses) with 4 response options, 1 optional item for additional considerations and a rating of credibility on a visual analogue scale ranging from very low to high. An accompanying manual provides rationales, detailed instructions and examples from the literature. Seventeen potential users tested ICEMAN; their suggestions improved the user-friendliness of the instrument. INTERPRETATION The Instrument for assessing the Credibility of Effect Modification Analyses offers explicit guidance for investigators, systematic reviewers, journal editors and others considering making a claim of effect modification or interpreting a claim made by others.
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Affiliation(s)
- Stefan Schandelmaier
- Departments of Health Research Methods, Evidence, and Impact (Schandelmaier, Briel, Walsh, Thabane, Guyatt), Medicine (Walsh, Guyatt), Pediatrics (Thabane) and Anesthesia (Thabane), McMaster University, Hamilton, Ont.; Institute for Clinical Epidemiology and Biostatistics (Schandelmaier, Briel), Department of Clinical Research, Basel University, Basel, Switzerland; Division of Biostatistics and Bioinformatics (Varadhan), Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Md.; Department of Biostatistics (Schmid), Brown University School of Public Health, Brown University, Providence, RI; Indian institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, New Delhi, India; VA Center for Clinical Management and Research (Hayward); Department of Internal Medicine (Hayward), University of Michigan School of Medicine; Department of Orthopaedic Surgery (Gagnier), University of Michigan; Department of Epidemiology (Gagnier), School of Public Health, University of Michigan, Ann Arbor, Mich.; Biostat (Borenstein), Englewood, NJ; Department of Social Dentistry (van der Heijden), Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands; Center for Evidence Synthesis in Health (Dahabreh) and Departments of Health Services, Policy, and Practice (Dahabreh) and Epidemiology (Dahabreh), School of Public Health, Brown University, Providence, RI; Chinese Evidence-Based Medicine Center (Sun), West China Hospital, Sichuan University, Chengdu, China; Institute of Medical Biometry and Statistics (Sauerbrei), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany; Population Health Research Institute (Walsh), Hamilton Health Sciences/McMaster University, Hamilton, Ont.; Departments of Medicine (Ioannidis), Health Research and Policy (Ioannidis) and Biomedical Data Science (Ioannidis), and Statistics and Meta-Research Innovation Center at Stanford (METRICS) (Ioannidis), Stanford University, Stanford, Calif.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont.
| | - Matthias Briel
- Departments of Health Research Methods, Evidence, and Impact (Schandelmaier, Briel, Walsh, Thabane, Guyatt), Medicine (Walsh, Guyatt), Pediatrics (Thabane) and Anesthesia (Thabane), McMaster University, Hamilton, Ont.; Institute for Clinical Epidemiology and Biostatistics (Schandelmaier, Briel), Department of Clinical Research, Basel University, Basel, Switzerland; Division of Biostatistics and Bioinformatics (Varadhan), Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Md.; Department of Biostatistics (Schmid), Brown University School of Public Health, Brown University, Providence, RI; Indian institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, New Delhi, India; VA Center for Clinical Management and Research (Hayward); Department of Internal Medicine (Hayward), University of Michigan School of Medicine; Department of Orthopaedic Surgery (Gagnier), University of Michigan; Department of Epidemiology (Gagnier), School of Public Health, University of Michigan, Ann Arbor, Mich.; Biostat (Borenstein), Englewood, NJ; Department of Social Dentistry (van der Heijden), Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands; Center for Evidence Synthesis in Health (Dahabreh) and Departments of Health Services, Policy, and Practice (Dahabreh) and Epidemiology (Dahabreh), School of Public Health, Brown University, Providence, RI; Chinese Evidence-Based Medicine Center (Sun), West China Hospital, Sichuan University, Chengdu, China; Institute of Medical Biometry and Statistics (Sauerbrei), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany; Population Health Research Institute (Walsh), Hamilton Health Sciences/McMaster University, Hamilton, Ont.; Departments of Medicine (Ioannidis), Health Research and Policy (Ioannidis) and Biomedical Data Science (Ioannidis), and Statistics and Meta-Research Innovation Center at Stanford (METRICS) (Ioannidis), Stanford University, Stanford, Calif.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Ravi Varadhan
- Departments of Health Research Methods, Evidence, and Impact (Schandelmaier, Briel, Walsh, Thabane, Guyatt), Medicine (Walsh, Guyatt), Pediatrics (Thabane) and Anesthesia (Thabane), McMaster University, Hamilton, Ont.; Institute for Clinical Epidemiology and Biostatistics (Schandelmaier, Briel), Department of Clinical Research, Basel University, Basel, Switzerland; Division of Biostatistics and Bioinformatics (Varadhan), Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Md.; Department of Biostatistics (Schmid), Brown University School of Public Health, Brown University, Providence, RI; Indian institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, New Delhi, India; VA Center for Clinical Management and Research (Hayward); Department of Internal Medicine (Hayward), University of Michigan School of Medicine; Department of Orthopaedic Surgery (Gagnier), University of Michigan; Department of Epidemiology (Gagnier), School of Public Health, University of Michigan, Ann Arbor, Mich.; Biostat (Borenstein), Englewood, NJ; Department of Social Dentistry (van der Heijden), Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands; Center for Evidence Synthesis in Health (Dahabreh) and Departments of Health Services, Policy, and Practice (Dahabreh) and Epidemiology (Dahabreh), School of Public Health, Brown University, Providence, RI; Chinese Evidence-Based Medicine Center (Sun), West China Hospital, Sichuan University, Chengdu, China; Institute of Medical Biometry and Statistics (Sauerbrei), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany; Population Health Research Institute (Walsh), Hamilton Health Sciences/McMaster University, Hamilton, Ont.; Departments of Medicine (Ioannidis), Health Research and Policy (Ioannidis) and Biomedical Data Science (Ioannidis), and Statistics and Meta-Research Innovation Center at Stanford (METRICS) (Ioannidis), Stanford University, Stanford, Calif.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Christopher H Schmid
- Departments of Health Research Methods, Evidence, and Impact (Schandelmaier, Briel, Walsh, Thabane, Guyatt), Medicine (Walsh, Guyatt), Pediatrics (Thabane) and Anesthesia (Thabane), McMaster University, Hamilton, Ont.; Institute for Clinical Epidemiology and Biostatistics (Schandelmaier, Briel), Department of Clinical Research, Basel University, Basel, Switzerland; Division of Biostatistics and Bioinformatics (Varadhan), Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Md.; Department of Biostatistics (Schmid), Brown University School of Public Health, Brown University, Providence, RI; Indian institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, New Delhi, India; VA Center for Clinical Management and Research (Hayward); Department of Internal Medicine (Hayward), University of Michigan School of Medicine; Department of Orthopaedic Surgery (Gagnier), University of Michigan; Department of Epidemiology (Gagnier), School of Public Health, University of Michigan, Ann Arbor, Mich.; Biostat (Borenstein), Englewood, NJ; Department of Social Dentistry (van der Heijden), Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands; Center for Evidence Synthesis in Health (Dahabreh) and Departments of Health Services, Policy, and Practice (Dahabreh) and Epidemiology (Dahabreh), School of Public Health, Brown University, Providence, RI; Chinese Evidence-Based Medicine Center (Sun), West China Hospital, Sichuan University, Chengdu, China; Institute of Medical Biometry and Statistics (Sauerbrei), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany; Population Health Research Institute (Walsh), Hamilton Health Sciences/McMaster University, Hamilton, Ont.; Departments of Medicine (Ioannidis), Health Research and Policy (Ioannidis) and Biomedical Data Science (Ioannidis), and Statistics and Meta-Research Innovation Center at Stanford (METRICS) (Ioannidis), Stanford University, Stanford, Calif.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Niveditha Devasenapathy
- Departments of Health Research Methods, Evidence, and Impact (Schandelmaier, Briel, Walsh, Thabane, Guyatt), Medicine (Walsh, Guyatt), Pediatrics (Thabane) and Anesthesia (Thabane), McMaster University, Hamilton, Ont.; Institute for Clinical Epidemiology and Biostatistics (Schandelmaier, Briel), Department of Clinical Research, Basel University, Basel, Switzerland; Division of Biostatistics and Bioinformatics (Varadhan), Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Md.; Department of Biostatistics (Schmid), Brown University School of Public Health, Brown University, Providence, RI; Indian institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, New Delhi, India; VA Center for Clinical Management and Research (Hayward); Department of Internal Medicine (Hayward), University of Michigan School of Medicine; Department of Orthopaedic Surgery (Gagnier), University of Michigan; Department of Epidemiology (Gagnier), School of Public Health, University of Michigan, Ann Arbor, Mich.; Biostat (Borenstein), Englewood, NJ; Department of Social Dentistry (van der Heijden), Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands; Center for Evidence Synthesis in Health (Dahabreh) and Departments of Health Services, Policy, and Practice (Dahabreh) and Epidemiology (Dahabreh), School of Public Health, Brown University, Providence, RI; Chinese Evidence-Based Medicine Center (Sun), West China Hospital, Sichuan University, Chengdu, China; Institute of Medical Biometry and Statistics (Sauerbrei), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany; Population Health Research Institute (Walsh), Hamilton Health Sciences/McMaster University, Hamilton, Ont.; Departments of Medicine (Ioannidis), Health Research and Policy (Ioannidis) and Biomedical Data Science (Ioannidis), and Statistics and Meta-Research Innovation Center at Stanford (METRICS) (Ioannidis), Stanford University, Stanford, Calif.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Rodney A Hayward
- Departments of Health Research Methods, Evidence, and Impact (Schandelmaier, Briel, Walsh, Thabane, Guyatt), Medicine (Walsh, Guyatt), Pediatrics (Thabane) and Anesthesia (Thabane), McMaster University, Hamilton, Ont.; Institute for Clinical Epidemiology and Biostatistics (Schandelmaier, Briel), Department of Clinical Research, Basel University, Basel, Switzerland; Division of Biostatistics and Bioinformatics (Varadhan), Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Md.; Department of Biostatistics (Schmid), Brown University School of Public Health, Brown University, Providence, RI; Indian institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, New Delhi, India; VA Center for Clinical Management and Research (Hayward); Department of Internal Medicine (Hayward), University of Michigan School of Medicine; Department of Orthopaedic Surgery (Gagnier), University of Michigan; Department of Epidemiology (Gagnier), School of Public Health, University of Michigan, Ann Arbor, Mich.; Biostat (Borenstein), Englewood, NJ; Department of Social Dentistry (van der Heijden), Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands; Center for Evidence Synthesis in Health (Dahabreh) and Departments of Health Services, Policy, and Practice (Dahabreh) and Epidemiology (Dahabreh), School of Public Health, Brown University, Providence, RI; Chinese Evidence-Based Medicine Center (Sun), West China Hospital, Sichuan University, Chengdu, China; Institute of Medical Biometry and Statistics (Sauerbrei), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany; Population Health Research Institute (Walsh), Hamilton Health Sciences/McMaster University, Hamilton, Ont.; Departments of Medicine (Ioannidis), Health Research and Policy (Ioannidis) and Biomedical Data Science (Ioannidis), and Statistics and Meta-Research Innovation Center at Stanford (METRICS) (Ioannidis), Stanford University, Stanford, Calif.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Joel Gagnier
- Departments of Health Research Methods, Evidence, and Impact (Schandelmaier, Briel, Walsh, Thabane, Guyatt), Medicine (Walsh, Guyatt), Pediatrics (Thabane) and Anesthesia (Thabane), McMaster University, Hamilton, Ont.; Institute for Clinical Epidemiology and Biostatistics (Schandelmaier, Briel), Department of Clinical Research, Basel University, Basel, Switzerland; Division of Biostatistics and Bioinformatics (Varadhan), Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Md.; Department of Biostatistics (Schmid), Brown University School of Public Health, Brown University, Providence, RI; Indian institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, New Delhi, India; VA Center for Clinical Management and Research (Hayward); Department of Internal Medicine (Hayward), University of Michigan School of Medicine; Department of Orthopaedic Surgery (Gagnier), University of Michigan; Department of Epidemiology (Gagnier), School of Public Health, University of Michigan, Ann Arbor, Mich.; Biostat (Borenstein), Englewood, NJ; Department of Social Dentistry (van der Heijden), Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands; Center for Evidence Synthesis in Health (Dahabreh) and Departments of Health Services, Policy, and Practice (Dahabreh) and Epidemiology (Dahabreh), School of Public Health, Brown University, Providence, RI; Chinese Evidence-Based Medicine Center (Sun), West China Hospital, Sichuan University, Chengdu, China; Institute of Medical Biometry and Statistics (Sauerbrei), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany; Population Health Research Institute (Walsh), Hamilton Health Sciences/McMaster University, Hamilton, Ont.; Departments of Medicine (Ioannidis), Health Research and Policy (Ioannidis) and Biomedical Data Science (Ioannidis), and Statistics and Meta-Research Innovation Center at Stanford (METRICS) (Ioannidis), Stanford University, Stanford, Calif.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Michael Borenstein
- Departments of Health Research Methods, Evidence, and Impact (Schandelmaier, Briel, Walsh, Thabane, Guyatt), Medicine (Walsh, Guyatt), Pediatrics (Thabane) and Anesthesia (Thabane), McMaster University, Hamilton, Ont.; Institute for Clinical Epidemiology and Biostatistics (Schandelmaier, Briel), Department of Clinical Research, Basel University, Basel, Switzerland; Division of Biostatistics and Bioinformatics (Varadhan), Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Md.; Department of Biostatistics (Schmid), Brown University School of Public Health, Brown University, Providence, RI; Indian institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, New Delhi, India; VA Center for Clinical Management and Research (Hayward); Department of Internal Medicine (Hayward), University of Michigan School of Medicine; Department of Orthopaedic Surgery (Gagnier), University of Michigan; Department of Epidemiology (Gagnier), School of Public Health, University of Michigan, Ann Arbor, Mich.; Biostat (Borenstein), Englewood, NJ; Department of Social Dentistry (van der Heijden), Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands; Center for Evidence Synthesis in Health (Dahabreh) and Departments of Health Services, Policy, and Practice (Dahabreh) and Epidemiology (Dahabreh), School of Public Health, Brown University, Providence, RI; Chinese Evidence-Based Medicine Center (Sun), West China Hospital, Sichuan University, Chengdu, China; Institute of Medical Biometry and Statistics (Sauerbrei), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany; Population Health Research Institute (Walsh), Hamilton Health Sciences/McMaster University, Hamilton, Ont.; Departments of Medicine (Ioannidis), Health Research and Policy (Ioannidis) and Biomedical Data Science (Ioannidis), and Statistics and Meta-Research Innovation Center at Stanford (METRICS) (Ioannidis), Stanford University, Stanford, Calif.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Geert J M G van der Heijden
- Departments of Health Research Methods, Evidence, and Impact (Schandelmaier, Briel, Walsh, Thabane, Guyatt), Medicine (Walsh, Guyatt), Pediatrics (Thabane) and Anesthesia (Thabane), McMaster University, Hamilton, Ont.; Institute for Clinical Epidemiology and Biostatistics (Schandelmaier, Briel), Department of Clinical Research, Basel University, Basel, Switzerland; Division of Biostatistics and Bioinformatics (Varadhan), Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Md.; Department of Biostatistics (Schmid), Brown University School of Public Health, Brown University, Providence, RI; Indian institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, New Delhi, India; VA Center for Clinical Management and Research (Hayward); Department of Internal Medicine (Hayward), University of Michigan School of Medicine; Department of Orthopaedic Surgery (Gagnier), University of Michigan; Department of Epidemiology (Gagnier), School of Public Health, University of Michigan, Ann Arbor, Mich.; Biostat (Borenstein), Englewood, NJ; Department of Social Dentistry (van der Heijden), Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands; Center for Evidence Synthesis in Health (Dahabreh) and Departments of Health Services, Policy, and Practice (Dahabreh) and Epidemiology (Dahabreh), School of Public Health, Brown University, Providence, RI; Chinese Evidence-Based Medicine Center (Sun), West China Hospital, Sichuan University, Chengdu, China; Institute of Medical Biometry and Statistics (Sauerbrei), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany; Population Health Research Institute (Walsh), Hamilton Health Sciences/McMaster University, Hamilton, Ont.; Departments of Medicine (Ioannidis), Health Research and Policy (Ioannidis) and Biomedical Data Science (Ioannidis), and Statistics and Meta-Research Innovation Center at Stanford (METRICS) (Ioannidis), Stanford University, Stanford, Calif.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Issa J Dahabreh
- Departments of Health Research Methods, Evidence, and Impact (Schandelmaier, Briel, Walsh, Thabane, Guyatt), Medicine (Walsh, Guyatt), Pediatrics (Thabane) and Anesthesia (Thabane), McMaster University, Hamilton, Ont.; Institute for Clinical Epidemiology and Biostatistics (Schandelmaier, Briel), Department of Clinical Research, Basel University, Basel, Switzerland; Division of Biostatistics and Bioinformatics (Varadhan), Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Md.; Department of Biostatistics (Schmid), Brown University School of Public Health, Brown University, Providence, RI; Indian institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, New Delhi, India; VA Center for Clinical Management and Research (Hayward); Department of Internal Medicine (Hayward), University of Michigan School of Medicine; Department of Orthopaedic Surgery (Gagnier), University of Michigan; Department of Epidemiology (Gagnier), School of Public Health, University of Michigan, Ann Arbor, Mich.; Biostat (Borenstein), Englewood, NJ; Department of Social Dentistry (van der Heijden), Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands; Center for Evidence Synthesis in Health (Dahabreh) and Departments of Health Services, Policy, and Practice (Dahabreh) and Epidemiology (Dahabreh), School of Public Health, Brown University, Providence, RI; Chinese Evidence-Based Medicine Center (Sun), West China Hospital, Sichuan University, Chengdu, China; Institute of Medical Biometry and Statistics (Sauerbrei), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany; Population Health Research Institute (Walsh), Hamilton Health Sciences/McMaster University, Hamilton, Ont.; Departments of Medicine (Ioannidis), Health Research and Policy (Ioannidis) and Biomedical Data Science (Ioannidis), and Statistics and Meta-Research Innovation Center at Stanford (METRICS) (Ioannidis), Stanford University, Stanford, Calif.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Xin Sun
- Departments of Health Research Methods, Evidence, and Impact (Schandelmaier, Briel, Walsh, Thabane, Guyatt), Medicine (Walsh, Guyatt), Pediatrics (Thabane) and Anesthesia (Thabane), McMaster University, Hamilton, Ont.; Institute for Clinical Epidemiology and Biostatistics (Schandelmaier, Briel), Department of Clinical Research, Basel University, Basel, Switzerland; Division of Biostatistics and Bioinformatics (Varadhan), Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Md.; Department of Biostatistics (Schmid), Brown University School of Public Health, Brown University, Providence, RI; Indian institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, New Delhi, India; VA Center for Clinical Management and Research (Hayward); Department of Internal Medicine (Hayward), University of Michigan School of Medicine; Department of Orthopaedic Surgery (Gagnier), University of Michigan; Department of Epidemiology (Gagnier), School of Public Health, University of Michigan, Ann Arbor, Mich.; Biostat (Borenstein), Englewood, NJ; Department of Social Dentistry (van der Heijden), Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands; Center for Evidence Synthesis in Health (Dahabreh) and Departments of Health Services, Policy, and Practice (Dahabreh) and Epidemiology (Dahabreh), School of Public Health, Brown University, Providence, RI; Chinese Evidence-Based Medicine Center (Sun), West China Hospital, Sichuan University, Chengdu, China; Institute of Medical Biometry and Statistics (Sauerbrei), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany; Population Health Research Institute (Walsh), Hamilton Health Sciences/McMaster University, Hamilton, Ont.; Departments of Medicine (Ioannidis), Health Research and Policy (Ioannidis) and Biomedical Data Science (Ioannidis), and Statistics and Meta-Research Innovation Center at Stanford (METRICS) (Ioannidis), Stanford University, Stanford, Calif.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Willi Sauerbrei
- Departments of Health Research Methods, Evidence, and Impact (Schandelmaier, Briel, Walsh, Thabane, Guyatt), Medicine (Walsh, Guyatt), Pediatrics (Thabane) and Anesthesia (Thabane), McMaster University, Hamilton, Ont.; Institute for Clinical Epidemiology and Biostatistics (Schandelmaier, Briel), Department of Clinical Research, Basel University, Basel, Switzerland; Division of Biostatistics and Bioinformatics (Varadhan), Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Md.; Department of Biostatistics (Schmid), Brown University School of Public Health, Brown University, Providence, RI; Indian institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, New Delhi, India; VA Center for Clinical Management and Research (Hayward); Department of Internal Medicine (Hayward), University of Michigan School of Medicine; Department of Orthopaedic Surgery (Gagnier), University of Michigan; Department of Epidemiology (Gagnier), School of Public Health, University of Michigan, Ann Arbor, Mich.; Biostat (Borenstein), Englewood, NJ; Department of Social Dentistry (van der Heijden), Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands; Center for Evidence Synthesis in Health (Dahabreh) and Departments of Health Services, Policy, and Practice (Dahabreh) and Epidemiology (Dahabreh), School of Public Health, Brown University, Providence, RI; Chinese Evidence-Based Medicine Center (Sun), West China Hospital, Sichuan University, Chengdu, China; Institute of Medical Biometry and Statistics (Sauerbrei), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany; Population Health Research Institute (Walsh), Hamilton Health Sciences/McMaster University, Hamilton, Ont.; Departments of Medicine (Ioannidis), Health Research and Policy (Ioannidis) and Biomedical Data Science (Ioannidis), and Statistics and Meta-Research Innovation Center at Stanford (METRICS) (Ioannidis), Stanford University, Stanford, Calif.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Michael Walsh
- Departments of Health Research Methods, Evidence, and Impact (Schandelmaier, Briel, Walsh, Thabane, Guyatt), Medicine (Walsh, Guyatt), Pediatrics (Thabane) and Anesthesia (Thabane), McMaster University, Hamilton, Ont.; Institute for Clinical Epidemiology and Biostatistics (Schandelmaier, Briel), Department of Clinical Research, Basel University, Basel, Switzerland; Division of Biostatistics and Bioinformatics (Varadhan), Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Md.; Department of Biostatistics (Schmid), Brown University School of Public Health, Brown University, Providence, RI; Indian institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, New Delhi, India; VA Center for Clinical Management and Research (Hayward); Department of Internal Medicine (Hayward), University of Michigan School of Medicine; Department of Orthopaedic Surgery (Gagnier), University of Michigan; Department of Epidemiology (Gagnier), School of Public Health, University of Michigan, Ann Arbor, Mich.; Biostat (Borenstein), Englewood, NJ; Department of Social Dentistry (van der Heijden), Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands; Center for Evidence Synthesis in Health (Dahabreh) and Departments of Health Services, Policy, and Practice (Dahabreh) and Epidemiology (Dahabreh), School of Public Health, Brown University, Providence, RI; Chinese Evidence-Based Medicine Center (Sun), West China Hospital, Sichuan University, Chengdu, China; Institute of Medical Biometry and Statistics (Sauerbrei), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany; Population Health Research Institute (Walsh), Hamilton Health Sciences/McMaster University, Hamilton, Ont.; Departments of Medicine (Ioannidis), Health Research and Policy (Ioannidis) and Biomedical Data Science (Ioannidis), and Statistics and Meta-Research Innovation Center at Stanford (METRICS) (Ioannidis), Stanford University, Stanford, Calif.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - John P A Ioannidis
- Departments of Health Research Methods, Evidence, and Impact (Schandelmaier, Briel, Walsh, Thabane, Guyatt), Medicine (Walsh, Guyatt), Pediatrics (Thabane) and Anesthesia (Thabane), McMaster University, Hamilton, Ont.; Institute for Clinical Epidemiology and Biostatistics (Schandelmaier, Briel), Department of Clinical Research, Basel University, Basel, Switzerland; Division of Biostatistics and Bioinformatics (Varadhan), Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Md.; Department of Biostatistics (Schmid), Brown University School of Public Health, Brown University, Providence, RI; Indian institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, New Delhi, India; VA Center for Clinical Management and Research (Hayward); Department of Internal Medicine (Hayward), University of Michigan School of Medicine; Department of Orthopaedic Surgery (Gagnier), University of Michigan; Department of Epidemiology (Gagnier), School of Public Health, University of Michigan, Ann Arbor, Mich.; Biostat (Borenstein), Englewood, NJ; Department of Social Dentistry (van der Heijden), Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands; Center for Evidence Synthesis in Health (Dahabreh) and Departments of Health Services, Policy, and Practice (Dahabreh) and Epidemiology (Dahabreh), School of Public Health, Brown University, Providence, RI; Chinese Evidence-Based Medicine Center (Sun), West China Hospital, Sichuan University, Chengdu, China; Institute of Medical Biometry and Statistics (Sauerbrei), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany; Population Health Research Institute (Walsh), Hamilton Health Sciences/McMaster University, Hamilton, Ont.; Departments of Medicine (Ioannidis), Health Research and Policy (Ioannidis) and Biomedical Data Science (Ioannidis), and Statistics and Meta-Research Innovation Center at Stanford (METRICS) (Ioannidis), Stanford University, Stanford, Calif.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Lehana Thabane
- Departments of Health Research Methods, Evidence, and Impact (Schandelmaier, Briel, Walsh, Thabane, Guyatt), Medicine (Walsh, Guyatt), Pediatrics (Thabane) and Anesthesia (Thabane), McMaster University, Hamilton, Ont.; Institute for Clinical Epidemiology and Biostatistics (Schandelmaier, Briel), Department of Clinical Research, Basel University, Basel, Switzerland; Division of Biostatistics and Bioinformatics (Varadhan), Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Md.; Department of Biostatistics (Schmid), Brown University School of Public Health, Brown University, Providence, RI; Indian institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, New Delhi, India; VA Center for Clinical Management and Research (Hayward); Department of Internal Medicine (Hayward), University of Michigan School of Medicine; Department of Orthopaedic Surgery (Gagnier), University of Michigan; Department of Epidemiology (Gagnier), School of Public Health, University of Michigan, Ann Arbor, Mich.; Biostat (Borenstein), Englewood, NJ; Department of Social Dentistry (van der Heijden), Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands; Center for Evidence Synthesis in Health (Dahabreh) and Departments of Health Services, Policy, and Practice (Dahabreh) and Epidemiology (Dahabreh), School of Public Health, Brown University, Providence, RI; Chinese Evidence-Based Medicine Center (Sun), West China Hospital, Sichuan University, Chengdu, China; Institute of Medical Biometry and Statistics (Sauerbrei), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany; Population Health Research Institute (Walsh), Hamilton Health Sciences/McMaster University, Hamilton, Ont.; Departments of Medicine (Ioannidis), Health Research and Policy (Ioannidis) and Biomedical Data Science (Ioannidis), and Statistics and Meta-Research Innovation Center at Stanford (METRICS) (Ioannidis), Stanford University, Stanford, Calif.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Gordon H Guyatt
- Departments of Health Research Methods, Evidence, and Impact (Schandelmaier, Briel, Walsh, Thabane, Guyatt), Medicine (Walsh, Guyatt), Pediatrics (Thabane) and Anesthesia (Thabane), McMaster University, Hamilton, Ont.; Institute for Clinical Epidemiology and Biostatistics (Schandelmaier, Briel), Department of Clinical Research, Basel University, Basel, Switzerland; Division of Biostatistics and Bioinformatics (Varadhan), Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Md.; Department of Biostatistics (Schmid), Brown University School of Public Health, Brown University, Providence, RI; Indian institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, New Delhi, India; VA Center for Clinical Management and Research (Hayward); Department of Internal Medicine (Hayward), University of Michigan School of Medicine; Department of Orthopaedic Surgery (Gagnier), University of Michigan; Department of Epidemiology (Gagnier), School of Public Health, University of Michigan, Ann Arbor, Mich.; Biostat (Borenstein), Englewood, NJ; Department of Social Dentistry (van der Heijden), Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands; Center for Evidence Synthesis in Health (Dahabreh) and Departments of Health Services, Policy, and Practice (Dahabreh) and Epidemiology (Dahabreh), School of Public Health, Brown University, Providence, RI; Chinese Evidence-Based Medicine Center (Sun), West China Hospital, Sichuan University, Chengdu, China; Institute of Medical Biometry and Statistics (Sauerbrei), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany; Population Health Research Institute (Walsh), Hamilton Health Sciences/McMaster University, Hamilton, Ont.; Departments of Medicine (Ioannidis), Health Research and Policy (Ioannidis) and Biomedical Data Science (Ioannidis), and Statistics and Meta-Research Innovation Center at Stanford (METRICS) (Ioannidis), Stanford University, Stanford, Calif.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
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Su N, Lagerweij MD, van der Heijden GJMG. Assessment of predictive performance of caries risk assessment models based on a systematic review and meta-analysis. J Dent 2021; 110:103664. [PMID: 33984413 DOI: 10.1016/j.jdent.2021.103664] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/05/2021] [Accepted: 04/09/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To assess the predictive performance of caries risk assessment (CRA) models for prediction of caries increment for individuals based on a systematic review and meta-analyses. DATA/SOURCES We included external validation studies assessing the predictive performance of CRA models for prediction of caries increment for individuals, using discrimination and calibration as the outcome parameters. PubMed, EMBASE, and CINAHL were searched electronically on 10th September 2020 to identify prediction modeling studies on external validation of CRA models. The risk of bias of the included studies was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). STUDY SELECTION A total of 22 studies with seven different CRA models were included. As for full Cariogram, the pooled area under the receiver operating characteristic curve (AUC) was 0.78 (95 %CI: 0.68; 0.85) based on eight studies regardless of the risk of bias levels, and 0.82 (95 %CI: 0.58; 0.93) based on four studies with low risk of bias only. The pooled observed: expected ratio (O:E ratio) of full Cariogram was 0.91 (95 %CI: 0.72; 1.14) based on 12 studies regardless of the risk of bias levels, and 0.89 (95 %CI: 0.71; 1.12) based on five studies with low risk of bias only. As for reduced Cariogram, the pooled AUC was 0.72 (95 %CI: 0.67; 0.77) based on six studies regardless of the risk of bias levels, and 0.74 (95 %CI: 0.45; 0.91) based on two studies with low risk of bias only. The pooled O:E ratio of reduced Cariogram was 0.84 (95 %CI: 0.59; 1.18) based on six studies regardless of the risk of bias levels, and 1.05 (95 %CI: 0.43; 2.59) based on two studies with low risk of bias only. Based on an insufficient number of studies for the other CRA models, the pooled AUCs ranged from 0.50 to 0.88, while the pooled O:E ratio ranged from 0.38 to 1.00. CONCLUSION The average predictive performance of both full and reduced Cariogram seems to be acceptable. However, the evidence from research does not allow a firm conclusion on the performance of the other included CRA models, due to the insufficient number of high-quality studies. CLINICAL SIGNIFICANCE Both full and reduced Cariogram were found to be reliable CRA models for prediction of caries increment in clinical practices for dental patients and communities for general populations. The reduced Cariogram showed better predictive performance and less burden in terms of time and resources to individuals than the full Cariogram. Therefore, the reduced Cariogram could be more recommended than the full Cariogram.
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Affiliation(s)
- Naichuan Su
- Department of Social Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amasterdam and VU University, the Netherlands.
| | - Maxim D Lagerweij
- Department of Cariology, Endodontology and Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amasterdam and VU University, the Netherlands
| | - Geert J M G van der Heijden
- Department of Social Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amasterdam and VU University, the Netherlands
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9
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Beukers NGFM, Su N, Loos BG, van der Heijden GJMG. Lower Number of Teeth Is Related to Higher Risks for ACVD and Death-Systematic Review and Meta-Analyses of Survival Data. Front Cardiovasc Med 2021; 8:621626. [PMID: 34026863 PMCID: PMC8138430 DOI: 10.3389/fcvm.2021.621626] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/22/2021] [Indexed: 12/17/2022] Open
Abstract
Tooth loss reflects the endpoint of two major dental diseases: dental caries and periodontitis. These comprise 2% of the global burden of human diseases. A lower number of teeth has been associated with various systemic diseases, in particular, atherosclerotic cardiovascular diseases (ACVD). The aim was to summarize the evidence of tooth loss related to the risk for ACVD or death. Cohort studies with prospective follow-up data were retrieved from Medline-PubMed and EMBASE. Following the PRISMA guidelines, two reviewers independently selected articles, assessed the risk of bias, and extracted data on the number of teeth (tooth loss; exposure) and ACVD-related events and all-cause mortality (ACM) (outcome). A total of 75 articles were included of which 44 were qualified for meta-analysis. A lower number of teeth was related to a higher outcome risk; the pooled risk ratio (RR) for the cumulative incidence of ACVD ranged from 1.69 to 2.93, and for the cumulative incidence of ACM, the RR ranged from 1.76 to 2.27. The pooled multiple adjusted hazard ratio (HR) for the incidence density of ACVD ranged from 1.02 to 1.21, and for the incidence density of ACM, the HR ranged from 1.02 to 1.30. This systematic review and meta-analyses of survival data show that a lower number of teeth is a risk factor for both ACVD and death. Health care professionals should use this information to inform their patients and increase awareness on the importance of good dental health and increase efforts to prevent tooth loss.
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Affiliation(s)
- Nicky G F M Beukers
- Academic Centre for Dentistry Amsterdam, Department of Periodontology, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Naichuan Su
- Academic Centre for Dentistry Amsterdam, Department of Social Dentistry, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Bruno G Loos
- Academic Centre for Dentistry Amsterdam, Department of Periodontology, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Geert J M G van der Heijden
- Academic Centre for Dentistry Amsterdam, Department of Social Dentistry, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Baâdoudi F, Duijster D, Maskrey N, Ali FM, Rosing K, van der Heijden GJMG. Academic detailing in oral healthcare - results of the ADVOCATE Field Studies. Acta Odontol Scand 2020; 78:481-493. [PMID: 32100593 DOI: 10.1080/00016357.2020.1729406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Academic detailing (AD) is a defined form of educational outreach that can be used to influence decision making and reduce unwarranted variation in healthcare delivery. This paper describes the results of the proof of concept phase of the ADVOCATE Field Studies. This study evaluated the feasibility, acceptability and usefulness of AD reinforced with feedback data, to promote prevention-oriented, patient-centred and evidence-based oral healthcare delivery by general dental practitioners (GDPs).Methods: In the Field Studies, six groups of GDPs (n = 39) were recruited in The Netherlands, Germany and Denmark. Each group had four meetings reinforced with feedback data for open discussions on dental practice and healthcare delivery. Conventional and directed content analysis was used to analyze the qualitative data collected from focus group interviews, debriefing interviews, field notes and evaluation forms.Results: A total of nine themes were identified. Seven themes related to the process of the Field Studies and covered experiences, barriers and facilitators to AD group meetings, data collection and the use of an electronic dashboard for data presentation and storage. Two themes related to the outcomes of the study, describing how GDPs perceived they made changes to their clinical practice as a result of the Field Studies.Conclusions: The ADVOCATE Field Studies approach offers a novel way of collecting and providing feedback to care providers which has the potential to reduce variation oral healthcare delivery. AD plus feedback data is a useful, feasible approach which creates awareness and gives insight into care delivery processes. Some logistic and technical barriers to adoption were identified, which if resolved would further improve the approach and likely increase the acceptability amongst GDPs.
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Affiliation(s)
- Fatiha Baâdoudi
- Department of Social Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Denise Duijster
- Department of Social Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Neal Maskrey
- Department of Social Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands.,School of Pharmacy, Keele University, Keele, UK
| | - Fatima M Ali
- Department of Social Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Kasper Rosing
- Department for Community Dentistry, Faculty of Health and Medical Sciences, School of Dentistry, University of Copenhagen, Copenhagen, Denmark
| | - Geert J M G van der Heijden
- Department of Social Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
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11
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Kaper NM, Aarts MCJ, Stokroos RJ, van der Heijden GJMG. Healthcare utilisation, follow-up of guidelines and practice variation on rhinosinusitis in adults: A healthcare reimbursement claims study in The Netherlands. Clin Otolaryngol 2020; 45:159-166. [PMID: 31581355 PMCID: PMC9328289 DOI: 10.1111/coa.13453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 09/18/2019] [Accepted: 09/29/2019] [Indexed: 01/05/2023]
Abstract
Objectives To provide insight into healthcare utilisation of rhinosinusitis, compare data with clinical practice guideline recommendations and assess practice variation. Design Anonymised data from claims reimbursement registries of healthcare insurers were analysed, from 1 January 2016 until 31 December 2016. Setting Secondary and tertiary care in the Netherlands. Participants Patients ≥18 years with diagnostic code “sinusitis.” Main outcome measures Healthcare utilisation (prevalence, co‐morbidity, diagnostic testing, surgery), costs, comparison with guideline recommendation, practice variation. Results We identified 56 825 patients, prevalence was 0.4%. Costs were € 45 979 554—that is 0.2% of total hospital‐related care costs (€21 831.3 × 106). Most patients were <75 years, with a slight female preponderance. 29% had comorbidities (usually COPD/asthma). 9% underwent skin prick testing, 61% nasal endoscopy, 2% X‐ray and 51% CT. Surgery rate was 16%, mostly in daycare. Nearly, all surgical procedures were performed endonasally and concerned the maxillary and/or ethmoid sinus. Seven recommendations (25%) could be (partially) compared to the distribution of claims data. Except for endoscopy, healthcare utilisation patterns were in line with guideline recommendations. We compared results for three geographical regions and found generally corresponding rates of diagnostic testing and surgery. Conclusion Prevalence was lower than reported previously. Within the boundaries of guideline recommendations, we encountered acceptable variation in healthcare utilisation in Dutch hospitals. Health reimbursement claims data can provide insight into healthcare utilisation, but they do not allow evaluation of the quality and outcomes of care, and therefore, results should be interpreted with caution.
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Affiliation(s)
- Nina M Kaper
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mark C J Aarts
- Department of Otorhinolaryngology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Robert J Stokroos
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert J M G van der Heijden
- Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
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12
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Everaars B, Weening-Verbree LF, Jerković-Ćosić K, Schoonmade L, Bleijenberg N, de Wit NJ, van der Heijden GJMG. Measurement properties of oral health assessments for non-dental healthcare professionals in older people: a systematic review. BMC Geriatr 2020; 20:4. [PMID: 31900125 PMCID: PMC6942417 DOI: 10.1186/s12877-019-1349-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/06/2019] [Indexed: 11/28/2022] Open
Abstract
Background Regular inspection of the oral cavity is required for prevention, early diagnosis and risk reduction of oral- and general health-related problems. Assessments to inspect the oral cavity have been designed for non-dental healthcare professionals, like nurses. The purpose of this systematic review was to evaluate the content and the measurement properties of oral health assessments for use by non-dental healthcare professionals in assessing older peoples’ oral health, in order to provide recommendations for practice, policy, and research. Methods A systematic search in PubMed, EMBASE.com, and Cinahl (via Ebsco) has been performed. Search terms referring to ‘oral health assessments’, ‘non-dental healthcare professionals’ and ‘older people (60+)’ were used. Two reviewers individually performed title/abstract, and full-text screening for eligibility. The included studies have investigated at least one measurement property (validity/reliability) and were evaluated on their methodological quality using “The Consensus-based Standards for the selection of health Measurement Instruments” (COSMIN) checklist. The measurement properties were then scored using quality criteria (positive/negative/indeterminate). Results Out of 879 hits, 18 studies were included in this review. Five studies showed good methodological quality on at least one measurement property and 14 studies showed poor methodological quality on some of their measurement properties. None of the studies assessed all measurement properties of the COSMIN. In total eight oral health assessments were found: the Revised Oral Assessment Guide (ROAG); the Minimum Data Set (MDS), with oral health component; the Oral Health Assessment Tool (OHAT); The Holistic Reliable Oral Assessment Tool (THROAT); Dental Hygiene Registration (DHR); Mucosal Plaque Score (MPS); The Brief Oral Health Screening Examination (BOHSE) and the Oral Assessment Sheet (OAS). Most frequently assessed items were: lips, mucosa membrane, tongue, gums, teeth, denture, saliva, and oral hygiene. Conclusion Taken into account the scarce evidence of the proposed assessments, the OHAT and ROAG are most complete in their included oral health items and are of best methodological quality in combination with positive quality criteria on their measurement properties. Non-dental healthcare professionals, policymakers and researchers should be aware of the methodological limitations of the available oral health assessments and realize that the quality of the measurement properties remains uncertain.
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Affiliation(s)
- Babette Everaars
- University of Applied Sciences Utrecht, Research Group Innovations in Preventive Care, Heidelberglaan 7, 3512, CS, Utrecht, The Netherlands. .,Department of Social Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Gustav Mahlerlaan 3004, 1081LA, Amsterdam, The Netherlands.
| | - Linet F Weening-Verbree
- Hanze University of Applied Sciences Groningen, Center of Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen (RUG), A. Deusinglaan 1, 9713, AV, Groningen, The Netherlands
| | - Katarina Jerković-Ćosić
- University of Applied Sciences Utrecht, Research group innovations in Preventive Care, Heidelberglaan 7, 3512, CS, Utrecht, The Netherlands
| | - Linda Schoonmade
- Medical Library, VU University Amsterdam, De Boelelaan 1117, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Nienke Bleijenberg
- University of Applied Sciences Utrecht, Research Group Innovations in Preventive Care, Heidelberglaan 7, 3512, CS, Utrecht, The Netherlands.,Utrecht University, University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Huispost Str.6.131, 3508, GA, Utrecht, The Netherlands
| | - Niek J de Wit
- Utrecht University, University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Huispost Str.6.131, 3508, GA, Utrecht, The Netherlands
| | - Geert J M G van der Heijden
- Department of Social Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Gustav Mahlerlaan 3004, 1081LA, Amsterdam, The Netherlands
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13
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Kaper NM, Ramakers GGJ, Aarts MCJ, van der Heijden GJMG. Publications on Clinical Research in Otolaryngology-A Systematic Analysis of Leading Journals in 2010. Front Surg 2019; 6:18. [PMID: 31024926 PMCID: PMC6467099 DOI: 10.3389/fsurg.2019.00018] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/18/2019] [Indexed: 11/13/2022] Open
Abstract
Background: We wanted to asses and characterize the volume of Otolaryngology publications on clinical research, published in major journals. Methods and Material: To assess volume and study type of clinical research in Otolaryngology we performed a literature search in high impact factor journals. We included 10 high impact factor Otolaryngology journals and 20 high impact factor medical journals outside this field (2011). We extracted original publications and systematic reviews from 2010. Publications were classified according to their research question, that is therapy, diagnosis, prognosis or etiology. Results: From Otolaryngology journals (impact factor 1.8 to 2.8) we identified 694 (46%) publications on original observations and 27 (2%) systematic reviews. From selected medical journals (impact factor 6.0 to 101.8) 122 (2%) publications related to Otolaryngology, 102 (83%) were on original observations and 2 (0.04%) systematic reviews. The most common category was therapy (40%). Conclusion: Half of publications in Otolaryngology concerns clinical research, which is higher than other specialties. In medical journals outside the field of Otolaryngology, a small proportion (2%) of publications is related to Otolaryngology. Striking is that systematic reviews, which are considered high level evidence, make up for only 2% of publications. We must ensure an increase of clinical research for optimizing medical practice.
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Affiliation(s)
- Nina M Kaper
- Department of Otolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Geerte G J Ramakers
- Department of Otolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mark C J Aarts
- Department of Otolaryngology, Jeroen Bosch Hospital, s'-Hertogenbosch, Netherlands
| | - Geert J M G van der Heijden
- Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam, VU University, Amsterdam, Netherlands
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14
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Duijster D, Oude Groeniger J, van der Heijden GJMG, van Lenthe FJ. Material, behavioural, cultural and psychosocial factors in the explanation of socioeconomic inequalities in oral health. Eur J Public Health 2019; 28:590-597. [PMID: 29272383 PMCID: PMC6051465 DOI: 10.1093/eurpub/ckx209] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background This study aimed to assess the contribution of material, behavioural, cultural and psychosocial factors in the explanation of socioeconomic inequalities (education and income) in oral health of Dutch adults. Methods Cross-sectional data from participants (25-75 years of age) of the fifth wave of the GLOBE cohort were used (n = 2812). Questionnaires were used to obtain data on material factors (e.g. financial difficulties), behavioural factors (e.g. smoking), cultural factors (e.g. cultural activities) and psychosocial factors (e.g. psychological distress). Oral health outcomes were self-reported number of teeth and self-rated oral health (SROH). Mediation analysis, using multivariable negative binomial regression and logistic regression, was performed. Results Education level and income showed a graded positive relationship with both oral health outcomes. Adding material, behavioural, cultural and psychosocial factors substantially reduced the rate ratio for the number of teeth of the lowest education group from 0.79 (95% confidence interval (CI): 0.75-0.83) to 0.92 (95% CI: 0.87-0.97) and of the lowest income group from 0.80 (95% CI: 0.73-0.88) to 1.04 (95% CI: 0.96-1.14). Inclusion of all factors also substantially reduced the odds ratio for poor SROH of the lowest education group from 1.61 (95% CI: 1.28-2.03) to 1.12 (95% CI: 0.85-1.48) and of the lowest income groups from 3.18 (95% CI: 2.13-4.74) to 1.48 (95% CI: 0.90-2.45). Conclusion In general, behavioural factors contributed most to the explanation of socioeconomic inequalities in adult oral health, followed by material factors. The contribution of cultural and psychosocial factors was relatively moderate.
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Affiliation(s)
- Denise Duijster
- Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Joost Oude Groeniger
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Geert J M G van der Heijden
- Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Frank J van Lenthe
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
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15
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van der Windt DA, Burke DL, Babatunde O, Hattle M, McRobert C, Littlewood C, Wynne-Jones G, Chesterton L, van der Heijden GJMG, Winters JC, Rhon DI, Bennell K, Roddy E, Heneghan C, Beard D, Rees JL, Riley RD. Predictors of the effects of treatment for shoulder pain: protocol of an individual participant data meta-analysis. Diagn Progn Res 2019; 3:15. [PMID: 31410370 PMCID: PMC6686538 DOI: 10.1186/s41512-019-0061-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/16/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Shoulder pain is one of the most common presentations of musculoskeletal pain with a 1-month population prevalence of between 7 and 26%. The overall prognosis of shoulder pain is highly variable with 40% of patients reporting persistent pain 1 year after consulting their primary care clinician. Despite evidence for prognostic value of a range of patient and disease characteristics, it is not clear whether these factors also predict (moderate) the effect of specific treatments (such as corticosteroid injection, exercise, or surgery). OBJECTIVES This study aims to identify predictors of treatment effect (i.e. treatment moderators or effect modifiers) by investigating the association between a number of pre-defined individual-level factors and the effects of commonly used treatments on shoulder pain and disability outcomes. METHODS This will be a meta-analysis using individual participant data (IPD). Eligible trials investigating the effectiveness of advice and analgesics, corticosteroid injection, physiotherapy-led exercise, psychological interventions, and/or surgical treatment in patients with shoulder conditions will be identified from systematic reviews and an updated systematic search for trials, and risk of bias will be assessed. Authors of all eligible trials will be approached for data sharing. Outcomes measured will be shoulder pain and disability, and our previous work has identified candidate predictors. The main analysis will be conducted using hierarchical one-stage IPD meta-analysis models, examining the effect of treatment-predictor interaction on outcome for each of the candidate predictors and describing relevant subgroup effects where significant interaction effects are detected. Random effects will be used to account for clustering and heterogeneity. Sensitivity analyses will be based on (i) exclusion of trials at high risk of bias, (ii) use of restricted cubic splines to model potential non-linear associations for candidate predictors measured on a continuous scale, and (iii) the use of a two-stage IPD meta-analysis framework. DISCUSSION Our study will collate, appraise, and synthesise IPD from multiple studies to examine potential predictors of treatment effect in order to assess the potential for better and more efficient targeting of specific treatments for individuals with shoulder pain. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018088298.
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Affiliation(s)
- Danielle A. van der Windt
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Danielle L. Burke
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Opeyemi Babatunde
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Miriam Hattle
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Cliona McRobert
- 0000 0004 1936 8470grid.10025.36School of Health Sciences, University of Liverpool, Liverpool, UK
| | - Chris Littlewood
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Gwenllian Wynne-Jones
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Linda Chesterton
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Geert J. M. G. van der Heijden
- 0000000084992262grid.7177.6Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jan C. Winters
- 0000 0000 9558 4598grid.4494.dDepartment of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Daniel I. Rhon
- San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX USA
| | - Kim Bennell
- 0000 0001 2179 088Xgrid.1008.9Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Edward Roddy
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Staffordshire and Stoke-on-Trent Partnership Trust, Stoke-on-Trent, UK
| | - Carl Heneghan
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Primary Care and Health Science, University of Oxford, Oxford, UK
| | - David Beard
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Jonathan L. Rees
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Richard D. Riley
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
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16
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Su N, Wang H, van Wijk AJ, Visscher CM, Lobbezoo F, Shi Z, van der Heijden GJMG. Prediction Models for Oral Health-Related Quality of Life in Patients with Temporomandibular Joint Osteoarthritis 1 and 6 Months After Arthrocentesis with Hyaluronic Acid Injections. J Oral Facial Pain Headache 2018; 33:54–66. [PMID: 30153315 DOI: 10.11607/ofph.2044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To develop models for prognostic prediction of oral health-related quality of life (OHRQoL) for patients with temporomandibular joint osteoarthritis (TMJ OA) at 1- and 6-month follow-ups after arthrocentesis treatment with hyaluronic acid (HA) injections once a week for 4 weeks. METHODS From a cohort of 522 adult patients with TMJ OA treated with arthrocentesis with HA injections, 510 and 463 adult patients were included in the 1- and 6-month follow-ups, respectively. Patient characteristics and history, clinical examinations, and questionnaires were recorded as potential predictors at start of treatment, and all patients underwent an identical treatment protocol. Patients' OHRQoL values at 1 and 6 months after completing the treatment were used as outcome measures. Logistic regression methods were used to develop prediction models, and the performance and validity of these models were evaluated according to state-of-the-art methods, including receiver-operating characteristics curve for the discrimination of the models and calibration plots for the calibration of the models. RESULTS History of mental disease, maximal protrusion of the jaw, muscular pain with palpation, joint pain with palpation, awake bruxism, chewing-side preference, and low OHRQoL at baseline were significantly associated with OHRQoL at the 1-month follow-up, while age, pain in other joints, history of mental disease, joint pain with palpation, sleep bruxism, awake bruxism, chewing-side preference, and low OHRQoL at baseline were significantly associated with OHRQoL at the 6-month follow-up. While the performance of both models was found to be good in terms of calibration, discrimination, and internal validity, the added predictive values of the 1-month and 6-month models for ruling in the risk of low OHRQoL were 19% and 31%, respectively, while those for ruling it out were 28% and 15%, respectively. CONCLUSION Several predictors were found to be significantly associated with patients' OHRQoL after treatment. Both prediction models may be reliable and valid for clinicians to predict a patient's risk of low OHRQoL at follow-up, so the models may be useful for clinicians in decision-making for patient management and for informing the patient.
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Schoemaker CG, van der Heijden GJMG. Does GRADE gently close the door on sharing decisions with patients? J Clin Epidemiol 2018; 102:146-147. [PMID: 29935231 DOI: 10.1016/j.jclinepi.2018.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 06/12/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Casper G Schoemaker
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Department Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
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18
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Broers DLM, van der Heijden GJMG, Rozema FR, de Jongh A. Do patients benefit from orthognathic surgery? A systematic review on the effects of elective orthognathic surgery on psychosocial functioning and patient satisfaction. Eur J Oral Sci 2017; 125:411-418. [DOI: 10.1111/eos.12371] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Dyonne L. M. Broers
- Centre for Special Care Dentistry; Amsterdam the Netherlands
- Department of Social Dentistry; University of Amsterdam and Vrije Universiteit; Amsterdam the Netherlands
| | | | - Frederik R. Rozema
- Department of Oral Medicine; Academic Centre for Dentistry Amsterdam; University of Amsterdam and Vrije Universiteit; Amsterdam the Netherlands
- Department of Oral and Maxillofacial Surgery; Academic Medical Centre; University of Amsterdam; Amsterdam the Netherlands
| | - Ad de Jongh
- Centre for Special Care Dentistry; Amsterdam the Netherlands
- Department of Social Dentistry; University of Amsterdam and Vrije Universiteit; Amsterdam the Netherlands
- School of Health Sciences; Salford University; Manchester UK
- Institute of Health and Society; University of Worcester; Worcester UK
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19
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Widyahening IS, Wangge G, van der Graaf Y, van der Heijden GJMG. Adapting clinical guidelines in low-resources countries: a study on the guideline on the management and prevention of type 2 diabetes mellitus in Indonesia. J Eval Clin Pract 2017; 23:121-127. [PMID: 27592587 PMCID: PMC5347874 DOI: 10.1111/jep.12628] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 07/26/2016] [Accepted: 07/26/2016] [Indexed: 12/13/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Most of the clinical guidelines in low-resource countries are adaptations from preexisting international guidelines. This adaptation can be problematic when those international guidelines are not based on current evidence or original evidence-based international guidelines are not followed. This study aims to evaluate the quality of an Indonesian type 2 diabetes mellitus guideline adapted from selected international guidelines. METHODS The "Consensus on the Management and Prevention of type 2 Diabetes in Indonesia 2011" is a guideline by the Indonesian Society of Endocrinology (Perkeni). Four parent guidelines identified from its list of references were from the International Diabetes Federation (IDF), American Association of Clinical Endocrinologist (AACE), American Diabetes Association (ADA), and one jointly released by ADA and European Association for the Study of Diabetes (EASD). Two reviewers independently assessed its quality using the Appraisal of Guidelines, Research and Evaluation Collaboration (AGREE II) instrument. Six recommendations were compared: (1) screening for diabetes; (2) diagnosis; (3) control of hyperglycemia; (4) target blood glucose; (5) target blood pressure; and (6) treatment of dyslipidemia. RESULTS Perkeni's guideline satisfied 55% of the AGREE II items, while its parent guidelines satisfied 59% to 74%. Perkeni's shows low score on "rigor of development" and "applicability" and the lowest score in the "scope and purpose" domain. Differences were found in 4 recommendations: the screening of diabetes, control of hyperglycemia, target blood glucose, and treatment of dyslipidemia. In 3 of 4, Perkeni followed the ADA's recommendation. CONCLUSION Derivation of recommendations from parent guidelines and their adaptation to the context of Indonesian health care lacks transparency. When guidelines are either derived from other guidelines or adapted for use in different context, evidence-based practice principles should be followed and adhered to.
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Affiliation(s)
- Indah S. Widyahening
- Community Medicine DepartmentFaculty of Medicine Universitas IndonesiaJakartaIndonesia
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Grace Wangge
- Community Medicine DepartmentFaculty of Medicine Universitas IndonesiaJakartaIndonesia
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
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Kortekaas MF, Bartelink MLEL, van der Heijden GJMG, Hoes AW, de Wit NJ. Development and validation of a new instrument measuring guideline adherence in clinical practice. Fam Pract 2016; 33:562-8. [PMID: 27461491 DOI: 10.1093/fampra/cmw063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Education in evidence-based medicine (EBM) is an important part of the postgraduate training of GPs. Evaluation of its effect on EBM behaviour in daily clinical practice is difficult and instruments are scarce. Working in accordance with guidelines is considered as one of the key indicators of EBM behaviour. OBJECTIVE To develop and validate an instrument assessing guideline adherence of GP trainees in clinical practice. METHODS We developed an instrument that assesses guideline adherence, taking conscious deviation into account. The instrument assesses guideline adherence on 59 different management decisions (diagnosis N = 17, therapy N = 20, referral N = 22) for 23 conditions as described in 27 different clinical practice guidelines. We validated this instrument using performance data as collected by third-year GP trainees on three important properties: validity, reliability and feasibility. RESULTS Performance data were collected by 76 GP trainees on 12106 patient consultations with 12587 different reasons for encounter. Overall, guideline adherence was 82% (95% confidence interval 77-88%). The significant correlation with the national GP knowledge test (r 0.33, P 0.004) showed the instrument to be a valid instrument. Interrater reliabilities (intraclass correlation coefficient) varied between moderate and excellent (0.64-1.00, P < 0.001). The instrument proved feasible with coverage of 24% (N = 3082) of reasons for encounter presented to GP trainees and a mean and median time of 1 minute to score a patient consultation. CONCLUSION This instrument proved valid, reliable and feasible to assess guideline adherence among trainees in the clinical primary care setting.
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Affiliation(s)
- Marlous F Kortekaas
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands and
| | - Marie-Louise E L Bartelink
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands and
| | - Geert J M G van der Heijden
- Department Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands and
| | - Niek J de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands and
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Beukers NGFM, van der Heijden GJMG, van Wijk AJ, Loos BG. Periodontitis is an independent risk indicator for atherosclerotic cardiovascular diseases among 60 174 participants in a large dental school in the Netherlands. J Epidemiol Community Health 2016; 71:37-42. [PMID: 27502782 PMCID: PMC5256268 DOI: 10.1136/jech-2015-206745] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 03/22/2016] [Accepted: 06/07/2016] [Indexed: 12/02/2022]
Abstract
Background The association between periodontitis and atherosclerotic cardiovascular diseases (ACVD) has been established in some modestly sized studies (<10 000). Rarely, however, periodontitis has been studied directly; often tooth loss or self-reported periodontitis has been used as a proxy measure for periodontitis. Our aim is to investigate the adjusted association between periodontitis and ACVD among all individuals registered in a large dental school in the Netherlands (Academic Centre for Dentistry Amsterdam (ACTA)). Methods Anonymised data were extracted from the electronic health records for all registered patients aged >35 years (period 1998–2013). A participant was recorded as having periodontitis based on diagnostic and treatment codes. Any affirmative answer for cerebrovascular accidents, angina pectoris and/or myocardial infarction labelled a participant as having ACVD. Other risk factors for ACVD, notably age, sex, smoking, diabetes, hypertension, hypercholesterolaemia and social economic status, were also extracted. Logistic regression analyses were used to evaluate the adjusted associations between periodontitis and ACVD. Results 60 174 individuals were identified; 4.7% of the periodontitis participants (455/9730) and 1.9% of the non-periodontitis participants (962/50 444) reported ACVD; periodontitis showed a significant association with ACVD (OR 2.52; 95% CI 2.3 to 2.8). After adjustment for the confounders, periodontitis remained independently associated with ACVD (OR 1.59; 95% CI 1.39 to 1.81). With subsequent stratification for age and sex, periodontitis remained independently associated with ACVD. Conclusions This cross-sectional analysis of a large cohort in the Netherlands of 60 174 participants shows the independent association of periodontitis with ACVD.
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Affiliation(s)
- Nicky G F M Beukers
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Geert J M G van der Heijden
- Department of Public Oral Health, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Arjen J van Wijk
- Department of Public Oral Health, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Bruno G Loos
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
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Kaper NM, Swennen MHJ, van Wijk AJ, Kalkman CJ, van Rheenen N, van der Graaf Y, van der Heijden GJMG. The "evidence-based practice inventory": reliability and validity was demonstrated for a novel instrument to identify barriers and facilitators for Evidence Based Practice in health care. J Clin Epidemiol 2015; 68:1261-9. [PMID: 26086726 DOI: 10.1016/j.jclinepi.2015.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 05/17/2015] [Accepted: 06/03/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To design and validate a practical questionnaire for clinicians, to identify barriers and facilitators for evidence-based practice (EBP), that is, the use of research evidence in patient care. The inventory is ultimately intended for departments to assess local conditions for EBP, to aim and evaluate efforts at improving or maximizing EBP. STUDY DESIGN AND SETTING We derived candidate items from existing EBP scales, psychology, and behavioral economics. In an online Delphi study, 537 international expert clinicians, researchers, teachers, and policymakers interested in EBP identified items with sufficient face and content validity. We piloted and validated the resulting draft inventory among 127 clinicians from various specialties and career stages. RESULTS The Delphi study started with 114 items and resulted in a draft inventory with 29 items in five dimensions. During the pilot, the inventory was easy to complete within 15 minutes and the items showed sufficient response variation. In four of five dimensions, test-retest reliability was substantial to almost perfect and the power to discriminate between groups with different expertise was adequate, whereas internal consistency showed that the items generally measured the same construct. On the basis of internal consistency and factor analysis, we excluded three items. The final EBP inventory consists of 26 items in five dimensions: decision making, subjective norm, attitude, perceived behavior control, and intention and behavior. DISCUSSION AND CONCLUSION The EBP inventory was developed with support of EBP experts and validated among various academic clinicians. It shows adequate face and content validity, internal consistency, test-retest reliability, discriminative power, and completion will take <15 minutes. We recommend further evaluation of its value in field trials.
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Affiliation(s)
- Nina M Kaper
- Department of Otorhinolaryngology and Head and Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
| | - Maartje H J Swennen
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Huispost nr. STR 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Arjen J van Wijk
- Department of Social Dentistry, Academic Centre for Dentistry (ACTA), University of Amsterdam and VU University Amsterdam, Gustav Mahler Laan 3004, 1081 LA, Amsterdam, The Netherlands
| | - Cor J Kalkman
- Division of Intensive Care and Emergency Medicine, Department of Anaesthesia, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Nanda van Rheenen
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Huispost nr. STR 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Yolanda van der Graaf
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Huispost nr. STR 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Geert J M G van der Heijden
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Huispost nr. STR 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands; Department of Social Dentistry, Academic Centre for Dentistry (ACTA), University of Amsterdam and VU University Amsterdam, Gustav Mahler Laan 3004, 1081 LA, Amsterdam, The Netherlands
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van Dongen TMA, Schilder AGM, Venekamp RP, de Wit GA, van der Heijden GJMG. Cost-effectiveness of treatment of acute otorrhea in children with tympanostomy tubes. Pediatrics 2015; 135:e1182-9. [PMID: 25896832 DOI: 10.1542/peds.2014-3141] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Acute otorrhea is a common problem in children with tympanostomy tubes. We recently demonstrated that treatment with antibiotic-glucocorticoid eardrops is clinically superior to oral antibiotics and initial observation. The aim of this study was to assess the cost-effectiveness of these three common treatment strategies for this condition. METHODS We performed an open-label pragmatic trial in which 230 children with acute uncomplicated tympanostomy-tube otorrhea were randomly allocated to receive 1 of 3 treatments: hydrocortisone-bacitracin-colistin eardrops, oral amoxicillin-clavulanate suspension, and initial observation (no assigned medication prescription to fill). Parents kept a daily diary capturing ear-related symptoms, health care resource use, and non-health care costs for 6 months. At 2 weeks and 6 months, the study doctor visited the children at home performing otoscopy. Using a societal perspective, treatment failure (otoscopic presence of otorrhea at 2 weeks) and number of days with otorrhea as reported in the daily diary were balanced against the costs. RESULTS Antibiotic-glucocorticoid eardrops were clinically superior to oral antibiotics and initial observation both at 2 weeks and 6 months. At 2 weeks, mean total cost per patient was US$42.43 for antibiotic-glucocorticoid eardrops, US$70.60 for oral antibiotics, and US$82.03 for initial observation. At 6 months, mean total cost per patient was US$368.20, US$420.73, and US$640.44, respectively. Because of the dominance of eardrops, calculating incremental cost-effectiveness ratios was redundant. CONCLUSIONS Antibiotic-glucocorticoid eardrops are clinically superior and cost less than oral antibiotics and initial observation in children with tympanostomy tubes who develop otorrhea.
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Affiliation(s)
| | - Anne G M Schilder
- Departments of Epidemiology, Otorhinolaryngology, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht, Netherlands; UCL ENT Clinical Trials Programme, Ear Institute, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Roderick P Venekamp
- Departments of Epidemiology, Otorhinolaryngology, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht, Netherlands
| | - G Ardine de Wit
- Public Health, Health Technology Assessment and Medical Humanities, Julius Center for Health Sciences and Primary Care, and Department of Nutrition, Prevention and Care, National Institute of Public Health and the Environment, Bilthoven, Netherlands; and
| | - Geert J M G van der Heijden
- Departments of Epidemiology, Otorhinolaryngology, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht, Netherlands; Department of Social Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands
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Schlösser TPC, Stadhouder A, Schimmel JJP, Lehr AM, van der Heijden GJMG, Castelein RM. Reliability and validity of the adapted Dutch version of the revised Scoliosis Research Society 22-item questionnaire. Spine J 2014; 14:1663-72. [PMID: 24360746 DOI: 10.1016/j.spinee.2013.09.046] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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: 06/03/2013] [Revised: 08/27/2013] [Accepted: 09/27/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT As in other fields of medicine, there is an increasing interest among orthopedic surgeons to measure health-related quality of life in adolescent idiopathic scoliosis patients and to evaluate the burden of disease and the effectiveness of different treatment strategies. The development of the revised Scoliosis Research Society 22-item patient questionnaire (SRS-22r) enabled a comprehensive evaluation of health-related quality of life of these patients. Over the years, the SRS-22r gained wide acceptance and has been used in several different countries, languages, and cultures. The SRS-22r has not been translated into Dutch to date. PURPOSE To translate the SRS-22r into Dutch and adapt it cross-culturally as outlined by international guidelines and to test its psychometric properties to measure health-related quality of life of adolescent idiopathic scoliosis patients in the Netherlands. STUDY DESIGN/SETTING A cross-sectional, multicenter validation study. PATIENT SAMPLE A total of 135 adolescent idiopathic scoliosis patients (mean age 15.1 years old) of three major scoliosis centers in the Netherlands were enrolled in this study. Ninety-two (68%) subjects completed the Dutch SRS-22r, Child Health Questionnaire (CHQ)-CF87 (golden standard for adolescents), and Short Form (SF)-36 (golden standard for adults). Two weeks later, 73 (79%) of 92 respondents returned a second SRS-22r. Demographics, curve type, Risser stage, and treatment status were documented. OUTCOME MEASURES Floor and ceiling effects, internal consistency, reproducibility, concurrent validity, and discriminative ability of the Dutch version of the SRS-22r questionnaire. METHODS For content analysis, SRS-22r domain scores (function, pain, self-image, mental health, and satisfaction with management) were explored and floor and ceiling effects were determined. Cronbach's α was calculated for internal consistency of each domain of the questionnaires and reproducibility was assessed by test-retest reliability analysis. Using Pearson's correlation coefficient, comparison of the domains of the Dutch SRS-22r with the domains of the SF-36 and Child Health Questionnaire-CF87 assessed the concurrent validity. Differences in SRS-22r domain scores between untreated patients with different curve severity determined the discriminative ability of the questionnaire. RESULTS The SRS-22r domains as well as the SF-36 and CHQ-CF87 domains demonstrated no floor effects, but the function, pain, and satisfaction with management domains had ceiling effects, indicating the proportion of subjects with the maximum score between 19.6% and 33.0%. Internal consistency was very satisfactory for all SRS-22r domains: Cronbach's α was between 0.718 and 0.852. By omitting question 15, the internal consistency of the function domain increased from 0.746 to 0.827. Test-retest reliability was ≥0.799 for all SRS-22r domains. The function, pain, mental health, and self-image domains correlated under the 0.001 significance level with the corresponding CHQ-CF87 and SF-36 domains. The satisfaction with management domain did not correlate with the other questionnaires. The SRS-22r had the ability to detect differences between groups with different curve severity; patients with a severe scoliotic curvature had significantly lower pain and self-image domain scores than patients with relatively mild scoliosis. CONCLUSIONS The Dutch SRS-22r had the properties needed for the measurement of patient perceived health-related quality of life of adolescent idiopathic scoliosis patients in the Netherlands. The Dutch SRS-22r could be used for the longitudinal follow-up of adolescent idiopathic scoliosis patients from adolescence to adulthood and for establishing the effects of conservative or invasive surgical treatment.
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Affiliation(s)
- Tom P C Schlösser
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Agnita Stadhouder
- Department of Orthopaedic Surgery, Vrije Universiteit medical center, De Boelelaan 117, 1081 HZ, Amsterdam, The Netherlands
| | - Janneke J P Schimmel
- Research Department, Sint Maartenskliniek, Hengstdal 3, 6574 NA, Ubbergen, The Netherlands
| | - A Mechteld Lehr
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Geert J M G van der Heijden
- Department Social Dentistry, Academic Center for Dentistry Amsterdam, VU Amsterdam University and University of Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands; Department of Epidemiology, Division Julius Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - René M Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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Widyahening IS, Wangge G, Saldi SRF, Lestari BW, Apriani L, Sastroasmoro S, Glasziou P, van der Graaf Y, van der Heijden GJMG. Quality and reporting of publications by Indonesian researchers: a literature survey. J Evid Based Med 2014; 7:163-71. [PMID: 25156942 DOI: 10.1111/jebm.12112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 06/18/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To evaluate the quality of reporting of the risk of bias of the Indonesian medical research. METHODS Publications from PubMed and non-PubMed indexed Indonesian medical journals between January 2008 to December 2010 were assessed for risk of bias based on criterion combination from Hedges-criteria and the Oxford Center for Evidence-Based Medicine. We assessed whether the publications addressed the risk of bias adequately (quality of reporting) and whether the risk of bias criterion was fulfilled (quality of methods). The quality (both of reporting and of methods) of a study was classified as "high" if, for at least two-thirds of the criteria were adequately reported and fulfilled. It was classified as "low" when only one-third of the criteria were reported and or fulfilled. RESULTS Of the 1753 publications, 29% (n = 507) were original medical research. For 21% (109/507) the quality of reporting was high; for 15% (77/507) the quality of methods was high. The proportion of high quality was significantly higher among PubMed than non-PubMed, with difference between proportions: (95%CI of difference: 3 to 23). CONCLUSION A small proportion of Indonesian studies have high quality of reporting or methods. When international reporting guidelines are endorsed and followed, the quality of future studies may improve.
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Affiliation(s)
- Indah S Widyahening
- Community Medicine Department, Faculty of Medicine, University of Indonesia, Indonesia
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Smelt AFH, Louter MA, Kies DA, Blom JW, Terwindt GM, van der Heijden GJMG, De Gucht V, Ferrari MD, Assendelft WJJ. What do patients consider to be the most important outcomes for effectiveness studies on migraine treatment? Results of a Delphi study. PLoS One 2014; 9:e98933. [PMID: 24932784 PMCID: PMC4059644 DOI: 10.1371/journal.pone.0098933] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 05/09/2014] [Indexed: 11/25/2022] Open
Abstract
Background The outcome measures most frequently used in studies on the effectiveness of migraine treatment are whether the patient is free of pain, nausea, and free of photophobia/phonophobia within two hours. However, no patient-centred outcome measures are available. Therefore, we performed an online Delphi procedure to compile a list of outcome measures deemed most important to migraine patients. Methods From a large database of migraine patients, we randomly selected 150 males and 150 females patients. We asked the open-ended question: ‘If a new medicine was developed for migraine attacks, what would you wish the effect of this medication to be?’ In the second and third rounds, we presented the answers of the first round and asked the patients to rate the importance of each item. Results The initial response rate was 56% (n = 169). In the subsequent rounds the response rates were 90% (n = 152), and 97% (n = 147), respectively. Patients wanted their attack medication to treat the headache within 30 min, to prevent the attack from getting worse, to ensure they could function properly within 1 h, and prevent the recurrence of symptoms during the same day. Conclusions The currently used outcome measures in migraine research do not sufficiently reflect the wishes of patients. Patients want the medication to work faster, to take away pain at an earlier stage, to make them able to function properly quickly, and to prevent recurrence. These aspects should be considered in future evaluation of new attack medication for migraine.
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Affiliation(s)
- Antonia F. H. Smelt
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- * E-mail:
| | - Mark A. Louter
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Dennis A. Kies
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeanet W. Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Gisela M. Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Geert J. M. G. van der Heijden
- Department of Social Dentistry, Academic Center of Dentistry Amsterdam, VU Amsterdam University and University of Amsterdam, Amsterdam, The Netherlands
| | | | - Michel D. Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem J. J. Assendelft
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Schlösser TPC, van der Heijden GJMG, Versteeg AL, Castelein RM. How 'idiopathic' is adolescent idiopathic scoliosis? A systematic review on associated abnormalities. PLoS One 2014; 9:e97461. [PMID: 24820478 PMCID: PMC4018432 DOI: 10.1371/journal.pone.0097461] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 04/20/2014] [Indexed: 11/23/2022] Open
Abstract
Background Despite more than a century of dedicated research, the etiology and pathogenesis of adolescent idiopathic scoliosis (AIS) remain unclear. By definition, ‘idiopathic’ implies an unknown cause. Nevertheless, many abnormalities concomitant to AIS have been described, often with the suggestion that these abnormalities are related to etio-pathogenesis. Insight in the concomitant abnormalities may assist in improving the understanding of the etiological pathways of AIS. We aimed to systematically review and synthesize available studies on abnormalities concomitant to AIS. Methods Original studies comparing untreated AIS patients with healthy adolescents on abnormalities other than the deformity of the spine were retrieved from PubMed and Embase. We followed PRISMA guidelines and to quantify the relationship between each abnormality and AIS we used a best-evidence-syntheses for relating risk-of-bias to consistency of effect sizes. Results We identified 88 relevant citations, forty-seven carried high risk-of-bias and twenty studies did not report quantitative data in a sufficient manner. The remaining twenty-one publications failed to report data from before initiation of the deformity and blind assessments. These cross-sectional studies provided data on fourteen abnormalities concomitant to AIS. With our best-evidence-syntheses we were unable to find both strong evidence and a consistent pattern of occurrence for AIS and any of these abnormalities. From moderate risk-of-bias studies a relatively consistent pattern of occurrence for AIS and impaired gait control (4 studies; 155 subjects; Cohen’s d = 1.00) and decreased bone mineral density (2 studies; 954 subjects; Cohen’s d = −0.83) was found. For nine abnormalities a consistent pattern of occurrence with AIS was found, but the evidence for these was weak. Conclusions Based on the available literature, strong evidence is lacking for a consistent pattern of occurrence of AIS and any abnormality. The relevance for understanding the multifactorial etiology of AIS is very limited.
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Affiliation(s)
- Tom P. C. Schlösser
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geert J. M. G. van der Heijden
- Department of Epidemiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Social Dentistry, Academic Center for Dentistry Amsterdam, VU Amsterdam University and University of Amsterdam, Amsterdam, the Netherlands
| | - Anne L. Versteeg
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - René M. Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail:
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Abstract
BACKGROUND Recent guidance for the management of acute otorrhea in children with tympanostomy tubes is based on limited evidence from trials comparing oral antibiotic agents with topical antibiotics. METHODS In this open-label, pragmatic trial, we randomly assigned 230 children, 1 to 10 years of age, who had acute tympanostomy-tube otorrhea to receive hydrocortisone-bacitracin-colistin eardrops (76 children) or oral amoxicillin-clavulanate suspension (77) or to undergo initial observation (77). The primary outcome was the presence of otorrhea, as assessed otoscopically, 2 weeks after study-group assignment. Secondary outcomes were the duration of the initial otorrhea episode, the total number of days of otorrhea and the number of otorrhea recurrences during 6 months of follow-up, quality of life, complications, and treatment-related adverse events. RESULTS Antibiotic-glucocorticoid eardrops were superior to oral antibiotics and initial observation for all outcomes. At 2 weeks, 5% of children treated with antibiotic-glucocorticoid eardrops had otorrhea, as compared with 44% of those treated with oral antibiotics (risk difference, -39 percentage points; 95% confidence interval [CI], -51 to -26) and 55% of those treated with initial observation (risk difference, -49 percentage points; 95% CI, -62 to -37). The median duration of the initial episode of otorrhea was 4 days for children treated with antibiotic-glucocorticoid eardrops versus 5 days for those treated with oral antibiotics (P<0.001) and 12 days for those who were assigned to initial observation (P<0.001). Treatment-related adverse events were mild, and no complications of otitis media, including local cellulitis, perichondritis, mastoiditis, and intracranial complications, were reported at 2 weeks. CONCLUSIONS Antibiotic-glucocorticoid eardrops were more effective than oral antibiotics and initial observation in children with tympanostomy tubes who had uncomplicated acute otorrhea. (Funded by the Netherlands Organization for Health Research and Development; Netherlands Trial Register number, NTR1481.).
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Affiliation(s)
- Thijs M A van Dongen
- From the Department of Epidemiology, Julius Center for Health Sciences and Primary Care (T.M.A.D., G.J.M.G.H., R.P.V., M.M.R., A.G.M.S.), and the Department of Otorhinolaryngology, Division of Surgical Specialties (G.J.M.G.H., R.P.V., A.G.M.S.), University Medical Center Utrecht, Utrecht, the Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam (G.J.M.G.H.), and the Departments of Operating Rooms and Health Evidence, Radboud University Medical Center, Nijmegen (M.M.R.) - all in the Netherlands; and the Ear Institute, University College London, London (A.G.M.S.)
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Lammers MJW, van der Heijden GJMG, Pourier VEC, Grolman W. Bilateral cochlear implantation in children: a systematic review and best-evidence synthesis. Laryngoscope 2014; 124:1694-9. [PMID: 24390811 DOI: 10.1002/lary.24582] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 12/18/2013] [Accepted: 12/31/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the effectiveness of bilateral cochlear implantation over unilateral implantation in children with sensorineural hearing loss. DATA SOURCES Pubmed, Embase, and Web of Science. REVIEW METHODS All studies comparing a bilateral cochlear implant group with a unilateral implant group were included. RESULTS Twenty-one studies compared a bilateral cochlear implant group with a unilateral group. No randomized trials were identified. Due to the clinical heterogeneity, statistical pooling was not feasible and a best-evidence synthesis was performed. The results of this best-evidence synthesis indicate the positive effect of the second implant for especially sound localization and possibly for preverbal communication and language development. There was insufficient evidence to make a valid comparison between bilateral implantation and a bimodal fitting. CONCLUSION Although randomized trials are lacking, the results of our best-evidence synthesis indicate that the second cochlear implant might be especially useful in sound localization and possibly also in language development.
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Affiliation(s)
- Marc J W Lammers
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht
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Hennus PML, de Kort LMO, Bosch JLH, de Jong TPVM, van der Heijden GJMG. A systematic review on the accuracy of diagnostic procedures for infravesical obstruction in boys. PLoS One 2014; 9:e85474. [PMID: 24586242 PMCID: PMC3930523 DOI: 10.1371/journal.pone.0085474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 11/28/2013] [Indexed: 11/30/2022] Open
Abstract
Background Infravesical obstruction leads to kidney and bladder dysfunction in a significant proportion of boys. The aim of this review is to determine the value of diagnostic tests for ascertainment of infravesical obstruction in boys. Methodology We searched PubMed and EMBASE databases until January 1, 2013, to identify papers that described original diagnostic accuracy research for infravesical obstruction in boys. We extracted information on (1) patient characteristics and clinical presentation of PUV and (2) diagnostic pathway, (3) diagnostic accuracy measures and (4) assessed risk of bias. Principal Findings We retrieved 15 studies describing various diagnostic pathways in 1,189 boys suspected for infravesical obstruction. The included studies reflect a broad clinical spectrum of patients, but all failed to present a standardised approach to confirm the presence and severity of obstruction. The risk of bias of included studies is rather high due to work-up bias and missing data. Conclusions As a consequence of low quality of methods of the available studies we put little confidence in the reported estimates for the diagnostic accuracy of US, VCUG and new additional tests for ruling in or ruling out infravesical obstruction. To date, firm evidence to support common diagnostic pathways is lacking. Hence, we are unable to draw conclusions on diagnostic accuracy of tests for infravesical obstruction. In order to be able to standardise the diagnostic pathway for infravesical obstruction, adequate design and transparent reporting is mandatory.
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Affiliation(s)
- Pauline M. L. Hennus
- Department of Urology, University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail:
| | | | - J. L. H. Bosch
- Department of Urology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tom P. V. M. de Jong
- Department of Urology, University Medical Center Utrecht, Utrecht, the Netherlands
- Pediatric Renal Center, Wilhelmina Children’s Hospital and University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geert J. M. G. van der Heijden
- Department of Epidemiology, Division Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Social Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands
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van den Broek MFM, Gudden C, Kluijfhout WP, Stam-Slob MC, Aarts MCJ, Kaper NM, van der Heijden GJMG. No Evidence for Distinguishing Bacterial from Viral Acute Rhinosinusitis Using Symptom Duration and Purulent Rhinorrhea. Otolaryngol Head Neck Surg 2014; 150:533-7. [DOI: 10.1177/0194599814522595] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To evaluate the diagnostic value of symptom duration and purulent rhinorrhea in adults suspected of having acute bacterial rhinosinusitis. Data Sources PubMed, EMBASE, and the Cochrane Library. Review Methods We performed a comprehensive systematic search on March 28, 2013. We included studies on the diagnostic value of duration of symptoms and purulent rhinorrhea in patients suspected of having acute bacterial rhinosinusitis. We assessed study design of included articles for directness of evidence and risk of bias. We extracted prevalence and positive and negative predictive values. Results Of 4173 unique publications, we included 1 study with high directness of evidence and moderate risk of bias. The prior probability of bacterial rhinosinusitis was 0.29 (95% confidence interval [CI], 0.24-0.35); we could not extract posterior probabilities. Odds ratios (95% CI) from univariate analysis were 1.03 (0.78-1.36) for duration of symptoms and 2.69 (1.39-5.18) for colored discharge on the floor of the nasal cavity. Conclusion and Recommendation We included 1 study with moderate risk of bias, reporting data in such a manner that we could not assess the value of symptom duration and purulent rhinorrhea in adults suspected of having acute bacterial rhinosinusitis. Recommendations to distinguish between a viral and a bacterial source based on purulent rhinorrhea are not supported by evidence, and the decision to prescribe antibiotic treatment should not depend on its presence. Based on judgment driven by theory and subsidiary evidence of a greater likelihood of bacterial rhinosinusitis after 10 days, antibiotic therapy may seem a reasonable empirical option.
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Affiliation(s)
- Medard F. M. van den Broek
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Corien Gudden
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wouter P. Kluijfhout
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Manon C. Stam-Slob
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mark C. J. Aarts
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nina M. Kaper
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geert J. M. G. van der Heijden
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, the Netherlands
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Broeder TP, Grooteman KV, Overdijkink SB, Selhorst CE, Kaper NM, Grolman W, van der Heijden GJMG. Inconclusive Evidence That Age Predicts a Prolonged or Chronic Course of Acute Rhinosinusitis in Adults. Otolaryngol Head Neck Surg 2013; 150:365-70. [DOI: 10.1177/0194599813516278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To review the evidence whether the risk for a prolonged or chronic course increases with age in adult patients with acute rhinosinusitis. Data Sources PubMed, EMBASE, and the Cochrane Library. Review Methods A comprehensive literature search was performed on March 24, 2013, and articles were screened and selected using predefined inclusion and exclusion criteria. Articles reporting studies on age as a predictor for the course in patients with acute rhinosinusitis were included. For included articles, the design of reported studies was assessed for directness of evidence and risk of bias. We aimed to extract hazard ratios for age as a continuous variable. Results Out of 13,382 unique publications, 3 articles with moderate risk of bias were included, with a maximum follow-up period of 30 days. The reported hazard ratios for recovery at 10, 15, and 30 days are 1.0 (95% confidence interval, 0.9-1.1) for age as a continuous variable, 0.86 (0.66-1.11) for age dichotomized at 38 years, and 0.58 (0.40-0.84) for age dichotomized for an increase with 20 years, respectively. Conclusion and Recommendation There is no evidence that age increases the risk for chronic rhinosinusitis in adult patients with acute rhinosinusitis. The literature is inconclusive that age increases the risk for a prolonged course of acute rhinosinusitis and, therefore, does not provide grounds for different management according to age of patients. As such, patients can be managed according to clinical practice guidelines with expectant observation and symptomatic treatment.
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Affiliation(s)
- Timo P. Broeder
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karina V. Grooteman
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne B. Overdijkink
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christel E. Selhorst
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nina M. Kaper
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert J. M. G. van der Heijden
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Social Dentistry, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
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Wuister AMH, Goto NA, Oostveen EJ, de Jong WU, van der Valk ES, Kaper NM, Aarts MCJ, Grolman W, van der Heijden GJMG. Nasal endoscopy is recommended for diagnosing adults with chronic rhinosinusitis. Otolaryngol Head Neck Surg 2013; 150:359-64. [PMID: 24567340 DOI: 10.1177/0194599813514510] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the diagnostic value of nasal endoscopic findings in adults suspected of chronic rhinosinusitis. DATA SOURCES PubMed, EMBASE, and the Cochrane Library. REVIEW METHODS A comprehensive search was performed up to March 5, 2013. Articles that assessed the diagnostic value of nasal endoscopy in adults suspected of chronic rhinosinusitis were included. For selected articles, the study design was assessed for directness of evidence and risk of bias. Prevalence, positive, and negative predictive values were extracted from reported data. RESULTS Out of 3899 unique publications, we included 3 diagnostic studies with a high directness of evidence and a low or moderate risk of bias for data extraction. They showed a prevalence of chronic rhinosinusitis (diagnosed with computed tomography) of .40 to .56. Compared with posterior probabilities we found an added value for ruling in chronic rhinosinusitis by a positive nasal endoscopy of 25% to 28% and an added value for ruling out chronic rhinosinusitis by a negative nasal endoscopy of 5% to 30%. CONCLUSION AND RECOMMENDATION Computed tomography is not considered necessary in case of a positive nasal endoscopy. While nasal endoscopy cannot rule out chronic rhinosinusitis, we advise computed tomography only for patients with a prolonged or complicated course of rhinosinusitis.
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Affiliation(s)
- Annemarie M H Wuister
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
Objective To assess the effectiveness of nasal saline irrigation in adult patients with chronic rhinosinusitis. Data Sources PubMed, EMBASE, the Cochrane Library. Review Methods A comprehensive search was performed, and 2 authors independently screened publications. The design of selected studies was assessed on directness of evidence and risk of bias. Results Of 1596 publications, 1 open-label randomized trial with high directness of evidence and moderate risk of bias was included. In this study, 127 patients were randomly allocated to isotonic nasal saline irrigation or isotonic nasal saline spray, as added to their usual medication. The mean 20-Item Sinonasal Outcome Test (SNOT-20) scores of those treated with nasal irrigation improved more than those allocated to nasal spray. While the authors consider an improvement of 16 or more to be clinically meaningful, the changes from baseline in mean SNOT-20 scores of those treated with irrigation (and the differences with those treated with nasal spray) at 2, 4, and 8 weeks were 12.2 (difference 5.5, [95% confidence interval −0.04 to 11.0]), 16.2 (difference 8.8 [3.2 to 14.4]), and 15.0 (difference 6.5 [0.4 to 12.6]), respectively. Side effects of posttreatment nasal dripping were common but minor and did not lead to discontinuation of treatment. Conclusion and Recommendation It should be explained to adult patients with chronic rhinosinusitis that there is limited information on the relative effect of nasal saline irrigation and nasal saline spray on subjective symptom improvement, since there is only 1 trial available with a moderate risk of bias showing limited benefit of irrigation over spray.
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Affiliation(s)
- Jelle W. G. van den Berg
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Linden M. de Nier
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nina M. Kaper
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Anne G. M. Schilder
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- UCL ENT Clinical Trials Programme, Ear Institute, Faculty of Brain Sciences, University College London, United Kingdom
| | - Roderick P. Venekamp
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Geert J. M. G. van der Heijden
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Social Dentistry, Academic Center for Dentistry (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands
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Hauer AJ, Luiten EL, van Erp NF, Blase PE, Aarts MCJ, Kaper NM, van der Heijden GJMG. No Evidence for Distinguishing Bacterial from Viral Acute Rhinosinusitis Using Fever and Facial/Dental Pain. Otolaryngol Head Neck Surg 2013; 150:28-33. [DOI: 10.1177/0194599813510891] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To assess the diagnostic value of fever and facial and dental pain in adults suspected of acute bacterial rhinosinusitis. Data Sources PubMed, EMBASE, and the Cochrane Library. Review Methods A comprehensive systematic search was performed on March 18, 2013. We included articles reporting studies on the diagnostic value of fever or facial and dental pain in patients suspected of acute bacterial rhinosinusitis. For included articles, the reported study design was assessed for directness of evidence and risk of bias. Prevalences, positive predictive values, and negative predictive values were extracted. Results Of 3171 unique records, we included 1 study with a high directness of evidence and a moderate risk of bias. The prior probability of bacterial rhinosinusitis was 0.29 (95% confidence interval: 0.24 to 0.35). We could not extract posterior probabilities with accompanying positive and negative predictive values. The study reported an odds ratio from univariate analysis for fever of 1.02 (0.52 to 2.00) and 1.65 (0.83 to 3.28) for facial and dental pain. In subsequent multivariate analysis, the odds ratio of facial and dental pain was 1.86 (1.06 to 3.29). Conclusion and Recommendation There is 1 study with moderate risk of bias, reporting data in such a manner that we could not assess the value of fever and facial and dental pain in adults suspected of an acute bacterial rhinosinusitis. Therefore, these symptoms should not be used in clinical practice to distinguish between a bacterial and viral source of acute rhinosinusitis or for decision making about prescribing antibiotic treatment.
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Affiliation(s)
- Allard J. Hauer
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Eric L. Luiten
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nicole F. van Erp
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter E. Blase
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mark C. J. Aarts
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nina M. Kaper
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geert J. M. G. van der Heijden
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, the Netherlands
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Frerichs KA, Nigten G, Romeijn K, Kaper NM, Grolman W, van der Heijden GJMG. Inconclusive Evidence for Allergic Rhinitis to Predict a Prolonged or Chronic Course of Acute Rhinosinusitis. Otolaryngol Head Neck Surg 2013; 150:22-7. [DOI: 10.1177/0194599813510892] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To systematically review the evidence on allergic rhinitis as a predictor for a prolonged or chronic course in adult patients with acute rhinosinusitis. Data Sources Pubmed, EMBASE, and the Cochrane library. Review Methods A systematic literature search was performed on March 15, 2013. During screening of title and abstract, 3 authors independently selected studies on allergic rhinitis as a predictor for the course of acute rhinosinusitis in adults. The reported study design was assessed for directness of evidence and risk of bias. We aimed to extract prior and posterior probabilities for a prolonged or chronic course of acute rhinosinusitis. Results Of 13,202 retrieved articles, 2 articles were eligible for study assessment. They provided a high directness of evidence but carried a high risk of bias. The studies showed an incidence of a prolonged and chronic course of, respectively, .19 (95% confidence interval [CI] .16-.23) and .05 (95% CI, .02-.13). In patients with allergic rhinitis, the incidence was .25 (95% CI, .18-.35) and .14 (95% CI, .04-.34), so the added value of allergic rhinitis to predict a prolonged course is 6% and to predict a chronic course 8%. Conclusion and Recommendation While the 2 included studies suggest that allergic rhinitis adds little to the prediction of a prolonged or chronic course in patients with acute rhinosinusitis, they carry a high risk of bias. As the available evidence does not provide grounds for different management of patients with and without allergic rhinitis, namely, according to clinical practice guidelines, both can be managed with expectant observation and symptomatic treatment.
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Affiliation(s)
- Kristine A. Frerichs
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gea Nigten
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kalynda Romeijn
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nina M. Kaper
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geert J. M. G. van der Heijden
- Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Social Dentistry, Academic Center for Dentistry (ACTA), VU University Amsterdam and University of Amsterdam, Amsterdam, the Netherlands
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Bittermann AJN, Wegner I, Noordman BJ, Vincent R, van der Heijden GJMG, Grolman W. An introduction of genetics in otosclerosis: a systematic review. Otolaryngol Head Neck Surg 2013; 150:34-9. [PMID: 24170657 DOI: 10.1177/0194599813509951] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To present an easy to read systematic review concerning the genetic etiology of otosclerosis to help health care providers in counseling otosclerosis patients more accurately. DATA SOURCES PubMed, Embase, CINAHL, and the Cochrane Library. REVIEW METHODS Studies on the genetic etiology of otosclerosis were selected. Association studies and family-based studies were included for further review. After quality assessment (risk of bias), data were extracted from the included studies. When available, odds ratios were presented. In case of corresponding genetic anomalies between the studies, it was the aim to combine results. RESULTS The number of available studies with low risk of bias is limited to 2 association studies and 1 family-based study. These high-quality studies show that otosclerosis in Japanese patients is not linked to the NOG gene and that a polymorphism in the Sp1 binding site located on the COL1A1 gene is associated with otosclerosis as well as OTSC1. Association and family-based studies with moderate risk of bias show a statistically significant association with the ACE gene, AGT gene, OTSC2, RELN gene, TGFB1 gene, 11q13.1, OTSC2, OTSC5, OTSC8, and OTSC10. These results may be spurious associations due to their bias and low statistical power. CONCLUSION The present systematic review shows that there is scattered evidence of limited quality and a lack of replication studies. It is not possible to point out 1 or more responsible genes, which play a key role within the genetic pathophysiologic mechanism of otosclerosis.
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Affiliation(s)
- Arnold J N Bittermann
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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Lammers MJW, Venekamp RP, Grolman W, van der Heijden GJMG. Bilateral cochlear implantation in children and the impact of the inter-implant interval. Laryngoscope 2013; 124:993-9. [DOI: 10.1002/lary.24395] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/18/2013] [Accepted: 08/19/2013] [Indexed: 01/24/2023]
Affiliation(s)
- Marc J. W. Lammers
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; The Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; The Netherlands
| | - Roderick P. Venekamp
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; The Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; The Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; The Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; The Netherlands
| | - Geert J. M. G. van der Heijden
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; The Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; The Netherlands
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Kaper NM, Breukel L, Venekamp RP, Grolman W, van der Heijden GJMG. Absence of Evidence for Enhanced Benefit of Antibiotic Therapy on Recurrent Acute Rhinosinusitis Episodes. Otolaryngol Head Neck Surg 2013; 149:664-7. [DOI: 10.1177/0194599813505841] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To systematically review the evidence base on the effectiveness of short-course antibiotic therapy in adult patients with a recurrent episode of acute rhinosinusitis as part of a disease pattern on severity and duration of symptoms and recurrences. Data Sources PubMed, EMBASE, and the Cochrane Library. Review Methods A comprehensive search was performed up to March 21, 2013. Articles reporting studies on the effects of short-course antibiotic therapy compared with placebo in patients with recurrent acute rhinosinusitis were included. For included articles, the design of reported studies was assessed for directness of evidence and risk of bias. Results In total, 3473 unique publications were retrieved, of which 30 were considered eligible based on title and abstract screening. In addition, 8 eligible articles were retrieved using cross-reference checking. Based on full-text evaluation, none of the retrieved 38 articles satisfied our predefined selection criteria. They did not compare antibiotic treatment with placebo, excluded patients with recurrent acute rhinosinusitis, or did not report findings for a subgroup of patients with recurrent acute rhinosinusitis. Conclusion and Recommendation To date, there is no evidence available on differences in effect of antibiotic therapy in primary or sporadic and recurrent episodes of acute rhinosinusitis. As such, decisions for or against initial antibiotic therapy in patients with recurring episodes of acute rhinosinusitis should be based on the same criteria used in managing primary or sporadic episodes of uncomplicated acute rhinosinusitis.
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Affiliation(s)
- Nina M. Kaper
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Laura Breukel
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roderick P. Venekamp
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert J. M. G. van der Heijden
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
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Swennen MHJ, Rutten FH, Kalkman CJ, van der Graaf Y, Sachs APE, van der Heijden GJMG. Do general practitioners follow treatment recommendations from guidelines in their decisions on heart failure management? A cross-sectional study. BMJ Open 2013; 3:e002982. [PMID: 24041845 PMCID: PMC3780330 DOI: 10.1136/bmjopen-2013-002982] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 05/28/2013] [Accepted: 05/29/2013] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To investigate whether general practitioners (GPs) follow treatment recommendations from clinical practice guidelines in their decisions on the management of heart failure patients, and assess whether doctors' characteristics are related to their decisions. DESIGN Cross-sectional vignette study. SETTING Continuing Medical Education meeting. PARTICIPANTS 451 Dutch GPs. MAIN OUTCOME MEASURES Answers to four multiple-choice treatment decisions in clinical vignettes of a patient with heart failure and a reduced ejection fraction. With univariable and multivariable regression analyses, respondent characteristics were related to optimal treatment decisions. RESULTS Of the 451 GPs, none took four optimal decisions: 7% considered stopping statin treatment, 36% initiated β-blocker treatment at a low-dose and 4% doubled the β-blocker in the up-titration phase. Finally, for our vignette patient now also suffering from chronic obstructive pulmonary disease, 45% of the GPs continued β-blocker therapy even when they considered prescribing a long-acting β2-agonist. While the relation between respondent characteristics and each decision was very different, none was independently associated with all four decisions. Giving priority to evidence-based medicine was independently related to stopping statin treatment and doubling the β-blocker in the up-titration phase. CONCLUSIONS GPs seem not to follow treatment recommendations from clinical practice guidelines in their decisions on the management of heart failure patients. The recommendations from guidelines may appear counterintuitive when statin treatment needs to be stopped when a patient feels comfortable, or when a β-blocker should be up-titrated in patients who experience more symptoms. Giving priority to evidence-based medicine is possibly positively related to difficult treatment decisions.
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Affiliation(s)
- Maartje H J Swennen
- Department of Clinical Epidemiology, Division Julius Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
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van Loon JWL, van Harn RP, Venekamp RP, Kaper NM, Sachs APE, van der Heijden GJMG. Limited Evidence for Effects of Intranasal Corticosteroids on Symptom Relief for Recurrent Acute Rhinosinusitis. Otolaryngol Head Neck Surg 2013; 149:668-73. [DOI: 10.1177/0194599813503791] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To systematically review the evidence base on the effectiveness of intranasal corticosteroids in adult patients with recurrent acute rhinosinusitis. Data Sources Pubmed, EMBASE, and the Cochrane Library. Review Methods A comprehensive search was performed up to March 20, 2013. Two reviewers independently screened publications on title and abstract. Design of selected studies was assessed on directness of evidence and risk of bias. For included studies, risk differences with 95% confidence intervals were extracted or recalculated. Results Of 1850 unique records, 3 trials were included. Risk of bias was high and directness of evidence was low for 2 trials, the third trial had low risk of bias with moderate directness of evidence. They found a statistical significant difference for the median number of days to clinical success (defined as patients’ report of symptoms to be cured or much improved) favoring intranasal corticosteroids (6 days) over placebo (9 days), while the difference in proportion of patients reporting clinical success after 21 days of treatment was 20% favoring intranasal corticosteroids over placebo. Conclusion and Recommendation The evidence for the benefit of intranasal corticosteroids on symptom relief in adult patients with recurrent acute rhinosinusitis is rather limited (ie, 3 trials are available; the best evidence is derived from 1 low risk of bias trial providing moderate directness of evidence that intranasal corticosteroids may speed up relief of symptoms in patients with recurrent acute rhinosinusitis). A large methodologically rigorous randomized trial in antibiotic-naïve patients is needed to provide a more definite recommendation.
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Affiliation(s)
- Juliette W. L. van Loon
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rochustina P. van Harn
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roderick P. Venekamp
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nina M. Kaper
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alfred P. E. Sachs
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert J. M. G. van der Heijden
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
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Swennen MHJ, van der Heijden GJMG, Boeije HR, van Rheenen N, Verheul FJM, van der Graaf Y, Kalkman CJ. Doctors' perceptions and use of evidence-based medicine: a systematic review and thematic synthesis of qualitative studies. Acad Med 2013; 88:1384-96. [PMID: 23887011 DOI: 10.1097/acm.0b013e31829ed3cc] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Many primary qualitative studies of barriers and facilitators for doctors' use of evidence-based medicine (EBM) are available, but knowledge remains fragmented. This study sought to synthesize the results of these qualitative studies, taking the variability across context (i.e., medical disciplines, career stages, practice settings, and time of study) into account. METHOD The authors searched PubMed through April 26, 2012, and independently selected studies according to prespecified criteria for relevance and methodological quality. Additionally, they performed a thematic synthesis through line-by-line interpretation, coding, and thematic arrangement of information. RESULTS The search resulted in 1,211 publications, of which 30 studies were included. Five major themes emerged on barriers and facilitators for doctors' use of EBM: individual mind-set, professional group norms, EBM competencies, balance between confidence and critical reflection, and managerial collaboration. The authors found particular barriers and facilitators across career stages. Although clinical experience and professional status were perceived to be helpful, they could also prevent doctors from identifying information needs and adopting new evidence. Although residents' lack of clinical experience raised awareness of information needs, residents perceived lack of clinical experience and their hierarchical dependence on staff as barriers to articulating information needs and to translating and introducing evidence to patient care. CONCLUSIONS Encouragement of group norms for safe communication and shared learning across career stages is perceived as the most prominent facilitator for EBM.
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Affiliation(s)
- Maartje H J Swennen
- Department of Clinical Epidemiology, Division Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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van Dongen TMA, van der Heijden GJMG, Freling HG, Venekamp RP, Schilder AGM. Parent-reported otorrhea in children with tympanostomy tubes: incidence and predictors. PLoS One 2013; 8:e69062. [PMID: 23874870 PMCID: PMC3709928 DOI: 10.1371/journal.pone.0069062] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 06/11/2013] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Although common in children with tympanostomy tubes, the current incidence of tympanostomy tube otorrhea (TTO) is uncertain. TTO is generally a sign of otitis media, when middle ear fluid drains through the tube. Predictors for otitis media are therefore suggested to have predictive value for the occurrence of TTO. OBJECTIVE To determine the incidence of TTO and its predictors. METHODS We performed a cohort study, using a parental web-based questionnaire to retrospectively collect data on TTO episodes and its potential predictors from children younger than 10 years of age with tympanostomy tubes. RESULTS Of the 1,184 children included in analyses (total duration of time since tube placement was 768 person years with a mean of 7.8 months per child), 616 children (52%) experienced one or more episodes of TTO. 137 children (12%) had TTO within the calendar month of tube placement. 597 (50%) children had one or more acute TTO episodes (duration <4 weeks) and 46 children (4%) one or more chronic TTO episodes (duration ≥4 weeks). 146 children (12%) experienced recurrent TTO episodes. Accounting for time since tube placement, 67% of children developed one or more TTO episodes in the year following tube placement. Young age, recurrent acute otitis media being the indication for tube placement, a recent history of recurrent upper respiratory tract infections and the presence of older siblings were independently associated with the future occurrence of TTO, and can therefore be seen as predictors for TTO. CONCLUSIONS Our survey confirms that otorrhea is a common sequela in children with tympanostomy tubes, which occurrence can be predicted by age, medical history and presence of older siblings.
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Affiliation(s)
- Thijs M A van Dongen
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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van der Heijden GJMG, Bakker R, Aarts MCJ, Rovers MM. Response to “ Routine Testing of Borrelia Serology in Sudden Sensorineural Hearing Loss” from James E. Saunders. Otolaryngol Head Neck Surg 2013; 148:180. [DOI: 10.1177/0194599812468277] [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: 11/17/2022]
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Widyahening IS, van der Heijden GJMG, Moy FM, van der Graaf Y, Sastroasmoro S, Bulgiba A. From west to east; experience with adapting a curriculum in evidence-based medicine. Perspect Med Educ 2012; 1:249-261. [PMID: 23240103 PMCID: PMC3518799 DOI: 10.1007/s40037-012-0029-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Clinical epidemiology (CE) and evidence-based medicine (EBM) have become an important part of medical school curricula. This report describes the implementation and some preliminary outcomes of an integrated CE and EBM module in the Faculty of Medicine Universitas Indonesia (UI), Jakarta and in the University of Malaya (UM) in Kuala Lumpur. A CE and EBM module, originally developed at the University Medical Center Utrecht (UMCU), was adapted for implementation in Jakarta and Kuala Lumpur. Before the start of the module, UI and UM staff followed a training of teachers (TOT). Student competencies were assessed through pre and post multiple-choice knowledge tests, an oral and written structured evidence summary (evidence-based case report, EBCR) as well as a written exam. All students also filled in a module evaluation questionnaire. The TOT was well received by staff in Jakarta and Kuala Lumpur and after adaptation the CE and EBM modules were integrated in both medical schools. The pre-test results of UI and UM were significantly lower than those of UMCU students (p < 0.001). The post test results of UMCU students were comparable (p = 0.48) with UI, but significantly different (p < 0.001) from UM. Common problems for the modules in both UI and UM were limited access to literature and variability of the tutors' skills. Adoption and integration of an existing Western CE-EBM teaching module into Asian medical curricula is feasible while learning outcomes obtained are quite similar.
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Affiliation(s)
- Indah S. Widyahening
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jl. Pegangsaan Timur 16, Jakarta Pusat, 10430 Indonesia
- Department of Epidemiology, Division Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
| | - Geert J. M. G. van der Heijden
- Department of Epidemiology, Division Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
| | - Foong Ming Moy
- Department of Social and Preventive Medicine, Faculty of Medicine, Julius Centre University of Malaya, University of Malaya, Kuala Lumpur, Malaysia
| | - Yolanda van der Graaf
- Department of Epidemiology, Division Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
| | - Sudigdo Sastroasmoro
- Center for Clinical Epidemiology and Evidence-Based Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Awang Bulgiba
- Department of Social and Preventive Medicine, Faculty of Medicine, Julius Centre University of Malaya, University of Malaya, Kuala Lumpur, Malaysia
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Widyahening IS, van der Heijden GJMG, Moy FM, van der Graaf Y, Sastroasmoro S, Bulgiba A. Direct short-term effects of EBP teaching: change in knowledge, not in attitude; a cross-cultural comparison among students from European and Asian medical schools. Med Educ Online 2012; 17:19623. [PMID: 23121993 PMCID: PMC3487025 DOI: 10.3402/meo.v17i0.19623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 10/02/2012] [Accepted: 10/03/2012] [Indexed: 05/28/2023]
Abstract
INTRODUCTION We report about the direct short-term effects of a Clinical Epidemiology and Evidence-based Medicine (CE-EBM) module on the knowledge, attitude, and behavior of students in the University Medical Center Utrecht (UMCU), Universitas Indonesia (UI), and University of Malaya (UM). METHODS We used an adapted version of a 26-item validated questionnaire, including four subscales: knowledge, attitude, behavior, and future use of evidence-based practice (EBP). The four components were compared among the students in the three medical schools before the module using one-way ANOVA. At the end of the module, we measured only knowledge and attitudes. We computed Cronbach's α to assess the reliability of the responses in our population. To assess the change in knowledge and attitudes, we used the paired t-test in the comparison of scores before and after the module. RESULTS In total, 526 students (224 UI, 202 UM, and 100 UMCU) completed the questionnaires. In the three medical schools, Cronbach's α for the pre-module total score and the four subscale scores always exceeded 0.62. UMCU students achieved the highest pre-module scores in all subscales compared to UI and UM with the comparison of average (SD) score as the following: knowledge 5.04 (0.4) vs. 4.73 (0.69) and 4.24 (0.74), p<0.001; attitude 4.52 (0.64) vs. 3.85 (0.68) and 3.55 (0.63), p<0.001; behavior 2.62 (0.55) vs. 2.35 (0.71) and 2.39 (0.92), p=0.016; and future use of EBP 4.32 (0.59) vs. 4.08 (0.62) and 3.7 (0.71), p<0.01. The CE-EBM module increased the knowledge of the UMCU (from average 5.04±0.4 to 5.35±0.51; p<0.001) and UM students (from average 4.24±0.74 to 4.53±0.72; p<0.001) but not UI. The post-module scores for attitude did not change in the three medical schools. CONCLUSION EBP teaching had direct short-term effects on knowledge, not on attitude. Differences in pre-module scores are most likely related to differences in the system and infrastructure of both medical schools and their curriculum.
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Affiliation(s)
- Indah S Widyahening
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
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Wegner I, van Benthem PPG, Aarts MCJ, Bruintjes TD, Grolman W, van der Heijden GJMG. Insufficient evidence for the effect of corticosteroid treatment on recovery of vestibular neuritis. Otolaryngol Head Neck Surg 2012; 147:826-31. [PMID: 22910304 DOI: 10.1177/0194599812457557] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors studied the effect of corticosteroid treatment on clinical recovery and recovery of vestibular function in patients with vestibular neuritis. The comprehensive search (March 29, 2012) yielded 496 original papers, of which 5 (including 199 patients) during full-text screening satisfied our eligibility criteria. Methods assessment showed that 1 study (30 patients) provided direct evidence and carried low risk of bias. Two studies properly reported on their random and concealed allocation of treatment. In 1 study, patients were not randomly allocated to treatment. Blinding of outcomes was lacking in 2 studies, whereas outcome data were clearly incomplete for 2 studies. Given the wide variety in outcome measures and scales and follow-up duration, the meaning of the size of reported effects is not clear. Therefore, the reported effects cannot simply be compared between studies, and this precludes pooling of study results. Still, there are large differences between studies in the size of the reported absolute effects after the placebo treatment. Moreover, the difference in effects between treatments is rather small and does not always favor corticosteroids. The moderate to high risk of bias of studies precludes firm conclusions, whereas the reported short-term effects on symptom recovery and improvement of peripheral vestibular function are too small to be clinically important. No long-term effect on symptom recovery has been shown. Recommendations or decisions for corticosteroid treatment in patients with vestibular neuritis cannot be based on current best evidence and therefore should be discussed with the patient.
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Affiliation(s)
- Inge Wegner
- Department of Otorhinolaryngology, University Medical Centre Utrecht, Utrecht, the Netherlands.
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Affiliation(s)
- Marc J W Lammers
- Department of Otolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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Bruins Slot MHE, Rutten FH, van der Heijden GJMG, Doevendans PA, Mast EG, Bredero AC, Glatz JFC, Hoes AW. Gender differences in pre-hospital time delay and symptom presentation in patients suspected of acute coronary syndrome in primary care. Fam Pract 2012; 29:332-7. [PMID: 22006039 DOI: 10.1093/fampra/cmr089] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe gender differences in pre-hospital delay times and symptom presentation in patients suspected of acute coronary syndrome (ACS) in a primary care setting. METHODS Over 150 participating GPs included 298 consecutive patients suspected of ACS (52% female, mean age 66 years, 22% eventually diagnosed with ACS according to international guidelines) in a 28-month time period. Data on time from call for help until GP consultation (doctor delay) were prospectively collected, while the time from onset of symptoms until call for help (patient delay) was recorded by the GP at the time of arrival at the patient, together with patient characteristics, including age, sex, previous medical history, chest pain, radiation of chest pain and nausea/sweating. RESULTS Median doctor delay was 45 [interquartile range (IQR) 20-55] minutes in women and 33 (IQR 26-72) minutes in men (P = 0.01). Median patient delay was 108 (IQR 39-348) minutes in women and 180 (IQR 48-396) minutes in men (P = 0.20). Women reported spreading chest pain more often than men (68% versus 57%, P = 0.06). Women diagnosed with ACS were older than men (mean 75 years versus 65 years, P < 0.001). CONCLUSIONS In patients suspected of ACS in primary care, no differences were found in patient delay, but doctor delay was longer in women than in men. Symptom presentation was largely similar between men and women, although women tended to report 'spreading' chest pain more often.
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Affiliation(s)
- Madeleine H E Bruins Slot
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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Bakker R, Aarts MCJ, van der Heijden GJMG, Rovers MM. No evidence for the diagnostic value of Borrelia serology in patients with sudden hearing loss. Otolaryngol Head Neck Surg 2012; 146:539-43. [PMID: 22394551 DOI: 10.1177/0194599811432535] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this evidence-based case report, we address the following clinical question: What is the predictive value of serological testing for Borrelia for diagnosing neuroborreliosis in patients with sudden sensorineural hearing loss? We searched for relevant articles in PubMed, Embase, and Web of Science. We retrieved 49 unique publications and screened the title and abstract of these articles for relevance. We included 2 of 12 studies initially considered relevant to answer our question. These 2 studies reported a seroprevalence of antibodies against Borrelia of 16% in patients with sudden sensorineural hearing loss (SHL) as compared with 13.5% in the general population, but in neither patients with definite neuroborreliosis were they found. To date, there is no evidence regarding the added value of routine diagnostic serologic testing for Borrelia in diagnosing neuroborreliosis in patients with sudden SHL. Neuroborreliosis seems to be a rare cause of sudden SHL, and routine screening of patients for borrelia antibodies in serum should therefore not be recommended.
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Affiliation(s)
- Renée Bakker
- Department of Otolaryngology, University Medical Centre, Utrecht, The Netherlands.
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