1
|
Schmucker C, Thörel E, Flatscher-Thöni M, Sow D, Göhner A, Stühlinger V, Mühlberger N, Lagrèze WA, Meerpohl J. Computer-Assisted Visual Training in Children and Adolescents with Developmental Visual Disorders. Dtsch Arztebl Int 2023; 120:747-753. [PMID: 37656479 PMCID: PMC10722492 DOI: 10.3238/arztebl.m2023.0191] [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] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND In this systematic review, we address the question whether children and adolescents with developmental visual disorders benefit from computer-assisted visual training. METHODS Systematic literature searches were carried out in three bibliographic databases (initial search in October 2021) and trial registries. Included were randomized controlled trials that evaluated the efficacy of computer-assisted visual training in children and adolescents with developmental visual disorders in comparison to no training, sham training, or conservative treatment. RESULTS The inclusion criteria were met by 17 trials (with a total of 1323 children and adolescents) focusing on binocular or monocular computer-assisted visual training for the treatment of amblyopia. In these trials, visual training was carried out for 2 to 24 weeks, either as "stand alone" therapy or in addition to occlusion therapy. Six trials showed a statistically significant difference in favor of the visual training for the outcome "best corrected visual acuity of the amblyopic eye." However, this difference was small and mostly below the threshold of clinical relevance of -0.05 logMAR (equivalent to an improvement of 0.5 lines on the eye chart, or 2.5 letters per line). Only few data were available for the outcomes "binocular vision" and "adverse events"; the differences between the groups were similarly small. CONCLUSION The currently available data do not permit any firm conclusions regarding the efficacy of visual training in children and adolescents with amblyopia. Moreover, treatment adherence was often insufficient and the treatment durations in the trials was relatively short. No results from randomized trials have yet been published with respect to other developmental visual disorders (refractive errors, strabismus).
Collapse
Affiliation(s)
- Christine Schmucker
- Institute for Evidence in Medicine, Medical Center – University of Freiburg, Faculty of Medicine, Albert Ludwig University of Freiburg
| | - Eberhard Thörel
- Institute for Evidence in Medicine, Medical Center – University of Freiburg, Faculty of Medicine, Albert Ludwig University of Freiburg
| | - Magdalena Flatscher-Thöni
- Institute for Public Health, Medical Decision Making and Health Technology Assessment, UMIT TIROL – Private University for Health Sciences and Technology
| | - Dorothea Sow
- Department of Information Management, Quality and Economic Efficiency in Health Care (IQWiG), Cologne
| | - Anne Göhner
- Center for Geriatric Medicine and Gerontology, Freiburg University Hospital, Faculty of Medicine, Albert Ludwigs University Freiburg
| | - Verena Stühlinger
- Institute for Public Health, Medical Decision Making and Health Technology Assessment, UMIT TIROL – Private University for Health Sciences and Technology
| | - Nikolai Mühlberger
- Institute for Public Health, Medical Decision Making and Health Technology Assessment, UMIT TIROL – Private University for Health Sciences and Technology
| | - Wolf A. Lagrèze
- Department of Ophthalmology, Freiburg University Hospital, Faculty of Medicine, Albert Ludwigs University Freiburg
- *The authors contributed equally to this paper
| | - Jörg Meerpohl
- Institute for Evidence in Medicine, Medical Center – University of Freiburg, Faculty of Medicine, Albert Ludwig University of Freiburg
- Cochrane Germany, Cochrane Germany Foundation, Freiburg
- *The authors contributed equally to this paper
| |
Collapse
|
2
|
Struwe C, Golinski M, Grimm C, Dickel S, Grummich K, Nothacker M, Voigt-Radloff S, Meerpohl J, Moerer O. A Comparison and Evaluation of International Guidelines on the Treatment of Severe SARS-CoV-2 Infection. Dtsch Arztebl Int 2022; 119:23-30. [PMID: 34939920 DOI: 10.3238/arztebl.m2022.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 08/31/2021] [Accepted: 12/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND When the SARS-CoV-2 pandemic began, no uniform treatment and care strategies for critically ill COVID-19 patients were yet available. National and international treatment recommendations were formulated under time pressure, initially on the basis of indirect evidence from the treatment of similar diseases. In this article, we give an overview of the content, currency, and methodological quality of the existing national and international guidelines, with special attention to the care of critically ill patients. METHODS Guidelines were identified by a comprehensive search, the included guidelines were assessed in standardized fashion with the AGREE II guideline assessment instrument and according to the AMWF rulebook criteria, and the core recommendations of the included and methodologically high-quality guidelines were compared. RESULTS Nine of the 97 guidelines that were identified fulfilled the content criteria for inclusion, and 6 of these fulfilled the qualitative criteria; these 6 guidelines still differed, however, in the topics to which they devoted the most attention, as well as in their methodological quality and currency. The treatment strategies for patients with severe respiratory failure (lung-protective ventilation strategies and rescue measures) deviated little from established standards. Uniform recommendations were made, among other things, for the administration of dexamethasone, which was recommended in all of the guidelines for patients requiring oxygen treatment, as well as for antithrombotic drug prophylaxis and for the prone positioning of ventilated patients. Many recommendations were based on insufficient evidence, and some were contradictory, e.g., those regarding antibiotic treatment or the choice between high-flow oxygen administration via nasal canula (HFNC) and noninvasive ventilation (NIV). CONCLUSION The consultation of multiple high-quality international guidelines and guideline recommendations shared in online portals such as MagicApp are helpful sources of information for clinicians. In view of the continuing lack of strong evidence, further research on intensive care treatments is needed (aspects of ventilation, positioning therapy, and the role of extracorporeal membrane oxygenation [ECMO]).
Collapse
|
3
|
Kaiser L, Hübscher M, Rissling O, Schulz S, Langer G, Meerpohl J, Schwingshackl L. [GRADE Guidelines: 19. Assessing the certainty of evidence in the importance of outcomes or values and preferences: Risk of bias and indirectness]. Z Evid Fortbild Qual Gesundhwes 2021; 160:78-88. [PMID: 33461905 DOI: 10.1016/j.zefq.2020.11.004] [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] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/11/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group defines patient values and preferences as the relative importance patients place on the main health outcomes. We provide GRADE guidance for assessing the risk of bias and indirectness domains for certainty of evidence about the relative importance of outcomes. STUDY DESIGN AND SETTING We applied the GRADE domains to rate the certainty of evidence in the importance of outcomes to several systematic reviews, iteratively reviewed draft guidance and consulted GRADE members and other stakeholders for feedback. RESULTS This is the first of two articles. A body of evidence addressing the importance of outcomes starts at "high certainty"; concerns with risk of bias, indirectness, inconsistency, imprecision, and publication bias lead to downgrading to moderate, low, or very low certainty. We propose the following subdomains of risk of bias: selection of the study population, missing data, the type of measurement instrument, and confounding; we have developed items for each subdomain. The population, intervention, comparison, and outcome elements associated with the evidence determine the degree of indirectness. CONCLUSION This article provides guidance and examples for rating the risk of bias and indirectness for a body of evidence summarizing the importance of outcomes.
Collapse
Affiliation(s)
- Laura Kaiser
- Abteilung Fachberatung Medizin, Gemeinsamer Bundesausschuss, Berlin, Deutschland; Universität Witten/Herdecke, Deutschland.
| | - Markus Hübscher
- Abteilung Fachberatung Medizin, Gemeinsamer Bundesausschuss, Berlin, Deutschland
| | - Olesja Rissling
- Abteilung Fachberatung Medizin, Gemeinsamer Bundesausschuss, Berlin, Deutschland
| | - Sandra Schulz
- Abteilung Fachberatung Medizin, Gemeinsamer Bundesausschuss, Berlin, Deutschland
| | - Gero Langer
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Jörg Meerpohl
- Institut für Evidenz in der Medizin, Universitätsklinikum und Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland; Cochrane Deutschland, Cochrane Deutschland Stiftung, Freiburg, Deutschland
| | - Lukas Schwingshackl
- Institut für Evidenz in der Medizin, Universitätsklinikum und Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
| |
Collapse
|
4
|
Schmucker C, Titscher V, Braun C, Nussbaumer-Streit B, Gartlehner G, Meerpohl J. Surgical and Non-Surgical Interventions in Complete Rotator Cuff Tears. Dtsch Arztebl Int 2020; 117:633-640. [PMID: 33263527 PMCID: PMC7817785 DOI: 10.3238/arztebl.2020.0633] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/03/2020] [Accepted: 05/18/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND This systematic review compares the efficacy and safety of surgical and non-surgical interventions for full- thickness rotator cuff tears. METHODS A systematic literature search was conducted in five databases. Randomized (RCTs) and non-randomized controlled trials of interventions (non-RCTs) for the surgical or non-surgical treatment of patients with traumatic or atraumatic full-thickness rotator cuff tears were included. The review protocol was published in the PROSPERO registry (CRD42018100343). RESULTS Ten studies (three RCTs with 332 participants; seven non-RCTs with 650 participants) met the inclusion criteria. One year after treatment, shoulder function, measured with the 100-point Constant score, had improved by 6.7 points (95% confidence interval [2.3; 11.0]) and pain, measured with the 10-cm visual analog scale, by 1.1 cm (0.5; 1.7] in the full-thickness rotator cuff tears treated surgically compared with non-surgical treatment. In one study the difference in favor of surgery persisted after 10 years' follow-up. For other outcomes, such as range of motion, muscle strength, quality of life, and adverse events, the data were sparse and the group differences were similar. The findings of the non-RCTs were comparable with those of the RCTs. CONCLUSION With regard to functional improvement and pain reduction, surgical treatment of full-thickness rotator cuff tears was superior to non-surgical treatment in the short and the long term. Whether the differences between the groups are relevant for individual cases is uncertain, as the measured results were distributed below and above the threshold of clinical relevance. The conclusions may not be applicable to rotator cuff tears over 3 cm in size or to young persons.
Collapse
Affiliation(s)
- Christine Schmucker
- Institute for Evidence in Medicine, Faculty of Medicine, University Hospital Freiburg
| | - Viktoria Titscher
- Cochrane Austria, Department of Evidence-based Medicine and Evaluation, Danube University Krems, Austria
| | - Cordula Braun
- Institute for Evidence in Medicine, Faculty of Medicine, University Hospital Freiburg
| | - Barbara Nussbaumer-Streit
- Cochrane Austria, Department of Evidence-based Medicine and Evaluation, Danube University Krems, Austria
| | - Gerald Gartlehner
- Cochrane Austria, Department of Evidence-based Medicine and Evaluation, Danube University Krems, Austria
- RTI International, Research Triangle Park, North Carolina, USA
| | - Jörg Meerpohl
- Institute for Evidence in Medicine, Faculty of Medicine, University Hospital Freiburg
- Cochrane Germany Foundation, Cochrane Germany, Freiburg
| |
Collapse
|
5
|
Kallenbach M, Conrad S, Hoffmann F, Matthias K, Gartlehner G, Langer G, Meerpohl J. [GRADE: Using evidence to decision frameworks for adoption, adaptation and de novo generation of trustworthy guideline recommendations - GRADE-ADOLOPMENT]. Z Evid Fortbild Qual Gesundhwes 2019; 144-145:90-99. [PMID: 31399391 DOI: 10.1016/j.zefq.2019.06.001] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Guideline developers can: (1) adopt existing recommendations from others; (2) adapt existing recommendations to their own context; or (3) create recommendations de novo. Monetary and nonmonetary resources, credibility, maximization of uptake, as well as logical arguments should guide the choice of the approach and processes. OBJECTIVES To describe a potentially efficient model for guideline production based on adoption, adaptation, and/or de novo development of recommendations utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) frameworks. STUDY DESIGN AND SETTING We applied the model in a new national guideline program producing 22 practice guidelines. We searched for relevant evidence that informs the direction and strength of a recommendation. We then produced GRADE EtDs for guideline panels to develop recommendations. RESULTS In two waves, a total of 80 EtD frameworks was produced approximately 4 months and 146 EtDs in about 6 months. Use of the EtD frameworks allowed panel members to understand judgments of other guideline groups about the criteria that bear on guideline recommendations and then make their own judgments about those criteria in a systematic approach. CONCLUSION The "GRADE-ADOLOPMENT" approach to guideline production combines adoption, adaptation, and, as needed, de novo development of recommendations. If guideline developers apply EtD criteria more widely and make their work publically available, this approach should prove even more useful.
Collapse
Affiliation(s)
- Maria Kallenbach
- Abteilung Fachberatung Medizin, Gemeinsamer Bundesausschuss, Berlin, Deutschland.
| | - Susann Conrad
- Abteilung Fachberatung Medizin, Gemeinsamer Bundesausschuss, Berlin, Deutschland
| | - Frauke Hoffmann
- Abteilung Fachberatung Medizin, Gemeinsamer Bundesausschuss, Berlin, Deutschland
| | - Katja Matthias
- Abteilung Fachberatung Medizin, Gemeinsamer Bundesausschuss, Berlin, Deutschland
| | - Gerald Gartlehner
- Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Donau-Universität Krems, Krems, Österreich; RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC, USA
| | - Gero Langer
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Jörg Meerpohl
- Institut für Evidenz in der Medizin (für Cochrane Deutschland Stiftung), Universitätsklinikum Freiburg - Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland; Cochrane Deutschland, Cochrane Deutschland Stiftung, Freiburg, Deutschland
| |
Collapse
|
6
|
Wieschowski S, Riedel N, Wollmann K, Kahrass H, Müller-Ohlraun S, Schürmann C, Kelley S, Kszuk U, Siegerink B, Dirnagl U, Meerpohl J, Strech D. Result dissemination from clinical trials conducted at German university medical centers was delayed and incomplete. J Clin Epidemiol 2019; 115:37-45. [PMID: 31195110 DOI: 10.1016/j.jclinepi.2019.06.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 11/27/2018] [Revised: 05/22/2019] [Accepted: 06/03/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Timely and comprehensive reporting of clinical trial results builds the backbone of evidence-based medicine and responsible research. The proportion of timely disseminated trial results can inform alternative national and international benchmarking of university medical centers (UMCs). STUDY DESIGN AND SETTING For all German UMCs, we tracked all registered trials completed between 2009 and 2013. The results and an interactive website benchmark German UMCs regarding their performance in result dissemination. RESULTS We identified and tracked 2,132 clinical trials. For 1,509 trials, one of the German UMCs took the academic lead. Of these 1,509 "lead trials," 39% published their results (mostly via journal publications) in a timely manner (<24 months after completion). More than 6 years after study completion, 26% of all eligible lead trials still had not disseminated results. CONCLUSION Despite substantial attention from many stakeholders to the topic, there is still a strong delay or even absence of result dissemination for many trials. German UMCs have several opportunities to improve this situation. Further research should evaluate whether and how a transparent benchmarking of UMC performance in result dissemination helps to increase value and reduce waste in medical research.
Collapse
Affiliation(s)
- Susanne Wieschowski
- Institute for Ethics, History, and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Nico Riedel
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany
| | - Katharina Wollmann
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany Foundation, Freiburg, Germany
| | - Hannes Kahrass
- Institute for Ethics, History, and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | | | - Christopher Schürmann
- Institute for Ethics, History, and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Sean Kelley
- Department of Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ute Kszuk
- Cochrane Germany Foundation, Freiburg, Germany
| | - Bob Siegerink
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Dirnagl
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany; Department of Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jörg Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Strech
- Institute for Ethics, History, and Philosophy of Medicine, Hannover Medical School, Hannover, Germany; QUEST Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany; Charité Universitätsmedizin Berlin, Berlin, Germany.
| |
Collapse
|
7
|
Conrad S, Kaiser L, Kallenbach M, Meerpohl J, Morche J. GRADE: Von der Evidenz zur Empfehlung oder Entscheidung - ein systematischer und transparenter Ansatz, um gut informierte Entscheidungen im Gesundheitswesen zu treffen. 2: Klinische Praxisleitlinien. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen 2019; 140:63-73. [DOI: 10.1016/j.zefq.2019.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
8
|
Strech D, Sievers S, Märschenz S, Riedel N, Wieschowski S, Meerpohl J, Langhof H, Müller-Ohlraun S, Dirnagl U. Tracking the timely dissemination of clinical studies. Characteristics and impact of 10 tracking variables. F1000Res 2018; 7:1863. [PMID: 31131084 PMCID: PMC6518431 DOI: 10.12688/f1000research.17022.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Accepted: 11/21/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Several meta-research studies and benchmarking activities have assessed how comprehensively and timely, academic institutions and private companies publish their clinical studies. These current "clinical trial tracking" activities differ substantially in how they sample relevant studies, and how they follow up on their publication. Methods: To allow informed policy and decision making on future publication assessment and benchmarking of institutions and companies, this paper outlines and discusses 10 variables that influence the tracking of timely publications. Tracking variables were initially selected by experts and by the authors through discussion. To validate the completeness of our set of variables, we conducted i) an explorative review of tracking studies and ii) an explorative tracking of registered clinical trials of three leading German university medical centres. Results: We identified the following 10 relevant variables impacting the tracking of clinical studies: 1) responsibility for clinical studies, 2) type and characteristics of clinical studies, 3) status of clinical studies, 4) source for sampling, 5) timing of registration, 6) determination of completion date, 7) timeliness of dissemination, 8) format of dissemination, 9) source for tracking, and 10) inter-rater reliability. Based on the description of these tracking variables and their influence, we discuss which variables could serve in what ways as a standard assessment of "timely publication". Conclusions: To facilitate the tracking and consequent benchmarking of how often and how timely academic institutions and private companies publish clinical study results, we have two core recommendations. First, the improvement in the link between registration and publication, for example via institutional policies for academic institutions and private companies. Second, the comprehensive and transparent reporting of tracking studies according to the 10 variables presented in this paper.
Collapse
Affiliation(s)
- Daniel Strech
- QUEST Center, Berlin Institute of Health (BIH), Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Sören Sievers
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Stefanie Märschenz
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nico Riedel
- QUEST Center, Berlin Institute of Health (BIH), Berlin, Germany
| | - Susanne Wieschowski
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Jörg Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Holger Langhof
- QUEST Center, Berlin Institute of Health (BIH), Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | | | - Ulrich Dirnagl
- QUEST Center, Berlin Institute of Health (BIH), Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
9
|
Abstract
ZusammenfassungDer Kommentar erläutert mit kurzen Beispielen die Notwendigkeit und Möglichkeiten der TIDieR-Leitlinie zur Forschungsberichterstattung.
Collapse
Affiliation(s)
| | - A. Blümle
- Universitätsklinikum Freiburg, Cochrane Deutschland, Freiburg
| | - J. Meerpohl
- Universitätsklinikum Freiburg, Cochrane Deutschland, Freiburg
| |
Collapse
|
10
|
Schmidt S, Kunath F, Kranz J, Zengerling F, Dräger DL, Kröger N, Krabbe LM, Miernik A, Borgmann H, Spek A, Meerpohl J, Dahm P, Wullich B. [Overcoming the language barrier: UroEvidence translates Cochrane abstracts]. Urologe A 2014; 54:76-7. [PMID: 25519997 DOI: 10.1007/s00120-014-3750-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- S Schmidt
- UroEvidence, Deutsche Gesellschaft für Urologie e.V., Düsseldorf/Berlin, Deutschland
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Brozek J, Akl E, Falck-Ytter Y, Kunstman P, Meerpohl J, Mustafa R, Nowak A, Oxman A, Santesso N, Wiercioch W, Schünemann H. P307 Guideline Development Tool (GDT) – Web-Based Solution For Guideline Developers And Authors Of Systematic Reviews. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
12
|
Brandt L, Elde T, Agoritsas T, Guyatt G, Kristiansen A, Alonso-Coello P, Akl E, Meerpohl J, Vandvik P. 084 PLUGGED-IN (Providing Likeable and Understandable Guidelines using GRADE in the EMR with Direct links to Individual patient data) Phase 2. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
13
|
Brozek J, Akl E, Falck-Ytter Y, Kunstman P, Meerpohl J, Mustafa R, Nowak A, Oxman A, Santesso N, Wiercioch W, Schünemann H. 046 Guideline Development Tool (GDT) – Web-Based Solution for Guideline Developers and Authors of Systematic Reviews. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
14
|
Kasenda B, von Elm EB, You J, Blümle A, Tomonaga Y, Saccilotto R, Amstutz A, Bengough T, Meerpohl J, Stegert M, Tikkinen KAO, Neumann I, Carrasco-Labra A, Faulhaber M, Mulla S, Mertz D, Akl EA, Bassler D, Busse JW, Ferreira-González I, Lamontagne F, Nordmann A, Rosenthal R, Schandelmaier S, Sun X, Vandvik PO, Johnston BC, Walter MA, Burnand B, Schwenkglenks M, Bucher HC, Guyatt GH, Briel M. Learning from failure--rationale and design for a study about discontinuation of randomized trials (DISCO study). BMC Med Res Methodol 2012; 12:131. [PMID: 22928744 PMCID: PMC3528626 DOI: 10.1186/1471-2288-12-131] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 08/01/2012] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Randomized controlled trials (RCTs) may be discontinued because of apparent harm, benefit, or futility. Other RCTs are discontinued early because of insufficient recruitment. Trial discontinuation has ethical implications, because participants consent on the premise of contributing to new medical knowledge, Research Ethics Committees (RECs) spend considerable effort reviewing study protocols, and limited resources for conducting research are wasted. Currently, little is known regarding the frequency and characteristics of discontinued RCTs. METHODS/DESIGN Our aims are, first, to determine the prevalence of RCT discontinuation for specific reasons; second, to determine whether the risk of RCT discontinuation for specific reasons differs between investigator- and industry-initiated RCTs; third, to identify risk factors for RCT discontinuation due to insufficient recruitment; fourth, to determine at what stage RCTs are discontinued; and fifth, to examine the publication history of discontinued RCTs.We are currently assembling a multicenter cohort of RCTs based on protocols approved between 2000 and 2002/3 by 6 RECs in Switzerland, Germany, and Canada. We are extracting data on RCT characteristics and planned recruitment for all included protocols. Completion and publication status is determined using information from correspondence between investigators and RECs, publications identified through literature searches, or by contacting the investigators. We will use multivariable regression models to identify risk factors for trial discontinuation due to insufficient recruitment. We aim to include over 1000 RCTs of which an anticipated 150 will have been discontinued due to insufficient recruitment. DISCUSSION Our study will provide insights into the prevalence and characteristics of RCTs that were discontinued. Effective recruitment strategies and the anticipation of problems are key issues in the planning and evaluation of trials by investigators, Clinical Trial Units, RECs and funding agencies. Identification and modification of barriers to successful study completion at an early stage could help to reduce the risk of trial discontinuation, save limited resources, and enable RCTs to better meet their ethical requirements.
Collapse
Affiliation(s)
- Benjamin Kasenda
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, 4031, Basel, Switzerland
| | - Erik B von Elm
- Cochrane Switzerland, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
- German Cochrane Centre, Institute of Medical Biometry and Medical Informatics, University Medical Centre Freiburg, Freiburg, Germany
| | - John You
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anette Blümle
- German Cochrane Centre, Institute of Medical Biometry and Medical Informatics, University Medical Centre Freiburg, Freiburg, Germany
| | - Yuki Tomonaga
- Institute for Social and Preventive Medicine, Zurich, Switzerland
| | - Ramon Saccilotto
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, 4031, Basel, Switzerland
| | - Alain Amstutz
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, 4031, Basel, Switzerland
| | - Theresa Bengough
- Cochrane Switzerland, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Jörg Meerpohl
- German Cochrane Centre, Institute of Medical Biometry and Medical Informatics, University Medical Centre Freiburg, Freiburg, Germany
| | - Mihaela Stegert
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, 4031, Basel, Switzerland
| | - Kari A O Tikkinen
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Urology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Ignacio Neumann
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Alonso Carrasco-Labra
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Markus Faulhaber
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Sohail Mulla
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Dominik Mertz
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Elie A Akl
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Departments of Medicine and Family Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - Dirk Bassler
- Department of Neonatology and Center for Pediatric Clinical Studies, University Children’s Hospital Tübingen, Tübingen, Germany
| | - Jason W Busse
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Ignacio Ferreira-González
- Epidemiology Unit, Department of Cardiology, Vall d'Hebron Hospital and CIBER de Epidemiología y Salud Publica (CIBERESP), Barcelona, Spain
| | - Francois Lamontagne
- Centre de Recherche Clinique Étienne-Le Bel and Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Alain Nordmann
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, 4031, Basel, Switzerland
| | - Rachel Rosenthal
- Department of Surgery, University Hospital Basel, Basel, Switzerland
| | - Stefan Schandelmaier
- Academy of Swiss Insurance Medicine, University Hospital Basel, Basel, Switzerland
| | - Xin Sun
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Per O Vandvik
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Bradley C Johnston
- Department of Anesthesia & Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Martin A Walter
- Department of Nuclear Medicine, University Hospital Bern, Bern, Switzerland
| | - Bernard Burnand
- Cochrane Switzerland, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | | | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, 4031, Basel, Switzerland
| | - Gordon H Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Matthias Briel
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, 4031, Basel, Switzerland
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
15
|
Bluemle A, Meerpohl J, Ruecker G, Antes G, Schumacher M, von Elm E. P1-541 Reporting of eligibility criteria of randomised trials: empirical study comparing trial protocols to subsequent articles. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976h.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
16
|
Pittler M, Blümle A, Meerpohl J, Antes G. CONSORT 2010: Aktualisierte Leitlinie für Berichte randomisierter Studien im Parallelgruppen-Design. Dtsch Med Wochenschr 2011. [DOI: 10.1055/s-0031-1272980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
17
|
Cario H, Grosse R, Janssen G, Jarisch A, Meerpohl J, Strauss G. [Guidelines for diagnosis and treatment of secondary iron overload in patients with congenital anemia]. Klin Padiatr 2010; 222:399-406. [PMID: 20862634 DOI: 10.1055/s-0030-1265178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In Germany and Central Europe, congenital disorders leading to secondary hemochromatosis are rare. The majority of these patients are treated in peripheral medical institutions. As a consequence, the experience of each institution in the treatment of secondary hemochromatosis in patients with congenital anemia is limited. Recent developments concerning new chelating agents, their combination for intensified chelation and new possibilities to diagnose and monitor iron overload have important consequences for the management of patients with secondary hemochromatosis and increase its complexity enormously. Therefore, the development of a guideline for rational and efficient diagnostics and treatment was necessary. The new guideline was developed within a formal consensus process and finally approved by a consensus conference with participants from both the pediatric and adult German hematology societies (GPOH and DGHO). Apart from general information and recommendations, the guideline contains 9 consensus statements on diagnostics (iron status, siderotic complications, chelator side-effects), the start of chelation, indications for intensified chelation, iron elimination in specific disorders, and iron elimination after stem cell transplantation. Here, these consensus statements are presented and discussed in detail. For the complete text of the guideline, please visit the AWMF homepage at http://www.leitlinien.net .
Collapse
Affiliation(s)
- H Cario
- Universitätsklinik für Kinder- und Jugendmedizin, Hämatologie und Onkologie, Ulm
| | | | | | | | | | | | | |
Collapse
|
18
|
Crétien A, Proust A, Delaunay J, Rincé P, Leblanc T, Ducrocq R, Simansour M, Marie I, Tamary H, Meerpohl J, Niemeyer C, Gazda H, Sieff C, Ball S, Tchernia G, Mohandas N, Da Costa L. Genetic variants in the noncoding region of RPS19 gene in Diamond-Blackfan anemia: potential implications for phenotypic heterogeneity. Am J Hematol 2010; 85:111-6. [PMID: 20054847 DOI: 10.1002/ajh.21601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Mutations in the RPS19 gene have been identified in 25% of individuals affected by Diamond-Blackfan anemia (DBA), a congenital erythroblastopenia characterized by an aregenerative anemia and a variety of malformations. More than 60 mutations in the five coding exons of RPS19 have been described to date. We previously reported a mutation (c.-1 + 26G>T) and an insertion at -631 upstream of ATG (c.-147_-146insGCCA) in the noncoding region. Because DBA phenotype is extremely heterogeneous from silent to severe and because haploinsufficiency seems to play a role in this process, it is likely that genetic variations in the noncoding regions affecting translation of RPS19 can modulate the phenotypic expression of DBA. However, to date, very few studies have addressed this question comprehensively. In this study, we performed detailed sequence analysis of the RPS19 gene in 239 patients with DBA and 110 of their relatives. We found that 6.2% of the patients with DBA carried allelic variations upstream of ATG: 3.3% with c.-1 + 26G>T; 2.5% with c.-147_-146insGCCA; and 0.4% with c.-174G>A. Interestingly, the c.-147_-146insGCCA, which has been found in a black American and French Caribbean control population, was not found in 500 Caucasian control chromosomes we studied. However, it was found in association with the same haplotype distribution of four intronic polymorphisms in our patients with DBA. Although a polymorphism, the frequency of this variant in the patients with DBA and its association with the same haplotype raises the possibility that this polymorphism and the other genetic variations in the noncoding region could play a role in DBA pathogenesis.
Collapse
|
19
|
Beyersmann J, Meerpohl J, Dettenkofer M, Wolkewitz M, Schumacher M. Risk factors disrupting mucosal integrity and subsequent vancomycin-resistant enterococcus infection. Pediatr Blood Cancer 2010; 54:184. [PMID: 19813246 DOI: 10.1002/pbc.22268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
20
|
Meerpohl J, Blümle A, Antes G, Elm EV. Leitlinien für Forschungsberichte sind auch für Leser medizinischer Fachartikel hilfreich. Dtsch Med Wochenschr 2009; 134:2078-83. [DOI: 10.1055/s-0029-1237560] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
21
|
Brozek JL, Akl EA, Jaeschke R, Lang DM, Bossuyt P, Glasziou P, Helfand M, Ueffing E, Alonso-Coello P, Meerpohl J, Phillips B, Horvath AR, Bousquet J, Guyatt GH, Schünemann HJ. Grading quality of evidence and strength of recommendations in clinical practice guidelines: Part 2 of 3. The GRADE approach to grading quality of evidence about diagnostic tests and strategies. Allergy 2009; 64:1109-16. [PMID: 19489757 DOI: 10.1111/j.1398-9995.2009.02083.x] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The GRADE approach to grading the quality of evidence and strength of recommendations provides a comprehensive and transparent approach for developing clinical recommendations about using diagnostic tests or diagnostic strategies. Although grading the quality of evidence and strength of recommendations about using tests shares the logic of grading recommendations for treatment, it presents unique challenges. Guideline panels and clinicians should be alert to these special challenges when using the evidence about the accuracy of tests as the basis for clinical decisions. In the GRADE system, valid diagnostic accuracy studies can provide high quality evidence of test accuracy. However, such studies often provide only low quality evidence for the development of recommendations about diagnostic testing, as test accuracy is a surrogate for patient-important outcomes at best. Inferring from data on accuracy that using a test improves outcomes that are important to patients requires availability of an effective treatment, improved patients' wellbeing through prognostic information, or - by excluding an ominous diagnosis - reduction of anxiety and the opportunity for earlier search for an alternative diagnosis for which beneficial treatment can be available. Assessing the directness of evidence supporting the use of a diagnostic test requires judgments about the relationship between test results and patient-important consequences. Well-designed and conducted studies of allergy tests in parallel with efforts to evaluate allergy treatments critically will encourage improved guideline development for allergic diseases.
Collapse
Affiliation(s)
- J L Brozek
- Department of Epidemiology, Italian National Cancer Institute Regina Elena, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Faivre L, Meerpohl J, Da Costa L, Marie I, Nouvel C, Gnekow A, Bender-Götze C, Bauters F, Coiffier B, Peaud PY, Rispal P, Berrebi A, Berger C, Flesch M, Sagot P, Varet B, Niemeyer C, Tchernia G, Leblanc T. High-risk pregnancies in Diamond-Blackfan anemia: a survey of 64 pregnancies from the French and German registries. Haematologica 2006; 91:530-3. [PMID: 16537118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Indexed: 05/07/2023] Open
Abstract
We reviewed 64 pregnancies in 26 women with Diamond-Blackfan anemia (DBA) included in the French and German DBA registries. Complications were seen in 42 pregnancies (66%) and included abortion, pre-eclampsia, in utero fetal death, intrauterine growth retardation, retroplacental hematoma, pre-term delivery and fetal malformations. Of the 34 children (53%) born alive, 13 had DBA. No correlations were found between pregnancy outcome and features of either maternal or child DBA. Pregnancies in DBA-affected women are at high risk, especially for complications likely to be of vascular-placental origin. Careful monitoring with prevention of severe anemia and early introduction of aspirin is suggested.
Collapse
Affiliation(s)
- Laurence Faivre
- Centre de Génétique Médicale, Hôpital d'Enfants, Dijon, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|