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Haggerty SP, Kumar SS, Collings AT, Alli VV, Miraflor E, Hanna NM, Athanasiadis DI, Morrell DJ, Ansari MT, Abou-Setta A, Walsh D, Stefanidis D, Slater BJ. SAGES peritoneal dialysis access guideline update 2023. Surg Endosc 2024; 38:1-23. [PMID: 37989887 DOI: 10.1007/s00464-023-10550-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/17/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Minimally invasive surgery has been used for both de novo insertion and salvage of peritoneal dialysis (PD) catheters. Advanced laparoscopic, basic laparoscopic, open, and image-guided techniques have evolved as the most popular techniques. The aim of this guideline was to develop evidence-based guidelines that support surgeons, patients, and other physicians in decisions on minimally invasive peritoneal dialysis access and the salvage of malfunctioning catheters in both adults and children. METHODS A guidelines committee panel of the Society of American Gastrointestinal and Endoscopic Surgeons reviewed the literature since the prior guideline was published in 2014 and developed seven key questions in adults and four in children. After a systematic review of the literature, by the panel, evidence-based recommendations were formulated using the Grading of Recommendations Assessment, Development and Evaluation approach. Recommendations for future research were also proposed. RESULTS After systematic review, data extraction, and evidence to decision meetings, the panel agreed on twelve recommendations for the peri-operative performance of laparoscopic peritoneal dialysis access surgery and management of catheter dysfunction. CONCLUSIONS In the adult population, conditional recommendations were made in favor of: staged hernia repair followed by PD catheter insertion over simultaneous and traditional start over urgent start of PD when medically possible. Furthermore, the panel suggested advanced laparoscopic insertion techniques rather than basic laparoscopic techniques or open insertion. Conditional recommendations were made for either advanced laparoscopic or image-guided percutaneous insertion and for either nonoperative or operative salvage. A recommendation could not be made regarding concomitant clean-contaminated surgery in adults. In the pediatric population, conditional recommendations were made for either traditional or urgent start of PD, concomitant clean or clean-contaminated surgery and PD catheter placement rather than staged, and advanced laparoscopic placement rather than basic or open insertion.
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Affiliation(s)
- Stephen P Haggerty
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
| | - Sunjay S Kumar
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Amelia T Collings
- Department of Surgery, Hiram C. Polk, Jr., University of Louisville, Louisville, KY, USA
| | - Vamsi V Alli
- Department of Surgery, Pennsylvania State College of Medicine, Hershey, PA, USA
| | - Emily Miraflor
- Department of Surgery, UCSF East Bay, University of California, San Francisco, CA, USA
| | - Nader M Hanna
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | | | - David J Morrell
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Mohammed T Ansari
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ahmed Abou-Setta
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Danielle Walsh
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bethany J Slater
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
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Ceppa EP, Collings AT, Abdalla M, Onkendi E, Nelson DW, Ozair A, Miraflor E, Rahman F, Whiteside J, Shah MM, Ayloo S, Dirks R, Kumar SS, Ansari MT, Sucandy I, Ali K, Douglas S, Polanco PM, Vreeland TJ, Buell J, Abou-Setta AM, Awad Z, Kwon CH, Martinie JB, Sbrana F, Pryor A, Slater BJ, Richardson W, Jeyarajah R, Alseidi A. SAGES/AHPBA guidelines for the use of microwave and radiofrequency liver ablation for the surgical treatment of hepatocellular carcinoma or colorectal liver metastases less than 5 cm. Surg Endosc 2023; 37:8991-9000. [PMID: 37957297 DOI: 10.1007/s00464-023-10468-1] [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: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Primary hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) represent the liver's two most common malignant neoplasms. Liver-directed therapies such as ablation have become part of multidisciplinary therapies despite a paucity of data. Therefore, an expert panel was convened to develop evidence-based recommendations regarding the use of microwave ablation (MWA) and radiofrequency ablation (RFA) for HCC or CRLM less than 5 cm in diameter in patients ineligible for other therapies. METHODS A systematic review was conducted for six key questions (KQ) regarding MWA or RFA for solitary liver tumors in patients deemed poor candidates for first-line therapy. Subject experts used the GRADE methodology to formulate evidence-based recommendations and future research recommendations. RESULTS The panel addressed six KQs pertaining to MWA vs. RFA outcomes and laparoscopic vs. percutaneous MWA. The available evidence was poor quality and individual studies included both HCC and CRLM. Therefore, the six KQs were condensed into two, recognizing that these were two disparate tumor groups and this grouping was somewhat arbitrary. With this significant limitation, the panel suggested that in appropriately selected patients, either MWA or RFA can be safe and feasible. However, this recommendation must be implemented cautiously when simultaneously considering patients with two disparate tumor biologies. The limited data suggested that laparoscopic MWA of anatomically more difficult tumors has a compensatory higher morbidity profile compared to percutaneous MWA, while achieving similar overall 1-year survival. Thus, either approach can be appropriate depending on patient-specific factors (very low certainty of evidence). CONCLUSION Given the weak evidence, these guidelines provide modest guidance regarding liver ablative therapies for HCC and CRLM. Liver ablation is just one component of a multimodal approach and its use is currently limited to a highly selected population. The quality of the existing data is very low and therefore limits the strength of the guidelines.
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Affiliation(s)
- Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA.
| | - Amelia T Collings
- Hiram C. Polk, Jr. Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Moustafa Abdalla
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Edwin Onkendi
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Daniel W Nelson
- Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Ahmad Ozair
- King George's Medical University, Lucknow, India
| | - Emily Miraflor
- UCSF East Bay Department of Surgery, UCSF, Oakland, CA, USA
| | - Faique Rahman
- Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Jake Whiteside
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA
| | - Mihir M Shah
- Division of Surgical Oncology, Department of Surgery, Emory University Winship Cancer Institute, Atlanta, GA, USA
| | | | - Rebecca Dirks
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA
| | - Sunjay S Kumar
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Kchaou Ali
- Department of Surgery A, Sfax Medical School, Sfax, Tunisia
| | - Sam Douglas
- Department of Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Patricio M Polanco
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Joseph Buell
- Department of Surgery, Mission Health Care System, Asheville, NC, USA
| | | | - Ziad Awad
- Department of Surgery, University of Florida, Jacksonville, FL, USA
| | - Choon Hyuck Kwon
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Fabio Sbrana
- Department of Surgery, Chicago Medical School, Rosalind Franklin University, Chicago, IL, USA
| | - Aurora Pryor
- Department of Surgery, Long Island Jewish Medical Center, Northwell Health, Great Neck, NY, USA
| | | | | | | | - Adnan Alseidi
- Department of Surgery, University of California, San Francisco, CA, USA
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3
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Hao Q, Gao Y, Zhao Y, Murad MH, Mustafa R, Ansari MT, Schünemann HJ, Rind DM, Brignardello-Petersen R, Guyatt G. GRADE concept 6: a novel application of external indirect evidence into GRADE ratings of evidence certainty in network meta-analysis. J Clin Epidemiol 2023; 163:95-101. [PMID: 37739191 DOI: 10.1016/j.jclinepi.2023.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/26/2023] [Revised: 08/28/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES We describe how consideration of external evidence may play an important role in judging certainty in the process of establishing the certainty of the evidence. Our example is a network meta-analysis (NMA) addressing treatment for Ebola virus disease, which informed a World Health Organization guideline. STUDY DESIGN AND SETTING Through Grading of Recommendations Assessment, Development, and Evaluations (GRADE) project group iterative online, in-person and email discussions, we developed this GRADE concept and obtained approval from the GRADE working group. Using the null as a threshold, we rated our certainty for network estimates in mortality, including consideration of evidence external to the NMA (i.e., did not meet eligibility criteria) and formal logical construction. RESULTS Based on the existing GRADE guidance, we rated the network estimate for one indirect comparison as low certainty. The formal logical construction that lead us reevaluate the certainty of the evidence is as follows: if A is superior to B, and B is not inferior to C, then A must be superior to C. After considering the logic and the external indirect evidence, we concluded at least moderate certainty for the comparison. CONCLUSION Systematic review authors and guideline developers should apply the fundamental logical construction for indirect comparisons and consider compelling external evidence in NMA certainty ratings.
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Affiliation(s)
- Qiukui Hao
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Ya Gao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yunli Zhao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Reem Mustafa
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - David M Rind
- Institute for Clinical and Economic Review, 14 Beacon Street, Boston, MA 02108, USA; Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | | | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Vreeland TJ, Collings AT, Ozair A, Adams AM, Dirks R, Kushner BS, Sucandy I, Morrell D, Whiteside J, Ansari MT, Cloyd J, Cleary SP, Ceppa E, Abou-Setta AM, Alseidi A, Awad Z, Ayloo S, Buell J, Orthopoulos G, Richardson W, Sbayi S, Wakabayashi G, Asbun H, Slater BJ, Pryor AD, Jeyarajah DR. SAGES/AHPBA guidelines for the use of minimally invasive surgery for the surgical treatment of colorectal liver metastases (CRLM). Surg Endosc 2023; 37:2508-2516. [PMID: 36810687 DOI: 10.1007/s00464-023-09895-x] [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: 08/25/2022] [Accepted: 01/16/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Colorectal liver metastases (CRLM) occur in roughly half of patients with colorectal cancer. Minimally invasive surgery (MIS) has become an increasingly acceptable and utilized technique for resection in these patients, but there is a lack of specific guidelines on the use of MIS hepatectomy in this setting. A multidisciplinary expert panel was convened to develop evidence-based recommendations regarding the decision between MIS and open techniques for the resection of CRLM. METHODS Systematic review was conducted for two key questions (KQ) regarding the use of MIS versus open surgery for the resection of isolated liver metastases from colon and rectal cancer. Evidence-based recommendations were formulated using the GRADE methodology by subject experts. Additionally, the panel developed recommendations for future research. RESULTS The panel addressed two KQs, which pertained to staged or simultaneous resection of resectable colon or rectal metastases. The panel made conditional recommendations for the use of MIS hepatectomy for both staged and simultaneous resection when deemed safe, feasible, and oncologically effective by the surgeon based on the individual patient characteristics. These recommendations were based on low and very low certainty of evidence. CONCLUSIONS These evidence-based recommendations should provide guidance regarding surgical decision-making in the treatment of CRLM and highlight the importance of individual considerations of each case. Pursuing the identified research needs may help further refine the evidence and improve future versions of guidelines for the use of MIS techniques in the treatment of CRLM.
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Affiliation(s)
| | - Amelia T Collings
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ahmad Ozair
- Faculty of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Alexandra M Adams
- Department of Surgery, Brooke Army Medical Center, San Antonio, TX, USA
| | - Rebecca Dirks
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - David Morrell
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jake Whiteside
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Jordan Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sean P Cleary
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eugene Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ahmed M Abou-Setta
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | | | - Joseph Buell
- Division of Surgery, Mission Healthcare System, HCA Healthcare, Asheville, NC, USA
| | - Georgios Orthopoulos
- Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Worcester, USA
| | | | - Samer Sbayi
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Department of Surgery, Ageo Central General Hospital, Ageo City, Japan
| | - Horacio Asbun
- Baptist Health Miami Cancer Institute, Miami, FL, USA
| | - Bethany J Slater
- Department of Surgery, University of Chicago Medicine, Chicago, USA
| | - Aurora D Pryor
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
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5
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Slater BJ, Collings A, Dirks R, Gould JC, Qureshi AP, Juza R, Rodríguez-Luna MR, Wunker C, Kohn GP, Kothari S, Carslon E, Worrell S, Abou-Setta AM, Ansari MT, Athanasiadis DI, Daly S, Dimou F, Haskins IN, Hong J, Krishnan K, Lidor A, Litle V, Low D, Petrick A, Soriano IS, Thosani N, Tyberg A, Velanovich V, Vilallonga R, Marks JM. Multi-society consensus conference and guideline on the treatment of gastroesophageal reflux disease (GERD). Surg Endosc 2023; 37:781-806. [PMID: 36529851 DOI: 10.1007/s00464-022-09817-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 08/29/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is one of the most common diseases in North America and globally. The aim of this guideline is to provide evidence-based recommendations regarding the most utilized and available endoscopic and surgical treatments for GERD. METHODS Systematic literature reviews were conducted for 4 key questions regarding the surgical and endoscopic treatments for GERD in adults: preoperative evaluation, endoscopic vs surgical or medical treatment, complete vs partial fundoplication, and treatment for obesity (body mass index [BMI] ≥ 35 kg/m2) and concomitant GERD. Evidence-based recommendations were formulated using the GRADE methodology by subject experts. Recommendations for future research were also proposed. RESULTS The consensus provided 13 recommendations. Through the development of these evidence-based recommendations, an algorithm was proposed for aid in the treatment of GERD. Patients with typical symptoms should undergo upper endoscopy, manometry, and pH-testing; additional testing may be required for patients with atypical or extra-esophageal symptoms. Patients with normal or abnormal findings on manometry should consider undergoing partial fundoplication. Magnetic sphincter augmentation or fundoplication are appropriate surgical procedures for adults with GERD. For patients who wish to avoid surgery, the Stretta procedure and transoral incisionless fundoplication (TIF 2.0) were found to have better outcomes than proton pump inhibitors alone. Patients with concomitant obesity were recommended to undergo either gastric bypass or fundoplication, although patients with severe comorbid disease or BMI > 50 should undergo Roux-en-Y gastric bypass for the additional benefits that follow weight loss. CONCLUSION Using the recommendations an algorithm was developed by this panel, so that physicians may better counsel their patients with GERD. There are certain patient factors that have been excluded from included studies/trials, and so these recommendations should not replace surgeon-patient decision making. Engaging in the identified research areas may improve future care for GERD patients.
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Affiliation(s)
- Bethany J Slater
- University of Chicago Medicine, 5841 S. Maryland Avenue, MC 4062, Chicago, IL, USA.
| | - Amelia Collings
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rebecca Dirks
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jon C Gould
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alia P Qureshi
- Division of General & GI Surgery, Foregut Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Ryan Juza
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - María Rita Rodríguez-Luna
- Research Institute Against Digestive Cancer (IRCAD) and ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
| | | | - Geoffrey P Kohn
- Department of Surgery, Monash University, Melbourne, VIC, Australia
| | - Shanu Kothari
- Department of Surgery, Prisma Health, Greenville, SC, USA
| | | | | | - Ahmed M Abou-Setta
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | - Shaun Daly
- Department of Surgery, University of California, Irvine, Orange, CA, USA
| | | | - Ivy N Haskins
- Department of Surgery, University of Nebraska Medical Center, Omaha, USA
| | - Julie Hong
- Department of Surgery, New York Presbyterian/Queens, Queens, USA
| | | | - Anne Lidor
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Virginia Litle
- Section of Thoracic Surgery, Department of Cardiovascular Surgery, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Donald Low
- Virginia Mason Medical Center, Seattle, WA, USA
| | - Anthony Petrick
- Department of General Surgery, Geisinger School of Medicine, Geisinger Medical Center, Danville, PA, USA
| | - Ian S Soriano
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Nirav Thosani
- McGovern Medical School, Center for Interventional Gastroenterology at UTHealth, Houston, TX, USA
| | - Amy Tyberg
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Vic Velanovich
- Division of Gastrointestinal Surgery, Tampa General, Tampa, FL, USA
| | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jeffrey M Marks
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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6
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Abdalla M, Collings AT, Dirks R, Onkendi E, Nelson D, Ozair A, Miraflor E, Rahman F, Whiteside J, Shah MM, Ayloo S, Abou-Setta A, Sucandy I, Kchaou A, Douglas S, Polanco P, Vreeland T, Buell J, Ansari MT, Pryor AD, Slater BJ, Awad Z, Richardson W, Alseidi A, Jeyarajah DR, Ceppa E. Surgical approach to microwave and radiofrequency liver ablation for hepatocellular carcinoma and colorectal liver metastases less than 5 cm: a systematic review and meta-analysis. Surg Endosc 2022; 37:3340-3353. [PMID: 36542137 DOI: 10.1007/s00464-022-09815-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Primary hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) represent the two most common malignant neoplasms of the liver. The objective of this study was to assess outcomes of surgical approaches to liver ablation comparing laparoscopic versus percutaneous microwave ablation (MWA), and MWA versus radiofrequency ablation (RFA) in patients with HCC or CRLM lesions smaller than 5 cm. METHODS A systematic review was conducted across seven databases, including PubMed, Embase, and Cochrane, to identify all comparative studies between 1937 and 2021. Two independent reviewers screened for eligibility, extracted data for selected studies, and assessed study bias using the modified Newcastle Ottawa Scale. Random effects meta-analyses were subsequently performed on all available comparative data. RESULTS From 1066 records screened, 11 studies were deemed relevant to the study and warranted inclusion. Eight of the 11 studies were at high or uncertain risk for bias. Our meta-analyses of two studies revealed that laparoscopic MW ablation had significantly higher complication rates compared to a percutaneous approach (risk ratio = 4.66; 95% confidence interval = [1.23, 17.22]), but otherwise similar incomplete ablation rates, local recurrence, and oncologic outcomes. The remaining nine studies demonstrated similar efficacy of MWA and RFA, as measured by incomplete ablation, complication rates, local/regional recurrence, and oncologic outcomes, for both HCC and CRLM lesions less than 5 cm (p > 0.05 for all outcomes). There was no statistical subgroup interaction in the analysis of tumors < 3 cm. CONCLUSION The available comparative evidence regarding both laparoscopic versus percutaneous MWA and MWA versus RFA is limited, evident by the few studies that suffer from high/uncertain risk of bias. Additional high-quality randomized trials or statistically matched cohort studies with sufficient granularity of patient variables, institutional experience, and physician specialty/training will be useful in informing clinical decision making for the ablative treatment of HCC or CRLM.
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Affiliation(s)
- Moustafa Abdalla
- Department of Surgery, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Amelia T Collings
- Department of Surgery, Indiana University School of Medicine, I545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA
| | - Rebecca Dirks
- Department of Surgery, Indiana University School of Medicine, I545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA
| | - Edwin Onkendi
- Department of Surgery, Texas Tech University Health Sciences, Lubbock, TX, USA
| | - Daniel Nelson
- Department of Surgery, William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | - Ahmad Ozair
- King George's Medical University, Chowk, Lucknow, India
| | - Emily Miraflor
- Department of Surgery, University of California, San Francisco - East Bay, CA, USA
| | - Faique Rahman
- Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, India
| | - Jake Whiteside
- Department of Surgery, Indiana University School of Medicine, I545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA
| | - Mihir M Shah
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Subhashini Ayloo
- Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ahmed Abou-Setta
- Knowledge Synthesis, University of Manitoba, Winnipeg, MB, Canada
| | - Iswanto Sucandy
- Department of Surgery, University of Central Florida, Tampa, FL, USA
| | - Ali Kchaou
- Department of Surgery, University of Sfax, Sfax, Tunisia
| | | | - Patricio Polanco
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Timothy Vreeland
- Department of Surgery, Brooke Army Medical Center, Houston, TX, USA
| | - Joseph Buell
- Department of Surgery and Pediatrics, Tulane University, New Orleans, LA, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Aurora D Pryor
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | | | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | | | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - D Rohan Jeyarajah
- Department of Surgery, TCU and UNTHSC School of Medicine, Fort Worth, TX, USA
| | - Eugene Ceppa
- Department of Surgery, Indiana University School of Medicine, I545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA.
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7
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Cuello CA, Morgan RL, Brozek J, Verbeek J, Thayer K, Ansari MT, Guyatt G, Schünemann HJ. Case studies to explore the optimal use of randomized and nonrandomized studies in evidence syntheses that use GRADE. J Clin Epidemiol 2022; 152:56-69. [PMID: 36198367 DOI: 10.1016/j.jclinepi.2022.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/13/2022] [Accepted: 09/23/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Randomized controlled trials (RCTs) are the preferred source of evidence for the relative effect of healthcare interventions summarized in knowledge syntheses. Nonrandomized studies of interventions (NRSI) may provide replacement, sequential, or complementary evidence to RCTs. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach can provide different options for properly using RCTs and NRSI integrated in health syntheses. In this article, we discuss different implications on the certainty of evidence when authors consider the use of NRSI and RCTs in systematic reviews using GRADE. Although this is a GRADE-related article, it is not an official GRADE guidance or concept article. STUDY DESIGN AND SETTING We present case studies used during GRADE working group meetings for discussion of the effects of using NRSI and RCTs on GRADE domains and on the certainty of evidence. Several concepts were discussed through iterative feedback with experts in GRADE methods and Cochrane authors. We compared suggested solutions for possible scenarios that can be met in evidence syntheses informing decisions and future guidance. RESULTS Different scenarios for the use of RCTs and NRSI in evidence syntheses are presented, focusing on how different GRADE ratings between RCTs and NRSI affect the overall assessment of the evidence and possible health recommendations. CONCLUSIONS Considering differences and similarities grounded in the GRADE approach between NRSI and RCTs may help complement one another and maximize the value of knowledge syntheses and health recommendations.
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Affiliation(s)
- Carlos A Cuello
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton Ontario, Canada; Canadian Agency of Drugs and Technology in Health, Toronto, Ontario, Canada
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton Ontario, Canada
| | - Jan Brozek
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jos Verbeek
- Cochrane Work Review Group, University Medical Centers Amsterdam, Amsterdam, the Netherlands
| | - Kris Thayer
- Integrated Risk Information System (IRIS) Division, National Center for Environmental Assessment, Environmental Protection Agency, Washington, USA
| | - Mohammed T Ansari
- Faculty of Medicine, School of Epidemiology and Public health. University of Ottawa, Ottawa Ontario, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton Ontario, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy.
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8
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Ozair A, Collings A, Adams AM, Dirks R, Kushner BS, Sucandy I, Morrell D, Abou-Setta AM, Vreeland T, Whiteside J, Cloyd JM, Ansari MT, Cleary SP, Ceppa E, Richardson W, Alseidi A, Awad Z, Ayloo S, Buell JF, Orthopoulos G, Sbayi S, Wakabayashi G, Slater BJ, Pryor A, Jeyarajah DR. Minimally invasive versus open hepatectomy for the resection of colorectal liver metastases: a systematic review and meta-analysis. Surg Endosc 2022; 36:7915-7937. [PMID: 36138246 DOI: 10.1007/s00464-022-09612-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 05/19/2022] [Accepted: 09/05/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND While surgical resection has a demonstrated utility for patients with colorectal liver metastases (CRLM), it is unclear whether minimally invasive surgery (MIS) or an open approach should be used. This review sought to assess the efficacy and safety of MIS versus open hepatectomy for isolated, resectable CRLM when performed separately from (Key Question (KQ) 1) or simultaneously with (KQ2) the resection of the primary tumor. METHODS PubMed, Embase, Google Scholar, Cochrane CENTRAL, International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov databases were searched to identify both randomized controlled trials (RCTs) and non-randomized comparative studies published during January 2000-September 2020. Two independent reviewers screened literature for eligibility, extracted data from included studies, and assessed internal validity using the Cochrane Risk of Bias 2.0 Tool and the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed using risk ratios (RR) and mean differences (MD). RESULTS From 2304 publications, 35 studies were included for meta-analysis. For staged resections, three RCTs and 20 observational studies were included. Data from RCTs indicated MIS having similar disease-free survival (DFS) at 1-year (RR 1.03, 95%CI 0.70-1.50), overall survival (OS) at 5-years (RR 1.04, 95%CI 0.84-1.28), fewer complications of Clavien-Dindo Grade III (RR 0.62, 95%CI 0.38-1.00), and shorter hospital length of stay (LOS) (MD -6.6 days, 95%CI -10.2, -3.0). For simultaneous resections, 12 observational studies were included. There was no evidence of a difference between MIS and the open group for DFS-1-year, OS-5-year, complications, R0 resections, blood transfusions, along with lower blood loss (MD -177.35 mL, 95%CI -273.17, -81.53) and shorter LOS (MD -3.0 days, 95%CI -3.82, -2.17). CONCLUSIONS Current evidence regarding the optimal approach for CRLM resection demonstrates similar oncologic outcomes between MIS and open techniques, however MIS hepatectomy had a shorter LOS, lower blood loss and complication rate, for both staged and simultaneous resections.
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Affiliation(s)
- Ahmad Ozair
- Faculty of Medicine, King George's Medical University, Uttar Pradesh, Lucknow, India
| | - Amelia Collings
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | - Alexandra M Adams
- Department of Surgery, Brooke Army Medical Centre, Fort Sam Houston, San Antonio, TX, USA
| | - Rebecca Dirks
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | - Bradley S Kushner
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Iswanto Sucandy
- Digestive Health Institute, AdventHealth Tampa, Tampa, FL, USA
| | - David Morrell
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ahmed M Abou-Setta
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Timothy Vreeland
- Department of Surgery, Brooke Army Medical Centre, Fort Sam Houston, San Antonio, TX, USA
| | - Jake Whiteside
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | - Jordan M Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sean P Cleary
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eugene Ceppa
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | | | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Subhashini Ayloo
- Department of Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Joseph F Buell
- Division of Surgery, Mission Healthcare System, HCA Healthcare, Asheville, NC, USA
| | - Georgios Orthopoulos
- Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA
| | - Samer Sbayi
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, New York, NY, USA
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Department of Surgery, Ageo Central General Hospital, Ageo City, Japan
| | - Bethany J Slater
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Aurora Pryor
- Department of Surgery, Stony Brook University, Stony Brook, NY, USA
| | - D Rohan Jeyarajah
- Department of Surgery, TCU School of Medicine, and Methodist Richardson Medical Center, 2805 East President George Bush Highway, Fort Worth, TX, USA.
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9
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Whaley P, Piggott T, Morgan RL, Hoffmann S, Tsaioun K, Schwingshackl L, Ansari MT, Thayer KA, Schünemann HJ. Biological plausibility in environmental health systematic reviews: a GRADE concept paper. Environ Int 2022; 162:107109. [PMID: 35305498 DOI: 10.1016/j.envint.2022.107109] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/20/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND "Biological plausibility" is a concept frequently referred to in environmental and public health when researchers are evaluating how confident they are in the results and inferences of a study or evidence review. Biological plausibility is not, however, a domain of one of the most widely-used approaches for assessing the certainty of evidence (CoE) which underpins the findings of a systematic review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) CoE Framework. Whether the omission of biological plausibility is a potential limitation of the GRADE CoE Framework is a topic that is regularly discussed, especially in the context of environmental health systematic reviews. OBJECTIVES We analyse how the concept of "biological plausibility", as applied in the context of assessing certainty of the evidence that supports the findings of a systematic review, is accommodated under the processes of systematic review and the existing GRADE domains. RESULTS AND DISCUSSION We argue that "biological plausibility" is a concept which primarily comes into play when direct evidence about the effects of an exposure on a population of concern (usually humans) is absent, at high risk of bias, is inconsistent, or limited in other ways. In such circumstances, researchers look toward evidence from other study designs in order to draw conclusions. In this respect, we can consider experimental animal and in vitro evidence as "surrogates" for the target populations, exposures, comparators and outcomes of actual interest. Through discussion of 10 examples of experimental surrogates, we propose that the concept of biological plausibility consists of two principal aspects: a "generalisability aspect" and a "mechanistic aspect". The "generalisability aspect" concerns the validity of inferences from experimental models to human scenarios, and asks the same question as does the assessment of external validity or indirectness in systematic reviews. The "mechanistic aspect" concerns certainty in knowledge of biological mechanisms and would inform judgements of indirectness under GRADE, and thus the overall CoE. While both aspects are accommodated under the indirectness domain of the GRADE CoE Framework, further research is needed to determine how to use knowledge of biological mechanisms in the assessment of indirectness of the evidence in systematic reviews.
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Affiliation(s)
- Paul Whaley
- Lancaster Environment Centre, Lancaster University, UK; Evidence-based Toxicology Collaboration at Johns Hopkins Bloomberg School of Public Health (EBTC), USA
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8N 3Z5, Canada
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8N 3Z5, Canada
| | - Sebastian Hoffmann
- Evidence-based Toxicology Collaboration at Johns Hopkins Bloomberg School of Public Health (EBTC), USA
| | - Katya Tsaioun
- Evidence-based Toxicology Collaboration at Johns Hopkins Bloomberg School of Public Health (EBTC), USA
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, University of Ottawa, Room 101, 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3, Canada
| | - Kristina A Thayer
- U.S. Environmental Protection Agency (US EPA), Office of Research and Development, Center for Public Health and Environmental Assessment (CPHEA), Chemical Pollutant Assessment Division (CPAD), 1200 Pennsylvania Avenue, NW (8623R), Washington, DC 20460, USA
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8N 3Z5, Canada; Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, HSC-2C, 1280 Main St West, Hamilton, ON L8N 3Z5, Canada; Dipartimento di Scienze Biomediche, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milan, Italy
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10
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Collings AT, Jeyarajah DR, Hanna NM, Dort J, Tsuda S, Nepal P, Lim R, Lin C, Hong JS, Ansari MT, Slater BJ, Pryor AD, Kohn GP. SAGES 2022 guidelines regarding the use of laparoscopy in the era of COVID-19. Surg Endosc 2022; 36:2723-2733. [PMID: 35237900 PMCID: PMC8890462 DOI: 10.1007/s00464-022-09133-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/23/2022] [Accepted: 02/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND SARS-CoV-2 has changed global healthcare since the pandemic began in 2020. The safety of minimally invasive surgery (MIS) utilizing insufflation from the standpoint of safety to the operating room personnel is currently being explored. The aims of this guideline are to examine the existing evidence to provide guidance regarding MIS for the patient with, or suspecting of having, the SARS-CoV-2 as well as the healthcare team involved. METHODS Systematic literature reviews were conducted for 2 key questions (KQ) regarding the safety of MIS in the setting of COVID-19 pandemic. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria. Evidence-based recommendations were formulated using a narrative synthesis of the literature by subject experts. Recommendations for future research were also proposed. RESULTS In KQ1, a total of 1361 articles were reviewed, with 2 articles meeting inclusion. In KQ2, a total of 977 articles were reviewed, with 4 articles met inclusions criteria, of which 2 studies reported on the SARS-CoV2 virus specifically. Despite many publications in the field, very little well-controlled and unbiased data exist to inform the recommendations. Of that which is available, it shows that both laparoscopic and open operations in Covid-positive patients had similar rates of OR staff positivity rates; however, patients who underwent laparoscopic procedures had a lower perioperative mortality than open procedures. Also, SARS-CoV-2 particles have been detected in the surgical plume at laparoscopy. CONCLUSION With demonstrated equivalence of operating room staff exposure, and noninferiority of laparoscopic access with respect to mortality, either laparoscopic or open approaches to abdominal operations may be used in patients with SARS-CoV-2. Measures should be employed for all laparoscopic or open cases to prevent exposure of operating room staff to the surgical plume, as virus can be present in this plume.
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Affiliation(s)
- Amelia T Collings
- Department of Surgery, Indiana University, Amelia Collings, 545 Barnhill Dr., Emerson 125, Indianapolis, IN, USA.
| | - D Rohan Jeyarajah
- TCU School of Medicine and Methodist Richardson Medical Center, Richardson, TX, USA
| | - Nader M Hanna
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Jonathan Dort
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | - Shawn Tsuda
- Valley Health System General Surgery Residency, Las Vegas, NV, USA
| | - Pramod Nepal
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medicine, Kagoshima, Japan
| | - Robert Lim
- University of Oklahoma School of Medicine at Tulsa, Tulsa, OK, USA
| | | | - Julie S Hong
- Department of Surgery, New York Presbyterian/Queens, New York, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Aurora D Pryor
- Department of Surgery, Stony Brook University, Stony Brook, USA
| | - Geoffrey P Kohn
- Monash University, Melbourne, Australia.,Melbourne Upper GI Surgical Group, Melbourne, Australia
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11
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Kindel TL, Dirks RC, Collings AT, Scholz S, Abou-Setta AM, Alli VV, Ansari MT, Awad Z, Broucek J, Campbell A, Cripps MW, Hollands C, Lim R, Quinteros F, Ritchey K, Whiteside J, Zagol B, Pryor AD, Walsh D, Haggerty S, Stefanidis D. Guidelines for the performance of minimally invasive splenectomy. Surg Endosc 2021; 35:5877-5888. [PMID: 34580773 DOI: 10.1007/s00464-021-08741-2] [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: 08/11/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Minimally invasive splenectomy (MIS) is increasingly favored for the treatment of benign and malignant diseases of the spleen over open access approaches. While many studies cite the superiority of MIS in terms of decreased morbidity and length of stay over a traditional open approach, the comparative effectiveness of specific technical and peri-operative approaches to MIS is unclear. OBJECTIVE To develop evidence-based guidelines that support clinicians, patients, and others in decisions on the peri-operative performance of MIS. METHODS A guidelines committee panel of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) including methodologists used the Grading of Recommendations Assessment, Development and Evaluation approach to grade the certainty of evidence and formulate recommendations. RESULTS Informed by a systematic review of the evidence, the panel agreed on eight recommendations for the peri-operative performance of MIS for adults and children in elective situations addressing six key questions. CONCLUSIONS Conditional recommendations were made in favor of lateral positioning for non-hematologic disease, intra-operative platelet administration for patients with idiopathic thrombocytopenic purpura instead of preoperative administration, and the use of mechanical devices to control the splenic hilum. Further, a conditional recommendation was made against routine intra-operative drain placement.
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Affiliation(s)
- Tammy L Kindel
- Department of Surgery, Medical College of Wisconsin, Wauwatosa, USA
| | - Rebecca C Dirks
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Amelia T Collings
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Stefan Scholz
- Department of Surgery, Division of Pediatric Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Ahmed M Abou-Setta
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Vamsi V Alli
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, USA
| | - Joseph Broucek
- Department of Surgery, Vanderbilt University Medical Center, Nashville, USA
| | - Andre Campbell
- Department of Surgery, University of California, San Francisco, San Francisco, USA
| | - Michael W Cripps
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Celeste Hollands
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Robert Lim
- Department of Surgery, University of Oklahoma School of Medicine Tulsa, Tulsa, USA
| | | | - Kim Ritchey
- Division of Pediatric Hematology and Oncology, University of Pittsburgh, Pittsburgh, USA
| | - Jake Whiteside
- Indiana University School of Medicine, Indianapolis, USA
| | - Bradley Zagol
- Charles George Veterans Affairs Medical Center, Asheville, USA
| | - Aurora D Pryor
- Department of Surgery, Stony Brook University, Stony Brook, USA
| | - Danielle Walsh
- Department of Surgery, East Carolina University, Greenville, USA
| | | | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA.
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12
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Slater BJ, Dirks RC, McKinley SK, Ansari MT, Kohn GP, Thosani N, Qumseya B, Billmeier S, Daly S, Crawford C, P Ehlers A, Hollands C, Palazzo F, Rodriguez N, Train A, Wassenaar E, Walsh D, Pryor AD, Stefanidis D. SAGES guidelines for the surgical treatment of gastroesophageal reflux (GERD). Surg Endosc 2021; 35:4903-4917. [PMID: 34279710 DOI: 10.1007/s00464-021-08625-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 05/17/2021] [Accepted: 06/28/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gastroesophageal Reflux Disease (GERD) is an extremely common condition with several medical and surgical treatment options. A multidisciplinary expert panel was convened to develop evidence-based recommendations to support clinicians, patients, and others in decisions regarding the treatment of GERD with an emphasis on evaluating different surgical techniques. METHODS Literature reviews were conducted for 4 key questions regarding the surgical treatment of GERD in both adults and children: surgical vs. medical treatment, robotic vs. laparoscopic fundoplication, partial vs. complete fundoplication, and division vs. preservation of short gastric vessels in adults or maximal versus minimal dissection in pediatric patients. Evidence-based recommendations were formulated using the GRADE methodology by subject experts. Recommendations for future research were also proposed. RESULTS The panel provided seven recommendations for adults and children with GERD. All recommendations were conditional due to very low, low, or moderate certainty of evidence. The panel conditionally recommended surgical treatment over medical management for adults with chronic or chronic refractory GERD. There was insufficient evidence for the panel to make a recommendation regarding surgical versus medical treatment in children. The panel suggested that once the decision to pursue surgical therapy is made, adults and children with GERD may be treated with either a robotic or a laparoscopic approach, and either partial or complete fundoplication based on surgeon-patient shared decision-making and patient values. In adults, the panel suggested either division or non-division of the short gastric vessels is appropriate, and that children should undergo minimal dissection during fundoplication. CONCLUSIONS These recommendations should provide guidance with regard to surgical decision-making in the treatment of GERD and highlight the importance of shared decision-making and patient values to optimize patient outcomes. Pursuing the identified research needs may improve future versions of guidelines for the treatment of GERD.
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Affiliation(s)
- Bethany J Slater
- Department of Surgery, University of Chicago Medicine, 5841 S. Maryland Avenue, MC 4062, Chicago, IL, 606037, USA.
| | - Rebecca C Dirks
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Geoffrey P Kohn
- Department of Surgery, Monash University, Eastern Health Clinical School, Melbourne, VIC, Australia
- Melbourne Upper GI Surgical Group, Melbourne, VIC, Australia
| | - Nirav Thosani
- Center for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical School, UTHealth, Houston, TX, USA
| | - Bashar Qumseya
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Fl, USA
| | - Sarah Billmeier
- Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Shaun Daly
- Department of Surgery, University of California Irvine, Irvine, USA
| | - Catherine Crawford
- Department of Surgery, Cambridge Health Alliance, Cambridge Massachusetts and Milford Regional Medical Center, Milford, MA, USA
| | - Anne P Ehlers
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Celeste Hollands
- Department of Surgery, Texas Tech University Health Sciences Center, Texas, USA
| | - Francesco Palazzo
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Noe Rodriguez
- Department of Surgery, Florida Atlantic University, Florida, USA
| | - Arianne Train
- Department of Surgery, Winn Army Community Hospital, Fort Stewart, GA, USA
| | - Eelco Wassenaar
- Department of Surgery, Gelre Hospitals, Zutphen, Netherlands
| | - Danielle Walsh
- Department of Surgery, East Carolina University, Greenville, NC, USA
| | - Aurora D Pryor
- Department of Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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13
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Jeyaraman MM, Robson RC, Copstein L, Al-Yousif N, Pollock M, Xia J, Balijepalli C, Hofer K, Mansour S, Fazeli MS, Ansari MT, Tricco AC, Rabbani R, Abou-Setta AM. Customized guidance/training improved the psychometric properties of methodologically rigorous risk of bias instruments for non-randomized studies. J Clin Epidemiol 2021; 136:157-167. [PMID: 33979663 DOI: 10.1016/j.jclinepi.2021.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 04/09/2021] [Accepted: 04/24/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate the impact of guidance and training on the inter-rater reliability (IRR), inter-consensus reliability (ICR) and evaluator burden of the Risk of Bias (RoB) in Non-randomized Studies (NRS) of Interventions (ROBINS-I) tool, and the RoB instrument for NRS of Exposures (ROB-NRSE). STUDY DESIGN AND SETTING In a before-and-after study, seven reviewers appraised the RoB using ROBINS-I (n = 44) and ROB-NRSE (n = 44), before and after guidance and training. We used Gwet's AC1 statistic to calculate IRR and ICR. RESULTS After guidance and training, the IRR and ICR of the overall bias domain of ROBINS-I and ROB-NRSE improved significantly; with many individual domains showing either a significant (IRR and ICR of ROB-NRSE; ICR of ROBINS-I), or nonsignificant improvement (IRR of ROBINS-I). Evaluator burden significantly decreased after guidance and training for ROBINS-I, whereas for ROB-NRSE there was a slight nonsignificant increase. CONCLUSION Overall, there was benefit for guidance and training for both tools. We highly recommend guidance and training to reviewers prior to RoB assessments and that future research investigate aspects of guidance and training that are most effective.
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Affiliation(s)
- Maya M Jeyaraman
- George & Fay Yee Center for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. R3E 0T6, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 0T6, Canada.
| | - Reid C Robson
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, Ontario, M5B 1T8, Canada
| | - Leslie Copstein
- George & Fay Yee Center for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. R3E 0T6, Canada
| | - Nameer Al-Yousif
- George & Fay Yee Center for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. R3E 0T6, Canada
| | - Michelle Pollock
- Institute of Health Economics, 1200-10405 Jasper Avenue, Edmonton, Alberta, T5J 3N4, Canada
| | - Jun Xia
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham Medical School, Nottingham, NG7 2UH, UK; Nottingham Ningbo GRADE Centre, The University of Nottingham Ningbo, 199 East Taikang Road, Ningbo, China
| | | | - Kimberly Hofer
- Evidinno Outcomes Research Inc., 1750 Davie Street, Suites 601 & 602, Vancouver, British Columbia, V6B 2Z4, Canada
| | - Samer Mansour
- Centre Hospitalier de l'Université de Montreal, 2900, boul. Édouard-Montpetit, Montréal (Québec) H3T 1J4, Canada; Faculty of Medicine, Department of Medicine, Université de Montréal, Roger-Gaudry Building, 2900 Edouard Montpetit Blvd, Montreal, Quebec H3T 1J4, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, 900 St Denis St, Montreal, Quebec H2 × 0A9, Canada
| | - Mir S Fazeli
- Evidinno Outcomes Research Inc., 1750 Davie Street, Suites 601 & 602, Vancouver, British Columbia, V6B 2Z4, Canada
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Room 101, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, Ontario, M5B 1T8, Canada; Epidemiology Division & Institute of Health, Management, and Policy Evaluation, Dalla Lana School of Public Health, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada; Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, 92 Barrie Street, Room 214, Kingston, Ontario, K7L 3N6, Canada
| | - Rasheda Rabbani
- George & Fay Yee Center for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. R3E 0T6, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Center for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. R3E 0T6, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 0T6, Canada
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14
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Kohn GP, Dirks RC, Ansari MT, Clay J, Dunst CM, Lundell L, Marks JM, Molena D, Rooker C, Saxena P, Swanstrom L, Wong RK, Pryor AD, Stefanidis D. SAGES guidelines for the use of peroral endoscopic myotomy (POEM) for the treatment of achalasia. Surg Endosc 2021; 35:1931-1948. [PMID: 33564964 DOI: 10.1007/s00464-020-08282-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/31/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Peroral endoscopic myotomy (POEM) is increasingly used as primary treatment for esophageal achalasia, in place of the options such as Heller myotomy (HM) and pneumatic dilatation (PD) OBJECTIVE: These evidence-based guidelines from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) intend to support clinicians, patients and others in decisions about the use of POEM for treatment of achalasia. RESULTS The panel agreed on 4 recommendations for adults and children with achalasia. CONCLUSIONS Strong recommendation for the use of POEM over PD was issued unless the concern of continued postoperative PPI use remains a key decision-making concern to the patient. Conditional recommendations included the option of using either POEM or HM with fundoplication to treat achalasia, and favored POEM over HM for achalasia subtype III.
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Affiliation(s)
- Geoffrey P Kohn
- Department of Surgery, Eastern Health Clinical School, Monash University, Clayton, VIC, Australia.
- Melbourne Upper GI Surgical Group, Melbourne, VIC, Australia.
| | - Rebecca C Dirks
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jason Clay
- International Foundation for Gastrointestinal Disorders, Mount Pleasant, USA
| | | | - Lars Lundell
- Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Odense University Hospital, Odense, Denmark
| | - Jeffrey M Marks
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Daniela Molena
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ceciel Rooker
- International Foundation for Gastrointestinal Disorders, Mount Pleasant, USA
| | - Payal Saxena
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Newtown, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Lee Swanstrom
- Institut de Chirugie, IHU Strasbourg, Strasbourg, France
| | - Reuben K Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Aurora D Pryor
- Department of Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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Ansari MT, Digge VK, Mahmood A. Giant Cell Tumor of Triquetrum: A Case Report with Literature Review. J Wrist Surg 2021; 10:158-163. [PMID: 33815953 PMCID: PMC8012084 DOI: 10.1055/s-0040-1713903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/28/2020] [Indexed: 10/23/2022]
Abstract
Background Giant cell tumor (GCT) of bone is a benign, aggressive tumor of bone and occurs commonly around the knee and distal radius. GCT of bone rarely occurs in hand. In hand, metacarpals are the most common site and there have been only a few case reports of GCT of the carpal bone. In hand, these tumors are very aggressive and these have a high tendency to recur after intralesional curettage. No long-term study is available for choosing an appropriate method of treatment for these tumors in hand. Case Description Herein, we report a case of GCT of the bone involving triquetrum which was managed by excision of triquetrum and scaphoid bone. The reconstruction of the wrist was done through limited carpal fusion, by doing three corner fusion of the wrist. At 2 years after surgery, the patient was asymptomatic and radiographs revealed fusion of lunocapitate and lunohamate joints with no evidence of recurrence. Literature review Current literature regarding GCT of triquetrum includes case reports that are reviewed in this report. Clinical Relevance This case illustrates the successful treatment of GCT of triquetrum, which is a rare tumor. Three-corner fusion is a reliable and reproducible procedure that has been used for other arthritic conditions. The use of three corner fusion procedure can be extended to GCT of carpal bones. It has been a motion-preserving alternative to proximal row carpectomy.
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Affiliation(s)
- Mohammed T. Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay K. Digge
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Asjad Mahmood
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Schünemann HJ, Mustafa RA, Brozek J, Steingart KR, Leeflang M, Murad MH, Bossuyt P, Glasziou P, Jaeschke R, Lange S, Meerpohl J, Langendam M, Hultcrantz M, Vist GE, Akl EA, Helfand M, Santesso N, Hooft L, Scholten R, Rosen M, Rutjes A, Crowther M, Muti P, Raatz H, Ansari MT, Williams J, Kunz R, Harris J, Rodriguez IA, Kohli M, Guyatt GH. GRADE guidelines: 21 part 1. Study design, risk of bias, and indirectness in rating the certainty across a body of evidence for test accuracy. J Clin Epidemiol 2020; 122:129-141. [PMID: 32060007 DOI: 10.1016/j.jclinepi.2019.12.020] [Citation(s) in RCA: 150] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 11/28/2019] [Accepted: 12/30/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This article provides updated GRADE guidance about how authors of systematic reviews and health technology assessments and guideline developers can assess the results and the certainty of evidence (also known as quality of the evidence or confidence in the estimates) of a body of evidence addressing test accuracy (TA). STUDY DESIGN AND SETTING We present an overview of the GRADE approach and guidance for rating certainty in TA in clinical and public health and review the presentation of results of a body of evidence regarding tests. Part 1 of the two parts in this 21st guidance article about how to apply GRADE focuses on understanding study design issues in test accuracy, provide an overview of the domains, and describe risk of bias and indirectness specifically. RESULTS Supplemented by practical examples, we describe how raters of the evidence using GRADE can evaluate study designs focusing on tests and how they apply the GRADE domains risk of bias and indirectness to a body of evidence of TA studies. CONCLUSION Rating the certainty of a body of evidence using GRADE in Cochrane and other reviews and World Health Organization and other guidelines dealing with in TA studies helped refining our approach. The resulting guidance will help applying GRADE successfully for questions and recommendations focusing on tests.
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Affiliation(s)
- Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster GRADE Centre, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4K1, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4K1, Canada.
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence, and Impact, McMaster GRADE Centre, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4K1, Canada; Department of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jan Brozek
- Department of Health Research Methods, Evidence, and Impact, McMaster GRADE Centre, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4K1, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4K1, Canada
| | - Karen R Steingart
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Mariska Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, Room J1b-214, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Mohammad Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55902, USA
| | - Patrick Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, Room J1b-214, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Paul Glasziou
- CREBP, Faculty Health Science & Medicine, Bond University, Gold Coast QLD 4229, Australia
| | - Roman Jaeschke
- Department of Health Research Methods, Evidence, and Impact, McMaster GRADE Centre, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4K1, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4K1, Canada
| | - Stefan Lange
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Köln, Germany Cologne, Germany
| | - Joerg Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Miranda Langendam
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, Room J1b-214, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Monica Hultcrantz
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), S:t Eriksgatan 117, SE-102 33, Stockholm, Sweden
| | - Gunn E Vist
- Norwegian Knowledge Centre for the Health Services, PO Box 7004, St Olavs Plass, 0130 Oslo, Norway
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Riad-El-Solh Beirut, Beirut 1107 2020, Lebanon
| | - Mark Helfand
- Oregon Evidence-based Practice Center, Oregon Health & Science University, Portland VA Medical Center, Portland, OR, USA
| | - Nancy Santesso
- Department of Health Research Methods, Evidence, and Impact, McMaster GRADE Centre, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4K1, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4K1, Canada
| | - Lotty Hooft
- Cochrane Netherlands/Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Rob Scholten
- Cochrane Netherlands/Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Måns Rosen
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), S:t Eriksgatan 117, SE-102 33, Stockholm, Sweden
| | - Anne Rutjes
- Clinical Trial Unit (CTU) Bern, Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Mark Crowther
- Department of Health Research Methods, Evidence, and Impact, McMaster GRADE Centre, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4K1, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4K1, Canada
| | - Paola Muti
- Department of Oncology, McMaster University, 711 Concession Street, Hamilton, Ontario L8V1C3, Canada
| | - Heike Raatz
- University of Basel, Klingelbergstrasse 61, CH-4056 Basel, Switzerland; Kleijnen Systematic Reviews Ltd, 6 Escrick Business Park, Escrick, York YO19 6FD, UK
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, Ottawa, Canada
| | - John Williams
- Duke University Medical Center and Durham Veterans Affairs Center for Health Services Research in Primary Care Durham, NC 27705, USA
| | - Regina Kunz
- Basel Institute of Clinical Epidemiology, University Hospital Basel, Hebelstrasse 10, Basel 4031, Switzerland
| | - Jeff Harris
- Harris Associates, 386 Richardson Way, Mill Valley, CA 94941, USA
| | - Ingrid Arévalo Rodriguez
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER of Epidemiology and Public Health, Madrid, Spain; Centro de investigación en Salud Pública y Epidemiología Clínica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Mikashmi Kohli
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster GRADE Centre, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4K1, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4K1, Canada; Department of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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17
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Jeyaraman MM, Al-Yousif N, Robson RC, Copstein L, Balijepalli C, Hofer K, Fazeli MS, Ansari MT, Tricco AC, Rabbani R, Abou-Setta AM. Inter-rater reliability and validity of risk of bias instrument for non-randomized studies of exposures: a study protocol. Syst Rev 2020; 9:32. [PMID: 32051035 PMCID: PMC7017505 DOI: 10.1186/s13643-020-01291-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 01/14/2020] [Accepted: 02/05/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A new tool, "risk of bias (ROB) instrument for non-randomized studies of exposures (ROB-NRSE)," was recently developed. It is important to establish consistency in its application and interpretation across review teams. In addition, it is important to understand if specialized training and guidance will improve the reliability in the results of the assessments. Therefore, the objective of this cross-sectional study is to establish the inter-rater reliability (IRR), inter-consensus reliability (ICR), and concurrent validity of the new ROB-NRSE tool. Furthermore, as this is a relatively new tool, it is important to understand the barriers to using this tool (e.g., time to conduct assessments and reach consensus-evaluator burden). METHODS Reviewers from four participating centers will apprise the ROB of a sample of NRSE publications using ROB-NRSE tool in two stages. For IRR and ICR, two pairs of reviewers will assess the ROB for each NRSE publication. In the first stage, reviewers will assess the ROB without any formal guidance. In the second stage, reviewers will be provided customized training and guidance. At each stage, each pair of reviewers will resolve conflicts and arrive at a consensus. To calculate the IRR and ICR, we will use Gwet's AC1 statistic. For concurrent validity, reviewers will appraise a sample of NRSE publications using both the Newcastle-Ottawa Scale (NOS) and ROB-NRSE tool. We will analyze the concordance between the two tools for similar domains and for the overall judgments using Kendall's tau coefficient. To measure evaluator burden, we will assess the time taken to apply ROB-NRSE tool (without and with guidance), and the NOS. To assess the impact of customized training and guidance on the evaluator burden, we will use the generalized linear models. We will use Microsoft Excel and SAS 9.4, to manage and analyze study data, respectively. DISCUSSION The quality of evidence from systematic reviews that include NRSE depends partly on the study-level ROB assessments. The findings of this study will contribute to an improved understanding of ROB-NRSE and how best to use it.
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Affiliation(s)
- Maya M Jeyaraman
- The George & Fay Yee Center for Healthcare Innovation, University of Manitoba, 363-753 McDermot Avenue, Winnipeg, Manitoba, R3E 0 T6, Canada. .,Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Nameer Al-Yousif
- The George & Fay Yee Center for Healthcare Innovation, University of Manitoba, 363-753 McDermot Avenue, Winnipeg, Manitoba, R3E 0 T6, Canada
| | - Reid C Robson
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Leslie Copstein
- The George & Fay Yee Center for Healthcare Innovation, University of Manitoba, 363-753 McDermot Avenue, Winnipeg, Manitoba, R3E 0 T6, Canada
| | | | - Kimberly Hofer
- Evidinno Outcomes Research Inc., Vancouver, British Columbia, Canada
| | - Mir S Fazeli
- Evidinno Outcomes Research Inc., Vancouver, British Columbia, Canada
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.,Epidemiology Division, Dalla Lana School of Public Health & Institute of Health, Management, and Policy Evaluation, University of Toronto, Toronto, Canada.,Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Ontario, Canada
| | - Rasheda Rabbani
- The George & Fay Yee Center for Healthcare Innovation, University of Manitoba, 363-753 McDermot Avenue, Winnipeg, Manitoba, R3E 0 T6, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ahmed M Abou-Setta
- The George & Fay Yee Center for Healthcare Innovation, University of Manitoba, 363-753 McDermot Avenue, Winnipeg, Manitoba, R3E 0 T6, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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18
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Dey D, Jingar P, Agrawal S, Shrivastava V, Bhattacharya A, Manhas J, Garg B, Ansari MT, Mridha AR, Sreenivas V, Khurana A, Sen S. Symphytum officinale augments osteogenesis in human bone marrow-derived mesenchymal stem cells in vitro as they differentiate into osteoblasts. J Ethnopharmacol 2020; 248:112329. [PMID: 31672526 DOI: 10.1016/j.jep.2019.112329] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/05/2019] [Revised: 10/11/2019] [Accepted: 10/19/2019] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Mesenchymal stem cells (MSCs) are multipotent stem cells possessing regenerative potential. Symphytum officinale (SO) is a medicinal plant and in homoeopathic literature, believed to accelerate bone healing. AIM OF THE STUDY This study aimed to determine if homoeopathic doses of SO could augment osteogenesis in MSCs as they differentiate into osteoblasts in vitro. MATERIALS AND METHODS Bone marrow samples were obtained from patients who underwent bone grafting procedures (n = 15). MSCs were isolated, expanded and characterized by flow cytometry (CD90, CD105). Cytotoxicity of SO was evaluated by MTT assay. Osteogenic differentiation was induced in MSCs with β-glycerophosphate, ascorbic acid and dexamethasone over 2 weeks. Different homoeopathic doses of SO (MT, 3C, 6C, 12C and 30C) were added to the basic differentiation medium (BDM) and efficiency of MSCs differentiating into osteoblasts were measured by evaluating expression of Osteocalcin using flow cytometry, and alkaline phosphatase activity using ELISA. Gene expression analyses for osteoblast markers (Runx-2, Osteopontin and Osteocalcin) were evaluated in differentiated osteoblasts using qPCR. RESULTS Flow cytometry (CD90, CD105) detected MSCs isolated from bone marrow (93-98%). MTT assay showed that the selected doses of SO did not induce any cytotoxicity in MSCs (24 hours). The efficiency of osteogenic differentiation (2 weeks) for different doses of Symphytum officinale was determined by flow cytometry (n = 10) for osteoblast marker, Osteocalcin, and most doses of Symphytum officinale enhanced osteogenesis. Interestingly, gene expression analysis for Runx-2 (n = 10), Osteopontin (n = 10), Osteocalcin (n = 10) and alkaline phosphatase activity (n = 8) also showed increased osteogenesis with the addition of Symphytum officinale to BDM, specially mother tincture. CONCLUSIONS Our findings suggest that homoeopathic dose (specially mother tincture) of Symphytum officinale has the potential to enhance osteogenesis.
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Affiliation(s)
- D Dey
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - P Jingar
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - S Agrawal
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - V Shrivastava
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - A Bhattacharya
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - J Manhas
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - B Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - M T Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - A R Mridha
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - V Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - A Khurana
- Central Council for Research in Homoeopathy, New Delhi, India
| | - S Sen
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India.
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19
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Jeyaraman MM, Rabbani R, Al-Yousif N, Robson RC, Copstein L, Xia J, Pollock M, Mansour S, Ansari MT, Tricco AC, Abou-Setta AM. Inter-rater reliability and concurrent validity of ROBINS-I: protocol for a cross-sectional study. Syst Rev 2020; 9:12. [PMID: 31931871 PMCID: PMC6958722 DOI: 10.1186/s13643-020-1271-6] [Citation(s) in RCA: 12] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/06/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The Cochrane Bias Methods Group recently developed the "Risk of Bias (ROB) in Non-randomized Studies of Interventions" (ROBINS-I) tool to assess ROB for non-randomized studies of interventions (NRSI). It is important to establish consistency in its application and interpretation across review teams. In addition, it is important to understand if specialized training and guidance will improve the reliability of the results of the assessments. Therefore, the objective of this cross-sectional study is to establish the inter-rater reliability (IRR), inter-consensus reliability (ICR), and concurrent validity of ROBINS-I. Furthermore, as this is a relatively new tool, it is important to understand the barriers to using this tool (e.g., time to conduct assessments and reach consensus-evaluator burden). METHODS Reviewers from four participating centers will appraise the ROB of a sample of NRSI publications using the ROBINS-I tool in two stages. For IRR and ICR, two pairs of reviewers will assess the ROB for each NRSI publication. In the first stage, reviewers will assess the ROB without any formal guidance. In the second stage, reviewers will be provided customized training and guidance. At each stage, each pair of reviewers will resolve conflicts and arrive at a consensus. To calculate the IRR and ICR, we will use Gwet's AC1 statistic. For concurrent validity, reviewers will appraise a sample of NRSI publications using both the New-castle Ottawa Scale (NOS) and ROBINS-I. We will analyze the concordance between the two tools for similar domains and for the overall judgments using Kendall's tau coefficient. To measure the evaluator burden, we will assess the time taken to apply the ROBINS-I (without and with guidance), and the NOS. To assess the impact of customized training and guidance on the evaluator burden, we will use the generalized linear models. We will use Microsoft Excel and SAS 9.4 to manage and analyze study data, respectively. DISCUSSION The quality of evidence from systematic reviews that include NRS depends partly on the study-level ROB assessments. The findings of this study will contribute to an improved understanding of the ROBINS-I tool and how best to use it.
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Affiliation(s)
- Maya M Jeyaraman
- The George and Fay Yee Center for Healthcare Innovation, University of Manitoba, 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada. .,Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Rasheda Rabbani
- The George and Fay Yee Center for Healthcare Innovation, University of Manitoba, 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nameer Al-Yousif
- The George and Fay Yee Center for Healthcare Innovation, University of Manitoba, 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada
| | - Reid C Robson
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Leslie Copstein
- The George and Fay Yee Center for Healthcare Innovation, University of Manitoba, 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada
| | - Jun Xia
- Nottingham Ningbo GRADE Centre, The University of Nottingham Ningbo, Ningbo, China
| | | | - Samer Mansour
- Centre Hospitalier de l'Université de Montreal, Quebec, Montreal, Canada.,Faculty of Medicine, Department of Medicine, Université de Montréal, Quebec, Montreal, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Montréal, Quebec, Montreal, Canada
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.,Epidemiology Division, Dalla Lana School of Public Health and Institute of Health, Management, and Policy Evaluation, University of Toronto, Toronto, Canada.,Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Ontario, Canada
| | - Ahmed M Abou-Setta
- The George and Fay Yee Center for Healthcare Innovation, University of Manitoba, 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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20
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Krinzinger H, Hall CL, Groom MJ, Ansari MT, Banaschewski T, Buitelaar JK, Carucci S, Coghill D, Danckaerts M, Dittmann RW, Falissard B, Garas P, Inglis SK, Kovshoff H, Kochhar P, McCarthy S, Nagy P, Neubert A, Roberts S, Sayal K, Sonuga-Barke E, Wong ICK, Xia J, Zuddas A, Hollis C, Konrad K, Liddle EB. Neurological and psychiatric adverse effects of long-term methylphenidate treatment in ADHD: A map of the current evidence. Neurosci Biobehav Rev 2019; 107:945-968. [PMID: 31545988 DOI: 10.1016/j.neubiorev.2019.09.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/09/2019] [Accepted: 09/13/2019] [Indexed: 10/26/2022]
Abstract
Methylphenidate (MPH), the most common medication for children with Attention Deficit/Hyperactivity Disorder (ADHD) in many countries, is often prescribed for long periods of time. Any long-term psychotropic treatment in childhood raises concerns about possible adverse neurological and psychiatric outcomes. We aimed to map current evidence regarding neurological and psychiatric outcomes, adverse or beneficial, of long-term MPH (> 1 year) treatment in ADHD. We coded studies using a "traffic light" system: Green: safe/favours MPH; Amber: warrants caution; Red: not safe/not well-tolerated. Un-categorisable study findings were coded as "Unclear". Although some evidence suggests an elevated risk of psychosis and tics, case reports describe remission on discontinuation. Several studies suggest that long-term MPH may reduce depression and suicide in ADHD. Evidence suggests caution in specific groups including pre-school children, those with tics, and adolescents at risk for substance misuse. We identified a need for more studies that make use of large longitudinal databases, focus on specific neuropsychiatric outcomes, and compare outcomes from long-term MPH treatment with outcomes following shorter or no pharmacological intervention.
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Affiliation(s)
- Helga Krinzinger
- Section Child Neuropsychology, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen, Germany
| | - Charlotte L Hall
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Madeleine J Groom
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Canada
| | - Tobias Banaschewski
- Department of Child & Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, & Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands
| | - Sara Carucci
- Child and Adolescent Neuropsychiatry Unit, Department of Biomedical Science, University of Cagliari & "A. Cao" Pediatric Hospital, Brotzu Hospital Trust, Cagliari, Italy
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
| | - Marina Danckaerts
- Department of Child and Adolescent Psychiatry, University Psychiatric Center, Leuven, KU, Belgium; Department of Neurosciences, University Psychiatric Center, Leuven, KU, Belgium
| | - Ralf W Dittmann
- Paediatric Psychopharmacology, Department of Child & Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bruno Falissard
- University Paris-Sud, Univ. Paris-Descartes, AP-HP, INSERM U1178, Paris, France
| | - Peter Garas
- Semmelweis University, Károly Rácz School of PhD Studies, Mental Health Sciences Phd School, Budapest, Hungary
| | - Sarah K Inglis
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Hanna Kovshoff
- School of Psychology, University of Southampton, Southampton, UK
| | - Puja Kochhar
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | | | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Antje Neubert
- Department of Paediatrics and Adolescents Medicine, University Hospital Erlangen, Erlangen, Germany
| | | | - Kapil Sayal
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK; Department of Experimental Clinical & Health Psychology, Ghent University, Ghent, Belgium
| | - Ian C K Wong
- Centre for Paediatric Pharmacy Research, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Jun Xia
- The Nottingham Ningbo GRADE Center, Nottingham China Health Institute, The University of Nottingham Ningbo, China
| | - Alessandro Zuddas
- Child and Adolescent Neuropsychiatry Unit, Department of Biomedical Science, University of Cagliari & "A. Cao" Pediatric Hospital, Brotzu Hospital Trust, Cagliari, Italy
| | - Chris Hollis
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK; National Institute of Health Research (NIHR) MindTech MedTech Cooperative, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Kerstin Konrad
- Section Child Neuropsychology, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen, Germany; JARA-BRAIN Institute II, Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany
| | - Elizabeth B Liddle
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK.
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Watt CL, Momoli F, Ansari MT, Sikora L, Bush SH, Hosie A, Kabir M, Rosenberg E, Kanji S, Lawlor PG. The incidence and prevalence of delirium across palliative care settings: A systematic review. Palliat Med 2019; 33:865-877. [PMID: 31184538 PMCID: PMC6691600 DOI: 10.1177/0269216319854944] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Delirium is a common and distressing neurocognitive condition that frequently affects patients in palliative care settings and is often underdiagnosed. AIM Expanding on a 2013 review, this systematic review examines the incidence and prevalence of delirium across all palliative care settings. DESIGN This systematic review and meta-analyses were prospectively registered with PROSPERO and included a risk of bias assessment. DATA SOURCES Five electronic databases were examined for primary research studies published between 1980 and 2018. Studies on adult, non-intensive care and non-postoperative populations, either receiving or eligible to receive palliative care, underwent dual reviewer screening and data extraction. Studies using standardized delirium diagnostic criteria or valid assessment tools were included. RESULTS Following initial screening of 2596 records, and full-text screening of 153 papers, 42 studies were included. Patient populations diagnosed with predominantly cancer (n = 34) and mixed diagnoses (n = 8) were represented. Delirium point prevalence estimates were 4%-12% in the community, 9%-57% across hospital palliative care consultative services, and 6%-74% in inpatient palliative care units. The prevalence of delirium prior to death across all palliative care settings (n = 8) was 42%-88%. Pooled point prevalence on admission to inpatient palliative care units was 35% (confidence interval = 0.29-0.40, n = 14). Only one study had an overall low risk of bias. Varying delirium screening and diagnostic practices were used. CONCLUSION Delirium is prevalent across all palliative care settings, with one-third of patients delirious at the time of admission to inpatient palliative care. Study heterogeneity limits meta-analyses and highlights the future need for rigorous studies.
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Affiliation(s)
- Christine L Watt
- 1 Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,2 Division of Palliative Care, Bruyère Continuing Care, Élisabeth Bruyère Hospital, Ottawa, ON, Canada
| | - Franco Momoli
- 3 Ottawa Hospital Research Institute, Ottawa, ON, Canada.,4 Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,5 School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mohammed T Ansari
- 5 School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lindsey Sikora
- 6 Health Sciences Library, University of Ottawa, Ottawa, ON, Canada
| | - Shirley H Bush
- 1 Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,2 Division of Palliative Care, Bruyère Continuing Care, Élisabeth Bruyère Hospital, Ottawa, ON, Canada.,3 Ottawa Hospital Research Institute, Ottawa, ON, Canada.,7 Bruyère Research Institute, Ottawa, ON, Canada
| | - Annmarie Hosie
- 8 IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
| | | | - Erin Rosenberg
- 9 Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,10 Department of Critical Care, The Ottawa Hospital, Ottawa, ON, Canada
| | - Salmaan Kanji
- 3 Ottawa Hospital Research Institute, Ottawa, ON, Canada.,11 Department of Pharmacy, The Ottawa Hospital, Ottawa, ON, Canada.,12 Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Peter G Lawlor
- 1 Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,2 Division of Palliative Care, Bruyère Continuing Care, Élisabeth Bruyère Hospital, Ottawa, ON, Canada.,3 Ottawa Hospital Research Institute, Ottawa, ON, Canada.,7 Bruyère Research Institute, Ottawa, ON, Canada
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Walls GM, Hanna GG, Qi F, Zhao S, Xia J, Ansari MT, Landau D. Corrigendum: Predicting Outcomes From Radical Radiotherapy for Non-small Cell Lung Cancer: A Systematic Review of the Existing Literature. Front Oncol 2019; 9:112. [PMID: 30881918 PMCID: PMC6405640 DOI: 10.3389/fonc.2019.00112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 12/03/2022] Open
Affiliation(s)
- Gerard M Walls
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, United Kingdom.,Cancer Centre Belfast City Hospital, Belfast, United Kingdom
| | - Gerard G Hanna
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, United Kingdom.,Cancer Centre Belfast City Hospital, Belfast, United Kingdom
| | - Fang Qi
- Systematic Review Solutions Ltd, The Ingenuity Centre, Nottingham, United Kingdom
| | - Sai Zhao
- Systematic Review Solutions Ltd, The Ingenuity Centre, Nottingham, United Kingdom
| | - Jun Xia
- Department of Global Health & Social Medicine, Faculty of Social Science & Public Policy, King's College London, London, United Kingdom
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - David Landau
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,King's College London, Strand, London, United Kingdom
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Lawlor PG, Rutkowski NA, MacDonald AR, Ansari MT, Sikora L, Momoli F, Kanji S, Wright DK, Rosenberg E, Hosie A, Pereira JL, Meagher D, Rice J, Scott J, Bush SH. A Scoping Review to Map Empirical Evidence Regarding Key Domains and Questions in the Clinical Pathway of Delirium in Palliative Care. J Pain Symptom Manage 2019; 57:661-681.e12. [PMID: 30550832 DOI: 10.1016/j.jpainsymman.2018.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 08/17/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 02/03/2023]
Abstract
CONTEXT Based on the clinical care pathway of delirium in palliative care (PC), a published analytic framework (AF) formulated research questions in key domains and recommended a scoping review to identify evidence gaps. OBJECTIVES To produce a literature map for key domains of the published AF: screening, prognosis and diagnosis, management, and the health-related outcomes. METHODS A standard scoping review framework was used by an interdisciplinary study team of nurse- and physician-delirium researchers, an information specialist, and review methodologists to conduct the review. Knowledge user engagement provided context in refining 19 AF questions. A peer-reviewed search strategy identified citations in Medline, PsycINFO, Embase, and CINAHL databases between 1980 and 2018. Two reviewers independently screened records for inclusion using explicit study eligibility criteria for the population, design, delirium diagnosis, and investigational intent. RESULTS Of 104 studies reporting empirical data and meeting eligibility criteria, most were conducted in patients with cancer (73.1%) and in inpatient PC units (52%). The most frequent study design was a one or more group, nonrandomized trial or cohort (67.3%). Evidence gaps were identified: delirium risk prediction; comparative effectiveness and harms of prevention, variability in delirium management across PC settings, advanced directive and substitute decision-maker input, and transition of care location; and estimating delirium reversibility. Future rigorous primary studies are required to address these gaps and preliminary concerns regarding the quality of extant literature. CONCLUSION Substantial evidence gaps exist, providing opportunities for future research regarding the assessment, prognosis, and management of delirium in PC settings.
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Affiliation(s)
- Peter G Lawlor
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Continuing Care, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | | | | | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Franco Momoli
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Salmaan Kanji
- Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David K Wright
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin Rosenberg
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Department of Critical Care, Ottawa, Ontario, Canada
| | - Annmarie Hosie
- University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Jose L Pereira
- Department of Family Medicine, University of Ottawa, Ontario, Canada; Division of Palliative Medicine, McMaster University, Ontario, Canada
| | - David Meagher
- University of Limerick School of Medicine, Limerick, Ireland
| | - Jill Rice
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Continuing Care, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - John Scott
- The Ottawa Hospital, Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Shirley H Bush
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Continuing Care, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Walls GM, Hanna GG, Qi F, Zhao S, Xia J, Ansari MT, Landau D. Predicting Outcomes From Radical Radiotherapy for Non-small Cell Lung Cancer: A Systematic Review of the Existing Literature. Front Oncol 2018; 8:433. [PMID: 30364202 PMCID: PMC6191477 DOI: 10.3389/fonc.2018.00433] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/17/2018] [Indexed: 12/23/2022] Open
Abstract
Radical radiotherapy (RT) is a potentially curative treatment in non-small cell lung cancer (NSCLC) and is delivered in conventional 2-Gy fractions, hypofractionated and ablative stereotactic courses. No reliable, predictive biomarkers for the clinical events of local control, appearance of distant metastases and development of toxicity have been introduced in routine clinical practice. Such a test would enable the Radiotherapist to tailor the clinical management of individual patients, considering their pre-treatment characteristics, in order reduce the risk of recurrence or toxicity e.g., dose modification, accelerated fractionation, hypofractionation, or concurrent systemic therapy. The aim of this review was to map the published literature relating to investigations of the potential predictive value of patient or treatment characteristics in radical RT for NSCLC. These investigations should remain a research focus for disease control given the upward trends in lung cancer incidence, and for the avoidance of toxicity, given the survivorship afforded to the cohort of patients that do well with radical RT, or with the increasing range of systemic agents following metastatic relapse. The conclusion of the presented analysis is that there are no published, effective and validated predictive tools for estimation of risk of local/distant recurrence or toxicity after radical RT for NSCLC. The authors have identified an important space for future research in the field of lung cancer radiotherapy.
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Affiliation(s)
- Gerard M Walls
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, United Kingdom.,Cancer Centre Belfast City Hospital, Belfast, United Kingdom
| | - Gerard G Hanna
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, United Kingdom.,Cancer Centre Belfast City Hospital, Belfast, United Kingdom
| | - Fang Qi
- Systematic Review Solutions Ltd, The Ingenuity Centre, Nottingham, United Kingdom
| | - Sai Zhao
- Systematic Review Solutions Ltd, The Ingenuity Centre, Nottingham, United Kingdom
| | - Jun Xia
- Department of Global Health & Social Medicine, Faculty of Social Science & Public Policy, King's College London, London, United Kingdom
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - David Landau
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,King's College London, Strand, London, United Kingdom
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Ansari MT, Kotwal PP, Majeed A. Intraosseous myoepithelioma: a rare tumour in the hand. J Hand Surg Eur Vol 2017; 42:530-531. [PMID: 27807178 DOI: 10.1177/1753193416676229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M T Ansari
- 1 Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - P P Kotwal
- 2 Orthopaedic Division, Pushpawati Singhania Research Institute, New Delhi, India
| | - A Majeed
- 1 Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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26
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Welch VA, Akl EA, Pottie K, Ansari MT, Briel M, Christensen R, Dans A, Dans L, Eslava-Schmalbach J, Guyatt G, Hultcrantz M, Jull J, Katikireddi SV, Lang E, Matovinovic E, Meerpohl JJ, Morton RL, Mosdol A, Murad MH, Petkovic J, Schünemann H, Sharaf R, Shea B, Singh JA, Solà I, Stanev R, Stein A, Thabaneii L, Tonia T, Tristan M, Vitols S, Watine J, Tugwell P. GRADE equity guidelines 3: considering health equity in GRADE guideline development: rating the certainty of synthesized evidence. J Clin Epidemiol 2017; 90:76-83. [PMID: 28389397 PMCID: PMC5680526 DOI: 10.1016/j.jclinepi.2017.01.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 01/11/2017] [Accepted: 01/26/2017] [Indexed: 01/13/2023]
Abstract
Objectives The aim of this paper is to describe a conceptual framework for how to consider health equity in the Grading Recommendations Assessment and Development Evidence (GRADE) guideline development process. Study Design and Setting Consensus-based guidance developed by the GRADE working group members and other methodologists. Results We developed consensus-based guidance to help address health equity when rating the certainty of synthesized evidence (i.e., quality of evidence). When health inequity is determined to be a concern by stakeholders, we propose five methods for explicitly assessing health equity: (1) include health equity as an outcome; (2) consider patient-important outcomes relevant to health equity; (3) assess differences in the relative effect size of the treatment; (4) assess differences in baseline risk and the differing impacts on absolute effects; and (5) assess indirectness of evidence to disadvantaged populations and/or settings. Conclusion The most important priority for research on health inequity and guidelines is to identify and document examples where health equity has been considered explicitly in guidelines. Although there is a weak scientific evidence base for assessing health equity, this should not discourage the explicit consideration of how guidelines and recommendations affect the most vulnerable members of society.
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Affiliation(s)
- Vivian A Welch
- Bruyère Research Institute, University of Ottawa and Bruyère Continuing Care, 85 Primrose Ave, Ottawa K1R 7G5, Canada.
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, P.O. Box: 11-0236, Riad-El-Solh Beirut, 1107 2020 Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Kevin Pottie
- Bruyère Research Institute, University of Ottawa and Bruyère Continuing Care, 85 Primrose Ave, Ottawa K1R 7G5, Canada; Departments of Family Medicine and Epidemiology and Community Medicine, Bruyère Research Institute, University of Ottawa, WHO and EU ECDC Consultant
| | - Mohammed T Ansari
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Room 101, 600 Peter Morand Crescent, Ottawa ON K1G 5Z3 Canada
| | - Matthias Briel
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel, Spitalstrasse 12, Basel 4031, Switzerland; Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Antonio Dans
- Department of Medicine, University of the Philippines-Manila, Manila 1000, Philippines
| | - Leonila Dans
- Department of Pediatrics, University of the Philippines-Manila, Taft Ave, Manila 1000, Philippines
| | - Javier Eslava-Schmalbach
- Group of Equity in Health, Hospital Universitario Nacional de Colombia, Faculty of Medicine, Universidad Nacional de Colombia; Technology Development Center, Sociedad Colombiana de Anestesiologia y Reanimacion -S.C.A.R.E. Cra 30 45-03, Bogota 111321, Colombia
| | - Gordon Guyatt
- Department of Clinical Epidemiology & Biostatistics and Department of Medicine, McMaster University Health Sciences Centre, McMaster University, 1280 Main Street West, Room HSC-2C12, Hamilton, Ontario L8S 4K1, Canada
| | - Monica Hultcrantz
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), S:t Eriksgatan 117, Stockholm SE-102 33, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, Stockholm SE-171 77, Sweden
| | - Janet Jull
- Bruyère Research Institute, University of Ottawa, 85 Primrose Avenue, Room 312, Ottawa, Ontario K1R 7G5
| | | | - Eddy Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | | | - Joerg J Meerpohl
- Cochrane Germany, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Strasse 153, Freiburg 79110, Germany; Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité - U1153, Inserm / Université Paris Descartes, Cochrane France, Hôpital Hôtel-Dieu, 1, place du Parvis Notre-Dame, Paris 75004, France
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Medical Foundation Building Level 6, 92-94 Parramatta Road, Camperdown, NSW 2050, Australia
| | - Annhild Mosdol
- Knowledge Centre for the Health Services, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway
| | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Jennifer Petkovic
- Bruyère Research Institute & University of Ottawa, 85 Primrose Avenue, Ottawa, Ontario K1R 7G5
| | - Holger Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ravi Sharaf
- Division of Gastroenterology, Northwell Health/Hofstra University School of Medicine, Long Island Jewish Medical Center, Research Building B202, 270-05 76th Avenue, New Hyde Park, NY 11040, USA
| | - Bev Shea
- Bruyère Research Institute and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Jasvinder A Singh
- Medicine Service, Birmingham Veterans Affairs Medical Center, 700, 19th Street South, Birmingham, AL 35233, USA; Department of Medicine at School of Medicine and the Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL 35294-0022, USA; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau, CIBER of Epidemiology and Public Health (CIBERESP-IIB Sant Pau), Barcelona, Spain
| | - Roger Stanev
- Institute of Technology, University of Washington, 1900 Commerce St., Tacoma, WA 98402, USA
| | - Airton Stein
- Public Health Department - Universidade Federal de Ciencias da Saude de Porto Alegre (Ufcspa), Rua Sarmento Leite, 245, CEP - CEP 90050-170 and HTA of Conceicao Hospital, Porto Alegre, Brazil
| | - Lehana Thabaneii
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Niesenweg 6, Bern 3012, Switzerland
| | - Mario Tristan
- IHCAI Foundation & Cochrane Central America & Spanish speaking Caribbean, Av 7. calles 35 y 37, No 35 30, Codigo Postal 10106, San Jose, Costa Rica
| | - Sigurd Vitols
- Clinical Pharmacology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Joseph Watine
- Laboratory Medicine, Hôpital La Chartreuse, avenue Caylet, F-12200, Villefranche-de-Rouergue, France
| | - Peter Tugwell
- Department of Medicine, Faculty of Medicine, University of Ottawa, K1H 8M5, Ottawa, Canada
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Abou-Setta AM, Jeyaraman MM, Attia A, Al-Inany HG, Ferri M, Ansari MT, Garritty CM, Bond K, Norris SL. Correction: Methods for Developing Evidence Reviews in Short Periods of Time: A Scoping Review. PLoS One 2017; 12:e0172372. [PMID: 28192493 PMCID: PMC5305189 DOI: 10.1371/journal.pone.0172372] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abou-Setta AM, Jeyaraman M, Attia A, Al-Inany HG, Ferri M, Ansari MT, Garritty CM, Bond K, Norris SL. Methods for Developing Evidence Reviews in Short Periods of Time: A Scoping Review. PLoS One 2016; 11:e0165903. [PMID: 27930662 PMCID: PMC5145149 DOI: 10.1371/journal.pone.0165903] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [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: 03/03/2016] [Accepted: 10/19/2016] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Rapid reviews (RR), using abbreviated systematic review (SR) methods, are becoming more popular among decision-makers. This World Health Organization commissioned study sought to summarize RR methods, identify differences, and highlight potential biases between RR and SR. METHODS Review of RR methods (Key Question 1 [KQ1]), meta-epidemiologic studies comparing reliability/ validity of RR and SR methods (KQ2), and their potential associated biases (KQ3). We searched Medline, EMBASE, Cochrane Library, grey literature, and checked reference lists, used personal contacts, and crowdsourcing (e.g. email listservs). Selection and data extraction was conducted by one reviewer (KQ1) or two reviewers independently (KQ2-3). RESULTS Across all KQs, we identified 42,743 citations through the literature searches. KQ1: RR methods from 29 organizations were reviewed. There was no consensus on which aspects of the SR process to abbreviate. KQ2: Studies comparing the conclusions of RR and SR (n = 9) found them to be generally similar. Where major differences were identified, it was attributed to the inclusion of evidence from different sources (e.g. searching different databases or including different study designs). KQ3: Potential biases introduced into the review process were well-identified although not necessarily supported by empirical evidence, and focused mainly on selective outcome reporting and publication biases. CONCLUSION RR approaches are context and organization specific. Existing comparative evidence has found similar conclusions derived from RR and SR, but there is a lack of evidence comparing the potential of bias in both evidence synthesis approaches. Further research and decision aids are needed to help decision makers and reviewers balance the benefits of providing timely evidence with the potential for biased findings.
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Affiliation(s)
- Ahmed M. Abou-Setta
- Knowledge Synthesis Platform, George & Fay Yee Center for Healthcare Innovation, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maya Jeyaraman
- Knowledge Synthesis Platform, George & Fay Yee Center for Healthcare Innovation, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Abdelhamid Attia
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, El-Manial, Cairo, Egypt
| | - Hesham G. Al-Inany
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, El-Manial, Cairo, Egypt
| | - Mauricio Ferri
- World Health Organization, Geneva, Republic and Canton of Geneva, Switzerland
| | - Mohammed T. Ansari
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Chantelle M. Garritty
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kenneth Bond
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada
| | - Susan L. Norris
- World Health Organization, Geneva, Republic and Canton of Geneva, Switzerland
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Sterne JAC, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hróbjartsson A, Kirkham J, Jüni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schünemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JPT. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016. [DOI: 78495111110.1136/bmj.i4919' target='_blank'>'"<>78495111110.1136/bmj.i4919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [78495111110.1136/bmj.i4919','', 'Mohammed T. Ansari')">Reference Citation Analysis] [78495111110.1136/bmj.i4919', 29)">What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
78495111110.1136/bmj.i4919" />
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Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hróbjartsson A, Kirkham J, Jüni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schünemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; 355:i4919. [PMID: 27733354 PMCID: PMC5062054 DOI: 10.1136/bmj.i4919] [Citation(s) in RCA: 7782] [Impact Index Per Article: 972.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Jonathan Ac Sterne
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Miguel A Hernán
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; and Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Boston, Massachusetts, USA
| | - Barnaby C Reeves
- School of Clinical Sciences, University of Bristol, Bristol, BS2 8HW, UK
| | - Jelena Savović
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol BS1 2NT, UK
| | - Nancy D Berkman
- Program on Health Care Quality and Outcomes, Division of Health Services and Social Policy Research, RTI International, Research Triangle Park, NC 27709, USA
| | - Meera Viswanathan
- RTI-UNC Evidence-based Practice Center, RTI International, Research Triangle Park, NC 27709, USA
| | - David Henry
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Douglas G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
| | - Mohammed T Ansari
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5, Canada
| | - Isabelle Boutron
- METHODS Team, Centre of Epidemiology and Statistics Sorbonne Paris Cité Research, INSERM UMR 1153, University Paris Descartes, Paris, France
| | - James R Carpenter
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine and MRC Clinical Trials Unit at UCL, London, UK
| | - An-Wen Chan
- Women's College Research Institute, Department of Medicine, University of Toronto, Canada
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Asbjørn Hróbjartsson
- Center for Evidence-Based Medicine, University of Southern Denmark & Odense University Hospital, 5000 Odense C, Denmark
| | - Jamie Kirkham
- Department of Biostatistics, University of Liverpool, Liverpool, L69 3GL, UK
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St Michael's Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Theresa D Pigott
- School of Education, Loyola University Chicago, Chicago, IL 60611, USA
| | - Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Deborah Regidor
- Evidence Services, Kaiser Permanente, Care Management Institute, Oakland, CA 94612, USA
| | - Hannah R Rothstein
- Department of Management, Zicklin School of Business, Baruch College-CUNY, New York, NY 10010, USA
| | - Lakhbir Sandhu
- Division of General Surgery, University of Toronto, Toronto, Canada
| | - Pasqualina L Santaguida
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, L8S 4K1, Canada
| | - Holger J Schünemann
- Departments of Clinical Epidemiology and Biostatistics and of Medicine, Cochrane Applicability and Recommendations Methods (GRADEing) Group, MacGRADE center, Ontario, L8N 4K1, Canada
| | - Beverly Shea
- Ottawa Hospital Research Institute, Center for Practice Changing Research and School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5, Canada
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Peter Tugwell
- Department of Medicine and School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lucy Turner
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Hugh Waddington
- International Initiative for Impact Evaluation, London School of Hygiene and Tropical Medicine, and London International Development Centre, London, UK
| | - Elizabeth Waters
- Jack Brockhoff Child Health & Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - George A Wells
- School of Epidemiology, Public Health and Preventive Medicine and Director, Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, K1Y 4W7, Canada
| | - Penny F Whiting
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK; and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol BS1 2NT, UK
| | - Julian Pt Higgins
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
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Singh K, Ansari MT, Patel RV, Bedard M, Keely E, Tierney M, Moher D. Comparative efficacy and safety of insulin analogs in hospitalized adults. Am J Health Syst Pharm 2015; 72:525-35. [PMID: 25788506 DOI: 10.2146/ajhp140161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The comparative efficacy, safety, and cost-effectiveness of rapid and long-acting insulin analogs compared with regular or neutral protamine Hagedorn nonanalog insulins or with oral antidiabetic agents in hospitalized adults were evaluated. METHODS A literature search was conducted to identify studies that compared the effects of rapid-acting, long-acting, or mixed insulin analogs with short- or intermediate-acting insulin or any other oral antidiabetic medication. RESULTS Twenty-three primary studies were included in the review. Rapid-acting analogs and basal-bolus analog regimens were found to reduce the duration of hospital stay by approximately one day compared with regular insulin and basal-bolus nonanalog regimens. One large cohort study found an adjusted 48% relative risk reduction in mortality with rapid-acting analogs versus regular insulin in a heterogeneous hospitalized hyperglycemic population. A randomized controlled trial found a significant reduction in postoperative complications with basal-bolus analogs compared with basal-bolus nonanalog insulin. When compared with regular sliding-scale insulin (SSI), fixed-dose insulin glargine with or without insulin glulisine was found to reduce the blood glucose concentration in patients with type 2 diabetes and reduce postoperative complications in surgical patients with diabetes. The quality of evidence was primarily very low or low for most outcomes. CONCLUSION A systematic literature review revealed a very low or low quality of evidence, suggesting that, compared with nonanalog regimens, rapid-acting insulin analogs reduce the duration of hospital stay and mortality rates and that basal- bolus analog regimens may reduce the duration of hospital stay and postoperative complications. There is also a low quality of evidence to suggest that a fixed-dose analog regimen of insulin glargine with or without insulin glulisine is more effective than regular SSI for reducing blood glucose concentrations and postoperative complications.
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Affiliation(s)
- Kavita Singh
- Kavita Singh, B.Sc.Phm., M.P.H., is Ph.D. Student, University of Ottawa, Ontario, Canada. Mohammed T. Ansari, M.B.B.S., M.Med. Sc., M.Phil., is Associate Investigator, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, and Adjunct Professor, Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa. Rakesh V. Patel, M.D. Pharm.D., is Director, Adult Critical Care Medicine Training Program, University of Ottawa, and Staff Intensivist, The Ottawa Hospital. Mario Bedard, B.Pharm., Pharm.D., is Director of Pharmacy, The Ottawa Hospital, Ottawa. Erin Keely, M.D., FRCPC, is Chief, Division of Endocrinology and Metabolism, The Ottawa Hospital, and Professor, Departments of Medicine and Obstetrics/Gynecology, University of Ottawa. Mike Tierney, B.Sc.Phm., M.Sc., is Vice President, Clinical Programs, The Ottawa Hospital. David Moher, Ph.D., is Senior Scientist, Ottawa Hospital Research Institute.
| | - Mohammed T Ansari
- Kavita Singh, B.Sc.Phm., M.P.H., is Ph.D. Student, University of Ottawa, Ontario, Canada. Mohammed T. Ansari, M.B.B.S., M.Med. Sc., M.Phil., is Associate Investigator, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, and Adjunct Professor, Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa. Rakesh V. Patel, M.D. Pharm.D., is Director, Adult Critical Care Medicine Training Program, University of Ottawa, and Staff Intensivist, The Ottawa Hospital. Mario Bedard, B.Pharm., Pharm.D., is Director of Pharmacy, The Ottawa Hospital, Ottawa. Erin Keely, M.D., FRCPC, is Chief, Division of Endocrinology and Metabolism, The Ottawa Hospital, and Professor, Departments of Medicine and Obstetrics/Gynecology, University of Ottawa. Mike Tierney, B.Sc.Phm., M.Sc., is Vice President, Clinical Programs, The Ottawa Hospital. David Moher, Ph.D., is Senior Scientist, Ottawa Hospital Research Institute
| | - Rakesh V Patel
- Kavita Singh, B.Sc.Phm., M.P.H., is Ph.D. Student, University of Ottawa, Ontario, Canada. Mohammed T. Ansari, M.B.B.S., M.Med. Sc., M.Phil., is Associate Investigator, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, and Adjunct Professor, Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa. Rakesh V. Patel, M.D. Pharm.D., is Director, Adult Critical Care Medicine Training Program, University of Ottawa, and Staff Intensivist, The Ottawa Hospital. Mario Bedard, B.Pharm., Pharm.D., is Director of Pharmacy, The Ottawa Hospital, Ottawa. Erin Keely, M.D., FRCPC, is Chief, Division of Endocrinology and Metabolism, The Ottawa Hospital, and Professor, Departments of Medicine and Obstetrics/Gynecology, University of Ottawa. Mike Tierney, B.Sc.Phm., M.Sc., is Vice President, Clinical Programs, The Ottawa Hospital. David Moher, Ph.D., is Senior Scientist, Ottawa Hospital Research Institute
| | - Mario Bedard
- Kavita Singh, B.Sc.Phm., M.P.H., is Ph.D. Student, University of Ottawa, Ontario, Canada. Mohammed T. Ansari, M.B.B.S., M.Med. Sc., M.Phil., is Associate Investigator, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, and Adjunct Professor, Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa. Rakesh V. Patel, M.D. Pharm.D., is Director, Adult Critical Care Medicine Training Program, University of Ottawa, and Staff Intensivist, The Ottawa Hospital. Mario Bedard, B.Pharm., Pharm.D., is Director of Pharmacy, The Ottawa Hospital, Ottawa. Erin Keely, M.D., FRCPC, is Chief, Division of Endocrinology and Metabolism, The Ottawa Hospital, and Professor, Departments of Medicine and Obstetrics/Gynecology, University of Ottawa. Mike Tierney, B.Sc.Phm., M.Sc., is Vice President, Clinical Programs, The Ottawa Hospital. David Moher, Ph.D., is Senior Scientist, Ottawa Hospital Research Institute
| | - Erin Keely
- Kavita Singh, B.Sc.Phm., M.P.H., is Ph.D. Student, University of Ottawa, Ontario, Canada. Mohammed T. Ansari, M.B.B.S., M.Med. Sc., M.Phil., is Associate Investigator, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, and Adjunct Professor, Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa. Rakesh V. Patel, M.D. Pharm.D., is Director, Adult Critical Care Medicine Training Program, University of Ottawa, and Staff Intensivist, The Ottawa Hospital. Mario Bedard, B.Pharm., Pharm.D., is Director of Pharmacy, The Ottawa Hospital, Ottawa. Erin Keely, M.D., FRCPC, is Chief, Division of Endocrinology and Metabolism, The Ottawa Hospital, and Professor, Departments of Medicine and Obstetrics/Gynecology, University of Ottawa. Mike Tierney, B.Sc.Phm., M.Sc., is Vice President, Clinical Programs, The Ottawa Hospital. David Moher, Ph.D., is Senior Scientist, Ottawa Hospital Research Institute
| | - Mike Tierney
- Kavita Singh, B.Sc.Phm., M.P.H., is Ph.D. Student, University of Ottawa, Ontario, Canada. Mohammed T. Ansari, M.B.B.S., M.Med. Sc., M.Phil., is Associate Investigator, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, and Adjunct Professor, Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa. Rakesh V. Patel, M.D. Pharm.D., is Director, Adult Critical Care Medicine Training Program, University of Ottawa, and Staff Intensivist, The Ottawa Hospital. Mario Bedard, B.Pharm., Pharm.D., is Director of Pharmacy, The Ottawa Hospital, Ottawa. Erin Keely, M.D., FRCPC, is Chief, Division of Endocrinology and Metabolism, The Ottawa Hospital, and Professor, Departments of Medicine and Obstetrics/Gynecology, University of Ottawa. Mike Tierney, B.Sc.Phm., M.Sc., is Vice President, Clinical Programs, The Ottawa Hospital. David Moher, Ph.D., is Senior Scientist, Ottawa Hospital Research Institute
| | - David Moher
- Kavita Singh, B.Sc.Phm., M.P.H., is Ph.D. Student, University of Ottawa, Ontario, Canada. Mohammed T. Ansari, M.B.B.S., M.Med. Sc., M.Phil., is Associate Investigator, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, and Adjunct Professor, Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa. Rakesh V. Patel, M.D. Pharm.D., is Director, Adult Critical Care Medicine Training Program, University of Ottawa, and Staff Intensivist, The Ottawa Hospital. Mario Bedard, B.Pharm., Pharm.D., is Director of Pharmacy, The Ottawa Hospital, Ottawa. Erin Keely, M.D., FRCPC, is Chief, Division of Endocrinology and Metabolism, The Ottawa Hospital, and Professor, Departments of Medicine and Obstetrics/Gynecology, University of Ottawa. Mike Tierney, B.Sc.Phm., M.Sc., is Vice President, Clinical Programs, The Ottawa Hospital. David Moher, Ph.D., is Senior Scientist, Ottawa Hospital Research Institute
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Abstract
Authors of Cochrane reviews are expected to update their reviews every 2 years. The updating process helps to ensure that reviews are current and include recent evidence. However, the updating process is time-consuming for authors, particularly when Cochrane methods evolve and authors are required to revisit some of the originally included studies.The Cochrane Collaboration's 'Risk of bias' tool is a mandatory component of Cochrane reviews, providing an assessment of the potential biases of included studies. The tool has been modified most recently in 2011, and the expectation is that new versions will continue to be produced and utilised in all Cochrane reviews. In this commentary we discuss, in the context of updating scenarios that are likely to be encountered, the potential options systematic review authors may have recourse to when the Cochrane Collaboration's 'Risk of bias' tool has been modified between the original review and its update. We recommend that authors who are updating reviews should revise their original assessments of included studies using the most recent version of the risk of bias tool. Despite the increased workload, use of the most recent version of the tool facilitates consistency of methods and reporting both across and within reviews, and ensures currency to the methodological rigour.
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Affiliation(s)
- Alain D Mayhew
- Knowledge Synthesis Group, Clinical Epidemiology Program, Centre for Practice-Changing Research (CPCR), Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Monisha Kabir
- Biology Programme, University of Ottawa, Ottawa, Canada.
| | - Mohammed T Ansari
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
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Ansari MT, Ahmadzai N, Coyle K, Coyle D, Moher D. Mitral Valve Clip for Treatment of Mitral Regurgitation: An Evidence-Based Analysis. Ont Health Technol Assess Ser 2015; 15:1-104. [PMID: 26379810 PMCID: PMC4561766] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Many of the 500,000 North American patients with chronic mitral regurgitation may be poor candidates for mitral valve surgery. OBJECTIVE The objective of this study was to investigate the comparative effectiveness, harms, and cost-effectiveness of percutaneous mitral valve repair using mitral valve clips in candidates at prohibitive risk for surgery. DATA SOURCES We searched articles in MEDLINE, Embase, and the Cochrane Library published from 1994 to February 2014 for evidence of effectiveness and harms; for economic literature we also searched NHS EED and Tufts CEA registry. Grey literature was also searched. REVIEW METHODS Primary studies were sought from existing systematic reviews that had employed reliable search and screening methods. Newer studies were sought by searching the period subsequent to the last search date of the review. Two reviewers screened records and assessed study validity. We used the Cochrane risk of bias tool for randomized, generic assessment for non-randomized studies, and the Phillips checklist for economic studies. RESULTS Ten studies including 1 randomized trial were included. The majority of the direct comparative evidence compared the mitral valve clip repair with surgery in patients not particularly at prohibitive surgical risk. Irrespective of degenerative or functional chronic mitral regurgitation etiology, evidence of effectiveness and harms is inconclusive and of very low quality. Very-low-quality evidence indicates that percutaneous mitral valve clip repair may provide a survival advantage, at least during the first 1 to 2 years, particularly in medically managed chronic functional mitral regurgitation. Because of limitations in the design of studies, the cost-effectiveness of mitral valve clips in patients at prohibitive risk for surgery also could not be established. LIMITATIONS Because of serious concerns of risk of bias, indirectness, and imprecision, evidence is of very low quality. CONCLUSIONS No meaningful conclusions can be drawn about the comparative effectiveness, harms, and cost-effectiveness of mitral valve clips in the population with chronic mitral regurgitation who are at prohibitive risk for surgery.
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Affiliation(s)
| | | | - Kathryn Coyle
- Brunel University London, Uxbridge, Middlesex, England, United Kingdom
| | - Doug Coyle
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario MAY 2015
| | - David Moher
- Ottawa Hospital Research Institute, Ottawa, Ontario
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Berkman ND, Lohr KN, Ansari MT, Balk EM, Kane R, McDonagh M, Morton SC, Viswanathan M, Bass EB, Butler M, Gartlehner G, Hartling L, McPheeters M, Morgan LC, Reston J, Sista P, Whitlock E, Chang S. Grading the strength of a body of evidence when assessing health care interventions: an EPC update. J Clin Epidemiol 2014; 68:1312-24. [PMID: 25721570 DOI: 10.1016/j.jclinepi.2014.11.023] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 11/12/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To revise 2010 guidance on grading the strength of evidence (SOE) of the effectiveness of drugs, devices, and other preventive and therapeutic interventions in systematic reviews produced by the Evidence-based Practice Center (EPC) program, established by the US Agency for Healthcare Research and Quality (AHRQ). STUDY DESIGN AND SETTING A cross-EPC working group reviewed authoritative systems for grading SOE [primarily the approach from the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group] and conducted extensive discussions with GRADE and other experts. RESULTS Updated guidance continues to be conceptually similar to GRADE. Reviewers are to evaluate SOE separately for each major treatment comparison for each major outcome. We added reporting bias as a required domain and retained study limitations (risk of bias), consistency, directness, and precision (and three optional domains). Additional guidance covers scoring consistency, precision, and reporting bias, grading bodies of evidence with randomized controlled trials and observational studies, evaluating single study bodies of evidence, using studies with high risk of bias, and presenting findings with greater clarity and transparency. SOE is graded high, moderate, low, or insufficient, reflecting reviewers' confidence in the findings for a specific treatment comparison and outcome. CONCLUSION No single approach for grading SOE suits all reviews, but a more consistent and transparent approach to reporting summary information will make reviews more useful to the broad range of audiences that AHRQ's work aims to reach. EPC working groups will consider ongoing challenges and modify guidance as needed, on issues such as combining trials and observational studies in bodies of evidence, weighting domains, and combining qualitative and quantitative syntheses.
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Affiliation(s)
- Nancy D Berkman
- Division of Social Policy, Health & Economics Research, RTI International (Research Triangle Institute), PO Box 12194, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA.
| | - Kathleen N Lohr
- Division of Social Policy, Health & Economics Research, RTI International (Research Triangle Institute), PO Box 12194, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Mohammed T Ansari
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Box 201B, Ottawa Hospital - General campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Ethan M Balk
- Center for Evidence-Based Medicine, Brown University, School of Public Health, Box G-S121-8, Providence, RI 02912, USA
| | - Robert Kane
- University of Minnesota, School of Public Health, 420 Delaware St SE, MMC 197, Minneapolis, MN 55455, USA
| | - Marian McDonagh
- Pacific Northwest Evidence-based Practice Center, Oregon Health Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Sally C Morton
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburg, PA 15261, USA
| | - Meera Viswanathan
- Division of Social Policy, Health & Economics Research, RTI International (Research Triangle Institute), PO Box 12194, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Eric B Bass
- Department of Medicine, and Department of Health Policy and Management, Johns Hopkins University, 624 North Broadway, Room 680A, Baltimore, MD, 21205, USA
| | - Mary Butler
- University of Minnesota, School of Public Health, 420 Delaware St SE, MMC 197, Minneapolis, MN 55455, USA
| | - Gerald Gartlehner
- Division of Social Policy, Health & Economics Research, RTI International (Research Triangle Institute), PO Box 12194, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA; Department for Clinical Epidemiology and Evidence-based Medicine, Danube University, Dr. Karl Dorrek Strasse 30, 3500 Krems, Austria
| | - Lisa Hartling
- Department of Pediatrics, University of Alberta, ECHA 4-472, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Melissa McPheeters
- Department of Health Policy, Vanderbilt University, Medical Center, 6th Floor, 2525 West End Avenue, Nashville, TN 37203, USA
| | - Laura C Morgan
- Division of Social Policy, Health & Economics Research, RTI International (Research Triangle Institute), PO Box 12194, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - James Reston
- Evidence-Based Practice Center and Health Technology Assessment Group, ECRI Institute Headquarters, 5200 Butler Pike, Plymouth Meeting, PA 19462, USA
| | - Priyanka Sista
- University of North Carolina School of Medicine, 1001 Bondurant Hall, CB# 9535, Chapel Hill, NC 27599, USA
| | - Evelyn Whitlock
- Center for Health Research, Kaiser Permanente, Northwest, 3800 N. Interstate Avenue, Portland, OR 97227, USA
| | - Stephanie Chang
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, USA
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35
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Hamel C, Stevens A, Singh K, Ansari MT, Myers E, Ziegler P, Hutton B, Sharma A, Bjerre LM, Fenton S, Lau DCW, O’Hara K, Reid R, Salewski E, Shrier I, Willows N, Tremblay M, Moher D. Do sugar-sweetened beverages cause adverse health outcomes in adults? A systematic review protocol. Syst Rev 2014; 3:108. [PMID: 25248499 PMCID: PMC4178316 DOI: 10.1186/2046-4053-3-108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/28/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Chronic diseases, such as cardiovascular disease and type 2 diabetes, impose significant burden to public health. Most chronic diseases are associated with underlying preventable risk factors, such as elevated blood pressure, blood glucose, and lipids, physical inactivity, excessive sedentary behaviours, overweight and obesity, and tobacco usage. Sugar-sweetened beverages are known to be significant sources of additional caloric intake, and given recent attention to their contribution in the development of chronic diseases, a systematic review is warranted. We will assess whether the consumption of sugar-sweetened beverages in adults is associated with adverse health outcomes and what the potential moderating factors are. METHODS/DESIGN Of interest are studies addressing sugar-sweetened beverage consumption, taking a broad perspective. Both direct consumption studies as well as those evaluating interventions that influence consumption (e.g. school policy, educational) will be relevant. Non-specific or multi-faceted behavioural, educational, or policy interventions may also be included subject to the level of evidence that exists for the other interventions/exposures. Comparisons of interest and endpoints of interest are pre-specified. We will include randomized controlled trials, controlled clinical trials, interrupted time series studies, controlled before-after studies, prospective and retrospective comparative cohort studies, case-control studies, and nested case-control designs. The MEDLINE, Embase, The Cochrane Library, CINAHL, ERIC, and PsycINFO databases and grey literature sources will be searched. The processes for selecting studies, abstracting data, and resolving conflicts are described. We will assess risk of bias using design-specific tools. To determine sets of confounding variables that should be adjusted for, we have developed causal directed acyclic graphs and will use those to inform our risk of bias assessments. Meta-analysis will be conducted where appropriate; parameters for exploring statistical heterogeneity and effect modifiers are pre-specified. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach will be used for determining the quality of evidence for outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014009638.
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Affiliation(s)
- Candyce Hamel
- Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6, Canada
| | - Adrienne Stevens
- Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6, Canada
| | - Kavita Singh
- University of Ottawa, 30 Marie Curie Street, Ottawa, ON K1N 6N5, Canada
| | - Mohammed T Ansari
- Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6, Canada
| | - Esther Myers
- E F Myers Consulting, Inc, 600 North Oak Street, Trenton, IL 62293, USA
| | - Paula Ziegler
- Research Evidence Analysis, Academy of Nutrition and Dietetics, 120 South Riverside Plaza, Suite 2000, Chicago, IL 60606, USA
| | - Brian Hutton
- Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6, Canada
| | - Arya Sharma
- Canadian Obesity Network, Royal Alexandra Hospital, MMC, Room 102, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada
| | - Lise M Bjerre
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Department of Family Medicine, University of Ottawa, 43 Bruyere Street, Annex E, Room 206, Ottawa, ON K1N 5C8, Canada
| | - Shannon Fenton
- Planning, Research and Analysis Branch, Ministry of Health and Long-Term Care, 80 Grosvenor Street, 8th Floor, Hepburn Block, Toronto, ON M7A 1R3, Canada
| | - David CW Lau
- Julia McFarlane Diabetes Research Centre, University of Calgary, G082-3330 Hospital Drive NW, Calgary, AB T2N 4H1, Canada
| | - Kathryn O’Hara
- School of Journalism and Communication Journalism, Carleton University, 4th Floor River Building, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada
| | - Robert Reid
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, University of Ottawa, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
| | - Erinn Salewski
- Healthy Living Section, Chronic Disease and Injury Prevention, Ottawa Public Health, 100 Constellation Drive, 7th Floor East (26-42), Ottawa, ON K2G 6J8, Canada
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, 3755 Cote Sainte-Catherine Road, Montreal, QC H3T 1E2, Canada
| | - Noreen Willows
- Department of Agricultural, Food and Nutritional Science, University of Alberta, 4-378 Edmonton Clinic Health Academy, Mailbox #54, 11405 87 Avenue, Edmonton, AB T6G 2P5, Canada
| | - Mark Tremblay
- Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - David Moher
- Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6, Canada
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Stevens A, Hamel C, Singh K, Ansari MT, Myers E, Ziegler P, Hutton B, Sharma A, Bjerre LM, Fenton S, Gow R, Hadjiyannakis S, O’Hara K, Pound C, Salewski E, Shrier I, Willows N, Moher D, Tremblay M. Do sugar-sweetened beverages cause adverse health outcomes in children? A systematic review protocol. Syst Rev 2014; 3:96. [PMID: 25192945 PMCID: PMC4160918 DOI: 10.1186/2046-4053-3-96] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/22/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cardiovascular disease and type 2 diabetes are examples of chronic diseases that impose significant morbidity and mortality in the general population worldwide. Most chronic diseases are associated with underlying preventable risk factors, such as elevated blood pressure, high blood glucose or glucose intolerance, high lipid levels, physical inactivity, excessive sedentary behaviours, and overweight/obesity. The occurrence of intermediate outcomes during childhood increases the risk of disease in adulthood. Sugar-sweetened beverages are known to be significant sources of additional caloric intake, and given recent attention to their contribution in the development of chronic diseases, a systematic review is warranted. We will assess whether the consumption of sugar-sweetened beverages in children is associated with adverse health outcomes and what the potential moderating factors are. METHODS/DESIGN Of interest are studies addressing sugar-sweetened beverage consumption, taking a broad perspective. Both direct consumption studies as well as those evaluating interventions that influence consumption (e.g. school policy, educational) will be relevant. Non-specific or multi-faceted behavioural, educational, or policy interventions may also be included subject to the level of evidence that exists for the other interventions/exposures. Comparisons of interest and endpoints of interest are pre-specified. We will include randomized controlled trials, controlled clinical trials, interrupted time series studies, controlled before-after studies, prospective and retrospective comparative cohort studies, case-control studies, and nested case-control designs. The MEDLINE®, Embase, The Cochrane Library, CINAHL, ERIC, and PsycINFO® databases and grey literature sources will be searched. The processes for selecting studies, abstracting data, and resolving conflicts are described. We will assess risk of bias using design-specific tools. To determine sets of confounding variables that should be adjusted for, we have developed causal directed acyclic graphs and will use those to inform our risk of bias assessments. Meta-analysis will be conducted where appropriate; parameters for exploring statistical heterogeneity and effect modifiers are pre-specified. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach will be used to determine the quality of evidence for outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014009641.
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Affiliation(s)
- Adrienne Stevens
- Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6, Canada
| | - Candyce Hamel
- Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6, Canada
| | - Kavita Singh
- University of Ottawa, 30 Marie Curie Street, Ottawa K1N 6N5, Canada
| | - Mohammed T Ansari
- Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6, Canada
| | - Esther Myers
- E F Myers Consulting Inc, 600 North Oak Street, Trenton, IL 62293, USA
| | - Paula Ziegler
- Research Evidence Analysis, Academy of Nutrition and Dietetics, 120 South Riverside Plaza, Suite 2000, Chicago, IL 60606, USA
| | - Brian Hutton
- Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6, Canada
| | - Arya Sharma
- Canadian Obesity Network, Royal Alexandra Hospital, MMC, Room 102, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada
| | - Lise M Bjerre
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Department of Family Medicine, University of Ottawa, 43 Bruyere Street, Annex E, Room 206, Ottawa, ON K1N 5C8, Canada
| | - Shannon Fenton
- Planning, Research and Analysis Branch, Ministry of Health and Long-Term Care, 80 Grosvenor Street, 8th Floor, Hepburn Block, Toronto, ON M7A 1R3, Canada
| | - Robert Gow
- Division of Cardiology, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Stasia Hadjiyannakis
- Division of Endocrinology, Department of Pediatrics and Department of Medicine, University of Ottawa, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Kathryn O’Hara
- School of Journalism and Communication Journalism, Carleton University, 4th Floor River Building, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada
| | - Catherine Pound
- Division of Pediatric Medicine, Children's Hospital of Eastern Ontario and Department of Medicine, University of Ottawa, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Erinn Salewski
- Healthy Living Section, Chronic Disease and Injury Prevention, Ottawa Public Health, 100 Constellation Drive, 7th Floor East (26-42), Ottawa, ON K2G 6J8, Canada
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, 3755 Cote Sainte-Catherine Road, Montreal, QC H3T 1E2, Canada
| | - Noreen Willows
- Department of Agricultural, Food and Nutritional Science, University of Alberta, 4-378 Edmonton Clinic Health Academy, Mailbox #54, 11405 87 Avenue, Edmonton, AB T6G 2P5, Canada
| | - David Moher
- Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6, Canada
| | - Mark Tremblay
- Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
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Buckley DI, Ansari MT, Butler M, Soh C, Chang CS. The refinement of topics for systematic reviews: lessons and recommendations from the Effective Health Care Program. J Clin Epidemiol 2014; 67:425-32. [PMID: 24581296 DOI: 10.1016/j.jclinepi.2013.10.023] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 08/31/2013] [Accepted: 10/07/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The Agency for Healthcare Research and Quality (AHRQ) Effective Health Care Program conducts systematic reviews of health-care topics nominated by stakeholders. Topics undergo refinement to ensure relevant questions of appropriate scope and useful reviews. Input from key informants, experts, and a literature scan informs changes in the nominated topic. AHRQ convened a work group to assess approaches and develop recommendations for topic refinement. STUDY DESIGN AND SETTING Work group members experienced in topic refinement generated a list of questions and guiding principles relevant to the refinement process. They discussed each issue and reached agreement on recommendations. RESULTS Topics should address important health-care questions or dilemmas, consider stakeholder priorities and values, reflect the state of the science, and be consistent with systematic review research methods. Guiding principles of topic refinement are fidelity to the nomination, relevance, research feasibility, responsiveness to stakeholder inputs, reduced investigator bias, transparency, and suitable scope. Suggestions for stakeholder engagement, synthesis of input, and reporting are discussed. Refinement decisions require judgment and balancing guiding principles. Variability in topics precludes a prescriptive approach. CONCLUSION Accurate, rigorous, and useful systematic reviews require well-refined topics. These guiding principles and methodological recommendations may help investigators refine topics for reviews.
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Affiliation(s)
- David I Buckley
- Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: FM, Portland, OR 97239, USA
| | - Mohammed T Ansari
- Clinical Epidemiology Program, Methods Centre, Box 201B, General Campus, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Mary Butler
- Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Clara Soh
- Kaiser Permanente Center for Health Research, Evidence-based Practice Center, 3800 N Interstate Ave, Portland, OR 97227, USA
| | - Christine S Chang
- Center for Outcomes and Evidence, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, USA
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Ahmadzai N, Newberry SJ, Maglione MA, Tsertsvadze A, Ansari MT, Hempel S, Motala A, Tsouros S, Schneider Chafen JJ, Shanman R, Moher D, Shekelle PG. A surveillance system to assess the need for updating systematic reviews. Syst Rev 2013; 2:104. [PMID: 24225065 PMCID: PMC3874670 DOI: 10.1186/2046-4053-2-104] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 10/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic reviews (SRs) can become outdated as new evidence emerges over time. Organizations that produce SRs need a surveillance method to determine when reviews are likely to require updating. This report describes the development and initial results of a surveillance system to assess SRs produced by the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) Program. METHODS Twenty-four SRs were assessed using existing methods that incorporate limited literature searches, expert opinion, and quantitative methods for the presence of signals triggering the need for updating. The system was designed to begin surveillance six months after the release of the original review, and then ceforth every six months for any review not classified as being a high priority for updating. The outcome of each round of surveillance was a classification of the SR as being low, medium or high priority for updating. RESULTS Twenty-four SRs underwent surveillance at least once, and ten underwent surveillance a second time during the 18 months of the program. Two SRs were classified as high, five as medium, and 17 as low priority for updating. The time lapse between the searches conducted for the original reports and the updated searches (search time lapse - STL) ranged from 11 months to 62 months: The STL for the high priority reports were 29 months and 54 months; those for medium priority reports ranged from 19 to 62 months; and those for low priority reports ranged from 11 to 33 months. Neither the STL nor the number of new relevant articles was perfectly associated with a signal for updating. Challenges of implementing the surveillance system included determining what constituted the actual conclusions of an SR that required assessing; and sometimes poor response rates of experts. CONCLUSION In this system of regular surveillance of 24 systematic reviews on a variety of clinical interventions produced by a leading organization, about 70% of reviews were determined to have a low priority for updating. Evidence suggests that the time period for surveillance is yearly rather than the six months used in this project.
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Affiliation(s)
- Nadera Ahmadzai
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Clinical Epidemiology Program, Center for Practice-Changing Research, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Sydne J Newberry
- Southern California Evidence-based Practice Center (SCEPC), The RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90401, USA
| | - Margaret A Maglione
- Southern California Evidence-based Practice Center (SCEPC), The RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90401, USA
| | - Alexander Tsertsvadze
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Clinical Epidemiology Program, Center for Practice-Changing Research, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Mohammed T Ansari
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Clinical Epidemiology Program, Center for Practice-Changing Research, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Susanne Hempel
- Southern California Evidence-based Practice Center (SCEPC), The RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90401, USA
| | - Aneesa Motala
- Southern California Evidence-based Practice Center (SCEPC), The RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90401, USA
| | - Sophia Tsouros
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Clinical Epidemiology Program, Center for Practice-Changing Research, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | | | - Roberta Shanman
- Southern California Evidence-based Practice Center (SCEPC), The RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90401, USA
| | - David Moher
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Clinical Epidemiology Program, Center for Practice-Changing Research, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Paul G Shekelle
- Southern California Evidence-based Practice Center (SCEPC), The RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90401, USA
- Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA
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Bonaparte JP, Ellis D, Quinn JG, Ansari MT, Rabski J, Kilty SJ. A comparative assessment of three formulations of botulinum toxin A for facial rhytides: a systematic review and meta-analyses. Syst Rev 2013; 2:40. [PMID: 23763852 PMCID: PMC3686697 DOI: 10.1186/2046-4053-2-40] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 05/22/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Botulinum toxin A is a commonly used biological medication in the field of facial plastic surgery. Currently, there are three distinct formulations of botulinum toxin A, each with their purported benefits and advantages. However, there is considerable confusion as to the relative efficacy and side-effects associated with each formulation. Therefore, the purpose of this paper is to systematically assess published studies and perform a meta-analysis to determine if there is a significant advantage of any of the individual formulations. METHODS/DESIGN A systematic literature search was performed for all relevant English language randomized controlled trials using Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, World Health Organization (WHO) International Clinical Trials Registry Platform, European Union (EU) Clinical Trials Register, Cochrane Library databases of clinical trials, and ClinicalTrials.gov. Inclusion criteria included any randomized controlled trial (RCT) that assessed the use of botulinum toxin for cosmetic purposes. The included articles were also analyzed for bias using the Cochrane Collaboration's tool for assessing the risk of bias in RCTs. DISCUSSION The results of this review will provide clinicians with an unbiased, high level of evidence of the comparative efficacy of individual preparations of botulinum toxin A.
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Affiliation(s)
- James P Bonaparte
- Department of Otolaryngology - Head and Neck Surgery, The University of Toronto, Toronto, ON M5G 2N2, Canada.
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Ghosh AN, Bhatta DR, Ansari MT, Tiwari HK, Mathuria JP, Gaur A, Supram HS, Gokhale S. Application of WHONET in the Antimicrobial Resistance Surveillance of Uropathogens: A First User Experience from Nepal. J Clin Diagn Res 2013; 7:845-8. [PMID: 23814725 DOI: 10.7860/jcdr/2013/5193.2955] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 03/07/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION WHONET is a freely downloadable, Windows-based database software which is used for the management and analysis of microbiology data, with a special focus on the analysis of antimicrobial susceptibility test results. Urinary Tract Infections (UTI) are a common medical problem and they are responsible for notable morbidity among young and sexually active women. OBJECTIVES The major objective of this study was the utilization and application of the WHONET program for the Antimicrobial Resistance (AMR) surveillance of uropathogens. METHODS A total of 3209 urine samples were collected from patients who visited Manipal Teaching Hospital with a clinical suspicion of UTI, during December 2010 to July 2011. The isolation and characterization of the isolates were done by conventional methods. Antimicrobial Susceptibility Testing (AST) was performed by Kirby Bauer's disc diffusion method. The data entry and analysis were done by using the WHONET 5.6 software. RESULTS Out of the 3209 specimens, 497 bacterial isolates were obtained and they were subjected to AST. Escherichia coli (66.2%) was the commonest bacterial isolate, followed by Enterococcus species (9.3%), Staphylococcus aureus (5.0%), and Klebsiella pneumoniae (4.2%). Among the gram-negative enteric bacilli, a high prevalence of resistance was observed against ampicillin and ciprofloxacin. The gram negative nonfermenters exhibited a high degree of resistance to ceftazidime. Staphylococcus species. showed a moderately high resistance to co-trimoxazole. One isolate was Vancomycin Resistant Enterococci (VRE). CONCLUSION This study, a first of its kind which was done in Nepal, was carried out by using the WHONET software to monitor, analyze and share the antimicrobial susceptibility data at various levels. This study was also aimed at building a surveillance network in Nepal, with the National Public Health Laboratory, Nepal, acting as a nodal centre. This would help in the formulation of antibiotic policies and in identifying hospital and community outbreaks at the nodal centre, as well as in sharing information with the clinicians at the local level.
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Affiliation(s)
- A N Ghosh
- Department of Microbiology, Gujarat Adani Institute of Medical Sciences (GAIMS), G K General Hospital , Bhuj, Kutch, Gujarat, India - 370001
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Ansari MT, Kotwal PP, Rao S. Reconstruction with fibular autograft and silicone implant arthroplasty after resection of giant-cell tumour of the proximal phalanx: a case report with 18-month follow-up. Musculoskelet Surg 2013; 98:153-7. [PMID: 23371838 DOI: 10.1007/s12306-013-0243-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 11/15/2012] [Indexed: 12/01/2022]
Abstract
Primary giant-cell tumour of phalanx is a rare entity. Only few cases are described in the literature. Giant-cell tumour of hand is reported to have high local recurrence rate. Curettage and bone grafting have been performed by few authors with limited success. Most of the cases have been treated with ray amputation. We report this case as the first reported case in the literature that has been treated with fibular autograft and silicone implant arthroplasty for giant-cell tumour of the proximal phalanx.
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Affiliation(s)
- M T Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India,
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Chung M, Newberry SJ, Ansari MT, Yu WW, Wu H, Lee J, Suttorp M, Gaylor JM, Motala A, Moher D, Balk EM, Shekelle PG. Two methods provide similar signals for the need to update systematic reviews. J Clin Epidemiol 2012; 65:660-8. [PMID: 22464414 PMCID: PMC4141462 DOI: 10.1016/j.jclinepi.2011.12.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 11/28/2011] [Accepted: 12/03/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Apply and compare two methods that identify signals for the need to update systematic reviews, using three Evidence-based Practice Center reports on omega-3 fatty acids as test cases. STUDY DESIGN AND SETTING We applied the RAND method, which uses domain (subject matter) expert guidance, and a modified Ottawa method, which uses quantitative and qualitative signals. For both methods, we conducted focused electronic literature searches of recent studies using the key terms from the original reports. We assessed the agreement between the methods and qualitatively assessed the merits of each system. RESULTS Agreement between the two methods was "substantial" or better (kappa>0.62) in three of the four systematic reviews. Overall agreement between the methods was "substantial" (kappa=0.64, 95% confidence interval [CI] 0.45-0.83). CONCLUSION The RAND and modified Ottawa methods appear to provide similar signals for the possible need to update systematic reviews in this pilot study. Future evaluation with a broader range of clinical topics and eventual comparisons between signals to update reports and the results of full evidence review updates will be needed. We propose a hybrid approach combining the best features of both methods, which should allow efficient review and assessment of the need to update.
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Affiliation(s)
- Mei Chung
- Tufts Evidence-based Practice Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA 02111, USA.
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Kanji S, Seely D, Yazdi F, Tetzlaff J, Singh K, Tsertsvadze A, Tricco AC, Sears ME, Ooi TC, Turek MA, Skidmore B, Ansari MT. Interactions of commonly used dietary supplements with cardiovascular drugs: a systematic review. Syst Rev 2012; 1:26. [PMID: 22651380 PMCID: PMC3534595 DOI: 10.1186/2046-4053-1-26] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 04/18/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND The objective of this systematic review was to examine the benefits, harms and pharmacokinetic interactions arising from the co-administration of commonly used dietary supplements with cardiovascular drugs. Many patients on cardiovascular drugs take dietary supplements for presumed benefits and may be at risk for adverse supplement-drug interactions. METHODS The Allied and Complementary Medicine Database, the Cochrane Library, EMBASE, International Bibliographic Information on Dietary Supplements and MEDLINE were searched from the inception of the review to October 2011. Grey literature was also reviewed.Two reviewers independently screened records to identify studies comparing a supplement plus cardiovascular drug(s) with the drug(s) alone. Reviewers extracted data using standardized forms, assessed the study risk of bias, graded the strength of evidence and reported applicability. RESULTS Evidence was obtained from 65 randomized clinical trials, 2 controlled clinical trials and 1 observational study. With only a few small studies available per supplement, evidence was insufficient for all predefined gradable clinical efficacy and harms outcomes, such as mortality and serious adverse events. One long-term pragmatic trial showed no benefit from co-administering vitamin E with aspirin on a composite cardiovascular outcome. Evidence for most intermediate outcomes was insufficient or of low strength, suggesting no effect. Incremental benefits were noted for triglyceridemia with omega-3 fatty acid added to statins; and there was an improvement in levels of high-density lipoprotein cholesterol with garlic supplementation when people also consumed nitrates CONCLUSIONS Evidence of low-strength indicates benefits of omega-3 fatty acids (plus statin, or calcium channel blockers and antiplatelets) and garlic (plus nitrates or warfarin) on triglycerides and HDL-C, respectively. Safety concerns, however, persist.
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Affiliation(s)
- Salmaan Kanji
- Clinical Epidemiology, The Ottawa Hospital Research Institute and the Department of Pharmacy, The Ottawa Hospital, Ottawa, ON, Canada
| | - Dugald Seely
- Clinical Epidemiology, The Ottawa Hospital Research Institute and the Department of Pharmacy, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Research & Clinical Epidemiology, The Canadian College of Naturopathic Medicine, Toronto, ON, Canada
| | - Fatemeh Yazdi
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa Evidence-based Practice Center, Ottawa, ON, Canada
| | - Jennifer Tetzlaff
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa Evidence-based Practice Center, Ottawa, ON, Canada
| | - Kavita Singh
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa Evidence-based Practice Center, Ottawa, ON, Canada
| | - Alexander Tsertsvadze
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa Evidence-based Practice Center, Ottawa, ON, Canada
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada
| | - Margaret E Sears
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa Evidence-based Practice Center, Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Teik C Ooi
- Division of Endocrinology and Metabolism, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Michele A Turek
- Division of Cardiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Becky Skidmore
- Division of Cardiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Mohammed T Ansari
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa Evidence-based Practice Center, Ottawa, ON, Canada
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Bhatta DR, Ansari MT, Gokhale S, Ghosh AN, De JK, Gurung HM. Ophthalmia Neonatorum: A Letter to Editor. Asian J Med Sci 2012. [DOI: 10.3126/ajms.v2i3.5237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Neonatal Conjunctivitis, also known as Ophthalmia Neonatorum, is a form of bacterial conjunctivitis contracted by newborn during delivery. It is a rare clinical entity in advanced countries, but relatively common in developing countries. Many bacteria and viruses can cause conjunctivitis in the neonates. Two most feared causes are Neisseria gonorrhoeae and Chlamydia trachomatis acquired from birth canal during delivery. We present a case of gonococcal Ophthalmia Neonatorum in a 20 days young neonate from mid-western (Myagdi), Nepal.DOI: http://dx.doi.org/10.3126/ajms.v2i3.5237Asian Journal of Medical Sciences 2 (2011) 72-78
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Gaudet LM, Singh K, Weeks L, Skidmore B, Tsertsvadze A, Ansari MT. Effectiveness of terbutaline pump for the prevention of preterm birth. A systematic review and meta-analysis. PLoS One 2012; 7:e31679. [PMID: 22363704 PMCID: PMC3283660 DOI: 10.1371/journal.pone.0031679] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 09/22/2011] [Accepted: 01/16/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Subcutaneous terbutaline (SQ terbutaline) infusion by pump is used in pregnant women as a prolonged (beyond 48-72 h) maintenance tocolytic following acute treatment of preterm contractions. The effectiveness and safety of this maintenance tocolysis have not been clearly established. We aimed to systematically evaluate the effectiveness and safety of subcutaneous (SQ) terbutaline infusion by pump for maintenance tocolysis. METHODOLOGY/PRINCIPAL FINDINGS MEDLINE, EMBASE, CINAHL, the Cochrane Library, the Centre for Reviews and Dissemination databases, post-marketing surveillance data and grey literature were searched up to April 2011 for relevant experimental and observational studies. Two randomized trials, one nonrandomized trial, and 11 observational studies met inclusion criteria. Non-comparative studies were considered only for pump-related harms. We excluded case-reports but sought FDA summaries of post-marketing surveillance data. Non-English records without an English abstract were excluded. Evidence of low strength from observational studies with risk of bias favored SQ terbutaline pump for the outcomes of delivery at <32 and <37 weeks, mean days of pregnancy prolongation, and neonatal death. Observational studies of medium to high risk of bias also demonstrated benefit for other surrogate outcomes, such as birthweight and neonatal intensive care unit (NICU) admission. Several cases of maternal deaths and maternal cardiovascular events have been reported in patients receiving terbutaline tocolysis. CONCLUSIONS/SIGNIFICANCE Although evidence suggests that pump therapy may be beneficial as maintenance tocolysis, our confidence in its validity and reproducibility is low, suggesting that its use should be limited to the research setting. Concerns regarding safety of therapy persist.
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Affiliation(s)
- Laura M. Gaudet
- Evidence-Based Practice Center, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Horizon Health Network, Department of Obstetrics and Gynecology, The Moncton Hospital, Moncton, New Brunswick, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Kavita Singh
- Evidence-Based Practice Center, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Laura Weeks
- Evidence-Based Practice Center, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Becky Skidmore
- Evidence-Based Practice Center, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alexander Tsertsvadze
- Evidence-Based Practice Center, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mohammed T. Ansari
- Evidence-Based Practice Center, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Loit E, Tricco AC, Tsouros S, Sears M, Ansari MT, Booth RA. Pre-analytic and analytic sources of variations in thiopurine methyltransferase activity measurement in patients prescribed thiopurine-based drugs: A systematic review. Clin Biochem 2011; 44:751-7. [PMID: 21402061 DOI: 10.1016/j.clinbiochem.2011.03.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 02/16/2011] [Accepted: 03/04/2011] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Low thiopurine S-methyltransferase (TPMT) enzyme activity is associated with increased thiopurine drug toxicity, particularly myelotoxicity. Pre-analytic and analytic variables for TPMT genotype and phenotype (enzyme activity) testing were reviewed. DESIGN AND METHODS A systematic literature review was performed, and diagnostic laboratories were surveyed. RESULTS Thirty-five studies reported relevant data for pre-analytic variables (patient age, gender, race, hematocrit, co-morbidity, co-administered drugs and specimen stability) and thirty-three for analytic variables (accuracy, reproducibility). TPMT is stable in blood when stored for up to 7 days at room temperature, and 3 months at -30°C. Pre-analytic patient variables do not affect TPMT activity. Fifteen drugs studied to date exerted no clinically significant effects in vivo. Enzymatic assay is the preferred technique. Radiochemical and HPLC techniques had intra- and inter-assay coefficients of variation (CVs) below 10%. CONCLUSION TPMT is a stable enzyme, and its assay is not affected by age, gender, race or co-morbidity.
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Affiliation(s)
- Evelin Loit
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Booth RA, Ansari MT, Loit E, Tricco AC, Weeks L, Doucette S, Skidmore B, Sears M, Sy R, Karsh J. Assessment of thiopurine S-methyltransferase activity in patients prescribed thiopurines: a systematic review. Ann Intern Med 2011; 154:814-23, W-295-8. [PMID: 21690596 DOI: 10.7326/0003-4819-154-12-201106210-00009] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [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: 11/22/2022] Open
Abstract
BACKGROUND The evidence for testing thiopurine S-methyltransferase (TPMT) enzymatic activity or genotype before starting therapy with thiopurine-based drugs is unclear. PURPOSE To examine the sensitivity and specificity of TPMT genotyping for TPMT enzymatic activity, reducing harm from thiopurine by pretesting, and the association of thiopurine toxicity with TPMT status in adults and children with chronic inflammatory diseases. DATA SOURCES MEDLINE, EMBASE, the Cochrane Library, and Ovid HealthSTAR (from inception to December 2010) and BIOSIS and Genetics Abstracts (to May 2009). STUDY SELECTION Two reviewers screened records and identified relevant studies in English. DATA EXTRACTION Data on patient characteristics, outcomes, and risk for bias were extracted by one reviewer and independently identified by another. DATA SYNTHESIS 54 observational studies and 1 randomized, controlled trial were included. Insufficient evidence addressed the effectiveness of pretesting. Genotyping sensitivity to identify patients with low and intermediate TPMT enzymatic activity ranged from 70.33% to 86.15% (lower-bound 95% CI, 54.52% to 70.88%; upper-bound CI, 78.50% to 96.33%). Sparse data precluded estimation of genotype sensitivity to identify patients with low to absent enzymatic activity. Genotyping specificity approached 100%. Compared with noncarriers, heterozygous and homozygous genotypes were both associated with leukopenia (odds ratios, 4.29 [CI, 2.67 to 6.89] and 20.84 [CI, 3.42 to 126.89], respectively). Compared with intermediate or normal activity, low TPMT enzymatic activity was significantly associated with myelotoxicity and leukopenia. LIMITATION Available evidence was not rigorous and was underpowered to detect a difference in outcomes. CONCLUSION Insufficient evidence addresses the effectiveness of TPMT pretesting in patients with chronic inflammatory diseases. Estimates of the sensitivity of genotyping are imprecise. Evidence confirms the known associations of leukopenia or myelotoxicity with reduced TPMT activity or variant genotype. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Affiliation(s)
- Ronald A Booth
- Ottawa Hospital, Ottawa Hospital Research Institute, and University of Ottawa, Ottawa, Ontario, Canada
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Booth RA, Ansari MT, Tricco AC, Loit E, Weeks L, Doucette S, Skidmore B, Hoch JS, Tsouros S, Sears M, Sy R, Karsh J, Mani S, Galipeau J, Yurkiewich A, Daniel R, Tsertsvadze A, Yazdi F. Assessment of thiopurine methyltransferase activity in patients prescribed azathioprine or other thiopurine-based drugs. Evid Rep Technol Assess (Full Rep) 2010:1-282. [PMID: 23126559 PMCID: PMC4781432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To examine whether pretreatment determination of thiopurine methyltransferase (TPMT) enzymatic activity (phenotyping) or TPMT genotype, to guide thiopurine therapy in chronic autoimmune disease patients, reduces treatment harms. Other objectives included assessing: preanalytic, analytic, and postanalytic requirements for TPMT testing; diagnostic accuracy of TPMT genotyping versus phenotyping; association of thiopurine toxicity with TPMT genotypic or phenotypic status; and costs of testing, care, and treating drug-associated complications. DATA SOURCES MEDLINE®, EMBASE®, and Healthstar were searched from inception to May 2010; the Cochrane Library® to October 2009; and BIOSIS®, Genetics Abstracts, and EconLit™ to May 2009, for English language records. REVIEW METHODS A reviewer screened records, and a second reviewer verified exclusions and subsequent selection of relevant studies. Studies in patients with leukemia and organ transplant were excluded. Additionally, laboratories that provide TPMT analytical services were surveyed to assess means of TPMT testing in practice. Where possible, risk of bias was assessed using standard criteria. Meta-analyses estimated diagnostic sensitivity, and specificity; and odds ratios of associations. RESULTS 1790 titles or abstracts, and 538 full text records were screened. 114 observational studies and one RCT were included. Majority of studies were rated fair quality, except for diagnostic studies with 37 percent of studies rated poor. In general, there were few patients who were homozygous (or compound heterozygous) for TPMT variant alleles in the included studies limiting applicability. There is insufficient evidence examining effectiveness of pretesting in terms of reduction in clinical adverse events. Sufficient preanalytical data were available regarding preferred specimen collection, stability and storage conditions for TPMT testing. There was no clinically significant effect of age, gender, various coadministered drugs, or most morbidities (with the exception of renal failure and dialysis). TPMT phenotyping methods had coefficients of variation generally below 10 percent. TPMT genotyping reproducibility is generally between 95-100 percent. The sensitivity of genotyping to identify patients with low or intermediate TPMT enzymatic activity is imprecise, ranging from 70.70 to 82.10 percent (95 percent CI, lower bound range 37.90 to 54.00 percent; upper bound range 84.60 to 96.90 percent). Sensitivity of homozygous TPMT genotype to correctly identify patients with low to absent enzymatic activity was 87.10 percent (95 percent CI 44.30 to 98.30 percent). Genotyping specificity approached 100 percent. Leukopenia was significantly associated with low and intermediate enzymatic activity (low activity OR 80.00, 95 percent CI 11.5 to 559; and intermediate activity OR 2.96, 95 percent CI 1.18 to 7.42), and homozygous and heterozygous TPMT variant allele genotype (OR 18.60, 95 percent CI 4.12 to 83.60; and 4.62, 95 percent CI 2.34 to 9.16, respectively). In general, TPMT phenotyping costs less than genotyping, although estimates across studies are quite heterogeneous. CONCLUSIONS There is insufficient direct evidence regarding the effectiveness of pretesting of TPMT status in patients with chronic autoimmune diseases. Indirect evidence confirms strong association of leukopenia with lower levels of TPMT activity and carrier genotype already established in the literature.
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Shamliyan TA, Kane RL, Ansari MT, Raman G, Berkman ND, Grant M, Janes G, Maglione M, Moher D, Nasser M, Robinson KA, Segal JB, Tsouros S. Development quality criteria to evaluate nontherapeutic studies of incidence, prevalence, or risk factors of chronic diseases: pilot study of new checklists. J Clin Epidemiol 2010. [PMID: 21071174 DOI: 10.1016/j.jclinepi.2010.08.006.] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVE To develop two checklists for the quality of observational studies of incidence or risk factors of diseases. STUDY DESIGN AND SETTING Initial development of the checklists was based on a systematic literature review. The checklists were refined after pilot trials of validity and reliability were conducted by seven experts, who tested the checklists on 10 articles. RESULTS The checklist for studies of incidence or prevalence of chronic disease had six criteria for external validity and five for internal validity. The checklist for risk factor studies had six criteria for external validity, 13 criteria for internal validity, and two aspects of causality. A Microsoft Access database produced automated standardized reports about external and internal validities. Pilot testing demonstrated face and content validities and discrimination of reporting vs. methodological qualities. Interrater agreement was poor. The experts suggested future reliability testing of the checklists in systematic reviews with preplanned protocols, a priori consensus about research-specific quality criteria, and training of the reviewers. CONCLUSION We propose transparent and standardized quality assessment criteria of observational studies using the developed checklists. Future testing of the checklists in systematic reviews is necessary to develop reliable tools that can be used with confidence.
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Affiliation(s)
- Tatyana A Shamliyan
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Shamliyan TA, Kane RL, Ansari MT, Raman G, Berkman ND, Grant M, Janes G, Maglione M, Moher D, Nasser M, Robinson KA, Segal JB, Tsouros S. Development quality criteria to evaluate nontherapeutic studies of incidence, prevalence, or risk factors of chronic diseases: pilot study of new checklists. J Clin Epidemiol 2010; 64:637-57. [PMID: 21071174 DOI: 10.1016/j.jclinepi.2010.08.006] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 08/01/2010] [Accepted: 08/22/2010] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To develop two checklists for the quality of observational studies of incidence or risk factors of diseases. STUDY DESIGN AND SETTING Initial development of the checklists was based on a systematic literature review. The checklists were refined after pilot trials of validity and reliability were conducted by seven experts, who tested the checklists on 10 articles. RESULTS The checklist for studies of incidence or prevalence of chronic disease had six criteria for external validity and five for internal validity. The checklist for risk factor studies had six criteria for external validity, 13 criteria for internal validity, and two aspects of causality. A Microsoft Access database produced automated standardized reports about external and internal validities. Pilot testing demonstrated face and content validities and discrimination of reporting vs. methodological qualities. Interrater agreement was poor. The experts suggested future reliability testing of the checklists in systematic reviews with preplanned protocols, a priori consensus about research-specific quality criteria, and training of the reviewers. CONCLUSION We propose transparent and standardized quality assessment criteria of observational studies using the developed checklists. Future testing of the checklists in systematic reviews is necessary to develop reliable tools that can be used with confidence.
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Affiliation(s)
- Tatyana A Shamliyan
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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