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Monteiro BP, Otis C, Nitulescu R, Troncy E. Quantitative sensory testing in canine musculoskeletal pain: Findings from a systematic review, meta-analysis feasibility assessment, and limitations. Vet J 2024; 304:106102. [PMID: 38492631 DOI: 10.1016/j.tvjl.2024.106102] [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: 08/11/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
Quantitative sensory testing (QST) allows the study of pain mechanisms, patient phenotyping, and response to therapy. The goals of this study were to conduct a systematic review of the use of QST in dogs with musculoskeletal disease including osteoarthritis (OA), and to assess, by means of a meta-analysis, the ability of QST to differentiate affected dogs from healthy controls. The study protocol was registered; three bibliographic databases were screened. Studies involving QST in healthy dogs and those with musculoskeletal disease were included. Data were extracted using a standardized form. Assessment of quality and risk of bias were performed using the CAMARADES critical assessment tool. Twenty-nine articles met the inclusion criteria [systematic review (n = 11); meta-analysis (n = 28)]. In the systematic review, ten studies performed static QST: mechanical [punctate tactile (n = 6); mechanical pressure (n = 5)]; thermal [cold (n = 3); hot (n = 4)]; electrical (n = 1); and one study performed dynamic QST [conditioned pain modulation (n = 1)]. Most studies were of good scientific quality and showed low to moderate risk of bias. A meta-analysis was not possible due to numerous and severe issues of heterogeneity of data among studies. Methods to reduce risk of bias and use of reporting guidelines are some of the most needed improvements in QST research in dogs. Standardization of QST methodology is urgently needed in future studies to allow for data synthesis and a clear understanding of the sensory phenotype of dogs with and without chronic pain including OA.
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Affiliation(s)
- B P Monteiro
- Research Group in Animal Pharmacology of Quebec (GREPAQ), Université de Montréal, Saint-Hyacinthe, Québec J2S 2M2, Canada
| | - C Otis
- Research Group in Animal Pharmacology of Quebec (GREPAQ), Université de Montréal, Saint-Hyacinthe, Québec J2S 2M2, Canada
| | - R Nitulescu
- University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec H2X 0A9, Canada; Centre d'intégration et d'analyse des données médicales (CITADEL) du Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec H2X 0A9, Canada
| | - E Troncy
- Research Group in Animal Pharmacology of Quebec (GREPAQ), Université de Montréal, Saint-Hyacinthe, Québec J2S 2M2, Canada; University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec H2X 0A9, Canada.
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Monteiro BP, Otis C, Del Castillo JRE, Nitulescu R, Brown K, Arendt-Nielsen L, Troncy E. Quantitative sensory testing in feline osteoarthritic pain - a systematic review and meta-analysis. Osteoarthritis Cartilage 2020; 28:885-896. [PMID: 32360738 DOI: 10.1016/j.joca.2020.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 09/10/2019] [Revised: 03/31/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023]
Abstract
UNLABELLED Quantitative sensory testing (QST) is a psychophysical test used to quantify somatosensory sensation under normal or pathological conditions including osteoarthritis (OA). OBJECTIVE This study aimed to conduct a systematic review and meta-analysis of studies using QST in healthy and osteoarthritic cats, registered at Systematic Review Research Facility (#26-06-2017). DESIGN Hierarchical models with random intercepts for each individual study extracted through the systematic review were fit to subject-level data; QST measures were contrasted between healthy and osteoarthritic cats. Four bibliographic databases were searched; quality and risk of bias assessment were performed using pre-established criteria. RESULTS Six articles were included; most were of high quality and low risk of bias. Punctate tactile threshold (n = 70) and mechanical temporal summation (n = 35) were eligible for analysis. Cats with OA have lower punctate tactile threshold [mean difference (95%HDI): -44 (-60; -26) grams] and facilitated temporal summation of pain [hazard ratio (95%HDI): 5.32 (2.19; 14) times] when compared with healthy cats. The effect of sex and body weight on sensory sensitivity remained inconclusive throughout all analyses. Due to the correlation between age and OA status, it remains difficult to assess the effect of OA on sensory sensitivity, independently of age. CONCLUSIONS Clear and transparent reporting using guidelines are warranted. Similar to people, centralized sensitization is a feature of OA in cats. Future studies should try to elucidate the age effect on feline OA. Research with natural OA in cats is promising with potential to benefit feline health and welfare, and improve translatability to clinical research.
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Affiliation(s)
- B P Monteiro
- GREPAQ (Groupe de Recherche en Pharmacologie Animale Du Québec), Department of Biomedical Sciences, Faculty of Veterinary Medicine - Université de Montréal, Saint-Hyacinthe, QC, Canada.
| | - C Otis
- GREPAQ (Groupe de Recherche en Pharmacologie Animale Du Québec), Department of Biomedical Sciences, Faculty of Veterinary Medicine - Université de Montréal, Saint-Hyacinthe, QC, Canada; University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada.
| | - J R E Del Castillo
- GREPAQ (Groupe de Recherche en Pharmacologie Animale Du Québec), Department of Biomedical Sciences, Faculty of Veterinary Medicine - Université de Montréal, Saint-Hyacinthe, QC, Canada.
| | - R Nitulescu
- University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada.
| | - K Brown
- University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada.
| | - L Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Sensory-Motor Interaction (SMI®), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
| | - E Troncy
- GREPAQ (Groupe de Recherche en Pharmacologie Animale Du Québec), Department of Biomedical Sciences, Faculty of Veterinary Medicine - Université de Montréal, Saint-Hyacinthe, QC, Canada; University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada.
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Costiniuk CT, Nitulescu R, Saneei Z, Wasef N, Salahuddin S, Wasef D, Young J, de Castro C, Routy JP, Lebouché B, Cox J, Smith BM, Ambroise S, Pexos C, Patel M, Szabo J, Haraoui LP, de Pokomandy A, Tsoukas C, Falutz J, LeBlanc R, Giannakis A, Frenette C, Jenabian MA, Bourbeau J, Klein MB. Prevalence and predictors of airflow obstruction in an HIV tertiary care clinic in Montreal, Canada: a cross-sectional study. HIV Med 2019; 20:192-201. [PMID: 30620136 PMCID: PMC6590155 DOI: 10.1111/hiv.12699] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 12/27/2022]
Abstract
Objectives The reported prevalence of chronic obstructive pulmonary disease (COPD) in people living with HIV (PLWHIV) varies widely. Our objective was to estimate the prevalence of airflow obstruction and COPD in unselected PLWHIV and identify characteristics that increase the risk of nonreversible airflow obstruction in order to guide case finding strategies for COPD. Methods All adults attending the Chronic Viral Illness Service were invited to participate in the study, regardless of smoking status or history of known COPD/asthma. Individuals underwent spirometric testing both before and after use of a salbutamol bronchodilator. Airflow obstruction was defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 0.7 post‐bronchodilation, whereas COPD was defined as FEV1/FVC < 0.7 post‐bronchodilation and Medical Research Council (MRC) score > 2. Multivariate logistic regression was used to evaluate risk factors associated with airflow obstruction, reported as adjusted odds ratios (aORs). Results Five hundred and three participants successfully completed spirometry testing. The median (Q1; Q3) age was 52 (44; 58) years. The median (Q1; Q3) CD4 count was 598 (438; 784) cells/μL and the median (Q1; Q3) nadir CD4 count was 224 (121; 351) cells/μL. There were 119 (24%) current smokers and 145 (29%) former smokers. Among those screened, 54 (11%) had airflow obstruction whereas three (1%) of the participants had COPD. Factors that were associated with airflow obstruction included a history of smoking [aOR 2.2; 95% confidence interval (CI) 1.1; 4.7], older age (aOR 1.6; 95% CI 1.2; 2.2), and lower CD4 count (aOR 0.8; 95% CI 0.7; 1.0). Conclusions Airflow obstruction was relatively uncommon. Our findings suggest that PLWHIV who are ≥50 years old, smokers and those with nadir CD4 counts ≤ 200 cells/μL could be targeted to undergo spirometry to diagnose chronic airflow obstruction.
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Affiliation(s)
- C T Costiniuk
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - R Nitulescu
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Z Saneei
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - N Wasef
- Department of Medicine, National University of Ireland, Galway, Ireland
| | - S Salahuddin
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - D Wasef
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - J Young
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - C de Castro
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - J P Routy
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - B Lebouché
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - J Cox
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - B M Smith
- Centre for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, QC, Canada.,Division of Respirology, McGill University Health Centre, Montreal, QC, Canada
| | - S Ambroise
- Division of Respirology, McGill University Health Centre, Montreal, QC, Canada
| | - C Pexos
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - M Patel
- Division of Respirology, McGill University Health Centre, Montreal, QC, Canada
| | - J Szabo
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - L P Haraoui
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - A de Pokomandy
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, QC, Canada
| | - C Tsoukas
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - J Falutz
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - R LeBlanc
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - A Giannakis
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - C Frenette
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - M A Jenabian
- Department of Biological Sciences and BioMed Research Centre, University of Quebec at Montreal (UQAM), Montreal, QC, Canada
| | - J Bourbeau
- Centre for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, QC, Canada.,Division of Respirology, McGill University Health Centre, Montreal, QC, Canada
| | - M B Klein
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, QC, Canada
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Abstract
OBJECTIVE Brain metastases among lung cancer patients can impair cognitive and functional ability, complicate care, and reduce survival. This study focuses on the economic burden of brain metastasis in lung cancer-direct healthcare costs to payers and indirect costs to patients, payers, and employers-in the US. METHODS Retrospective study using claims data from over 60 self-insured Fortune 500 companies across all US census regions (January 1999-March 2013). Adult, non-elderly lung cancer patients with brain metastasis were evaluated over two study periods: (1) pre-diagnosis (≤30 days prior to first observed lung cancer diagnosis to ≤30 days prior to first-observed brain metastasis diagnosis) and (2) post-diagnosis (≤30 days prior to first observed brain metastasis diagnosis to end of continuous eligibility or observation). OUTCOME MEASURES Healthcare costs to payers and resource utilization, salary loss to patients, disability payouts for payers, and productivity loss to employers. RESULTS A total of 132 patients were followed for a median of 8.4 and 6.6 months in the pre- and post-diagnosis periods, respectively. At diagnosis of brain metastasis, 21.2% of patients were on leave of absence and 6.1% on long-term disability leave. Substantial differences were observed in the pre- vs post-diagnosis periods. Specifically, patients incurred much greater healthcare utilization in the post-diagnosis period, resulting in $25,579 higher medical costs per-patient-per-6-months (PPP6M). During this period, patients missed significantly more work days, generating an incremental burden of $2853 PPP6M in salary loss for patients, $2557 PPP6M in disability payments for payers, and $4570 PPP6M in productivity loss for employers. LIMITATIONS Type of primary lung cancer and extent of brain metastasis could not be assessed in the data. The analysis was also limited to patients with comprehensive disability coverage. CONCLUSIONS Development of brain metastasis among lung cancer patients is associated with a substantial economic burden to payers, patients, and employers.
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Affiliation(s)
- A Guérin
- a a Analysis Group, Inc. , Montreal , QC , Canada
| | - M Sasane
- b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - K Dea
- a a Analysis Group, Inc. , Montreal , QC , Canada
| | - J Zhang
- b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - K Culver
- b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - R Nitulescu
- a a Analysis Group, Inc. , Montreal , QC , Canada
| | - E Q Wu
- c c Analysis Group, Inc. , Boston , MA , USA
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Guérin A, Sasane M, Wakelee H, Zhang J, Culver K, Dea K, Nitulescu R, Galebach P, Macalalad AR. Treatment, overall survival, and costs in patients with ALK-positive non-small-cell lung cancer after crizotinib monotherapy. Curr Med Res Opin 2015; 31:1587-97. [PMID: 26029864 DOI: 10.1185/03007995.2015.1057115] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Limited post-crizotinib treatment options for ALK-positive non-small cell lung cancer (NSCLC) might lead to poor survival and high economic burden. OBJECTIVE To evaluate real-world treatment patterns, overall survival (OS), and costs following crizotinib discontinuation. METHODS This study used chart review and claims data. First, 27 participating US oncologists reviewed medical records of ALK-positive NSCLC patients who discontinued crizotinib monotherapy and reported patient demographic and clinical information, including post-crizotinib treatment and mortality. OS was estimated using Kaplan-Meier analyses. Second, three large administrative US claims databases were pooled. NSCLC patients were selected if they discontinued crizotinib monotherapy. Post-crizotinib costs were analyzed separately for patients who did or did not discontinue antineoplastic treatment after crizotinib monotherapy. All data were collected prior to ceritinib approval for this patient population. RESULTS A total of 119 ALK-positive NSCLC patients discontinued crizotinib monotherapy. Upon discontinuation, 42% had no additional antineoplastic treatment and 13% received radiation therapy only. The median OS post-crizotinib was 61 days; patients with brain metastases had shorter OS than those who did not (44 vs. 69 days, P = 0.018), and patients without further antineoplastic treatment had shorter OS than those who did (17 vs. 180 days, P < 0.001). From claims data, 305 ALK-positive NSCLC patients discontinued crizotinib monotherapy. After discontinuation, 72% had no additional antineoplastic treatment. Among patients who continued antineoplastic treatment, monthly healthcare costs averaged $22,160, driven by pharmacy ($9202), inpatient ($6419), and outpatient radiotherapy ($2888) and imaging ($1179) costs. Among patients who discontinued any antineoplastic treatment, monthly healthcare costs averaged $3423, mostly driven by inpatient costs ($2074). CONCLUSIONS After crizotinib monotherapy, most patients either received radiotherapy only or discontinued antineoplastic treatment altogether. OS after discontinuing crizotinib was poor and shorter among those with brain metastases than without, and among those without subsequent antineoplastic treatment than with. Patients who continued antineoplastic treatment incurred substantial healthcare costs.
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Affiliation(s)
- A Guérin
- a a Analysis Group Inc. , Boston , MA , United States
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Macalalad A, Sasane M, Zhang J, Culver K, Dea K, Nitulescu R, Wu E, Guerin A. BM-19 * SYMPTOMATIC AND ECONOMIC BURDEN OF BRAIN METASTASES IN PATIENTS WITH ALK+ NSCLC. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou240.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gallagher CM, More K, Masaquel AS, Kamath T, Guerin A, Ionescu-Ittu R, Gauthier-Loiselle M, Nitulescu R, Sicignano N, Barnett B, Wu EQ. Overall Survival in Patients with HER2+ Early Stage Breast Cancer Patients Treated with Trastuzumab in the US Department of Defense Practice Setting. Value Health 2014; 17:A615. [PMID: 27202155 DOI: 10.1016/j.jval.2014.08.2164] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- C M Gallagher
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - K More
- Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | | | - T Kamath
- Genentech, South San Francisco, CA, USA
| | - A Guerin
- Analysis Group, Inc., Montréal, QC, Canada
| | | | | | | | | | - B Barnett
- Genentech, South San Francisco, CA, USA
| | - E Q Wu
- Analysis Group, Inc., Boston, MA, USA
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Tomescu D, Grigorescu B, Nitulescu R, Tomulescu V, Popescu I, Tulbure D. [Hemodynamic changes induced by positive pressure capnothorax during thoracoscopic thymectomy]. Chirurgia (Bucur) 2007; 102:263-70. [PMID: 17687853] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Low-flow insufflation of CO2 into the thorax helps the surgeon by increasing the surgical field during thoracoscopy, but older studies performed on animals (pigs and dogs) showed that positive pressure capnothorax had negative hemodynamic impact on animals and strongly recommended against using it on humans. We included in our study 24 ASA I-II myasthenic patients (20 females and 4 males) age 29 yo (+/- 10.2) weight 62.8 kg (+/- 10.6) whose thymuses were surgically removed by thoracoscopy. Using thoracic electrical bioimpedance (TEB) we assessed noninvasively cardiac index (CI) stroke index (SI) systemic stroke vascular resistance index (SSVRI) and end diastolic index (EDI). Well known for its hemodynamic stability we chose sevoflurane for induction and maintenance of anesthesia (VIMA). According to Copenhagen scale, adding minimal iv dose of fentanyl (3 mcg/kg) to sevoflurane induction, allowed us to endobronchial intubate in good and excellent conditions. During anesthesia almost all measured parameters (CI, SI, MAP, EDI) recorded statistically significant decrease but with minimal clinical significance. Thus, the maximal drop was measured during application of 10 mm Hg capnothorax: CI and SI dropped by 1.16 1/min/m2 (19%) (p = 0.02) and respectively 16.58 ml/m2 (21%) (p = 0.001). Thereby we are applying low-flow positive pressure insufflation of CO2 into the thorax, to almost all thoracoscopies performed in our clinic.
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Affiliation(s)
- Dana Tomescu
- Centrul de Anestezie şi Terapie Intensivă, Institutul Clinic Fundeni, Bucureşti.
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