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Visser M, Mendonça N, Avgerinou C, Cavdar S, Cederholm T, Cruz-Jentoft AJ, Kiesswetter E, Siebentritt HM, Sieber C, Torbahn G, Volkert D. A Core Outcome Set for nutritional intervention studies in older adults with malnutrition and those at risk: a study protocol. BMC Geriatr 2023; 23:221. [PMID: 37024825 PMCID: PMC10080774 DOI: 10.1186/s12877-023-03832-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 02/16/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Malnutrition (i.e., protein-energy malnutrition) in older adults has severe negative clinical consequences, emphasizing the need for effective treatments. Many, often small, randomized controlled trials (RCTs) testing the effectiveness of nutritional interventions for the treatment of malnutrition showed mixed results and a need for meta-analyses and data pooling has been expressed. However, evidence synthesis is hampered by the wide variety of outcomes and their method of assessment in previous RCTs. This paper describes the protocol for developing a Core Outcome Set (COS) for nutritional intervention studies in older adults with malnutrition and those at risk. METHODS The project consists of five phases. The first phase consists of a scoping review to identify frequently used outcomes in published RCTs and select additional patient-reported outcomes. The second phase includes a modified Delphi Survey involving experienced researchers and health care professionals working in the field of malnutrition in older adults, followed by the third phase consisting of a consensus meeting to discuss and agree what critical outcomes need to be included in the COS. The fourth phase will determine how each COS outcome should be measured based on a systematic literature review and a second consensus meeting. This will be followed by a dissemination and implementation phase. Patient and Public Involvement (PPI) representatives will contribute to study design, oversight, consensus, and dissemination. CONCLUSIONS The result of this project is a COS that should be included in any RCT evaluating the effect of nutritional interventions in older adults with malnutrition and those at risk. This COS will facilitate comparison of RCT results, will increase efficient use of research resources and will reduce bias due to measurement of the outcome and publication bias. Ultimately, the COS will support clinical decision making by identifying the most effective approaches for treating and preventing malnutrition in older adults.
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Affiliation(s)
- Marjolein Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands.
| | - Nuno Mendonça
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Rua do Instituto Bacteriológico n°5, Lisbon, 1150-082, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Christina Avgerinou
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sibel Cavdar
- Division of Geriatrics, Department of Internal Medicine, Ege University Hospital, Izmir, Turkey
- Ege University Hospital, Kazımdirik, University Street. No:9, Bornova/İzmir, 35100, Turkey
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Alfonso J Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Ctra. Colmenar km 9.1, Madrid, 28034, Spain
| | - Eva Kiesswetter
- Institute for Evidence in Medicine, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 86, Freiburg, 79110, Germany
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, Nürnberg, 90408, Germany
| | - Hanna M Siebentritt
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, Nürnberg, 90408, Germany
| | - Cornel Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, Nürnberg, 90408, Germany
- Department of Medicine, Kantonsspital Winterthur, Brauerstrasse 15, Postfach 834, Winterthur, Zurich, 8401, Switzerland
| | - Gabriel Torbahn
- Department of Pediatrics, Paracelsus Medical University, Nuremberg, Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, Nürnberg, 90408, Germany
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McLeod C, Norman R, Litton E, Saville BR, Webb S, Snelling TL. Choosing primary endpoints for clinical trials of health care interventions. Contemp Clin Trials Commun 2019; 16:100486. [PMID: 31799474 PMCID: PMC6881606 DOI: 10.1016/j.conctc.2019.100486] [Citation(s) in RCA: 60] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 10/29/2019] [Accepted: 11/09/2019] [Indexed: 01/15/2023] Open
Abstract
The purpose of late phase clinical trials is to generate evidence of sufficient validity and generalisability to be translated into practice and policy to improve health outcomes. It is therefore crucial that the chosen endpoints are meaningful to the clinicians, patients and policymakers that are the end-users of evidence generated by these trials. The choice of endpoints may be improved by understanding their characteristics and properties. This narrative review describes the evolution, range and relative strengths and weaknesses of endpoints used in late phase trials. It is intended to serve as a reference to assist those designing trials when choosing primary endpoint(s), and for the end-users charged with interpreting these trials to inform practice and policy.
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Affiliation(s)
- Charlie McLeod
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia.,School of Medicine, University of Western Australia, Nedlands, Australia.,Infectious Diseases Department, Perth Children's Hospital, Nedlands, Australia
| | - Richard Norman
- School of Public Health, Curtin University, Bentley, Australia
| | - Edward Litton
- School of Medicine, University of Western Australia, Nedlands, Australia.,St John of God Hospital, Subiaco, Australia
| | - Benjamin R Saville
- Berry Consultants, Austin, TX, United States.,Vanderbilt University Department of Biostatistics, Nashville, TN, United States
| | - Steve Webb
- St John of God Hospital, Subiaco, Australia.,School of Population Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Thomas L Snelling
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia.,Infectious Diseases Department, Perth Children's Hospital, Nedlands, Australia.,School of Public Health, Curtin University, Bentley, Australia.,Menzies School of Health Research, Tiwi, Australia
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Zhang Y, Wang G, Sun S, Gao Y, Xie Y, Liu Y. Risk assessment model for endpoints of ischemic stroke: A study protocol for a registry study. J TRADIT CHIN MED 2018; 38:936-942. [PMID: 32186142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the risk of ischemic stroke endpoints by establishing risk assessment models that combine Traditional Chinese Medicine (TCM) and modern medicine indicators. METHODS/DESIGN The proposed study is a registry-based participant survey conducted in seven hospitals nationwide in China. After obtaining informed consent, 3000 patients diagnosed with ischemic stroke will be recruited. One-year follow-ups will be performed on-site in hospitals and by telephone to track endpoint events. Comparative analysis of the prevalence of endpoint events and other TCM or modern medicine features in different groups will be conducted using frequency analysis and X2 tests, and the results will be expressed as composition ratios. Comparative analysis of quantitative scores and related patterns or symptoms will be conducted using a rank-sum test. Correlation analysis of endpoint events and TCM or modern medicine factors will be performed using a multivariate Cox proportional hazard model. DISCUSSION Previous reports have described modern medicine indicator-based risk assessment models for ischemic stroke endpoint events, but no such studies have included TCM features. Our new risk assessment model combines TCM and modern medicine indicators and thus has the potential to facilitate early warning, early intervention, and early control of ischemic stroke endpoint events.
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Affiliation(s)
- Yin Zhang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Guiqian Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Shuailing Sun
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yang Gao
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yanming Xie
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yue Liu
- Center for Evidence-Based Chinese Medicine, School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
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4
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Abstract
Functional dyspepsia is a disease, in which there is no organic lesion but chronic and repetitive postprandial fullness, early satiation, epigastric pain, and epigastric burning. Functional dyspepsia is not life-threatening but its symptoms are relapsing and remitting and persist over a lifetime, limiting the social life and reducing the quality of life. Therefore, the treatment for acute relapsing period may help improve the short-term symptoms. Continuous medication may be needed to improve the long-term symptoms. Research designs to demonstrate the short-term efficacy of therapeutic agents may differ from clinical trials to demonstrate long-term efficacy. There are many difficulties in clinical trial design, implementation, and screening because there are no international standards of clinical trials for functional dyspepsia. The purpose of this guideline recommendation is to develop a standard for clinical trials, such as clinical trial subjects and evaluation methods, in the development of therapeutic agents for functional dyspepsia. The ultimate aim is to enhance the safety and efficacy of therapeutic agents for functional dyspepsia and promote the development of new therapeutic agents.
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Affiliation(s)
- Han Hee Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Photomedicine Research Institute, Seoul, Korea
| | - Hye Kyung Jung
- Division of Gastroenterology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Myung Gyu Choi
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Photomedicine Research Institute, Seoul, Korea
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Anker SD, Schroeder S, Atar D, Bax JJ, Ceconi C, Cowie MR, Crisp A, Dominjon F, Ford I, Ghofrani HA, Gropper S, Hindricks G, Hlatky MA, Holcomb R, Honarpour N, Jukema JW, Kim AM, Kunz M, Lefkowitz M, Le Floch C, Landmesser U, McDonagh TA, McMurray JJ, Merkely B, Packer M, Prasad K, Revkin J, Rosano GMC, Somaratne R, Stough WG, Voors AA, Ruschitzka F. Traditional and new composite endpoints in heart failure clinical trials: facilitating comprehensive efficacy assessments and improving trial efficiency. Eur J Heart Fail 2016; 18:482-9. [PMID: 27071916 DOI: 10.1002/ejhf.516] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [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: 10/01/2015] [Revised: 12/15/2015] [Accepted: 01/17/2016] [Indexed: 02/05/2023] Open
Abstract
Composite endpoints are commonly used as the primary measure of efficacy in heart failure clinical trials to assess the overall treatment effect and to increase the efficiency of trials. Clinical trials still must enrol large numbers of patients to accrue a sufficient number of outcome events and have adequate power to draw conclusions about the efficacy and safety of new treatments for heart failure. Additionally, the societal and health system perspectives on heart failure have raised interest in ascertaining the effects of therapy on outcomes such as repeat hospitalization and the patient's burden of disease. Thus, novel methods for using composite endpoints in clinical trials (e.g. clinical status composite endpoints, recurrent event analyses) are being applied in current and planned trials. Endpoints that measure functional status or reflect the patient experience are important but used cautiously because heart failure treatments may improve function yet have adverse effects on mortality. This paper discusses the use of traditional and new composite endpoints, identifies qualities of robust composites, and outlines opportunities for future research.
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Affiliation(s)
- Stefan D Anker
- Innovative Clinical Trials, Depar tment of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Germany
| | | | - Dan Atar
- Department of Cardiology B, Oslo University Hospital Ulleval and University of Oslo, Norway
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Claudio Ceconi
- Unit of Cardiology, Hospital of Desenzano del Garda, Desenzano del Garda, Italy
| | - Martin R Cowie
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Hossein-Ardeschir Ghofrani
- University of Giessen and Marburg Lung Center, UGMLC [member of the German Center for Lung Research (DZL)], Giessen, Germany.,Kerckhoff-Klinik Bad Nauheim, Germany.,Imperial College London, UK
| | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Mark A Hlatky
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | - Ulf Landmesser
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - John J McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Bela Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Milton Packer
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Krishna Prasad
- United Kingdom Medicines and Healthcare Products Regulatory Agency, London, UK
| | | | - Giuseppe M C Rosano
- IRCCS San Raffaele Hospital Roma, Rome, Italy.,Cardiovascular and Cell Sciences Institute, St. George's University of London, London, UK
| | | | | | | | - Frank Ruschitzka
- Department of Cardiology, Heart Failure Clinic and Transplantation, University Heart Center Zurich, Zurich, Switzerland
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Abstract
Numerous clinical trials of molecular targeted drugs for cancer have been conducted, with remarkable results for certain drugs and accumulation of "negative data" causing a hitch in the development plan for some other compounds. Five recent issues and problems of molecular targeted therapies were discussed critically. Drug discovery and effects against driver mutations (activating mutations) and problems: possibility for circumventing inherent and acquired resistance with the aim of achieving radical cure. Synthetic lethality: reasonable patient selection in individualized treatment strategy. Response rate and progression-free survival improvement with or without overall survival benefit and enhancement of toxicity in bevacizumab therapy: best endpoints for the evaluation of effect of antiangiogenic therapy. Negative data on small-molecule targeted therapy, primarily vascular endothelial growth factor tyrosine kinase inhibitors: loose GO or NO-GO decision criteria for further development of new compounds in early clinical trials. Effect of immunotherapy: difficulty to verify by proof of principle study. We are faced to many questions for the development of efficient personalized therapy. Accumulation of scientific global preclinical and clinical evidences is essential to use these new therapeutic modalities for the improvement of oncologic health care.
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Affiliation(s)
- Nagahiro Saijo
- Division of Medical Oncology, Kinki University School of Medicine, Osaka, Japan
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