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Rafalko N, Webster JL, Jacob G, Kutzler MA, Goldstein ND. Generalizability of predictive models for Clostridioides difficile infection, severity and recurrence at an urban safety-net hospital. J Hosp Infect 2024; 146:10-20. [PMID: 38219834 DOI: 10.1016/j.jhin.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/21/2023] [Accepted: 01/01/2024] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Predictive models for Clostridioides difficile infection can identify high-risk patients and aid clinicians in preventing infection. Issues of generalizability regarding current predictive models have been acknowledged but, to the authors' knowledge, have never been quantified. METHODS C. difficile infection, severity and recurrence predictive models were created using multi-variate logistic regression through case-control sampling from an urban safety-net hospital. Models were validated using five-fold cross-validation, and inverse probability weights (IPW) based on two different catchment area definitions were used to improve external validity. Akaike Information Criterion (AIC), area under the receiver operating characteristic curve (AUROC), and sensitivity and specificity with bootstrapped confidence intervals (CI) were used to assess and compare model fit and performance. RESULTS Changes in performance before and after weighting were small across all models, although differences were more apparent after weighting the recurrence model (AUROC values of 0.78, 0.76 and 0.71 for the unweighted and two weighted models, respectively). Overall, the infection model performed the best (AUROC 0.82, 95% CI 0.78-0.85), followed by the recurrence model (AUROC 0.78, 95% CI 0.69-0.86) and then the severity model (AUROC 0.70, 95% CI 0.63-0.78). CONCLUSIONS The performance of the models after weighting did not change drastically, suggesting that the models predicting C. difficile infection, severity and recurrence may not be impacted by patient selection factors. However, other researchers may wish to consider addressing these catchment forces using IPW.
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Affiliation(s)
- N Rafalko
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - J L Webster
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - G Jacob
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - M A Kutzler
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - N D Goldstein
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA.
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Rung JM, Berey BL, Leeman RF. Initial evidence of delay discounting's predictive utility for alcohol self-administration in ecologically valid contexts among young adults who drink heavily. Drug Alcohol Depend 2024; 256:111068. [PMID: 38290204 PMCID: PMC10922828 DOI: 10.1016/j.drugalcdep.2023.111068] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/27/2023] [Accepted: 12/17/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND While delay discounting is robustly associated with alcohol use disorder, whether discounting predicts real-time alcohol use behaviors is unclear. Existing support comes from laboratory studies using intravenous alcohol self-administration methods, thus limiting ecological validity and generalizability. The present study evaluated whether delay discounting predicted real-time alcohol use in naturalistic settings with and without probabilistic negative consequences for consuming larger amounts of alcohol. METHODS This secondary analysis utilized data from three laboratory alcohol self-administration studies with young adults who engaged in frequent heavy drinking (N=206, 45% female). Participants completed a delay discounting measure before an alcohol self-administration session in an actual or simulated bar with (n=187) or without (n=19) probabilistic negative consequences (compensation loss) tied to performance on cognitive and psychomotor tasks after alcohol self-administration. Bootstrapped (unstandardized) coefficient estimates and 95% confidence intervals were utilized due to the sample size discrepancy. RESULTS Multiple regressions revealed that delay discounting did not significantly predict estimated blood alcohol concentration (eBAC) or number of drinks consumed when procedures included probabilistic negative consequences. Among participants who completed procedures without probabilistic negative consequences, delay discounting was positively associated with peak eBAC. CONCLUSION Counter to hypotheses, steeper delay discounting did not predict real-time alcohol use in contexts with probabilistic negative consequences, whereas preliminary evidence suggests that delay discounting predicts real-time alcohol use behaviors in contexts without probabilistic negative consequences. The specific discounting task may have impacted study findings, thus future research should consider how the sign (gain vs. loss), outcome certainty, and delay relate to alcohol consumption.
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Affiliation(s)
- Jillian M Rung
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA.
| | - Benjamin L Berey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA.
| | - Robert F Leeman
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA; Department of Health Sciences, School of Community Health and Behavioral Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
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Ingrasciotta Y, Spini A, L'Abbate L, Fiore ES, Carollo M, Ientile V, Isgrò V, Cavazzana A, Biasi V, Rossi P, Ejlli L, Belleudi V, Poggi F, Sapigni E, Puccini A, Ancona D, Stella P, Pollina Addario S, Allotta A, Leoni O, Zanforlini M, Tuccori M, Gini R, Trifirò G. Comparing clinical trial population representativeness to real-world users of 17 biologics approved for immune-mediated inflammatory diseases: An external validity analysis of 66,639 biologic users from the Italian VALORE project. Pharmacol Res 2024; 200:107074. [PMID: 38232909 DOI: 10.1016/j.phrs.2024.107074] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 01/19/2024]
Abstract
To date, no population-based studies have specifically explored the external validity of pivotal randomized clinical trials (RCTs) of biologics simultaneously for a broad spectrum of immuno-mediated inflammatory diseases (IMIDs). The aims of this study were, firstly, to compare the patients' characteristics and median treatment duration of biologics approved for IMIDs between RCTs' and real-world setting (RW); secondly, to assess the extent of biologic users treated for IMIDs in the real-world setting that would not have been eligible for inclusion into pivotal RCT for each indication of use. Using the Italian VALORE distributed database (66,639 incident biologic users), adult patients with IMIDs treated with biologics in the Italian real-world setting were substantially older (mean age ± SD: 50 ± 15 years) compared to those enrolled in pivotal RCTs (45 ± 15 years). In the real-world setting, certolizumab pegol was more commonly used by adult women with psoriasis/ankylosing spondylitis (F/M ratio: 1.8-1.9) compared to RCTs (F/M ratio: 0.5-0.6). The median treatment duration (weeks) of incident biologic users in RW was significantly higher than the duration of pivotal RCTs in almost all indications for use and most biologics (4-100 vs. 6-167). Furthermore, almost half (46.4%) of biologic users from RW settings would have been ineligible for inclusion in the respective indication-specific pivotal RCTs. The main reasons were: advanced age, recent history of cancer and presence of other concomitant IMIDs. These findings suggest that post-marketing surveillance of biologics should be prioritized for those patients.
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Affiliation(s)
- Ylenia Ingrasciotta
- University of Verona, Department of Diagnostics and Public Health, Verona, Italy
| | - Andrea Spini
- University of Verona, Department of Diagnostics and Public Health, Verona, Italy
| | - Luca L'Abbate
- University of Messina, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Messina, Italy
| | - Elena Sofia Fiore
- University of Verona, Department of Diagnostics and Public Health, Verona, Italy
| | - Massimo Carollo
- University of Verona, Department of Diagnostics and Public Health, Verona, Italy
| | - Valentina Ientile
- University of Verona, Department of Diagnostics and Public Health, Verona, Italy
| | - Valentina Isgrò
- University of Verona, Department of Diagnostics and Public Health, Verona, Italy
| | | | | | - Paola Rossi
- Direzione Centrale Salute Regione Friuli-Venezia Giulia, Trieste, Italy
| | - Lucian Ejlli
- Direzione Centrale Salute Regione Friuli-Venezia Giulia, Trieste, Italy
| | - Valeria Belleudi
- Lazio Regional Health Service, Department of Epidemiology, Rome, Italy
| | - Francesca Poggi
- Lazio Regional Health Service, Department of Epidemiology, Rome, Italy
| | - Ester Sapigni
- Emilia-Romagna Health Department, Hospital Assistance Service, Drug and Medical Device Area, Bologna, Italy
| | - Aurora Puccini
- Emilia-Romagna Health Department, Hospital Assistance Service, Drug and Medical Device Area, Bologna, Italy
| | | | | | | | - Alessandra Allotta
- Epidemiologic Observatory of the Sicily Regional Health Service, Palermo, Italy
| | - Olivia Leoni
- Lombardy Regional Centre of Pharmacovigilance and Regional Epidemiologic Observatory, Milan, Italy
| | | | - Marco Tuccori
- University Hospital of Pisa, Unit of Adverse Drug Reaction Monitoring, Italy
| | - Rosa Gini
- Agenzia Regionale di Sanità Toscana, Florence, Italy
| | - Gianluca Trifirò
- University of Verona, Department of Diagnostics and Public Health, Verona, Italy.
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4
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de Sousa K, van Etten J, Manners R, Abidin E, Abdulmalik RO, Abolore B, Acheremu K, Angudubo S, Aguilar A, Arnaud E, Babu A, Barrios M, Benavente G, Boukar O, Cairns JE, Carey E, Daudi H, Dawud M, Edughaen G, Ellison J, Esuma W, Mohammed SG, van de Gevel J, Gomez M, van Heerwaarden J, Iragaba P, Kadege E, Assefa TM, Kalemera S, Kasubiri FS, Kawuki R, Kidane YG, Kilango M, Kulembeka H, Kwadwo A, Madriz B, Masumba E, Mbiu J, Mendes T, Müller A, Moyo M, Mtunda K, Muzhingi T, Muungani D, Mwenda ET, Nadigatla GRVPR, Nanyonjo AR, N’Danikou S, Nduwumuremyi A, Nshimiyimana JC, Nuwamanya E, Nyirahabimana H, Occelli M, Olaosebikan O, Ongom PO, Ortiz-Crespo B, Oteng-Fripong R, Ozimati A, Owoade D, Quiros CF, Rosas JC, Rukundo P, Rutsaert P, Sibomana M, Sharma N, Shida N, Steinke J, Ssali R, Suchini JG, Teeken B, Tengey TK, Tufan HA, Tumwegamire S, Tuyishime E, Ulzen J, Umar ML, Onwuka S, Madu TU, Voss RC, Yeye M, Zaman-Allah M. The tricot approach: an agile framework for decentralized on-farm testing supported by citizen science. A retrospective. Agron Sustain Dev 2024; 44:8. [PMID: 38282889 PMCID: PMC10811175 DOI: 10.1007/s13593-023-00937-1] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/30/2024]
Abstract
Matching crop varieties to their target use context and user preferences is a challenge faced by many plant breeding programs serving smallholder agriculture. Numerous participatory approaches proposed by CGIAR and other research teams over the last four decades have attempted to capture farmers' priorities/preferences and crop variety field performance in representative growing environments through experimental trials with higher external validity. Yet none have overcome the challenges of scalability, data validity and reliability, and difficulties in capturing socio-economic and environmental heterogeneity. Building on the strengths of these attempts, we developed a new data-generation approach, called triadic comparison of technology options (tricot). Tricot is a decentralized experimental approach supported by crowdsourced citizen science. In this article, we review the development, validation, and evolution of the tricot approach, through our own research results and reviewing the literature in which tricot approaches have been successfully applied. The first results indicated that tricot-aggregated farmer-led assessments contained information with adequate validity and that reliability could be achieved with a large sample. Costs were lower than current participatory approaches. Scaling the tricot approach into a large on-farm testing network successfully registered specific climatic effects of crop variety performance in representative growing environments. Tricot's recent application in plant breeding networks in relation to decision-making has (i) advanced plant breeding lines recognizing socio-economic heterogeneity, and (ii) identified consumers' preferences and market demands, generating alternative breeding design priorities. We review lessons learned from tricot applications that have enabled a large scaling effort, which should lead to stronger decision-making in crop improvement and increased use of improved varieties in smallholder agriculture.
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Affiliation(s)
- Kauê de Sousa
- Digital Inclusion, Bioversity International, Montpellier, France
- Department of Agricultural Sciences, Inland Norway University of Applied Sciences, Hamar, Norway
| | - Jacob van Etten
- Digital Inclusion, Bioversity International, Montpellier, France
| | - Rhys Manners
- International Institute of Tropical Agriculture (IITA), Kigali, Rwanda
| | - Erna Abidin
- Reputed Agriculture 4 Development Stichting & Foundation, Kumasi, Ghana
| | - Rekiya O. Abdulmalik
- Department of Plant Science, Institute for Agricultural Research, Ahmadu Bello University, Zaria, 810211 Nigeria
| | - Bello Abolore
- International Institute of Tropical Agriculture (IITA), Ibadan, Nigeria
| | - Kwabena Acheremu
- Savanna Agricultural Research Institute, Council for Scientific and Industrial Research, Tamale, Ghana
| | | | - Amilcar Aguilar
- Centro Agronómico Tropical de Investigación y Enseñanza, Managua, Nicaragua
| | - Elizabeth Arnaud
- Digital Inclusion, Bioversity International, Montpellier, France
| | - Adventina Babu
- Tanzanian Agricultural Research Institute, Arusha, Tanzania
| | - Mirna Barrios
- Centro Agronómico Tropical de Investigación y Enseñanza, Managua, Nicaragua
| | - Grecia Benavente
- Digital Inclusion, Bioversity International, Montpellier, France
| | - Ousmane Boukar
- International Institute of Tropical Agriculture (IITA), Ibadan, Nigeria
| | - Jill E. Cairns
- International Maize and Wheat Improvement Center (CIMMYT), Harare, Zimbabwe
| | - Edward Carey
- Reputed Agriculture 4 Development Stichting & Foundation, Kumasi, Ghana
| | - Happy Daudi
- Tanzanian Agricultural Research Institute, Arusha, Tanzania
| | | | - Gospel Edughaen
- International Institute of Tropical Agriculture (IITA), Ibadan, Nigeria
| | | | - Williams Esuma
- National Crop Resources Research Institute, Kampala, Uganda
| | | | | | - Marvin Gomez
- Fundación para la Investigación Participativa con Agricultores de Honduras (FIPAH), La Ceiba, Atlántida Honduras
| | - Joost van Heerwaarden
- Department of Plant Sciences, Wageningen University and Research, Wageningen, The Netherlands
| | - Paula Iragaba
- National Crop Resources Research Institute, Kampala, Uganda
| | - Edith Kadege
- Tanzanian Agricultural Research Institute, Arusha, Tanzania
- School of Life Sciences and Bioengineering, The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Teshale M. Assefa
- Crops for Nutrition and Health, International Center for Tropical Agriculture (CIAT), Arusha, Tanzania
| | - Sylvia Kalemera
- Crops for Nutrition and Health, International Center for Tropical Agriculture (CIAT), Arusha, Tanzania
| | - Fadhili Salum Kasubiri
- Crops for Nutrition and Health, International Center for Tropical Agriculture (CIAT), Arusha, Tanzania
| | - Robert Kawuki
- National Crop Resources Research Institute, Kampala, Uganda
| | | | | | | | - Adofo Kwadwo
- Council for Scientific and Industrial Research-Crops Research Institute, Kumasi, Ghana
| | | | - Ester Masumba
- Tanzanian Agricultural Research Institute, Arusha, Tanzania
| | - Julius Mbiu
- Tanzanian Agricultural Research Institute, Arusha, Tanzania
| | | | - Anna Müller
- Digital Inclusion, Bioversity International, Montpellier, France
| | - Mukani Moyo
- International Potato Center (CIP), Nairobi, Kenya
| | - Kiddo Mtunda
- Tanzanian Agricultural Research Institute, Arusha, Tanzania
| | - Tawanda Muzhingi
- Department of Food, Bioprocessing and Nutrition Science, Raleigh, NC USA
| | - Dean Muungani
- International Institute of Tropical Agriculture (IITA), Ibadan, Nigeria
| | | | | | | | | | | | | | | | | | - Martina Occelli
- College of Agriculture and Life Sciences, Cornell University, Ithaca, NY USA
| | | | | | - Berta Ortiz-Crespo
- Crops for Nutrition and Health, International Center for Tropical Agriculture (CIAT), Arusha, Tanzania
| | - Richard Oteng-Fripong
- Savanna Agricultural Research Institute, Council for Scientific and Industrial Research, Tamale, Ghana
| | - Alfred Ozimati
- National Crop Resources Research Institute, Kampala, Uganda
| | - Durodola Owoade
- International Institute of Tropical Agriculture (IITA), Ibadan, Nigeria
| | - Carlos F. Quiros
- Digital Inclusion, Bioversity International, Montpellier, France
| | - Juan Carlos Rosas
- Genética y Fitomejoramiento, Escuela Agrícola Panamericana Zamorano, Tegucigalpa, Honduras
| | - Placide Rukundo
- Rwanda Agriculture and Animal Resources Development Board (RAB), Huye, Rwanda
| | - Pieter Rutsaert
- Sustainable Agrifood Systems, International Maize and Wheat Improvement Center (CIMMYT), Nairobi, Kenya
| | | | - Neeraj Sharma
- Tuberosum Technologies Inc., Broderick, Saskatchewan Canada
| | - Nestory Shida
- Tanzanian Agricultural Research Institute, Arusha, Tanzania
| | - Jonathan Steinke
- Digital Inclusion, Bioversity International, Montpellier, France
- Humboldt University Berlin, Berlin, Germany
| | - Reuben Ssali
- International Potato Center (CIP), Kampala, Uganda
| | | | - Béla Teeken
- International Institute of Tropical Agriculture (IITA), Ibadan, Nigeria
| | - Theophilus Kwabla Tengey
- Savanna Agricultural Research Institute, Council for Scientific and Industrial Research, Tamale, Ghana
| | - Hale Ann Tufan
- College of Agriculture and Life Sciences, Cornell University, Ithaca, NY USA
| | | | | | - Jacob Ulzen
- Digital Inclusion, Bioversity International, Montpellier, France
- Forest and Horticultural Crops Research Center, University of Ghana, Accra, Ghana
| | | | - Samuel Onwuka
- National Root Crops Research Institute, Umudike, Nigeria
| | - Tessy Ugo Madu
- National Root Crops Research Institute, Umudike, Nigeria
| | - Rachel C. Voss
- Sustainable Agrifood Systems, International Maize and Wheat Improvement Center (CIMMYT), Nairobi, Kenya
| | - Mary Yeye
- Institute for Agricultural Research (IAR), ABU, Zaria, Nigeria
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Nérette P, Brown E, Gautam R, Paré J, Wagener A. A new methodology to extrapolate disease freedom to an area using surveillance results from selected aquatic populations. Prev Vet Med 2023; 220:106029. [PMID: 37813052 DOI: 10.1016/j.prevetmed.2023.106029] [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: 10/14/2022] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023]
Abstract
According to Chapter 1.4 of the World Organisation for Animal Health (WOAH) Aquatic Animal Health Code, an entire country or zone can be classified as free of a disease only if there is compelling evidence that all susceptible populations within the country or zone are free. However, the methods for achieving freedom are not prescribed in the WOAH standards and guidelines. Within this context, this paper describes a novel methodology to determine if surveillance results can be extrapolated from a study population to a target population. A framework of six criteria was developed to standardize a method for extrapolating surveillance results to other susceptible populations that have not been sampled. Criteria 1 assesses the internal validity for the freedom claim on the source population. Criteria 2 assesses which other susceptible populations have a non-negligible probability of exposure. Criteria 3 assesses whether the risk of infection upon exposure of the source population is the same or greater than each of the other susceptible populations. Finally, Criteria 4, 5 and 6 assess if the other susceptible populations would transmit the infection to the source population or if they have the same exposure pathways as the source population. We illustrate the use of this novel methodology using two hypothetical case scenarios. The presented methodology has the advantage of being applicable either retrospectively or prospectively. When applied retrospectively, it can be used to assess if the surveillance results of the source population can be extrapolated to the target population. When applied prospectively it can be used to design a more efficient surveillance system by selecting source populations from which it is easier to extrapolate surveillance results to the rest of the target population. Conclusions drawn using this methodology depend on the validity of the assumptions made when working through the methodology. We therefore recommend cautious application of the criteria and thorough review of all assumptions.
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Affiliation(s)
- Pascale Nérette
- Animal Health Epidemiology, Surveillance & Laboratory Services, Canadian Food Inspection Agency, 3225 Cusson Avenue, Saint-Hyacinthe, Quebec J2S 0H7, Canada.
| | - Emily Brown
- Animal Health Epidemiology, Surveillance & Laboratory Services, Canadian Food Inspection Agency, 1400 Merivale Road, Ottawa, Ontario K1A 0Y9, Canada
| | - Raju Gautam
- Animal Health Strategic Planning & Research, Canadian Food Inspection Agency, 1400 Merivale Road, Ottawa, Ontario K1A 0Y9, Canada
| | - Julie Paré
- Animal Health Epidemiology, Surveillance & Laboratory Services, Canadian Food Inspection Agency, 3200 Sicotte St., P.O. Box 5000, Saint-Hyacinthe, Quebec J2S 7C6, Canada
| | - Annie Wagener
- Animal Health Strategic Planning & Research, Canadian Food Inspection Agency, 1400 Merivale Road, Ottawa, Ontario K1A 0Y9, Canada
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Torres G, Gradidge P. The quality and pattern of rehabilitation interventions prescribed for post-COVID-19 infection patients: A systematic review and meta-analysis. Prev Med Rep 2023; 35:102395. [PMID: 37705882 PMCID: PMC10495653 DOI: 10.1016/j.pmedr.2023.102395] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
Patients with prior COVID-19 infection may present with lasting multisystem symptoms that require intervention and includes exercise rehabilitation. The aim of this systematic review was to investigate the quality of articles, with emphasis on exercise rehabilitation, and conduct a meta-analysis on experimental and observational rehabilitation intervention studies on cardiorespiratory fitness and pulmonary function in post-COVID-19 infection patients. This systematic review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines for evaluating rehabilitation interventions in clinical practice. A methodical search of cohort and experimental studies occurred from January 2019 up to March 2023. Thirty-two studies were included for complete analysis. The quality of the eligible studies for complete review was fair overall. The studies did not provide a detailed account of key descriptors of exercise such as volume, progression, motivational strategies, adherence and replication. There was a significant difference in the 6-minute walk test (Mean difference (MD) = 51.69 m; confidence intervals (CIs) = 36.99 to 66.38; p < 0.001, level of heterogeneity (I2) = 0), percent of predicted forced expiratory volume in one second (MD = 7.95%; CIs = 3.46 to 12.44; p = 0.0005, I2 = 65%) and percent of predicted forced vital capacity (MD = 3.49%; 95% CI = 1.25 to 5.73; p = 0.002; I2 = 37%) between the experiment and control groups. The current evidence suggests that rehabilitation interventions significantly improve cardiorespiratory fitness and pulmonary function in post-COVID-19 infection patients; however, there is a need for conceptualising high-quality and long-term rehabilitation interventions, especially exercise interventions.
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Affiliation(s)
- G. Torres
- Department of Exercise Science and Sports Medicine, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - P.J. Gradidge
- Department of Exercise Science and Sports Medicine, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
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7
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Buckley PR, Murry VM, Gust CJ, Ladika A, Pampel FC. Racial and Ethnic Representation in Preventive Intervention Research: a Methodological Study. Prev Sci 2023; 24:1261-1274. [PMID: 37386352 DOI: 10.1007/s11121-023-01564-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/01/2023]
Abstract
Individuals who are Asian or Asian American, Black or African American, Native American or American Indian or Alaska Native, Native Hawaiian or Pacific Islander, and Hispanic or Latino (i.e., presently considered racial ethnic minoritized groups in the USA) lacked equal access to resources for mitigating risk during COVID-19, which highlighted public health disparities and exacerbated inequities rooted in structural racism that have contributed to many injustices, such as failing public school systems and unsafe neighborhoods. Minoritized groups are also vulnerable to climate change wherein the most severe harms disproportionately fall upon underserved communities. While systemic changes are needed to address these pervasive syndemic conditions, immediate efforts involve examining strategies to promote equitable health and well-being-which served as the impetus for this study. We conducted a descriptive analysis on the prevalence of culturally tailored interventions and reporting of sample characteristics among 885 programs with evaluations published from 2010 to 2021 and recorded in the Blueprints for Healthy Youth Development registry. Inferential analyses also examined (1) reporting time trends and (2) the relationship between study quality (i.e., strong methods, beneficial effects) and culturally tailored programs and racial ethnic enrollment. Two percent of programs were developed for Black or African American youth, and 4% targeted Hispanic or Latino populations. For the 77% of studies that reported race, most enrollees were White (35%) followed by Black or African American (28%), and 31% collapsed across race or categorized race with ethnicity. In the 64% of studies that reported ethnicity, 32% of enrollees were Hispanic or Latino. Reporting has not improved, and there was no relationship between high-quality studies and programs developed for racial ethnic youth, or samples with high proportions of racial ethnic enrollees. Research gaps on racial ethnic groups call for clear reporting and better representation to reduce disparities and improve the utility of interventions.
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Affiliation(s)
- Pamela R Buckley
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, USA.
| | - Velma McBride Murry
- Departments of Health Policy & Human and Organizational Development, Vanderbilt University Medical Center and Vanderbilt University, Nashville, USA
| | - Charleen J Gust
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, USA
| | - Amanda Ladika
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, USA
| | - Fred C Pampel
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, USA
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Boddez Y, Scheveneels S, Van Dessel P. Let's play pretend: Towards effective modelling in experimental psycho(patho)logy. J Behav Ther Exp Psychiatry 2023; 80:101809. [PMID: 37247975 DOI: 10.1016/j.jbtep.2022.101809] [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: 03/03/2022] [Revised: 10/12/2022] [Accepted: 11/12/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Models are omnipresent in science. We introduce a novel framework to achieve more effective modelling practices in general psychology and experimental psychopathology. METHOD We analyze three types of models that are common in psychology: laboratory models, computational models, and cognitive models. We then evaluate two common ways to assess the translational value of models (phenomenological similarity and deep similarity) as well as an arguably underappreciated way (functional similarity). Functional similarity is based on an assessment of whether variables (e.g., the administration of a pharmacological substance) have a similar effect (a) in the model (e.g., in a fear conditioning procedure) and (b) on the real-life target phenomenon (e.g., on real-life anxiety complaints). CONCLUSIONS We argue that the assessment of functional similarity is a powerful tool to assess the translational value of models in the field of experimental psychopathology and beyond.
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Affiliation(s)
- Yannick Boddez
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium.
| | - Sara Scheveneels
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, the Netherlands; Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
| | - Pieter Van Dessel
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
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9
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Schepers AM, Schorrlepp L, de Vries JD, de Kloe T, van der Linden D, Bijleveld E. Revisiting the link between the sustained attention to response task (SART) and daily-life cognitive failures. Conscious Cogn 2023; 114:103558. [PMID: 37657361 DOI: 10.1016/j.concog.2023.103558] [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: 01/12/2023] [Revised: 07/12/2023] [Accepted: 08/09/2023] [Indexed: 09/03/2023]
Abstract
In this study, we examined the relationship betweenerrors of commissionon theSustained Attention to Response Task(SART)andscores on the Cognitive Failures Questionnaire (CFQ). The goal was to assess theecological validity of the SARTin a sample of people scoring high on fatigue complaints.SART errors of commission were positively associated with CFQ scores and this finding remained after controlling for fatigue level, age, and SART reaction times.Thus, our results generally supported the ecological validity of the SART. However, when examining subsamples separately, we found the association between SART and CFQ only in our subsample of employees, not in our subsample of university students. The three subscales of the CFQ showed the same pattern of findings. Our results imply that, when using the SART to draw conclusions about everyday life, it is crucial to consider the characteristics of one's sample and control for relevant confounding variables.
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Affiliation(s)
- Annika M Schepers
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands.
| | - Leonie Schorrlepp
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands.
| | - Juriena D de Vries
- Department of Health, Medical and Neuropsychology, Leiden University, Leiden, the Netherlands.
| | - Tamara de Kloe
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Nijmegen, the Netherlands; Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands.
| | - Dimitri van der Linden
- Department of Psychology, Education, and Child Studies, Erasmus University, Rotterdam, the Netherlands.
| | - Erik Bijleveld
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands.
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10
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Ong SWX, Tong SYC, Daneman N. Are we enrolling the right patients? A scoping review of external validity and generalizability of clinical trials in bloodstream infections. Clin Microbiol Infect 2023:S1198-743X(23)00402-0. [PMID: 37633330 DOI: 10.1016/j.cmi.2023.08.019] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/15/2023] [Accepted: 08/20/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Having a representative population in randomized clinical trials (RCTs) improves external validity and generalizability of trial results. There are limited data examining differences between RCT-enrolled and real-world populations in bloodstream infections (BSI). OBJECTIVES We conducted a scoping review aiming to review studies assessing generalizability of BSI RCT populations, to identify sub-groups that have been systematically under-represented and to explore approaches to improve external validity of future RCTs. SOURCES MEDLINE, Embase, and Cochrane Library databases were searched for terms related to external validity or generalizability, BSI, and clinical trials in papers published up to 1 August 2023. Studies comparing enrolled versus nonenrolled patients, or papers discussing external validity or generalizability in the context of BSI RCTs were included. CONTENT Sixteen papers were included in the final review. Five compared RCT-enrolled and nonenrolled participants from the same source population. There were significant differences between the two groups in all studies, with nonenrolled patients having a greater comorbidity burden and consistently worse outcomes including mortality. We identified several barriers to improving generalizability of RCT populations and outlined potential approaches to reduce these barriers, such as alternative/simplified consent processes, streamlining eligibility criteria and follow-up procedures, quota-based sampling techniques, and ensuring diversity in site and study team selection. IMPLICATIONS Study cohorts in BSI RCTs are not representative of the general BSI patient population. As we increasingly adopt large pragmatic trials in infectious diseases, it is important to recognize the importance of maximizing generalizability to ensure that our research findings are of direct relevance to our patients.
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Affiliation(s)
- Sean W X Ong
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; Sunnybrook Health Sciences Centre, Toronto, Canada.
| | - Steven Y C Tong
- Department of Infectious Diseases, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Nick Daneman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
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11
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Missiou A, Ntalaouti E, Lionis C, Evangelou E, Tatsioni A. Underreporting contextual factors preclude the applicability appraisal in primary care randomized controlled trials. J Clin Epidemiol 2023; 160:24-32. [PMID: 37311513 DOI: 10.1016/j.jclinepi.2023.06.005] [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: 10/24/2022] [Revised: 05/21/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To assess applicability reporting in randomized controlled trials (RCTs) conducted in primary care (PC). STUDY DESIGN AND SETTING We used a random sample of PC RCTs published between 2000 and 2020 to assess applicability. We extracted data related to setting, population, intervention (including implementation), comparator, outcomes, and context. Based on data availability, we assessed whether the five predefined applicability questions were adequately addressed by each PC RCT. RESULTS Adequately described elements that were reported frequently (>50%) included the responsible organization for intervention provision (97, 93.3%), study population characteristics (94, 90.4%), intervention implementation including monitoring and evaluation (92, 88.5%), intervention components (89, 85.6%), time frame (82, 78.8%), baseline prevalence (58, 55.8%), and the type of setting and location (53, 51%). Elements that were often underreported included contextual factors, that is, evidence of differential effects across sociodemographic or other groupings (2, 1.9%), intervention components tailored for specific settings (7, 6.7%), health system structure (32, 30.8%), factors affecting implementation (40, 38.5%) and organization structure (50, 48.1%). The proportion of trials that adequately addressed each applicability question ranged between 1% and 20.2%, while none RCT could address all of them. CONCLUSION Underreporting contextual factors jeopardize the appraisal of applicability in PC RCTs.
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Affiliation(s)
- Aristea Missiou
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleni Ntalaouti
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete, Greece; Department of Health, Medicine and Care, General Practice, Linköping University, Linköping, Sweden
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece; Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
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12
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Bai X, Zeng P, Wang B, Zhang Z, Jin X, Kang Y, Cheng Y, Wu Q. Disparities between randomized clinical trial participants and sepsis patients in real-world. J Crit Care 2023; 77:154362. [PMID: 37413841 DOI: 10.1016/j.jcrc.2023.154362] [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: 03/27/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The external validity or "generalizability" of randomized controlled trials (RCTs) often needs be considered when making treatment decisions. We evaluate whether participants in large multicenter RCTs investigating sepsis were similar in age, disease severity, comorbidities, and mortality to the general population of sepsis patients. METHODS Using MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials, RCTs that enrolled 100 or more adult sepsis patients from two or more sites published from 01 January 2000 to 04 August 2019 were identified. The weighted mean age of trial participants was calculated as the main variable, and it was compared with the mean ages of the overall populations derived from the MIMIC database and the EICU database. Two researchers independently screened all abstracts and performed data extraction, then aggregated the data using a random effects model. Multiple linear regression was used to determine whether any factors were significantly associated with age disparities. RESULTS The mean age of the 60,577 participants in the 94 trials included in the analysis was significantly lower than those of the patients in the MIMIC and EICU databases (weighted mean age 62.28 years vs. 64.47 years for MIMIC and 65.20 years for EICU; both p < 0.001). Trial participants were less likely to have known comorbidities such as diabetes (13.96% vs. 30.64% for MIMIC and 35.75% for EICU; both p < 0.001). The weighted mortality rate in trial participants was higher than that in patients in the MIMIC and EICU databases (29.33% vs. 20.72% for MIMIC and 17.53% for EICU; both p < 0.001). Differences in age, severity score, and comorbidities remained statistically significant in sensitivity analyses. Multivariable regression suggested that commercially supported trials were more likely to include patients with higher severity scores (p = 0.002), but after adjustment for study region and sepsis diagnosis inclusion in such trials was not significantly associated with age. CONCLUSIONS On average, trial participants were younger than the general sepsis patient population. Commercial support influenced patient selection. Efforts to understand and address the above-described patient disparities are necessary to improve the generalizability of RCT results. TRIAL REGISTRATION PROSPERO CRD42019145692.
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Affiliation(s)
- Xue Bai
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Peng Zeng
- Department of Rehabilitation Medicine, West China Hospital,Sichuan University, Chengdu, China
| | - Bo Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhongwei Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaodong Jin
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yisong Cheng
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
| | - Qin Wu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
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13
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Goldkuhle M, Guyatt GH, Kreuzberger N, Akl EA, Dahm P, van Dalen EC, Hemkens LG, Klugar M, Mustafa RA, Nonino F, Schünemann HJ, Trivella M, Skoetz N. GRADE concept 4: rating the certainty of evidence when study interventions or comparators differ from PICO targets. J Clin Epidemiol 2023; 159:40-48. [PMID: 37146659 DOI: 10.1016/j.jclinepi.2023.04.018] [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: 01/11/2023] [Revised: 04/13/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVES This Grading of Recommendations Assessment, Development and Evaluation (GRADE) concept article offers systematic reviewers, guideline authors, and other users of evidence assistance in addressing randomized trial situations in which interventions or comparators differ from those in the target people, interventions, comparators, and outcomes. To clarify what GRADE considers under indirectness of interventions and comparators, we focus on a particular example: when comparator arm participants receive some or all aspects of the intervention management strategy (treatment switching). STUDY DESIGN AND SETTING An interdisciplinary panel of the GRADE working group members developed this concept article through an iterative review of examples in multiple teleconferences, small group sessions, and e-mail correspondence. After presentation at a GRADE working group meeting in November 2022, attendees approved the final concept paper, which we support with examples from systematic reviews and individual trials. RESULTS In the presence of safeguards against risk of bias, trials provide unbiased estimates of the effect of an intervention on the people as enrolled, the interventions as implemented, the comparators as implemented, and the outcomes as measured. Within the GRADE framework, differences in the people, interventions, comparators, and outcomes elements between the review or guideline recommendation targets and the trials as implemented constitute issues of indirectness. The intervention or comparator group management strategy as implemented, when it differs from the target comparator, constitutes one potential source of indirectness: Indirectness of interventions and comparators-comparator group receipt of the intervention constitutes a specific subcategory of said indirectness. The proportion of comparator arm participants that received the intervention and the apparent magnitude of effect bear on whether one should rate down, and if one does, to what extent. CONCLUSION Treatment switching and other differences between review or guideline recommendation target interventions and comparators vs. interventions and comparators as implemented in otherwise relevant trials are best considered issues of indirectness.
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Affiliation(s)
- Marius Goldkuhle
- Evidence-based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, Michael G DeGroote Cochrane Canada Centre, Cochrane Canada, McMaster GRADE Centre and Department of Medicine, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4K1, Canada
| | - Nina Kreuzberger
- Evidence-based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Lebanon, P.O.Box 11-0236 and Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4K1, Canada
| | - Philipp Dahm
- Minneapolis VA Health Care System, Urology Section 112D, One Veterans Drive, Minneapolis, Minnesota 55417
| | - Elvira C van Dalen
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS Utrecht, the Netherlands
| | - Lars G Hemkens
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland; Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, 100 00 Prague, Czech Republic
| | - Reem A Mustafa
- Department of Medicine and Population Health, University of Kansas Health System, 3901 Rainbow Blvd, MS3002, Kansas City, KS 66160, USA; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. W., Hamilton, Ontario L8S 4K1, Canada
| | - Francesco Nonino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Epidemiology and Statistics, Cochrane Review Group Multiple Sclerosis and Rare Diseases of the CNS, Via Altura 3, 40139 Bologna, Italy
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, Michael G DeGroote Cochrane Canada Centre, Cochrane Canada and McMaster GRADE Centre, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Biomedical Sciences, Humanitas University, Milan, Italy; Cochrane Canada, Hamilton, Ontario, Canada
| | - Marialene Trivella
- Department of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, UK; Department of Population Health, London School of Hygiene and Tropical Medicine, London
| | - Nicole Skoetz
- Evidence-based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
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14
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Chen X, Zhou H, Gao J, Shi Y, Yu J, Zhang Y. External validation of postoperative nausea and vomiting risk scores in patients with liver cancer: A single-centre prospective cohort study. Eur J Oncol Nurs 2023; 65:102350. [PMID: 37321132 DOI: 10.1016/j.ejon.2023.102350] [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: 03/09/2023] [Revised: 05/01/2023] [Accepted: 05/21/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES This study aimed to test the external validity of postoperative nausea and vomiting (PONV) risk assessment tools in patients undergoing hepatectomy, and to guide healthcare professionals' assessment of postoperative patients. BACKGROUND The identification of PONV risk is particularly important in the context of prevention. However, the predictive performance of the current PONV risk scores has not been confirmed in patients with liver cancer, and its applicability is still unknown. These uncertainties pose difficulties in performing routine risk assessment of PONV for patients with liver cancer in a clinical practice setting. METHODS Patients diagnosed with liver cancer and undergoing hepatectomy were prospectively consecutively recruited. All enrolled patients received PONV assessments and PONV risk assessments via the Apfel risk score and the Koivuranta risk score. Receiver operating characteristic curves (ROC curves) and calibration curves were used to assess the external validity. This study was reported according to the TRIPOD Checklist. RESULTS Among 214 PONV-assessed patients, 114 patients (53.3%) developed PONV. For the Apfel simplified risk score, the ROC area was 0.612 (95% confidence interval [CI]: 0.543-0.678) in the validation dataset, which demonstrated imperfect discrimination; the calibration curve showed poor calibration with a slope of 0.49. For the Koivuranta score, the ROC area was 0.628 (CI: 0.559-0.693) in the validation dataset, which showed limited discrimination; the calibration curve indicated an unsatisfactory calibration with a slope of 0.71. CONCLUSIONS The Apfel risk score and the Koivuranta risk score were not well validated in our study and disease-specific risk factors should be taken into account when updating or developing PONV risk stratification instruments.
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Affiliation(s)
- Xiao Chen
- Department of Nursing, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.
| | - Haiying Zhou
- Department of Nursing, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.
| | - Jian Gao
- Department of Biostatistics, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.
| | - Yinghong Shi
- Department of Liver Disease, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.
| | - Jingxian Yu
- Department of Nursing, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.
| | - Yuxia Zhang
- Department of Nursing, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.
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15
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Webster-Clark M, Keil AP. How Effect Measure Choice Influences Minimally Sufficient Adjustment Sets for External Validity. Am J Epidemiol 2023:7051039. [PMID: 36813295 DOI: 10.1093/aje/kwad041] [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: 05/03/2022] [Revised: 12/01/2022] [Accepted: 02/21/2023] [Indexed: 02/24/2023] Open
Abstract
Epidemiologic researchers generalizing or transporting effect estimates from a study to a target must account for effect measure modifiers (EMMs) on the scale of interest. Little attention is paid to how the EMMs required may vary depending on the mathematical nuances of each effect measure, however. We defined two types of EMM: marginal EMM, where the effect on the scale of interest differs across levels of a variable; and conditional EMM, where the effect differs conditional on other variables associated with the outcome. These types define three classes of variables: Class 1 (conditional EMM), Class 2 (marginal, but not conditional, EMM), or Class 3 (neither marginal nor conditional EMM). Class 1 variables are necessary to achieve a valid estimate of the RD in a target, while a RR requires Class 1 and Class 2 and an OR requires Class 1, Class 2, and Class 3 (i.e., all variables associated with the outcome). This does not mean that fewer variables are required for an externally valid RD (because variables may not modify effects on all scale) but does suggest researchers should consider the scale of the effect measure when identifying EMM necessary for an externally valid treatment effect estimate.
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Affiliation(s)
- Michael Webster-Clark
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC.,Department of Epidemiology, Gillings Schools of Global Public Health, UNC Chapel Hill, NC
| | - Alexander P Keil
- Department of Epidemiology, Gillings Schools of Global Public Health, UNC Chapel Hill, NC
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16
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Bosmani C, Carboni S, Samer C, Lovis C, Perneger T, Huttner A, Hirschel B. REPRESENT: REPresentativeness of RESearch data obtained through the 'General Informed ConsENT'. BMC Med Ethics 2023; 24:10. [PMID: 36782161 PMCID: PMC9926654 DOI: 10.1186/s12910-022-00877-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/15/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND We assessed potential consent bias in a cohort of > 40,000 adult patients asked by mail after hospitalization to consent to the use of past, present and future clinical and biological data in an ongoing 'general consent' program at a large tertiary hospital in Switzerland. METHODS In this retrospective cohort study, all adult patients hospitalized between April 2019 and March 2020 were invited to participate to the general consent program. Demographic and clinical characteristics were extracted from patients' electronic health records (EHR). Data of those who provided written consent (signatories) and non-responders were compared and analyzed with R studio. RESULTS Of 44,819 patients approached, 10,299 (23%) signed the form. Signatories were older (median age 54 [IQR 38-72] vs. 44 years [IQR 32-60], p < .0001), more comorbid (2614/10,299 [25.4%] vs. 4912/28,676 [17.1%] with Charlson comorbidity index ≤ 4, p < .0001), and more often of Swiss nationality (6592/10,299 [64%] vs. 13,813/28,676 [48.2%], p < .0001). CONCLUSIONS Our results suggest that actively seeking consent creates a bias and compromises the external validity of data obtained via 'general consent' programs. Other options, such as opt-out consent procedures, should be further assessed.
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Affiliation(s)
- Cristina Bosmani
- Faculty of Medicine, Clinical Research Center, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Sonia Carboni
- grid.150338.c0000 0001 0721 9812Faculty of Medicine, Clinical Research Center, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Caroline Samer
- grid.150338.c0000 0001 0721 9812Clinical Pharmacology and Toxicology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Christian Lovis
- grid.150338.c0000 0001 0721 9812Division of Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Perneger
- grid.150338.c0000 0001 0721 9812Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | - Angela Huttner
- grid.150338.c0000 0001 0721 9812Faculty of Medicine, Clinical Research Center, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Faculty of Medicine, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Bernard Hirschel
- Health Department of the Canton of Geneva, Geneva Cantonal Ethics Commission, Geneva, Switzerland
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17
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Turjeman A, Koppel F, Franceschini E, Yahav D, Dolci G, Bacca E, Babich T, Khazem E, Baum E, Nassar R, Bitterman R, Dishon-Benatta Y, Hassoun-Kheir N, Santoro A, Eliakim-Raz N, Poran I, Pertzov B, Stern A, Dickstein Y, Maroun E, Raines M, Meschiari M, Bishara J, Goldberg E, Venturelli C, Sarti M, Mussini C, Paul M, Leibovici L. External Validity of a Randomized Controlled Trial on Duration of Antibiotics for the Treatment of Gram-Negative Bacteremia. Gerontology 2023; 69:312-320. [PMID: 36273449 DOI: 10.1159/000526480] [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: 03/24/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Reports regarding the external validity of randomized controlled trials (RCTs) are scarce. We aimed to assess the population external validity of an investigator-initiated RCT on the duration of antibiotics for the treatment of Gram-negative bacteremia by comparing patients included in the RCT to patients that were not included in the trial. METHODS Hospitalized patients with Gram-negative bacteremia were recruited into an RCT and randomized to receive 7 or 14 days of covering antibiotic therapy in Israel and Italy from 2013 to 2017. In a concomitant observational study, RCT participants were compared with patients who fulfilled the inclusion criteria but were not included in the trial due to participation in other trials, discharge before approached by researchers, refusal to participate, or unwillingness of the treating physician to allow participants' recruitment. RESULTS Six hundred and four RCT patients were compared with 613 nonincluded patients. Almost 50% of nonincluded patients (288/613) were dependent on others for activities of daily living at baseline compared to 37.7% of RCT participants (228/604). Dementia was nearly 2-fold more frequent in nonincluded patients than those included (5.9% [36/613] versus 3.6% [22/604], p = 0.07). Patients who were not included in the RCT were more likely to acquire their infection in the hospital (53.3% [327/613] versus 29.1% [176/604], p < 0.001). The primary composite outcome of mortality, clinical failure, readmissions, or extended hospitalization at 90 days occurred in 353 of 613 nonincluded patients (57.6%) compared to 299 of 604 RCT participants (49.6%), p = 0.005. However, on multivariate analysis noninclusion in the RCT was not an independent risk factor for clinical failure and mortality. CONCLUSIONS RCTs, even with broad eligibility criteria, do not represent the whole spectrum of patients and leave out a population with more severe illness for whom the evidence is lacking.
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Affiliation(s)
- Adi Turjeman
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Fidi Koppel
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Erica Franceschini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Giovanni Dolci
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Erica Bacca
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Tanya Babich
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ebtehal Khazem
- Department of Internal Medicine H, Rambam Health Care Campus, Haifa, Israel
| | - Eyal Baum
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Rima Nassar
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Roni Bitterman
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Yael Dishon-Benatta
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Antonella Santoro
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Noa Eliakim-Raz
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itamar Poran
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Barak Pertzov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pulmonary Division, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Anat Stern
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Yaakov Dickstein
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Elias Maroun
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Marina Raines
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Marianna Meschiari
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Jihad Bishara
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Elad Goldberg
- Department of Medicine F, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Claudia Venturelli
- Clinical Microbiology Lab, University of Modena and Reggio Emilia, Modena, Italy
| | - Mario Sarti
- Clinical Microbiology Lab, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Leonard Leibovici
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Khan KS, Bueno Cavanillas A, Zamora J. [Systematic reviews in five steps: V. Interpreting the findings]. Semergen 2023; 49:101854. [PMID: 36410229 DOI: 10.1016/j.semerg.2022.101854] [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: 07/05/2022] [Revised: 09/10/2022] [Accepted: 09/17/2022] [Indexed: 11/19/2022]
Abstract
The last step in a systematic review is the interpretation of the findings. The important findings need to be explicitly identified. A level of strength of evidence should be assigned to support each key finding, based on factors such as study design, methodological quality and risk of publication bias. Variations in the magnitude of associations observed also need to be explored. The aim of this analysis is to determine in which clinical groups the intervention is more or less effective, the impact of exposure is greater or lesser, or a diagnostic test is more useful. At this stage, for better interpretation of the findings, the magnitude of the association can be estimated either globally or stratified according to the characteristics of the participants. All this is helpful in formulating recommendations for clinical practice and policy.
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Affiliation(s)
- K S Khan
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - A Bueno Cavanillas
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España.
| | - J Zamora
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, Madrid, España; Institute of Metabolism and Systems Research, Universidad de Birmingham, Birmingham, Reino Unido
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19
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Antequera A, Cuadrado-Conde MA, Roy-Vallejo E, Montoya-Martínez M, León-García M, Madrid-Pascual O, Calderón-Larrañaga S. Lack of sex-related analysis and reporting in Cochrane Reviews: a cross-sectional study. Syst Rev 2022; 11:281. [PMID: 36572932 PMCID: PMC9791738 DOI: 10.1186/s13643-021-01867-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/02/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Sex-specific analysis and reporting may allow a better understanding of intervention effects and can support the decision-making process. Well-conducted systematic reviews (SRs), like those carried out by the Cochrane Collaboration, provide clinical responses transparently and stress gaps of knowledge. This study aimed to describe the extent to which sex is analysed and reported in a cross-section of Cochrane SRs of interventions, and assess the association with the gender of main authorships. METHODS We searched SRs published during 2018 within the Cochrane Database of Systematic Reviews. An investigator appraised the sex-related analysis and reporting across sections of SRs and collected data on gender and country of affiliation of the review first and last authors, and a second checked for accuracy. We conducted descriptive statistics and bivariate logistic regression to explore the association between the gender of the authors and sex-related analysis and reporting. RESULTS Six hundred and ten Cochrane SRs were identified. After removing those that met no eligibility criteria, 516 reviews of interventions were included. Fifty-six reviews included sex-related reporting in the abstract, 90 considered sex in their design, 380 provided sex-disaggregated descriptive data, 142 reported main outcomes or performed subgroup analyses by sex, and 76 discussed the potential impact of sex or the lack of such on the interpretations of findings. Women represented 53.1 and 42.2% of first and last authorships, respectively. Women authors (in first and last position) had a higher possibility to report sex in at least one of the review sections (OR 2.05; CI 95% 1.12-3.75, P=0.020) than having none. CONCLUSIONS Sex consideration amongst Cochrane SRs was frequently missing. Structured guidance to sex-related analysis and reporting is needed to enhance the external validity of findings. Likewise, including gender diversity within the research workforce and relevant authorship positions may foster equity in the evidence generated.
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Affiliation(s)
- Alba Antequera
- Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | | | - Emilia Roy-Vallejo
- Internal Medicine Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - María Montoya-Martínez
- Servicio Murciano de Salud, Coordinación Estratégica para la Cronicidad Avanzada y Atención Sociosanitaria, Murcia, Spain
| | - Montserrat León-García
- Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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20
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Huls SPI, de Bekker-Grob EW. Can healthcare choice be predicted using stated preference data? The role of model complexity in a discrete choice experiment about colorectal cancer screening. Soc Sci Med 2022; 315:115530. [PMID: 36434890 DOI: 10.1016/j.socscimed.2022.115530] [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: 04/21/2022] [Revised: 10/17/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The validity of discrete choice experiments (DCEs) is crucial to its usage in healthcare decision-making, but there is only a limited number of health contexts in which external validity is demonstrated. This study aims to assess the internal and external validity of the DCE in the context of colorectal cancer (CRC) screening, and gather insights into the discrepancy between stated and revealed preferences. METHODS Stated and revealed preferences were elicited on an individual level from Dutch residents eligible for CRC screening in a DCE and a field experiment, respectively (N = 568). To identify the determinants of CRC screening participation and their relative importance, five random utility maximisation models that varied in complexity were used. We assessed the accuracy with which the models based on stated preferences predict individual-level screening choice in a holdout task (internal validity) and in the actual screening choice (external validity). Insights into the discrepancy between stated and revealed preferences were gathered by comparing groups of respondents. RESULTS Our findings show high internal and external validity. Choices could be accurately predicted for 95% of the respondents in the holdout task, and 90% in the actual screening choice. When scale and preference heterogeneity were taken into account model fit improved; individual-level prediction accuracy slightly increased for the holdout task but not for the actual screening choice. Respondents for whom stated preferences matched revealed preferences were generally in better health and found the GP's support for their screening decision more important. DISCUSSION Evidence was found that revealed preferences can be predicted accurately on an individual level. Incorporating heterogeneity improved internal validity but not external validity. Differences between stated and revealed preferences can be attributed to respondents' health and the support of their GP. We suggest researchers to continue investigating the internal and external validity of discrete choice experiments, and the role of model complexity.
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Affiliation(s)
- Samare P I Huls
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, the Netherlands.
| | - Esther W de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, the Netherlands
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21
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Yang MJ, Borges AM, Emery NN, Leyro TM. Trial-level bias score versus mean bias score: Comparison of the reliability and external validity using dot-probe task among daily smokers. Addict Behav 2022; 135:107456. [PMID: 35944381 PMCID: PMC10757633 DOI: 10.1016/j.addbeh.2022.107456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/08/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Attentional bias (AB) is an individual difference risk factor that represents the extent to which cigarette cues capture one's attention. AB is typically indexed by mean bias score (MBS), theoretically assuming that AB is static. However, poor reliability of MBS has threatened valid interpretation of the results on AB. Based on observed trial-by-trial temporal fluctuation and variability of attentional allocation, trial-level bias score (TLBS) has been introduced as an alternative index with evidence of better psychometric properties in various populations, as compared to MBS. However, such evidence is limited among daily smokers. The current study aimed to replicate and extend extant findings in a sample of daily smokers by hypothesizing that TLBS, as compared to MBS, would demonstrate superior reliability and external validity. METHODS Forty-eight daily smokers completed self-reports, ad-libitum smoking, and a dot-probe task three times, which was comprised of 36 pairs of pictorial stimuli of cigarette and neutral cues, yielding 144 total trials. RESULTS The TLBS demonstrated superior internal (range intra class correlation [ICC] = 0.79-0.95) and test-retest reliability (range ICC = 0.64-0.88) compared to MBS (range ICC = 0.31-0.40 and 0.06-0.16, respectively). However, few significant relations between either the MBS or TLBS and measures of biobehavioral and self-report indices of smoking reinforcement were observed. CONCLUSIONS The current findings demonstrate that TLBS, as compared to MBS, is a more reliable measure of AB among daily smokers, while evidence of its external validity is limited.
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Affiliation(s)
- Min-Jeong Yang
- Department of Psychology, Rutgers University, Piscataway, NJ 08854, USA; Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4115 E. Fowler Ave, Tampa, FL 33617, USA.
| | - Allison M Borges
- Department of Behavioral Health, The Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA 19104, USA.
| | - Noah N Emery
- Department of Psychology, Colorado State University, 210 Behavioral Sciences Building, 1876, Campus Delivery, Fort Collins, CO 80523-1876, USA.
| | - Teresa M Leyro
- Department of Psychology, Rutgers University, Piscataway, NJ 08854, USA.
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Kallmayer MA, Knappich C, Karlas A, Trenner M, Kuehnl A, Eckstein HH. External Validity of Randomised Controlled Trials on Carotid Revascularisation: Trial Populations May Not Always Reflect Patients in Clinical Practice. Eur J Vasc Endovasc Surg 2022; 64:452-460. [PMID: 35987505 DOI: 10.1016/j.ejvs.2022.07.044] [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: 08/09/2021] [Revised: 06/26/2022] [Accepted: 07/26/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The external validity of randomised controlled trials (RCTs) and their transferability to clinical practice is under investigated. This study aimed to analyse the exclusion criteria of recent carotid RCTs comparing carotid endarterectomy (CEA) and carotid artery stenting, and to assess the eligibility of consecutive clinical practice cohorts to those RCTs. METHODS An analysis of the clinical and anatomical exclusion criteria of RCTs for asymptomatic (SPACE-2, ACST-2, CREST-1, and CREST-2) and symptomatic carotid stenosis (SPACE-1, CREST-1, ICSS, and EVA-3S) was performed. Two hundred consecutive asymptomatic and 200 consecutive symptomatic patients, treated by CEA, or transfemoral or transcarotid artery stenting at a tertiary referral university centre were assessed for their potential eligibility for each corresponding RCT. RCT patient data were pooled and differences from the clinical practice cohort analysed. Statistics were descriptive and comparative using Fisher's exact and t tests. RESULTS The number of clinical and anatomical exclusion criteria differed widely between RCTs. Potential eligibility rates of the clinical practice cohort for RCTs with regard to asymptomatic carotid stenosis were 80.5% (ACST-2), 79.5% (SPACE-2), 47% (CREST-1), and 20% (CREST-2). For RCTs on symptomatic carotid stenosis the eligibility rates were 89% (ICSS), 86.5% (EVA-3S), 64% (SPACE-1), and 39% (CREST-1). Both clinical practice cohorts were older by about three years and patients were more often male vs. the RCTs. Furthermore, a history of smoking (asymptomatic patients), hypertension (symptomatic patients), and atrial fibrillation was diagnosed more often, whereas hypercholesterolaemia and coronary heart disease (asymptomatic patients) were less prevalent. More clinical practice patients were on antiplatelets, anticoagulants, and lipid lowering drugs. Symptomatic clinical practice patients presented more often with retinal ischaemia and less often with minor hemispheric strokes than patients in the RCTs. CONCLUSION The external validity of contemporary carotid RCTs varies considerably. Patients in routine clinical practice differ from RCT populations with respect to age, comorbidities, and medication. These data are of interest for clinicians and guideline authors and may be relevant for the design of future comparative trials.
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Affiliation(s)
- Michael A Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Christoph Knappich
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Angelos Karlas
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Matthias Trenner
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Andreas Kuehnl
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.
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Salminen J, Jung SG, Kamel A, Froneman W, Jansen BJ. Who is in the sample? An analysis of real and surrogate users as participants in user study research in the information technology fields. PeerJ Comput Sci 2022; 8:e1136. [PMID: 36426262 PMCID: PMC9680893 DOI: 10.7717/peerj-cs.1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Constructing a sample of real users as participants in user studies is considered by most researchers to be vital for the validity, usefulness, and applicability of research findings. However, how often user studies reported in information technology academic literature sample real users or surrogate users is unknown. Therefore, it is uncertain whether or not the use of surrogate users in place of real users is a widespread problem within user study practice. OBJECTIVE To determine how often user studies reported in peer-reviewed information technology literature sample real users or surrogate users as participants. METHOD We analyzed 725 user studies reported in 628 peer-reviewed articles published from 2013 through 2021 in 233 unique conference and journal outlets, retrieved from the ACM Digital Library, IEEE Xplore, and Web of Science archives. To study the sample selection choices, we categorized each study as generic (i.e., users are from the general population) or targeted (i.e., users are from a specific subpopulation), and the sampled study participants as real users (i.e., from the study population) or surrogate users (i.e., other than real users). RESULTS Our analysis of all 725 user studies shows that roughly two-thirds (75.4%) sampled real users. However, of the targeted studies, only around half (58.4%) sampled real users. Of the targeted studies sampling surrogate users, the majority (69.7%) used students, around one-in-four (23.6%) sampled through crowdsourcing, and the remaining 6.7% of studies used researchers or did not specify who the participants were. CONCLUSIONS Key findings are as follows: (a) the state of sampling real users in information technology research has substantial room for improvement for targeted studies; (b) researchers often do not explicitly characterize their study participants in adequate detail, which is probably the most disconcerting finding; and (c) suggestions are provided for recruiting real users, which may be challenging for researchers. IMPLICATIONS The results imply a need for standard guidelines for reporting the types of users sampled for a user study. We provide a template for reporting user study sampling with examples.
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Affiliation(s)
- Joni Salminen
- Qatar Computing Research Institute, Hamad Bin Khalifa University, Doha, Qatar
- Turku School of Economics, University of Turku, Turku, Finland
- School of Marketing and Communication, University of Vaasa, Vaasa, Finland
| | - Soon-gyo Jung
- Qatar Computing Research Institute, Hamad Bin Khalifa University, Doha, Qatar
| | - Ahmed Kamel
- Department of Clinical Pharmacy, Cairo University, Cairo, Egypt
| | - Willemien Froneman
- Africa Open Institute, Stellenbosch University, Stellenbosch, South Africa
| | - Bernard J. Jansen
- Qatar Computing Research Institute, Hamad Bin Khalifa University, Doha, Qatar
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Rodriquenz MG, Negrete-Najar JP, Sam C, Sehovic M, Extermann M. Assessment of the external validity of the National Comprehensive Cancer Network (NCCN) guidelines for pancreatic ductal adenocarcinoma in a population of older patients aged 70 years and older. J Geriatr Oncol 2022; 13:952-961. [PMID: 35597730 DOI: 10.1016/j.jgo.2022.04.015] [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: 11/06/2020] [Revised: 04/11/2022] [Accepted: 04/26/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Pancreatic ductal adenocarcinoma (PDAC) mainly occurs in older adults. Since randomized clinical trials (RCTs) provide the highest-quality evidence incorporated in NCCN recommendations, the underrepresentation of older patients in RCTs challenges guidelines' external validity and limits the solidity of evidence in this specific population. MATERIALS AND METHODS The study aimed to investigate external validity of NCCN guidelines for PDCA and the impact of reference studies eligibility on overall survival (OS) in a real-world older population. We retrieved RCTs supporting NCCN recommendations for management of PDAC and identified ten topics. We matched a cohort of 707 PDAC patients aged ≥70 years from the Moffitt Cancer Center database with eligibility criteria of 96 reference RCTs to check the proportion of patients eligible for at least two RCTs. Eligibility >60% was rated full validity, 30%-60% partial validity and < 30% limited validity. We also performed log-rank test to assessed whether "eligibility" status affects OS, stratifying by age (70-74; 75-79; ≥80). RESULTS AND DISCUSSION We found full validity for neoadjuvant (57/73 patients; 69.86%), locally advanced (28/39; 71.79%) and second line (88/110; 80%) treatment, while lowest validity was found for adjuvant chemotherapy (37/86; 43%). Eligible status was correlated with a significant OS benefit for adjuvant chemoradiation (p = 0.002) in all-comers and for first-line polychemotherapy in patients aged ≥80 (p = 0.01). Our analysis supports the limitation of guidelines' external validity in older patients, and hints at possible correlations with survival, although no definitive conclusions can be drawn at this stage. Renewing RCT design with broader eligibility criteria might help increase inclusion of older and thus strengthen the evidence.
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Affiliation(s)
- Maria Grazia Rodriquenz
- Division of Medical Oncology, Ospedale IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, San Giovanni Rotondo, FG, Italy.
| | - Juan-Pablo Negrete-Najar
- Clínica de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Distrito Federal, Mexico
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Rudolph KE, Russell M, Luo SX, Rotrosen J, Nunes EV. Under-representation of key demographic groups in opioid use disorder trials. Drug Alcohol Depend Rep 2022; 4:100084. [PMID: 36187300 PMCID: PMC9524855 DOI: 10.1016/j.dadr.2022.100084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background The extent to which clinical trials of medications for opioid use disorder (MOUD) are representative or not is unknown. Some patient characteristics modify MOUD effectiveness; if these same characteristics differ in distribution between the trial population and usual-care population, this could contribute to lack of generalizability-a discrepancy between trial and usual-care effectiveness. Our objective was to identify interpretable, multidimensional subgroups who were prescribed MOUD in substance use treatment programs in the US but who were not represented or under-represented by clinical trial participants. Methods This was a secondary descriptive analysis of trial and real-world data. The trial data included twenty-seven US opioid treatment programs in the National Drug Abuse Treatment Clinical Trials Network, N = 2,199 patients. The real-world data included US substance use treatment programs that receive public funding, N = 740,015 patients. We characterized real-world patient populations who were non-represented and under-represented in the trial data in terms of sociodemographic and clinical characteristics that could modify MOUD effectiveness. Results We found that 10.7% of MOUD patients in TEDS-A were not represented in the three clinical trials. As expected, pregnant MOUD patients (n = 19,490) were not represented. Excluding pregnancy, education and marital status from the characteristics, 2.6% of MOUD patients were not represented. Patients aged 65 years and older (n = 11,204), and those 50-64 years who identified as other (non-White, non-Black, and non-Hispanic) race/ethnicity or multi-racial (n = 7,281) were under-represented. Conclusions Quantifying and characterizing non- or under-represented subgroups in trials can provide the data necessary to improve representation in future trials and address research-to-practice gaps.
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Affiliation(s)
- Kara E. Rudolph
- Department of Epidemiology, Columbia University, 722 W 168th St, Room 522, New York, NY 10032, United States,Corresponding author. Tel.: +12123422926
| | - Matthew Russell
- Department of Epidemiology, Columbia University, 722 W 168th St, Room 522, New York, NY 10032, United States
| | - Sean X. Luo
- Department of Psychiatry, School of Medicine, Columbia University, and New York State Psychiatric Institute, New York, New York, United States
| | - John Rotrosen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, New York, United States
| | - Edward V. Nunes
- Department of Psychiatry, School of Medicine, Columbia University, and New York State Psychiatric Institute, New York, New York, United States
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Mupepele AC, Dormann CF. Reply to: "Research on agroforestry systems and biodiversity conservation: what can we conclude so far and what should we improve?" by Boinot et al. 2022. BMC Ecol Evol 2022; 22:65. [PMID: 35585511 PMCID: PMC9115991 DOI: 10.1186/s12862-022-02016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
In our article ‘European agroforestry has no unequivocal effect on biodiversity: a time-cumulative meta-analysis’ (BMC Ecology and Evolution, 2021) we synthesize the effect of agroforestry on biodiversity. Boinot et al. (BMC Ecology and Evolution, 2022) criticise our approach arguing that our definitions of agroforestry and biodiversity are too narrow; that we use inappropriate control sites for primary studies lacking distance to the treatment sites; that there are too few studies for a meta-analysis in silvoarable systems; and that local practice should be emphasized. We agree on the importance of local practices and that more studies would improve the robustness of our meta-analytical results. However, our conclusions are robust to removing studies criticised for inappropriate controls. We also recognize the problem of different definitions of agroforestry and using species richness as sole proxy for biodiversity. We appreciate being given the opportunity to clarify our results and to trigger future discussions about definitions and the interpretation of results from meta-analysis.
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Affiliation(s)
- Anne-Christine Mupepele
- Nature Conservation and Landscape Ecology, University of Freiburg, Tennenbacherstr. 4, 79106, Freiburg, Germany.
| | - Carsten F Dormann
- Biometry and Environmental System Analysis, University of Freiburg, Tennenbacherstr. 4, 79106, Freiburg, Germany
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Jung A, Balzer J, Braun T, Luedtke K. Identification of tools used to assess the external validity of randomized controlled trials in reviews: a systematic review of measurement properties. BMC Med Res Methodol 2022; 22:100. [PMID: 35387582 PMCID: PMC8985274 DOI: 10.1186/s12874-022-01561-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 02/28/2022] [Indexed: 02/08/2023] Open
Abstract
Background Internal and external validity are the most relevant components when critically appraising randomized controlled trials (RCTs) for systematic reviews. However, there is no gold standard to assess external validity. This might be related to the heterogeneity of the terminology as well as to unclear evidence of the measurement properties of available tools. The aim of this review was to identify tools to assess the external validity of RCTs. It was further, to evaluate the quality of identified tools and to recommend the use of individual tools to assess the external validity of RCTs in future systematic reviews. Methods A two-phase systematic literature search was performed in four databases: PubMed, Scopus, PsycINFO via OVID, and CINAHL via EBSCO. First, tools to assess the external validity of RCTs were identified. Second, studies investigating the measurement properties of these tools were selected. The measurement properties of each included tool were appraised using an adapted version of the COnsensus based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Results 38 publications reporting on the development or validation of 28 included tools were included. For 61% (17/28) of the included tools, there was no evidence for measurement properties. For the remaining tools, reliability was the most frequently assessed property. Reliability was judged as “sufficient” for three tools (very low certainty of evidence). Content validity was rated as “sufficient” for one tool (moderate certainty of evidence). Conclusions Based on these results, no available tool can be fully recommended to assess the external validity of RCTs in systematic reviews. Several steps are required to overcome the identified difficulties to either adapt and validate available tools or to develop a better suitable tool. Trial registration Prospective registration at Open Science Framework (OSF): 10.17605/OSF.IO/PTG4D. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01561-5.
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Affiliation(s)
- Andres Jung
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
| | - Julia Balzer
- Faculty of Applied Public Health, European University of Applied Sciences, Werftstr. 5, 18057, Rostock, Germany
| | - Tobias Braun
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6‑8, 44801, Bochum, Germany.,Department of Health, HSD Hochschule Döpfer (University of Applied Sciences), Waidmarkt 9, 50676, Cologne, Germany
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
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Frampton G, Whaley P, Bennett M, Bilotta G, Dorne JLCM, Eales J, James K, Kohl C, Land M, Livoreil B, Makowski D, Muchiri E, Petrokofsky G, Randall N, Schofield K. Principles and framework for assessing the risk of bias for studies included in comparative quantitative environmental systematic reviews. Environ Evid 2022; 11:1-23. [PMID: 38264537 PMCID: PMC10805236 DOI: 10.1186/s13750-022-00264-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/05/2022] [Indexed: 01/25/2024]
Abstract
The internal validity of conclusions about effectiveness or impact in systematic reviews, and of decisions based on them, depends on risk of bias assessments being conducted appropriately. However, a random sample of 50 recently-published articles claiming to be quantitative environmental systematic reviews found 64% did not include any risk of bias assessment, whilst nearly all that did omitted key sources of bias. Other limitations included lack of transparency, conflation of quality constructs, and incomplete application of risk of bias assessments to the data synthesis. This paper addresses deficiencies in risk of bias assessments by highlighting core principles that are required for risk of bias assessments to be fit-for-purpose, and presenting a framework based on these principles to guide review teams on conducting risk of bias assessments appropriately and consistently. The core principles require that risk of bias assessments be Focused, Extensive, Applied and Transparent (FEAT). These principles support risk of bias assessments, appraisal of risk of bias tools, and the development of new tools. The framework follows a Plan-Conduct-Apply-Report approach covering all stages of risk of bias assessment. The scope of this paper is comparative quantitative environmental systematic reviews which address PICO or PECO-type questions including, but not limited to, topic areas such as environmental management, conservation, ecosystem restoration, and analyses of environmental interventions, exposures, impacts and risks.
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Affiliation(s)
- Geoff Frampton
- Southampton Health Technology Assessments Centre (SHTAC), Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Whaley
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
- Evidence-Based Toxicology Collaboration at Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Micah Bennett
- U.S. Environmental Protection Agency, Region 5, Chicago, IL 60604, USA
| | - Gary Bilotta
- School of Environment and Technology, University of Brighton, Brighton, UK
| | - Jean-Lou C. M. Dorne
- Scientific Committee and Emerging Risks Unit, European Food Safety Authority, Via Carlo Magno 1A, 43121 Parma, Italy
| | - Jacqualyn Eales
- European Centre for Environment and Human Health, College of Medicine and Health, University of Exeter, Knowledge Spa, Truro TR1 3HD, UK
| | - Katy James
- Centre for Evidence-Based Agriculture, Harper Adams University, Newport, Shropshire TF10 8NB, UK
| | - Christian Kohl
- Institute for Biosafety in Plant Biotechnology (SB), Julius Kühn Institute (JKI) - Federal Research Centre for Cultivated Plants, Berlin, Germany
| | | | | | - David Makowski
- UMR518, University Paris-Saclay, INRAE, AgroParistech, 16 rue Claude Bernard, 75231 Paris, France
| | - Evans Muchiri
- Centre for Anthropological Research, University of Johannesburg, Johannesburg, South Africa
| | - Gillian Petrokofsky
- Oxford Long-Term Ecology Lab, Department of Zoology, University of Oxford, Oxford, UK
| | - Nicola Randall
- Centre for Evidence-Based Agriculture, Harper Adams University, Newport, Shropshire TF10 8NB, UK
| | - Kate Schofield
- Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC 20460, USA
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Gough K, Pascoe MC, Bergin R, Drosdowsky A, Schofield P. Differential adherence to peer and nurse components of a supportive care package-The appeal of peer support may be related to women's health and psychological status. Patient Educ Couns 2022; 105:762-768. [PMID: 34244032 DOI: 10.1016/j.pec.2021.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/08/2021] [Accepted: 06/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Knowledge of factors associated with intervention non-adherence may provide insights into the clinical utility of non-pharmacologic interventions. METHODS This study compared complete and incomplete adherers to two separate components of a novel intervention package for women undergoing curative intent radiotherapy for gynaecological cancer on socio-demographic, clinical and pre-radiotherapy patient-reported outcomes data. RESULTS Adherence to the tailored specialist nurse consultations was satisfactory (71% participated in all available sessions, 19% participated in all but one). Adherence to the telephone peer support sessions was less satisfactory (47% participated in all available sessions, 24% participated in all but one session). Complete adherers to the peer sessions reported significantly lower levels of psychological distress and significantly higher levels of physical, emotional and functional wellbeing before radiotherapy. No other statistically significant differences were observed between complete and incomplete adherers to the nurse- or peer-led sessions. CONCLUSION Women's ability or motivation to engage with peer support may be influenced by their health and psychological status. Further, the extent of intervention non-adherence to the peer-led component may have compromised the assessment of its efficacy. PRACTICE IMPLICATIONS Peer support may be less acceptable or appropriate for women with more complex care needs. Such women may prefer specialised care from trained professionals.
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Affiliation(s)
- Karla Gough
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; Department of Nursing, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, VIC 3052, Australia.
| | - Michaela C Pascoe
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC 3011, Australia.
| | - Rebecca Bergin
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC 3000, Australia.
| | - Allison Drosdowsky
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia.
| | - Penelope Schofield
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; Swinburne University of Technology, Hawthorn, VIC 3122, Australia.
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Anderson KP, Wolf PJ. How Within-Study Comparisons can Inform Research and Evaluation Design for the Third Sector. Voluntas 2022; 33:1235-1244. [PMID: 35233150 PMCID: PMC8876077 DOI: 10.1007/s11266-022-00464-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
Within-study comparisons (WSCs) compare quasi-experimental results to an experimental benchmark and assess the extent to which quasi-experiments (QEs) sacrifice internal validity for external validity. WSCs inform decisions about when to use experiments or QEs, as well as methodological decisions (e.g., covariate selection) about how to implement QEs when they are necessary or preferred. We review the methodological literature on WSCs and present the findings from a WSC of a school voucher program as an example of the use of WSCs to inform policy debates involving the third sector. Prior literature and our results suggest that QE evaluations of third-sector institutions can produce low levels of bias, but only if analytic models include key proxy variables for voluntary self-selection into programs.
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Affiliation(s)
| | - Patrick J. Wolf
- Graduate Education Building, University of Arkansas, Room 201, Fayetteville, AR 72701 USA
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31
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Cait J, Cait A, Scott RW, Winder CB, Mason GJ. Conventional laboratory housing increases morbidity and mortality in research rodents: results of a meta-analysis. BMC Biol 2022; 20:15. [PMID: 35022024 PMCID: PMC8756709 DOI: 10.1186/s12915-021-01184-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/07/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Over 120 million mice and rats are used annually in research, conventionally housed in shoebox-sized cages that restrict natural behaviours (e.g. nesting and burrowing). This can reduce physical fitness, impair thermoregulation and reduce welfare (e.g. inducing abnormal stereotypic behaviours). In humans, chronic stress has biological costs, increasing disease risks and potentially shortening life. Using a pre-registered protocol ( https://atrium.lib.uoguelph.ca/xmlui/handle/10214/17955 ), this meta-analysis therefore tested the hypothesis that, compared to rodents in 'enriched' housing that better meets their needs, conventional housing increases stress-related morbidity and all-cause mortality. RESULTS Comprehensive searches (via Ovid, CABI, Web of Science, Proquest and SCOPUS on May 24 2020) yielded 10,094 publications. Screening for inclusion criteria (published in English, using mice or rats and providing 'enrichments' in long-term housing) yielded 214 studies (within 165 articles, using 6495 animals: 59.1% mice; 68.2% male; 31.8% isolation-housed), and data on all-cause mortality plus five experimentally induced stress-sensitive diseases: anxiety, cancer, cardiovascular disease, depression and stroke. The Systematic Review Center for Laboratory animal Experimentation (SYRCLE) tool assessed individual studies' risks of bias. Random-effects meta-analyses supported the hypothesis: conventional housing significantly exacerbated disease severity with medium to large effect sizes: cancer (SMD = 0.71, 95% CI = 0.54-0.88); cardiovascular disease (SMD = 0.72, 95% CI = 0.35-1.09); stroke (SMD = 0.87, 95% CI = 0.59-1.15); signs of anxiety (SMD = 0.91, 95% CI = 0.56-1.25); signs of depression (SMD = 1.24, 95% CI = 0.98-1.49). It also increased mortality rates (hazard ratio = 1.48, 95% CI = 1.25-1.74; relative median survival = 0.91, 95% CI = 0.89-0.94). Meta-regressions indicated that such housing effects were ubiquitous across species and sexes, but could not identify the most impactful improvements to conventional housing. Data variability (assessed via coefficient of variation) was also not increased by 'enriched' housing. CONCLUSIONS Conventional housing appears sufficiently distressing to compromise rodent health, raising ethical concerns. Results also add to previous work to show that research rodents are typically CRAMPED (cold, rotund, abnormal, male-biased, poorly surviving, enclosed and distressed), raising questions about the validity and generalisability of the data they generate. This research was funded by NSERC, Canada.
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Affiliation(s)
- Jessica Cait
- Department of Integrative Biology, College of Biological Science, University of Guelph, Guelph, Ontario, Canada
| | - Alissa Cait
- Department of Translational Immunology, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - R Wilder Scott
- School of Biomedical Engineering, Faculty of Medicine and Applied Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charlotte B Winder
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Georgia J Mason
- Department of Integrative Biology, College of Biological Science, University of Guelph, Guelph, Ontario, Canada.
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Abstract
There is a common misconception in applied research that generalizations from a study to a specific client can only be made with a large sample size. In single-case design research, however, generalizations are made from a line of replication studies rather than from a single large-N study. In this brief tutorial, we summarize how generalizations are made from single-case design research, and provide a model elevator speech to assist behavior analysts in talking about single-case design research with others.
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Affiliation(s)
- Seth G Walker
- Behavior Analyst Certification Board, 7950 Shaffer Parkway, Littleton, CO 80127 USA
| | - James E Carr
- Behavior Analyst Certification Board, 7950 Shaffer Parkway, Littleton, CO 80127 USA
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33
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Nguyen QD, Moodie EM, Desmarais P, Goulden R, Forget MF, Peters E, Saeed S, Keezer MR, Wolfson C. Appraising clinical applicability of studies: mapping and synthesis of current frameworks, and proposal of the FrACAS framework and VICORT checklist. BMC Med Res Methodol 2021; 21:248. [PMID: 34773994 PMCID: PMC8590785 DOI: 10.1186/s12874-021-01445-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Not all research findings are translated to clinical practice. Reasons for lack of applicability are varied, and multiple frameworks and criteria exist to appraise the general applicability of epidemiological and clinical research. In this two-part study, we identify, map, and synthesize frameworks and criteria; we develop a framework to assist clinicians to appraise applicability specifically from a clinical perspective. METHODS We conducted a literature search in PubMed and Embase to identify frameworks appraising applicability of study results. Conceptual thematic analysis was used to synthesize frameworks and criteria. We carried out a framework development process integrating contemporary debates in epidemiology, findings from the literature search and synthesis, iterative pilot-testing, and brainstorming and consensus discussions to propose a concise framework to appraise clinical applicability. RESULTS Of the 4622 references retrieved, we identified 26 unique frameworks featuring 21 criteria. Frameworks and criteria varied by scope and level of aggregation of the evidence appraised, target user, and specific area of applicability (internal validity, clinical applicability, external validity, and system applicability). Our proposed Framework Appraising the Clinical Applicability of Studies (FrACAS) classifies studies in three domains (research, practice informing, and practice changing) by examining six criteria sequentially: Validity, Indication-informativeness, Clinical relevance, Originality, Risk-benefit comprehensiveness, and Transposability (VICORT checklist). CONCLUSIONS Existing frameworks to applicability vary by scope, target user, and area of applicability. We introduce FrACAS to specifically assess applicability from a clinical perspective. Our framework can be used as a tool for the design, appraisal, and interpretation of epidemiological and clinical studies.
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Affiliation(s)
- Quoc Dinh Nguyen
- Division of Geriatrics, Centre hospitalier de l'Université de Montréal, 1000, Saint-Denis, Montreal, Quebec, H2X0C1, Canada.
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada.
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.
| | - Erica M Moodie
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Philippe Desmarais
- Division of Geriatrics, Centre hospitalier de l'Université de Montréal, 1000, Saint-Denis, Montreal, Quebec, H2X0C1, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Robert Goulden
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
- Department of Medicine, McGill University, Montreal, Canada
| | - Marie-France Forget
- Division of Geriatrics, Centre hospitalier de l'Université de Montréal, 1000, Saint-Denis, Montreal, Quebec, H2X0C1, Canada
| | - Eric Peters
- Department of Anesthesia, Centre hospitalier universitaire Sainte-Justine, Montreal, Canada
| | - Sahar Saeed
- Department of Infectious Disease, Washington University in St. Louis, St. Louis, USA
| | - Mark R Keezer
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Departments of Neurosciences & Social and Preventative Medicine, Université de Montréal, Montreal, Canada
| | - Christina Wolfson
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
- Department of Medicine, McGill University, Montreal, Canada
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, Canada
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Lim YMF, Molnar M, Vaartjes I, Savarese G, Eijkemans MJC, Uijl A, Vradi E, Suzart-Woischnik K, Brugts JJ, Brunner-La Rocca HP, Blanc-Guillemaud V, Couvelard F, Baudier C, Dyszynski T, Waechter S, Lund LH, Hoes AW, Tyl B, Asselbergs FW, Gerlinger C, Grobbee DE, Cronin M, Koudstaal S. Generalisability of Randomised Controlled Trials in Heart Failure with Reduced Ejection Fraction. Eur Heart J Qual Care Clin Outcomes 2021; 8:761-769. [PMID: 34596659 PMCID: PMC9603541 DOI: 10.1093/ehjqcco/qcab070] [Citation(s) in RCA: 9] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 01/23/2023]
Abstract
Background Heart failure (HF) trials have stringent inclusion and exclusion criteria, but limited data exist regarding generalizability of trials. We compared patient characteristics and outcomes between patients with HF and reduced ejection fraction (HFrEF) in trials and observational registries. Methods and Results Individual patient data for 16 922 patients from five randomized clinical trials and 46 914 patients from two HF registries were included. The registry patients were categorized into trial-eligible and non-eligible groups using the most commonly used inclusion and exclusion criteria. A total of 26 104 (56%) registry patients fulfilled the eligibility criteria. Unadjusted all-cause mortality rates at 1 year were lowest in the trial population (7%), followed by trial-eligible patients (12%) and trial-non-eligible registry patients (26%). After adjustment for age and sex, all-cause mortality rates were similar between trial participants and trial-eligible registry patients [standardized mortality ratio (SMR) 0.97; 95% confidence interval (CI) 0.92–1.03] but cardiovascular mortality was higher in trial participants (SMR 1.19; 1.12–1.27). After full case-mix adjustment, the SMR for cardiovascular mortality remained higher in the trials at 1.28 (1.20–1.37) compared to RCT-eligible registry patients. Conclusion In contemporary HF registries, over half of HFrEF patients would have been eligible for trial enrolment. Crude clinical event rates were lower in the trials, but, after adjustment for case-mix, trial participants had similar rates of survival as registries. Despite this, they had about 30% higher cardiovascular mortality rates. Age and sex were the main drivers of differences in clinical outcomes between HF trials and observational HF registries.
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Affiliation(s)
- Yvonne Mei Fong Lim
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Institute for Clinical Research, National Institutes of Health, Selangor, Malaysia
| | - Megan Molnar
- Medical Affairs & Pharmacovigilance, Bayer AG, Berlin, Germany
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Insitutet, Stockholm, Sweden
| | - Marinus J C Eijkemans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Alicia Uijl
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Eleni Vradi
- Biomedical Data Science II, Bayer AG, Berlin, Germany
| | | | - Jasper J Brugts
- Department of Cardiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | | | | | - Fabrice Couvelard
- Institut de Recherches Internationales SERVIER (I.R.I.S.), Suresnes, France
| | - Claire Baudier
- Institut de Recherches Internationales SERVIER (I.R.I.S.), Suresnes, France
| | | | | | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Insitutet, Stockholm, Sweden
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Benoit Tyl
- Institut de Recherches Internationales SERVIER (I.R.I.S.), Suresnes, France
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Christoph Gerlinger
- Statistics and Data Insights, Bayer AG, Berlin, Germany.,Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Saar, Germany
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Julius Clinical, Zeist, the Netherlands
| | | | - Stefan Koudstaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Cardiology, Groene Hart Ziekenhuis, Gouda, the Netherlands
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Lee KM, Ferreira-Santos F, Satpute AB. Predictive processing models and affective neuroscience. Neurosci Biobehav Rev 2021; 131:211-228. [PMID: 34517035 DOI: 10.1016/j.neubiorev.2021.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/30/2019] [Revised: 02/10/2021] [Accepted: 09/07/2021] [Indexed: 01/17/2023]
Abstract
The neural bases of affective experience remain elusive. Early neuroscience models of affect searched for specific brain regions that uniquely carried out the computations that underlie dimensions of valence and arousal. However, a growing body of work has failed to identify these circuits. Research turned to multivariate analyses, but these strategies, too, have made limited progress. Predictive processing models offer exciting new directions to address this problem. Here, we use predictive processing models as a lens to critique prevailing functional neuroimaging research practices in affective neuroscience. Our review highlights how much work relies on rigid assumptions that are inconsistent with a predictive processing approach. We outline the central aspects of a predictive processing model and draw out their implications for research in affective and cognitive neuroscience. Predictive models motivate a reformulation of "reverse inference" in cognitive neuroscience, and placing a greater emphasis on external validity in experimental design.
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Affiliation(s)
- Kent M Lee
- Northeastern University, 360 Huntington Ave, 125 NI, Boston, MA 02118, USA.
| | - Fernando Ferreira-Santos
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Portugal
| | - Ajay B Satpute
- Northeastern University, 360 Huntington Ave, 125 NI, Boston, MA 02118, USA
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Jungo KT, Meier R, Valeri F, Schwab N, Schneider C, Reeve E, Spruit M, Schwenkglenks M, Rodondi N, Streit S. Baseline characteristics and comparability of older multimorbid patients with polypharmacy and general practitioners participating in a randomized controlled primary care trial. BMC Fam Pract 2021; 22:123. [PMID: 34157981 PMCID: PMC8220761 DOI: 10.1186/s12875-021-01488-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/09/2021] [Indexed: 11/15/2022]
Abstract
Objectives Recruiting general practitioners (GPs) and their multimorbid older patients for trials is challenging for multiple reasons (e.g., high workload, limited mobility). The comparability of study participants is important for interpreting study findings. This manuscript describes the baseline characteristics of GPs and patients participating in the ‘Optimizing PharmacoTherapy in older multimorbid adults In primary CAre’ (OPTICA) trial, a study of optimization of pharmacotherapy for multimorbid older adults. The overall aim of this study was to determine if the GPs and patients participating in the OPTICA trial are comparable to the real-world population in Swiss primary care. Design Analysis of baseline data from GPs and patients in the OPTICA trial and a reference cohort from the FIRE (‘Family medicine ICPC Research using Electronic medical records’) project. Setting Primary care, Switzerland. Participants Three hundred twenty-three multimorbid (≥ 3 chronic conditions) patients with polypharmacy (≥ 5 regular medications) aged ≥ 65 years and 43 GPs recruited for the OPTICA trial were compared to 22,907 older multimorbid patients with polypharmacy and 227 GPs from the FIRE database. Methods We compared the characteristics of GPs and patients participating in the OPTICA trial with other GPs and other older multimorbid adults with polypharmacy in the FIRE database. We described the baseline willingness to have medications deprescribed of the patients participating in the OPTICA trial using the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire. Results The GPs in the FIRE project and OPTICA were similar in terms of sociodemographic characteristics and their work as a GP (e.g. aged in their fifties, ≥ 10 years of experience, ≥ 60% are self-employed, ≥ 80% work in a group practice). The median age of patients in the OPTICA trial was 77 years and 45% of trial participants were women. Patients participating in the OPTICA trial and patients in the FIRE database were comparable in terms of age, certain clinical characteristics (e.g. systolic blood pressure, body mass index) and health services use (e.g. selected lab and vital data measurements). More than 80% of older multimorbid patients reported to be willing to stop ≥ 1 of their medications if their doctor said that this would be possible. Conclusion The characteristics of patients and GPs recruited into the OPTICA trial are relatively comparable to characteristics of a real-world Swiss population, which indicates that recruiting a generalizable patient sample is possible in the primary care setting. Multimorbid patients in the OPTICA trial reported a high willingness to have medications deprescribed. Trial registration Clinicaltrials.gov (NCT03724539), KOFAM (Swiss national portal) (SNCTP000003060), Universal Trial Number (U1111-1226-8013) Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01488-8.
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Affiliation(s)
- Katharina Tabea Jungo
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Rahel Meier
- Institute of Primary Care, University and University Hospital of Zurich, Zurich, Switzerland
| | - Fabio Valeri
- Institute of Primary Care, University and University Hospital of Zurich, Zurich, Switzerland
| | - Nathalie Schwab
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudio Schneider
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Emily Reeve
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,Geriatric Medicine Research, Faculty of Medicine and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
| | - Marco Spruit
- Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands.,Public Health & Primary Care, Leiden University Medical Centre, Leiden University, Leiden, The Netherlands
| | - Matthias Schwenkglenks
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.,Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
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DEVER JILLA, AMAYA ASHLEY, SRIVASTAV ANUP, LU PENGJUN, ROYCROFT JESSICA, STANLEY MARSHICA, STRINGER MCHRISTOPHER, BOSTWICK MICHAELG, GREBY STACIEM, SANTIBANEZ TAMMYA, WILLIAMS WALTERW. FIT FOR PURPOSE IN ACTION: DESIGN, IMPLEMENTATION, AND EVALUATION OF THE NATIONAL INTERNET FLU SURVEY. J Surv Stat Methodol 2021; 9:449-476. [PMID: 36060551 PMCID: PMC9434706 DOI: 10.1093/jssam/smz050] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Researchers strive to design and implement high-quality surveys to maximize the utility of the data collected. The definitions of quality and usefulness, however, vary from survey to survey and depend on the analytic needs. Survey teams must evaluate the trade-offs of various decisions, such as when results are needed and their required level of precision, in addition to practical constraints like budget, before finalizing the design. Characteristics within the concept of fit for purpose (FfP) can provide the framework for considering the trade-offs. Furthermore, this tool can enable an evaluation of quality for the resulting estimates. Implementation of a FfP framework in this context, however, is not straightforward. In this article, we provide the reader with a glimpse of a FfP framework in action for obtaining estimates on early season influenza vaccination coverage estimates and on knowledge, attitudes, behaviors, and barriers related to influenza and influenza prevention among civilian noninstitutionalized adults aged 18 years and older in the United States. The result is the National Internet Flu Survey (NIFS), an annual, two-week internet survey sponsored by the US Centers for Disease Control and Prevention. In addition to critical design decisions, we use the established NIFS FfP framework to discuss the quality of the NIFS in meeting the intended objectives. We highlight aspects that work well and other survey traits requiring further evaluation. Differences found in comparing the NIFS to the National Flu Survey, the National Health Interview Survey, and Behavioral Risk Factor Surveillance System are discussed via their respective FfP characteristics. The findings presented here highlight the importance of the FfP framework for designing surveys, defining data quality, and providing a set a metrics used to advertise the intended use of the survey data and results.
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Affiliation(s)
- JILL A. DEVER
- Address correspondence to Jill A. Dever, RTI International, 701 13th St. NW, Suite 750, Washington, DC 20005-3967, USA;
| | - ASHLEY AMAYA
- RTI International, 701 13th St NW, Suite 750, Washington, DC 20005-3967, USA
| | - ANUP SRIVASTAV
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA and Leidos Inc., 11951 Freedom Drive, Reston, VA 20190, USA
| | - PENG-JUN LU
- National Center for Immunization and Respiratory Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
| | - JESSICA ROYCROFT
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - MARSHICA STANLEY
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - M. CHRISTOPHER STRINGER
- formerly at RTI International, is with the U.S. Census Bureau, 4600 Silver Hill Road, Hillcrest Heights, MD 20746, USA
| | - MICHAEL G. BOSTWICK
- formerly at RTI International, is with Squarespace, 8 Clarkson St, New York, NY 10014, USA
| | - STACIE M. GREBY
- National Center for Immunization and Respiratory Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
| | - TAMMY A. SANTIBANEZ
- National Center for Immunization and Respiratory Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
| | - WALTER W. WILLIAMS
- National Center for Immunization and Respiratory Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
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Scheveneels S, Boddez Y, Hermans D. Predicting clinical outcomes via human fear conditioning: A narrative review. Behav Res Ther 2021; 142:103870. [PMID: 34000680 DOI: 10.1016/j.brat.2021.103870] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Abstract
A common assumption in human fear conditioning research is that findings are informative for the etiology and treatment of clinical anxiety. One way to empirically evaluate the external validity of fear conditioning is by prospective studies. We review available prospective research investigating whether individual performance in fear conditioning predicts individual differences in anxiety levels and exposure-based treatment outcome. We focus on fear extinction, generalization, acquisition, and avoidance. Results suggest that reduced extinction and broader generalization predict higher anxiety levels. Results with respect to the predictive value of acquisition for anxiety levels are mixed. With regard to predicting exposure-based treatment outcome, some studies do find an association with extinction whereas others do not. The majority of studies does not find an association with acquisition. Evidence on extinction recall is limited and not consistent. The interpretation of these results requires caution. The number of available studies is limited. It is possible that not all work, in particular studies with only null effects, has found its way to publication. Future research on this topic will benefit from large sample sizes, preregistered hypotheses, full transparency about the conducted analyses and the publication of high-quality studies with null effects.
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Affiliation(s)
- Sara Scheveneels
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium.
| | - Yannick Boddez
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium; Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
| | - Dirk Hermans
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
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Treweek S, Banister K, Bower P, Cotton S, Devane D, Gardner HR, Isaacs T, Nestor G, Oshisanya A, Parker A, Rochester L, Soulsby I, Williams H, Witham MD. Developing the INCLUDE Ethnicity Framework-a tool to help trialists design trials that better reflect the communities they serve. Trials 2021; 22:337. [PMID: 33971916 PMCID: PMC8108025 DOI: 10.1186/s13063-021-05276-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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: 01/22/2021] [Accepted: 04/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Ensuring that a trial is designed so that its participants reflect those who might benefit from the results, or be spared harms, is key to the potential benefits of the trial reaching all they should. This paper describes the process, facilitated by Trial Forge, that was used between July 2019 and October 2020 to develop the INCLUDE Ethnicity Framework, part of the wider INCLUDE initiative from the National Institute for Health Research to improve inclusion of under-served groups in clinical research studies. Methods Development of the Framework was done in seven phases: (1) outline, (2) initial draft, (3) stakeholder meeting, (4) modify draft, (5) Stakeholder feedback, (6) applying the Framework and (7) packaging. Phases 2 and 3 were face-to-face meetings. Consultation with stakeholders was iterative, especially phases 4 to 6. Movement to the next phase was done once all or most stakeholders were comfortable with the results of the current phase. When there was a version of the Framework that could be considered final, the Framework was applied to six trials to create a set of examples (phase 6). Finally, the Framework, guidance and examples were packaged ready for dissemination (phase 7). Results A total of 40 people from stakeholder groups including patient and public partners, clinicians, funders, academics working with various ethnic groups, trial managers and methodologists contributed to the seven phases of development. The Framework comprises two parts. The first part is a list of four key questions:
Who should my trial apply to? Are the groups identified likely to respond in different ways? Will my study intervention make it harder for some groups to engage? Will the way I have designed the study make it harder for some groups to engage?
The second part is a set of worksheets to help trial teams address these questions. The Framework can be used for any stage of trial, for a healthcare intervention in any disease area. The Framework was launched on 1st October 2020 and is available open access at the Trial Forge website: https://www.trialforge.org/trial-forge-centre/include/. Conclusion Thinking about the number of people in our trials is not enough: we need to start thinking more carefully about who our participants are. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05276-8.
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Affiliation(s)
- Shaun Treweek
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Aberdeen, AB25 2ZD, UK.
| | - Katie Banister
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Aberdeen, AB25 2ZD, UK
| | - Peter Bower
- NIHR Clinical Research Network, Manchester Academic Health Science Centre, Centre for Primary Care and Health Services Research, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Seonaidh Cotton
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Aberdeen, AB25 2ZD, UK
| | - Declan Devane
- National University of Ireland Galway, School of Nursing and Midwifery, University Road, Galway, Ireland
| | - Heidi R Gardner
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Aberdeen, AB25 2ZD, UK
| | - Talia Isaacs
- UCL Centre for Applied Linguistics, UCL Institute of Education, University College London, London, UK
| | - Gary Nestor
- NIHR Clinical Research Network Cluster E, Campus for Ageing and Vitality, Newcastle University, Newcastle, NE4 5PL, UK
| | | | - Adwoa Parker
- York Clinical Trials Unit, University of York, York, UK
| | - Lynn Rochester
- Translational and Clinical Research Institute; NIHR Clinical Research Network Cluster E, Campus for Ageing and Vitality, Newcastle University, Newcastle, NE4 5PL, UK
| | | | - Hywel Williams
- Centre of Evidence-Based Dermatology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Miles D Witham
- NIHR Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle University and Newcastle upon Tyne NHS Trust, Newcastle, NE4 5PL, UK
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Mazzini GS, Khoraki J, Browning MG, Pessoa BM, Wolfe LG, Campos GM. Population Diversity Challenge the External Validity of the European Randomized Controlled Trials Comparing Laparoscopic Gastric Bypass and Sleeve Gastrectomy. Obes Surg 2021; 30:992-1000. [PMID: 31768868 DOI: 10.1007/s11695-019-04247-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Two randomized controlled trials (RCTs) from Europe recently showed similar weight loss and rates of type 2 diabetes (T2D) remission following laparoscopic gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). However, results from observational studies in the United States (US) have discordant results. We compared 1-year weight loss and T2D remission between LRYGB and LSG in a heterogeneous patient cohort from the US, albeit with similar inclusion and exclusion criteria to the European RCTs. METHODS Logistic regression was used to propensity match LSG and LRYGB patients according to age, gender, race, preoperative BMI, and T2D. Inclusion and exclusion criteria were adopted from the two European RCTs. Demographic, anthropometric, weight outcomes, and comorbidities prevalence were compared at baseline and 1-year follow-up. RESULTS We included 278 patients (139 LSG and 139 RYGB; median age 42 years, 89% female, 57% black race, 22% with public health insurance, and 25% with T2D). One year after surgery, mean %EWL was 77.3 ± 19.5% with LRYGB and 63.1 ± 21% with LSG (P < 0.001). Mean %TWL was 34.2 ± 7.3% after LRYGB and 28.1 ± 8.2% after LSG, (P < 0.001). The proportion of patients who achieved T2D remission was comparable between surgeries (LRGYB: 68.6% vs. LSG: 66.7%, P = 0.89). LSG, older age, black race, and higher preoperative BMI were independently associated with lower %EWL. Independent correlates of weight loss were different for LRYGB and LSG. CONCLUSIONS Weight loss, but not the likelihood of T2D remission, was greater with LRYGB than LSG in a diverse patient cohort in the US. Further research efforts connecting population diversity to discordant results across studies is needed to better counsel patients with regards to expected postoperative outcomes.
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Affiliation(s)
- Guilherme S Mazzini
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, 1200 E. Broad Street, Richmond, VA, USA.,Division of Gastrointestinal Surgery, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos Street, Porto Alegre, RS, Brazil
| | - Jad Khoraki
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, 1200 E. Broad Street, Richmond, VA, USA
| | - Matthew G Browning
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, 1200 E. Broad Street, Richmond, VA, USA
| | - Bernardo M Pessoa
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, 1200 E. Broad Street, Richmond, VA, USA
| | - Luke G Wolfe
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, 1200 E. Broad Street, Richmond, VA, USA
| | - Guilherme M Campos
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, 1200 E. Broad Street, Richmond, VA, USA.
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Terzikhan N, Hofman A, Goudsmit J, Ikram MA. External validity of phase III trials on vaccines against SARS-CoV-2 to a middle-aged and elderly Western European population. Eur J Epidemiol 2021; 36:319-324. [PMID: 33634346 PMCID: PMC7906827 DOI: 10.1007/s10654-021-00729-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/08/2021] [Indexed: 11/03/2022]
Abstract
Initial results from various phase-III trials on vaccines against SARS-CoV-2 are promising. For proper translation of these results to clinical guidelines, it is essential to determine how well the general population is reflected in the study populations of these trials. This study was conducted among 7162 participants (age-range: 51-106 years; 58% women) from the Rotterdam Study. We quantified the proportion of participants that would be eligible for the nine ongoing phase-III trials. We further quantified the eligibility among participants at high risk to develop severe COVID-19. Since many trials were not explicit in their exclusion criterion with respect to 'acute' or 'unstable preexisting' diseases, we performed two analyses. First, we included all participants irrespective of this criterion. Second, we excluded persons with acute or 'unstable preexisting' diseases. 97% of 7162 participants was eligible for any trial with eligibility for separate trials ranging between 11-97%. For high-risk individuals the corresponding numbers were 96% for any trial with separate trials ranging from 5-96%. Importantly, considering persons ineligible due to 'acute' or 'unstable pre-existing' disease drastically dropped the eligibilities for all trials below 43% for the total population and below 36% for high-risk individuals. The eligibility for ongoing vaccine trials against SARS-CoV-2 can reduce by half depending on interpretation and application of a single unspecified exclusion criterion. This exclusion criterion in our study would especially affect the elderly and those with pre-existing morbidities. These findings thus indicate the difficulty as well as importance of developing clinical recommendations for vaccination and applying these to the appropriate target populations. This becomes especially paramount considering the fact that many countries worldwide have initiated their vaccination programs by first targeting the elderly and most vulnerable persons.
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Affiliation(s)
- Natalie Terzikhan
- Department of Epidemiology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Albert Hofman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jaap Goudsmit
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Human Immunomics Initiative, Department of Epidemiology, Harvard T.H. Chan School of Public Health and Human Vaccines Project, Boston, MA, USA.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mohammad Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
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Shackelford GE, Martin PA, Hood ASC, Christie AP, Kulinskaya E, Sutherland WJ. Dynamic meta-analysis: a method of using global evidence for local decision making. BMC Biol 2021; 19:33. [PMID: 33596922 PMCID: PMC7888140 DOI: 10.1186/s12915-021-00974-w] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 02/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Meta-analysis is often used to make generalisations across all available evidence at the global scale. But how can these global generalisations be used for evidence-based decision making at the local scale, if the global evidence is not perceived to be relevant to local decisions? We show how an interactive method of meta-analysis—dynamic meta-analysis—can be used to assess the local relevance of global evidence. Results We developed Metadataset (www.metadataset.com) as a proof-of-concept for dynamic meta-analysis. Using Metadataset, we show how evidence can be filtered and weighted, and results can be recalculated, using dynamic methods of subgroup analysis, meta-regression, and recalibration. With an example from agroecology, we show how dynamic meta-analysis could lead to different conclusions for different subsets of the global evidence. Dynamic meta-analysis could also lead to a rebalancing of power and responsibility in evidence synthesis, since evidence users would be able to make decisions that are typically made by systematic reviewers—decisions about which studies to include (e.g. critical appraisal) and how to handle missing or poorly reported data (e.g. sensitivity analysis). Conclusions In this study, we show how dynamic meta-analysis can meet an important challenge in evidence-based decision making—the challenge of using global evidence for local decisions. We suggest that dynamic meta-analysis can be used for subject-wide evidence synthesis in several scientific disciplines, including agroecology and conservation biology. Future studies should develop standardised classification systems for the metadata that are used to filter and weight the evidence. Future studies should also develop standardised software packages, so that researchers can efficiently publish dynamic versions of their meta-analyses and keep them up-to-date as living systematic reviews. Metadataset is a proof-of-concept for this type of software, and it is open source. Future studies should improve the user experience, scale the software architecture, agree on standards for data and metadata storage and processing, and develop protocols for responsible evidence use. Supplementary Information The online version contains supplementary material available at 10.1186/s12915-021-00974-w.
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Affiliation(s)
- Gorm E Shackelford
- Department of Zoology, University of Cambridge, Cambridge, CB2 3QZ, UK. .,BioRISC (Biosecurity Research Initiative at St Catharine's), St Catharine's College, Cambridge, CB2 1RL, UK.
| | - Philip A Martin
- Department of Zoology, University of Cambridge, Cambridge, CB2 3QZ, UK.,BioRISC (Biosecurity Research Initiative at St Catharine's), St Catharine's College, Cambridge, CB2 1RL, UK
| | - Amelia S C Hood
- Department of Zoology, University of Cambridge, Cambridge, CB2 3QZ, UK
| | - Alec P Christie
- Department of Zoology, University of Cambridge, Cambridge, CB2 3QZ, UK
| | - Elena Kulinskaya
- School of Computing Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - William J Sutherland
- Department of Zoology, University of Cambridge, Cambridge, CB2 3QZ, UK.,BioRISC (Biosecurity Research Initiative at St Catharine's), St Catharine's College, Cambridge, CB2 1RL, UK
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Dir AL, Watson DP, Zhiss M, Taylor L, Bray BC, McGuire A. Barriers impacting the POINT pragmatic trial: the unavoidable overlap between research and intervention procedures in "real-world" research. Trials 2021; 22:114. [PMID: 33541402 PMCID: PMC7859893 DOI: 10.1186/s13063-021-05065-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 01/20/2021] [Indexed: 12/03/2022] Open
Abstract
Background This manuscript provides a research update to the ongoing pragmatic trial of Project POINT (Planned Outreach, Intervention, Naloxone, and Treatment), an emergency department-based peer recovery coaching intervention for linking patients with opioid use disorder to evidence-based treatment. The research team has encountered a number of challenges related to the “real-world” study setting since the trial began. Using an implementation science lens, we sought to identify and describe barriers impacting both the intervention and research protocols of the POINT study, which are often intertwined in pragmatic trials due to the focus on external validity. Method Qualitative data were collected from 3 peer recovery coaches, 2 peer recovery coach supervisors, and 3 members of the research team. Questions and deductive qualitative analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Results Nine unique barriers were noted, with 5 of these barriers impacting intervention and research protocol implementation simultaneously. These simultaneous barriers were timing of intervention delivery, ineffective communication with emergency department staff, lack of privacy in the emergency department, the fast-paced emergency department setting, and patient’s limited resources. Together, these barriers represent the intervention characteristics, inner setting, and outer setting domains of the CFIR. Conclusion Results highlight the utility of employing an implementation science framework to assess implementation issues in pragmatic trials and how this approach might be used as a quality assurance mechanism given the considerable overlap that exists between research and intervention protocols in real-world trial settings. Previously undocumented changes to the trial design that have been made as a result of the identified barriers are discussed.
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Affiliation(s)
- Allyson L Dir
- Department of Psychiatry, Indiana University School of Medicine, 410 W 10th Street, Suite 2000, Indianapolis, IN, 46202, USA
| | - Dennis P Watson
- Lighthouse Institute, Chestnut Health Systems, 221 W Walton St., Chicago, IL, 60610, USA.
| | - Matthew Zhiss
- School of Social Work, Indiana University Purdue University Indianapolis, 902 West New York Street, Indianapolis, IN, 46202, USA
| | - Lisa Taylor
- Center for Dissemination and Implementation Science, Department of Medicine, College of Medicine, University of Illinois at Chicago, 818 S. Wolcott, Chicago, IL, 60612, USA
| | - Bethany C Bray
- Center for Dissemination and Implementation Science, Department of Medicine, College of Medicine, University of Illinois at Chicago, 818 S. Wolcott, Chicago, IL, 60612, USA
| | - Alan McGuire
- Department of Psychology, Indiana University Purdue University Indianapolis, 402 N. Blackford St., Indianapolis, IN, 46202, USA.,Center for Health Information and Communication, Health Services Research and Development, Richard L. Roudebush VAMC, 1481 W. 10th St. (11H) Rm. C8108, Indianapolis, IN, 46202, USA
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Mathes T, Rombey T, Kuss O, Pieper D. No inexplicable disagreements between real-world data-based nonrandomized controlled studies and randomized controlled trials were found. J Clin Epidemiol 2021; 133:1-13. [PMID: 33359322 DOI: 10.1016/j.jclinepi.2020.12.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/13/2020] [Revised: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES We assessed disagreements between nonrandomized controlled studies based on real-world data (NRCS-RWDs) and randomized controlled trials (RCTs). STUDY DESIGN AND SETTING We systematically searched for studies that compared treatment effect estimates from NRCS-RWDs and RCTs on the same clinical question. We assessed the potential difference between NRCS-RWDs and RCTs related to internal and external validity. We calculated various meta-epidemiological measures to assess agreement. In case of disagreements, we tried to identify the probable causes of disagreements. RESULTS We included 12 studies comparing 15 treatment effect estimates of NRCS-RWDs and RCTs. There were many potential causes of disagreement. Ninety-five percent confidence intervals overlapped for 12 of 15 treatment effect estimates. Our analysis on predicted vs. observed overlap showed that there were no more disagreements than expected by chance. We observed only two substantial differences between the 15 treatment effect estimates. In both cases, we identified risk of bias in the NRCS-RWDs as the most probable cause of disagreement. CONCLUSION Our findings suggest that there are clinical questions where the difference in risk of bias between a well-conducted NRCS-RWD and an RCT is negligible. In our analysis, threats to external validity appeared to have no or only a weak impact on the disagreements of treatment effect estimates.
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Affiliation(s)
- Tim Mathes
- Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, 51067 Cologne, Germany.
| | - Tanja Rombey
- Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, 51067 Cologne, Germany
| | - Oliver Kuss
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research, Heinrich Heine University Düsseldorf, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, 51067 Cologne, Germany
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Auliffe SM, Korakakis V, Hilfiker R, Whiteley R, O'Sullivan K. Participant characteristics are poorly reported in exercise trials in tendinopathy: A systematic review. Phys Ther Sport 2020; 48:43-53. [PMID: 33360409 DOI: 10.1016/j.ptsp.2020.12.012] [Citation(s) in RCA: 4] [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: 09/25/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the reporting of eligibility criteria and baseline participant characteristics in randomised controlled trials investigating the effects of exercise interventions in tendinopathy. METHODS Randomised controlled trials investigating the effects of exercise therapy compared to a non-exercising intervention in upper and lower limb tendinopathy were included. Data extraction was categorised into the following domains: participant demographics, tendinopathy descriptors, general health, participant recruitment and eligibility criteria. RESULTS The review included the following tendinopathies: Achilles (n = 9), gluteal (n = 2), lateral elbow tendinopathy (n = 15), patellar (n = 3) plantar (n = 3), and rotator cuff (n = 13). Age, sex, duration of symptoms and symptom severity were commonly reported across the review, while prior history of tendinopathy was poorly reported (6/45). Variables such as physical activity level (17/45), sleep (0/45), psychological factors (2/45), medication at baseline (8/45), co morbid health complaints (10/45) and sociodemographic factors (11/45) were poorly reported across the included studies. Substantial variation existed between studies in the specific eligibility criteria used. CONCLUSION The findings of this systematic review demonstrate that participant characteristics are poorly reported in exercise trials in tendinopathy. To improve effectiveness of exercise interventions in tendinopathy, improved reporting of participant characteristics may allow better comparisons and targeted interventions for specific subgroups.
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Affiliation(s)
- Seán Mc Auliffe
- Department of Physical Therapy & Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar.
| | | | - Roger Hilfiker
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland Valais, Leukerbad, Switzerland
| | - Rodney Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Kieran O'Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland; Ageing Research Centre, University of Limerick, Limerick, Ireland
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Lee H, Cook JA, Lamb SE, Parsons N, Keene DJ, Sims AL, Costa ML, Griffin XL. The findings of a surgical hip fracture trial were generalizable to the UK national hip fracture database. J Clin Epidemiol 2020; 131:141-151. [PMID: 33278614 DOI: 10.1016/j.jclinepi.2020.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/17/2020] [Accepted: 11/23/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To estimate the generalizability of treatment effects observed in a randomized trial of hip fracture surgery implants to a broader population of people undergoing hip surgery in the United Kingdom. STUDY DESIGN AND SETTING In 2018, the WHiTE-3 trial (n = 958) demonstrated that a modular hemiarthroplasty implant conferred no additional benefit over the traditional monoblock implant for quality of life and length of hospital stay. We compared and weighted the trial sample against two target populations: WHiTE-cohort (n = 2,457) and UK-National Hip Fracture Database (NHFD, n = 190,894), and re-estimate expected treatment effects for the target populations. RESULTS Despite differences in baseline characteristics of the trial sample and target populations, the re-estimated treatment effects were comparable. For quality of life, the differences between the trial estimate and WHiTE-cohort and NHFD estimates were 0.01 points on the EuroQol (EQ5D). For length of stay, the difference between the trial estimate and WHiTE-cohort was 0.50 days; and the difference between the trial estimate and NHFD estimate was -0.47 days. CONCLUSION This generalizability analysis of the WHiTE-3 trial found that the inferences from the trial can be generalized to a wider population of individuals in the UK NHFD and the WHiTE-cohort who met the inclusion criteria for WHiTE-3.
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Affiliation(s)
- Hopin Lee
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
| | - Jonathan A Cook
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; College of Medicine and Health, University of Exeter, UK
| | - Nick Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - David J Keene
- Kadoorie Centre, John Radcliffe Hospital, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alex L Sims
- Northumbria NHS Foundation Trust, Northumberland, UK
| | - Matthew L Costa
- Kadoorie Centre, John Radcliffe Hospital, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Xavier L Griffin
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Newark Street, London, UK; Barts Health NHS Trust, London, UK
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Berniūnas R, Beinorius A, Dranseika V, Silius V, Rimkevičius P. The weirdness of belief in free will. Conscious Cogn 2020; 87:103054. [PMID: 33254053 DOI: 10.1016/j.concog.2020.103054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 06/19/2020] [Revised: 11/07/2020] [Accepted: 11/11/2020] [Indexed: 11/25/2022]
Abstract
It has been argued that belief in free will is socially consequential and psychologically universal. In this paper we look at the folk concept of free will and its critical assessment in the context of recent psychological research. Is there a widespread consensus about the conceptual content of free will? We compared English "free will" with its lexical equivalents in Lithuanian, Hindi, Chinese and Mongolian languages and found that unlike Lithuanian, Chinese, Hindi and Mongolian lexical expressions of "free will" do not refer to the same concept free will. What kind people have been studied so far? A review of papers indicate that, overall, 91% of participants in studies on belief in free will were WEIRD. Thus, given that free will has no cross-culturally universal conceptual content and that most of the reviewed studies were based on WEIRD samples, belief in free will is not a psychological universal.
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Affiliation(s)
| | - Audrius Beinorius
- Vilnius University, Institute of Asian and Transcultural Studies, Lithuania
| | - Vilius Dranseika
- Vilnius University, Institute of Philosophy/Institute of Asian and Transcultural Studies, Lithuania
| | - Vytis Silius
- Vilnius University, Institute of Asian and Transcultural Studies, Lithuania
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Sanchez-Flack JC, Herman A, Buscemi J, Kong A, Bains A, Fitzgibbon ML. A systematic review of the implementation of obesity prevention interventions in early childcare and education settings using the RE-AIM framework. Transl Behav Med 2020; 10:1168-1176. [PMID: 33044537 PMCID: PMC7549410 DOI: 10.1093/tbm/ibz179] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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] [Indexed: 11/14/2022] Open
Abstract
Previous systematic reviews have examined the efficacy of obesity prevention interventions within early childcare/education settings. Often lacking in these reviews is reporting on external validity, which continues to be underemphasized compared to internal validity. More attention to external validity would help better translate evidence-based interventions to real-world settings. This systematic review aimed to determine the availability of data on both internal and external validity across dimensions of the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework in studies reporting on obesity prevention interventions in early childcare/education settings. Inclusion criteria included: randomized controlled trials, early childcare/education setting, targeted children 2-6 years old, addressed both diet and physical activity, collected measures of weight status and diet and/or physical activity, and published within the last 10 years. Searches were conducted in ERIC, PsychInfo, and PubMed; 23 studies met inclusion criteria. A validated RE-AIM abstraction tool was used to code studies. Most commonly reported dimensions were Reach (62.3%), Implementation (53.5%), and Efficacy/Effectiveness (48.7%). Adoption (21.7%) and Maintenance (11.6%) were less often reported. All studies reported on primary outcomes, but few reported on RE-AIM indicators of characteristics of participation and adoption, quality of life, methods used to identify staff, staff inclusion/exclusion criteria and adoption rates, implementation fidelity, measures of cost to start-up and deliver the intervention, and indicators of maintenance. This systematic review underscores the need for more focus on external validity to inform replication, dissemination, and implementation so that evidence-based early childcare/education obesity interventions can be generalized to real-world settings.
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Affiliation(s)
| | - Annie Herman
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Angela Kong
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Alexis Bains
- Department of Kinesiology and Nutrition, College of Applied Health, Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Marian L Fitzgibbon
- Department of Pediatrics and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
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Pahus L, Suehs CM, Halimi L, Bourdin A, Chanez P, Jaffuel D, Marciano J, Gamez AS, Vachier I, Molinari N. Patient distrust in pharmaceutical companies: an explanation for women under-representation in respiratory clinical trials? BMC Med Ethics 2020; 21:72. [PMID: 32791969 PMCID: PMC7424561 DOI: 10.1186/s12910-020-00509-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 07/23/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Patient skepticism concerning medical innovations can have major consequences for current public health and may threaten future progress, which greatly relies on clinical research. The primary objective of this study is to determine the variables associated with patient acceptation or refusal to participate in clinical research. Specifically, we sought to evaluate if distrust in pharmaceutical companies and associated psychosocial factors could represent a recruitment bias in clinical trials and thus threaten the applicability of their results. METHODS This prospective, multicenter survey consisted in the administration of a self-questionnaire to patients during a pulmonology consultation. The 1025 questionnaires distributed collected demographics, socio-professional and basic health literacy characteristics. Patients were asked to rank their level of trust for pharmaceutical companies and indicate their willingness to participate in different categories of research (pre or post marketing, sponsored by an academic institution or pharmaceutical company). Logistic regression was used to determine factors contributing to "trust" versus "distrust" group membership and willingness to participate in each category of research. RESULTS One thousand patients completed the survey, corresponding to a response rate of 97.5%. Data from 838 patients were analyzed in this study. 48.3% of respondents declared that they trusted pharmaceutical companies, while 35.5% declared distrust. Being female (p = 0.042), inactive in the employment market(p = 0.007), and not-knowing the name of one's disease(p = 0.010) are factors related to declared distrust. Distrust-group membership is associated with unwillingness to participate in certain categories of trials such as pre-marketing and industry-sponsored trials. CONCLUSION Distrust in pharmaceutical companies is associated with a specific patient profile and with refusal to participate in certain subcategories of trials. This potential recruitment bias may explain the under-representation of certain categories of patients such as women in pre-marketing drug trials.
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Affiliation(s)
- Laurie Pahus
- Aix Marseille Univ, APHM, Hôpital NORD, CIC 9502, Clinique des bronches allergies et sommeil, Chemin des Bourrely, 13015, Marseille, France.
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.
- Aix Marseille Univ, INSERM U1263, INRA 1260 (C2VN), Marseille, France.
| | - Carey Meredith Suehs
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Laurence Halimi
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Arnaud Bourdin
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
- Association pour l'Assistance et la Réhabilitation à Domicile (APARD), Montpellier, France
| | - Pascal Chanez
- Aix Marseille Univ, APHM, Hôpital NORD, CIC 9502, Clinique des bronches allergies et sommeil, Chemin des Bourrely, 13015, Marseille, France
- Aix Marseille Univ, INSERM U1263, INRA 1260 (C2VN), Marseille, France
| | - Dany Jaffuel
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
- Association pour l'Assistance et la Réhabilitation à Domicile (APARD), Montpellier, France
- Polyclinique Saint-Privat, Maladies Respiratoires et Troubles Respiratoires du Sommeil, Boujan sur Libron, France
| | | | - Anne-Sophie Gamez
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Isabelle Vachier
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Nicolas Molinari
- IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France
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50
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Palmowski A, Nielsen SM, Buttgereit T, Palmowski Y, Boers M, Christensen R, Buttgereit F. Glucocorticoid-trials in rheumatoid arthritis mostly study representative real-world patients: A systematic review and meta-analysis. Semin Arthritis Rheum 2020; 50:1400-1405. [PMID: 32222381 DOI: 10.1016/j.semarthrit.2020.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/15/2020] [Accepted: 02/25/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Randomized controlled trials (RCTs) are considered the gold standard in clinical research due to credible causality. Their results, however, may not be generalizable to real-world populations. While glucocorticoids (GCs) remain a mainstay of rheumatoid arthritis (RA) treatment, it is unclear whether the results of GC-RCTs are generalizable to current real-world RA patients. METHODS MEDLINE was searched for RCTs and, as comparators, cohort studies (CSs) in RA evaluating systemic GCs. Random-effects meta-analyses were performed for descriptive baseline characteristics (including general demographics, comorbidities, and disease activity) that have been shown to be able to modify the benefit-risk-ratio of various RA therapeutics. These meta-analyses were stratified by study type (RCT and CS). Stratified estimates were subsequently compared. Further sensitivity analyses were performed stratifying by disease duration. RESULTS 56 RCTs (7053 participants) and 10 CSs (14,688 participants) were included. 12 characteristics were reported frequently enough to allow for comparative analysis. In 10/12 characteristics (83%), RCT estimates did not appear to differ from CS estimates. However, RCT participants were younger (-4.7 years [95% CI -7.2 to -2.1]; p < 0.001) and had higher erythrocyte sedimentation rates (11.8 mm/h [5.7 to 17.8]; p < 0.001) than CS participants. Comorbidities could not be assessed due to insufficient reporting. CONCLUSION Our findings suggest that evidence from GC trials in RA is of acceptable generalizability to current real-world patients - especially compared to findings from biologic agents in RA. However, RCT participants were younger than real-world patients, potentially limiting the generalizability of trial results to elderly patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42019134675).
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Affiliation(s)
- Andriko Palmowski
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Sabrina M Nielsen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2000 Frederiksberg, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, 5000 Odense, Denmark
| | - Thomas Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Dermatology, Venerology, and Allergology, Charité - University Medicine Berlin, 10117 Berlin, Germany
| | - Yannick Palmowski
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, 10117 Berlin, Germany
| | - Maarten Boers
- Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, 1007 MB Amsterdam, the Netherlands
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2000 Frederiksberg, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, 5000 Odense, Denmark
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
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