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De Corso E, Pipolo C, Cantone E, Ottaviano G, Gallo S, Trimarchi M, Torretta S, Cavaliere C, Lucidi D, Seccia V, Settimi S, Canevari FRM, Pasquini E, La Mantia I, Garzaro M, Bellocchi G, De Benedetto M, Lombardo N, Macchi A, Malvezzi L, Motta G, Vicini C, Maselli A, Dell’Era V, Dragonetti A, Asprea F, Lupato V, Ghidini A, Masieri S, Mattavelli D, Salzano FA, Passali D, Galli J, Pagella F. Practical recommendations for managing severe chronic rhinosinusitis with nasal polyps in the era of biologics. Acta Otorhinolaryngol Ital 2023; 43:324-340. [PMID: 37224173 PMCID: PMC10551726 DOI: 10.14639/0392-100x-n2422] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/09/2023] [Indexed: 05/26/2023]
Abstract
Objective We conducted a national survey to understand how rhinology practice has changed with the advent of biologics and how this affected patients with uncontrolled, severe chronic rhinosinusitis with nasal polyps (CRSwNP). We aimed to analyse the results of the survey and infer practical recommendations for clinical practice. Methods A group of ear, nose, and throat specialists (ENTs) experienced in the management of CRSwNP developed a 74-question survey. ENTs from rhinology centres authorised to prescribe biologics in the context of the national health system were invited to answer it between 01/05/2022 and 31/07/2022. The responses underwent descriptive analyses, and the authors discussed the results and derived practical recommendations for clinical practice. Results ENTs working in rhinology centres changed their practices coinciding with the advent of biologics. CRSwNP evaluations have become more complex because they involve diagnostic confirmation, determining the patients' immunologic profile, and other factors. We observed heterogenous behaviours in practice that may be conditioned by the novelty of the topic. The results of the survey were used to develop practical recommendations for ENTs and are summarised herein. Conclusions Clinical practice in rhinology outpatient clinics has changed profoundly in the era of biologics. Our practical recommendations for clinicians working in rhinology centres are expected to help standardise practice and improve care.
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Affiliation(s)
- Eugenio De Corso
- Otorhinolaryngology Unit, Head and Neck Department, A. Gemelli Universitary Hospital Foundation IRCCS, Rome, Italy
| | - Carlotta Pipolo
- Otorhinolaryngology Unit, Head and Neck Department, Dipartimento di Scienze della Salute, Università degli Studi di Milano, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | - Elena Cantone
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, Unit of Ear, Nose and Throat, “Federico II” University, Naples, Italy
| | - Giancarlo Ottaviano
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
| | - Stefania Gallo
- Otorhinolaryngology Unit, Head and Neck Department, ASST Sette Laghi and UPLOAD Research Center, University of Insubria, Varese, Italy
| | - Matteo Trimarchi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Torretta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Cavaliere
- Dipartimento di scienze odontostomatologiche e maxillo facciali. Sapienza University of Rome, Rome, Italy
| | - Daniela Lucidi
- Department of Otolaryngology – Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Veronica Seccia
- Otolaryngology, Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Pisa University Hospital, Pisa, Italy
| | | | - Frank Rikki Mauritz Canevari
- UOC di Otorinolaringoiatria IRCCS Policlinico San Martino Genova, Dipartimento DISC Università di Genova, Genoa, Italy
| | - Ernesto Pasquini
- ENT Unit “Bellaria” Hospital – Specialized Dep AUSL Bologna, Italy
| | | | | | | | | | - Nicola Lombardo
- ENT Unit Department of Medical and Surgical Sciences, University Magna Græcia Catanzaro, Italy
| | - Alberto Macchi
- ENT University of Insubria, ASST Settelaghi, Varese, Italy
| | - Luca Malvezzi
- IRCCS Humanitas Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Rozzano (MI), Italy
| | - Gaetano Motta
- Otorhinolaryngology – Head and Neck Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Alessandro Maselli
- Department Otorhinolaryngology, Hospital of Barletta, Barletta (BT), Italy
| | - Valeria Dell’Era
- ENT Division, Maggiore Hospital, Eastern Piedmont University – Novara, Italy
| | | | - Francesco Asprea
- Otorinolaringoiatria e audiologia. Università degli studi di Messina, Messina, Italy
| | - Valentina Lupato
- Division of Otolaryngology, Ospedale Civile di Pordenone, Azienda Sanitaria Friuli Occidentale (ASFO), Pordenone, Italy
| | - Angelo Ghidini
- Otorinolaringoiatria Azienda USL di Reggio Emilia/IRCCS, Italy
| | - Simonetta Masieri
- Dipartimento di scienze odontostomatologiche e maxillo facciali. Sapienza University of Rome, Rome, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia – University of Brescia, Brescia, Italy
| | | | | | - Jacopo Galli
- Otorhinolaryngology Unit, Head and Neck Department, A. Gemelli Universitary Hospital Foundation IRCCS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Fabio Pagella
- Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
- Otorhinolaryngology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Zhang X, Stamey JD, Mathur MB. Assessing the impact of unmeasured confounders for credible and reliable real-world evidence. Pharmacoepidemiol Drug Saf 2020; 29:1219-1227. [PMID: 32929830 DOI: 10.1002/pds.5117] [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: 12/27/2019] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE We review statistical methods for assessing the possible impact of bias due to unmeasured confounding in real world data analysis and provide detailed recommendations for choosing among the methods. METHODS By updating an earlier systematic review, we summarize modern statistical best practices for evaluating and correcting for potential bias due to unmeasured confounding in estimating causal treatment effect from non-interventional studies. RESULTS We suggest a hierarchical structure for assessing unmeasured confounding. First, for initial sensitivity analyses, we strongly recommend applying a recently developed method, the E-value, that is straightforward to apply and does not require prior knowledge or assumptions about the unmeasured confounder(s). When some such knowledge is available, the E-value could be supplemented by the rule-out or array method at this step. If these initial analyses suggest results may not be robust to unmeasured confounding, subsequent analyses could be conducted using more specialized statistical methods, which we categorize based on whether they require access to external data on the suspected unmeasured confounder(s), internal data, or no data. Other factors for choosing the subsequent sensitivity analysis methods are also introduced and discussed, including the types of unmeasured confounders and whether the subsequent sensitivity analysis is intended to provide a corrected causal treatment effect. CONCLUSION Various analytical methods have been proposed to address unmeasured confounding, but little research has discussed a structured approach to select appropriate methods in practice. In providing practical suggestions for choosing appropriate initial and, potentially, more specialized subsequent sensitivity analyses, we hope to facilitate the widespread reporting of such sensitivity analyses in non-interventional studies. The suggested approach also has the potential to inform pre-specification of sensitivity analyses before executing the analysis, and therefore increase the transparency and limit selective study reporting.
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Affiliation(s)
- Xiang Zhang
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| | - James D Stamey
- Department of Statistics, Baylor University, Waco, Texas, USA
| | - Maya B Mathur
- Quantitative Sciences Unit, Stanford University, Stanford, California, USA
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Stängle S, Schnepp W, Mezger M, Büche D, Fringer A. Voluntary Stopping of Eating and Drinking in Switzerland From Different Points of View: Protocol for a Mixed-Methods Study. JMIR Res Protoc 2018; 7:e10358. [PMID: 30578180 PMCID: PMC6320426 DOI: 10.2196/10358] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/31/2018] [Accepted: 08/31/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND "To die with dignity" has reached the significance of a core value in democratic societies. Based on this unconditional value, people require autonomy and care. "Voluntary stopping of eating and drinking" (VSED) represents an alternative to assisted suicide because no one else is involved in the action of death fastening, even though from outside, it might be considered as an extreme form of passive euthanasia. However, there are no data available about the prevalence and frequency of either explicit VSED or the implicit reduction of food and liquid in Switzerland. The responsible and independent ethics committee of the Greater Region of Eastern Switzerland (EKOS 17/083) approved this study. OBJECTIVE The objectives of the study were to research the prevalence and frequency of different types (implicit and explicit) of VSED in Switzerland; to explore the experiences, attitudes, handling and recommendations made by palliative care experts; to develop a practical recommendation about VSED, which will be validated by experts in Delphi rounds. METHODS This protocol describes a convergent mixed-method design to answer the research questions. In the first step, a cross-sectional trilingual survey (in German, French, and Italian) will be carried out to obtain a comprehensive representative picture of VSED in Switzerland. In the second step, qualitative research will be carried out by focus group interviews with palliative care experts. The interviews will be recorded, transcribed, and analyzed using generic coding, and embedded in an explorative descriptive qualitative approach. Based on the results of the first two steps, a practical recommendation will be developed. Experts will validate the practical recommendation in Delphi rounds. RESULTS The enrolment was completed in summer of 2018. Data analysis is currently underway and the first results are expected to be submitted for publication in the end of 2019. CONCLUSIONS The results of this study will provide important information about the prevalence and frequency of VSED as well as the interpretation of palliative care experts about handling VSED in daily work. Furthermore, the practice recommendation will help professionals and institutions to improve the quality of care in patients and their relatives who made the decision to fasten death by VSED. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/10358.
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Affiliation(s)
- Sabrina Stängle
- Department of Nursing Science, Faculty of Health, University Witten/Herdecke, Witten, Germany.,Institute of Nursing, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Wilfried Schnepp
- Department of Nursing Science, Faculty of Health, University Witten/Herdecke, Witten, Germany
| | - Mirjam Mezger
- Institute of Nursing, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Daniel Büche
- Palliative Centre St Gallen, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - André Fringer
- Department of Nursing Science, Faculty of Health, University Witten/Herdecke, Witten, Germany.,Institute of Nursing, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
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