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Edwards KM, Griffin MR. Postmarketing Vaccine Safety Assessments: Important Work in Progress. JAMA 2024; 331:915-917. [PMID: 38502085 DOI: 10.1001/jama.2023.26630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
| | - Marie R Griffin
- School of Medicine, Vanderbilt University, Nashville, Tennessee
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Kannan S, Bruch JD, Song Z. Changes in Hospital Adverse Events and Patient Outcomes Associated With Private Equity Acquisition. JAMA 2023; 330:2365-2375. [PMID: 38147093 PMCID: PMC10751598 DOI: 10.1001/jama.2023.23147] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/22/2023] [Indexed: 12/27/2023]
Abstract
Importance The effects of private equity acquisitions of US hospitals on the clinical quality of inpatient care and patient outcomes remain largely unknown. Objective To examine changes in hospital-acquired adverse events and hospitalization outcomes associated with private equity acquisitions of US hospitals. Design, Setting, and Participants Data from 100% Medicare Part A claims for 662 095 hospitalizations at 51 private equity-acquired hospitals were compared with data for 4 160 720 hospitalizations at 259 matched control hospitals (not acquired by private equity) for hospital stays between 2009 and 2019. An event study, difference-in-differences design was used to assess hospitalizations from 3 years before to 3 years after private equity acquisition using a linear model that was adjusted for patient and hospital attributes. Main Outcomes and Measures Hospital-acquired adverse events (synonymous with hospital-acquired conditions; the individual conditions were defined by the US Centers for Medicare & Medicaid Services as falls, infections, and other adverse events), patient mix, and hospitalization outcomes (including mortality, discharge disposition, length of stay, and readmissions). Results Hospital-acquired adverse events (or conditions) were observed within 10 091 hospitalizations. After private equity acquisition, Medicare beneficiaries admitted to private equity hospitals experienced a 25.4% increase in hospital-acquired conditions compared with those treated at control hospitals (4.6 [95% CI, 2.0-7.2] additional hospital-acquired conditions per 10 000 hospitalizations, P = .004). This increase in hospital-acquired conditions was driven by a 27.3% increase in falls (P = .02) and a 37.7% increase in central line-associated bloodstream infections (P = .04) at private equity hospitals, despite placing 16.2% fewer central lines. Surgical site infections doubled from 10.8 to 21.6 per 10 000 hospitalizations at private equity hospitals despite an 8.1% reduction in surgical volume; meanwhile, such infections decreased at control hospitals, though statistical precision of the between-group comparison was limited by the smaller sample size of surgical hospitalizations. Compared with Medicare beneficiaries treated at control hospitals, those treated at private equity hospitals were modestly younger, less likely to be dually eligible for Medicare and Medicaid, and more often transferred to other acute care hospitals after shorter lengths of stay. In-hospital mortality (n = 162 652 in the population or 3.4% on average) decreased slightly at private equity hospitals compared with the control hospitals; there was no differential change in mortality by 30 days after hospital discharge. Conclusions and Relevance Private equity acquisition was associated with increased hospital-acquired adverse events, including falls and central line-associated bloodstream infections, along with a larger but less statistically precise increase in surgical site infections. Shifts in patient mix toward younger and fewer dually eligible beneficiaries admitted and increased transfers to other hospitals may explain the small decrease in in-hospital mortality at private equity hospitals relative to the control hospitals, which was no longer evident 30 days after discharge. These findings heighten concerns about the implications of private equity on health care delivery.
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Affiliation(s)
- Sneha Kannan
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Joseph Dov Bruch
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Zirui Song
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston
- Center for Primary Care, Harvard Medical School, Harvard University, Boston, Massachusetts
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Keng MJ, Leal J, Mafham M, Bowman L, Armitage J, Mihaylova B. Performance of the UK Prospective Diabetes Study Outcomes Model 2 in a Contemporary UK Type 2 Diabetes Trial Cohort. Value Health 2022; 25:435-442. [PMID: 35227456 PMCID: PMC8881217 DOI: 10.1016/j.jval.2021.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 08/27/2021] [Accepted: 09/06/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The UK Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS-OM) developed using 30-year (1977-2007) data from the UKPDS is widely used for health outcomes' projections and economic evaluations of therapies for patients with type 2 diabetes (T2D). Nevertheless, its reliability for contemporary UK T2D populations is unclear. We assessed the performance of version 2 of the model (UKPDS-OM2) using data from A Study of Cardiovascular Events in Diabetes (ASCEND), which followed participants with diabetes in the UK between 2005 and 2017. METHODS The UKPDS-OM2 was used to predict the occurrence of myocardial infarction (MI), other ischemic heart disease, stroke, cardiovascular (CV) death, and other death among the 14 569 participants with T2D in ASCEND, all without previous CV disease at study entry. Calibration (comparison of predicted and observed year-on-year cumulative incidence over 10 years) and discrimination (c-statistics) of the model were assessed for each endpoint. The percentage error in event rates at year 7 (mean duration of follow up) was used to quantify model bias. RESULTS The UKPDS-OM2 substantially overpredicted MI, stroke, CV death, and other death over the 10-year follow-up period (by 149%, 42%, 269%, and 52%, respectively, at year 7). Discrimination of the model for MI and other ischemic heart disease (c-statistics 0.58 and 0.60, respectively) was poorer than that for other outcomes (c-statistics ranging from 0.66 to 0.72). CONCLUSIONS The UKPDS-OM2 substantially overpredicted risks of key CV outcomes and death in people with T2D in ASCEND. Appropriate adjustments or a new model may be required for assessments of long-term effects of treatments in contemporary T2D cohorts.
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Affiliation(s)
- Mi Jun Keng
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK; British Heart Foundation Centre of Research Excellence, Oxford, England, UK.
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK
| | - Marion Mafham
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK
| | - Louise Bowman
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK
| | - Jane Armitage
- British Heart Foundation Centre of Research Excellence, Oxford, England, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK
| | - Borislava Mihaylova
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK; Wolfson Institute of Population Health, Queen Mary University of London, London, England, UK
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Otte WM, Vinkers CH, Habets PC, van IJzendoorn DGP, Tijdink JK. Analysis of 567,758 randomized controlled trials published over 30 years reveals trends in phrases used to discuss results that do not reach statistical significance. PLoS Biol 2022; 20:e3001562. [PMID: 35180228 PMCID: PMC8893613 DOI: 10.1371/journal.pbio.3001562] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 03/03/2022] [Accepted: 01/31/2022] [Indexed: 11/19/2022] Open
Abstract
The power of language to modify the reader's perception of interpreting biomedical results cannot be underestimated. Misreporting and misinterpretation are pressing problems in randomized controlled trials (RCT) output. This may be partially related to the statistical significance paradigm used in clinical trials centered around a P value below 0.05 cutoff. Strict use of this P value may lead to strategies of clinical researchers to describe their clinical results with P values approaching but not reaching the threshold to be "almost significant." The question is how phrases expressing nonsignificant results have been reported in RCTs over the past 30 years. To this end, we conducted a quantitative analysis of English full texts containing 567,758 RCTs recorded in PubMed between 1990 and 2020 (81.5% of all published RCTs in PubMed). We determined the exact presence of 505 predefined phrases denoting results that approach but do not cross the line of formal statistical significance (P < 0.05). We modeled temporal trends in phrase data with Bayesian linear regression. Evidence for temporal change was obtained through Bayes factor (BF) analysis. In a randomly sampled subset, the associated P values were manually extracted. We identified 61,741 phrases in 49,134 RCTs indicating almost significant results (8.65%; 95% confidence interval (CI): 8.58% to 8.73%). The overall prevalence of these phrases remained stable over time, with the most prevalent phrases being "marginally significant" (in 7,735 RCTs), "all but significant" (7,015), "a nonsignificant trend" (3,442), "failed to reach statistical significance" (2,578), and "a strong trend" (1,700). The strongest evidence for an increased temporal prevalence was found for "a numerical trend," "a positive trend," "an increasing trend," and "nominally significant." In contrast, the phrases "all but significant," "approaches statistical significance," "did not quite reach statistical significance," "difference was apparent," "failed to reach statistical significance," and "not quite significant" decreased over time. In a random sampled subset of 29,000 phrases, the manually identified and corresponding 11,926 P values, 68,1% ranged between 0.05 and 0.15 (CI: 67. to 69.0; median 0.06). Our results show that RCT reports regularly contain specific phrases describing marginally nonsignificant results to report P values close to but above the dominant 0.05 cutoff. The fact that the prevalence of the phrases remained stable over time indicates that this practice of broadly interpreting P values close to a predefined threshold remains prevalent. To enhance responsible and transparent interpretation of RCT results, researchers, clinicians, reviewers, and editors may reduce the focus on formal statistical significance thresholds and stimulate reporting of P values with corresponding effect sizes and CIs and focus on the clinical relevance of the statistical difference found in RCTs.
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Affiliation(s)
- Willem M. Otte
- Biomedical MR Imaging and Spectroscopy, Center for Image Sciences, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Christiaan H. Vinkers
- Department of Psychiatry, Department of Anatomy and Neurosciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Philippe C. Habets
- Department of Psychiatry, Department of Anatomy and Neurosciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - David G. P. van IJzendoorn
- Department of Pathology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Joeri K. Tijdink
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Philosophy, Vrije Universiteit, Amsterdam, the Netherlands
- * E-mail:
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Gero D, Muller X, Staiger RD, Gutschow CA, Vonlanthen R, Bueter M, Clavien PA, Puhan MA. How to Establish Benchmarks for Surgical Outcomes?: A Checklist Based on an International Expert Delphi Consensus. Ann Surg 2022; 275:115-120. [PMID: 32398485 DOI: 10.1097/sla.0000000000003931] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To define a standardized methodology for establishing benchmarks for relevant outcomes in surgery. SUMMARY BACKGROUND DATA Benchmarking is an established tool to improve quality in industry and economics, and is emerging in assessing outcome values in surgery. Despite a recent 10-step approach to identify such benchmark values, a standardized and more widely agreed-on approach is still lacking. METHODS A multinational web-based Delphi survey with a focus on methodological requirements for establishing benchmarks for surgical outcomes was performed. Participants were selected among internationally renowned specialists in abdominal, vascular, and thoracic surgery. Consensus was defined as ≥70% agreement and results were used to develop a checklist to establish benchmarks in surgery. RESULTS Forty-one surgical opinion leaders from 19 countries and 5 continents were involved. Experts' response rates were 98% and 80% in rounds 1 and 2, respectively. Upon completion of the final Delphi round, consensus was successfully achieved for 26 of 36 items covering the following areas: center eligibility, validation of databases, patient cohort selection, procedure selection, duration of follow-up, statistical analysis, and publication requirements regarding center-specific outcomes. CONCLUSIONS This multinational Delphi survey represents the first expert-led process for developing a standardized approach for establishing benchmarks for relevant outcome measures in surgery. The provided consensual checklist customizes the methodology of outcome reporting in surgery and thus improves reproducibility and comparability of data and should ultimately serve to improve quality of care.
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Affiliation(s)
- Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Xavier Muller
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Roxane D Staiger
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Christian A Gutschow
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - René Vonlanthen
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Oversoe SK, Sorensen BS, Tabaksblat EM, Gronbaek H, Kelsen J. Cell-Free DNA and Clinical Characteristics in Patients with Small Intestinal or Pancreatic Neuroendocrine Tumors. Neuroendocrinology 2022; 112:43-50. [PMID: 33461190 DOI: 10.1159/000514457] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/26/2020] [Accepted: 01/15/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Neuroendocrine tumors (NETs) are rare and characterized by a heterogeneous clinical course and an unmet need for better prognostic markers. Plasma cell-free DNA (cfDNA) has prognostic value in other malignancies but is not previously investigated in NETs. We studied cfDNA levels in patients with mainly low-grade small intestinal NET -(siNET) or pancreatic NET (pNET) and evaluated the prognostic potential of cfDNA. MATERIALS AND METHODS We included 70 NET patients, siNET (n = 50) and pNET (n = 20). Plasma cfDNA levels were determined by droplet digital PCR for the beta-2-microglobulin gene every 6 months during a period of 3 years, including in a subgroup of 19 patients during peptide receptor radionuclide therapy (PRRT) therapy. RESULTS cfDNA levels were higher in both siNET and pNET compared to a previously established healthy cohort (p < 0.0001). -cfDNA levels did not predict overall survival (crude hazard ratio [HR] 0.95 [0.57-1.58], p = 0.837, adjusted for smoking status HR 0.77 [0.51-1.17], p = 0.22). The impact of cfDNA level on progression-free survival showed different trends in siNET and pNET. There was no effect of PRRT treatment on cfDNA levels and no difference in cfDNA levels between patients with and without progressive disease after PRRT (ANOVA p = 0.66). cfDNA levels were significantly higher in never-smokers and previous smokers than in current smokers (p = 0.029). DISCUSSION/CONCLUSION cfDNA levels are higher in NET patients than in healthy controls; however, there was no association with prognosis, and cfDNA levels were unaffected by PRRT. Our observations suggest that cfDNA levels are not associated with the disease course in low-grade NET in contrast to other malignancies.
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Affiliation(s)
- Stine Karlsen Oversoe
- Department of Hepatology and Gastroenterology, Denmark, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
| | - Boe Sandahl Sorensen
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | | | - Henning Gronbaek
- Department of Hepatology and Gastroenterology, Denmark, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Kelsen
- Department of Hepatology and Gastroenterology, Denmark, Aarhus University Hospital, Aarhus, Denmark
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Affiliation(s)
- Thom Mayer
- National Football League Players Association, Washington, DC
- Duke University School of Medicine, Durham, North Carolina
| | - Arjun Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
- Yale-New Haven Health Services Corporation, Center for Outcomes Research & Evaluation (CORE), New Haven, Connecticut
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Street A, Smith P. How can we make valid and useful comparisons of different health care systems? Health Serv Res 2021; 56 Suppl 3:1299-1301. [PMID: 34755335 PMCID: PMC8579199 DOI: 10.1111/1475-6773.13883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 09/18/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Andrew Street
- Department of Health PolicyLondon School of Economics and Political ScienceLondonUK
| | - Peter Smith
- Centre for Health EconomicsUniversity of YorkYorkUK
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Hu S, Luo W, Darzi A, Pan Y, Zhao G, Liu Y, Xiong C. Do racial and ethnic disparities in following stay-at-home orders influence COVID-19 health outcomes? A mediation analysis approach. PLoS One 2021; 16:e0259803. [PMID: 34762685 PMCID: PMC8584966 DOI: 10.1371/journal.pone.0259803] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/26/2021] [Indexed: 11/20/2022] Open
Abstract
Racial/ethnic disparities are among the top-selective underlying determinants associated with the disproportional impact of the COVID-19 pandemic on human mobility and health outcomes. This study jointly examined county-level racial/ethnic differences in compliance with stay-at-home orders and COVID-19 health outcomes during 2020, leveraging two-year geo-tracking data of mobile devices across ~4.4 million point-of-interests (POIs) in the contiguous United States. Through a set of structural equation modeling, this study quantified how racial/ethnic differences in following stay-at-home orders could mediate COVID-19 health outcomes, controlling for state effects, socioeconomics, demographics, occupation, and partisanship. Results showed that counties with higher Asian populations decreased most in their travel, both in terms of reducing their overall POIs' visiting and increasing their staying home percentage. Moreover, counties with higher White populations experienced the lowest infection rate, while counties with higher African American populations presented the highest case-fatality ratio. Additionally, control variables, particularly partisanship, median household income, percentage of elders, and urbanization, significantly accounted for the county differences in human mobility and COVID-19 health outcomes. Mediation analyses further revealed that human mobility only statistically influenced infection rate but not case-fatality ratio, and such mediation effects varied substantially among racial/ethnic compositions. Last, robustness check of racial gradient at census block group level documented consistent associations but greater magnitude. Taken together, these findings suggest that US residents' responses to COVID-19 are subject to an entrenched and consequential racial/ethnic divide.
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Affiliation(s)
- Songhua Hu
- Maryland Transportation Institute (MTI), Department of Civil and Environmental Engineering, University of Maryland, College Park, MD, United States of America
| | - Weiyu Luo
- Maryland Transportation Institute (MTI), Department of Civil and Environmental Engineering, University of Maryland, College Park, MD, United States of America
| | - Aref Darzi
- Maryland Transportation Institute (MTI), Department of Civil and Environmental Engineering, University of Maryland, College Park, MD, United States of America
| | - Yixuan Pan
- Shock Trauma and Anesthesiology Research (STAR) Center, School of Medicine, University of Maryland, Baltimore, MD, United States of America
| | - Guangchen Zhao
- Maryland Transportation Institute (MTI), Department of Civil and Environmental Engineering, University of Maryland, College Park, MD, United States of America
| | - Yuxuan Liu
- Maryland Transportation Institute (MTI), Department of Civil and Environmental Engineering, University of Maryland, College Park, MD, United States of America
| | - Chenfeng Xiong
- Maryland Transportation Institute (MTI), Department of Civil and Environmental Engineering, University of Maryland, College Park, MD, United States of America
- Shock Trauma and Anesthesiology Research (STAR) Center, School of Medicine, University of Maryland, Baltimore, MD, United States of America
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Alketbi A, Basit S, Hamza N, Walton LM, Moustafa IM. The added value of cognition-targeted exercise versus symptom-targeted exercise for multiple sclerosis fatigue: A randomized controlled pilot trial. PLoS One 2021; 16:e0258752. [PMID: 34748549 PMCID: PMC8575272 DOI: 10.1371/journal.pone.0258752] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Fatigue is considered one of the most common symptoms of multiple sclerosis (MS) and lacks a current standardized treatment. Therefore, the aim of this study was to examine the feasibility and effectiveness of a cognition-targeted exercise versus symptom-targeted exercise for MS fatigue. METHODS In this Pilot, parallel-group, randomized controlled trial, sixty participants with multiple sclerosis, were randomly assigned to either a Cognition-Targeted Exercise (CTE) (N = 30, mean age 41) or a Symptom-Targeted Exercise (STE) (N = 30, mean age 42). The participants in the experimental group received eight, 50-minute sessions of weekly Cognitive Behavior Therapy (CBT) in addition to a CTE Program; whereas, participants in the control group received eight, 50-minute sessions of weekly CBT in addition to the standardized physiotherapy program (STE Program). Feasibility was assessed through recruitment rate, participant retention, adherence and safety, in addition to clinical outcome measures, including: (1) Modified Fatigue Impact Scale (MFIS), (2) Work and Social Adjustment Scale (WSAS), (3) Hospital Anxiety and Depression Scale (HADS), and Perceived Stress Scale (PSS). All outcome measures were assessed at baseline (pretreatment), following completion of the eight visit intervention protocol, and at 3-months follow-up. RESULTS The recruitment rate was 60% and 93% of participants completed the entire study. The recruited participants complied with 98% of the required visits. No adverse events were recorded. A Generalized Estimation Equation Model revealed a significant difference over time as an interaction term during the post and follow up visit for all clinical outcome measures (p < .001). CONCLUSION The addition of CTE to CBT exhibited positive and more lasting influence on MS fatigue outcomes compared to Symptom-Targeted Exercise (STE). Feasibility and efficacy data from this pilot study provide support for a full-scale RCT of CTE as an integral component of Multiple Sclerosis fatigue management.
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Affiliation(s)
- Azza Alketbi
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Salah Basit
- Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Nouran Hamza
- Biostatistician at Medical Agency for Research and Statistics (MARS), Egypt
| | - Lori M. Walton
- Department of Physical Therapy, University of Scranton, Scranton, Pennsylvania, United States of America
| | - Ibrahim M. Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Paixão C, Rebelo P, Oliveira A, Jácome C, Cruz J, Martins V, Simão P, Marques A. Responsiveness and Minimal Clinically Important Difference of the Brief-BESTest in People With COPD After Pulmonary Rehabilitation. Phys Ther 2021; 101:6365141. [PMID: 34499161 DOI: 10.1093/ptj/pzab209] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/21/2021] [Accepted: 07/11/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE he Brief-Balance Evaluation Systems Test (Brief-BESTest) is a comprehensive, reliable, and valid balance test that provides valuable information to guide balance training in people with chronic obstructive pulmonary disease (COPD). Its clinical interpretability is, however, currently limited, because cutoff points to identify clinically relevant changes in people with COPD after pulmonary rehabilitation are still lacking. This study aimed to establish the responsiveness and minimal clinically important difference (MCID) for the Brief-BESTest in people with COPD after pulmonary rehabilitation (PR). METHODS A secondary analysis of data from 2 previous studies was conducted. The modified British Medical Research Council (mMRC) dyspnea scale, the 6-Minute Walk Test (6-MWT), and the Brief-BESTest (0-24 points) were collected in people with COPD pre/post a 12-week PR program including balance training. The MCID was computed using anchor- and distribution-based methods. Changes in the 6-MWT and the mMRC were assessed and used as anchors. The pooled MCID was computed using the arithmetic weighted mean (2/3 anchor- and 1/3 distribution-based methods). RESULTS Seventy-one people with COPD (69 years [SD = 8]; 76% male; FEV1 = 49.8%predicted [SD = 18%]) were included. There was a significant improvement in the Brief-BESTest after PR (mean difference = 3 points [SD = 3]). Significant correlations were found between the Brief-BESTest and the mMRC (r = -.31) and the 6-MWT (r = .37). The pooled MCID was 3.3 points. CONCLUSION An improvement of at least 3 points in the Brief-BESTest in people with COPD will enhance the interpretability of PR effects on balance performance of this population and guide tailored interventions. IMPACT The Brief-BESTest outcome measure is comprehensive, easily administered, and simple to interpret in clinical practice. This study represents a significant contribution toward the clinical interpretation of changes in balance in people with COPD following PR.
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Affiliation(s)
- Cátia Paixão
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- iBiMED-Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
- Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Patrícia Rebelo
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- iBiMED-Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
- Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Ana Oliveira
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Cristina Jácome
- CINTESIS-Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joana Cruz
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- ciTechCare-Center for Innovative Care and Health Technology, School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal
| | - Vitória Martins
- Pulmonology Department, Hospital Distrital da Figueira da Foz, Figueira da Foz, Portugal
| | - Paula Simão
- Pulmonology Department, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Alda Marques
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- iBiMED-Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
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Dovell G, Staniszewska A, Ramirez J, Murray I, Ambler GK, Twine CP, Hinchliffe RJ. A systematic review of outcome reporting for interventions to treat people with diabetic foot ulceration. Diabet Med 2021; 38:e14664. [PMID: 34324741 DOI: 10.1111/dme.14664] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/23/2021] [Accepted: 07/27/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Diabetic foot ulceration (DFU) is a challenging clinical problem that affects up to a quarter of patients with diabetes in their lifetime. An agreed set of outcomes for assessing treatments or interventions for DFU has not previously been considered. The aim of this study was to identify outcomes that are reported in clinical studies assessing a treatment or intervention for DFU, to inform the development of a core outcome set (COS). METHODS Systematic literature searches were performed between January 2016 and March 2019. The search strategy was pre-registered with PROSPERO (CRD42019128250). Two authors independently screened abstracts for full text review. Outcomes were extracted from selected papers verbatim and categorized into domains according to established taxonomy. Consistency of outcome reporting was assessed. Overlapping outcomes were merged independently to condense the extracted list of outcomes for use in forthcoming consensus processes. RESULTS Of 4645 abstracts identified, 114 studies met the inclusion criteria. There were 69 randomized studies, 40 prospective studies and 5 protocols. Some 948 outcomes were extracted verbatim. Outcome reporting was consistent for 474 (53%) outcomes. De-duplication left 714 unique verbatim outcomes across 33 domains. Merging of overlapping unique verbatim outcomes established 95 merged outcomes. CONCLUSION This study describes contemporary outcomes reported in studies assessing interventions for DFU. Outcome reporting is considered to be poor as it was consistent in just over half of outcomes extracted. Merging of outcomes has identified 95 outcomes that can be taken forward in the development of a COS.
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Affiliation(s)
- George Dovell
- Centre for Surgical Research, University of Bristol, Bristol, UK
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
| | | | - Jozel Ramirez
- Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Ines Murray
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
| | - Graeme K Ambler
- Centre for Surgical Research, University of Bristol, Bristol, UK
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
| | | | - Robert J Hinchliffe
- Centre for Surgical Research, University of Bristol, Bristol, UK
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
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Landstra CP, Andres A, Chetboun M, Conte C, Kelly Y, Berney T, de Koning EJP, Piemonti L, Stock PG, Pattou F, Vantyghem MC, Bellin MD, Rickels MR. Examination of the Igls Criteria for Defining Functional Outcomes of β-cell Replacement Therapy: IPITA Symposium Report. J Clin Endocrinol Metab 2021; 106:3049-3059. [PMID: 34061967 PMCID: PMC8571711 DOI: 10.1210/clinem/dgab386] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT The Igls criteria were developed to provide a consensus definition for outcomes of β-cell replacement therapy in the treatment of diabetes during a January 2017 workshop sponsored by the International Pancreas & Islet Transplant Association (IPITA) and the European Pancreas & Islet Transplant Association. In July 2019, a symposium at the 17th IPITA World Congress was held to examine the Igls criteria after 2 years in clinical practice, including validation against continuous glucose monitoring (CGM)-derived glucose targets, and to propose future refinements that would allow for comparison of outcomes with artificial pancreas system approaches. EVIDENCE ACQUISITION Utilization of the criteria in various clinical and research settings was illustrated by population as well as individual outcome data of 4 islet and/or pancreas transplant centers. Validation against CGM metrics was conducted in 55 islet transplant recipients followed-up to 10 years from a fifth center. EVIDENCE SYNTHESIS The Igls criteria provided meaningful clinical assessment on an individual patient and treatment group level, allowing for comparison both within and between different β-cell replacement modalities. Important limitations include the need to account for changes in insulin requirements and C-peptide levels relative to baseline. In islet transplant recipients, CGM glucose time in range improved with each category of increasing β-cell graft function. CONCLUSIONS Future Igls 2.0 criteria should consider absolute rather than relative levels of insulin use and C-peptide as qualifiers with treatment success based on glucose assessment using CGM metrics on par with assessment of glycated hemoglobin and severe hypoglycemia events.
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Affiliation(s)
- Cyril P Landstra
- Division of Endocrinology & Division of Nephrology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Axel Andres
- Divison of Transplantation and Visceral Surgery, Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Mikael Chetboun
- Department of General and Endocrine Surgery, Centre Hospitalier Universitaire de Lille, and Inserm, Translational Research for Diabetes, Université de Lille, Lille, France
| | - Caterina Conte
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy
| | - Yvonne Kelly
- Division of Transplantation, Department of Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - Thierry Berney
- Divison of Transplantation and Visceral Surgery, Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Eelco J P de Koning
- Division of Endocrinology & Division of Nephrology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Lorenzo Piemonti
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy
| | - Peter G Stock
- Division of Transplantation, Department of Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - François Pattou
- Department of General and Endocrine Surgery, Centre Hospitalier Universitaire de Lille, and Inserm, Translational Research for Diabetes, Université de Lille, Lille, France
| | - Marie-Christine Vantyghem
- Department of Endocrinology, Diabetology and Metabolism, Centre Hospitalier Universitaire de Lille, and Inserm, Translational Research for Diabetes, Université de Lille, Lille, France
| | - Melena D Bellin
- Division of Endocrinology, Department of Pediatrics, and the Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN, USA
| | - Michael R Rickels
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, and Institute for Diabetes, Obesity & Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Correspondence: Michael R. Rickels, MD, MS, Institute for Diabetes, Obesity & Metabolism, University of Pennsylvania Perelman School of Medicine, 12-134 Smilow Center for Translational Research, 3400 Civic Center Boulevard, Philadelphia, PA, USA 19104-5160.
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Braun RG, Heitsch L, Cole JW, Lindgren AG, de Havenon A, Dude JA, Lohse KR, Cramer SC, Worrall BB. Domain-Specific Outcomes for Stroke Clinical Trials: What the Modified Rankin Isn't Ranking. Neurology 2021; 97:367-377. [PMID: 34172537 PMCID: PMC8397584 DOI: 10.1212/wnl.0000000000012231] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 04/20/2021] [Indexed: 11/15/2022] Open
Abstract
Global outcome measures that are widely used in stroke clinical trials, such as the modified Rankin Scale (mRS), lack sufficient detail to detect changes within specific domains (e.g., sensory, motor, visual, linguistic, or cognitive function). Yet such data are vital for understanding stroke recovery and its mechanisms. Poststroke deficits in specific domains differ in their rate and degree of recovery and in their effects on overall independence and quality of life. For example, even in a patient with complete recovery of strength, persistent deficits in the nonmotor domains such as language and cognition may make a return to independent living impossible. In such cases, global measures based solely on the patient's degree of independence would overlook a complete recovery in the motor domain. Capturing these important aspects of recovery demands a domain-specific approach. If stroke outcomes trials are to incorporate finer-grained recovery metrics-which can require substantial time, effort, and expertise to implement-efficiency must be a priority. In this article, we discuss how commonly collected clinical data from the NIH Stroke Scale can guide the judicious selection of relevant recovery domains for more detailed testing. Our overarching goal is to make the implementation of domain-specific testing more feasible for large-scale clinical trials on stroke recovery.
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Affiliation(s)
- Robynne G Braun
- From the Department of Neurology (R.G.B., J.W.C.), University of Maryland, Baltimore; Department of Emergency Medicine (L.H.), Washington University, St. Louis, MO; Department of Clinical Sciences, Lund (A.L.), Lund University; Department of Neurology (A.G.L.), Skåne University Hospital, Lund, Sweden; Departments of Neurology (A.d.H.) and Health and Kinesiology (J.A.D., K.R.L.), University of Utah, Salt Lake City; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; and Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville.
| | - Laura Heitsch
- From the Department of Neurology (R.G.B., J.W.C.), University of Maryland, Baltimore; Department of Emergency Medicine (L.H.), Washington University, St. Louis, MO; Department of Clinical Sciences, Lund (A.L.), Lund University; Department of Neurology (A.G.L.), Skåne University Hospital, Lund, Sweden; Departments of Neurology (A.d.H.) and Health and Kinesiology (J.A.D., K.R.L.), University of Utah, Salt Lake City; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; and Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville
| | - John W Cole
- From the Department of Neurology (R.G.B., J.W.C.), University of Maryland, Baltimore; Department of Emergency Medicine (L.H.), Washington University, St. Louis, MO; Department of Clinical Sciences, Lund (A.L.), Lund University; Department of Neurology (A.G.L.), Skåne University Hospital, Lund, Sweden; Departments of Neurology (A.d.H.) and Health and Kinesiology (J.A.D., K.R.L.), University of Utah, Salt Lake City; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; and Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville
| | - Arne G Lindgren
- From the Department of Neurology (R.G.B., J.W.C.), University of Maryland, Baltimore; Department of Emergency Medicine (L.H.), Washington University, St. Louis, MO; Department of Clinical Sciences, Lund (A.L.), Lund University; Department of Neurology (A.G.L.), Skåne University Hospital, Lund, Sweden; Departments of Neurology (A.d.H.) and Health and Kinesiology (J.A.D., K.R.L.), University of Utah, Salt Lake City; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; and Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville
| | - Adam de Havenon
- From the Department of Neurology (R.G.B., J.W.C.), University of Maryland, Baltimore; Department of Emergency Medicine (L.H.), Washington University, St. Louis, MO; Department of Clinical Sciences, Lund (A.L.), Lund University; Department of Neurology (A.G.L.), Skåne University Hospital, Lund, Sweden; Departments of Neurology (A.d.H.) and Health and Kinesiology (J.A.D., K.R.L.), University of Utah, Salt Lake City; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; and Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville
| | - Jason A Dude
- From the Department of Neurology (R.G.B., J.W.C.), University of Maryland, Baltimore; Department of Emergency Medicine (L.H.), Washington University, St. Louis, MO; Department of Clinical Sciences, Lund (A.L.), Lund University; Department of Neurology (A.G.L.), Skåne University Hospital, Lund, Sweden; Departments of Neurology (A.d.H.) and Health and Kinesiology (J.A.D., K.R.L.), University of Utah, Salt Lake City; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; and Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville
| | - Keith R Lohse
- From the Department of Neurology (R.G.B., J.W.C.), University of Maryland, Baltimore; Department of Emergency Medicine (L.H.), Washington University, St. Louis, MO; Department of Clinical Sciences, Lund (A.L.), Lund University; Department of Neurology (A.G.L.), Skåne University Hospital, Lund, Sweden; Departments of Neurology (A.d.H.) and Health and Kinesiology (J.A.D., K.R.L.), University of Utah, Salt Lake City; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; and Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville
| | - Steven C Cramer
- From the Department of Neurology (R.G.B., J.W.C.), University of Maryland, Baltimore; Department of Emergency Medicine (L.H.), Washington University, St. Louis, MO; Department of Clinical Sciences, Lund (A.L.), Lund University; Department of Neurology (A.G.L.), Skåne University Hospital, Lund, Sweden; Departments of Neurology (A.d.H.) and Health and Kinesiology (J.A.D., K.R.L.), University of Utah, Salt Lake City; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; and Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville
| | - Bradford B Worrall
- From the Department of Neurology (R.G.B., J.W.C.), University of Maryland, Baltimore; Department of Emergency Medicine (L.H.), Washington University, St. Louis, MO; Department of Clinical Sciences, Lund (A.L.), Lund University; Department of Neurology (A.G.L.), Skåne University Hospital, Lund, Sweden; Departments of Neurology (A.d.H.) and Health and Kinesiology (J.A.D., K.R.L.), University of Utah, Salt Lake City; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; and Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville
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Abstract
Editor's note: This is the fifth article in a series on clinical research by nurses. The series is designed to give nurses the knowledge and skills they need to participate in research, step by step. Each column will present the concepts that underpin evidence-based practice-from research design to data interpretation. The articles will be accompanied by a podcast offering more insight and context from the author. To see all the articles in the series, go to http://links.lww.com/AJN/A204.
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Affiliation(s)
- Bernadette Capili
- Bernadette Capili is director of the Heilbrunn Family Center for Research Nursing at Rockefeller University, New York City. This manuscript was supported in part by grant No. UL1TR001866 from the National Institutes of Health's National Center for Advancing Translational Sciences Clinical and Translational Science Awards Program. Contact author: . The author has disclosed no potential conflicts of interest, financial or otherwise. A podcast with the author is available at www.ajnonline.com
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16
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Affiliation(s)
- Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, New York
| | - Mechelle R Sanders
- Department of Family Medicine, University of Rochester Medical Center, Rochester, New York
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Getaneh T, Asres A, Hiyaru T, Lake S. Adverse perinatal outcomes and its associated factors among adult and advanced maternal age pregnancy in Northwest Ethiopia. Sci Rep 2021; 11:14072. [PMID: 34234283 PMCID: PMC8263553 DOI: 10.1038/s41598-021-93613-x] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/25/2021] [Indexed: 02/06/2023] Open
Abstract
Even though reduction of neonatal mortality is needed to achieve Sustainable Development Goals 2030, advanced maternal age is still an independent and a substantial risk factor for different adverse perinatal outcomes, in turn causes neonatal morbidity and mortality. In Ethiopia, research has validated that advanced maternal age is a significant factor in adverse perinatal outcomes, but researches which addressed or estimated its adverse perinatal outcomes are limited, reported inconsistent result and specifically no study was done in the study area. Therefore, this study was aimed to compare adverse perinatal outcomes and its associated factors among women with adult and advanced maternal age pregnancy in Northwest Ethiopia. Comparative cross-sectional study was conducted in Awi Zone, public hospitals, Northwest Ethiopia. Systematic random sampling was employed to select 348 adult and 176 advanced aged pregnant women. Structured questionnaire were used to collect the data. The collected data were analyzed using Statistical Package for the Social Sciences version 25. Binary and multivariate logistic regressions were fitted to assess the association between adverse perinatal outcomes and explanatory variables. P-value less than 0.05 was used to declare statistical significance. Significant percentage of advanced aged women (29.1%) had adverse perinatal outcomes compared to (14.5%) adult aged women. Similarly, proportion low birth weight, preterm birth and low Apgar score were significantly higher among advanced maternal age. The odds of composite adverse perinatal outcomes were higher among advanced maternal age women when compared to adult aged women (AOR 2.01, 95% CI 1.06, 3.79). No formal education (AOR 2.75, 95% CI 1.27, 5.95), short birth interval (AOR 2.25, 95% CI 1.07, 4.73) and complications during pregnancy (AOR 2.12, 95% CI 1.10, 4.10) were also factors significantly associated with adverse perinatal outcomes. Being advanced maternal age is at higher risk for adverse perinatal outcomes compared to adult aged women. Maternal illiteracy, short birth interval and complications during pregnancy were also significantly associated with adverse perinatal outcomes. Access of equal education, provision of family planning and perinatal care (including early detection and management of complication) is recommended.
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Affiliation(s)
- Temesgen Getaneh
- Department of Midwifery, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.
| | - Azezu Asres
- Department of Midwifery, College of Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Toyiba Hiyaru
- Department of Midwifery, College of Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Selamawit Lake
- Department of Midwifery, College of Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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18
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Mokkink L, Terwee C, de Vet H. Key concepts in clinical epidemiology: Responsiveness, the longitudinal aspect of validity. J Clin Epidemiol 2021; 140:159-162. [PMID: 34116141 DOI: 10.1016/j.jclinepi.2021.06.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/26/2021] [Accepted: 06/03/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Responsiveness is one of nine measurement properties that reflect the quality of outcome measurement instruments. METHODS In this article, we explain that responsiveness is considered longitudinal validity, which refers to the degree to which an instrument is able to measure change in the construct to be measured. RESULTS Responsiveness should be assessed in a longitudinal design, where hypotheses are tested about (1) the expected direction and magnitude of correlations between change scores on the instrument of interest and change scores of other instruments; (2) expected differences in change scores between different subgroups (i.e. known groups); or (3) the magnitude of the change in score that is expected on the construct of interest after a treatment with known efficacy. CONCLUSION Responsiveness cannot be proven, though, it is an ongoing process of testing hypotheses.
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Affiliation(s)
- Lidwine Mokkink
- Amsterdam UMC, Vrije Universiteit Amsterdam, Departement of Epidemiology and Data Science, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Caroline Terwee
- Amsterdam UMC, Vrije Universiteit Amsterdam, Departement of Epidemiology and Data Science, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Henrica de Vet
- Amsterdam UMC, Vrije Universiteit Amsterdam, Departement of Epidemiology and Data Science, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands
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Zervos TM, Asmaro K, Air EL. Contemporary Analysis of Minimal Clinically Important Difference in the Neurosurgical Literature. Neurosurgery 2021; 88:713-719. [PMID: 33369670 DOI: 10.1093/neuros/nyaa490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 09/09/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Minimal clinically important difference (MCID) is determined when a patient or physician defines the minimal change that outweighs the costs and untoward effects of a treatment. These measurements are "anchored" to validated quality-of-life instruments or physician-rated, disease-activity indices. To capture the subjective clinical experience in a measurable way, there is an increasing use of MCID. OBJECTIVE To review the overall concept, method of calculation, strengths, and weaknesses of MCID and its application in the neurosurgical literature. METHODS Recent articles were reviewed based on PubMed query. To illustrate the strengths and limitations of MCID, studies regarding the measurement of pain are emphasized and their impact on subsequent publications queried. RESULTS MCID varies by population baseline characteristics and calculation method. In the context of pain, MCID varied based on the quality of pain, chronicity, and treatment options. CONCLUSION MCID evaluates outcomes relative to whether they provide a meaningful change to patients, incorporating the risks and benefits of a treatment. Using MCID in the process of evaluating outcomes helps to avoid the error of interpreting a small but statistically significant outcome difference as being clinically important.
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Wiercioch W, Nieuwlaat R, Dahm P, Iorio A, Mustafa RA, Neumann I, Rochwerg B, Manja V, Alonso-Coello P, Ortel TL, Santesso N, Vesely SK, Akl EA, Schünemann HJ. Development and application of health outcome descriptors facilitated decision-making in the production of practice guidelines. J Clin Epidemiol 2021; 138:115-127. [PMID: 33992716 DOI: 10.1016/j.jclinepi.2021.04.016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/06/2021] [Accepted: 04/21/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Stakeholders involved in developing recommendations need to have a common understanding of health outcomes and the perspective of affected individuals. In this paper we report on the development and application of health outcome descriptors (HODs) to inform decision-making by panels developing guideline recommendations. STUDY DESIGN AND SETTING Ten American Society of Hematology guideline panels addressing the management of venous thromboembolism developed HODs, rated their importance and health utility, applied them to prioritize outcomes, and to balance potential benefits and harms to formulate recommendations. RESULTS It was feasible to involve 18 panelists in developing 127 HODs. There was high agreement (82%) across the ten panels about outcomes perceived as critical or important for decision-making. Panelists' utility ratings of the outcomes were strongly correlated with panelists' outcome importance ratings (Pearson's r=-0.88). HODs were incorporated into Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence-to-decision (EtD) frameworks to support a shared understanding of health outcomes in panel deliberations. CONCLUSION HODs serve as a valuable tool to promote an explicit, common understanding of health outcomes during clinical guideline development and across different stakeholders. They are helpful across multiple steps of guideline development to facilitate panels' judgements, aiming to avoid variable implicit interpretations of health outcomes.
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Affiliation(s)
- Wojtek Wiercioch
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Robby Nieuwlaat
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA; Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS USA
| | - Ignacio Neumann
- Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Veena Manja
- Department of Surgery, University of California Davis, CA, USA; Department of Medicine, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Thomas L Ortel
- Departments of Medicine and Pathology, Duke University Medical Center, Durham, NC, USA
| | - Nancy Santesso
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Sara K Vesely
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Internal Medicine, American University of Beirut, Lebanon
| | - Holger J Schünemann
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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de Havenon A, Ney JP, Callaghan B, Hohmann S, Shippey E, Yaghi S, Anadani M, Majersik JJ. Characteristics and Outcomes Among US Patients Hospitalized for Ischemic Stroke Before vs During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2110314. [PMID: 33999162 PMCID: PMC8129817 DOI: 10.1001/jamanetworkopen.2021.10314] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE After the emergence of COVID-19, studies reported a decrease in hospitalizations of patients with ischemic stroke (IS), but there are little to no data regarding hospitalizations for the remainder of 2020, including outcome data from a large cohort of patients with IS and comorbid COVID-19. OBJECTIVE To assess hospital discharge rates, demographic factors, and outcomes of hospitalization associated with the COVID-19 pandemic among US patients with IS before vs during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the Vizient Clinical Data Base on 324 013 patients with IS at 478 nonfederal hospitals in 43 US states between January 1, 2019, and December 31, 2020. Patients were eligible if they were admitted to the hospital on a nonelective basis and were not receiving hospice care at the time of admission. A total of 41 166 discharged between January and March 2020 were excluded from the analysis because they had unreliable data on COVID-19 status, leaving 282 847 patients for the study. EXPOSURE Ischemic stroke and laboratory-confirmed COVID-19. MAIN OUTCOMES AND MEASURES Monthly counts of discharges among patients with IS in 2020. Demographic characteristics and outcomes, including in-hospital death, among patients with IS who were discharged in 2019 (control group) were compared with those of patients with IS with or without comorbid COVID-19 (COVID-19 and non-COVID-19 groups, respectively) who were discharged between April and December 2020. RESULTS Of the 282 847 patients included in the study, 165 912 (50.7% male; 63.4% White; 26.3% aged ≥80 years) were allocated to the control group; 111 418 of 116 935 patients (95.3%; 51.9% male; 62.8% White; 24.6% aged ≥80 years) were allocated to the non-COVID-19 group and 5517 of 116 935 patients (4.7%; 58.0% male; 42.5% White; 21.3% aged ≥80 years) to the COVID-19 group. A mean (SD) of 13 846 (553) discharges per month among patients with IS was reported in 2019. Discharges began decreasing in February 2020, reaching a low of 10 846 patients in April 2020 before returning to a prepandemic level of 13 639 patients by July 2020. A mean (SD) of 13 492 (554) discharges per month was recorded for the remainder of 2020. Black and Hispanic patients accounted for 21.4% and 7.0% of IS discharges in 2019, respectively, but accounted for 27.5% and 16.0% of those discharged with IS and comorbid COVID-19 in 2020. Compared with patients in the control and non-COVID-19 groups, those in the COVID-19 group were less likely to smoke (16.0% vs 17.2% vs 6.4%, respectively) and to have hypertension (73.0% vs 73.1% vs 68.2%) or dyslipidemia (61.2% vs 63.2% vs 56.6%) but were more likely to have diabetes (39.8% vs 40.5% vs 53.0%), obesity (16.2% vs 18.4% vs 24.5%), acute coronary syndrome (8.0% vs 9.2% vs 15.8%), or pulmonary embolus (1.9% vs 2.4% vs 6.8%) and to require intubation (11.3% vs 12.3% vs 37.6%). After adjusting for baseline factors, patients with IS and COVID-19 were more likely to die in the hospital than were patients with IS in 2019 (adjusted odds ratio, 5.17; 95% CI, 4.83-5.53; National Institutes of Health Stroke Scale adjusted odds ratio, 3.57; 95% CI, 3.15-4.05). CONCLUSIONS AND RELEVANCE In this cohort study, after the emergence of COVID-19, hospital discharges of patients with IS decreased in the US but returned to prepandemic levels by July 2020. Among patients with IS between April and December 2020, comorbid COVID-19 was relatively common, particularly among Black and Hispanic populations, and morbidity was high.
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Affiliation(s)
| | - John P. Ney
- Department of Neurology, Boston University, Boston, Massachusetts
| | | | | | | | - Shadi Yaghi
- Department of Neurology, New York University, New York
| | - Mohammad Anadani
- Department of Neurology, Washington University in St Louis, St Louis, Missouri
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Gulle H, Prior T, Miller S, Birn-Jeffery AV, Morrissey D. Online questionnaire, clinical and biomechanical measurements for outcome prediction of plantar heel pain: feasibility for a cohort study. J Foot Ankle Res 2021; 14:34. [PMID: 33902655 PMCID: PMC8077700 DOI: 10.1186/s13047-021-00472-w] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Plantar heel pain (PHP) accounts for 11-15% of foot symptoms requiring professional care in adults. Recovery is variable, with no robust prognostic guides for sufferers, clinicians or researchers. Therefore, we aimed to determine the validity, reliability and feasibility of questionnaire, clinical and biomechanical measures selected to generate a prognostic model in a subsequent cohort study. METHODS Thirty-six people (19 females & 17 males; 20-63 years) were recruited with equal numbers in each of three groups: people with PHP (PwPHP), other foot pain (PwOP) and healthy (H) controls. Eighteen people performed a questionnaire battery twice in a randomised order to determine online and face-to-face agreement. The remaining 18 completed the online questionnaire once, plus clinical measurements including strength and range of motion, mid-foot mobility, palpation and ultrasound assessment of plantar fascia. Nine of the same people underwent biomechanical assessment in the form of a graded loaded challenge augmenting walking with added external weight and amended step length on two occasions. Outcome measures were (1) feasibility of the data collection procedure, measurement time and other feedback; (2) establishing equivalence to usual procedures for the questionnaire battery; known-group validity for clinical and imaging measures; and initial validation and reliability of biomechanical measures. RESULTS There were no systematic differences between online and face-to-face administration of questionnaires (p-values all > .05) nor an administration order effect (d = - 0.31-0.25). Questionnaire reliability was good or excellent (ICC2,1_absolute)(ICC 0.86-0.99), except for two subscales. Full completion of the survey took 29 ± 14 min. Clinically, PwPHP had significantly less ankle-dorsiflexion and hip internal-rotation compared to healthy controls [mean (±SD) for PwPHP-PwOP-H = 14°(±6)-18°(±8)-28°(±10); 43°(±4)- 45°(±9)-57°(±12) respectively; p < .02 for both]. Plantar fascia thickness was significantly higher in PwPHP (3.6(0.4) mm vs 2.9(0.4) mm, p = .01) than the other groups. The graded loading challenge demonstrated progressively increasing ground reaction forces. CONCLUSION Online questionnaire administration was valid therefore facilitating large cohort recruitment and being relevant to remote service evaluation and research. The physical and ultrasound examination revealed the expected differences between groups, while the graded loaded challenge progressively increases load and warrants future research. Clinician and researchers can be confident about these methodological approaches and the cohort study, from which useful clinical tools should result, is feasible. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Halime Gulle
- Sports and Exercise Medicine, William Harvey Research Institute, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, Bancroft road, London, E1 4DG UK
| | - Trevor Prior
- Sports and Exercise Medicine, William Harvey Research Institute, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, Bancroft road, London, E1 4DG UK
- Consultant Podiatric Surgeon, Homerton University Hospital, Homerton Row, London, E9 6SR UK
| | - Stuart Miller
- Sports and Exercise Medicine, William Harvey Research Institute, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, Bancroft road, London, E1 4DG UK
| | - Aleksandra V. Birn-Jeffery
- School of Engineering and Materials Science, Institute of Bioengineering, Queen Mary University London, Mile End, Bancroft road, London, E1 4DG, UK
| | - Dylan Morrissey
- Sports and Exercise Medicine, William Harvey Research Institute, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, Bancroft road, London, E1 4DG UK
- Physiotherapy Department, Barts Health NHS Trust, London, UK
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Rydja J, Eleftheriou A, Lundin F. Evaluating the cerebrospinal fluid tap test with the Hellström iNPH scale for patients with idiopathic normal pressure hydrocephalus. Fluids Barriers CNS 2021; 18:18. [PMID: 33827613 PMCID: PMC8025497 DOI: 10.1186/s12987-021-00252-5] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/23/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The cerebrospinal fluid tap test (CSF TT) is used for selecting shunt surgery candidates among patients with idiopathic normal pressure hydrocephalus (iNPH). We aimed to evaluate the predictive value of the CSF TT, by using the Hellström iNPH scale for shunted iNPH patients with a standardized method. METHODS One hundred and sixteen shunt-operated iNPH patients were retrospectively included in this study. The gait and balance domains in the iNPH scale were used as outcome measures for the CSF TT and the total iNPH scale score as the postoperative outcome. A positive response to CSF TT was defined as a change of ≥ 5 points in the gait domain and ≥ 16 points in the balance domain. Differences between CSF TT responders and non-responders, sensitivity, specificity, positive and negative predictive values, accuracy, and correlations between changes from baseline to post CSF TT and from baseline to the postoperative follow-up, were calculated. RESULTS In the CSF TT there were 63.8% responders in the gait domain and correspondingly 44.3% in the balance domain. CSF TT responders had a significantly better postoperative outcome in the total scale score (gait P ≤ 0.001, balance P ≤ 0.012) and gait CSF TT responders improved more in gait (P ≤ 0.001) and balance CSF TT responders in balance (P ≤ 0.001). No differences between CSF TT gait or balance responders could be found in neuropsychological or urinary continence assessments postoperatively. The sensitivity and specificity of the CSF TT and the outcome of the total iNPH scale score postoperatively were 68.1% and 52.0% for gait and 47.8% and 68.0% for balance, respectively. CONCLUSIONS The CSF TT, with the Hellström iNPH scale as the outcome measure, has clear limitations in predicting postoperative results. The gait domain may be used to predict outcomes for gait, but the balance domain is too insensitive.
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Affiliation(s)
- Johanna Rydja
- Department of Activity and Health, and Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden
| | - Andreas Eleftheriou
- Department of Neurology, and Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden
| | - Fredrik Lundin
- Department of Neurology, and Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden
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Abstract
BACKGROUND Accurate identification of maternal deaths is paramount for audit and policy purposes. Our aim was to determine the accuracy and completeness of data on maternal deaths in hospital and those recorded on a death certificate, and the level of agreement between the 2 data sources. METHODS We conducted a retrospective population-based study using data for Ontario, Canada, from Apr. 1, 2002, to Dec. 31, 2015. We used Canadian Institute for Health Information (CIHI) databases to identify deaths during inpatient, emergency department and same-day surgery encounters. We captured Vital Statistics deaths in the Office of the Registrar General, Deaths (ORGD) data set. Deaths were considered within 42 days and within 365 days after a pregnancy outcome (live birth, miscarriage, ectopic pregnancy or induced abortion) for all multiple and singleton pregnancies. We calculated agreement statistics and 95% confidence intervals (CIs). RESULTS Among 1 679 455 live births and stillbirths, 398 pregnancy-related deaths in the ORGD data set were mapped to a birth in CIHI databases, and 77 (16.2%) were not. Among 2 039 849 recognized pregnancies, 534 pregnancy-related deaths in the ORGD data set were linked to CIHI records, and 68 (11.3%) were not. Among live births and stillbirths, after pregnancy-related deaths in the ORGD data set not matched to a maternal death in the CIHI databases were removed, concordance measures between CIHI and ORGD records for maternal death within 42 days after delivery included a κ value of 0.87 (95% CI 0.82-0.91) and positive percent agreement of 0.88 (95% CI 0.83-0.94). The corresponding measures were similar for maternal death within 42 days after the end of a recognized pregnancy. When unlinked pregnancy-related deaths in the ORGD data set were retained, agreement measures declined for death within 42 days after a live birth or stillbirth (κ = 0.68, 95% CI 0.62-0.74). For maternal death within 365 days after a live birth or stillbirth, or after the end of a recognized pregnancy, the concordance statistics were generally favourable when unlinked pregnancy-related deaths in the ORGD data set were removed but were substantially declined when they were retained. INTERPRETATION Maternal mortality cannot be ascertained solely with the use of hospital data, including beyond 42 days after the end of pregnancy. To improve linkage, we propose including health insurance numbers on provincial and territorial medical death certificates.
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Affiliation(s)
- Kayvan Aflaki
- Institute of Medical Science (Aflaki), University of Toronto; ICES Central (Park), Toronto, Ont.; Maternal, Child and Youth Health Division (Nelson, Luo), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Departments of Medicine (Ray) and Obstetrics and Gynecology (Ray), St. Michael's Hospital, Toronto, Ont
| | - Alison L Park
- Institute of Medical Science (Aflaki), University of Toronto; ICES Central (Park), Toronto, Ont.; Maternal, Child and Youth Health Division (Nelson, Luo), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Departments of Medicine (Ray) and Obstetrics and Gynecology (Ray), St. Michael's Hospital, Toronto, Ont
| | - Chantal Nelson
- Institute of Medical Science (Aflaki), University of Toronto; ICES Central (Park), Toronto, Ont.; Maternal, Child and Youth Health Division (Nelson, Luo), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Departments of Medicine (Ray) and Obstetrics and Gynecology (Ray), St. Michael's Hospital, Toronto, Ont
| | - Wei Luo
- Institute of Medical Science (Aflaki), University of Toronto; ICES Central (Park), Toronto, Ont.; Maternal, Child and Youth Health Division (Nelson, Luo), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Departments of Medicine (Ray) and Obstetrics and Gynecology (Ray), St. Michael's Hospital, Toronto, Ont
| | - Joel G Ray
- Institute of Medical Science (Aflaki), University of Toronto; ICES Central (Park), Toronto, Ont.; Maternal, Child and Youth Health Division (Nelson, Luo), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Departments of Medicine (Ray) and Obstetrics and Gynecology (Ray), St. Michael's Hospital, Toronto, Ont.
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Issaka RB, Taylor P, Baxi A, Inadomi JM, Ramsey SD, Roth J. Model-Based Estimation of Colorectal Cancer Screening and Outcomes During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e216454. [PMID: 33843997 PMCID: PMC8042520 DOI: 10.1001/jamanetworkopen.2021.6454] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/28/2021] [Indexed: 02/06/2023] Open
Abstract
Importance COVID-19 has decreased colorectal cancer screenings. Objective To estimate the degree to which expanding fecal immunochemical test-based colorectal cancer screening participation during the COVID-19 pandemic is associated with clinical outcomes. Design, Setting, and Participants A previously developed simulation model was adopted to estimate how much COVID-19 may have contributed to colorectal cancer outcomes. The model included the US population estimated to have completed colorectal cancer screening pre-COVID-19 according the American Cancer Society. The model was designed to estimate colorectal cancer outcomes between 2020 and 2023. This analysis was completed between July and December 2020. Exposures Adults screened for colorectal cancer and colorectal cancer cases detected by stage. Main Outcomes and Measures Estimates of colorectal cancer outcomes across 4 scenarios: (1) 9 months of 50% colorectal cancer screenings followed by 21 months of 75% colorectal cancer screenings; (2) 18 months of 50% screening followed by 12 months of 75% screening; (3) scenario 1 with increased use of fecal immunochemical tests; and (4) scenario 2 with increased use of fecal immunochemical tests. Results In our simulation model, COVID-19-related reductions in care utilization resulted in an estimated 1 176 942 to 2 014 164 fewer colorectal cancer screenings, 8346 to 12 894 fewer colorectal cancer diagnoses, and 6113 to 9301 fewer early-stage colorectal cancer diagnoses between 2020 and 2023. With an abbreviated period of reduced colorectal cancer screenings, increasing fecal immunochemical test use was associated with an estimated additional 588 844 colorectal cancer screenings and 2836 colorectal cancer diagnoses, of which 1953 (68.9%) were early stage. In the event of a prolonged period of reduced colorectal cancer screenings, increasing fecal immunochemical test use was associated with an estimated additional 655 825 colorectal cancer screenings and 2715 colorectal cancer diagnoses, of which 1944 (71.6%) were early stage. Conclusions and Relevance These results suggest that the increased use of fecal immunochemical tests during the COVID-19 pandemic was associated with increased colorectal cancer screening participation and more colorectal cancer diagnoses at earlier stages. If our estimates are borne out in real-world clinical practice, increasing fecal immunochemical test-based colorectal cancer screening participation during the COVID-19 pandemic could mitigate the consequences of reduced screening rates during the pandemic for colorectal cancer outcomes.
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Affiliation(s)
- Rachel B. Issaka
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Division of Gastroenterology, University of Washington School of Medicine, Seattle
| | | | - Anand Baxi
- Division of Gastroenterology, University of Washington School of Medicine, Seattle
| | - John M. Inadomi
- Department of Medicine, University of Utah School of Medicine, Salt Lake City
| | - Scott D. Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Joshua Roth
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Abstract
AIMS The global epidemic of diabetes mellitus continues to expand, including its large impact on national health care. Measuring diabetes outcomes and their causes of variation highlights areas for improvement in care and efficiency gains; large registries carry this potential. By means of a systematic review, we aimed to give an overview of national registries worldwide by quantifying their data and assessing their influence on diabetes care. METHODS The literature on MEDLINE up to March 31, 2020, was searched, using keywords diabetes mellitus, national, registry, registration, and/or database. National disease-specific registries from corresponding articles were included. Database characteristics and clinical variables were obtained. All registries were compared to the ICHOM standard set of outcomes. RESULTS We identified 12 national clinical diabetes registries, comprising a total of 7,181,356 diabetic patients worldwide. Nearly all registries recorded weight, HbA1c, lipid profile, and insulin treatment; the recording of other variables varied to a great extent. Overall, registries corresponded fairly well with the ICHOM set. Most registries proved to monitor and improve the quality of diabetes care using guidelines as a benchmark. The effects on national healthcare policy were more variable and often less clear. CONCLUSIONS National diabetes registries confer clear insights into diagnostics, complications, and treatment. The extent to which registries influenced national healthcare policy was less clear. A globally implemented standard outcome set has the potential to improve concordance between national registries, enhance the comparison and exchange of diabetes outcomes, and allocate resources and interventions where most needed.
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Affiliation(s)
- Jessica C G Bak
- Department of Vascular Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Erik H Serné
- Department of Vascular Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mark H H Kramer
- Department of Vascular Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Carianne L Verheugt
- Department of Vascular Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Goldstine J, Knox K, Beekman J, Cobussen-Boekhorst H, Conti A, Gray M, Inglese G, England A, Rodriguez G, Stanley J, Vaughn S, Howlett SE, Rockwood K. A Patient-Centric Tool to Facilitate Goal Attainment Scaling in Neurogenic Bladder and Bowel Dysfunction: Path to Individualization. Value Health 2021; 24:413-420. [PMID: 33641776 DOI: 10.1016/j.jval.2020.10.023] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/30/2020] [Accepted: 10/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES People with neurogenic bladder and/or bowel dysfunction experience diverse challenges that can be difficult to evaluate with standardized outcome measures. Goal attainment scaling (GAS) is an individualized, patient-centric outcome measure that enables patients/caregivers to identify and track their own treatment goals. Because creating goals de novo can be cumbersome, we aimed to develop a neurogenic bladder/bowel dysfunction goal menu to facilitate goal attainment scaling uptake and use. METHODS We conducted a workshop with 6 expert clinicians to develop an initial menu. Individual interviews with 12 people living with neurogenic bladder and/or bowel dysfunction and 2 clinician panels with 5 additional experts aided us in refining the menu. A thematic framework analysis identified emergent themes for analysis and reporting. RESULTS Interview participants were adults (median = 36 years, range 25-58), most with spinal cord injury (75%; 9/12). Of 24 goals identified initially, 2 (8%) were not endorsed and were removed, and 3 goals were added. Most participants listed "Impact on Life" goals (eg, Exercise, Emotional Well-Being) among their 5 most important goals (58%; 35/60). Three main themes emerged: challenges posed by incontinence, limitations on everyday life, and need for personalized care. CONCLUSIONS We developed a clinical outcome assessment tool following a multistep process of representative stakeholder engagement. This patient-centric tool consists of 25 goals specific to people living with neurogenic bladder and/or bowel dysfunction. Asking people what matters most to them can identify important constructs that clinicians might have overlooked.
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Affiliation(s)
| | - Kari Knox
- DGI Clinical Inc, Halifax, NS, Canada
| | | | | | | | - Mikel Gray
- University of Virginia, Charlottesville, VA, USA
| | | | | | | | | | | | - Susan E Howlett
- DGI Clinical Inc, Halifax, NS, Canada; Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada; Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Kenneth Rockwood
- DGI Clinical Inc, Halifax, NS, Canada; Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
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Li Y, Ying M, Cai X, Thirukumaran CP. Association of Mandatory Bundled Payments for Joint Replacement With Postacute Care Outcomes Among Medicare and Medicaid Dual Eligible Patients. Med Care 2021; 59:101-110. [PMID: 33273296 PMCID: PMC7855778 DOI: 10.1097/mlr.0000000000001473] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE The Medicare comprehensive care for joint replacement (CJR) model, a mandatory bundled payment program started in April 2016 for hospitals in randomly selected metropolitan statistical areas (MSAs), may help reduce postacute care (PAC) use and episode costs, but its impact on disparities between Medicaid and non-Medicaid beneficiaries is unknown. OBJECTIVE To determine effects of the CJR program on differences (or disparities) in PAC use and outcomes by Medicare-Medicaid dual eligibility status. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study of 2013-2017, based on difference-in-differences (DID) analyses on Medicare data for 1,239,452 Medicare-only patients, 57,452 dual eligibles with full Medicaid benefits, and 50,189 dual eligibles with partial Medicaid benefits who underwent hip or knee surgery in hospitals of 75 CJR MSAs and 121 control MSAs. MAIN OUTCOME MEASURES Risk-adjusted differences in rates of institutional PAC [skilled nursing facility (SNF), inpatient rehabilitation, or long-term hospital care] use and readmissions; and for the subgroup of patients discharged to SNF, risk-adjusted differences in SNF length of stay, payments, and quality measured by star ratings, rate of successful discharge to community, and rate of transition to long-stay nursing home resident. RESULTS The CJR program was associated with reduced institutional PAC use and readmissions for patients in all 3 groups. For example, it was associated with reductions in 90-day readmission rate by 1.8 percentage point [DID estimate=-1.8; 95% confidence interval (CI), -2.6 to -0.9; P<0.001] for Medicare-only patients, by 1.6 percentage points (DID estimate=-1.6; 95% CI, -3.1 to -0.1; P=0.04) for full-benefit dual eligibles, and by 2.0 percentage points (DID estimate=-2.0; 95% CI, -3.6 to -0.4; P=0.01) for partial-benefit dual eligibles. These CJR-associated effects did not differ between dual eligibles (differences in above DID estimates=0.2; 95% CI, -1.4 to 1.7; P=0.81 for full-benefit patients; and -0.3; 95% CI, -1.9 to 1.3; P=0.74 for partial-benefit patients) and Medicare-only patients. Among patients discharged to SNF, the CJR program showed no effect on successful community discharge, transition to long-term care, or their persistent disparities. CONCLUSIONS The CJR program did not help reduce persistent disparities in readmissions or SNF-specific outcomes related to Medicare-Medicaid dual eligibility, likely due to its lack of financial incentives for reduced disparities and improved SNF outcomes.
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Affiliation(s)
- Yue Li
- Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center
| | - Meiling Ying
- Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center
| | - Xueya Cai
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center
| | - Caroline Pinto Thirukumaran
- Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center
- Department of Orthopaedics, University of Rochester Medical Center
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Arienti C, Lazzarini SG, Patrini M, Puljak L, Pollock A, Negrini S. The Structure of Research Questions in Randomized Controlled Trials in the Rehabilitation Field: A Methodological Study. Am J Phys Med Rehabil 2021; 100:29-33. [PMID: 33031109 DOI: 10.1097/phm.0000000000001612] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study is to assess whether and how the PICO (Population, Intervention, Comparator, and Outcomes) format is described to frame research questions in randomized controlled trials looking at effectiveness of rehabilitation interventions. DESIGN A methodological study was conducted. Randomized controlled trials in the rehabilitation field, published between July 1, 2019, and December 31, 2019, were included. The framing of the primary research question from each trial was evaluated. RESULTS A total of 97 randomized controlled trials were included in the analysis. The most frequent framing of the primary research question was as an "objective" statement (55%), and in 33% of the articles, this was stated as an "objective" together with a "hypothesis" description. All PICO elements were present in 55% of research questions, but only 49% have used the statement suggested by Cochrane. CONCLUSION The findings of this study suggest that a specific item about the "research question" and the rationale that drove the proposed design following the form suggested by Cochrane should be included in the RCT Rehabilitation Checklist.
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Affiliation(s)
- Chiara Arienti
- From the IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy (CA, SGL, MP); Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Zagreb, Croatia (LP); Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom (AP); Department of Biomedical, Surgical, and Dental Sciences, University of Milan "La Statale", Milan, Italy (SN); and IRCCS Istituto Ortopedico Galeazzi, Milan, Italy (SN)
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Hughes KL, Clarke M, Williamson PR. A systematic review finds Core Outcome Set uptake varies widely across different areas of health. J Clin Epidemiol 2021; 129:114-123. [PMID: 32987162 PMCID: PMC7815247 DOI: 10.1016/j.jclinepi.2020.09.029] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/11/2020] [Accepted: 09/09/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of our review was to bring together studies that had assessed the uptake of core outcome sets (COS) to explore the level of uptake across different COS and areas of health. STUDY DESIGN AND SETTING We examined the citations of 337 COS reports to identify studies that had assessed the uptake of a particular COS in randomized controlled trials (RCTs) or systematic reviews (SRs). RESULTS We identified 24 studies that had assessed uptake in RCTs and two studies that had assessed uptake in SRs. The studies covered a total of 17/337 (5%) COS. Uptake rates reported for RCTs varied from 0% of RCTs (gout) to 82% RCTs (rheumatoid arthritis) measuring the full COS. Studies that assessed uptake of individual core outcomes showed a wide variation in uptake between the outcomes. Suggested barriers to uptake included lack of validated measures, lack of patient and other key stakeholder involvement in COS development, and lack of awareness of the COS. CONCLUSIONS Few studies have been undertaken to assess the uptake of COS in RCTs and SRs. Further studies are needed to assess whether COS have been implemented across a wider range of disease categories and to explore the barriers and facilitators to COS uptake.
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Affiliation(s)
- Karen L Hughes
- MRC North West Hub for Trials Methodology Research, Department of Health Data Science, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool L69 3GL, United Kingdom.
| | - Mike Clarke
- Centre for Public Health, Institute of Clinical Sciences, Block B, Queen's University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, United Kingdom
| | - Paula R Williamson
- MRC North West Hub for Trials Methodology Research, Department of Health Data Science, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool L69 3GL, United Kingdom
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Wang D, Taylor-Vaisey A, Negrini S, Côté P. Criteria to Evaluate the Quality of Outcome Reporting in Randomized Controlled Trials of Rehabilitation Interventions. Am J Phys Med Rehabil 2021; 100:17-28. [PMID: 32969969 DOI: 10.1097/phm.0000000000001601] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT No standardized guideline for the reporting of outcomes measures in randomized controlled trials of rehabilitation interventions is currently available. This study includes four phases to identify, synthesize, and make recommendations for potential attributes of reporting criteria of outcome measures in rehabilitation randomized controlled trials. First, we surveyed the author instructions for rehabilitation journals to determine how journals require authors to report outcomes. Second, we reviewed all consolidated standards of reporting trials extensions to determine how other speciality groups require reporting of outcomes in randomized controlled trials. Third, we conducted a focused scoping review to examine the nature and variations of criteria used to evaluate the quality of outcome measures in randomized controlled trials. Finally, we synthesized the information from phases 1-3 and propose four criteria specific to the reporting of outcomes in randomized controlled trials of rehabilitation interventions: (1) clearly describe the construct to be measured as outcome(s); (2) justify the selection of outcome measures by mapping to World Health Organization International Classification of Function, Disability, and Health (International Classification of Functioning) framework; justify the psychometric properties (relevance, validity, reliability) of the selected measurement tool; (3) clearly describe the timing of outcome measurement, with consideration of the health condition, the course of disease, and hypothesized effect of intervention; and (4) complete and unselective reporting of outcome data.
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Affiliation(s)
- Dan Wang
- From the Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada (DW, AT-V, PC); Centre for Disability Prevention and Rehabilitation at Ontario Tech University and CMCC, Toronto, Ontario, Canada (DW, AT-V, PC); Department of Biomedical, Surgical and Dental Sciences, University "La Statale," Milan, Italy (SN); and Istituto Ortopedico Galeazzi, Milan, Italy (SN)
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Lenze EJ, Nicol GE, Barbour DL, Kannampallil T, Wong AWK, Piccirillo J, Drysdale AT, Sylvester CM, Haddad R, Miller JP, Low CA, Lenze SN, Freedland KE, Rodebaugh TL. Precision clinical trials: a framework for getting to precision medicine for neurobehavioural disorders. J Psychiatry Neurosci 2021; 46:E97-E110. [PMID: 33206039 PMCID: PMC7955843 DOI: 10.1503/jpn.200042] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The goal of precision medicine (individually tailored treatments) is not being achieved for neurobehavioural conditions such as psychiatric disorders. Traditional randomized clinical trial methods are insufficient for advancing precision medicine because of the dynamic complexity of these conditions. We present a pragmatic solution: the precision clinical trial framework, encompassing methods for individually tailored treatments. This framework includes the following: (1) treatment-targeted enrichment, which involves measuring patients' response after a brief bout of an intervention, and then randomizing patients to a full course of treatment, using the acute response to predict long-term outcomes; (2) adaptive treatments, which involve adjusting treatment parameters during the trial to individually optimize the treatment; and (3) precise measurement, which involves measuring predictor and outcome variables with high accuracy and reliability using techniques such as ecological momentary assessment. This review summarizes precision clinical trials and provides a research agenda, including new biomarkers such as precision neuroimaging, transcranial magnetic stimulation-electroencephalogram digital phenotyping and advances in statistical and machine-learning models. Validation of these approaches - and then widespread incorporation of the precision clinical trial framework - could help achieve the vision of precision medicine for neurobehavioural conditions.
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Affiliation(s)
- Eric J Lenze
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Ginger E Nicol
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Dennis L Barbour
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Thomas Kannampallil
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Alex W K Wong
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Jay Piccirillo
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Andrew T Drysdale
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Chad M Sylvester
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Rita Haddad
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - J Philip Miller
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Carissa A Low
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Shannon N Lenze
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Kenneth E Freedland
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Thomas L Rodebaugh
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
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Guo Y, Chen Z, Xu K, George TJ, Wu Y, Hogan W, Shenkman EA, Bian J. International Classification of Diseases, Tenth Revision, Clinical Modification social determinants of health codes are poorly used in electronic health records. Medicine (Baltimore) 2020; 99:e23818. [PMID: 33350768 PMCID: PMC7769291 DOI: 10.1097/md.0000000000023818] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/19/2020] [Indexed: 11/26/2022] Open
Abstract
There have been increasing calls for clinicians to document social determinants of health (SDOH) in electronic health records (EHRs). One potential source of SDOH in the EHRs is in the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Z codes (Z55-Z65). In February 2018, ICD-10-CM Official Guidelines for Coding and Reporting approved that all clinicians, not just the physicians, involved in the care of a patient can document SDOH using these Z codes.To examine the utilization rate of the ICD-10-CM Z codes using data from a large network of EHRs.We conducted a retrospective analysis of EHR data between 2015 to 2018 in the OneFlorida Clinical Research Consortium, 1 of the 13 Clinical Data Research Networks funded by Patient-Centered Outcomes Research Institute. We calculated the Z code utilization rate at both the encounter and patient levels.We found a low rate of utilization for these Z codes (270.61 per 100,000 at the encounter level and 2.03% at the patient level). We also found that the rate of utilization for these Z codes increased (from 255.62 to 292.79 per 100,000) since the official approval of Z code reporting from all clinicians by the American Hospital Association Coding Clinic and ICD-10-CM Official Guidelines for Coding and Reporting became effective in February 2018.The SDOH Z codes are rarely used by clinicians. Providing clear guidelines and incentives for documenting the Z codes can promote their use in EHRs. Improvements in the EHR systems are probably needed to better document SDOH.
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Affiliation(s)
- Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida
- Cancer Informatics Shared Resources, University of Florida Health Cancer Center
| | - Zhaoyi Chen
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida
| | - Ke Xu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida
- Cancer Informatics Shared Resources, University of Florida Health Cancer Center
| | - Thomas J. George
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida
- Cancer Informatics Shared Resources, University of Florida Health Cancer Center
| | - William Hogan
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida
| | - Elizabeth A. Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida
- Cancer Informatics Shared Resources, University of Florida Health Cancer Center
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Abstract
SCORE-15 (Systemic Clinical Outcome and Routine Evaluation) is a 15-item questionnaire for completion by family members aged 12 years and older to assess outcomes in systemic therapy. This study aimed to investigate (a) the psychometric properties and the internal consistency reliability of the Italian version of SCORE-15, (b) clinical responsiveness, and (c) normative (Italian) criteria. Furthermore, (d) the study sought to evaluate the participants' representation of both their family and their problems, analyzing open-ended questions included in the SCORE-15. Data were collected from two clinical centers for 208 families (n = 507). Results confirmed the three-factor structure (i.e., strengths, difficulties, and communication), a good internal consistency reliability, and indicated a cutoff threshold for the Italian version. Furthermore, results showed that SCORE-15 is a good instrument for clinical responsiveness and that it can be used to explore the way in which family members describe their families and problems. Overall, SCORE-15 is a brief, psychometrically robust family assessment instrument that may be used for both researchers and practitioners in several domains of clinical and social psychology.
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Affiliation(s)
| | - Luigi Schepisi
- Istituto Italiano di Psicoterapia Relazionale (IIPR), Rome, Italy
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35
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Duffy JMN, Bhattacharya S, Bhattacharya S, Bofill M, Collura B, Curtis C, Evers JLH, Giudice LC, Farquharson RG, Franik S, Hickey M, Hull ML, Jordan V, Khalaf Y, Legro RS, Lensen S, Mavrelos D, Mol BW, Niederberger C, Ng EHY, Puscasiu L, Repping S, Sarris I, Showell M, Strandell A, Vail A, van Wely M, Vercoe M, Vuong NL, Wang AY, Wang R, Wilkinson J, Youssef MA, Farquhar CM. Standardizing definitions and reporting guidelines for the infertility core outcome set: an international consensus development study. Fertil Steril 2020; 115:201-212. [PMID: 33272619 DOI: 10.1016/j.fertnstert.2020.11.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/08/2020] [Accepted: 07/22/2020] [Indexed: 01/21/2023]
Abstract
STUDY QUESTION Can consensus definitions for the core outcome set for infertility be identified in order to recommend a standardized approach to reporting? SUMMARY ANSWER Consensus definitions for individual core outcomes, contextual statements, and a standardized reporting table have been developed. WHAT IS KNOWN ALREADY Different definitions exist for individual core outcomes for infertility. This variation increases the opportunities for researchers to engage with selective outcome reporting, which undermines secondary research and compromises clinical practice guideline development. STUDY DESIGN, SIZE, DURATION Potential definitions were identified by a systematic review of definition development initiatives and clinical practice guidelines and by reviewing Cochrane Gynaecology and Fertility Group guidelines. These definitions were discussed in a face-to-face consensus development meeting, which agreed consensus definitions. A standardized approach to reporting was also developed as part of the process. PARTICIPANTS/MATERIALS, SETTING, METHODS Healthcare professionals, researchers, and people with fertility problems were brought together in an open and transparent process using formal consensus development methods. MAIN RESULTS AND THE ROLE OF CHANCE Forty-four potential definitions were inventoried across four definition development initiatives, including the Harbin Consensus Conference Workshop Group and International Committee for Monitoring Assisted Reproductive Technologies, 12 clinical practice guidelines, and Cochrane Gynaecology and Fertility Group guidelines. Twenty-seven participants, from 11 countries, contributed to the consensus development meeting. Consensus definitions were successfully developed for all core outcomes. Specific recommendations were made to improve reporting. LIMITATIONS, REASONS FOR CAUTION We used consensus development methods, which have inherent limitations. There was limited representation from low- and middle-income countries. WIDER IMPLICATIONS OF THE FINDINGS A minimum data set should assist researchers in populating protocols, case report forms, and other data collection tools. The generic reporting table should provide clear guidance to researchers and improve the reporting of their results within journal publications and conference presentations. Research funding bodies, the Standard Protocol Items: Recommendations for Interventional Trials statement, and over 80 specialty journals have committed to implementing this core outcome set. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the Catalyst Fund, Royal Society of New Zealand, Auckland Medical Research Fund, and Maurice and Phyllis Paykel Trust. Siladitya Bhattacharya reports being the Editor-in-Chief of Human Reproduction Open and an editor of the Cochrane Gynaecology and Fertility group. Hans Evers reports being the Editor Emeritus of Human Reproduction. Richard Legro reports consultancy fees from Abbvie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. Ben Mol reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. Craig Niederberger reports being the Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring, and a financial interest in NexHand. Ernest Ng reports research sponsorship from Merck. Annika Strandell reports consultancy fees from Guerbet. Jack Wilkinson reports being a statistical editor for the Cochrane Gynaecology and Fertility group. Andy Vail reports that he is a Statistical Editor of the Cochrane Gynaecology & Fertility Review Group and of the journal Reproduction. His employing institution has received payment from HFEA for his advice on review of research evidence to inform their 'traffic light' system for infertility treatment 'add-ons'. Lan Vuong reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the work presented. All authors have completed the disclosure form. TRIAL REGISTRATION NUMBER Core Outcome Measures in Effectiveness Trials Initiative: 1023.
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Affiliation(s)
- J M N Duffy
- King's Fertility, Fetal Medicine Research Institute, London, UK; Institute for Women's Health, University College London, London, UK.
| | - S Bhattacharya
- School of Medicine, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK
| | - S Bhattacharya
- School of Medicine, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK
| | - M Bofill
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - B Collura
- RESOLVE: The National Infertility Association, Virginia, United States
| | - C Curtis
- Fertility New Zealand, Auckland, New Zealand; School of Psychology, University of Waikato, Hamilton, New Zealand
| | - J L H Evers
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L C Giudice
- Center for Research, Innovation and Training in Reproduction and Infertility, Center for Reproductive Sciences, University of California, San Francisco, California, United States; International Federation of Fertility Societies, Philadelphia, Pennsylvania, United States
| | - R G Farquharson
- Department of Obstetrics and Gynaecology, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - S Franik
- Department of Obstetrics and Gynaecology, Münster University Hospital, Münster, Germany
| | - M Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - M L Hull
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - V Jordan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Y Khalaf
- Department of Women and Children's Health, King's College London, Guy's Hospital, London
| | - R S Legro
- Department of Obstetrics and Gynaecology, Penn State College of Medicine, Pennsylvania
| | - S Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - D Mavrelos
- Reproductive Medicine Unit, University College Hospital, London, UK
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - C Niederberger
- Department of Urology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - E H Y Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong; Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, China
| | - L Puscasiu
- University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - S Repping
- Amsterdam University Medical Centers, Amsterdam, The Netherlands; National Health Care Institute, Diemen, The Netherlands
| | - I Sarris
- King's Fertility, Fetal Medicine Research Institute, London, UK
| | - M Showell
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
| | - A Strandell
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - A Vail
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - M van Wely
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - M Vercoe
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
| | - N L Vuong
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - A Y Wang
- Faculty of Health, University of Technology, Sydney, Broadway, Australia
| | - R Wang
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - J Wilkinson
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - M A Youssef
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - C M Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand; Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
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Farmer CA, Kaat AJ, Thurm A, Anselm I, Akshoomoff N, Bennett A, Berry L, Bruchey A, Barshop BA, Berry-Kravis E, Bianconi S, Cecil KM, Davis RJ, Ficicioglu C, Porter FD, Wainer A, Goin-Kochel RP, Leonczyk C, Guthrie W, Koeberl D, Love-Nichols J, Mamak E, Mercimek-Andrews S, Thomas RP, Spiridigliozzi GA, Sullivan N, Sutton VR, Udhnani MD, Waisbren SE, Miller JS. Person Ability Scores as an Alternative to Norm-Referenced Scores as Outcome Measures in Studies of Neurodevelopmental Disorders. Am J Intellect Dev Disabil 2020; 125:475-480. [PMID: 33211814 DOI: 10.1352/1944-7558-125.6.475] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/31/2019] [Indexed: 06/11/2023]
Abstract
Although norm-referenced scores are essential to the identification of disability, they possess several features which affect their sensitivity to change. Norm-referenced scores often decrease over time among people with neurodevelopmental disorders who exhibit slower-than-average increases in ability. Further, the reliability of norm-referenced scores is lower at the tails of the distribution, resulting in floor effects and increased measurement error for people with neurodevelopmental disorders. In contrast, the person ability scores generated during the process of constructing a standardized test with item response theory are designed to assess change. We illustrate these limitations of norm-referenced scores, and relative advantages of ability scores, using data from studies of autism spectrum disorder and creatine transporter deficiency.
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Affiliation(s)
| | | | - Audrey Thurm
- Audrey Thurm, National Institute of Mental Health
| | - Irina Anselm
- Irina Anselm, Boston Children's Hospital and Harvard University
| | | | | | | | | | | | | | - Simona Bianconi
- Simona Bianconi, Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | | | | | - Can Ficicioglu
- Can Ficicioglu, Children's Hospital of Philadelphia and University of Pennsylvania
| | - Forbes D Porter
- Forbes D. Porter, Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | | | | | | | | | | | | | - Eva Mamak
- Eva Mamak, The Hospital for Sick Children
| | | | | | | | - Nancy Sullivan
- Nancy Sullivan, Boston Children's Hospital and Harvard Medical School
| | | | | | - Susan E Waisbren
- Susan E. Waisbren, Boston Children's Hospital and Harvard University
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Thurm A, Kelleher B, Wheeler A. Outcome Measures for Core Symptoms of Intellectual Disability: State of the Field. Am J Intellect Dev Disabil 2020; 125:418-433. [PMID: 33211819 DOI: 10.1352/1944-7558-125.6.418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 07/28/2020] [Indexed: 06/11/2023]
Abstract
Intellectual disability (ID) is defined by impairments in intellectual and adaptive functioning. As such, tools designed to assess these domains would theoretically be ideal outcome measures for treatment trials targeting core symptoms of ID. However, measures of intellectual and adaptive functioning have rarely been used as primary outcome measures to date and further study is needed regarding their usefulness to measure change. This area of inquiry is important because promising, mechanism-modifying treatments for conditions leading to ID are being initiated. To show efficacy, these treatments need to demonstrate an impact on core features of ID. After reviewing literature on this topic, we suggest solutions to several problems outlined, including use of out-of-age-range testing, alternative metrics, and development of new measures.
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Affiliation(s)
- Audrey Thurm
- Audrey Thurm, National Institute of Mental Health
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Meier ST. Construct Validity of Outcome Rating Scale (ORS) Scores in Clinical Samples: Extension of Harris, Murphy, and Rakes' (2019) Narrative Review. J Evid Based Soc Work (2019) 2020; 17:648-661. [PMID: 32620070 DOI: 10.1080/26408066.2020.1784345] [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] [Indexed: 06/11/2023]
Abstract
PURPOSE A recent review of 24 studies primarily evaluated psychometric properties of the Outcome Rating Scale (ORS) related to coefficient alpha and convergent validity. METHOD To provide a fuller picture, this review examined effect size (ES) estimates and the full range of correlations between ORS scores and related measures. RESULTS Mean ORS ESs equaled 1.00 for 44 comparison periods. ORS scores correlated highest with measures of depression and evidenced larger ESs in depression treatments. DISCUSSION The ORS functions as a robust measure for detecting client progress in clinical samples that were primarily young, female, and Caucasian. Some results suggest ORS scores primarily reflect a rapid response to interventions. CONCLUSION AND LIMITATIONS Future research should assess ORS scores' psychometric properties in response to interventions with more heterogeneous client samples as well as its capacity to monitor change beyond initial sessions.
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Affiliation(s)
- Scott T Meier
- Department of Counseling, School, and Educational Psychology, University at Buffalo , Buffalo, NY, USA
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Raspa M, Bann CM, Gwaltney A, Benke TA, Fu C, Glaze DG, Haas R, Heydemann P, Jones M, Kaufmann WE, Lieberman D, Marsh E, Peters S, Ryther R, Standridge S, Skinner SA, Percy AK, Neul JL. A Psychometric Evaluation of the Motor-Behavioral Assessment Scale for Use as an Outcome Measure in Rett Syndrome Clinical Trials. Am J Intellect Dev Disabil 2020; 125:493-509. [PMID: 33211820 PMCID: PMC7778880 DOI: 10.1352/1944-7558-125.6.493] [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] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 07/23/2020] [Indexed: 05/13/2023]
Abstract
Rett syndrome (RTT) is a neurodevelopmental disorder that primarily affects females. Recent work indicates the potential for disease modifying therapies. However, there remains a need to develop outcome measures for use in clinical trials. Using data from a natural history study (n = 1,075), we examined the factor structure, internal consistency, and validity of the clinician-reported Motor Behavior Assessment scale (MBA). The analysis resulted in a five-factor model: (1) motor dysfunction, (2) functional skills, (3) social skills, (4) aberrant behavior, and (5) respiratory behaviors. Item Response Theory (IRT) analyses demonstrated that all items had acceptable discrimination. The revised MBA subscales showed a positive relationship with parent reported items, age, and a commonly used measure of clinical severity in RTT, and mutation type. Further work is needed to evaluate this measure longitudinally and to add items related to the RTT phenotype.
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Affiliation(s)
- Melissa Raspa
- Melissa Raspa, Carla M. Bann, and Angela Gwaltney, RTI International
| | - Carla M Bann
- Melissa Raspa, Carla M. Bann, and Angela Gwaltney, RTI International
| | - Angela Gwaltney
- Melissa Raspa, Carla M. Bann, and Angela Gwaltney, RTI International
| | | | - Cary Fu
- Cary Fu, Vanderbilt Kennedy Center
| | | | - Richard Haas
- Richard Haas, University of California San Diego
| | | | | | | | | | - Eric Marsh
- David Lieberman and Eric Marsh, Children's Hospital Boston
| | | | - Robin Ryther
- Robin Ryther, Washington University School of Medicine
| | | | | | - Alan K Percy
- Alan K. Percy, University of Alabama at Birmingham
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Ghio S, Baldi E, Vicentini A, Lenti MV, Di Sabatino A, Di Matteo A, Zuccaro V, Piloni D, Corsico A, Gnecchi M, Speciale F, Sabena A, Oltrona Visconti L, Perlini S. Cardiac involvement at presentation in patients hospitalized with COVID-19 and their outcome in a tertiary referral hospital in Northern Italy. Intern Emerg Med 2020; 15:1457-1465. [PMID: 32960429 PMCID: PMC7505942 DOI: 10.1007/s11739-020-02493-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/04/2020] [Indexed: 12/15/2022]
Abstract
The correlation between myocardial injury and clinical outcome in COVID-19 patients is gaining attention in the literature. The aim of the present study was to evaluate the role of cardiac involvement and of respiratory failure in a cohort of COVID-19 patients hospitalized in an academic hospital in Lombardy, one of the most affected Italian (and worldwide) regions by the epidemic. The study included 405 consecutive patients with confirmed COVID-19 admitted to a medical ward from February 25th to March 31st, 2020. Follow-up of surviving patients ended either at hospital discharge or by July 30th, 2020. Myocardial injury was defined on the basis of the presence of blood levels of hs-TnI above the 99th percentile upper reference limit. Respiratory function was assessed as PaO2/FiO2 (P/F) ratio. The primary end-point was death for any cause. During hospitalization, 124 patients died. Death rate increased from 7.9% in patients with normal hs-TnI plasma levels and no cardiac comorbidity to 61.5% in patients with elevated hs-TnI and cardiac involvement (p < 0.001). At multivariable analysis, older age, P/F ratio < 200 (both p < 0.001) and hs-TnI plasma levels were independent predictors of death. However, it must be emphasized that the median values of hs-TnI were within normal range in non-survivors. Cardiac involvement at presentation was associated with poor prognosis in COVID-19 patients, but, even in a population of COVID-19 patients who did not require invasive ventilation at hospital admission, mortality was mainly driven by older age and respiratory failure.
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Affiliation(s)
- Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
| | - Enrico Baldi
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology, Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Cardiology Unit, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Alessandro Vicentini
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology, Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, University of Pavia, Pavia, Italy
| | - Angela Di Matteo
- Division of Infectious Disease, Fondazione IRCCS Policlinico San Matteo, Pavia, University of Pavia, Pavia, Italy
| | - Valentina Zuccaro
- Division of Infectious Disease, Fondazione IRCCS Policlinico San Matteo, Pavia, University of Pavia, Pavia, Italy
| | - Davide Piloni
- Division of Respiratory Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, University of Pavia, Pavia, Italy
| | - Angelo Corsico
- Division of Respiratory Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, University of Pavia, Pavia, Italy
| | - Massimiliano Gnecchi
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology, Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Cardiology Unit, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Francesco Speciale
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Pavia, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Anna Sabena
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Pavia, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Luigi Oltrona Visconti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Stefano Perlini
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Pavia, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
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Brady NC, Romine RES, Holbrook A, Fleming KK, Kasari C. Measuring Change in the Communication Skills of Children With Austim Spectrum Disorder Using the Communication Complexity Scale. Am J Intellect Dev Disabil 2020; 125:481-492. [PMID: 33211817 DOI: 10.1352/1944-7558-125.6.481] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/30/2020] [Indexed: 06/11/2023]
Abstract
Changes in minimal verbal communication by children with autism spectrum disorder (ASD) were measured with the Communication Complexity Scale (CCS) and other communication assessments. The CCS measures complexity of preverbal and beginning verbal communication used to communicate behavior regulation and joint attention. The purpose was to investigate if the CCS was responsive to changes associated with a behavioral intervention aimed at improving communication skills. Changes were detected with CCS scores, rates of initiating joint attention, and the Mullen Scales of Early Learning (MSEL) Expressive Language subscale. Significant changes in CCS scores were also detected for a subgroup of participants who did not show significant changes on the MSEL Expressive Language subscale, demonstrating that CCS scores are sensitive to changes associated with a behavioral intervention.
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Affiliation(s)
- Nancy C Brady
- Nancy C. Brady and Rebecca E. Swinburne Romine, University of Kansas
| | | | | | | | - Connie Kasari
- Connie Kasari, University of California, Los Angeles
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42
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da Silva JCRA, de Azevedo KPM, Farinasso CM, da Silva DLM, Stefani C, Figueiredo ACMG, de Souza PM, Piuvezam G, Capucho HC. Placebo use and outcome quality: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22915. [PMID: 33126350 PMCID: PMC7598826 DOI: 10.1097/md.0000000000022915] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The Pharmaceutical industry sponsorship, research outcome and quality has been already evaluated for clinical trials in order to analyze if this kind of sponsorship affects the results of clinical trials. In this sense, this study has the aim to investigate whether placebo use allows positive outcomes regarding efficacy and safety compared to synthetic medicines. METHODS We designed and registered a study protocol for a systematic review for methodology data. We will only randomized clinical trials that use placebo as comparator. The main outcome will be the evaluation of placebo use regarding the tendency for positive results (efficacy and security) when comparing to synthetic medicines. PubMed, Cochrane, LILACS (BVS), Web of Science, Scopus, and Excerpta Medica dataBASE (EMBASE) databases will be searched. Gray literature will be identified through the databases Proquest (Dissertation and Theses), OpenGrey and Google Scholar. Two review authors will independently assess trial quality and will extract data in accordance with standard Cochrane methodology. If necessary, we will also contact authors for additional information. The Cochrane Collaboration's risk of bias tool will be used. If feasible, it means homogenous data, we will conduct random effects meta-analysis. Subgroup analyses will be conducted for different justifications for placebo use and for studies sponsored/not sponsored by the pharmaceutical industry. RESULTS Our present findings will indicate the effects of placebo use as comparator regarding efficacy and safety of the oral synthetic medicines. DISCUSSION This systematic review will identify, summarize, and analyze if there is a trend for positive efficacy and safety results for synthetic medicines in clinical trials when compared with placebo and if the justification for placebo use is considered ethically acceptable. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018110829.
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Affiliation(s)
| | - Kesley Pablo Morais de Azevedo
- Department of Public Health, Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, University Campus Lagoa Nova, Natal, Rio Grande do Norte
| | | | | | - Cristine Stefani
- University of Brasilia, University Campus Darcy Ribeiro Asa Norte, Brasília, Distrito Federal
| | | | | | - Grasiela Piuvezam
- Department of Public Health, Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, University Campus Lagoa Nova, Natal, Rio Grande do Norte
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Stoppe C, Hill A, Day AG, Kristof AS, Hundeshagen G, Kneser U, Beier J, Lumenta D, Kim BS, Plock J, Collins DP, Gille J, Jiang X, Heyland DK. The initial validation of a novel outcome measure in severe burns- the Persistent Organ Dysfunction +Death: Results from a multicenter evaluation. Burns 2020; 47:765-775. [PMID: 33288334 DOI: 10.1016/j.burns.2020.09.003] [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] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/25/2020] [Accepted: 09/24/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A need exists to improve the efficiency of clinical trials in burn care. The objective of this study was to validate "Persistent Organ Dysfunction" plus death as endpoint in burn patients and to demonstrate its statistical efficiency. METHODS This secondary outcome analysis of a dataset from a prospective international multicenter RCT (RE-ENERGIZE) included patients with burned total body surface area >20% and a 6-month follow-up. Persistent organ dysfunction was defined as persistence of organ dysfunction with life-supportiing technologies and ICU care. RESULTS In the 539 included patients, the prevalence of 0p p+ pdeath was 40% at day 14 and of 27% at day 28. At both timepoints, survivors with POD (vs. survivors without POD) had a higher mortality rate, longer ICU- and hospital-stays, and a reduced quality of life. POD + death as an endpoint could result in reduced sample size requirements for clinical trials. Detecting a 25% relative risk reduction in 28-day mortality would require a sample size of 4492 patients, whereas 1236 patients would be required were 28-day POD + death used. CONCLUSIONS POD + death represents a promising composite outcome measure that may reduce the sample size requirements of clinical trials in severe burns patients. Further validation in larger clinical trials is warranted. STUDY TYPE Prospective cohort study, level of evidence: II.
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Affiliation(s)
- Christian Stoppe
- Department of Intensive Care Medicine, University Hospital RWTH, Aachen, Germany; CARE-Cardiovascular Critical Care & Anesthesia Evaluation and Research, Aachen, Germany
| | - Aileen Hill
- Department of Intensive Care Medicine, University Hospital RWTH, Aachen, Germany; CARE-Cardiovascular Critical Care & Anesthesia Evaluation and Research, Aachen, Germany
| | - Andrew G Day
- KGH Research Institute, Kingston Health Sciences Centre, Kingston, Ontario
| | - Arnold S Kristof
- Meakins-Christie Laboratories and Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Faculty of Medicine, Departments of Medicine and Critical Care, Montreal, Canada
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center. BG Trauma Center Ludwigshafen; University of Heidelberg, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center. BG Trauma Center Ludwigshafen; University of Heidelberg, Germany
| | - Justus Beier
- Department of Plastic, Hand and Burn Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - David Lumenta
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Jan Plock
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Declan P Collins
- Department of Burns and Plastic Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Jochen Gille
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy. Burn Unit. St. Georg Hospital GmbH Leipzig, 04129 Leipzig, Germany
| | - Xuran Jiang
- Department of Critical Care Medicine, Queen´s University, K7L 2V7 Kingston, Canada
| | - Daren K Heyland
- Department of Critical Care Medicine, Queen´s University, K7L 2V7 Kingston, Canada.
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Goto S, Haas S, Ageno W, Goldhaber SZ, Turpie AGG, Weitz JI, Angchaisuksiri P, Nielsen JD, Kayani G, Farjat A, Schellong S, Bounameaux H, Mantovani LG, Prandoni P, Kakkar AK. Assessment of Outcomes Among Patients With Venous Thromboembolism With and Without Chronic Kidney Disease. JAMA Netw Open 2020; 3:e2022886. [PMID: 33112399 PMCID: PMC7593818 DOI: 10.1001/jamanetworkopen.2020.22886] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Patients with venous thromboembolism (VTE) and concomitant chronic kidney disease (CKD) have been reported to have a higher risk of thrombosis and major bleeding complications compared with patients without concomitant CKD. The use of anticoagulation therapy is challenging, as many anticoagulant medications are excreted by the kidney. Large-scale data are needed to clarify the impact of CKD for anticoagulant treatment strategies and clinical outcomes of patients with VTE. OBJECTIVE To compare clinical characteristics, treatment patterns, and 12-month outcomes among patients with VTE and concomitant moderate to severe CKD (stages 3-5) vs patients with VTE and mild to no CKD (stages 1-2) in a contemporary international registry. DESIGN, SETTING, AND PARTICIPANTS The Global Anticoagulant Registry in the Field-Venous Thromboembolism (GARFIELD-VTE) study is a prospective noninterventional investigation of real-world treatment practices. A total of 10 684 patients from 415 sites in 28 countries were enrolled in the GARFIELD-VTE between May 2014 and January 2017. This cohort study included 8979 patients (6924 patients with mild to no CKD and 2055 patients with moderate to severe CKD) who had objectively confirmed VTE within 30 days before entry in the registry. Chronic kidney disease stages were defined by estimated glomerular filtration rates. Data were extracted from the study database on December 8, 2018, and analyzed between May 1, 2019, and July 30, 2020. EXPOSURE Moderate to severe CKD vs mild to no CKD. MAIN OUTCOMES AND MEASURES The primary outcomes were all-cause mortality, recurrent VTE, and major bleeding. Event rates and 95% CIs were calculated and expressed per 100 person-years. Hazard ratios (HRs) were estimated with Cox proportional hazards regression models and adjusted for relevant confounding variables. All-cause mortality was considered a competing risk for other clinical outcomes in the estimation of cumulative incidences. RESULTS Of the 10 684 patients with objectively confirmed VTE, serum creatinine data were available for 8979 patients (84.0%). Of those, 4432 patients (49.4%) were female and 5912 patients (65.8%) were White; 6924 patients (77.1%; median age, 57 years; interquartile range [IQR], 44-69 years) were classified as having mild to no CKD, and 2055 patients (22.9%; median age, 70 years; IQR, 59-78 years) were classified as having moderate to severe CKD. Calculations using the equation from the Modification of Diet in Renal Disease study indicated that, among the 6924 patients with mild to no CKD, 2991 patients had stage 1 CKD, and 3933 patients had stage 2 CKD; among the 2055 patients with moderate to severe CKD, 1650 patients had stage 3 CKD, 190 patients had stage 4 CKD, and 215 patients had stage 5 CKD. The distribution of VTE presentation was comparable between groups. In total, 1171 patients (57.0%) with moderate to severe CKD and 4079 patients (58.9%) with mild to no CKD presented with deep vein thrombosis alone, 547 patients (26.6%) with moderate to severe CKD and 1723 patients (24.9%) with mild to no CKD presented with pulmonary embolism alone, and 337 patients (16.4%) with moderate to severe CKD and 1122 patients (16.2%) with mild to no CKD presented with both pulmonary embolism and deep vein thrombosis. Compared with patients with mild to no CKD, patients with moderate to severe CKD were more likely to be female (3259 women [47.1%] vs 1173 women [57.1%]) and older than 65 years (2313 patients [33.4%] vs 1278 patients [62.2%]). At baseline, the receipt of parenteral therapy alone was comparable between the 2 groups (355 patients [17.3%] with moderate to severe CKD vs 1253 patients [18.1%] with mild to no CKD). Patients with moderate to severe CKD compared with those with mild to no CKD were less likely to be receiving direct oral anticoagulant therapy, either alone (557 patients [27.1%] vs 2139 patients [30.9%]) or in combination with parenteral therapy (319 patients [15.5%] vs 1239 patients [17.9%]). Patients with moderate to severe CKD had a higher risk of all-cause mortality (adjusted hazard ratio [aHR], 1.44; 95% CI, 1.21-1.73), major bleeding (aHR, 1.40; 95% CI, 1.03-1.90), and recurrent VTE (aHR, 1.40; 95% CI, 1.10-1.77) than patients with mild to no CKD. CONCLUSIONS AND RELEVANCE In this study of patients with VTE, the presence of moderate to severe CKD was associated with increases in the risk of death, VTE recurrence, and major bleeding compared with the presence of mild to no CKD.
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Affiliation(s)
- Shinya Goto
- Department of Medicine (Cardiology), Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Sylvia Haas
- Technical University of Munich, Munich, Germany
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | | | - Jeffrey I. Weitz
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Gloria Kayani
- Thrombosis Research Institute, London, United Kingdom
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Xu H, Yang Y, Wang C, Yang J, Li W, Zhang X, Ye Y, Dong Q, Fu R, Sun H, Yan X, Gao X, Wang Y, Jia X, Sun Y, Wu Y, Zhang J, Zhao W, Sabatine MS, Wiviott SD. Association of Hospital-Level Differences in Care With Outcomes Among Patients With Acute ST-Segment Elevation Myocardial Infarction in China. JAMA Netw Open 2020; 3:e2021677. [PMID: 33095249 PMCID: PMC7584928 DOI: 10.1001/jamanetworkopen.2020.21677] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
IMPORTANCE The incidence of acute myocardial infarction has increased over the past decades in China, and management challenges include an unbalanced economy, disparate resources, and variable access to medical care across the nation. OBJECTIVE To examine the variations in care and outcomes of patients with ST-segment elevation myocardial infarction among 3 levels of hospitals in the typical Chinese public hospital model. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the China Acute Myocardial Infarction Registry to compare the differences in care and outcomes among patients at 108 hospitals from 31 provinces and municipalities throughout mainland China. Participants included patients with ST-segment elevation myocardial infarction directly admitted to hospitals between January 2013 and September 2014. Data analyses were performed from June 2015 to June 2019. EXPOSURES Care in province-level, prefecture-level, or county-level hospitals in China. MAIN OUTCOMES AND MEASURES The primary outcome was in-hospital mortality. Secondary outcomes included presentation, treatments, and major complications. RESULTS A total of 12 695 patients (9593 men [75.6%]; median [interquartile range] age, 63 [54-72] years) were included; 3985 were at province-level hospitals, 6731 were at prefecture-level hospitals, and 1979 were at county-level hospitals. Compared with patients admitted to province-level hospitals, those admitted to prefecture-level and county-level hospitals were older (median [interquartile range] age, 61 [52-70] years vs 63 [54-72] years and 65 [57-75] years) and more likely to be women (815 women [20.5%] vs 1620 women [24.1%] and 667 women [33.7%]). Patients in prefecture-level and county-level hospitals were less likely to use ambulances compared with patients at province-level hospitals (11.6% [95% CI, 10.8%-12.4%] and 12.0% [95% CI, 10.6%-13.5%] vs 19.4% [95% CI, 18.1%-20.7%]; P < .001) and were less likely to experience early presentation, with onset-to-arrival times less than 12 hours for 75.3% (95% CI, 73.9%-76.6%) of patients at province-level hospitals, 70.8% (95% CI, 69.7%-71.9%) of patients at prefecture-level hospitals, and 69.8% (95% CI, 67.7%-71.8%) of patients at county-level hospitals (P < .001). The rates of reperfusion therapy were significantly lower in low-level hospitals (54.3% [95% CI, 53.1%-55.5%] for prefecture-level hospitals and 45.8% [95% CI, 43.6%-48.1%] for county-level hospitals) compared with province-level hospitals (69.4% [95% CI, 67.9%-70.8%]; P < .001). There was a progressively higher rate of in-hospital mortality at the 3 levels of hospitals: 3.1% (95% CI, 2.6%-3.7%) for province-level hospitals, 5.3% (95% CI, 4.8%-5.9%) for prefecture-level hospitals, and 10.2% (95% CI, 8.9%-11.7%) for county-level hospitals (P for trend < .001). After adjustment for patient characteristics, presentation, hospital facility, and treatments, the odds of death remained higher in prefecture-level (odds ratio, 1.39 [95% CI, 1.06-1.84]) and county-level (odds ratio, 1.43 [95% CI, 0.97-2.11]) hospitals compared with province-level hospitals (P for trend = .04). CONCLUSIONS AND RELEVANCE These findings suggest that there are significant variations in care and outcomes of patients among the 3 levels of hospitals in China. More efforts should be made to address the identified gaps, particularly in the prefecture-level and county-level hospitals. This work can inform national quality improvements efforts in China and in other developing countries.
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Affiliation(s)
- Haiyan Xu
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Chuangshi Wang
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jingang Yang
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wei Li
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xuan Zhang
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yunqing Ye
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qiuting Dong
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Rui Fu
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hui Sun
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xinxin Yan
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaojin Gao
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yang Wang
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xuan Jia
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yi Sun
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yuan Wu
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jun Zhang
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wei Zhao
- Information Technology Center, Fuwai Hospital, Beijing, China
| | - Marc S. Sabatine
- Thrombolysis in Myocardial Infarction Study Group, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephen D. Wiviott
- Thrombolysis in Myocardial Infarction Study Group, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Werner RN, Gaskins M, Dressler C, Nast A, Schaefer C, Aigner F, Siegel R. Measuring importance of outcomes to patients: a cross-sectional survey for the German anal cancer guideline. J Clin Epidemiol 2020; 129:40-50. [PMID: 32987160 DOI: 10.1016/j.jclinepi.2020.09.026] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/04/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We aimed to generate evidence on patients' values and preferences to inform the development of the German national Evidence-based Anal Cancer Guideline. STUDY DESIGN AND SETTING We developed a list of health outcomes based on a systematic search. We then asked anal cancer patients and experts of the guideline development group in an online survey to (a) rate the relative importance of the outcomes in different clinical situations using a nine-point, three-category scale, and (b) select seven outcomes they considered most important for decision-making in each situation. RESULTS Participants rated almost half of the outcomes (45%) as critical for decision-making, and more than half (53%) as important. Only two outcomes (2%) were rated as low in importance. Agreement between expert and patient ratings was low to fair, and we found important discrepancies in how the relative importance of the outcomes was perceived. However, the rankings of outcomes were highly correlated. CONCLUSION Determining the relative importance placed by anal cancer patients on outcomes provided useful information for developing guideline recommendations. Our approach may be useful for guideline developers who aim to include the patient perspective. Moreover, our findings may help health professionals caring for anal cancer patients in joint decision-making.
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Affiliation(s)
- Ricardo N Werner
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Venerology and Allergy, Berlin, Germany.
| | - Matthew Gaskins
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Venerology and Allergy, Berlin, Germany
| | - Corinna Dressler
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Venerology and Allergy, Berlin, Germany
| | - Alexander Nast
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Venerology and Allergy, Berlin, Germany
| | - Corinna Schaefer
- German Agency for Quality in Medicine (AEZQ), Department of Evidence Based Medicine and Guidelines, Department of Patient Information, Berlin, Germany
| | - Felix Aigner
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Virchow-Klinikum and Charité Mitte, Berlin, Germany; Department of Surgery, St. John of God Hospital (Krankenhaus der Barmherzigen Brüder) Graz, Graz, Austria
| | - Robert Siegel
- Department of General, Visceral and Oncological Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany; Department of Visceral, Vascular, and Transplantation Surgery, Faculty of Health, Witten/Herdecke University, Witten, Germany
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Pizzi LT, Onukwugha E, Corey R, Albarmawi H, Murray J. Competencies for Professionals in Health Economics and Outcomes Research: The ISPOR Health Economics and Outcomes Research Competencies Framework. Value Health 2020; 23:1120-1127. [PMID: 32940228 DOI: 10.1016/j.jval.2020.04.1834] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/11/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
The need for Health Economics and Outcomes Research (HEOR) has expanded globally, fueling demand for professionals trained in the discipline. By leveraging the expertise and perspectives of its members, the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) established a set of competencies for HEOR professionals. The resulting 41 competencies were organized into 13 topic domains that collectively comprise the ISPOR Health Economics and Outcomes Research Competencies Framework. In this article, we explain the collaborative process used by the ISPOR Institutional Council and Faculty Advisor Council to identify and validate the framework. This process entailed expertise from the council members combined with natural language processing to examine competencies included in ISPOR Career Center HEOR job postings, qualitative input from a focused Institutional Council-Faculty Advisor Council workgroup, and quantitative input from 3 surveys of mutually exclusive member groups: a general member survey to assess importance and relevance of each competency, a faculty member survey to assess the extent to which HEOR graduate degree programs cover each of the competencies, and a student member survey to assess exposure to each of the competencies. Organization of the competencies into topic domains was achieved by engaging the Education Council, which applied a taxonomy consistent with ISPOR's educational programming. The resulting ISPOR Health Economics and Outcomes Research Competencies Framework has the important potential of serving as a tool to guide academic curricula, fellowships, and continuing education programs, and assessment of job candidates. As the HEOR field advances, so do the job types and the breadth of topics in which professionals must demonstrate competence. Future work will entail revisiting the competencies to ensure their currency and comprehensiveness, and tailoring the framework according to major specialty areas.
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Affiliation(s)
- Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University Ernest Mario School of Pharmacy, Piscataway, NJ, USA.
| | - Ebere Onukwugha
- Pharmaceutical Research Computing, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | | | - Husam Albarmawi
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - James Murray
- Global Patient Outcomes and Real-World Evidence, Eli Lilly and Company, Indianapolis, IN, USA
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Kok PS, Cho D, Yoon WH, Ritchie G, Marschner I, Lord S, Friedlander M, Simes J, Lee CK. Validation of Progression-Free Survival Rate at 6 Months and Objective Response for Estimating Overall Survival in Immune Checkpoint Inhibitor Trials: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e2011809. [PMID: 32897371 PMCID: PMC7489825 DOI: 10.1001/jamanetworkopen.2020.11809] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
IMPORTANCE Progression-free survival (PFS) rate at 6 months has been proposed as a potential surrogate for overall survival (OS) rate at 12 months for immune checkpoint inhibitor (ICI) trials but requires further assessment for validation. OBJECTIVE To validate 6-month PFS and objective response rate (ORR) as estimators of 12-month OS in the ICI arms of randomized clinical trials (RCTs). DATA SOURCES Electronic databases (Medline, EMBASE, and the Cochrane Central Register of Controlled Trials) were searched for ICI RCTs published between January 2000 and June 2019. STUDY SELECTION Eligible studies were phase 2 and phase 3 ICI RCTs in advanced solid cancers that reported ORR, PFS, and OS. A total of 99 articles (from 60 studies) of 2502 articles were selected by consensus. DATA EXTRACTION AND SYNTHESIS Data were screened and extracted independently. Estimation models for 12-month OS and to assess correlation coefficient between end points were developed using linear regression. Data were extracted in July 2019, and analyses were conducted in September 2019. This study is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. MAIN OUTCOMES AND MEASURES Validation of previously reported 6-month PFS and ORR estimation models for 12-month OS using contemporary RCTs. Calibration of 6-month PFS and ORR model-estimated vs observed 12-month OS in ICI arms were assessed by correlation coefficient (r) and weighted Brier scores. Secondary analyses were performed for subgroups (ie, ICI-only, ICI-combination, line of therapy, programmed cell death 1 ligand 1 selected, and unselected). RESULTS Data from 60 RCTs with 74 experimental ICI arms were used. The development data set included 25 arms from studies published January 2000 to January 2017. The estimation model for 12-month OS using 6-month PFS was: (1.06 × PFS6) + 0.16 + (0.04 × melanoma) - (0.03 × NSCLC) + (0 × other tumors), in which PFS6 indicates 6-month PFS and NSCLC indicates non-small cell lung cancer. The estimation model for 12-month OS using ORR was (0.15 × ORR) + 0.52 + (0 × melanoma) - (0.02 × NSCLC) - (0.01 × other tumors). A total of 49 arms from studies published after January 2017 to June 2019 formed the validation data set. When the models were applied on the validation data set, calibration between the 6-month PFS model estimated vs observed 12-month OS was good (r = 0.89; Brier score, 0.008), but poor for the ORR model (r = 0.47; Brier score, 0.03). Findings were similar across all subgroups. CONCLUSIONS AND RELEVANCE The findings of this study suggest that the estimation model using 6-month PFS could reliably estimate 12-month OS in ICI trials. This study could assist in better selection and prioritization of ICI agents for testing in RCTs based on phase 2 single-arm RCT results.
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Affiliation(s)
- Peey-Sei Kok
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, Australia
| | - Doah Cho
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Won-Hee Yoon
- Cancer Care Centre, St George Hospital, Sydney, Australia
| | - Georgia Ritchie
- Mid North Coast Cancer Institute, Port Macquarie Base Hospital, Port Macquarie, Australia
| | - Ian Marschner
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Sally Lord
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
| | | | - John Simes
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Chee Khoon Lee
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
- Cancer Care Centre, St George Hospital, Sydney, Australia
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Cornett KMD, Menezes MP, Bray P, Shy RR, Moroni I, Pagliano E, Pareyson D, Estilow T, Yum SW, Bhandari T, Muntoni F, Laura M, Reilly MM, Finkel RS, Eichinger KJ, Herrmann DN, Shy ME, Burns J. Refining clinical trial inclusion criteria to optimize the standardized response mean of the CMTPedS. Ann Clin Transl Neurol 2020; 7:1713-1715. [PMID: 32762141 PMCID: PMC7480902 DOI: 10.1002/acn3.51145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/13/2020] [Indexed: 11/07/2022] Open
Abstract
The CMT Pediatric Scale (CMTPedS) is a reliable, valid, and responsive clinical outcome measure of disability in children with CMT. The aim of this study was to identify the most responsive patient subset(s), based on the standardized response mean (SRM), to optimize the CMTPedS as a primary outcome measure for upcoming clinical trials. Analysis was based on a 2-year natural history data from 187 children aged 3-20 years with a range of CMT genetic subtypes. Subsets based on age (3-8 years), disability level (CMTPedS score 0-14), and CMT type (CMT1A) increased the SRM of the CMTPedS considerably. Refining the inclusion criteria in clinical trials to younger, mildly affected cases of CMT1A optimizes the responsiveness of the CMTPedS.
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Affiliation(s)
- Kayla M. D. Cornett
- School of Health SciencesUniversity of SydneyThe Children’s Hospital at WestmeadSydneyNew South WalesAustralia
| | - Manoj P. Menezes
- Paediatrics and Child HealthUniversity of SydneyThe Children’s Hospital at WestmeadSydneyNew South WalesAustralia
| | - Paula Bray
- School of Health SciencesUniversity of SydneyThe Children’s Hospital at WestmeadSydneyNew South WalesAustralia
| | - Rosemary R. Shy
- Department of PediatricsCarver College of MedicineUniversity of IowaIowa CityIowa
| | | | | | | | - Tim Estilow
- Department of Occupational TherapyThe Children’s Hospital of PhiladelphiaPhiladelphiaPennsylvania
| | - Sabrina W. Yum
- Division of NeurologyPerelman School of MedicineThe Children's Hospital of PhiladelphiaUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Trupti Bhandari
- UCL Institute of Child Health and National Institute for Health Research Great Ormond Street Hospital Biomedical Research CentreLondonUK
| | - Francesco Muntoni
- UCL Institute of Child Health and National Institute for Health Research Great Ormond Street Hospital Biomedical Research CentreLondonUK
- MRC Centre for Neuromuscular DiseasesUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Matilde Laura
- MRC Centre for Neuromuscular DiseasesUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Mary M. Reilly
- MRC Centre for Neuromuscular DiseasesUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Richard S. Finkel
- Translational Neurosciences (Pediatrics)St. Jude Children's Research HospitalMemphisTennessee
| | | | | | - Michael E. Shy
- Department of NeurologyCarver College of MedicineUniversity of IowaIowa CityIowa
| | - Joshua Burns
- School of Health SciencesUniversity of SydneyThe Children’s Hospital at WestmeadSydneyNew South WalesAustralia
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Bray P, Cornett KMD, Estilow T, Pareyson D, Zuccarino R, Skorupinska M, Pipis M, Sowden JE, Scherer S, Reilly MM, Shy ME, Herrmann DN, Burns J, Eichinger KJ. Reliability of the Charcot-Marie-Tooth functional outcome measure. J Peripher Nerv Syst 2020; 25:288-291. [PMID: 32844461 PMCID: PMC7520097 DOI: 10.1111/jns.12406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 01/28/2023]
Abstract
The CMT-FOM is a 13-item clinical outcome assessment (COA) that measures physical ability in adults with Charcot-Marie-Tooth disease (CMT). Test-retest reliability, internal consistency and convergent validity have been established for the CMT-FOM. This current study sought to establish inter-rater reliability. Following an in-person training of six international clinical evaluators we recruited 10 participants with genetically diagnosed CMT1A, (aged 18-74 years, 6 female). Participants were evaluated using the CMT-FOM over 2 days. Participants were given at least a 3 hour rest between evaluations, and were assessed twice each day. Following the provision of training by master trainers, all 13 items of the CMT-FOM exhibited excellent inter-rater reliability for raw scores (ICC1,1 0.825-0.989) and z-scores (ICC1,1 0.762-0.969). Reliability of the CMT-FOM total score was excellent (ICC1,1 0.983, 95% CI 0.958-0.995). The CMT-FOM is a reliable COA used by clinical evaluators internationally. The next steps are to establish further validation through psychometric evaluation of the CMT-FOM in the Accelerate Clinical Trials in CMT (ACT-CMT) study.
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Affiliation(s)
- Paula Bray
- University of Sydney School of Health Sciences & Children’s Hospital at Westmead, Sydney, Australia
| | - Kayla MD Cornett
- University of Sydney School of Health Sciences & Children’s Hospital at Westmead, Sydney, Australia
| | - Timothy Estilow
- Department of Occupational Therapy, The Children’s Hospital of Philadelphia Philadelphia PA USA
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Davide Pareyson
- Fondazione IRCCS, Istituto Neurologico Carlo Besta, Milan, Italy
| | - Riccardo Zuccarino
- Carver College of Medicine, Dept of Neurology, University of Iowa, Iowa City, IA, USA
- Neuromuscular Omnicentre (NEMO)-Fondazione Serena Onlus, Via del Giappone 3, Arenzano, Genoa, Italy
| | - Mariola Skorupinska
- MRC Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Menelaos Pipis
- MRC Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Janet E Sowden
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Steven Scherer
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary M Reilly
- MRC Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Michael E Shy
- Carver College of Medicine, Dept of Neurology, University of Iowa, Iowa City, IA, USA
| | - David N Herrmann
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Joshua Burns
- University of Sydney School of Health Sciences & Children’s Hospital at Westmead, Sydney, Australia
| | - Katy J Eichinger
- Department of Neurology, University of Rochester, Rochester, NY, USA
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