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OBJECTIVE: To identify impacts of patient and family engagement in child health research on the research process, research teams, and patient and family partners. STUDY DESIGN: A scoping review was conducted using the MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Web of Science databases. English-language studies were included if they described ≥1 impact of patient and family engagement on child health research (age <18 years), researchers, or patient and family partners. Data were retrieved by 2 independent extractors. RESULTS: Of the 7688 studies identified, 25 were included in our analysis. Impacts of patient and family engagement were mostly on the research process (n = 24 studies; 96%), 11 (44%) determined impacts on the research team, and 17 (68%) reported impacts on patient and family partners. Less than one-half (n = 11; 44%) had a primary purpose of determining the impact of patient engagement, and no study used a specific evaluation tool. CONCLUSIONS: Patient and family engagement can strengthen the relevance and feasibility of research and empower researchers and patient partners. Measuring and reporting the impact of engagement is rare. Systematic and standardized evaluation of engagement is needed to understand how, when, and why to engage patients and families.
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Saúde da Criança , Participação do Paciente , Criança , Humanos , Adolescente , IdiomaRESUMO
The efficacy of convalescent plasma for coronavirus disease 2019 (COVID-19) is unclear. Although most randomized controlled trials have shown negative results, uncontrolled studies have suggested that the antibody content could influence patient outcomes. We conducted an open-label, randomized controlled trial of convalescent plasma for adults with COVID-19 receiving oxygen within 12 d of respiratory symptom onset ( NCT04348656 ). Patients were allocated 2:1 to 500 ml of convalescent plasma or standard of care. The composite primary outcome was intubation or death by 30 d. Exploratory analyses of the effect of convalescent plasma antibodies on the primary outcome was assessed by logistic regression. The trial was terminated at 78% of planned enrollment after meeting stopping criteria for futility. In total, 940 patients were randomized, and 921 patients were included in the intention-to-treat analysis. Intubation or death occurred in 199/614 (32.4%) patients in the convalescent plasma arm and 86/307 (28.0%) patients in the standard of care arm-relative risk (RR) = 1.16 (95% confidence interval (CI) 0.94-1.43, P = 0.18). Patients in the convalescent plasma arm had more serious adverse events (33.4% versus 26.4%; RR = 1.27, 95% CI 1.02-1.57, P = 0.034). The antibody content significantly modulated the therapeutic effect of convalescent plasma. In multivariate analysis, each standardized log increase in neutralization or antibody-dependent cellular cytotoxicity independently reduced the potential harmful effect of plasma (odds ratio (OR) = 0.74, 95% CI 0.57-0.95 and OR = 0.66, 95% CI 0.50-0.87, respectively), whereas IgG against the full transmembrane spike protein increased it (OR = 1.53, 95% CI 1.14-2.05). Convalescent plasma did not reduce the risk of intubation or death at 30 d in hospitalized patients with COVID-19. Transfusion of convalescent plasma with unfavorable antibody profiles could be associated with worse clinical outcomes compared to standard care.
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COVID-19/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , COVID-19/epidemiologia , Canadá/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Imunização Passiva , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/imunologia , Resultado do Tratamento , Estados Unidos/epidemiologia , Soroterapia para COVID-19RESUMO
Breast cancer is the most common cancer in women worldwide. Most current guidelines recommend using multigene profiling assays to aid the decision on the addition of chemotherapy to adjuvant hormone therapy for women who present with early-stage, hormone receptor-positive, HER2-negative disease. One of these assays is the Oncotype DX, which predicts the disease recurrence risk and adjuvant chemotherapy benefits. Given its high cost, there is an economic incentive to evaluate its surrogates, such as the Magee equations. We assessed health system costs associated with the use of the Magee scores. A probabilistic decision tree was used to calculate the difference in mean health system costs based on data obtained from a randomized trial and the published literature. Costs were calculated from a perspective of Canada's publicly funded health care system. A series of sensitivity analysis was conducted to assess the robustness of the study findings. The Magee equations were associated with a total cost savings of C$100 per patient (95% CI, -C$3068 to C$5022) compared with standard of care. The difference in costs was highly sensitive to the extent that the Magee scores could reduce the frequency of adjuvant chemotherapy and Oncotype DX requests.
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Neoplasias da Mama , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/genética , Custos e Análise de Custo , Testes Diagnósticos de Rotina , Feminino , Humanos , RiscoRESUMO
OBJECTIVE: To determine the efficacy of high dose folic acid supplementation for prevention of pre-eclampsia in women with at least one risk factor: pre-existing hypertension, prepregnancy diabetes (type 1 or 2), twin pregnancy, pre-eclampsia in a previous pregnancy, or body mass index ≥35. DESIGN: Randomised, phase III, double blinded international, multicentre clinical trial. SETTING: 70 obstetrical centres in five countries (Argentina, Australia, Canada, Jamaica, and UK). PARTICIPANTS: 2464 pregnant women with at least one high risk factor for pre-eclampsia were randomised between 2011 and 2015 (1144 to the folic acid group and 1157 to the placebo group); 2301 were included in the intention to treat analyses. INTERVENTION: Eligible women were randomised to receive either daily high dose folic acid (four 1.0 mg oral tablets) or placebo from eight weeks of gestation to the end of week 16 of gestation until delivery. Clinicians, participants, adjudicators, and study staff were masked to study treatment allocation. MAIN OUTCOME MEASURE: The primary outcome was pre-eclampsia, defined as hypertension presenting after 20 weeks' gestation with major proteinuria or HELLP syndrome (haemolysis, elevated liver enzymes, low platelets). RESULTS: Pre-eclampsia occurred in 169/1144 (14.8%) women in the folic acid group and 156/1157 (13.5%) in the placebo group (relative risk 1.10, 95% confidence interval 0.90 to 1.34; P=0.37). There was no evidence of differences between the groups for any other adverse maternal or neonatal outcomes. CONCLUSION: Supplementation with 4.0 mg/day folic acid beyond the first trimester does not prevent pre-eclampsia in women at high risk for this condition. TRIAL REGISTRATION: Current Controlled Trials ISRCTN23781770 and ClinicalTrials.gov NCT01355159.
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Suplementos Nutricionais/efeitos adversos , Ácido Fólico/administração & dosagem , Hipertensão/prevenção & controle , Pré-Eclâmpsia/prevenção & controle , Adulto , Argentina/epidemiologia , Austrália/epidemiologia , Canadá/epidemiologia , Diabetes Gestacional/prevenção & controle , Método Duplo-Cego , Feminino , Ácido Fólico/provisão & distribuição , Síndrome HELLP/etiologia , Humanos , Jamaica/epidemiologia , Gravidez , Proteinúria/etiologia , Fatores de Risco , Reino Unido/epidemiologia , Complexo Vitamínico B/administração & dosagem , Complexo Vitamínico B/provisão & distribuição , Adulto JovemRESUMO
INTRODUCTION: Numerous factors may influence the survival/success of post-retained restorations of endodontically treated teeth (ETT). The aim of this review was to assess the influence of the number of remaining coronal walls, the use or disuse of posts, and their type on the clinical performance of these restorations. METHODS: Randomized controlled trials and controlled clinical trials for ETT restored with a combination of post/crown or no post/crown were searched for in MEDLINE, Embase, and the Cochrane Library. Two authors independently reviewed all identified titles and abstracts for eligibility. Tables were generated to summarize the included studies, and reports of randomized trials were assessed for bias using the Cochrane risk of bias tool. RESULTS: Nine articles were identified as meeting the inclusion criteria. Teeth without ferrule presented the highest values of variation of success/survival (0%-97%), whereas teeth with remaining coronal walls (1, 2, 3, or 4 walls with ferrule) presented lower variation. The use of posts with a high elastic modulus success/survival ranged between 71.8% and 100%, whereas posts with a low elastic modulus ranged between 28.5% and 100%. The survival of crowns without posts varied between 0% and 100%. The poor performance of posts with a low elastic modulus and without posts was associated with the absence of ferrule and the preservation of only 1 coronal wall. CONCLUSIONS: The restoration of ETT should focus on the maintenance of the coronal structure. Until more studies with longer follow-up periods are available, posts with a high elastic modulus appear to present with better performance when restoring ETT with no ferrule.
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Coroas , Técnica para Retentor Intrarradicular , Retenção em Prótese Dentária , Falha de Restauração Dentária , Humanos , Fatores de RiscoRESUMO
OBJECTIVES: To validate an algorithm to identify cases of intussusception using the health administrative data of Ontario, Canada, and to apply the algorithm to estimate provincial incidence of intussusception, preceding the introduction of the universal rotavirus vaccination program. STUDY DESIGN: We determined the accuracy of various combinations of diagnostic, procedural, and billing codes using the chart-abstracted diagnoses of patients of the Children's Hospital of Eastern Ontario as the reference standard. We selected an algorithm that maximized positive predictive value while maintaining a high sensitivity and used it to ascertain annual incidence of intussusception for fiscal years 1995-2010. We explored temporal trends in incidence using Poisson regression. RESULTS: The selected algorithm included only the International Classification of Diseases (ICD)-9 or ICD-10 code for intussusception in the hospitalization database and was sensitive (89.3%) and highly specific (>99.9%). The positive predictive value of the ICD code was 72.4%, and the negative predictive value was >99.9%. We observed the highest mean incidence (34 per 100000) in male children <1 year of age. Temporal trends in incidence varied by age group. There was a significant mean decrease in incidence of 4% per year in infants (<1 year) until 2004 and rates stabilized thereafter. CONCLUSIONS: We have demonstrated that intussusception can be accurately identified within health administrative data using validated algorithms. We have described changes in temporal trends in intussusception incidence in Ontario and established a baseline to allow ongoing monitoring as part of vaccine safety surveillance.