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Current Opinion in Pediatrics Dec 2019Randomized controlled trials leading to innovations that improve outcomes in acute life-threatening illnesses in children are scarce. A key issue is how we refocus... (Review)
Review
PURPOSE OF REVIEW
Randomized controlled trials leading to innovations that improve outcomes in acute life-threatening illnesses in children are scarce. A key issue is how we refocus research on outcomes that matter and are more relevant to those making emergency decisions, and those involved with managing and living with the late-outcome. We have used information from recent trials in critically ill children - in particular those illnesses without any primary neurologic involvement - to develop an approach to brain-related outcomes that will maximize child and family benefit from research.
RECENT FINDINGS
Fifteen recent pediatric critical care trials illustrate four types of brain-related outcomes assessment: death or organ-system-failures - as illustrated by studies in systemic illness; neurological and neuropsychological outcomes - as illustrated by the glycemic control studies; cognitive outcomes - as illustrated by a sedative trial; and composite outcomes - as illustrated by the therapeutic hypothermia studies.
SUMMARY
The 15 research trials point to five areas that will need to be addressed and incorporated into future trial design, including use of: neurologic monitoring during intensive care unit admission; postdischarge outcomes assessments; strategies to improve retention in long-term follow-up; child and family-centered outcomes; and core outcomes datasets.
Topics: Brain; Critical Illness; Humans; Intensive Care Units; Outcome Assessment, Health Care; Patient Selection; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 31693587
DOI: 10.1097/MOP.0000000000000826 -
British Journal of Anaesthesia Jan 2019
Topics: Anesthesia; Anesthesiology; Hip Fractures; Humans; Outcome Assessment, Health Care
PubMed: 30579392
DOI: 10.1016/j.bja.2018.11.009 -
Value in Health : the Journal of the... May 2023
Topics: Humans; Economics, Medical; Outcome Assessment, Health Care; Economics
PubMed: 36914093
DOI: 10.1016/j.jval.2023.03.002 -
Anesthesiology Mar 2015
Topics: Humans; Outcome Assessment, Health Care; Patient-Centered Care; Perioperative Care; Survival Rate
PubMed: 25689756
DOI: 10.1097/ALN.0000000000000587 -
Journal of the American Board of Family... 2017This issue is about improving primary health care outcomes, from behavioral health to opioid issues to diagnosing hypertension to providing hope for childhood obesity....
This issue is about improving primary health care outcomes, from behavioral health to opioid issues to diagnosing hypertension to providing hope for childhood obesity. It includes hints for integrating behavioral health and care managers into family medicine practices. Opiate prescribing practices vary considerably between Japan and the United States, with helpful insights for our opiate abuse epidemic. Suicidality is high among patients taking opiates. Diagnosing hypertension the recommended way is not easily accomplished. Primary care clinicians are important in infertility and prostate cancer treatment, and in support of men who commit interpersonal violence and people with cognitive impairment who wander. The "July effect" seems to persist. Parents' views on obesity in children can be changed-for the better. Family physicians have less burnout than has been previously reported, and many provide palliative care. Doctors think diseases, patients think about how well they feel. Do we find healthy lifestyles in retirement?
Topics: Family Practice; Humans; Outcome Assessment, Health Care; Primary Health Care; Quality Improvement; United States
PubMed: 28379816
DOI: 10.3122/jabfm.2017.02.170028 -
Female Pelvic Medicine & Reconstructive... 2018The 2016 American Urogynecologic Society Prolapse Consensus Conference brought together thought leaders in the field of pelvic organ prolapse (POP). The goal was to...
OBJECTIVES
The 2016 American Urogynecologic Society Prolapse Consensus Conference brought together thought leaders in the field of pelvic organ prolapse (POP). The goal was to identify critical areas of need for future research. This article summarizes the findings.
METHODS
Prior to the conference, 5 major focus areas were identified. Focus areas were explored over the 2-day conference. Clinicians, clinical and basic science researchers, and representatives from government agencies, industry, patient advocacy groups, and the public convened to identify the major gaps in knowledge in each of these focus areas.
RESULTS
The 5 major topics were as follows: (1) mechanistic research on pelvic supportive structures and how these are altered with pregnancy, delivery, and aging; (2) novel prostheses or implants that address pathophysiology and provide mechanical support; (3) large-scale community-based research; (4) clinical trials to optimize outcomes after POP surgery; and (5) evidence-based quality measures for POP outcomes. Key recommendations were made for each topic.
CONCLUSIONS
Critical gaps in our knowledge were identified. These limit scientific discovery across all 5 topic areas. Further scientific progress would be advanced by (1) developing a standardized group of POP outcomes and quality measures for large trials and community-based research, (2) creating specimen biorepositories that are integrated with robust clinical data, and (3) developing collaborative teams with expertise from a variety of disciplines, convened to tackle our most challenging and complex scientific questions.
Topics: Biomedical Research; Evidence-Based Medicine; Female; Humans; Outcome Assessment, Health Care; Pelvic Organ Prolapse; Societies, Medical; United States
PubMed: 29309287
DOI: 10.1097/SPV.0000000000000533 -
American Journal of Surgery Jul 2022
Topics: Biomedical Research; Humans; Outcome Assessment, Health Care; Surgeons
PubMed: 35317922
DOI: 10.1016/j.amjsurg.2022.03.013 -
Current Opinion in Rheumatology Mar 2017Incorporation of the patients' perspective in clinical research is critical to ensure that outcomes measured reflect those, which matter most to patients. This review... (Review)
Review
PURPOSE OF REVIEW
Incorporation of the patients' perspective in clinical research is critical to ensure that outcomes measured reflect those, which matter most to patients. This review summarizes recent efforts to include the patients' perspective in the development of outcome measures and the importance of encouraging patient participation in decision-making and self-management.
RECENT FINDINGS
Since the inclusion of fatigue as a patient-endorsed core outcome measure in rheumatoid arthritis (RA) trials, OMERACT has been instrumental in advocating for patient involvement in the development of core domains and instruments; current endeavors include cultivating an understanding of remission through the eyes of patients and gaining a sense of how to measure features of pain and 'stiffness' deemed as important to patients. The concept of remission was further explored in RA patients, highlighting a common goal of returning to normality; additionally, various tools have been developed to assess for unmet needs in rheumatology patients. Advances have also been made in the development and revision of patient-centered core measures in rheumatologic diagnoses outside of RA.
SUMMARY
Incorporating the patients' perspective is now considered an essential feature in outcomes research. Future research should focus on how best to involve patients in specific research activities.
Topics: Arthritis, Rheumatoid; Decision Making; Fatigue; Humans; Outcome Assessment, Health Care; Pain; Patient Participation; Patient Reported Outcome Measures; Rheumatic Diseases; Rheumatology; Self Care
PubMed: 28072590
DOI: 10.1097/BOR.0000000000000372 -
Early Intervention in Psychiatry Dec 2017The aim of this study was to analyse the effect of age at onset on the long-term clinical, social and global outcomes of schizophrenia through a systematic review and a... (Meta-Analysis)
Meta-Analysis Review
The aim of this study was to analyse the effect of age at onset on the long-term clinical, social and global outcomes of schizophrenia through a systematic review and a meta-analysis. Original studies were searched from Web of Science, PsycINFO, Pubmed and Scopus, as well as manually. Naturalistic studies with at least a 2-year follow-up were included. Of the 3509 search results, 81 articles fulfilled the inclusion criteria. The meta-analysis was performed in Stata as a random-effect analysis with correlation coefficients between age at onset and the outcomes (categorized into remission, relapse, hospitalization, positive symptoms, negative symptoms, total symptoms, general clinical outcome, employment, social/occupational functioning and global outcome). There was a statistically significant (P < .05) correlation between younger age at onset and more hospitalizations (number of studies, n = 9; correlation, r = 0.17; 95% confidence interval, CI 0.09-0.25), more negative symptoms (n = 7; r = 0.14; 95% CI 0.01-0.27), more relapses (n = 3; r = 0.11; 95% CI 0.02-0.20), poorer social/occupational functioning (n = 12; r = 0.15; 95% CI 0.05-0.25) and poorer global outcome (n = 13; r = 0.14; 95% CI 0.07-0.22). Other relationships were not significant. This was the first systematic review of the effects of age at onset on the long-term outcomes of schizophrenia. The results show that age at onset has a small, but significant impact on some of the outcomes of schizophrenia.
Topics: Age of Onset; Humans; Outcome Assessment, Health Care; Schizophrenia
PubMed: 28449199
DOI: 10.1111/eip.12412 -
Value in Health : the Journal of the... Nov 2020
Topics: Betacoronavirus; COVID-19; Coronavirus; Coronavirus Infections; Cost-Benefit Analysis; Humans; Outcome Assessment, Health Care; Pandemics; Pneumonia, Viral; SARS-CoV-2; United Kingdom
PubMed: 33127008
DOI: 10.1016/j.jval.2020.09.009