Methodological review

方法审查
  • 文章类型: Journal Article
    描述和分析已验证ICF-CS的横断面研究的方法学特征和质量。
    进行了系统审查,以确定以英文发表的实证研究,这些研究使用横截面设计验证了任何ICF-CS。搜索的数据库包括WebofScience,Scopus,CINAHL,PubMed,Embase,和PsycINFO。搜索于2022年11月进行,并于2023年10月进行了更新。两名独立审稿人对符合纳入标准的研究进行编码,并使用AXIS工具评估其方法学质量和偏倚风险。通过计算频率和百分比进行合成。
    分析了87篇验证24个ICF-CSs的文章。大多数文章显示了研究目标和测量的结果变量之间的一致性优势。然而,绝大多数人没有报告样本量计算(在德尔菲研究中高达94.2%),在世卫组织非洲和东地中海区域进行的验证研究很少。
    验证ICF-CSs的横断面研究质量令人满意,尽管有几篇文章没有描述样本量计算等方面。ICF-CS研究的有效性证据可以通过进行更多的多中心研究来改善,在WHO不同地区复制ICF-CS验证研究,并通过对现有研究的综合。
    ICF-CSs的横断面验证研究具有令人满意的质量,支持在类似于此处评估的临床康复环境中使用CSs。对于尚未验证或有效性证据有限的ICF-CSs,需要进行其他验证研究。本综述的方法学结果构成了一个路线图,可以指导未来ICF-CS验证研究的发展和质量。了解通过横截面设计验证了哪些ICF-CS对于计划和设计干预措施以及仪器开发很有用。
    UNASSIGNED: To describe and analyze the methodological characteristics and quality of cross-sectional studies that have validated an ICF-CS.
    UNASSIGNED: A systematic review was conducted to identify empirical studies published in English that validated any ICF-CS using a cross-sectional design. Databases searched included Web of Science, Scopus, CINAHL, PubMed, Embase, and PsycINFO. The search was conducted in November 2022 with an update in October 2023. Two independent reviewers coded studies that met the inclusion criteria and assessed their methodological quality and risk of bias using the AXIS tool. Synthesis was performed by calculating frequencies and percentages.
    UNASSIGNED: 87 articles validating 24 ICF-CSs were analyzed. Most articles showed strengths in consistency between study objectives and the outcome variables measured. However, a large majority did not report sample size calculation (up to 94.2% in Delphi studies), and few validation studies were conducted in the WHO regions of Africa and the Eastern Mediterranean.
    UNASSIGNED: The quality of cross-sectional studies validating ICF-CSs was satisfactory, although several articles did not describe aspects such as sample size calculation. Validity evidence for ICF-CS studies could be improved by conducting more multicenter studies, replicating ICF-CS validation studies in different WHO regions, and through synthesis of existing research.
    Cross-sectional validation studies of ICF-CSs have satisfactory quality, supporting the use of the CSs in clinical rehabilitation settings similar to those evaluated here.Additional validation studies are required for ICF-CSs that have not yet been validated or for which validity evidence is limited.The methodological findings of this review constitute a roadmap that could guide the development and improve the quality of future ICF-CS validation studies.Knowing which ICF-CSs are validated through cross-sectional designs is useful for planning and designing interventions and instrument development.
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  • 文章类型: Journal Article
    目标:为了追求健康公平,世界卫生组织最近呼吁对眼睛健康的不平等进行更广泛的监测。基于人群的眼睛健康调查可以提供这些信息,但是在设计中是否考虑到服务不足的群体,实施,和调查报告是未知的。我们对自2000年以来发表的调查进行了系统的方法审查,以检查有多少基于人群的眼睛健康调查在其设计中考虑了服务不足的群体。reporting,或实施。
    方法:我们确定了所有基于人群的横断面调查,这些调查报告了客观测量的视力障碍或失明的患病率。使用PROGRESS+框架来识别服务不足的群体,我们评估了每项研究是否在整个理论基础上考虑了15个项目中服务不足的群体,抽样或招聘方法,或参与和患病率的报告。
    结果:本综述纳入了388项眼部健康调查。很少有研究在研究计划或实施期间前瞻性地考虑服务不足的群体,例如,在他们的样本量计算(n=5,≈1%)或招聘策略(n=70,18%)中。研究考虑服务不足群体的最常见方式是报告患病率估计值(n=374,96%)。在研究期间,我们观察到出版物所考虑的不同PROGRESS+因素的数量略有增加。95%(n=267)的研究认为性别/性别在至少一个项目中。43%(n=166)的纳入研究主要针对服务不足的人群,特别是对于居住在农村地区的人们的地方研究,我们确定了在社会排斥群体中进行稳健的基于人群的研究的例子.
    结论:需要更多的努力来改进设计,实施,和报告调查,以监测不平等和促进眼睛健康的公平。理想情况下,国家一级对视力损害和服务覆盖面的监测将辅之以小规模研究,以了解服务最不足群体所经历的差距。
    OBJECTIVE: In pursuit of health equity, the World Health Organization has recently called for more extensive monitoring of inequalities in eye health. Population-based eye health surveys can provide this information, but whether underserved groups are considered in the design, implementation, and reporting of surveys is unknown. We conducted a systematic methodological review of surveys published since 2000 to examine how many population-based eye health surveys have considered underserved groups in their design, implementation, or reporting.
    METHODS: We identified all population-based cross-sectional surveys reporting the prevalence of objectively measured vision impairment or blindness. Using the PROGRESS + framework to identify underserved groups, we assessed whether each study considered underserved groups within 15 items across the rationale, sampling or recruitment methods, or the reporting of participation and prevalence rates.
    RESULTS: 388 eye health surveys were included in this review. Few studies prospectively considered underserved groups during study planning or implementation, for example within their sample size calculations (n = 5, ∼1%) or recruitment strategies (n = 70, 18%). The most common way that studies considered underserved groups was in the reporting of prevalence estimates (n = 374, 96%). We observed a modest increase in the number of distinct PROGRESS + factors considered by a publication over the study period. Gender/sex was considered within at least one item by 95% (n = 367) of studies. Forty-three percent (n = 166) of included studies were conducted primarily on underserved population groups, particularly for subnational studies of people living in rural areas, and we identified examples of robust population-based studies in socially excluded groups.
    CONCLUSIONS: More effort is needed to improve the design, implementation, and reporting of surveys to monitor inequality and promote equity in eye health. Ideally, national-level monitoring of vision impairment and service coverage would be supplemented with smaller-scale studies to understand the disparities experienced by the most underserved groups.
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  • 文章类型: Journal Article
    习惯代表随着时间的推移重复的行为模式,对个体健康产生重大影响。虽然存在衡量个人习惯的特定工具,能够同时探索多个健康维度的仪器数量有限。这项研究有两个主要目标:1)检查文献,以找到评估健康习惯的现有工具,特别是在西班牙人口中;2)通过方法学审查,开发和验证能够测量多个维度的健康习惯的工具。营养和社会健康习惯量表(NutSo-HH)的构思,tested,并通过认知访谈和专家内容验证的试点测试进行完善。通过验证性因子分析和已知群体效度来探索结构效度,而与“西班牙人口健康营养指数”相比,验证了标准的有效性。使用欧米茄系数评估可靠性。验证性因子分析产生了令人满意的拟合指数。最终的模型包括两个二级因素(营养习惯和健康习惯)和两个一级因素(地中海饮食和饮酒)。Omega系数范围为0.521至0.815。NutSo-HH量表是评估西班牙年轻人营养和社会习惯的有效且可靠的工具。这种新颖的仪器填补了该领域的空白,允许通过单一尺度探索各种健康决定因素,并为公共卫生营养领域的决策提供支持。
    Habits represent repeated patterns of behavior over time that exert a significant influence on individual health. While specific tools exist to measure individual habits, the number of instruments capable of simultaneously exploring multiple dimensions of health is limited. This research had two main objectives: 1) to examine the literature to find existing tools for evaluating health habits, especially in the Spanish population; 2) through a methodological review, to develop and validate a tool capable of measuring multiple dimensions of health habits. The Nutritional and Social Health Habits Scale (NutSo-HH) was conceived, tested, and refined through pilot testing with cognitive interviews and expert content validation. Construct validity was explored through confirmatory factor analysis and known-group validity, while criterion validity was verified in comparison with the ``Healthy Nutrition Index for the Spanish Population.\'\' Reliability was assessed using omega coefficients. Confirmatory factor analysis yielded satisfactory fit indices. The final model included two second-order factors (nutritional habits and health habits) and two first-order factors (Mediterranean diet and alcohol consumption). Omega coefficients ranged from 0.521 to 0.815. The NutSo-HH Scale emerges as a valid and reliable tool to assess nutritional and social habits among Spanish young adults. This novel instrument fills a gap in the field, allowing exploration of various health determinants through a single scale and providing support for decision-making in the realm of public health nutrition.
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  • 文章类型: Journal Article
    目的:考虑到试点和可行性(PAF)试验在应对外科试验挑战方面的关键作用,足够的报告完整性至关重要。我们的目的是评估报告的完整性,并评估PAF试验的CONSORT扩展项目是否已在外科PAF试验中报告。
    方法:这是一项根据PRISMA指南报告的荟萃研究。如果是评估手术干预的试点或可行性随机试验,则纳入研究。主要结果是总体遵守CONSORT声明扩展到随机PAF试验清单。进行泊松回归以探索研究因素与报告完整性之间的关联。
    方法:Medline,Embase,和CENTRAL的搜索时间为2011年1月1日至12月31日和2021年。
    结果:在筛选1,991条引文后,包括2011年的38项研究和2021年的34项研究。所有纳入研究的CONSORT报告得分均值为21.5(SD6.3)。排除不适用于所有研究的项目后,报告34个项目(0.59)中的平均20.1个(标准差6.1)。2021年发表的研究(与2011年)没有报告更多的CONSORT项目(发生率比[IRR]1.01,95%置信区间[CI]0.89-1.15)。在临床试验注册中注册的研究(IRR1.29,95CI1.12-1.48)和随机分组超过50名患者(IRR1.16,95CI1.04-1.30)与报告的更多CONSORT项目相关。
    结论:外科PAF试验的报告完整性较差,在CONSORT扩展发表后没有改善。
    OBJECTIVE: Given the key role that pilot and feasibility (PAF) trials play in addressing the challenges of surgical trials, adequate reporting completeness is essential. Our aim was to assess completeness of reporting and evaluate if the items of the Consolidated Standards of Reporting Trials (CONSORT) extension for PAF trials have been reported in surgical PAF trials.
    METHODS: This is a metaresearch study reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they were pilot or feasibility randomized trials evaluating a surgical intervention. The primary outcome was overall adherence to the CONSORT statement extension to randomized PAF trials checklist. A Poisson regression was performed to explore the association between research factors and reporting completeness.
    METHODS: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched from January 1-December 31, 2011 and 2021.
    RESULTS: After screening 1991 citations, 38 studies from 2011 to 34 studies from 2021 were included. The mean CONSORT reporting score across all included studies was 21.5 (standard deviation 6.3). After excluding items that were not applicable to all studies, a mean of 20.1 (standard deviation 6.1) of 34 items (0.59) were reported. Studies published in 2021 (vs 2011) did not have a greater number of CONSORT items reported (incidence rate ratio [IRR] 1.01, 95% confidence interval [CI] 0.89-1.15). Studies registered in a clinical trial registry (IRR 1.29, 95% CI 1.12-1.48) and randomizing more than 50 patients (IRR 1.16, 95% CI 1.04-1.30) were associated with more CONSORT items reported.
    CONCLUSIONS: The reporting completeness of surgical PAF trials is poor and has not improved after the publication of the CONSORT extension.
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  • 文章类型: Journal Article
    背景:新兴的COVID-19疫苗随机对照试验(RCT)已成为公共卫生决策的证据基础。虽然建议RCT通过健康公平分层器报告结果,以减少医疗保健方面的偏见和研究差距,尚不清楚这是否在COVID-19疫苗试验中进行。
    目的:严格审查健康公平性分层器在COVID-19疫苗试验中的使用。
    方法:我们对COVID-NMA系统评价数据库中已发布的COVID-19疫苗试验进行了方法学评价,直至2023年2月8日。基于PROGRESS-Plus框架,我们检查了以下健康公平分层:居住地,种族/民族,职业,性别/性别,宗教,教育,社会经济地位,社会资本,年龄,残疾,关系的特征,临时情况。我们根据全面健康公平性报告的三个标准对每项研究进行了一式两份的评估:1)描述参与者,2)报告与股权相关的结果,3)讨论试验结果的公平相关含义。
    结果:我们回顾了144份试验手稿。描述参与者最常用的PROGRESS-Plus分层器是年龄(100%),居住地(100%)性别/性别(99%),和种族/族裔(64%)。年龄最常用于分解或调整结果(67%),其次是性别(35%)。对公平相关含义的讨论通常表明有关年龄的结果的可概括性有限(40%的研究)。一半(47%)的研究认为所有三个标准至少有一个健康公平性分层。没有试验包括与宗教有关的分层,社会经济地位,性取向,或关系的特征。
    结论:COVID-19疫苗试验提供了对PROGRESS-Plus定义的健康公平性分层器的有限描述,以及不经常分解的结果,或讨论了与健康公平性相关的研究含义。考虑到大流行期间加剧的健康差距,在RCT中增加对PROGRESS-Plus的使用将支持对健康差异的更细致入微的理解,并更好地为改善健康公平的行动提供信息。
    OBJECTIVE: An emerging body of randomized controlled trials (RCTs) on COVID-19 vaccines has served as the evidence base for public health decision-making. While it is recommended that RCTs report results by health equity stratifiers to reduce bias in health care and gaps in research, it is unknown whether this was done in COVID-19 vaccine trials. To critically examine the use of health equity stratifiers in COVID-19 vaccine trials.
    METHODS: We conducted a methodological review of published COVID-19 vaccine trials available in the COVID-19 living Network Meta-Analysis systematic review database through February 8, 2023. Based on the PROGRESS-Plus framework, we examined the following health equity stratifiers: place of residence, race/ethnicity, occupation, gender/sex, religion, education, socio-economic status, social capital, age, disability, features of relationships, and temporary situations. We assessed each study in duplicate according to three criteria for comprehensive health-equity reporting: 1) describing participants, 2) reporting equity-relevant results, and 3) discussing equity-relevant implications of trial findings.
    RESULTS: We reviewed 144 trial manuscripts. The most frequently used PROGRESS-Plus stratifiers to describe participants were age (100%), place of residence (100%), gender/sex (99%), and race/ethnicity (64%). Age was most often used to disaggregate or adjust results (67%), followed by gender or sex (35%). Discussions of equity-relevant implications often indicated limited generalizability of results concerning age (40% of studies). Half (47%) of the studies considered at least one health equity stratifier for all three criteria. No trials included stratifiers related to religion, socioeconomic status, sexual orientation, or features of relationships.
    CONCLUSIONS: COVID-19 vaccine trials provided a limited description of health equity stratifiers as defined by PROGRESS-Plus and infrequently disaggregated results or discussed the study implications as they related to health equity. Considering the health disparities exacerbated during the pandemic, increased uptake of PROGRESS-Plus in RCTs would support a more nuanced understanding of health disparities and better inform actions to improve health equity.
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  • 文章类型: Journal Article
    此方法综述包括有关音乐实践的作用和影响的文献(1987-2022年),包括音乐疗法和参与式音乐干预措施,对监狱等监狱环境中的幸福感,监狱,移民拘留中心。我们提供了55项研究中使用的关键方法学程序的全面描述:(1)研究问题的关键要素;(2)音乐实践类型;(3)音乐流派;(4)方法和设计;(5)位置;(6)理论框架;和(7)样本。我们的审查表明,由于对研究人员的限制,在监狱中进行研究存在困难,缺乏随机对照试验,由于方法论方法的异质性,结果的概括性有限。我们建议,文献基础将受益于对抽样程序相关问题的更多关注,与种族和性别认同有关的研究问题,以及音乐干预所使用的音乐实践类型之间的划分。
    This methodological review includes literature (1987-2022) concerning the role and influence of musical practices-including music therapy and participatory music interventions-on well-being in carceral settings such as jails, prisons, and immigration detention centers. We provide a thorough description of key methodological procedures used in 55 studies: (1) Key Elements of Research Questions; (2) Types of Musical Practices; (3) Musical Genres; (4) Methodologies and Designs; (5) Locations; (6) Theoretical Frameworks; and (7) Samples. Our review indicates that there is difficulty in conducting research in prisons due to limitations imposed on researchers, a paucity of randomized-control trials, and limited generalizability of results due to the heterogeneity of methodological approaches. We suggest that the literature base would benefit from increased attention to issues related to sampling procedures, research questions related to race and gender identity, as well as the delineation between the types of musical practices utilized by music interventions.
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  • 文章类型: Systematic Review
    背景:量化护理的空间访问-可及性和可用性的相互作用-对于医疗保健计划和理解服务(mal-)分布的含义至关重要。大量方法旨在测量潜在的空间访问医疗保健服务。本研究进行了系统的回顾,以识别和评估用于空间医疗保健访问测量的重力模型类型方法,并总结了这些措施在实证研究中的使用。
    方法:使用两步方法来确定(1)方法学研究,该研究提出了一种用于测量医疗保健空间访问的新型重力模型,以及(2)在医疗保健环境中应用这些方法之一的实证研究。审查是根据PRISMA指南进行的。EMBASE,CINAHL,WebofScience,和Scopus在第一步就被搜查了.第二步使用正向引文搜索。
    结果:我们在309项研究中确定了43项研究,这些研究提出了方法学发展和346项经验应用案例。出现了两个主要的概念发展:两步浮动集水区(2SFCA)方法和核密度(KD)方法。几乎所有其他方法的发展都是从2SFCA方法演变而来的,形成2SFCA方法族。2SFCA系列中的新方法引入了有关集水区内距离衰减的发展。可变集水区大小,结果单位,供应商竞争,局部和全局距离衰减,特定于子组的访问,多种运输方式,和时间相关的访问。旨在近似现实的方法发展,适合特定的上下文,或正确的方法。实证研究几乎只应用2SFCA家族的方法,而其他重力模型类型很少应用。在应用研究中经常实施集水区内的距离衰减,然而,最初的2SFCA方法在实证研究中仍然很常见。大多数实证研究将空间访问度量用于描述性目的。越来越多,重力模型测量值也可作为健康结果的潜在解释因子.
    结论:用于测量潜在的空间医疗保健获取的重力模型几乎完全由2SFCA方法家族主导-无论是方法学发展还是在实证研究中的应用。虽然方法论的发展包括越来越复杂的方法论,研究实践主要应用具有直截了当的直觉和适度的数据和计算要求的重力模型。
    BACKGROUND: Quantifying spatial access to care-the interplay of accessibility and availability-is vital for healthcare planning and understanding implications of services (mal-)distribution. A plethora of methods aims to measure potential spatial access to healthcare services. The current study conducts a systematic review to identify and assess gravity model-type methods for spatial healthcare access measurement and to summarize the use of these measures in empirical research.
    METHODS: A two-step approach was used to identify (1) methodological studies that presented a novel gravity model for measuring spatial access to healthcare and (2) empirical studies that applied one of these methods in a healthcare context. The review was conducted according to the PRISMA guidelines. EMBASE, CINAHL, Web of Science, and Scopus were searched in the first step. Forward citation search was used in the second step.
    RESULTS: We identified 43 studies presenting a methodological development and 346 empirical application cases of those methods in 309 studies. Two major conceptual developments emerged: The Two-Step Floating Catchment Area (2SFCA) method and the Kernel Density (KD) method. Virtually all other methodological developments evolved from the 2SFCA method, forming the 2SFCA method family. Novel methodologies within the 2SFCA family introduced developments regarding distance decay within the catchment area, variable catchment area sizes, outcome unit, provider competition, local and global distance decay, subgroup-specific access, multiple transportation modes, and time-dependent access. Methodological developments aimed to either approximate reality, fit a specific context, or correct methodology. Empirical studies almost exclusively applied methods from the 2SFCA family while other gravity model types were applied rarely. Distance decay within catchment areas was frequently implemented in application studies, however, the initial 2SFCA method remains common in empirical research. Most empirical studies used the spatial access measure for descriptive purposes. Increasingly, gravity model measures also served as potential explanatory factor for health outcomes.
    CONCLUSIONS: Gravity models for measuring potential spatial healthcare access are almost exclusively dominated by the family of 2SFCA methods-both for methodological developments and applications in empirical research. While methodological developments incorporate increasing methodological complexity, research practice largely applies gravity models with straightforward intuition and moderate data and computational requirements.
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  • 文章类型: Journal Article
    目的:阶梯式楔形整群随机试验(SW-CRT),在这种情况下,集群被随机分配到将过渡到干预条件的时间-而不是试验组-是一种相对较新的设计.与传统的平行臂试验相比,SW-CRT具有额外的设计和分析考虑。为今后的方法学发展提供信息,包括对试验者的指导和统计模拟研究参数的选择,我们对最近发表的SW-CRT进行了回顾.具体目标是描述(1)在实践中使用的设计类型,(2)坚持统计分析的关键要求,和(3)围绕协变量调整的实践。我们还检查了依从性随时间和期刊影响因子的变化。
    方法:我们使用电子搜索来识别2016-2022年发布的SW-CRT的主要报告。两名审稿人从每份试验报告及其方案中提取信息,如果可用,并通过讨论解决分歧。
    结果:我们确定了160项符合条件的试验,将11(8-18)簇的中位数(Q1-Q3)随机化为5(4-7)序列。大多数(122,76%)是横断面的(几乎都是持续招聘的),23(14%)是封闭队列,15(9%)是开放队列。许多试验具有复杂的设计特征,例如多个或多变量主要结果(50,31%)或时间依赖性重复测量(27,22%)。最常见的主要结局类型是二元结局(51%);连续结局较不常见(26%)。最常用的分析方法是广义线性混合模型(112,70%);广义估计方程的使用频率较低(12,8%)。在142项少于40组的试验中,只有9例(6%)报告使用适用于少数集群的方法。统计分析明确调整了119例(74%)的时间效应,对于132(83%)的集群内相关性,以及13个(8%)中不同的时期间相关性。共变量包括在82(51%)的主要结果的主要分析中,最常见的是个体水平的共变量;然而,明确和完整的协变量的预规范并不常见.遵守一些关键的方法论要求(针对时间效应进行调整,在较高和较低影响因子期刊上发表的试验中,对期间内相关性的考虑)较高。没有观察到随着时间的推移的实质性改善,尽管观察到占不同时期间相关性的比例略有改善。
    结论:未来的方法开发应优先考虑具有二元或时间到事件结果的SW-CRT方法,少量的集群,持续的招聘设计,多变量结果,或时间相关的重复措施。审判人员,期刊编辑,和同行评审员应该意识到,SW-CRT对平行臂设计有额外的方法学要求,包括需要考虑周期效应以及复杂的内部相关性。
    The stepped-wedge cluster randomized trial (SW-CRT), in which clusters are randomized to a time at which they will transition to the intervention condition - rather than a trial arm - is a relatively new design. SW-CRTs have additional design and analytical considerations compared to conventional parallel arm trials. To inform future methodological development, including guidance for trialists and the selection of parameters for statistical simulation studies, we conducted a review of recently published SW-CRTs. Specific objectives were to describe (1) the types of designs used in practice, (2) adherence to key requirements for statistical analysis, and (3) practices around covariate adjustment. We also examined changes in adherence over time and by journal impact factor.
    We used electronic searches to identify primary reports of SW-CRTs published 2016-2022. Two reviewers extracted information from each trial report and its protocol, if available, and resolved disagreements through discussion.
    We identified 160 eligible trials, randomizing a median (Q1-Q3) of 11 (8-18) clusters to 5 (4-7) sequences. The majority (122, 76%) were cross-sectional (almost all with continuous recruitment), 23 (14%) were closed cohorts and 15 (9%) open cohorts. Many trials had complex design features such as multiple or multivariate primary outcomes (50, 31%) or time-dependent repeated measures (27, 22%). The most common type of primary outcome was binary (51%); continuous outcomes were less common (26%). The most frequently used method of analysis was a generalized linear mixed model (112, 70%); generalized estimating equations were used less frequently (12, 8%). Among 142 trials with fewer than 40 clusters, only 9 (6%) reported using methods appropriate for a small number of clusters. Statistical analyses clearly adjusted for time effects in 119 (74%), for within-cluster correlations in 132 (83%), and for distinct between-period correlations in 13 (8%). Covariates were included in the primary analysis of the primary outcome in 82 (51%) and were most often individual-level covariates; however, clear and complete pre-specification of covariates was uncommon. Adherence to some key methodological requirements (adjusting for time effects, accounting for within-period correlation) was higher among trials published in higher versus lower impact factor journals. Substantial improvements over time were not observed although a slight improvement was observed in the proportion accounting for a distinct between-period correlation.
    Future methods development should prioritize methods for SW-CRTs with binary or time-to-event outcomes, small numbers of clusters, continuous recruitment designs, multivariate outcomes, or time-dependent repeated measures. Trialists, journal editors, and peer reviewers should be aware that SW-CRTs have additional methodological requirements over parallel arm designs including the need to account for period effects as well as complex intracluster correlations.
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  • 文章类型: Journal Article
    癌症是主要的公共卫生问题,与心理社会困扰和自杀风险增加有关。这种风险增加的原因仍在表征中。这项研究的目的是强调美国现有的癌症相关自杀的观察性研究,并确定未来研究的差距。这项工作有助于为自杀预防干预措施的临床和政策决策以及正在进行的癌症患者自杀风险检测和量化研究提供信息。我们确定了73项同行评审的研究(2010-2022年),这些研究使用PubMed和Embase搜索检查了癌症和自杀的交集。总的来说,回顾的研究表明,与普通人群相比,癌症患者的自杀风险更高。总的来说,怀特的风险更高,男性,和老年癌症患者,以及生活在农村地区和社会经济地位较低的患者。未来的研究应进一步调查接受癌症诊断对患者心理健康的心理社会方面,以及新疗法的影响及其对癌症患者自杀风险和差异的可用性,以更好地制定政策。
    Cancer is a major public health concern associated with an increased risk of psychosocial distress and suicide. The reasons for this increased risk are still being characterized. The purpose of this study is to highlight existing observational studies on cancer-related suicides in the United States and identify gaps for future research. This work helps inform clinical and policy decision-making on suicide prevention interventions and ongoing research on the detection and quantification of suicide risk among cancer patients. We identified 73 peer-reviewed studies (2010-2022) that examined the intersection of cancer and suicide using searches of PubMed and Embase. Overall, the reviewed studies showed that cancer patients have an elevated risk of suicide when compared to the general population. In general, the risk was higher among White, male, and older cancer patients, as well as among patients living in rural areas and with lower socioeconomic status. Future studies should further investigate the psychosocial aspects of receiving a diagnosis of cancer on patients\' mental health as well as the impact of new treatments and their availability on suicide risk and disparities among cancer patients to better inform policies.
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  • 文章类型: Journal Article
    传统上,在剂量发现临床试验中,治疗毒性和耐受性由临床医生评估。研究表明,临床医生报告的评分者间可靠性可能不足,与患者报告的结果相关性较差,并在捕获真正的毒性负担下。引入患者报告的结果(PRO),患者可以评估自己的症状不良事件或生活质量,有可能补充目前的做法,以帮助剂量优化。没有国际建议为将PRO纳入剂量发现试验设计和分析提供指导。我们的评论旨在识别和描述当前的统计方法和数据可视化技术,用于分析和可视化已发表的早期剂量发现肿瘤学试验(DFOTs)中的PRO数据。
    2016年6月至2022年12月发布的DFOTs,其中介绍了PRO分析方法,被纳入本方法学综述。我们在PubMed中提取了35篇符合条件的论文。提取的研究特征包括:PRO目标,PRO措施,统计分析和可视化技术,以及PRO是否参与中期和最终剂量选择决定。
    大多数论文(30,85.7%)没有明确的PRO目标。20篇(57.1%)论文使用推理统计技术来分析PRO,包括生存分析和混合效应模型。一项试验使用PRO对临床医生评估的剂量限制性毒性(DLT)进行分类。三项(8.6%)试验使用PRO来确认推荐剂量的耐受性。25份试验报告在其出版物中的图形或表格中直观地呈现PRO数据,其中12篇论文纵向呈现PRO评分。
    这篇评论强调了DFOT中PRO分析的统计方法和报告通常描述得很差,并且不一致。许多试验的PRO目标没有明确描述,这使得评估所使用的统计技术的适当性具有挑战性。根据不为PRO供电的DFOT得出结论可能会产生误导。由于没有早期DFOT中PROs分析方法的指导和标准化,比较不同试验的研究结果具有挑战性.因此,迫切需要建立国际指南,以增强剂量发现环境中PRO分析的统计方法和图形表示。
    EA已被支持作为MRC/NIHR试验方法学研究伙伴关系中癌症研究所博士研究生的一部分进行这项工作。AM由皇家马斯登NHS基金会信托基金的国家健康研究所(NIHR)生物医学研究中心支持,癌症研究所和帝国理工学院。
    UNASSIGNED: Traditionally, within dose-finding clinical trials, treatment toxicity and tolerability are assessed by clinicians. Research has shown that clinician reporting may have inadequate inter-rater reliability, poor correlation with patient reported outcomes, and under capture the true toxicity burden. The introduction of patient-reported outcomes (PROs), where the patient can assess their own symptomatic adverse events or quality of life, has potential to complement current practice to aid dose optimisation. There are no international recommendations offering guidance for the inclusion of PROs in dose-finding trial design and analysis. Our review aimed to identify and describe current statistical methods and data visualisation techniques employed to analyse and visualise PRO data in published early phase dose-finding oncology trials (DFOTs).
    UNASSIGNED: DFOTs published from June 2016-December 2022, which presented PRO analysis methods, were included in this methodological review. We extracted 35 eligible papers indexed in PubMed. Study characteristics extracted included: PRO objectives, PRO measures, statistical analysis and visualisation techniques, and whether the PRO was involved in interim and final dose selection decisions.
    UNASSIGNED: Most papers (30, 85.7%) did not include clear PRO objectives. 20 (57.1%) papers used inferential statistical techniques to analyse PROs, including survival analysis and mixed-effect models. One trial used PROs to classify a clinicians\' assessed dose-limiting toxicities (DLTs). Three (8.6%) trials used PROs to confirm the tolerability of the recommended dose. 25 trial reports visually presented PRO data within a figure or table within their publication, of which 12 papers presented PRO score longitudinally.
    UNASSIGNED: This review highlighted that the statistical methods and reporting of PRO analysis in DFOTs are often poorly described and inconsistent. Many trials had PRO objectives which were not clearly described, making it challenging to evaluate the appropriateness of the statistical techniques used. Drawing conclusions based on DFOTs which are not powered for PROs may be misleading. With no guidance and standardisation of analysis methods for PROs in early phase DFOTs, it is challenging to compare study findings across trials. Therefore, there is a crucial need to establish international guidance to enhance statistical methods and graphical presentation for PRO analysis in the dose-finding setting.
    UNASSIGNED: EA has been supported to undertake this work as part of a PhD studentship from the Institute of Cancer Research within the MRC/NIHR Trials Methodology Research Partnership. AM is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at the Royal Marsden NHS Foundation Trust, the Institute of Cancer Research and Imperial College.
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