Relative Efficacy Of Interventions Research Articles

Abstract P1-15-09: What are the outcomes of importance for patient education in breast cancer?

Abstract Background: Patient education is an important component of quality cancer care. However, there remains much debate about its effects, merits and limitations. There is a lack of consensus on the intended effects of educational interventions and a lack of standardized outcome measures to assess quality. As a result, multiple outcomes measures are used without consistency and in differing combinations in the literature making it difficult to compare relative efficacy of interventions. The primary objective of this study was to identify outcomes of importance for patient education interventions in breast cancer. Methods: A generic qualitative study using interpretive description was conducted to discover what key stakeholders in the process of patient education in breast cancer (patients, physicians and nurses) would identify as outcomes of importance. The study population included breast cancer patients, physicians and nurses caring for breast cancer patients at the Juravinski Hospital and Cancer Centre in Hamilton, Ontario. Four focus groups and one semi-structured interview was conducted using purposeful sampling and an iterative design. Results: Eight patients, five nurses and four physicians participated in this study. Five common themes to all groups with respect to outcomes of importance in patient education were discovered: improving knowledge, improving coping ability, providing an orientation to the cancer system, enabling shared decision making and impacting behaviour during cancer treatment. Conclusion: Despite the surprising variability and inconsistency of outcomes discovered in the patient education literature, this qualitative study demonstrated that patients, physicians and nurses generally agree on what constitute important outcomes and serves as a first step in the process of developing validated outcomes for patient education interventions in cancer. Citation Format: Ghazaleh Kazemi, Mark Levine, Harold Reiter, Christina Sinding. What are the outcomes of importance for patient education in breast cancer? [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-15-09.

Relative efficacy of interventions in the treatment of second-line non-small cell lung cancer: a systematic review and network meta-analysis

BackgroundLocally advanced or metastatic non-small cell lung cancer (NSCLC) that has progressed after first-line treatment has a poor prognosis. Recent randomized clinical trials (RCTs) have demonstrated survival benefits of alternative treatments to docetaxel. However, information is lacking on which patients benefit the most and what drug or regimen is optimal. We report a systematic review and network meta-analysis (NMA) of second-line treatments in all subgroup combinations determined by histology, programmed death ligand 1 (PD-L1) expression, and epidermal growth factor receptor (EGFR) mutation.MethodsMEDLINE, PubMed, EMBASE, Biosciences Information Service (using the Dialog Platform), Cochrane Library, and abstracts from scientific meetings were searched for RCTs published up to September 2015. Key outcomes were overall survival (OS) and progression-free survival (PFS). Bayesian hierarchical exchangeable NMAs were conducted to calculate mean survival times and relative differences for eight subgroups, using docetaxel as the reference comparator. For OS, the NMA was based on hazard ratios applied to a first-order fractional polynomial model fitted to the reference treatment. For PFS, a second-order fractional polynomial model was fitted to reconstructed patient-level data for the entire network of evidence.ResultsThe search identified 30 studies containing 17 different treatment regimens. Docetaxel plus ramucirumab was associated with a significant improvement in OS and PFS, relative to docetaxel, regardless of patient type. Docetaxel plus nintedanib showed similar efficacy to docetaxel plus ramucirumab in the nonsquamous populations. EGFR tyrosine kinase inhibitors (TKIs) erlotinib and gefitinib showed superior levels of efficacy in EGFR mutation-positive populations and the one PD-1 immunotherapy (nivolumab) studied showed superior efficacy in the populations exhibiting high PD-L1 expression.ConclusionsIn the absence of head-to-head comparisons, we performed a mixed-treatment analysis to synthesize evidence of the efficacy of each treatment. Benefits are optimized by targeting specific treatments to individual patients guided by histology, PD-L1 expression, and EGFR mutation status.Systematic review registrationThis review is registered in PROSPERO (registration number: CRD42014013780 available at www.crd.york.ac.uk/PROSPERO).

Network meta-analysis of randomised trials of pharmacological, psychotherapeutic, exercise and collaborative care interventions for depressive symptoms in patients with coronary artery disease: hybrid systematic review of systematic reviews protocol

BackgroundDepression is common in patients with coronary artery disease (CAD) and is associated with poorer outcomes and higher costs. Several randomised controlled trials (RCTs) targeting depression, of various modalities (including pharmacological, psychotherapeutic and other approaches), have been conducted and summarised in pairwise meta-analytic reviews. However, no study has considered the cumulative evidence within a network, which can provide valuable indirect comparisons and information about the relative efficacy of interventions. Therefore, we will adopt a review of review methodology to develop a network meta-analysis (NMA) of depression interventions for depression in CAD.MethodsWe will search relevant databases from inception for systematic reviews of RCTs of depression treatments for people with CAD, supplementing this with comprehensive searches for recent or ongoing studies. We will extract data from and summarise characteristics of individual RCTs, including participants, study characteristics, outcome measures and adverse events. Cochrane risk of bias ratings will also be extracted or if not present will be conducted by the authors.RCTs that compare depression treatments (grouped as pharmacological, psychotherapeutic, combined pharmacological/psychotherapeutic, exercise, collaborative care) to placebo, usual care, waitlist control or attention controls, or directly in head-to-head comparisons, will be included. Primary outcomes will be the change in depressive symptoms (summarised with a standardised mean difference) and treatment acceptability (treatment discontinuation: % of people who withdrew). Secondary outcomes will include change in 6-month depression outcomes, health-related quality of life (HRQoL), mortality, cardiovascular morbidity, health services use and adverse events. Secondary analyses will form further networks with individual anti-depressants and psychotherapies.We will use frequentist, random effects multivariate network meta-analysis to synthesise the evidence for depression intervention and to achieve a ranking of treatments, using Stata. Rankograms and surface under the cumulative ranking curves will be used for treatment ranking. Local and global methods will evaluate consistency. GRADE will be used to assess evidence quality for primary outcomes.DiscussionThe present review will address uncertainties about the evidence in terms of depression management in CAD and may allow for a ranking of treatments, including providing important information for future research efforts.Systematic review registrationPROSPERO CRD42018108293

Behaviour change interventions for the management of Raynaud’s phenomenon: a systematic literature review

ObjectivesRaynaud’s phenomenon (RP) is a significant cause of morbidity. Vasodilator medications cause unwanted adverse effects, with behavioural and lifestyle changes forming the mainstay of self-management; this is difficult to implement...

Meta-analysis of variance: an illustration comparing the effects of two dietary interventions on variability in weight.

Meta-analysis, which drives evidence-based practice, typically focuses on the average response of subjects to a treatment. For instance in nutritional research the difference in average weight of participants on different diets is typically used to draw conclusions about the relative efficacy of interventions. As a result of their focus on the mean, meta-analyses largely overlook the effects of treatments on inter-subject variability. Recent tools from the study of biological evolution, where inter-individual variability is one of the key ingredients for evolution by natural selection, now allow us to study inter-subject variability using established meta-analytic models. Here we use meta-analysis to study how low carbohydrate (LC) ad libitum diets and calorie restricted diets affect variance in mass. We find that LC ad libitum diets may have a more variable outcome than diets that prescribe a reduced calorie intake. Our results suggest that whilst LC diets are effective in a large proportion of the population, for a subset of individuals, calorie restricted diets may be more effective. There is evidence that LC ad libitum diets rely on appetite suppression to drive weight loss. Extending this hypothesis, we suggest that between-individual variability in protein appetite may drive the trends that we report. A priori identification of an individual's target intake for protein may help define the most effective dietary intervention to prescribe for weight loss.

Relative Efficacy of Behavioral Interventions in Preschool Children Attending Head Start

This study tested the relative efficacy of two interventions for children referred for consultation services due to problem behavior in the classroom. Teachers nominated children for participation due to frequent disruptive behaviors, such as inappropriate vocalizations and off-task behavior. Four Black males from 3 to 4 years old who attended Head Start centers served as the participants. Each child received a functional assessment that included a teacher-completed functional assessment rating scale and a brief functional analysis. Following functional assessments, an alternating treatments design was used to test the relative efficacy of an intervention matched to function and the Mystery Motivator intervention, not matched to function. Results indicate that both the intervention matched to function and the Mystery Motivator intervention were superior to a no-intervention control condition, but the function-matched intervention was more effective than the Mystery Motivator intervention for reducing problem behaviors and increasing appropriate engagement for all four children. Results are discussed in terms of learning principles potentially responsible for differential efficacy, as well as implications for applied practice.

Pharmacological Treatment of Postoperative Shivering: A Quantitative Systematic Review of Randomized Controlled Trials

Shivering is a frequent complication in the postoperative period. The relative efficacy of interventions that are used for the treatment of postoperative shivering is not well understood. We performed a systematic search (MEDLINE, EMBASE, Cochrane Library, hand searching, all languages, to August, 2000) for full reports of randomized comparisons of any pharmacological antishivering intervention (active) with placebo (control) in the postoperative period. Dichotomous data on absence of further shivering after treatment and adverse effects were extracted from original reports. Relative risk (RR) and number-needed-to-treat (NNT) were calculated with 95% confidence interval (CI) using a fixed effect model. Data from 20 trials (944 adults received an active intervention, 413 were controls) were analyzed. Antishivering efficacy depended on the active regimen and the length of follow-up. Efficacy with meperidine 25 mg, clonidine 150 μg, ketanserin 10 mg, and doxapram 100 mg was reported in at least three trials; all were significantly more effective than control. After 1 min, the NNT of meperidine 25 mg for no further shivering compared with placebo was 2.7 (RR, 6.8; 95% CI, 2.5–18.5). After 5 min, the NNT of meperidine 25 mg was 1.3 (RR, 9.6; 95% CI, 5.7–16), the NNT of clonidine 150 μg was 1.3 (RR, 6.8; 95% CI, 3.3–14.2), the NNT of doxapram 100 mg was 1.7 (RR 4.0; 95% CI, 2.4–6.5), and the NNT of ketanserin 10 mg was 2.3 (RR 3.1; 95% CI, 1.9–5.1). After 10 min, the NNT of meperidine 25 mg was 1.5 (RR 4.0; 95% CI, 2.5–6.2). After 15 min, the NNT of ketanserin 10 mg was 3.3 (RR 1.5; 95% CI, 1.2–1.9). Long-term outcome data were lacking. There were not enough data for alfentanil, fentanyl, morphine, nalbuphine, lidocaine, magnesium, metamizol, methylphenidate, nefopam, pentazocine, and tramadol to draw meaningful conclusions. Reporting of adverse drug reactions was sparse. Fewer than two shivering patients need to be treated with meperidine 25 mg, clonidine 150 μg, or doxapram 100 mg for one to stop shivering within 5 min who would have continued to shiver had they all received a placebo.

Pharmacological treatment of postoperative shivering: a quantitative systematic review of randomized controlled trials.

Shivering is a frequent complication in the postoperative period. The relative efficacy of interventions that are used for the treatment of postoperative shivering is not well understood. We performed a systematic search (MEDLINE, EMBASE, Cochrane Library, hand searching, all languages, to August, 2000) for full reports of randomized comparisons of any pharmacological antishivering intervention (active) with placebo (control) in the postoperative period. Dichotomous data on absence of further shivering after treatment and adverse effects were extracted from original reports. Relative risk (RR) and number-needed-to-treat (NNT) were calculated with 95% confidence interval (CI) using a fixed effect model. Data from 20 trials (944 adults received an active intervention, 413 were controls) were analyzed. Antishivering efficacy depended on the active regimen and the length of follow-up. Efficacy with meperidine 25 mg, clonidine 150 microg, ketanserin 10 mg, and doxapram 100 mg was reported in at least three trials; all were significantly more effective than control. After 1 min, the NNT of meperidine 25 mg for no further shivering compared with placebo was 2.7 (RR, 6.8; 95% CI, 2.5-18.5). After 5 min, the NNT of meperidine 25 mg was 1.3 (RR, 9.6; 95% CI, 5.7-16), the NNT of clonidine 150 microg was 1.3 (RR, 6.8; 95% CI, 3.3-14.2), the NNT of doxapram 100 mg was 1.7 (RR 4.0; 95% CI, 2.4-6.5), and the NNT of ketanserin 10 mg was 2.3 (RR 3.1; 95% CI, 1.9-5.1). After 10 min, the NNT of meperidine 25 mg was 1.5 (RR 4.0; 95% CI, 2.5-6.2). After 15 min, the NNT of ketanserin 10 mg was 3.3 (RR 1.5; 95% CI, 1.2-1.9). Long-term outcome data were lacking. There were not enough data for alfentanil, fentanyl, morphine, nalbuphine, lidocaine, magnesium, metamizol, methylphenidate, nefopam, pentazocine, and tramadol to draw meaningful conclusions. Reporting of adverse drug reactions was sparse. Fewer than two shivering patients need to be treated with meperidine 25 mg, clonidine 150 microg, or doxapram 100 mg for one to stop shivering within 5 min who would have continued to shiver had they all received a placebo. Less than two shivering patients need to be treated with meperidine 25 mg, clonidine 150 microg, or doxapram 100 mg for one to stop shivering within 5 min who would have continued to shiver had they all received a placebo.