Purpose Our aim is to advance response shift research by explicating the implications of publishe... more Purpose Our aim is to advance response shift research by explicating the implications of published syntheses by the Response Shift – in Sync Working Group in an integrative way and suggesting ways for improving the quality of future response shift studies. Methods Members of the Working Group further discussed the syntheses of the literature on definitions, theoretical underpinnings, operationalizations, and response shift methods. They outlined areas in need of further explication and refinement, and delineated additional implications for future research. Results First, the proposed response shift definition was further specified and its implications for the interpretation of results explicated in relation to former, published definitions. Second, the proposed theoretical model was further explained in relation to previous theoretical models and its implications for formulating research objectives highlighted. Third, ways to explore alternative explanations per response shift metho...
Background Cox proportional hazards regression models and machine learning models are widely used... more Background Cox proportional hazards regression models and machine learning models are widely used for predicting the risk of dementia. Existing comparisons of these models have mostly been based on empirical datasets and have yielded mixed results. This study examines the accuracy of various machine learning and of the Cox regression models for predicting time-to-event outcomes using Monte Carlo simulation in people with mild cognitive impairment (MCI). Methods The predictive accuracy of nine time-to-event regression and machine learning models were investigated. These models include Cox regression, penalized Cox regression (with Ridge, LASSO, and elastic net penalties), survival trees, random survival forests, survival support vector machines, artificial neural networks, and extreme gradient boosting. Simulation data were generated using study design and data characteristics of a clinical registry and a large community-based registry of patients with MCI. The predictive performance...
Objectives Improving diet quality among low-income populations remains a public health priority. ... more Objectives Improving diet quality among low-income populations remains a public health priority. In Canada, the British Columbia (BC) Farmers’ Market Nutrition Coupon Program (FMNCP) aims to improve the diet quality of low-income households by providing coupons to purchase healthy foods from BC farmers’ markets. This randomized controlled trial, conducted in 2019, examined the impact of the FMNCP on the diet quality of low-income adults. Methods Low-income adults ≥18 years were randomized to a FMNCP group (n = 143) that received 16 weeks’ worth of coupons valued at $21/week to purchase fruits, vegetables, dairy, meat, poultry, fish, eggs, and nuts from farmers’ markets, or to a no-intervention control group (n = 142). Participants completed data collection, including two 24-hour dietary recalls, at baseline (0 weeks), post-intervention (10–15 weeks), and 16 weeks post-intervention (26–31 weeks). Dietary intake data from the 24-hour dietary recalls were used to calculate Healthy Eati...
Background An unplanned extubation is the uncontrolled and accidental removal of a breathing tube... more Background An unplanned extubation is the uncontrolled and accidental removal of a breathing tube. The health impact of an unplanned extubation ranges from minimal to life-threatening, but this is an important quality indicator in pediatric critical care. ObjectiveTo comprehensively synthesize literature published on quality improvement (QI) practices implemented to reduce the rate of unplanned extubations in critically ill children. Methods Data Sources and Study Selection: A search was conducted in MEDLINE, Embase, and CINHAL from inception through April 29, 2021. Two reviewers independently screened citations in duplicate using pre-determined eligibility criteria. Data Extraction and Data Synthesis: Data from included studies were abstracted using a tool created by the authors, and QI interventions were categorized using the Behavior Change Wheel. Study quality was assessed using the Quality Improvement Minimum Quality Criteria Set (QI-MQCS). Results were presented as descriptive...
Oral Presentations Theme 1: Applied Sciences and Interventions for Brain Health and Dementia ABST... more Oral Presentations Theme 1: Applied Sciences and Interventions for Brain Health and Dementia ABSTRACT #1: Novel peptide aptamers as potential therapeutic candidates for the treatment of Alzheimer’s disease Tahir Ali (1, 2), Antonia N. Klein (1, 3), Alex Vu (1, 2), and Sabine Gilch (1, 2)1: Novel peptide aptamers as potential therapeutic candidates for the treatment of Alzheimer’s disease Tahir Ali (1, 2), Antonia N. Klein (1, 3), Alex Vu (1, 2), and Sabine Gilch (1, 2) 1Calgary Prion Research Unit, Department of Comparative Biology & Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada 2Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta,
Conclusion: consider changing "highlights the potential usefulness" of PRECIS-2. Author... more Conclusion: consider changing "highlights the potential usefulness" of PRECIS-2. Authors: We have revised this section of the abstract completely. Introduction P1 line 38 Spelling Loudon instead of Ludon Authors: This is now addressed P2 line 53, [24] reference to Cochrane review Authors: This is now addressed Method p1 2.1 Line 13 need to insert references [13] [14] Authors: Addressed Method P1 Line 28 insert reference [16] Authors: This is now addressed. 2.2 Line 38 weren't the trials Randomised Controlled trials? Check! Authors: This is now addressed 2.2 Line 41, "similar to" would be better word than "consistent". Yoong et al created their own adaptation from PRECIS (2009) Scale 0-4. PRECIS-2 was developed with a scale of 1-5 which you used for your study. Authors: This is now addressed. Perhaps just say we used PRECIS-2 [16] 2.3 p1 line 25 Authors: This is now addressed. Please could you state which Kappa statistic was calculated using R softwa...
Background There remains no effective intervention capable of reversing most cases of dementia. C... more Background There remains no effective intervention capable of reversing most cases of dementia. Current research is focused on prevention by addressing risk factors that are shared between cardiovascular disease and dementia (e.g., hypertension) before the cognitive, functional, and behavioural symptoms of dementia manifest. A promising preventive treatment is exercise. This study describes the methods of a randomized controlled trial (RCT) that assesses the effects of aerobic exercise and behavioural support interventions in older adults at increased risk of dementia due to genetic and/or cardiovascular risk factors. The specific aims are to determine the effect of aerobic exercise on cognitive performance, explore the biological mechanisms that influence cognitive performance after exercise training, and determine if changes in cerebrovascular physiology and function persist 1 year after a 6-month aerobic exercise intervention followed by a 1-year behavioural support programme (at...
Background: Efficient healthcare workflow leads to faster reperfusion and better functional outco... more Background: Efficient healthcare workflow leads to faster reperfusion and better functional outcomes of stroke in the early-time window. We investigated the impact of care delays on the outcomes of stroke patients treated with endovascular thrombectomy (EVT) in the late window. Methods: Pooled data from seven randomized clinical trials and registries that only included patients who underwent EVT in the late time window (onset/last known well (LKW) time to imaging time of 6 hours or more) were combined for this analysis. The time intervals from stroke onset to successful reperfusion were analyzed. Logistic regression was used to estimate the likelihood of a functionally independent outcome at 90 days (modified Rankin scale 0-2) for each time interval while adjusting for relevant patients’ characteristics. Negative binomial regression was used to evaluate the relationship between each time interval and the predictors. Results: 584 patients were included in this analysis. The median ag...
Chronic kidney disease (CKD) affects over 10% of adult Canadians and is associated with high risk... more Chronic kidney disease (CKD) affects over 10% of adult Canadians and is associated with high risks of morbidity and mortality following non-ST-elevation acute coronary syndrome (ACS). ACS is managed invasively or conservatively with medication, however, people with CKD are 20-50% less likely to receive invasive management than patients without CKD. There are important knowledge gaps to support shared decision-making for ACS in this patient population related to risk prediction of clinical outcomes and patient preferences for treatment options. This thesis' objectives are to: 1) understand patient preferences towards invasive versus conservative management of ACS, 2) develop tools for predicting long-term adverse outcomes following ACS, and 3) estimate net effects of invasive management based on trade-offs in reducing risks of mortality or readmission for myocardial infarction (MI) versus increasing risk of end-stage kidney disease (ESKD). To achieve these objectives, we conducte...
Table S1. Total effects of covariates on the SF-12 mental health sub-scale items for differential... more Table S1. Total effects of covariates on the SF-12 mental health sub-scale items for differential item functioning (DIF) and No-DIF models, stratified by type of joint replacement. Table S2. Total effects of covariates on the SF-12 physical health sub-scale items for differential item functioning (DIF) and No-DIF models, stratified by type of joint replacement. (PDF 189 kb)
Background Administrative data have limited sensitivity for case finding of atrial fibrillation/a... more Background Administrative data have limited sensitivity for case finding of atrial fibrillation/atrial flutter (AF/AFL). Linkage with clinical repositories of interpreted ECGs may enhance diagnostic yield of AF/AFL. Methods and Results We retrieved 369 ECGs from the institutional Marquette Universal System for Electrocardiography (MUSE) repository as validation samples, with rhythm coded as AF (n=49), AFL (n=50), or other competing rhythm diagnoses (n=270). With blinded, duplicate review of ECGs as the reference comparison, we compared multiple MUSE coding definitions for identifying AF/AFL. We tested the agreement between MUSE diagnosis and reference comparison, and calculated the sensitivity and specificity. Using a data set linking clinical registries, administrative data, and the MUSE repository (n=11 662), we assessed the incremental diagnostic yield of AF/AFL by incorporating ECG data to administrative data‐based algorithms. The agreement between MUSE diagnosis and reference c...
Discriminant analysis procedures that assume parsimonious covariance and/or means structures have... more Discriminant analysis procedures that assume parsimonious covariance and/or means structures have been proposed for distinguishing between two or more populations in multivariate repeated measures designs. However, these procedures rely on the assumptions of multivariate normality which is not tenable in multivariate repeated measures designs which are characterized by binary, ordinal, or mixed types of response distributions. This study investigates the accuracy of repeated measures discriminant analysis (RMDA) based on the multivariate generalized estimating equations (GEE) framework for classification in multivariate repeated measures designs with the same or different types of responses repeatedly measured over time. Monte Carlo methods were used to compare the accuracy of RMDA procedures based on GEE, and RMDA based on maximum likelihood estimators (MLE) under diverse simulation conditions, which included number of repeated measure occasions, number of responses, sample size, c...
IntroductionTo date, there is no broadly accepted dementia risk score for use in individuals with... more IntroductionTo date, there is no broadly accepted dementia risk score for use in individuals with mild cognitive impairment (MCI), partly because there are few large datasets available for model development. When evidence is limited, the knowledge and experience of experts becomes more crucial for risk stratification and providing MCI patients with prognosis. Structured expert elicitation (SEE) includes formal methods to quantify experts’ beliefs and help experts to express their beliefs in a quantitative form, reducing biases in the process. This study proposes to (1) assess experts’ beliefs about important predictors for 3-year dementia risk in persons with MCI through SEE methodology and (2) to integrate expert knowledge and patient data to derive dementia risk scores in persons with MCI using a Bayesian approach.Methods and analysisThis study will use a combination of SEE methodology, prospectively collected clinical data, and statistical modelling to derive a dementia risk scor...
OBJECTIVE To identify research gaps and inform implementation we systematically reviewed the lite... more OBJECTIVE To identify research gaps and inform implementation we systematically reviewed the literature evaluating cost-effectiveness of recommended treatments (education, exercise and diet) for the management of hip and/or knee OA. METHODS We searched Medline, Embase, Cochrane Central Register of Controlled Trials, National Health Services Economic Evaluation Database, and EconLit from inception to November 2019 for trial-based economic evaluations investigating hip and/or knee OA core treatments. Two investigators screened relevant publications, extracted data and synthesized results. Risk of bias was assessed using the Consensus on Health Economic Criteria list. RESULTS Two cost-minimization, five cost-effectiveness and 16 cost-utility analyses evaluated core treatments in six health systems. Exercise therapy with and without education or diet was cost-effective or cost-saving compared to education or physician-delivered usual care at conventional willingness to pay (WTP) thresholds in 15 out of 16 publications. Exercise interventions were not more cost-effective than physiotherapist-delivered usual care in three studies at conventional WTP thresholds. Education interventions were not cost-effective compared to usual care or placebo at conventional WTP thresholds in three out of four publications. CONCLUSIONS Structured core treatment programs were clinically effective and cost-effective, compared to physician-delivered usual care, in five health care systems. Providing education about core treatments was not consistently cost-effective. Implementing structured core treatment programs into funded clinical pathways would likely be an efficient use of health system resources and enhance physician-delivered usual primary care.
Epilepsy severity has been recognized as a significant predictor of health-related quality of lif... more Epilepsy severity has been recognized as a significant predictor of health-related quality of life in patients with epilepsy. However, clinical markers of epilepsy severity such as seizure frequency often fail to capture important aspects of the disease. This study investigates the factors associated with patient-reported severity of epilepsy, assessed by the Global Assessment of Severity of Epilepsy (GASE) scale in adults with epilepsy. Data from a cohort of 250 patients consecutively enrolled in the Neurological Diseases and Depression Study (NEEDS) were used to assess the determinants of epilepsy severity as measured by the GASE scale. Multiple linear regression analyses were used to examine the mediation effect of clinical and sociodemographic characteristics on patients' ratings on the GASE scale. The mean age of the study participants was 39.8 (SD=14.9) years, of which 44.4% were male. About 66.8% of the participants reported "not at all severe" or "a little severe" epilepsy, while 0.4% reported "extremely severe" epilepsy. One-year seizure freedom, number of antiseizure medications, medication side effects, depression, anxiety, and seizure-related disability were identified as significant determinants of patients' ratings of epilepsy severity. Seizure-related disability mediated the effects of 1-year seizure freedom, number of antiseizure medications, and medication side effects on epilepsy severity. Overall, patients with epilepsy who reported higher GASE scores were less likely to achieve 1-year seizure freedom and more likely to be on more antiseizure medications, experience more side effects from medication, endorse more depression and anxiety symptoms, and have increased self-reported seizure-related disability. The identified determinants of global, self-rated epilepsy severity can aid the design of appropriate interventions and support services for patients with severe epilepsy.
Purpose Our aim is to advance response shift research by explicating the implications of publishe... more Purpose Our aim is to advance response shift research by explicating the implications of published syntheses by the Response Shift – in Sync Working Group in an integrative way and suggesting ways for improving the quality of future response shift studies. Methods Members of the Working Group further discussed the syntheses of the literature on definitions, theoretical underpinnings, operationalizations, and response shift methods. They outlined areas in need of further explication and refinement, and delineated additional implications for future research. Results First, the proposed response shift definition was further specified and its implications for the interpretation of results explicated in relation to former, published definitions. Second, the proposed theoretical model was further explained in relation to previous theoretical models and its implications for formulating research objectives highlighted. Third, ways to explore alternative explanations per response shift metho...
Background Cox proportional hazards regression models and machine learning models are widely used... more Background Cox proportional hazards regression models and machine learning models are widely used for predicting the risk of dementia. Existing comparisons of these models have mostly been based on empirical datasets and have yielded mixed results. This study examines the accuracy of various machine learning and of the Cox regression models for predicting time-to-event outcomes using Monte Carlo simulation in people with mild cognitive impairment (MCI). Methods The predictive accuracy of nine time-to-event regression and machine learning models were investigated. These models include Cox regression, penalized Cox regression (with Ridge, LASSO, and elastic net penalties), survival trees, random survival forests, survival support vector machines, artificial neural networks, and extreme gradient boosting. Simulation data were generated using study design and data characteristics of a clinical registry and a large community-based registry of patients with MCI. The predictive performance...
Objectives Improving diet quality among low-income populations remains a public health priority. ... more Objectives Improving diet quality among low-income populations remains a public health priority. In Canada, the British Columbia (BC) Farmers’ Market Nutrition Coupon Program (FMNCP) aims to improve the diet quality of low-income households by providing coupons to purchase healthy foods from BC farmers’ markets. This randomized controlled trial, conducted in 2019, examined the impact of the FMNCP on the diet quality of low-income adults. Methods Low-income adults ≥18 years were randomized to a FMNCP group (n = 143) that received 16 weeks’ worth of coupons valued at $21/week to purchase fruits, vegetables, dairy, meat, poultry, fish, eggs, and nuts from farmers’ markets, or to a no-intervention control group (n = 142). Participants completed data collection, including two 24-hour dietary recalls, at baseline (0 weeks), post-intervention (10–15 weeks), and 16 weeks post-intervention (26–31 weeks). Dietary intake data from the 24-hour dietary recalls were used to calculate Healthy Eati...
Background An unplanned extubation is the uncontrolled and accidental removal of a breathing tube... more Background An unplanned extubation is the uncontrolled and accidental removal of a breathing tube. The health impact of an unplanned extubation ranges from minimal to life-threatening, but this is an important quality indicator in pediatric critical care. ObjectiveTo comprehensively synthesize literature published on quality improvement (QI) practices implemented to reduce the rate of unplanned extubations in critically ill children. Methods Data Sources and Study Selection: A search was conducted in MEDLINE, Embase, and CINHAL from inception through April 29, 2021. Two reviewers independently screened citations in duplicate using pre-determined eligibility criteria. Data Extraction and Data Synthesis: Data from included studies were abstracted using a tool created by the authors, and QI interventions were categorized using the Behavior Change Wheel. Study quality was assessed using the Quality Improvement Minimum Quality Criteria Set (QI-MQCS). Results were presented as descriptive...
Oral Presentations Theme 1: Applied Sciences and Interventions for Brain Health and Dementia ABST... more Oral Presentations Theme 1: Applied Sciences and Interventions for Brain Health and Dementia ABSTRACT #1: Novel peptide aptamers as potential therapeutic candidates for the treatment of Alzheimer’s disease Tahir Ali (1, 2), Antonia N. Klein (1, 3), Alex Vu (1, 2), and Sabine Gilch (1, 2)1: Novel peptide aptamers as potential therapeutic candidates for the treatment of Alzheimer’s disease Tahir Ali (1, 2), Antonia N. Klein (1, 3), Alex Vu (1, 2), and Sabine Gilch (1, 2) 1Calgary Prion Research Unit, Department of Comparative Biology & Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada 2Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta,
Conclusion: consider changing "highlights the potential usefulness" of PRECIS-2. Author... more Conclusion: consider changing "highlights the potential usefulness" of PRECIS-2. Authors: We have revised this section of the abstract completely. Introduction P1 line 38 Spelling Loudon instead of Ludon Authors: This is now addressed P2 line 53, [24] reference to Cochrane review Authors: This is now addressed Method p1 2.1 Line 13 need to insert references [13] [14] Authors: Addressed Method P1 Line 28 insert reference [16] Authors: This is now addressed. 2.2 Line 38 weren't the trials Randomised Controlled trials? Check! Authors: This is now addressed 2.2 Line 41, "similar to" would be better word than "consistent". Yoong et al created their own adaptation from PRECIS (2009) Scale 0-4. PRECIS-2 was developed with a scale of 1-5 which you used for your study. Authors: This is now addressed. Perhaps just say we used PRECIS-2 [16] 2.3 p1 line 25 Authors: This is now addressed. Please could you state which Kappa statistic was calculated using R softwa...
Background There remains no effective intervention capable of reversing most cases of dementia. C... more Background There remains no effective intervention capable of reversing most cases of dementia. Current research is focused on prevention by addressing risk factors that are shared between cardiovascular disease and dementia (e.g., hypertension) before the cognitive, functional, and behavioural symptoms of dementia manifest. A promising preventive treatment is exercise. This study describes the methods of a randomized controlled trial (RCT) that assesses the effects of aerobic exercise and behavioural support interventions in older adults at increased risk of dementia due to genetic and/or cardiovascular risk factors. The specific aims are to determine the effect of aerobic exercise on cognitive performance, explore the biological mechanisms that influence cognitive performance after exercise training, and determine if changes in cerebrovascular physiology and function persist 1 year after a 6-month aerobic exercise intervention followed by a 1-year behavioural support programme (at...
Background: Efficient healthcare workflow leads to faster reperfusion and better functional outco... more Background: Efficient healthcare workflow leads to faster reperfusion and better functional outcomes of stroke in the early-time window. We investigated the impact of care delays on the outcomes of stroke patients treated with endovascular thrombectomy (EVT) in the late window. Methods: Pooled data from seven randomized clinical trials and registries that only included patients who underwent EVT in the late time window (onset/last known well (LKW) time to imaging time of 6 hours or more) were combined for this analysis. The time intervals from stroke onset to successful reperfusion were analyzed. Logistic regression was used to estimate the likelihood of a functionally independent outcome at 90 days (modified Rankin scale 0-2) for each time interval while adjusting for relevant patients’ characteristics. Negative binomial regression was used to evaluate the relationship between each time interval and the predictors. Results: 584 patients were included in this analysis. The median ag...
Chronic kidney disease (CKD) affects over 10% of adult Canadians and is associated with high risk... more Chronic kidney disease (CKD) affects over 10% of adult Canadians and is associated with high risks of morbidity and mortality following non-ST-elevation acute coronary syndrome (ACS). ACS is managed invasively or conservatively with medication, however, people with CKD are 20-50% less likely to receive invasive management than patients without CKD. There are important knowledge gaps to support shared decision-making for ACS in this patient population related to risk prediction of clinical outcomes and patient preferences for treatment options. This thesis' objectives are to: 1) understand patient preferences towards invasive versus conservative management of ACS, 2) develop tools for predicting long-term adverse outcomes following ACS, and 3) estimate net effects of invasive management based on trade-offs in reducing risks of mortality or readmission for myocardial infarction (MI) versus increasing risk of end-stage kidney disease (ESKD). To achieve these objectives, we conducte...
Table S1. Total effects of covariates on the SF-12 mental health sub-scale items for differential... more Table S1. Total effects of covariates on the SF-12 mental health sub-scale items for differential item functioning (DIF) and No-DIF models, stratified by type of joint replacement. Table S2. Total effects of covariates on the SF-12 physical health sub-scale items for differential item functioning (DIF) and No-DIF models, stratified by type of joint replacement. (PDF 189 kb)
Background Administrative data have limited sensitivity for case finding of atrial fibrillation/a... more Background Administrative data have limited sensitivity for case finding of atrial fibrillation/atrial flutter (AF/AFL). Linkage with clinical repositories of interpreted ECGs may enhance diagnostic yield of AF/AFL. Methods and Results We retrieved 369 ECGs from the institutional Marquette Universal System for Electrocardiography (MUSE) repository as validation samples, with rhythm coded as AF (n=49), AFL (n=50), or other competing rhythm diagnoses (n=270). With blinded, duplicate review of ECGs as the reference comparison, we compared multiple MUSE coding definitions for identifying AF/AFL. We tested the agreement between MUSE diagnosis and reference comparison, and calculated the sensitivity and specificity. Using a data set linking clinical registries, administrative data, and the MUSE repository (n=11 662), we assessed the incremental diagnostic yield of AF/AFL by incorporating ECG data to administrative data‐based algorithms. The agreement between MUSE diagnosis and reference c...
Discriminant analysis procedures that assume parsimonious covariance and/or means structures have... more Discriminant analysis procedures that assume parsimonious covariance and/or means structures have been proposed for distinguishing between two or more populations in multivariate repeated measures designs. However, these procedures rely on the assumptions of multivariate normality which is not tenable in multivariate repeated measures designs which are characterized by binary, ordinal, or mixed types of response distributions. This study investigates the accuracy of repeated measures discriminant analysis (RMDA) based on the multivariate generalized estimating equations (GEE) framework for classification in multivariate repeated measures designs with the same or different types of responses repeatedly measured over time. Monte Carlo methods were used to compare the accuracy of RMDA procedures based on GEE, and RMDA based on maximum likelihood estimators (MLE) under diverse simulation conditions, which included number of repeated measure occasions, number of responses, sample size, c...
IntroductionTo date, there is no broadly accepted dementia risk score for use in individuals with... more IntroductionTo date, there is no broadly accepted dementia risk score for use in individuals with mild cognitive impairment (MCI), partly because there are few large datasets available for model development. When evidence is limited, the knowledge and experience of experts becomes more crucial for risk stratification and providing MCI patients with prognosis. Structured expert elicitation (SEE) includes formal methods to quantify experts’ beliefs and help experts to express their beliefs in a quantitative form, reducing biases in the process. This study proposes to (1) assess experts’ beliefs about important predictors for 3-year dementia risk in persons with MCI through SEE methodology and (2) to integrate expert knowledge and patient data to derive dementia risk scores in persons with MCI using a Bayesian approach.Methods and analysisThis study will use a combination of SEE methodology, prospectively collected clinical data, and statistical modelling to derive a dementia risk scor...
OBJECTIVE To identify research gaps and inform implementation we systematically reviewed the lite... more OBJECTIVE To identify research gaps and inform implementation we systematically reviewed the literature evaluating cost-effectiveness of recommended treatments (education, exercise and diet) for the management of hip and/or knee OA. METHODS We searched Medline, Embase, Cochrane Central Register of Controlled Trials, National Health Services Economic Evaluation Database, and EconLit from inception to November 2019 for trial-based economic evaluations investigating hip and/or knee OA core treatments. Two investigators screened relevant publications, extracted data and synthesized results. Risk of bias was assessed using the Consensus on Health Economic Criteria list. RESULTS Two cost-minimization, five cost-effectiveness and 16 cost-utility analyses evaluated core treatments in six health systems. Exercise therapy with and without education or diet was cost-effective or cost-saving compared to education or physician-delivered usual care at conventional willingness to pay (WTP) thresholds in 15 out of 16 publications. Exercise interventions were not more cost-effective than physiotherapist-delivered usual care in three studies at conventional WTP thresholds. Education interventions were not cost-effective compared to usual care or placebo at conventional WTP thresholds in three out of four publications. CONCLUSIONS Structured core treatment programs were clinically effective and cost-effective, compared to physician-delivered usual care, in five health care systems. Providing education about core treatments was not consistently cost-effective. Implementing structured core treatment programs into funded clinical pathways would likely be an efficient use of health system resources and enhance physician-delivered usual primary care.
Epilepsy severity has been recognized as a significant predictor of health-related quality of lif... more Epilepsy severity has been recognized as a significant predictor of health-related quality of life in patients with epilepsy. However, clinical markers of epilepsy severity such as seizure frequency often fail to capture important aspects of the disease. This study investigates the factors associated with patient-reported severity of epilepsy, assessed by the Global Assessment of Severity of Epilepsy (GASE) scale in adults with epilepsy. Data from a cohort of 250 patients consecutively enrolled in the Neurological Diseases and Depression Study (NEEDS) were used to assess the determinants of epilepsy severity as measured by the GASE scale. Multiple linear regression analyses were used to examine the mediation effect of clinical and sociodemographic characteristics on patients' ratings on the GASE scale. The mean age of the study participants was 39.8 (SD=14.9) years, of which 44.4% were male. About 66.8% of the participants reported "not at all severe" or "a little severe" epilepsy, while 0.4% reported "extremely severe" epilepsy. One-year seizure freedom, number of antiseizure medications, medication side effects, depression, anxiety, and seizure-related disability were identified as significant determinants of patients' ratings of epilepsy severity. Seizure-related disability mediated the effects of 1-year seizure freedom, number of antiseizure medications, and medication side effects on epilepsy severity. Overall, patients with epilepsy who reported higher GASE scores were less likely to achieve 1-year seizure freedom and more likely to be on more antiseizure medications, experience more side effects from medication, endorse more depression and anxiety symptoms, and have increased self-reported seizure-related disability. The identified determinants of global, self-rated epilepsy severity can aid the design of appropriate interventions and support services for patients with severe epilepsy.
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