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1.
BMC Med Res Methodol ; 23(1): 267, 2023 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-37951877

RESUMO

BACKGROUND: Planning the design of a new trial comparing two treatments already in a network of trials with an a-priori plan to estimate the effect size using a network meta-analysis increases power or reduces the sample size requirements. However, when the comparison of interest is between a treatment already in the existing network (old treatment) and a treatment that hasn't been studied previously (new treatment), the impact of leveraging information from the existing network to inform trial design has not been extensively investigated. We aim to identify the most powerful trial design for a comparison of interest between an old treatment A and a new treatment Z, given a fixed total sample size. We consider three possible designs: a two-arm trial between A and Z ('direct two-arm'), a two-arm trial between another old treatment B and Z ('indirect two-arm'), and a three-arm trial among A, B, and Z. METHODS: We compare the standard error of the estimated effect size between treatments A and Z for each of the three trial designs using formulas. For continuous outcomes, the direct two-arm trial always has the largest power, while for a binary outcome, the minimum variances among the three trial designs are conclusive only when [Formula: see text]. Simulation studies are conducted to demonstrate the potential for the indirect two-arm and three-arm trials to outperform the direct two-arm trial in terms of power under the condition of [Formula: see text]. RESULTS: Based on the simulation results, we observe that the indirect two-arm and three-arm trials have the potential to be more powerful than a direct two-arm trial only when [Formula: see text]. This power advantage is influenced by various factors, including the risk of the three treatments, the total sample size, and the standard error of the estimated effect size from the existing network meta-analysis. CONCLUSIONS: The standard two-arm trial design between two treatments in the comparison of interest may not always be the most powerful design. Utilizing information from the existing network meta-analysis, incorporating an additional old treatment into the trial design through an indirect two-arm trial or a three-arm trial can increase power.


Assuntos
Ensaios Clínicos como Assunto , Projetos de Pesquisa , Humanos , Simulação por Computador , Metanálise em Rede , Tamanho da Amostra
2.
BMC Med Res Methodol ; 23(1): 79, 2023 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-37013490

RESUMO

BACKGROUND: In network meta-analysis, estimation of a comparative effect can be performed for treatments that are connected either directly or indirectly. However, disconnected trial networks may arise, which poses a challenge to comparing all available treatments of interest. Several modeling approaches attempt to compare treatments from disconnected networks but not without strong assumptions and limitations. Conducting a new trial to connect a disconnected network can enable calculation of all treatment comparisons and help researchers maximize the value of the existing networks. Here, we develop an approach to finding the best connecting trial given a specific comparison of interest. METHODS: We present formulas to quantify the variation in the estimation of a particular comparative effect of interest for any possible connecting two-arm trial. We propose a procedure to identify the optimal connecting trial that minimizes this variation in effect estimation. RESULTS: We show that connecting two treatments indirectly might be preferred to direct connection through a new trial, by leveraging information from the existing disconnected networks. Using a real network of studies on the use of vaccines in the treatment of bovine respiratory disease (BRD), we illustrate a procedure to identify the best connecting trial and confirm our findings via simulation. CONCLUSION: Researchers wishing to conduct a connecting two-arm study can use the procedure provided here to identify the best connecting trial. The choice of trial that minimizes the variance of a comparison of interest is network dependent and it is possible that connecting treatments indirectly may be preferred to direct connection.


Assuntos
Projetos de Pesquisa , Animais , Bovinos , Humanos , Metanálise em Rede , Simulação por Computador
3.
J Dairy Sci ; 106(12): 9514-9531, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37678786

RESUMO

Excessive and protracted lipolysis in adipose tissues of dairy cows is a major risk factor for clinical ketosis (CK). This metabolic disease is common in postpartum cows when lipolysis provides fatty acids as an energy substrate to offset negative energy balance. Lipolysis in cows can be induced by the canonical (hormonally induced) and inflammatory pathways. Current treatments for CK focus on improving glucose in blood (i.e., oral propylene glycol [PG], or i.v. dextrose). However, these therapies do not inhibit the canonical and inflammatory lipolytic pathways. Niacin (NIA) can reduce activation of the canonical pathway. Blocking inflammatory responses with cyclooxygenase inhibitors such as flunixin meglumine (FM) can inhibit inflammatory lipolytic activity. The objective of this study was to determine the effects of including NIA and FM in the standard PG treatment for postpartum CK on circulating concentrations of ketone bodies. A 4-group, parallel, individually randomized trial was conducted in multiparous Jersey cows (n = 80) from a commercial dairy in Michigan during a 7-mo period. Eligible cows had CK symptoms (lethargy, depressed appetite, and milk yield) and hyperketonemia (blood ß-hydroxybutyrate [BHB] ≥1.2 mmol/L). Cows with CK were randomly assigned to 1 of 3 groups where the first group received 310 g of oral PG once per day for 5 d; the second group received PG for 5 d + 24 g of oral NIA once per day for 3 d (PGNIA); and the third group received PG for 5 d + NIA for 3 d + 1.1 mg/kg i.v. FM once per day for 3 d (PGNIAFM). The control group consisted of cows that were clinically healthy (HC; untreated; BHB <1.2 mmol/L, n = 27) matching for parity and DIM with all 3 groups. Animals were sampled at enrollment (d 0), and d 3, 7, and 14 to evaluate ketone bodies and circulating metabolic and inflammatory biomarkers. Effects of treatment, sampling day, and their interactions were evaluated using mixed effects models. Logistic regression was used to calculate the odds ratio (OR) of returning to normoketonemia (BHB <1.2 mmol/L). Compared with HC, enrolled CK cows exhibited higher blood concentrations of dyslipidemia markers, including nonesterified fatty acids (NEFA) and BHB, and lower glucose and insulin levels. Cows with CK also had increased levels of biomarkers of pain (substance P), inflammation, including lipopolysaccharide-binding protein, haptoglobin, and serum amyloid A, and proinflammatory cytokines IL-4, MCP-1, MIP-1α, and TNFα. Importantly, 72.2% of CK cows presented endotoxemia and had higher circulating bacterial DNA compared with HC. By d 7, the percentage of cows with normoketonemia were higher in PGNIAFM = 87.5%, compared with PG = 58.33%, and PGNIA = 62.5%. At d 7 the OR for normoketonemia in PGNIAFM cows were 1.5 (95% CI, 1.03-2.17) and 1.4 (95% CI, 0.99-1.97) relative to PG and PGNIA, respectively. At d 3, 7, and 14, PGNIAFM cows presented the lowest values of BHB (PG = 1.36; PGNIA = 1.24; PGNIAFM = 0.89 ± 0.13 mmol/L), NEFA (PG = 0.58; PGNIA = 0.59; PGNIAFM = 0.45 ± 0.02 mmol/L), and acute phase proteins. Cows in PGNIAFM also presented the highest blood glucose increment across time points and insulin by d 7. These data provide evidence that bacteremia or endotoxemia, systemic inflammation, and pain may play a crucial role in CK pathogenesis. Additionally, targeting lipolysis and inflammation with NIA and FM during CK effectively reduces dyslipidemia biomarkers, improves glycemia, and improves overall clinical recovery.


Assuntos
Doenças dos Bovinos , Dislipidemias , Endotoxemia , Cetose , Gravidez , Feminino , Bovinos , Animais , Lactação , Lipólise , Ácidos Graxos não Esterificados , Endotoxemia/veterinária , Período Pós-Parto/metabolismo , Leite/metabolismo , Insulina , Inflamação/metabolismo , Inflamação/veterinária , Cetose/tratamento farmacológico , Cetose/veterinária , Cetose/metabolismo , Biomarcadores/metabolismo , Ácido 3-Hidroxibutírico , Corpos Cetônicos , Glucose/metabolismo , Dor/veterinária , Dislipidemias/metabolismo , Dislipidemias/veterinária , Doenças dos Bovinos/metabolismo
4.
BMC Med Res Methodol ; 22(1): 299, 2022 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-36418960

RESUMO

BACKGROUND: A critical step in trial design is determining the sample size and sample allocation to ensure the proposed study has sufficient power to test the hypothesis of interest: superiority, equivalence, or non-inferiority. When data are available from prior trials and leveraged with the new trial to answer the scientific questions, the value of society's investment in prior research is increased. When prior information is available, the trial design including the sample size and allocation should be adapted accordingly, yet the current approach to trial design does not utilize such information. Ensuring we maximize the value of prior research is essential as there are always constraints on resources, either physical or financial, and designing a trial with adequate power can be a challenge. METHODS: We propose an approach to increasing the power of a new trial by incorporating evidence from a network meta-analysis into the new trial design and analysis. We illustrate the methodology through an example network meta-analysis, where the goal is to identify the optimal allocation ratio for the new three-arm trial, which involves the reference treatment, the new treatment, and the negative control. The primary goal of the new trial is to show that the new treatment is non-inferior to the reference treatment. It may also be of interest to know if the new treatment is superior to the negative control. We propose an optimal treatment allocation strategy which is derived from minimizing the standard error of the log odds ratio estimate of the comparison of interest. We conducted a simulation study to assess the proposed methods to design a new trial while borrowing information from the existing network meta-analysis and compare it to even allocation methods. RESULTS: Using mathematical derivation and simulations, we document that our proposed approach can borrow information from a network meta-analysis to modify the treatment allocation ratio and increase the power of the new trial given a fixed total sample size or to reduce the total sample size needed to reach a desired power. CONCLUSIONS: When prior evidence about the hypotheses of interest is available, the traditional equal allocation strategy is not the most powerful approach anymore. Our proposed methodology can improve the power of trial design, reduce the cost of trials, and maximize the utility of prior investments in research.


Assuntos
Metanálise em Rede , Humanos , Razão de Chances , Tamanho da Amostra , Simulação por Computador
5.
J Dairy Sci ; 105(11): 8594-8608, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36055845

RESUMO

Clinical trials are a valuable study design for evaluating interventions when it is ethical and feasible for investigators to randomly allocate study animals to intervention groups. Researchers may choose to evaluate the comparative efficacy of intervention groups for their effect on outcomes that are relevant to the specific objectives of their trial. However, the results across multiple trials on the same intervention and with the same outcome should be considered when making decisions on whether to use an intervention, because the results of a single trial are subject to sampling error and do not reflect all biological variability. The objective of this review was to provide an overview of important concepts when selecting intervention groups and outcomes within a randomized controlled trial, and when building a body of evidence for intervention efficacy across multiple trials. Empirical evidence is presented to highlight that integrating and interpreting the efficacy of an intervention across trials is hindered by a lack of replication of interventions across trials. Inconsistency in the outcomes and their measurement among trials also limits the ability to build a body of evidence for the efficacy of interventions. The development of core outcome sets for specific topic areas in dairy science, updated as necessary, may improve consistency across trials and aid in the development of a body of evidence for evidence-based decision-making.


Assuntos
Ensaios Clínicos Veterinários como Assunto , Projetos de Pesquisa , Animais , Bovinos
6.
J Dairy Sci ; 105(7): 6155-6163, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35570046

RESUMO

Research allows for the discovery of new knowledge and is integral to evidence-based decision-making. However, research is only useful if it is available. The aim of this study was to explore publication and accessibility of full-text reports for controlled trials (experimental studies) conducted in dairy cattle. We determined the proportion of controlled trials presented as abstracts at the 2015 Joint Annual Meeting of the American Dairy Science Association and the American Society of Animal Science or the 2015 American Association of Bovine Practitioners Annual Conference that were subsequently published. Factors associated with publication or non-publication in a peer-reviewed journal were evaluated using risk ratios. For trials that were subsequently published, we compared the sample size, numerical results, and inference between the conference abstract and the subsequent publication. Approximately half of the trials (177 out of 380) reported at conferences were subsequently published. Source conference, whether the conference abstract results were described as preliminary, whether there was at least one positive outcome, author affiliation, whether the trial involved deliberate disease induction, and total sample size were not strongly associated with subsequent publication. For trials that were published, the sample size differed between the conference proceedings and full publications for 22%, the numerical results differed in 29%, and the inference differed for 11%. We also evaluated whether trials included in 9 recent systematic reviews were in English and were available without subscription or cost. Of the 390 trials included in recent systematic reviews, approximately 40% were available only through subscription or access fee. These results suggest that publication and accessibility of research results is suboptimal, representing an area of wastage in dairy cattle research. Researchers should ensure that they publish the results of trials comprehensively in searchable publications, even if the results are not novel or do not detect expected differences, and, when possible, make the results available freely.


Assuntos
Relatório de Pesquisa , Animais , Bovinos , Tamanho da Amostra , Estados Unidos
7.
Vet Surg ; 51(4): 557-567, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35383972

RESUMO

OBJECTIVE: To evaluate the use of mesenchymal stem cells (MSCs), autologous conditioned serum (ACS), platelet-rich plasma (PRP), and autologous protein solution (APS) for the treatment of equine musculoskeletal disease by diplomates of the American College of Veterinary Surgery (ACVS), and American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR). STUDY DESIGN: Cross-sectional study. SAMPLE POPULATION: Diplomates (n = 423). METHODS: An email link was sent to ACVS and ACVMR diplomates. A survey contained 59 questions regarding demographics, as well as indications, frequency, adverse effects, and limitations of use. Responses were analyzed using Fisher's exact test. RESULTS: One hundred and fifty four surveys were analyzed. Years in practice and type of practice were not associated with biologic therapy use. PRP was the most used therapy (120/137; 87.5%). PRP and MSCs were most often administered intralesionally while ACS and APS were most often administered intra-articularly. ACS (50/104; 48.1%) treatment was repeated commonly within 2 weeks of initial injection. MSCs (39/90; 43.3%) and PRP (38/100; 38%) were commonly repeated 1-2 months after initial injection and APS was typically repeated >4 months after initial injection (21/53; 39.6%). Local inflammation and expense were the most common adverse effect and limitation of use. CONCLUSION: Diplomates most commonly utilized PRP and MSC intralesionally for soft-tissue injuries, and ACS and ACP intra-articularly for joint injury. Protocols for repeated administration varied widely. Local inflammation was a clinical concern with the use of biologics. CLINICAL SIGNIFICANCE: Biologic therapies are used commonly by ACVS and ACVSMR diplomates for soft tissue and joint disease.


Assuntos
Doenças dos Cavalos , Doenças Musculoesqueléticas , Plasma Rico em Plaquetas , Animais , Terapia Biológica/veterinária , Estudos Transversais , Doenças dos Cavalos/terapia , Cavalos , Humanos , Inflamação/veterinária , Doenças Musculoesqueléticas/terapia , Doenças Musculoesqueléticas/veterinária , Inquéritos e Questionários
8.
BMC Med Res Methodol ; 21(1): 186, 2021 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-34544374

RESUMO

BACKGROUND: The emergence of antimicrobial resistance across populations is a global threat to public health. Surveillance programs often monitor human and animal populations to evaluate trends of emergence in these populations. Many national level antibiotic resistance surveillance programs quantify the proportion of resistant bacteria as a means of monitoring emergence and control measures. The reason for monitoring these different populations are many, including interest in similar changes in resistance which might provide insight into emergence and control options. METHODS: In this research, we developed a method to quantify the correlation in antimicrobial resistance across populations, for the conventionally unnoticed mean shift of the susceptible bacteria. With the proposed Bayesian latent class mixture model with censoring and multivariate normal hierarchy, we address several challenges associated with analyzing the minimum inhibitory concentration data. RESULTS: Application of this approach to the surveillance data from National Antimicrobial Resistance Monitoring System led to a detection of positive correlation in the central tendency of azithromycin resistance of the susceptible populations from Salmonella serotype Typhimurium across food animal and human populations. CONCLUSIONS: Our proposed approach has been shown to be accurate and superior to the commonly used naïve estimation by simulation studies. Further implementation of this Bayesian model could serve as a useful tool to indicate the co-existence of antimicrobial resistance, and potentially a need of clinical intervention.


Assuntos
Antibacterianos , Farmacorresistência Bacteriana , Animais , Antibacterianos/farmacologia , Teorema de Bayes , Humanos , Testes de Sensibilidade Microbiana
9.
BMC Vet Res ; 16(1): 416, 2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33138811

RESUMO

BACKGROUND: Food animal veterinarians face commodity specific and urgent global challenges yet conditions preventing use of best available knowledge have been sparsely studied. The American Association of Swine Veterinarians (AASV) membership (N = 1289) was surveyed online to benchmark their information priorities and their motivations and sources for keeping current with infectious disease research, and to describe their reported time, skill, access, and process as barriers to knowledge translation (KT). RESULTS: Respondents (n = 80) were mostly from Canada (n = 40) and the U.S.A (n = 31) and demographics approximated the AASV's. Colleagues are the first choice for information on difficult cases (49%, 95%CI: 38-61). Half of respondents (53%, 95%CI: 41-64) spend an hour or less per week keeping up with infectious disease research. The majority reported moderate or less than moderate efficiency (62%, 95%CI: 51-72), and moderate or greater stress (59%, 95%CI: 48-70) with their process for keeping up. Journal article methods sections are commonly not read, almost a third (32%, 95% CI: 22-43) reported either they do not evaluate statistical methods or that they had poor confidence to do so, and half (52, 95%CI: 41-63) could not explain 'confounding bias'. Approximately half (55%, 95%CI: 41-69) with direct oversight of swine herds had full access to 2 or fewer academic journals. Approximately a third of respondents (34%, 95%CI: 24-46) selected only formats involving single research studies (either full text or summaries) as preferred reading materials for keeping current over expert summaries of the body of evidence. CONCLUSION: KT barriers are considerable and a source of stress for many swine veterinarians. Sub-optimal efficiency with keeping up and low confidence to appraise aspects of research are concerns. Results are consistent with previous literature and illustrate need for improved KT infrastructure and for additional training in statistical methods and interpretation of primary research. Further evaluation is warranted of why approximately a third of veterinarians in this study, for the purpose of keeping up, preferentially choose to review individual research studies over choices that would include an expert summary of the body of evidence. Consideration of reasons for this preference will be important in the planning of KT infrastructure improvements.


Assuntos
Medicina Baseada em Evidências/métodos , Doenças dos Suínos , Pesquisa Translacional Biomédica , Médicos Veterinários/estatística & dados numéricos , Animais , Doenças Transmissíveis/veterinária , Humanos , Publicações Periódicas como Assunto , Inquéritos e Questionários , Suínos , Médicos Veterinários/psicologia , Medicina Veterinária/métodos
10.
J Dairy Sci ; 102(6): 4759-4771, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31005322

RESUMO

Reproducibility is an essential element of the scientific process, and it requires clear and complete reporting of study design, conduct, and analysis. In the human and animal health literature, incomplete reporting is associated with biased effect estimates. Moreover, incomplete reporting precludes knowledge synthesis and undervalues the resources allocated to the primary research. The Reporting Guidelines for Randomized Controlled Trials for Livestock and Food Safety (REFLECT) statement, published in 2010, is a checklist developed by expert consensus to provide guidance on what study elements should be reported in any intervention trial (designed experiment) involving livestock. The Journal of Dairy Science (JDS) has recently endorsed the use of reporting guidelines. To assess the status of reporting of controlled experiments in JDS and to provide a baseline for future comparison, we evaluated the reporting of 18 items from the REFLECT statement checklist in a sample of 137 controlled trials published in JDS in 2017. Two reviewers independently screened titles and abstracts for relevance and then evaluated a sample of 120 papers reporting controlled trials (experimental studies involving at least one intervention and one comparison or control group), using yes or no questions. Although some items, such as treatment details and statistical analysis, were well reported, other areas, including sample size justification, allocation concealment, blinding, study flow, baseline data, and ancillary analyses, were often not reported or were incompletely described. This work highlights the need for authors and reviewers to take advantage of guidelines and checklists for reporting. Adherence to reporting guidelines can help improve the completeness of reporting of research, expedite and better inform the peer-review process, increase clarity for the reader, and allow for knowledge synthesis, such as meta-analysis, all of which serve to increase the value of the work conducted.


Assuntos
Ensaios Clínicos Veterinários como Assunto , Políticas Editoriais , Guias como Assunto , Animais , Estudos Transversais , Projetos de Pesquisa , Relatório de Pesquisa/normas
11.
Risk Anal ; 39(10): 2237-2258, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31039285

RESUMO

The inclusion of deep tissue lymph nodes (DTLNs) or nonvisceral lymph nodes contaminated with Salmonella in wholesale fresh ground pork (WFGP) production may pose risks to public health. To assess the relative contribution of DTLNs to human salmonellosis occurrence associated with ground pork consumption and to investigate potential critical control points in the slaughter-to-table continuum for the control of human salmonellosis in the United States, a quantitative microbial risk assessment (QMRA) model was established. The model predicted an average of 45 cases of salmonellosis (95% CI = [19, 71]) per 100,000 Americans annually due to WFGP consumption. Sensitivity analysis of all stochastic input variables showed that cooking temperature was the most influential parameter for reducing salmonellosis cases associated with WFGP meals, followed by storage temperature and Salmonella concentration on contaminated carcass surface before fabrication. The input variables were grouped to represent three main factors along the slaughter-to-table chain influencing Salmonella doses ingested via WFGP meals: DTLN-related factors, factors at processing other than DTLNs, and consumer-related factors. The evaluation of the impact of each group of factors by second-order Monte Carlo simulation showed that DTLN-related factors had the lowest impact on the risk estimate among the three groups of factors. These findings indicate that interventions to reduce Salmonella contamination in DTLNs or to remove DTLNs from WFGP products may be less critical for reducing human infections attributable to ground pork than improving consumers' cooking habits or interventions of carcass decontamination at processing.


Assuntos
Linfonodos/microbiologia , Carne Vermelha/microbiologia , Intoxicação Alimentar por Salmonella/epidemiologia , Infecções por Salmonella/epidemiologia , Salmonella/isolamento & purificação , Animais , Humanos , Medição de Risco , Intoxicação Alimentar por Salmonella/prevenção & controle , Suínos
12.
BMC Vet Res ; 13(1): 314, 2017 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-29115951

RESUMO

A round table discussion was held during the LAVA-ESLAV-ECLAM conference on Reproducibility of Animal Studies on the 25th of September 2017 in Edinburgh. The aim of the round table was to discuss how to enhance the rate at which the quality of reporting animal research can be improved. This signed statement acknowledges the efforts that participant organizations have made towards improving the reporting of animal studies and confirms an ongoing commitment to drive further improvements, calling upon both academics and laboratory animal veterinarians to help make this cultural change.


Assuntos
Experimentação Animal/normas , Animais , Disseminação de Informação , Melhoria de Qualidade , Reprodutibilidade dos Testes , Projetos de Pesquisa/normas
13.
Nephrol Nurs J ; 43(6): 463-493, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-30550076

RESUMO

Patients with advanced chronic kidney disease (CKD) face many choices regarding future dialysis modalities. Decision-making is difficult for patients. The objective of this study was to describe the decision-making needs from the perspectives of patients with advanced CKD, professionals, and others involved in the decision. Guided by a shared decision-making model, this qualitative study was conducted using interviews with key informants (17 patients, two peer helpers, and eight health professionals) and a focus group (five nurses). The results revealed evolving decisional needs in five-stage through the decision making journey: 1) Progress toward acceptance of dialysis, 2) Receive information, 3) Take some time for personal reflection, 4) Seek opinion and support of other, and 5) Re-evaluate one's choice. As we anticipate decisional needs, we will be able to develop decision support interventions that are stage-matched.


Assuntos
Tomada de Decisões , Processo de Enfermagem , Diálise Renal , Insuficiência Renal Crônica/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Enfermagem em Nefrologia , Insuficiência Renal Crônica/enfermagem , Adulto Jovem
14.
Vet Ophthalmol ; 18(2): 147-51, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24674456

RESUMO

OBJECTIVE: To describe Schirmer tear test I and rebound tonometry findings in healthy bovine calves. ANIMALS STUDIED: Thirty-three clinically normal dairy breed calves of mean (SD) 11 (1.1) weeks (range, 9.3-13.3 weeks) of age were evaluated. PROCEDURES: A Schirmer tear test I was performed on each eye followed by tonometry, using a TonoVet(®) without topical anesthesia. We report means (SD) and statistical analysis of data for each assay. RESULTS: For both Schirmer tear test (STT) I and tonometry, significant differences were not found between fellow eyes (P = 0.1536 and P = 0.83, respectively). The mean (SD) STT I value of all eyes was 20.4 (5.0) mm/min (range, 9-34 mm/min) while the mean (SD) intraocular pressure (IOP) value of all eyes was 15.2 (5.2) mmHg (range, 7-25 mmHg). CONCLUSIONS: This study reports normal data for the STT I and rebound tonometry in calves. This data may be useful in complete ophthalmic examinations of cattle, guiding diagnosis of glaucoma, uveitis, and keratoconjunctivitis sicca. However, results of these diagnostic modalities must be interpreted in light of clinical signs, given the wide range of normal values obtained in this study.


Assuntos
Bovinos/fisiologia , Lágrimas/metabolismo , Tonometria Ocular/veterinária , Animais , Feminino , Masculino
15.
BMC Musculoskelet Disord ; 15: 54, 2014 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-24564877

RESUMO

BACKGROUND: To evaluate feasibility and potential effectiveness of a patient decision aid (PtDA) for patients and a preference report for surgeons to reduce wait times and improve decision quality in patients with osteoarthritis considering total knee replacement. METHODS: A prospective two-arm pilot randomized controlled trial. Patients with osteoarthritis were eligible if they understood English and were referred for surgical consultation about an initial total knee arthroplasty at a Canadian orthopaedic joint assessment clinic. Patients were randomized to the PtDA intervention or usual education. The intervention was an osteoarthritis PtDA for patients and a one-page preference report summarizing patients' clinical and decisional data for their surgeon. The main feasibility outcomes were rates of recruitment and questionnaire completion; the preliminary effectiveness outcomes were wait times and decision quality. RESULTS: Of 180 patients eligible for surgical consultation, 142 (79%) were recruited and randomized to the PtDA intervention (n = 71) or usual education (n = 71). Data collection yielded a 93% questionnaire completion rate with less than 1% missing items. After one year, 13% of patients remained on the surgical wait list. The median time from referral to being off the wait list (censored using survival analysis techniques) was 33.4 weeks for the PtDA group (n = 69, 95% CI: 26.0, 41.4) and 33.0 weeks for usual education (n = 71, 95% CI: 26.1, 39.9). Patients exposed to the PtDA had higher decision quality based on knowledge (71% versus 47%; p < 0.0001) and quality decision being an informed choice that is consistent with their values for option outcomes (56.4% versus 25.0%; p < 0.001). CONCLUSIONS: Recruitment of patients with osteoarthritis considering surgery and data collection were feasible. As some patients remained on the surgical waiting list after one year, follow-up should be extended to two years. Patients exposed to the PtDA achieved higher decision quality compared to those receiving usual education but there was no difference in wait for surgery. TRIALS REGISTRATION: ClinicalTrials.Gov NCT00743951.


Assuntos
Artroplastia do Joelho , Técnicas de Apoio para a Decisão , Osteoartrite do Joelho/cirurgia , Educação de Pacientes como Assunto , Preferência do Paciente , Listas de Espera , Idoso , Artroplastia do Joelho/psicologia , Comportamento de Escolha , Estudos de Viabilidade , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/complicações , Osteoartrite do Joelho/psicologia , Folhetos , Participação do Paciente , Projetos Piloto , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Encaminhamento e Consulta , Inquéritos e Questionários , Materiais de Ensino , Centros de Atenção Terciária , Gravação em Vídeo
16.
BMC Med Inform Decis Mak ; 14: 112, 2014 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-25495552

RESUMO

BACKGROUND: Over 100 trials show that patient decision aids effectively improve patients' information comprehension and values-based decision making. However, gaps remain in our understanding of several fundamental and applied questions, particularly related to the design of interactive, personalized decision aids. This paper describes an interdisciplinary development process for, and early field testing of, a web-based patient decision support research platform, or virtual decision lab, to address these questions. METHODS: An interdisciplinary stakeholder panel designed the web-based research platform with three components: a) an introduction to shared decision making, b) a web-based patient decision aid, and c) interactive data collection items. Iterative focus groups provided feedback on paper drafts and online prototypes. A field test assessed a) feasibility for using the research platform, in terms of recruitment, usage, and acceptability; and b) feasibility of using the web-based decision aid component, compared to performance of a videobooklet decision aid in clinical care. RESULTS: This interdisciplinary, theory-based, patient-centered design approach produced a prototype for field-testing in six months. Participants (n = 126) reported that: the decision aid component was easy to use (98%), information was clear (90%), the length was appropriate (100%), it was appropriately detailed (90%), and it held their interest (97%). They spent a mean of 36 minutes using the decision aid and 100% preferred using their home/library computer. Participants scored a mean of 75% correct on the Decision Quality, Knowledge Subscale, and 74 out of 100 on the Preparation for Decision Making Scale. Completing the web-based decision aid reduced mean Decisional Conflict scores from 31.1 to 19.5 (p < 0.01). CONCLUSIONS: Combining decision science and health informatics approaches facilitated rapid development of a web-based patient decision support research platform that was feasible for use in research studies in terms of recruitment, acceptability, and usage. Within this platform, the web-based decision aid component performed comparably with the videobooklet decision aid used in clinical practice. Future studies may use this interactive research platform to study patients' decision making processes in real-time, explore interdisciplinary approaches to designing web-based decision aids, and test strategies for tailoring decision support to meet patients' needs and preferences.


Assuntos
Informação de Saúde ao Consumidor/métodos , Técnicas de Apoio para a Decisão , Osteoartrite do Joelho/terapia , Preferência do Paciente , Assistência Centrada no Paciente/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Sistemas de Apoio a Decisões Clínicas , Estudos de Viabilidade , Feminino , Humanos , Internet , Masculino , Informática Médica/métodos , Pessoa de Meia-Idade , New Hampshire , Osteoartrite do Joelho/psicologia , Interface Usuário-Computador , Adulto Jovem
17.
Vet Ophthalmol ; 17(4): 305-8, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24674385

RESUMO

OBJECTIVE: To evaluate corneal sensitivity as measured by the corneal touch threshold in healthy bovine calves. ANIMALS STUDIED: Twelve clinically normal male calves with predominantly Holstein genetics and a median age of 76.5 days (range, 67-92 days). PROCEDURES: Corneal touch threshold (CTT) of the central cornea was measured in both eyes of each calf using a Cochet-Bonnet aesthesiometer. RESULTS: The mean ± standard deviation corneal touch threshold of all eyes was 1.33 ± 1.1 g/mm(2) (range, 0.62-66.15 g/mm(2) ), corresponding to a filament length of 34.56 ± 8.02 mm (range, 14-47.5 mm). There was no significant difference between fellow eyes. CONCLUSIONS: Cochet-Bonnet aesthesiometry was well tolerated in all 12 calves using a modified head restraint. Calves in this study may have a relatively sensitive central cornea compared to adult cattle and some other species; however, wide variation among individuals and eyes may be possible. Studies utilizing larger calf populations are necessary to establish reference ranges.


Assuntos
Bovinos/fisiologia , Córnea/fisiologia , Tato/fisiologia , Animais , Masculino
18.
Syst Rev ; 13(1): 128, 2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38725074

RESUMO

BACKGROUND: Binary outcomes are likely the most common in randomized controlled trials, but ordinal outcomes can also be of interest. For example, rather than simply collecting data on diseased versus healthy study subjects, investigators may collect information on the severity of disease, with no disease, mild, moderate, and severe disease as possible levels of the outcome. While some investigators may be interested in all levels of the ordinal variable, others may combine levels that are not of particular interest. Therefore, when research synthesizers subsequently conduct a network meta-analysis on a network of trials for which an ordinal outcome was measured, they may encounter a network in which outcome categorization varies across trials. METHODS: The standard method for network meta-analysis for an ordinal outcome based on a multinomial generalized linear model is not designed to accommodate the multiple outcome categorizations that might occur across trials. In this paper, we propose a network meta-analysis model for an ordinal outcome that allows for multiple categorizations. The proposed model incorporates the partial information provided by trials that combine levels through modification of the multinomial likelihoods of the affected arms, allowing for all available data to be considered in estimation of the comparative effect parameters. A Bayesian fixed effect model is used throughout, where the ordinality of the outcome is accounted for through the use of the adjacent-categories logit link. RESULTS: We illustrate the method by analyzing a real network of trials on the use of antibiotics aimed at preventing liver abscesses in beef cattle and explore properties of the estimates of the comparative effect parameters through simulation. We find that even with the categorization of the levels varying across trials, the magnitudes of the biases are relatively small and that under a large sample size, the root mean square errors become small as well. CONCLUSIONS: Our proposed method to conduct a network meta-analysis for an ordinal outcome when the categorization of the outcome varies across trials, which utilizes the adjacent-categories logit link, performs well in estimation. Because the method considers all available data in a single estimation, it will be particularly useful to research synthesizers when the network of interest has only a limited number of trials for each categorization of the outcome.


Assuntos
Metanálise em Rede , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Avaliação de Resultados em Cuidados de Saúde , Modelos Estatísticos
19.
Front Vet Sci ; 11: 1442308, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39144077

RESUMO

This manuscript summarizes a presentation delivered by the first author at the 2024 symposium for the Calvin Schwabe Award for Lifetime Achievement in Veterinary Epidemiology and Preventive Medicine, which was awarded to Dr. Jan Sargeant. Epidemiologic research plays a crucial role in understanding the complex relationships between exposures and health outcomes. However, the accuracy of the conclusions drawn from these investigations relies upon the meticulous selection and measurement of exposure variables. Appropriate exposure variable selection is crucial for understanding disease etiologies, but it is often the case that we are not able to directly measure the exposure variable of interest and use proxy measures to assess exposures instead. Inappropriate use of proxy measures can lead to erroneous conclusions being made about the true exposure of interest. These errors may lead to biased estimates of associations between exposures and outcomes. The consequences of such biases extend beyond research concerns as health decisions can be made based on flawed evidence. Recognizing and mitigating these biases are essential for producing reliable evidence that informs health policies and interventions, ultimately contributing to improved population health outcomes. To address these challenges, researchers must adopt rigorous methodologies for exposure variable selection and validation studies to minimize measurement errors.

20.
Front Vet Sci ; 11: 1402981, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38835899

RESUMO

This study summarizes a presentation at the symposium for the Calvin Schwabe Award for Lifetime Achievement in Veterinary Epidemiology and Preventive Medicine, which was awarded to the first author. As epidemiologists, we are taught that "correlation does not imply causation." While true, identifying causes is a key objective for much of the research that we conduct. There is empirical evidence that veterinary epidemiologists are conducting observational research with the intent to identify causes; many studies include control for confounding variables, and causal language is often used when interpreting study results. Frameworks for studying causes include the articulation of specific hypotheses to be tested, approaches for the selection of variables, methods for statistical estimation of the relationship between the exposure and the outcome, and interpretation of that relationship as causal. When comparing observational studies in veterinary populations to those conducted in human populations, the application of each of these steps differs substantially. The a priori identification of exposure-outcome pairs of interest are less common in observational studies in the veterinary literature compared to the human literature, and prior knowledge is used to select confounding variables in most observational studies in human populations, whereas data-driven approaches are the norm in veterinary populations. The consequences of not having a defined exposure-outcome hypotheses of interest and using data-driven analytical approaches include an increased probability of biased results and poor replicability of results. A discussion by the community of researchers on current approaches to studying causes in observational studies in veterinary populations is warranted.

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