8 research outputs found
'Damage control orthopaedics' in patients with delayed referral to a tertiary care center: experience from a place where Composite Trauma Centers do not exist
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Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study
Get PDFOBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally
A methodological checklist for fMRI drug cue reactivity studies:development and expert consensus
No full textCue reactivity measured by functional magnetic resonance imaging is used in studies of substance-use disorders. This Consensus Statement is the result of a Delphi process to arrive at parameters that should be reported in describing these studies. Cue reactivity is one of the most frequently used paradigms in functional magnetic resonance imaging (fMRI) studies of substance use disorders (SUDs). Although there have been promising results elucidating the neurocognitive mechanisms of SUDs and SUD treatments, the interpretability and reproducibility of these studies is limited by incomplete reporting of participants characteristics, task design, craving assessment, scanning preparation and analysis decisions in fMRI drug cue reactivity (FDCR) experiments. This hampers clinical translation, not least because systematic review and meta-analysis of published work are difficult. This consensus paper and Delphi study aims to outline the important methodological aspects of FDCR research, present structured recommendations for more comprehensive methods reporting and review the FDCR literature to assess the reporting of items that are deemed important. Forty-five FDCR scientists from around the world participated in this study. First, an initial checklist of items deemed important in FDCR studies was developed by several members of the Enhanced NeuroImaging Genetics through Meta-Analyses (ENIGMA) Addiction working group on the basis of a systematic review. Using a modified Delphi consensus method, all experts were asked to comment on, revise or add items to the initial checklist, and then to rate the importance of each item in subsequent rounds. The reporting status of the items in the final checklist was investigated in 108 recently published FDCR studies identified through a systematic review. By the final round, 38 items reached the consensus threshold and were classified under seven major categories: Participants Characteristics, General fMRI Information, General Task Information, Cue Information, Craving Assessment Inside Scanner, Craving Assessment Outside Scanner and Pre- and Post-Scanning Considerations. The review of the 108 FDCR papers revealed significant gaps in the reporting of the items considered important by the experts. For instance, whereas items in the General fMRI Information category were reported in 90.5% of the reviewed papers, items in the Pre- and Post-Scanning Considerations category were reported by only 44.7% of reviewed FDCR studies. Considering the notable and sometimes unexpected gaps in the reporting of items deemed to be important by experts in any FDCR study, the protocols could benefit from the adoption of reporting standards. This checklist, a living document to be updated as the field and its methods advance, can help improve experimental design, reporting and the widespread understanding of the FDCR protocols. This checklist can also provide a sample for developing consensus statements for protocols in other areas of task-based fMRI.Funding Agencies|National Institute on Alcohol Abuse and Alcoholism (NIAAA)United States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute on Alcohol Abuse & Alcoholism (NIAAA) [P50 AA010761]; Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)German Research Foundation (DFG) [402170461-TRR 265, 40217046-TRR 265, 421888313, 437718741, 324164820]; DFGGerman Research Foundation (DFG)European Commission [402170461 - TRR 265]; California Tobacco-Related Disease Research Grant Program of the University of California [T30IP0962]; Laureate Institute for Brain Research (LIBR); Warren K. Family Foundation; Oklahoma Center for Advancement of Science and Technologies (OCAST) [HR18-139]; Brain and Behavior Foundation (NARSAD Young Investigator Award) [27305]; National Institute on Drug Abuse (NIDA)United States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute on Drug Abuse (NIDA) [R01 DA030344, R21DA044465]; NIDAUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute on Drug Abuse (NIDA) [R01DA041528, R01DA048301, R01DA047851, K23DA042898, K12 DA000167, U01 DA041089, U24 DA041147, P30 DA048742]; NCCIH [R01AT010627]; NIAAAUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute on Alcohol Abuse & Alcoholism (NIAAA) [F32AA027699, R01 AA027765, R01 AA026859, U01 AA021692, U24 AA021695, R01AA023665, R01AA022328]; NIHUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [R01DA039135, K02DA042987, R01 DA041866, R01AA026844, K08AA023545, K23AA023894, R01DA040670, R21HL144673, R01DA041438, R21DA045853]; Bundesministerium fur Bildung und ForschungFederal Ministry of Education & Research (BMBF) [FKZ: 01ZX1503, 01ZX1909B]; Shanghai Municipal Science and Technology Major project [2019SHZDZX02]; Eli Lilly Canada Chair on schizophrenia researchEli Lilly; Australian Medical Research Future FundMedical Research Future Fund (MRFF) [MRF1141214]; National Natural Science Foundation of ChinaNational Natural Science Foundation of China (NSFC) [81871426]</p
A methodological checklist for fMRI drug cue reactivity studies : development and expert consensus
No full textCue reactivity measured by functional magnetic resonance imaging is used in studies of substance-use disorders. This Consensus Statement is the result of a Delphi process to arrive at parameters that should be reported in describing these studies. Cue reactivity is one of the most frequently used paradigms in functional magnetic resonance imaging (fMRI) studies of substance use disorders (SUDs). Although there have been promising results elucidating the neurocognitive mechanisms of SUDs and SUD treatments, the interpretability and reproducibility of these studies is limited by incomplete reporting of participants characteristics, task design, craving assessment, scanning preparation and analysis decisions in fMRI drug cue reactivity (FDCR) experiments. This hampers clinical translation, not least because systematic review and meta-analysis of published work are difficult. This consensus paper and Delphi study aims to outline the important methodological aspects of FDCR research, present structured recommendations for more comprehensive methods reporting and review the FDCR literature to assess the reporting of items that are deemed important. Forty-five FDCR scientists from around the world participated in this study. First, an initial checklist of items deemed important in FDCR studies was developed by several members of the Enhanced NeuroImaging Genetics through Meta-Analyses (ENIGMA) Addiction working group on the basis of a systematic review. Using a modified Delphi consensus method, all experts were asked to comment on, revise or add items to the initial checklist, and then to rate the importance of each item in subsequent rounds. The reporting status of the items in the final checklist was investigated in 108 recently published FDCR studies identified through a systematic review. By the final round, 38 items reached the consensus threshold and were classified under seven major categories: Participants Characteristics, General fMRI Information, General Task Information, Cue Information, Craving Assessment Inside Scanner, Craving Assessment Outside Scanner and Pre- and Post-Scanning Considerations. The review of the 108 FDCR papers revealed significant gaps in the reporting of the items considered important by the experts. For instance, whereas items in the General fMRI Information category were reported in 90.5% of the reviewed papers, items in the Pre- and Post-Scanning Considerations category were reported by only 44.7% of reviewed FDCR studies. Considering the notable and sometimes unexpected gaps in the reporting of items deemed to be important by experts in any FDCR study, the protocols could benefit from the adoption of reporting standards. This checklist, a living document to be updated as the field and its methods advance, can help improve experimental design, reporting and the widespread understanding of the FDCR protocols. This checklist can also provide a sample for developing consensus statements for protocols in other areas of task-based fMRI.Funding Agencies|National Institute on Alcohol Abuse and Alcoholism (NIAAA)United States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute on Alcohol Abuse & Alcoholism (NIAAA) [P50 AA010761]; Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)German Research Foundation (DFG) [402170461-TRR 265, 40217046-TRR 265, 421888313, 437718741, 324164820]; DFGGerman Research Foundation (DFG)European Commission [402170461 - TRR 265]; California Tobacco-Related Disease Research Grant Program of the University of California [T30IP0962]; Laureate Institute for Brain Research (LIBR); Warren K. Family Foundation; Oklahoma Center for Advancement of Science and Technologies (OCAST) [HR18-139]; Brain and Behavior Foundation (NARSAD Young Investigator Award) [27305]; National Institute on Drug Abuse (NIDA)United States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute on Drug Abuse (NIDA) [R01 DA030344, R21DA044465]; NIDAUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute on Drug Abuse (NIDA) [R01DA041528, R01DA048301, R01DA047851, K23DA042898, K12 DA000167, U01 DA041089, U24 DA041147, P30 DA048742]; NCCIH [R01AT010627]; NIAAAUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute on Alcohol Abuse & Alcoholism (NIAAA) [F32AA027699, R01 AA027765, R01 AA026859, U01 AA021692, U24 AA021695, R01AA023665, R01AA022328]; NIHUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [R01DA039135, K02DA042987, R01 DA041866, R01AA026844, K08AA023545, K23AA023894, R01DA040670, R21HL144673, R01DA041438, R21DA045853]; Bundesministerium fur Bildung und ForschungFederal Ministry of Education & Research (BMBF) [FKZ: 01ZX1503, 01ZX1909B]; Shanghai Municipal Science and Technology Major project [2019SHZDZX02]; Eli Lilly Canada Chair on schizophrenia researchEli Lilly; Australian Medical Research Future FundMedical Research Future Fund (MRFF) [MRF1141214]; National Natural Science Foundation of ChinaNational Natural Science Foundation of China (NSFC) [81871426]</p
