Is “Health on The Net” Certification a Reliable Indicator of Quality? A Meta-Analysis of Romanian English Language Medical Websites

Background: Health on the Net (HON) promotes access to reliable medical information. The study aimed to investigate the prevalence of HON certification and whether it is associated with the quality of informational content. Methods: The study included the results of 21 researches conducted between 2018-2021 about the quality of online medical information (1040 Romanian and English language webpages). HON certification was assessed using the HONcode toolbar application. Completeness and accuracy scores were extracted from previous research. The frequency of certification and compliance with individual HON principles was calculated. Associations between HON certification and information quality scores (completeness and accuracy) were tested using the student t-test. The threshold for statistical significance was set at 0.05. Results: Health on the Net certification was present on 1.1% and 21.6% of the Romanian and English websites, respectively. Compliance with the HON principles varied between 9.7% and 82.7% of Romanian-language websites and between 35.6% and 88.5% of English-language ones. The principle with the highest compliance was transparency regarding the texts' authors in both languages. The minimum compliance was with the principle of displaying the date of the last update in the case of Romanian-language websites and of attributing sources in the case of English-language websites. Association tests between HON certification and information quality showed the following results: HON certification vs. completeness p=0.201 for the Romanian subsample and p<0.0001 for the English-language subsample; HON certification vs. accuracy p=0.018 for the Romanian subsample and p=0.886 for the English-language subsample. Conclusions: Health on the Net certification of Romanian-language sites was almost absent, while English-language websites had relatively higher, but still low certification rates. HON certification was associated with content accuracy for Romanian-language websites and with the completeness of information for English-language sites. If subsequent research confirms the results of this meta-analysis, users should reconsider their reliance on HON certification

Sarcopenia és életminőség: a Sarcopenia Quality of Life (SarQoL) kérdőív hiteles magyar fordítása = Sarcopenia and quality of life: the validated Hungarian translation of the Sarcopenia Quality of Life (SarQoL) questionnaire

Absztrakt: Bevezetés: A sarcopenia, vagy időskori izomerő- és izomtömeg-csökkenés, napjaink komoly népegészségtani problémája. A betegséggel járó csökkent fizikai teljesítőképesség miatt az érintettek életminősége bizonyíthatóan romlik. Az általános életminőséget mérő skálák, mint a Rand Corporation Short Form 36 (SF-36) vagy a European Quality of Life (EuroQoL-5D) kérdőív nem mérik, és így nem mutatják ki a sarcopenia – életminőségre kifejtett – speciális hatását. A Sarcopenia Quality of Life (SarQoL – sarcopenia és életminőség) az első kimondottan erre a betegségre vonatkozó kérdőív, amelyet nemrég abból a célból fejlesztettek ki, hogy átfogó képet nyújtson a 65 évesnél idősebb sarcopeniás személyek életminőségéről. Célkitűzés: Az eredeti SarQoL kérdőív magyar nyelvű, érvényes változatának kifejlesztése volt a célunk, annak fordítása, kultúrközi adaptációja és magyar nyelvi validálása révén. Módszer: A fordításhoz az ajánlott nemzetközi protokollt követtük, ennek öt lépése: két külön magyar fordítás, a két változat szintézise, visszafordítása angol nyelvre, az eredeti és a visszafordított változatok szakértői csoport általi összevetése, előtesztelés. A magyar nyersfordítást 20 különböző iskolázottságú és társadalmi hátterű vizsgált személy (10 klinikailag sarcopeniásként kórismézett és 10 nem sarcopeniás) töltötte ki. Minden személynél felmértük a kérdések érthetőségét, a válaszadáskor adódó esetleges nehézségeket. Eredmények: Az eredeti kérdőív szerzői által a fordításhoz előírt módszertan elvárásai szerint a végső változat az eredetivel mind tartalmilag, mind pontosságában megegyezett. A SarQoL kérdőívet kifejlesztő munkacsoport a magyar változatot közérthetőnek, feladatára alkalmasnak, hitelesnek találta. Következtetés: A klinikai jellemzők alapján kórismézett sarcopeniás személyek által kitöltött kérdőív a hazai tartalmi hitelesítést követően hasznos és szükséges életminőség-értékelő eszközként áll majd a sarcopeniás magyar betegek rendelkezésére. Orv Hetil. 2018; 159(36): 1483–1486. | Abstract: Introduction: Sarcopenia, or age-related muscle loss, is emerging as a serious public health concern. Due to the impaired physical performance associated with sarcopenia, a reduced quality of life (QoL) has been evidenced in the affected individuals. Generic instruments, such as Rand Corporation Short Form 36 (SF-36) or the European Quality of Life (EuroQoL-5D) questionnaires do not accurately assess the impact of sarcopenia on QoL. SarQoL (Sarcopenia Quality of Life) questionnaire, was the first disease-specific questionnaire addressing the quality of life in patients with sarcopenia and has been recently designed for providing a global assessment of the quality of life in community-dwelling elderly subjects aged 65 years and older. Aim: Our aim was the development of a valid Hungarian version of the original SarQoL, through the translation, cultural adaptation and content validation of the original questionnaire. Method: We followed the recommended process, the international protocol of translation in five steps: two initial translations, synthesis of the two translations, backward translation, expert committee to compare translations with the original questionnaire and pretest. The pretest process involved 20 subjects (10 clinically sarcopenic and 10 non-sarcopenic with different educational and socioeconomic backgrounds) who were asked to complete the questionnaire. Feedbacks were requested from all subjects regarding the comprehensibility of questions or difficulties in completing the test. Results: Using the recommended best practice protocol for translation, the pre-final version is comparable with the original instrument in terms of content and accuracy. Conclusion: After the content validation with clinically sarcopenic persons it should be a useful tool to assess the quality of life of people with sarcopenia among elderly Hungarian patients. Orv Hetil. 2018; 159(36): 1483–1486

Systematic Literature Review of Economic Evaluations of Treatment Alternatives in Chronic Lymphocytic Leukemia

BackgroundEconomic evaluations are widely used to predict the economic impact of new treatment alternatives. Comprehensive economic reviews in the field of chronic lymphocytic leukemia (CLL) are warranted to supplement the existing analyses focused on specific therapeutic areas.MethodsA systematic literature review was conducted based on literature searches in Medline and EMBASE to summarize the published health economics models related to all types of CLL therapies. Narrative synthesis of relevant studies was performed focusing on compared treatments, patient populations, modelling approaches and key findings.ResultsWe included 29 studies, the majority of which were published between 2016 and 2018, when data from large clinical trials in CLL became available. Treatment regimens were compared in 25 cases, while the remaining four studies considered treatment strategies with more complex patient pathways. Based on the review results, Markov modelling with a simple structure of three health states (progression-free, progressed, death) can be considered as the traditional basis to simulate cost effectiveness. However, more recent studies added further complexity, including additional health states for different therapies (e.g. best supportive care or stem cell transplantation), for progression-free state (e.g. by differentiating between with or without treatment), or for response status (i.e. partial response and complete response).ConclusionsAs personalized medicine is increasingly gaining recognition, we expect that future economic evaluations will also incorporate new solutions, which are necessary to capture a larger number of genetic and molecular markers and more complex patient pathways with individual patient-level allocation of treatment options and thus economic assessments.Peer reviewe

A reference case for economic evaluations in osteoarthritis: An expert consensus article from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)

Background: General recommendations for a reference case for economic studies in rheumatic diseases were published in 2002 in an initiative to improve the comparability of cost-effectiveness studies in the field. Since then, economic evaluations in osteoarthritis (OA) continue to show considerable heterogeneity in methodological approach. Objectives: To develop a reference case specific for economic studies in OA, including the standard optimal care, with which to judge new pharmacologic and non-pharmacologic interventions. Methods: Four subgroups of an ESCEO expert working group on economic assessments (13 experts representing diverse aspects of clinical research and/or economic evaluations) were charged with producing lists of recommendations that would potentially improve the comparability of economic analyses in OA: outcome measures, comparators, costs and methodology. These proposals were discussed and refined during a face-to-face meeting in 2013. They are presented here in the format of the recommendations of the recently published Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, so that an initiative on economic analysis methodology might be consolidated with an initiative on reporting standards. Results: Overall, three distinct reference cases are proposed, one for each hand, knee and hip OA; with diagnostic variations in the first two, giving rise to different treatment options: interphalangeal or thumb-based disease for hand OA and the presence or absence of joint malalignment for knee OA. A set of management strategies is proposed, which should be further evaluated to help establish a consensus on the "standard optimal care" in each proposed reference case. The recommendations on outcome measures, cost itemisation and methodological approaches are also provided. Conclusions: The ESCEO group proposes a set of disease-specific recommendations on the conduct and reporting of economic evaluations in OA that could help the standardisation and comparability of studies that evaluate therapeutic strategies of OA in terms of costs and effectiveness

Quality of life in sarcopenia measured with the SarQoL questionnaire: A meta-analysis of individual patient data.

peer reviewedAge-related sarcopenia, resulting from a gradual loss in skeletal muscle mass and strength, is pivotal to the increased prevalence of functional limitation among the older adult community. The purpose of this meta-analysis of individual patient data is to investigate the difference in health-related quality of life between sarcopenic individuals and those without the condition using the Sarcopenia Quality of Life (SarQoL) questionnaire. A protocol was published on PROSPERO. Multiple databases and the grey literature were searched until March 2023 for studies reporting quality of life assessed with the SarQoL for patients with and without sarcopenia. Two researchers conducted the systematic review independently. A two-stage meta-analysis was performed. First, crude (mean difference) and adjusted (beta coefficient) effect sizes were calculated within each database; then, a random effect meta-analysis was applied to pool them. Heterogeneity was measured using the Q-test and I2 value. Subgroup analyses were performed to investigate the source of potential heterogeneity. The strength of evidence of this association was assessed using GRADE. From the 413 studies identified, 32 were eventually included, of which 10 were unpublished data studies. Sarcopenic participants displayed significantly reduced health-related quality of life compared with non-sarcopenic individuals (mean difference = -12.32; 95 % CI = [-15.27; -9.37]). The model revealed significant heterogeneity. Subgroup analyses revealed a substantial impact of regions, clinical settings, and diagnostic criteria on the difference in health-related quality of life between sarcopenic and non-sarcopenic individuals. The level of evidence was moderate. This meta-analysis of individual patient data suggested that sarcopenia is associated with lower health-related quality of life measured with SarQoL

Algorithm for the use of biochemical markers of bone turnover in the diagnosis, assessment and follow-up of treatment for osteoporosis

Introduction Increased biochemical bone turnover markers (BTMs) measured in serum are associated with bone loss, increased fracture risk and poor treatment adherence, but their role in clinical practice is presently unclear. The aim of this consensus group report is to provide guidance to clinicians on how to use BTMs in patient evaluation in postmenopausal osteoporosis, in fracture risk prediction and in the monitoring of treatment efficacy and adherence to osteoporosis medication. Methods A working group with clinical scientists and osteoporosis specialists was invited by the Scientific Advisory Board of European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Results Serum bone formation marker PINP and resorption marker βCTX-I are the preferred markers for evaluating bone turnover in the clinical setting due to their specificity to bone, performance in clinical studies, wide use and relatively low analytical variability. BTMs cannot be used to diagnose osteoporosis because of low sensitivity and specificity, but can be of value in patient evaluation where high values may indicate the need to investigate some causes of secondary osteoporosis. Assessing serum levels of βCTX-I and PINP can improve fracture prediction slightly, with a gradient of risk of about 1.2 per SD increase in the bone marker in addition to clinical risk factors and bone mineral density. For an individual patient, BTMs are not useful in projecting bone loss or treatment efficacy, but it is recommended that serum PINP and βCTX-I be used to monitor adherence to oral bisphosphonate treatment. Suppression of the BTMs greater than the least significant change or to levels in the lower half of the reference interval in young and healthy premenopausal women is closely related to treatment adherence. Conclusion In conclusion, the currently available evidence indicates that the principal clinical utility of BTMs is for monitoring oral bisphosphonate therapy