Balancing properties. A need for the application of propensity score methods in estimation of treatment effects

There has been recently a striking increase in the use of propensity score methods in health sciences research as a tool to adjust for selection bias in making causal inferences from observational controlled studies. However, reviews of published studies that use these techniques suggest that investigators often do not pay proper attention to thorough verification of appropriate fulfilment of propensity score adjusting properties. By using a case study in which balance is not achieved, we illustrate the need to systematically asses the accomplishment of the balancing property of the propensity score as a critical requirement for obtaining unbiased treatment effects estimatesPeer Reviewe

Balancing properties. A need for the application of propensity score methods in estimation of treatment effects

There has been recently a striking increase in the use of propensity score methods in health sciences research as a tool to adjust for selection bias in making causal inferences from observational controlled studies. However, reviews of published studies that use these techniques suggest that investigators often do not pay proper attention to thorough verification of appropriate fulfilment of propensity score adjusting properties. By using a case study in which balance is not achieved, we illustrate the need to systematically asses the accomplishment of the balancing property of the propensity score as a critical requirement for obtaining unbiased treatment effects estimate

Meta-Analysis of the Embryo Freezing Transfer Interval

Background The decision of whether frozen embryo transfer (FET) should be performed in the cycle immediately after OPU or at least one cycle later is controversial. FET could improve pregnancy rates in IVF; however, how much time is needed for the endometrium to return to optimal receptivity after ovarian stimulation is not known. Methods Electronic search in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials to identify studies providing data on the influence of the interval between embryo freezing (or OPU) and FET in FET cycles published between January 1, 2007, and February 1, 2020. Main findings Data analyzed indicated that in the immediate FET cycles, there was a trend to an increased biochemical pregnancy rate (RR = 1.08; CI = 1.00-1.18), whereas the clinical pregnancy rate was somewhat higher, but without reaching statistical significance (RR = 1.07; CI = 0.99-1.15). The live birth rate was similar in the two groups (RR = 1.05; CI = 0.95-1.15), as was the implantation rate (RR = 0.98; CI = 0.83-1.16). Stratifying by embryo stage or FET type (freeze-all or FET after failed fresh transfer) showed no differences. Conclusion Systematically delaying FET does not offer benefits to IVF outcomes. In addition, immediate transfer is associated with a nonsignificant trend to better clinical pregnancy rate and it also avoids the psychological effects of prolonging the stress on prospective parents

Tumor necrosis factor alpha drugs in rheumatoid arthritis: systematic review and metaanalysis of efficacy and safety

Es reproducción del documento publicado en http://dx.doi.org/10.1186/1471-2474-9-52Background: To analyse available evidence on the efficacy and safety of anti-TNF alpha drugs (infliximab, etanercept and adalimumab) for treating rheumatoid arthritis (RA). Methods: We searched systematically for randomised controlled clinical trials on treatment of RA with anti-TNF alpha drugs, followed by a systematic review with metaanalysis. Trials were searched from MEDLINE, EMBASE and Cochrane Library databases. The American College of Rheumatology (ACR) efficacy response criteria were used. Safety parameters provided by the trials were also assessed. Positive and undesired effects were estimated using combined relative risks (RR), number needed to treat (NNT) and number needed to harm (NNH). Heterogeneity was evaluated by Cochrane's Q and I-2 statistics. Results: Thirteen trials (7087 patients) met the inclusion criteria. The combined RR to achieve a therapeutic response to treatment with recommended doses of any anti-TNF alpha drug was 1.81 (95% CI 1.43 - 2.29) with a NNT of 5 (5 - 6) for ACR20. NNT for ACR50 [5 (5 - 6)] and ACR70 [7 (7 - 9)] were similar. Overall therapeutic effects were also similar regardless of the specific anti-TNF alpha drug used and when higher than recommended doses were administered. However, lower than recommended doses elicited low ACR70 responses (NNT 15). Comparison of anti-TNF alpha drugs plus methotrexate (MTX) with MTX alone in patients with insufficient prior responses to MTX showed NNT values of 3 for ACR20, 4 for ACR50 and 8 for ACR70. Comparison of anti-TNF alpha drugs with placebo showed a similar pattern. Comparisons of anti-TNF alpha drugs plus MTX with MTX alone in patients with no previous resistance to MTX showed somewhat lower effects. Etanercept and adalimumab administered as monotherapy showed effects similar to those of MTX. Side effects were more common among patients receiving anti-TNF alpha drugs than controls (overall combined NNH 27). Patients receiving infliximab were more likely to drop out because of side effects (NNH 24) and to suffer severe side effects (NNH 31), infections (NNH 10) and infusion reactions (NNH 9). Patients receiving adalimumab were also more likely to drop out because of side effects (NNH 47) and to suffer injection site reactions (NNH 22). Patients receiving etanercept were less likely to drop out because of side effects (NNH for control versus etanercept 26) but more likely to experience injection site reactions (NNH 5). Conclusion: Anti-TNF alpha drugs are effective in RA patients, with apparently similar results irrespective of the drug administered. Doses other than those recommended are also beneficial. The main factor influencing therapeutic efficacy is the prior response to DMARD treatment. The effect of treatment with etanercept or adalimumab does not differ from that obtained with MTX. The published safety profile for etanercept is superior but the fact that no patients are treated with higher than recommended doses requires explanation

Gender-Based Analysis of the Psychological Impact of the COVID-19 Pandemic on Healthcare Workers in Spain

Purpose: This study aims to analyze from a gender perspective the psychological distress experienced by the medical workforce during the peak of the pandemic in Spain. Methods: This is a single-center, observational analytic study. The study population comprised all associated health workers of the Cruces University Hospital, invited by email to participate in the survey. It consisted of a form covering demographic data, the general health questionnaire-28 (GHQ-28), and the perceived stress scale (PSS-14). We used multivariant regression analysis to check the effect of gender on the scores. We used gender analysis in both design and interpretation of data following SAGER guidelines. Results: Females made 74.6% of our sample, but their proportion was higher in lower-paid positions such as nursery (89.9%) than in higher-paid ones. The percentage of women categorized as cases with the GHQ-28 was 78.4%, a proportion significantly higher than in the male population (61.3%, p < 0.001). The multivariant regression analysis showed that being women, working as orderly hospital porters, and having a past psychiatric history were risk factors for higher scores in both the GHQ-28 and PSS-14. Conclusion: Women and those with lower-paid positions were at risk of higher psychological distress and worse quality of life within the medical workforce during the first wave of the pandemic. Gender analysis must be incorporated to analyze this fact better

Clinical intervals and diagnostic characteristics in a cohort of prostate cancer patients in Spain: a multicentre observational study

Background: Little is known about the healthcare process for patients with prostate cancer, mainly because hospital-based data are not routinely published. The main objective of this study was to determine the clinical characteristics of prostate cancer patients, the diagnostic process and the factors that might influence intervals from consultation to diagnosis and from diagnosis to treatment. Methods: We conducted a multicentre, cohort study in seven hospitals in Spain. Patients' characteristics and diagnostic and therapeutic variables were obtained from hospital records and patients' structured interviews from October 2010 to September 2011. We used a multilevel logistic regression model to examine the association between patient care intervals and various variables influencing these intervals (age, BMI, educational level, ECOG, first specialist consultation, tumour stage, PSA, Gleason score, and presence of symptoms) and calculated the odds ratio (OR) and the interquartile range (IQR). To estimate the random inter-hospital variability, we used the median odds ratio (MOR). Results: 470 patients with prostate cancer were included. Mean age was 67.8 (SD: 7.6) years and 75.4 % were physically active. Tumour size was classified as T1 in 41.0 % and as T2 in 40 % of patients, their median Gleason score was 6.0 (IQR:1.0), and 36.1 % had low risk cancer according to the D'Amico classification. The median interval between first consultation and diagnosis was 89 days (IQR:123.5) with no statistically significant variability between centres. Presence of symptoms was associated with a significantly longer interval between first consultation and diagnosis than no symptoms (OR:1.93, 95%CI 1.29-2.89). The median time between diagnosis and first treatment (therapeutic interval) was 75.0 days (IQR:78.0) and significant variability between centres was found (MOR:2.16, 95%CI 1.45-4.87). This interval was shorter in patients with a high PSA value (p = 0.012) and a high Gleason score (p = 0.026). Conclusions: Most incident prostate cancer patients in Spain are diagnosed at an early stage of an adenocarcinoma. The period to complete the diagnostic process is approximately three months whereas the therapeutic intervals vary among centres and are shorter for patients with a worse prognosis. The presence of prostatic symptoms, PSA level, and Gleason score influence all the clinical intervals differently

Balancing properties : a need for the application of propensity score methods in estimation of treatment effects

There has been recently a striking increase in the use of propensity score methods in health sciences research as a tool to adjust for selection bias in making causal inferences from observational controlled studies. However, reviews of published studies that use these techniques suggest that investigators often do not pay proper attention to thorough verification of appropriate fulfilment of propensity score adjusting properties. By using a case study in which balance is not achieved, we illustrate the need to systematically asses the accomplishment of the balancing property of the propensity score as a critical requirement for obtaining unbiased treatment effects estimates

Balancing properties. A need for the application of propensity score methods in estimation of treatment effects

There has been recently a striking increase in the use of propensity score methods in health sciences research as a tool to adjust for selection bias in making causal inferences from observational controlled studies. However, reviews of published studies that use these techniques suggest that investigators often do not pay proper attention to thorough verification of appropriate fulfilment of propensity score adjusting properties. By using a case study in which balance is not achieved, we illustrate the need to systematically asses the accomplishment of the balancing property of the propensity score as a critical requirement for obtaining unbiased treatment effects estimatesPeer Reviewe

Principales resultados del programa de cribado de cáncer colorrectal en el País Vasco

ResumenObjetivoDescribir la estrategia del Programa de Cribado de Cáncer Colorrectal en el País Vasco y los principales resultados de participación en la primera ronda (2009-2011).MétodoEstudio retrospectivo de las invitaciones realizadas en 2009-2011 y comparación de las tasas de participación y positividad de la prueba de sangre oculta en heces por sexo y grupos de edad.ResultadosSe obtuvieron 235.371 invitaciones válidas (personas correctamente localizadas), con una participación media del 64,3% (intervalo de confianza del 95% [IC95%]: 64,1-64,5) y con diferencias significativas (p<0,001) entre mujeres (67,1%; IC95%: 66,9-67,4) y hombres (61,4%; IC95%: 61,1-61,7). El porcentaje de positivos fue superior (p<0,001) en los hombres (9,1%; IC95%: 8,9-9,2) que en las mujeres (4,8%; IC95%: 4,7-4,9).ConclusionesLas tasas de participación en el programa se consideraron adecuadas en comparación con los estudios revisados. Estas tasas podrían estar relacionadas con la estrategia de invitación y con factores culturales y sociales.AbstractObjectiveTo describe the procedures of the colorectal cancer screening program in the Basque Country (Spain), and the main results of the first rounds in 2009-2011.MethodWe carried out a retrospective study of invitations to attend screening between 2009 and 2011. Participation rates and the number of positive results of the fecal occult blood test (FOBT) were analyzed by sex and age group.ResultsThere were 235.371 valid invitations (sent to the correct addresses), with an average participation rate of 64.3% (95%CI: 64.1-64.5%). Significant differences were found (p<0,001) between women (67.1%; 95%CI: 66.9-67.4) and men (61.4%; 95%CI: 61.1-61.7). The rate of positive FOBT results was higher (p<0,001) among men (9.1%; 95%CI: 8.9-9.2) than among women (4.8%; 95%CI: 4.7-4.9).ConclusionsParticipation rates were adequate compared with those in the reviewed literature. These rates were probably affected by the invitation strategy and by cultural and social factors

Follow-up care over 12 months of patients with prostate cancer in Spain: A multicenter prospective cohort study

The therapeutic approach is crucial to prostate cancer prognosis. We describe treatments and outcomes for a Spanish cohort of patients with prostate cancer during the first 12 months after diagnosis and identify the factors that influenced the treatment they received.This multicenter prospective cohort study included patients with prostate cancer followed up for 12 months after diagnosis. Treatment was stratified by factors such as hospital, age group (<70 and ≥70 years), and D'Amico cancer risk classification. The outcomes were Eastern Cooperative Oncology Group (ECOG) performance status, adverse events (AEs), and mortality. The patient characteristics associated with the different treatment modalities were analyzed using multivariate logistic regression.We included 470 men from 7 Spanish tertiary hospitals (mean (standard deviation) age 67.8 (7.6) years), 373 (79.4%) of which received treatment (alone or in combination) as follows: surgery (n = 163; 34.7%); radiotherapy (RT) (n = 149; 31.7%); and hormone therapy (HT) (n = 142; 30.2%). The remaining patients (n = 97) were allocated to no treatment, that is, watchful waiting (14.0%) or active surveillance (5.7%). HT was the most frequently administered treatment during follow-up and RT plus HT was the most common therapeutic combination. Surgery was more frequent in patients aged <70, with lower histologic tumor grades, Gleason scores <7, and lower prostate-specific antigen levels; while RT was more frequent in patients aged ≥70 with histologic tumor grade 4, and higher ECOG scores. HT was more frequent in patients aged ≥70, with histologic tumor grades 3 to 4, Gleason score ≥8, ECOG ≥1, and higher prostate-specific antigen levels. The number of fully active patients (ECOG score 0) decreased significantly during follow-up, from 75.3% at diagnosis to 65.1% at 12 months (P < .001); 230 (48.9%) patients had at least 1 AE, and 12 (2.6%) patients died.Surgery or RT were the main curative options. A fifth of the patients received no treatment. Palliative HT was more frequently administered to older patients with higher tumor grades and higher Gleason scores. Close to half of the patients experienced an AE related to their treatment