A Multiple Stakeholder Multicriteria Decision Analysis in Diabetic Macular Edema Management: The MULTIDEX‑EMD Study

Background The clinical and economic management of retinal diseases has become more complex following the introduction of new intravitreal treatments. Multicriteria decision analysis (MCDA) offers the potential to overcome the challenges associated with traditional decision-making tools. Objectives A MCDA to determine the most relevant criteria to decision-making in the management of diabetic macular edema (DME) based on the perspectives of multiple stakeholders in Spain was developed. This MCDA was termed the MULTIDEX-EMD study. Methods Nineteen stakeholders (7 physicians, 4 pharmacists, 5 health authorities and health management experts, 1 psychologist, and 2 patient representatives) participated in this three-phase project. In phase A, an advisory board defined all of the criteria that could influence DME treatment decision-making. These criteria were then screened using a discrete choice experiment (DCE) (phase B). Next, a multinomial logit model was fitted by applying the backward elimination algorithm (relevant criteria: p value = 15 letters (p value < 0.001), effect duration per administration (p value = 0.008), retinal detachment (p value < 0.001), endophthalmitis (p value = 0.012), myocardial infarction (p value < 0.001), intravitreal hemorrhage (p value = 0.021), annual treatment cost per patient (p value = 0.001), health-related quality of life (HRQoL) (p value = 0.004), and disability level (p value = 0.021). Conclusions From a multi-stakeholder perspective, the selection of an appropriate treatment for DME patients should guarantee patient safety and maximize the visual acuity improvement and treatment effect duration. It should also contribute to system sustainability by being affordable, it should have a positive impact on HRQoL, and it should prevent disability

Conclusiones y propuestas de manejo de las poblaciones y especies de anfibios y reptiles alóctonos en España

El criterio fundamental para considerar que una especie es alóctona en el territorio español se basa en la constatación de que la colonización no ha sido natural, sino de origen antrópico.Peer Reviewe

A multiple stakeholder multicriteria decision analysis in diabetic macular edema management: the MULTIDEX‑EMD study

Background The clinical and economic management of retinal diseases has become more complex following the introduction of new intravitreal treatments. Multicriteria decision analysis (MCDA) ofers the potential to overcome the challenges associated with traditional decision-making tools. Objectives A MCDA to determine the most relevant criteria to decision-making in the management of diabetic macular edema (DME) based on the perspectives of multiple stakeholders in Spain was developed. This MCDA was termed the MULTIDEX-EMD study. Methods Nineteen stakeholders (7 physicians, 4 pharmacists, 5 health authorities and health management experts, 1 psychologist, and 2 patient representatives) participated in this three-phase project. In phase A, an advisory board defned all of the criteria that could infuence DME treatment decision-making. These criteria were then screened using a discrete choice experiment (DCE) (phase B). Next, a multinomial logit model was ftted by applying the backward elimination algorithm (relevant criteria: p value<0.05). Finally, the results were discussed in a deliberative process (phase C). Results Thirty-one criteria were initially defned (phase A) and grouped into 5 categories: efcacy/efectiveness, safety, organizational and economic impact, patient-reported outcomes, and other therapeutic features. The DCE results (phase B) showed that 10 criteria were relevant to the decision-making process for a 50- to 65-year-old DME patient: mean change in best corrected visual acuity (p value<0.001), percentage of patients with an improvement of ≥15 letters (p value<0.001), efect duration per administration (p value=0.008), retinal detachment (p value<0.001), endophthalmitis (p value=0.012), myocardial infarction (p value<0.001), intravitreal hemorrhage (p value=0.021), annual treatment cost per patient (p value=0.001), health-related quality of life (HRQoL) (p value=0.004), and disability level (p value=0.021). Conclusions From a multi-stakeholder perspective, the selection of an appropriate treatment for DME patients should guarantee patient safety and maximize the visual acuity improvement and treatment efect duration. It should also contribute to system sustainability by being afordable, it should have a positive impact on HRQoL, and it should prevent disability

Non-Standard Errors

In statistics, samples are drawn from a population in a data-generating process (DGP). Standard errors measure the uncertainty in estimates of population parameters. In science, evidence is generated to test hypotheses in an evidence-generating process (EGP). We claim that EGP variation across researchers adds uncertainty: Non-standard errors (NSEs). We study NSEs by letting 164 teams test the same hypotheses on the same data. NSEs turn out to be sizable, but smaller for better reproducible or higher rated research. Adding peer-review stages reduces NSEs. We further find that this type of uncertainty is underestimated by participants

Tratamiento del rechazo agudo hiperinmune con plasmaféresis y Rituximab. Nuestra Experiencia

El trasplante renal consiste en la extracción de un riñón de un individuo sano y su colocación en un paciente con insuficiencia renal crónica terminal1. El rechazo inmunológico es la principal complicación tras el trasplante. Se denomina rechazo al conjunto de manifestaciones clínicas, funcionales, anatomopatológicas, que pueden aparecer en un receptor de trasplante renal, como consecuencia de la activación del sistema inmune contra el injerto. El rechazo puede aparecer desde el momento de revascularización del órgano hasta años más tarde2. La incidencia del rechazo dependerá esencialmente de dos factores: las características del receptor y el tratamiento inmunosupresor utilizado. En general se acepta que un 30-40% de los pacientes desarrollan algún episodio de rechazo en el trasplante inmediato (3 primeros meses)1. En la mayoría de los protocolos se utilizan como tratamiento convencional bolos de metil-prednisolona a dosis que varían entre 250 y 1.000mg/día, durante 3-4 días. Con esta pauta se consigue respuesta entre el 60-70% de los casos. En el resto de los casos se habla de rechazo corticoresistente2. La Plasmaferesis ha sido recientemente introducida en el tratamiento del rechazo agudo del trasplante renal resistente al tratamiento convencional con esteroides3. La aféresis puede definirse como una modalidad terapéutica que consiste en la extracción de un volumen determinado de plasma (de 2 a 5 litros) con el fin de eliminar aquellos patógenos considerados responsables de una enfermedad o bien sus manifestaciones clínicas. El recambio plasmático mediante filtración a través de membranas se realiza mediante el montaje de un circuito extracorpóreo