Use of real-world evidence for healthcare decision-making in the Middle East: practical considerations and future directions

2019 ◽  
Vol 19 (3) ◽  
pp. 245-250
Author(s):  
Kasem S. Akhras ◽  
Alawi A. Alsheikh-Ali ◽  
Samer Kabbani
2021 ◽  
Vol 24 ◽  
pp. S194
Author(s):  
L. Costa ◽  
A.L. Hincapie ◽  
R. Gilardino ◽  
B. Tang ◽  
G. Julian ◽  
...  

2020 ◽  
Vol 36 (S1) ◽  
pp. 16-16
Author(s):  
Paola Andrea Rivera-Ramirez ◽  
Fabián Alejandro Fiestas-Saldarriaga

IntroductionIn the absence of direct evidence from randomized controlled trials (RCTs), real-world evidence (RWE) can play an important role in healthcare decision making. As part of a health technology assessment, we assessed the comparative risk of tuberculosis (TB) associated with using infliximab and etanercept in patients with rheumatoid arthritis.MethodsWe performed a systematic literature search using the PubMed database to identify relevant meta-analyses.ResultsWe located two relevant meta-analyses: one based on RCTs and one based on observational studies. Evidence from seven RCTs on infliximab (2,686 patients; 12 TB events) and two RCTs on etanercept (663 patients; 2 TB events) suggested no significant differences in the risk of TB between the two treatments, compared with placebo. In contrast, evidence from ten observational studies that directly compared the two treatments (443,941 patients; 253 TB events) indicated a significantly higher risk of TB with infliximab than with etanercept.ConclusionsAlthough RWE is prone to confounding and bias, in this case it had the advantage of providing direct comparisons with larger sample sizes and longer follow up than evidence from RCTs. As a result, RWE was used to inform decision making on the risk of TB with infliximab and etanercept in patients with rheumatoid arthritis.


2019 ◽  
Vol 22 (6) ◽  
pp. 739-749 ◽  
Author(s):  
Nahila Justo ◽  
Manuel A. Espinoza ◽  
Barbara Ratto ◽  
Martha Nicholson ◽  
Diego Rosselli ◽  
...  

2015 ◽  
Vol 18 (7) ◽  
pp. A693 ◽  
Author(s):  
L Degli Esposti ◽  
S Saragoni ◽  
D Sangiorgi ◽  
S Buda ◽  
A Cangini ◽  
...  

2021 ◽  
Vol 24 ◽  
pp. S157
Author(s):  
H. Monsanto ◽  
C. Parellada ◽  
J. Orengo ◽  
J.S. Velasco ◽  
Bavel J van ◽  
...  

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 384-384
Author(s):  
Hyejin Kim ◽  
Molly Perkins ◽  
Thaddeus Pope ◽  
Patricia Comer ◽  
Mi-Kyung Song

Abstract ‘Unbefriended’ adults are those who lack decision-making capacity and have no surrogates or advance care plans. Little data exist on nursing homes (NHs)’ healthcare decision-making practices for unbefriended residents. This study aimed to describe NH staff’s perceptions of healthcare decision making on behalf of unbefriended residents. Sixty-six staff including administrators, physicians, nurses, and social workers from three NHs in one geographic area of Georgia, USA participated in a 31-item survey. Their responses were analyzed using descriptive statistics and conventional content analysis. Of 66 participants, eleven had been involved in healthcare decision-making for unbefriended residents. The most common decision was do-not-resuscitate orders. Decisions primarily were made by relying on the resident’s primary care physician and/or discussing within a facility interdisciplinary team. Key considerations in the decision-making process included “evidence that the resident would not have wanted further treatment” and the perception that “further treatment would not be in the resident’s best interest”. Compared with decision making for residents with surrogates, participants perceived decision making for unbefriended residents to be equally-more difficult. Key barriers to making decisions included uncertainty regarding what the resident would have wanted in the given situation and concerns regarding the ethically and legally right course of action. Facilitators (reported by 52 participants) included some information/knowledge about the resident, an understanding regarding decision-making-related law/policy, and facility-level support. The findings highlight the complexity and difficulty of healthcare decision making for unbefriended residents and suggest more discussions among all key stakeholders to develop practical strategies to support decision-making practices in NHs.


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