scholarly journals O16 A study examining the reliability of digital ulcer definitions as proposed by the UK Scleroderma Study Group: challenges and insights for future clinical trial design

Rheumatology ◽  
2018 ◽  
Vol 57 (suppl_3) ◽  
Author(s):  
Michael Hughes ◽  
Monica Bhushan ◽  
Kuntal Chakravarty ◽  
Christopher P Denton ◽  
Shirish Dubey ◽  
...  
2018 ◽  
Vol 3 (2) ◽  
pp. 170-174 ◽  
Author(s):  
Michael Hughes ◽  
Andrew Tracey ◽  
Monica Bhushan ◽  
Kuntal Chakravarty ◽  
Christopher P Denton ◽  
...  

Introduction: The reliability of clinician grading of systemic sclerosis–related digital ulcers has been reported to be poor to moderate at best, which has important implications for clinical trial design. The aim of this study was to examine the reliability of new proposed UK Scleroderma Study Group digital ulcer definitions among UK clinicians with an interest in systemic sclerosis. Methods: Raters graded (through a custom-built interface) 90 images (80 unique and 10 repeat) of a range of digital lesions collected from patients with systemic sclerosis. Lesions were graded on an ordinal scale of severity: ‘no ulcer’, ‘healed ulcer’ or ‘digital ulcer’. Results: A total of 23 clinicians – 18 rheumatologists, 3 dermatologists, 1 hand surgeon and 1 specialist rheumatology nurse – completed the study. A total of 2070 (1840 unique + 230 repeat) image gradings were obtained. For intra-rater reliability, across all images, the overall weighted kappa coefficient was high (0.71) and was moderate (0.55) when averaged across individual raters. Overall inter-rater reliability was poor (0.15). Conclusion: Although our proposed digital ulcer definitions had high intra-rater reliability, the overall inter-rater reliability was poor. Our study highlights the challenges of digital ulcer assessment by clinicians with an interest in systemic sclerosis and provides a number of useful insights for future clinical trial design. Further research is warranted to improve the reliability of digital ulcer definition/rating as an outcome measure in clinical trials, including examining the role for objective measurement techniques, and the development of digital ulcer patient–reported outcome measures.


2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S604-S604
Author(s):  
Amy Irwin ◽  
Sara Giddins ◽  
Irina Yushkevich ◽  
Alexiss Jeffers ◽  
Michelle Barron ◽  
...  

2015 ◽  
Vol 36 (33) ◽  
pp. 2219-2227 ◽  
Author(s):  
Felix Mahfoud ◽  
Michael Böhm ◽  
Michel Azizi ◽  
Atul Pathak ◽  
Isabelle Durand Zaleski ◽  
...  

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13576-e13576
Author(s):  
Bruno Henrique Rala De Paula ◽  
Gary Doherty

e13576 Background: The COVID-19 pandemic has had profound detrimental consequences on cancer patient outcomes and clinical cancer research, with considerable adaptations made to both standard care and clinical research to optimise patient safety. Detailed perspectives of clinical researchers on such risk mitigation, and granular insight into which adaptions should persist long term, are required to inform future clinical trial design. Methods: We designed and performed an in depth, global survey (open between 04/22/20 and 06/10/2020) of cancer research professionals to assess the impact of the pandemic on clinical care and research, and how researchers prioritise and view clinical research methodologies. Results: 162 valid responses were received (58.7% oncologists, 14.8% research nurses; 69.1% working in academic centers) from six continents. There was significant heterogeneity in how the pandemic has affected healthcare workers, patients on standard of care or investigational trial treatments, and clinical trial recruitment. Our results detail how trial and non-trial patient care has altered in respondents’ centres and how respondents would prioritise specific trial designs while the pandemic continues. We show marked variance in the perceived value of specific trial protocol features and assessments (regardless of the pandemic). More respondents agreed than disagreed that trial eligibility criteria are too restrictive (48% agreed versus 28% disagreed), that screening assessments generally have unnecessary tests (51% versus 23%), that physical examination should only be performed when clinically indicated (43% versus 30%), that electronic patient outcomes/questionnaires are better at detecting adverse events that a consultation with a study doctor (33% versus 29%), that wearable technology/validated tools for patients to perform self-examination would provide more useful information than vital sign assessment in the study center (48% versus 13%), and that replacing routine in person visits with virtual visits would not significantly compromise patient safety (36% versus 28%). However, 65% of respondents indicated that fully virtual clinical trials (in the absence of reported clinically significant toxicities) would not be sufficiently safe (versus 15% who indicated that they would be). Conclusions: These detailed data provide further evidence of a significant adverse impact of the pandemic on cancer patient care and drug development, may help inform risk mitigation for studies in times of heightened infection risk, and aid with future clinical trial design.


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