Implementing Precision Psychiatry: A Systematic Review of Individualized Prediction Models for Clinical Practice

Abstract Background The impact of precision psychiatry for clinical practice has not been systematically appraised. This study aims to provide a comprehensive review of validated prediction models to estimate the individual risk of being affected with a condition (diagnostic), developing outcomes (prognostic), or responding to treatments (predictive) in mental disorders. Methods PRISMA/RIGHT/CHARMS-compliant systematic review of the Web of Science, Cochrane Central Register of Reviews, and Ovid/PsycINFO databases from inception until July 21, 2019 (PROSPERO CRD42019155713) to identify diagnostic/prognostic/predictive prediction studies that reported individualized estimates in psychiatry and that were internally or externally validated or implemented. Random effect meta-regression analyses addressed the impact of several factors on the accuracy of prediction models. Findings Literature search identified 584 prediction modeling studies, of which 89 were included. 10.4% of the total studies included prediction models internally validated (n = 61), 4.6% models externally validated (n = 27), and 0.2% (n = 1) models considered for implementation. Across validated prediction modeling studies (n = 88), 18.2% were diagnostic, 68.2% prognostic, and 13.6% predictive. The most frequently investigated condition was psychosis (36.4%), and the most frequently employed predictors clinical (69.5%). Unimodal compared to multimodal models (β = .29, P = .03) and diagnostic compared to prognostic (β = .84, p < .0001) and predictive (β = .87, P = .002) models were associated with increased accuracy. Interpretation To date, several validated prediction models are available to support the diagnosis and prognosis of psychiatric conditions, in particular, psychosis, or to predict treatment response. Advancements of knowledge are limited by the lack of implementation research in real-world clinical practice. A new generation of implementation research is required to address this translational gap.

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Effects of evidence-based clinical practice guidelines in cardiovascular health care quality improvements: A systematic review

F1000Research ◽

10.12688/f1000research.18865.2 ◽

2019 ◽

Vol 8 ◽

pp. 1041

Author(s):

Anggie Ramírez-Morera ◽

Mario Tristan ◽

Juan Carlos Vazquez

Keyword(s):

Systematic Review ◽

Health Care ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Control Group ◽

Evidence Based ◽

Cochrane Central Register ◽

Health Care Structure ◽

The Impact

Background: The development of evidence-based clinical practice guidelines (EB-CPGs) has increasing global growth; however, the certainty of impact on patients and health systems, as well as the magnitude of the impact, is not apparent. The objective of this systematic review was to assess the effectiveness of the application of EB-CPGs for the improvement of the quality of health care in three dimensions: structure, process and results in the patient for the management of cardiovascular disease. Methods: We followed the methods described by the Cochrane Handbook and present a descriptive analysis because of the high heterogeneity found across the included studies. We searched the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE databases, as well as the grey literature, between 1990 and June 2016. No language restrictions were applied. Only randomised clinical trials (RCTs) were selected. Three authors independently carried out the data extraction, using a modified version of the Cochrane Effective Practice and Organization of Care form. Results: Of the total of 84 interventions included in the nine RCTs evaluated, three (4%) were related to health care structure, 54 (64%) to the health care delivery process and 27 (32%) to patient outcomes. Regarding the impact of using the EB-CPGs, in 55 interventions (65%), there were no significant differences between control and experimental groups. In four interventions (5%), the result favoured the control group, and the result favoured the intervention group on 25 of the interventions (30%). Conclusions: This systematic review showed that EB-CPGs could be useful to improve the process and structure of health care and, to a lesser extent, to improve the patients’ outcomes. After analysing many studies, we could have one more hypothesis for further research, which could shed more light upon those undiscovered variables that might interfere with the use of the EB-CPGs. Registration: PROSPERO CRD42013003589

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Effects of evidence-based clinical practice guidelines in cardiovascular health care quality improvements: A systematic review

F1000Research ◽

10.12688/f1000research.18865.1 ◽

2019 ◽

Vol 8 ◽

pp. 1041

Author(s):

Anggie Ramírez-Morera ◽

Mario Tristan ◽

Juan Carlos Vazquez

Keyword(s):

Systematic Review ◽

Health Care ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Care Quality ◽

Control Group ◽

Cochrane Central Register ◽

Health Care Structure ◽

The Impact

Background: The development of clinical practice guidelines (CPGs) has increasing global growth; however, the certainty of impact on patients and health systems, as well as the magnitude of the impact, is not apparent. The objective of this systematic review was to assess the effectiveness of the application of CPGs for the improvement of the quality of health care in three domains: structure, process and results in the patient for the management of cardiovascular disease. Methods: We followed the methods described by the Cochrane Handbook and present a descriptive analysis because of the high heterogeneity found across the included studies. We searched the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE databases, as well as the grey literature, between 1990 and June 2016. No language restrictions were applied. Only randomised clinical trials (RCTs) were selected. Three authors independently carried out the data extraction, using a modified version of the Cochrane Effective Practice and Organization of Care form. Results: Of the total of 84 interventions included in the nine RCTs evaluated, three (4%) were related to health care structure, 54 (64%) to the health care delivery process and 27 (32%) to patient outcomes. Regarding the impact of using the CPGs, in 55 interventions (65%), there were no significant differences between control and experimental groups. In four interventions (5%), the result favoured the control group, and the result favoured the intervention group on 25 of the interventions (30%). Conclusions: This systematic review showed that CPGs could be useful to improve the process and structure of health care and, to a lesser extent, to improve the results in patients. However, evidence was weak. There are probably still undiscovered variables that interfere with the use of the CPGs and, therefore, with their impact. Therefore, more studies of good quality are needed. Registration: PROSPERO CRD42013003589.

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Effects of evidence-based clinical practice guidelines in cardiovascular health care quality improvements: A systematic review

F1000Research ◽

10.12688/f1000research.18865.3 ◽

2019 ◽

Vol 8 ◽

pp. 1041

Author(s):

Anggie Ramírez-Morera ◽

Mario Tristan ◽

Juan Carlos Vazquez

Keyword(s):

Systematic Review ◽

Health Care ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Control Group ◽

Evidence Based ◽

Cochrane Central Register ◽

Health Care Structure ◽

The Impact

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Interventions directed at men for preventing intimate partner violence: a systematic review protocol

Systematic Reviews ◽

10.1186/s13643-021-01712-7 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Dina Idriss-Wheeler ◽

Julia Hajjar ◽

Sanni Yaya

Keyword(s):

Systematic Review ◽

Intimate Partner Violence ◽

Health Outcomes ◽

Partner Violence ◽

Intimate Partner ◽

Cochrane Central Register ◽

Female Partners ◽

Key Characteristics ◽

Unpublished Manuscripts ◽

The Impact

Abstract Background Intimate partner violence (IPV) is a population health problem linked to a myriad of negative psychological, physical, emotional, sexual and reproductive health outcomes for women. The movement towards working with boys and men over the past couple of decades has increased the number of interventions specifically directed at men who perpetrate violence against a female partner. There is little evidence-based research on key characteristics of effective interventions directed at men to reduce or prevent IPV against female partners. The objective of this systematic review is to identify interventions specifically directed at males , as the perpetrators of violence against women, that have proven to be effective in preventing or reducing intimate partner violence. Methods The following electronic databases will be used to search for peer-reviewed studies: MEDLINE (OVID), Embase (OVID), PsycInfo (OVID), CINAHL (EBSCO), Global Health (EBSCO), Gender Watch (ProQuest), Web of Science (Web of Knowledge), PROSPERO, Cochrane Central Register of Controlled Trials Database (Ovid) and SCOPUS. We will include randomized control trials, non-randomized studies of interventions published in peer-reviewed journals and relevant unpublished manuscripts, books/chapters and clinical or programme study reports. Studies have to demonstrate direction of effect (i.e. pre-post intervention/difference between groups) in terms of prevention or reduction in the outlined outcomes. Primary outcomes include change in behaviour and knowledge of male perpetrator regarding the impact of IPV on women as well as women’s experience of IPV. Secondary outcomes include change in behaviours around substance use and social activities, decrease in negative mental health outcomes and interactions with law enforcement. Studies will be screened, appraised and extracted by two reviewers; any conflicts will be resolved through discussion. Narrative synthesis will be used to analyse and present findings. If sufficient and comparable data is available, a meta-analysis will be conducted. Discussion This review will provide synthesized evidence on interventions directed at males to reduce or prevent their perpetration of intimate partner violence against female partners. Implications for practice will include key characteristics of interventions proven to be effective based on evidence synthesis and certainty of findings. Recommendations for further research will also be considered. Systematic review registration This protocol was submitted for registration in the International Prospective Register of Systematic Reviews (PROSPERO) on September 4, 2020.

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Abstract NS6: To Rest or Mobilize... When to Start Early Mobilization in Acute Stroke: a Systematic Review

Stroke ◽

10.1161/str.47.suppl_1.ns6 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Michelle Whaley ◽

Wendy Dusenbury ◽

Andrei V Alexandrov ◽

Georgios Tsivgoulis ◽

Anne W Alexandrov

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Acute Stroke ◽

Early Mobilization ◽

Future Research ◽

Cochrane Central Register ◽

Large Artery ◽

Stroke Subtype ◽

Vascular Insufficiency ◽

The Impact

Background: Recent nursing initiatives encourage early mobilization of neurocritical care patients, but whether this intervention can be safely generalized to acute stroke is debatable. We performed a systematic review of findings from recent studies to provide direction for patient management and future research. Methods: An exhaustive literature search was performed in Medline, SCOPUS and the Cochrane Central Register of Controlled Trials to identify published clinical trial research using a very early mobility intervention (within 24 hours) in acute ischemic stroke patients. The primary efficacy outcome supporting the search was neurologic disability reduction or improved functional outcomes, and the primary safety outcome was neurologic deterioration. Studies were critically reviewed for inclusion by 3 separate investigators, findings were synthesized, and an overall recommendation for very early mobilization use in acute stroke was assigned according to GRADE criteria. Results: We initially identified 12 papers focused on early mobilization in acute stroke; of these, 6 observational studies were excluded, 1 study was excluded due to an ambiguous population, and 3 studies were excluded due to first initial mobilization out of bed occurring greater than 24 hours after admission. Two prospective randomized outcome blinded evaluation (PROBE) studies were retained, consisting of a total 2160 patients; ischemic stroke subtype was not disclosed in either study, limiting an understanding of the impact of very early mobilization on small versus large artery occlusion. Slower mobilization occurring beyond the first 24 hours was associated with higher rates of favorable outcome (mRS 0-2) at 90 days, whereas very early mobilization within the first 24 hours was associated with a number needed to harm of 25. Conclusions: In acute stroke, evidence supports a rested approach to care within the first 24 hours of hospitalization (GRADE: Strong recommendation, high quality of evidence). Similar to acute myocardial infarction, vascular insufficiency experienced in stroke likely warrants a more guarded approach to mobility. Additional studies exploring timing beyond 24 hours and dose of mobility interventions are warranted in discreet populations.

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Association of ABO haplotypes with the risk of venous thrombosis: impact on disease risks estimation

Blood ◽

10.1182/blood.2020008997 ◽

2020 ◽

Author(s):

Louisa Goumidi ◽

Florian Thibord ◽

Kerri L. Wiggins ◽

Ruifang Li-Gao ◽

Michael R Brown ◽

...

Keyword(s):

Venous Thrombosis ◽

Blood Group ◽

Plasma Levels ◽

Odds Ratio ◽

Prediction Models ◽

Genetic Risk Score ◽

Individual Risk ◽

Abo Blood Group ◽

Increased Risk ◽

The Impact

Genetic risk score (GRS) analysis is an increasingly popular approach to derive individual risk prediction models for complex diseases. In the context of venous thrombosis (VT), any GRS shall integrate information at the ABO blood group locus, the latter being one of the major susceptibility locus for this disease. However, there is yet no consensus about which single nucleotide polymorphisms (SNPs) must be investigated when one is interested in properly assessing the association of ABO locus with VT risk. Using comprehensive haplotype analyses of ABO blood group tagging SNPs in up to 5,425 cases and 8,445 controls from 6 studies, we demonstrated that using only rs8176719 (tagging O1) to correctly assess the impact of ABO locus on VT risk is suboptimal as 5% of rs8176719-delG carriers are not exposed at higher VT risk. Instead, we recommend to use 4 SNPs, rs2519093 (tagging A1), rs1053878 (A2), rs8176743 (B) and rs41302905 (O2) in any analysis aimed at assessing the impact of ABO locus on VT risk to avoid any risk misestimation. Compared to O1 haplotype that can be inferred from these 4 SNPs, the A2 haplotype is associated with a modest increase in VT risk (odds ratio ~1.2), A1 and B haplotypes are associated with a ~1.8 fold increased risk while O2 tend to be slightly protective (odds ratio ~0.80). In addition, our analyses clearly showed that while the A1 an B blood group are associated with increased vWF and FVIII plasma levels only the A1 blood group is associated wih ICAM plasma levels but in an opposite direction, leaving additional avenues to be explored in order to fully understand the whole spectrum of biological effect of ABO locus on cardiovascular traits.

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Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis

BMJ Open ◽

10.1136/bmjopen-2017-020991 ◽

2018 ◽

Vol 8 (2) ◽

pp. e020991 ◽

Cited By ~ 9

Author(s):

Wen Wang ◽

Wenwen Chen ◽

Yanmei Liu ◽

Reed Alexander C Siemieniuk ◽

Ling Li ◽

...

Keyword(s):

Systematic Review ◽

Treatment Failure ◽

Meta Analysis ◽

Late Recurrence ◽

Controlled Trials ◽

Cochrane Central Register ◽

High Quality ◽

Moderate Quality ◽

The Impact ◽

Risk Of Treatment

ObjectiveTo assess the impact of adjunctive antibiotic therapy on uncomplicated skin abscesses.DesignSystematic review and network meta-analysis.Data sourcesMedline, Embase, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov.Study selectionA BMJ Rapid Recommendation panel provided input on design, important outcomes and the interpretation of the results. Eligible randomised controlled trials (RCTs) included a comparison of antibiotics against no antibiotics or a comparison of different antibiotics in patients with uncomplicated skin abscesses, and reported outcomes prespecified by the linked guideline panel.Review methodsReviewers independently screened abstracts and full texts for eligibility, assessed risk of bias and extracted data. We performed random-effects meta-analyses that compared antibiotics with no antibiotics, along with a limited number of prespecified subgroup hypotheses. We also performed network meta-analysis with a Bayesian framework to compare effects of different antibiotics. Quality of evidence was assessed with The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.ResultsFourteen RCTs including 4198 patients proved eligible. Compared with no antibiotics, antibiotics probably lower the risk of treatment failure (OR 0.58, 95% CI 0.37 to 0.90; low quality), recurrence within 1 month (OR 0.48, 95% CI 0.30 to 0.77; moderate quality), hospitalisation (OR 0.55, 95% CI 0.32 to 0.94; moderate quality) and late recurrence (OR 0.64, 95% CI 0.48 to 0.85; moderate quality). However, relative to no use, antibiotics probably increase the risk of gastrointestinal side effects (trimethoprim and sulfamethoxazole (TMP-SMX): OR 1.28, 95% CI 1.04 to 1.58; moderate quality; clindamycin: OR 2.29, 95% CI 1.35 to 3.88; high quality) and diarrhoea (clindamycin: OR 2.71, 95% CI 1.50 to 4.89; high quality). Cephalosporins did not reduce the risk of treatment failure compared with placebo (moderate quality).ConclusionsIn patients with uncomplicated skin abscesses, moderate-to-high quality evidence suggests TMP-SMX or clindamycin confer a modest benefit for several important outcomes, but this is offset by a similar risk of adverse effects. Clindamycin has a substantially higher risk of diarrhoea than TMP-SMX. Cephalosporins are probably not effective.

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Prostate cancer risk calculators for healthy population: A systematic review (Preprint)

10.2196/preprints.30430 ◽

2021 ◽

Author(s):

Antonio Bandala-Jacques ◽

Kevin Daniel Castellanos Esquivel ◽

Fernanda Pérez-Hurtado ◽

Cristobal Hernández-Silva ◽

Nancy Reynoso-Noverón

Keyword(s):

Prostate Cancer ◽

Risk Factors ◽

Systematic Review ◽

Cancer Risk ◽

Digital Rectal Examination ◽

Prostate Cancer Risk ◽

Individual Risk ◽

Healthy Population ◽

Risk Of Cancer ◽

The Impact

BACKGROUND Screening for prostate cancer has long been a debated, complex topic. The use of risk calculators for prostate cancer is recommended for determining patients’ individual risk of cancer and the subsequent need for a prostate biopsy. These tools could lead to a better discrimination of patients in need of invasive diagnostic procedures and for optimized allocation of healthcare resources OBJECTIVE To systematically review available literature on current prostate cancer risk calculators’ performance in healthy population, by comparing the impact factor of individual items on different cohorts, and the models’ overall performance. METHODS We performed a systematic review of available prostate cancer risk calculators targeted at healthy population. We included studies published from January 2000 to March 2021 in English, Spanish, French, Portuguese or German. Two reviewers independently decided for or against inclusion based on abstracts. A third reviewer intervened in case of disagreements. From the selected titles, we extracted information regarding the purpose of the manuscript, the analyzed calculators, the population for which it was calibrated, the included risk factors, and the model’s overall accuracy. RESULTS We included a total of 18 calculators across 53 different manuscripts. The most commonly analyzed ones were they PCPT and ERSPC risk calculators, developed from North American and European cohorts, respectively. Both calculators provided high precision for the diagnosis of aggressive prostate cancer (AUC as high as 0.798 for PCPT and 0.91 for ERSPC). We found 9 calculators developed from scratch for specific populations, which reached diagnostic precisions as high as 0.938. The most commonly included risk factors in the calculators were age, PSA levels and digital rectal examination findings. Additional calculators included race and detailed personal and family history CONCLUSIONS Both the PCPR and the ERSPC risk calculators have been successfully adapted for cohorts other than the ones they were originally created for with no loss of diagnostic accuracy. Furthermore, designing calculators from scratch considering each population’s sociocultural differences has resulted in risk tools that can be well adapted to be valid in more patients. The best risk calculator for prostate cancer will be that which was has been calibrated for its intended population and can be easily reproduced and implemented CLINICALTRIAL CRD42021242110

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Protocol for a systematic review and meta-analysis of respiratory rehabilitation following intensive care unit discharge for COVID-19 survivors

BMJ Open ◽

10.1136/bmjopen-2020-041184 ◽

2020 ◽

Vol 10 (12) ◽

pp. e041184

Author(s):

Dan Wang ◽

Jin Li ◽

Feilong Zhu ◽

Qianqin Hong ◽

Ming Zhang ◽

...

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Intensive Care ◽

Meta Analysis ◽

Biomedical Literature ◽

Controlled Trials ◽

Cochrane Central Register ◽

The Impact ◽

Respiratory Rehabilitation

IntroductionBoth physical and mental disorders may be exacerbated in patients with COVID-19 due to the experience of receiving intensive care; undergoing prolonged mechanical ventilation, sedation, proning and paralysis. Pulmonary rehabilitation is aimed to improve dyspnoea, relieve anxiety and depression, reduce the incidence of related complications, as well as prevent and improve dysfunction. However, the impact of respiratory rehabilitation on discharged patients with COVID-19 is currently unclear, especially on patients who have been mechanically ventilated over 24 hours. Therefore, we aim to investigate the efficacy of respiratory rehabilitation programmes, initiated after discharge from the intensive care unit, on the physical and mental health and health-related quality of life in critical patients with COVID-19.Methods and analysisWe have registered the protocol on PROSPERO and in the process of drafting it, we strictly followed the checklist of Preferred Reporting Items for Systematic Review and Meta-Analysis Potocols. We will search the PubMed, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, WanFang, VIP information databases and Chinese Biomedical Literature Database. Additionally, ongoing trials in the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov and ISRCTN registry will be searched as well. Studies in English or Chinese and from any country will be accepted regardless of study design. Two review authors will independently extract data and assess the quality of included studies. Continuous data are described as standard mean differences (SMDs) with 95% CIs. Dichotomous data from randomised controlled trials are described as risk ratio(RR) with 95% CIs; otherwise, it is described as odds ratio(OR) with 95% CIs. I2 and the Cochrane’s Q statistic will be used to conduct heterogeneity assessment. The quality of evidence of main outcomes will be evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation(GRADE) criteria. When included studies are sufficient, we will conduct subgroup analysis and sensitivity analysis; the publication bias will be statistically analysed using a funnel plot analysis and Egger’s test.Ethics and disseminationOur review, planning to include published studies, does not need the request to the ethical committee. The final results of this review will be published in a peer-reviewed journal after completion.Patient and public involvementNo patient involved.PROSPERO registration numberCRD42020186791.

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PIK3CA Mutations and Their Impact on Survival Outcomes of Patients with Cervical Cancer: A Systematic Review

Acta Cytologica ◽

10.1159/000509095 ◽

2020 ◽

Vol 64 (6) ◽

pp. 547-555

Author(s):

Vasilios Pergialiotis ◽

Christina Nikolaou ◽

Dimitrios Haidopoulos ◽

Maximos Frountzas ◽

Nikolaos Thomakos ◽

...

Keyword(s):

Systematic Review ◽

Cervical Cancer ◽

Cancer Progression ◽

Meta Analysis ◽

Current Evidence ◽

Survival Outcomes ◽

Cochrane Central Register ◽

Wild Type ◽

Pik3ca Mutations ◽

The Impact

Introduction: Several studies have implicated the PIK3/AKT pathway in the pathophysiology of cancer progression as its activation seems to be aberrant in several forms of cancer. The purpose of the present systematic review is to evaluate the impact of PIK3CA mutations on survival outcomes of patients with cervical cancer. Methods: We used the Medline (1966–2020), Scopus (2004–2020), ClinicalTrials.gov (2008–2020), EMBASE (1980–2020), Cochrane Central Register of Controlled Trials (CENTRAL) (1999–2020), and Google Scholar (2004–2020) databases in our primary search along with the reference lists of electronically retrieved full-text papers. Statistical meta-analysis was performed with the RevMan 5.3 software. Results: Overall, 12 articles were included in the present study that comprised 2,196 women with cervical cancer. Of those, 3 studies did not report significant differences in survival outcomes among patients with mutated versus wild-type PIK3CA tumors, 5 studies reported decreased survival outcomes, and 3 studies revealed increased survival rates. The meta-analysis revealed that patients with the mutated PIK3CA genotypes had worse overall survival compared to patients with wild-type PIK3CA (HR 2.31; 95% CI: 1.51, 3.55; 95% PI: 0.54, 9.96; data from 3 studies) and the same was observed in the case of DFS rates (HR 1.82; 95% CI: 1.47, 2.25; 95% PI: 1.29, 2.56; data from 4 studies). Conclusion: Current evidence concerning the impact of PIK3CA mutations on survival outcomes of patients with cervical cancer is inconclusive, although the majority of included studies support a potential negative effect, primarily among those with squamous cell carcinoma tumors.

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