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Duarte C.,Centro Hospitalar Universitario Of Coimbra | Duarte C.,University of Coimbra | De Oliveira Ferreira R.J.,Centro Hospitalar Universitario Of Coimbra | De Oliveira Ferreira R.J.,Health science Research Unit Nursing UICiSA E | And 4 more authors.
Journal of Rheumatology | Year: 2015

Objective. To identify the instruments used to assess polymyalgia rheumatica (PMR) in published studies. Methods. A systematic literature review of clinical trials and longitudinal observational studies related to PMR, published from 1970 to 2014, was carried out. All outcome and assessment instruments were extracted and categorized according to core areas and domains, as defined by the OMERACT (Outcome Measures in Rheumatology) Filter 2.0. Results. Thirty-five articles (3221 patients) were included: 12 randomized controlled trials (RCT); 3 nonrandomized trials; and 20 observational studies. More than 20 domains were identified, measured by 29 different instruments. The most frequently used measures were pain, morning stiffness, patient global assessment and physician global assessment, erythrocyte sedimentation rate, and C-reactive protein. The definition of outcomes varied considerably between studies. Conclusion. The outcome measures and instruments used in PMR are numerous and diversely defined. The establishment of a core set of validated and standardized outcome measurements is needed. © Copyright 2015 The Journal of Rheumatology. All rights reserved.


Marques A.,Centro Hospitalar Universitario Of Coimbra | Marques A.,Health science Research Unit Nursing UICiSA E | Ferreira R.J.O.,Centro Hospitalar Universitario Of Coimbra | Ferreira R.J.O.,Health science Research Unit Nursing UICiSA E | And 6 more authors.
Annals of the Rheumatic Diseases | Year: 2015

Objectives: To identify and synthesise the best available evidence on the accuracy of the currently available tools for predicting fracture risk. Methods: We systematically searched PubMed MEDLINE, Embase and Cochrane databases to 2014. Two reviewers independently selected articles, collected data from studies, and carried out a hand search of the references of the included studies. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) checklist was used, and the primary outcome was the area under the curve (AUC) and 95% CIs, obtained from receiver operating characteristic (ROC) analyses. We excluded tools if they had not been externally validated or were designed for specific disease populations. Random effects meta-analyses were performed with the selected tools. Results: Forty-five studies met inclusion criteria, corresponding to 13 different tools. Only three tools had been tested more than once in a population-based setting: FRAX (26 studies in 9 countries), GARVAN (6 studies in 3 countries) and QFracture (3 studies in the UK, 1 also including Irish participants). Twenty studies with these three tools were included in a total of 17 meta-analyses (for hip or major osteoporotic fractures; men or women; with or without bone mineral density). Conclusions: Most of the 13 tools are feasible in clinical practice. FRAX has the largest number of externally validated and independent studies. The overall accuracy of the different tools is satisfactory (>0.70), with QFracture reaching 0.89 (95% CI 0.88 to 0.89). Significant methodological limitations were observed in many studies, suggesting caution when comparing tools based solely on the AUC.


Marques A.,Centro Hospitalar iversitario Of Coimbra | Marques A.,Health science Research Unit Nursing UICiSA E | Ferreira R.J.O.,Centro Hospitalar iversitario Of Coimbra | Ferreira R.J.O.,Health science Research Unit Nursing UICiSA E | And 6 more authors.
Annals of the Rheumatic Diseases | Year: 2015

Objectives To identify and synthesise the best available evidence on the accuracy of the currently available tools for predicting fracture risk. Methods We systematically searched PubMed MEDLINE, Embase and Cochrane databases to 2014. Two reviewers independently selected articles, collected data from studies, and carried out a hand search of the references of the included studies. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) checklist was used, and the primary outcome was the area under the curve (AUC) and 95% CIs, obtained from receiver operating characteristic (ROC) analyses. We excluded tools if they had not been externally validated or were designed for specific disease populations. Random effects meta-analyses were performed with the selected tools. Results Forty-five studies met inclusion criteria, corresponding to 13 different tools. Only three tools had been tested more than once in a population-based setting: FRAX (26 studies in 9 countries), GARVAN (6 studies in 3 countries) and QFracture (3 studies in the UK, 1 also including Irish participants). Twenty studies with these three tools were included in a total of 17 meta-analyses (for hip or major osteoporotic fractures; men or women; with or without bone mineral density). Conclusions Most of the 13 tools are feasible in clinical practice. FRAX has the largest number of externally validated and independent studies. The overall accuracy of the different tools is satisfactory (>0.70), with QFracture reaching 0.89 (95% CI 0.88 to 0.89). Significant methodological limitations were observed in many studies, suggesting caution when comparing tools based solely on the AUC. © 2015 BMJ Publishing Group Ltd & European League Against Rheumatism. All rights reserved.


Marques A.,Centro Hospitalar Universitario Of Coimbra | Marques A.,Health science Research Unit Nursing UICiSA E | Lourenco O.,University of Coimbra | Ortsater G.,Quantify Research | And 4 more authors.
Calcified Tissue International | Year: 2016

Cost-effective intervention thresholds (ITs) based on FRAX® were determined for Portugal. Assuming a willingness to pay (WTP) of €32,000 per quality-adjusted life years (QALYs), treatment with generic alendronate is cost effective for men and women aged 50 years or more, with 10-year probabilities for major osteoporotic fractures and hip above 8.8 and 2.5 %, respectively. The aim of the present study was to identify the 10-year probabilities of a major and hip osteoporotic fracture using FRAX® validated for Portugal, above which pharmacologic interventions become cost effective in the Portuguese context. A previously developed and validated state transition Markov cohort model was populated with epidemiologic, economic and quality-of-life fracture data from Portugal. Cost-effectiveness of FRAX®-based ITs was calculated for generic alendronate and proprietary zoledronic acid, denosumab and teriparatide were compared to “no intervention”, assuming a WTP of €32,000 (two times national Gross Domestic Product per capita) per QALYs. In the Portuguese epidemiological and economic context, treatment with generic alendronate was cost effective for men and women aged 50 years or more, with 10-year probabilities at or above 8.8 % for major osteoporotic fractures and 2.5 % for hip fractures. Cost-effective threshold 10-year probabilities for major osteoporotic and hip fractures were higher for zoledronic acid (20.4 and 10.1 %), denosumab (34.9 and 10.1 %) and teriparatide (77.8 and 62.6 %), respectively. A tool is provided to perform the calculation of cost-effective ITs for different medications, according to age group and diverse levels of WTP. Cost-effective ITs, for different medications, age groups and WTP, based on 10-year probabilities of major and hip fracture probabilities calculated with FRAX are provided. © 2016 Springer Science+Business Media New York

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