Systematic Reviews and Meta-Analyses of Home Telemonitoring Interventions for Patients With Chronic Diseases: A Critical Assessment of Their Methodological Quality

Review

Systematic Reviews and Meta-Analyses of Home Telemonitoring Interventions for Patients With Chronic Diseases: A Critical Assessment of Their Methodological Quality

Spyros Kitsiou¹, PhD; Guy Paré^1*, PhD; Mirou Jaana^2,3*, PhD

¹Canada Research Chair in Information Technology in Health Care, HEC Montreal, Montreal, QC, Canada
²Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
³School of Business, Lebanese American University, Beirut, Lebanon
^*these authors contributed equally

Corresponding Author:

Spyros Kitsiou, PhD

Canada Research Chair in Information Technology in Health Care
HEC Montreal
3000, chemin de la Côte‑Sainte‑Catherine
Montreal, QC, H3T 2A7
Canada
Phone: 1 514 340 6000 ext 2653
Fax: 1 514 340 6132
Email: spyros.kitsiou [at] hec.ca

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ABSTRACT

Background: Systematic reviews and meta-analyses of home telemonitoring interventions for patients with chronic diseases have increased over the past decade and become increasingly important to a wide range of clinicians, policy makers, and other health care stakeholders. While a few criticisms about their methodological rigor and synthesis approaches have recently appeared, no formal appraisal of their quality has been conducted yet.
Objective: The primary aim of this critical review was to evaluate the methodology, quality, and reporting characteristics of prior reviews that have investigated the effects of home telemonitoring interventions in the context of chronic diseases.
Methods: Ovid MEDLINE, the Database of Abstract of Reviews of Effects (DARE), and Health Technology Assessment Database (HTA) of the Cochrane Library were electronically searched to find relevant systematic reviews, published between January 1966 and December 2012. Potential reviews were screened and assessed for inclusion independently by three reviewers. Data pertaining to the methods used were extracted from each included review and examined for accuracy by two reviewers. A validated quality assessment instrument, R-AMSTAR, was used as a framework to guide the assessment process.
Results: Twenty-four reviews, nine of which were meta-analyses, were identified from more than 200 citations. The bibliographic search revealed that the number of published reviews has increased substantially over the years in this area and although most reviews focus on studying the effects of home telemonitoring on patients with congestive heart failure, researcher interest has extended to other chronic diseases as well, such as diabetes, hypertension, chronic obstructive pulmonary disease, and asthma. Nevertheless, an important number of these reviews appear to lack optimal scientific rigor due to intrinsic methodological issues. Also, the overall quality of reviews does not appear to have improved over time. While several criteria were met satisfactorily by either all or nearly all reviews, such as the establishment of an a priori design with inclusion and exclusion criteria, use of electronic searches on multiple databases, and reporting of studies characteristics, there were other important areas that needed improvement. Duplicate data extraction, manual searches of highly relevant journals, inclusion of gray and non-English literature, assessment of the methodological quality of included studies and quality of evidence were key methodological procedures that were performed infrequently. Furthermore, certain methodological limitations identified in the synthesis of study results have affected the results and conclusions of some reviews.
Conclusions: Despite the availability of methodological guidelines that can be utilized to guide the proper conduct of systematic reviews and meta-analyses and eliminate potential risks of bias, this knowledge has not yet been fully integrated in the area of home telemonitoring. Further efforts should be made to improve the design, conduct, reporting, and publication of systematic reviews and meta-analyses in this area.

(J Med Internet Res 2013;15(7):e150)
doi:10.2196/jmir.2770

KEYWORDS

meta-analysis as topic; systematic review as topic; home telemonitoring; telehealth; telemetry; quality assessment; risk of bias; chronic diseases; heart failure; diabetes; hypertension; pulmonary disease

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Original research article

Evaluation of association between Airway Hyperresponsiveness, Asthma Control Test, and Asthma Therapy Assessment Questionnaire in asthmatic children

Rapino Daniele, Marina Attanasi, Nicola P Consilvio, Alessandra Scaparrotta, Anna Cingolani, Marzia Cerasa, Angelika Mohn, Sabrina Di Pillo and Francesco Chiarelli

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Multidisciplinary Respiratory Medicine 2013, 8:48 doi:10.1186/2049-6958-8-48

Published: 23 July 2013

Abstract (provisional)

Background

Achieving asthma control is a major challenge in children, otherwise symptoms perception remain poor especially at this age. The aim of this study is to evaluate the relationship between Asthma Control Test (ACTTM), Asthma Therapy Assessment Questionnaire (ATAQTM) and exercise-induced bronchospasm (EIB).

Methods

We studied 80 asthmatic children. Airways hyperresponsiveness (AHR) was assessed by exercise-induced bronchospasm (Balke Protocol). Asthma control was evaluated using two questionnaires in all subjects: ACT (composed by Childhood-ACT and ACT) and ATAQ. In addition the use of short acting beta 2 agonist agents (SABAs) was assessed for each patient. Non-parametric variables were compared by Chi Square Test. Binomial logistic regression was performed to estimate the two questionnaires Odds Ratio (OR) in finding AHR.

Results

We have found that ATAQ has a sensitivity and a specificity of 0.72 and 0.45 respectively; instead, ACT has a sensitivity and a specificity of 0.5 and 0.39 respectively in evaluating AHR. Patients with uncontrolled asthma according to ATAQ revealed a significant higher percentage of AHR compared with ACT (72% vs 50%, p < 0.01).

Confirming this finding, patients declaring uncontrolled asthma to ATAQ have a significantly higher percentage (34%) of frequent SABAs use than the group with uncontrolled asthma to ACT (21%) (p <0 .01="" p="">

Binomial logistic regression shows how a test revealing uncontrolled asthma is associated with the increasing odds of having AHR according to ATAQ (OR = 3.8, p = 0.05), not to ACT (OR = 0.2, p = 0.1).

Conclusions

Our results show that ATAQ reflects AHR and asthma control better than ACT. Children with uncontrolled asthma according to ATAQ have higher odds of having AHR and use of rescue medications (SABAs) compared to patients declaring uncontrolled asthma according to ACT. However both questionnaires are not sufficient alone to fully evaluate asthma control in children and it is always necessary to perform functional tests and investigate patients lifestyle, drug use and other important data that a simple questionnaire is not able to point out

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Research

A qPCR-based metric of Th2 airway inflammation in asthma

Nirav R Bhakta, Owen D Solberg, Christine P Nguyen, Cindy N Nguyen, Joseph R Arron, John V Fahy and Prescott G Woodruff

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Clinical and Translational Allergy 2013, 3:24 doi:10.1186/2045-7022-3-24

Published: 17 July 2013

Abstract (provisional)

Background

Using microarray profiling of airway epithelial cells, we previously identified a Th2-high molecular phenotype of asthma based on expression of periostin, CLCA1 and serpinB2 and characterized by specific inflammatory, remodeling, and treatment response features. The goal of the current study was to develop a qPCR-based assay of Th2 inflammation to overcome the limitations of microarray-based methods.

Methods

Airway epithelial brushings were obtained by bronchoscopy from two clinical studies comprising 44 healthy controls and 62 subjects with asthma, 39 of whom were studied before and after a standardized 8 week course of inhaled corticosteroids (ICS). The qPCR-based expression of periostin, CLCA1 and serpinB2 were combined into a single metric.

Results

In asthma, the three-gene-mean of periostin, CLCA1 and serpinB2 correlated with FeNO (r = 0.75, p = 0.0002), blood eosinophils (r = 0.58, p = 0.003) and PC20 methacholine (r = -0.65, p = 0.0006), but not total serum IgE (r = 0.33, p = 0.1). Higher baseline three-gene-mean correlated with greater improvement in FEV1 with ICS at 2, 4 and 8 weeks (all p < 0.05). By ROC analysis, the area under the curve (AUC) of the three-gene-mean for FEV1 improvement with ICS at 4 and 8 weeks was 0.94 and 0.87, respectively, which are higher than the AUCs of FeNO, blood eosinophils, IgE or PC20. Th2 airway inflammation as measured by this three-gene-mean also had predictive capacity for an improvement in symptoms.

Conclusions

The three-gene-mean of periostin, CLCA1 and serpinB2 in airway epithelial brushings identifies Th2-high and low populations, is correlated with other Th2 biomarkers, and performs well for prediction of FEV1 improvement with ICS. The three-gene-mean provides a measurement of Th2 airway inflammation that is clinically relevant and that can serve as a valuable tool to evaluate non-invasive biomarkers to predict treatment responses to existing and emerging asthma therapies.

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Front. Immunol., 12 July 2013 | doi: 10.3389/fimmu.2013.00185

Multi-faceted functions of secretory IgA at mucosal surfaces

Blaise Corthésy*

• R&D Laboratory, Department of Immunology and Allergy, University State Hospital Lausanne (CHUV), Lausanne, Switzerland

Secretory IgA (SIgA) plays an important role in the protection and homeostatic regulation of intestinal, respiratory, and urogenital mucosal epithelia separating the outside environment from the inside of the body. This primary function of SIgA is referred to as immune exclusion, a process that limits the access of numerous microorganisms and mucosal antigens to these thin and vulnerable mucosal barriers. SIgA has been shown to be involved in avoiding opportunistic pathogens to enter and disseminate in the systemic compartment, as well as tightly controlling the necessary symbiotic relationship existing between commensals and the host. Clearance by peristalsis appears thus as one of the numerous mechanisms whereby SIgA fulfills its function at mucosal surfaces. Sampling of antigen-SIgA complexes by microfold (M) cells, intimate contact occurring with Peyer’s patch dendritic cells (DC), down-regulation of inflammatory processes, modulation of epithelial, and DC responsiveness are some of the recently identified processes to which the contribution of SIgA has been underscored. This review aims at presenting, with emphasis at the biochemical level, how the molecular complexity of SIgA can serve these multiple and non-redundant modes of action.

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Keywords: secretory IgA, mucosal homeostasis, antibody, epithelium, infectious agents, commensal bacteria

Citation: Corthésy B (2013) Multi-faceted functions of secretory IgA at mucosal surfaces.Front. Immunol. 4:185. doi: 10.3389/fimmu.2013.00185

Received: 21 May 2013; Paper pending published: 06 June 2013;
Accepted: 24 June 2013; Published online: 12 July 2013.

Edited by:

Nils Yngve Lycke, University of Gothenburg, Sweden

Reviewed by:

Oliver Pabst, Hannover Medical School, Germany
Jo Spencer, King’s College London, UK
Mats Bemark, University of Gothenburg, Sweden

Copyright: © 2013 Corthésy. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in other forums, provided the original authors and source are credited and subject to any copyright notices concerning any third-party graphics etc.

*Correspondence: Blaise Corthésy, R&D Laboratory, Department of Immunology and Allergy, University State Hospital (CHUV), Rue du Bugnon, 1011 Lausanne, Switzerland e-mail: blaise.corthesy@chuv.ch

• PLoS One
• v.8(7); 2013
• PMC3707846

PLoS One. 2013; 8(7): e67920.

Published online 2013 July 10. doi:  10.1371/journal.pone.0067920

PMCID: PMC3707846

High Levels of Both n-3 and n-6 Long-Chain Polyunsaturated Fatty Acids in Cord Serum Phospholipids Predict Allergy Development

Malin Barman,1,* Sara Johansson,1 Bill Hesselmar,2 Agnes E. Wold,3 Ann-Sofie Sandberg,1 and Anna Sandin4

Susanne Krauss-Etschmann, Editor

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Abstract

Background

Long-chain polyunsaturated fatty acids (LCPUFAs) reduce T-cell activation and dampen inflammation. They might thereby counteract the neonatal immune activation and hamper normal tolerance development to harmless environmental antigens. We investigated whether fatty acid composition of cord serum phospholipids affects allergy development up to age 13 years.

Methods

From a population-based birth-cohort born in 1996/7 and followed until 13 years of age (n=794), we selected cases with atopic eczema (n=37) or respiratory allergy (n=44), as well as non-allergic non-sensitized controls (n=48) based on diagnosis at 13 years of age. Cord and maternal sera obtained at delivery from cases and controls were analysed for proportions of saturated, monounsaturated and polyunsaturated fatty acids among serum phospholipids.

Results

The cord serum phospholipids from subject who later developed either respiratory allergy or atopic eczema had significantly higher proportions of 5/8 LCPUFA species, as well as total n-3 LCPUFA, total n-6 LCPUFA and total LCPUFA compared to cord serum phospholipids from controls who did not develop allergy (P-0.001 for all comparisons). Conversely, individuals later developing allergy had lower proportion of the monounsaturated fatty acid 181n-9 as well as total MUFA (p-0.001) among cord serum phospholipids. The risk of respiratory allergy at age 13 increased linearly with the proportion of n-3 LCPUFA (Ptrend-0.001), n-6 LCPUFA (Ptrend=0.001), and total LCPUFA (Ptrend-0.001) and decreased linearly with the proportions of total MUFA (Ptrend=0.025) in cord serum phospholipids. Furthermore, Kaplan-Meier estimates of allergy development demonstrated that total LCPUFA proportion in cord serum phospholipids was significantly associated with respiratory allergy (P=0.008) and sensitization (P=0.002), after control for sex and parental allergy.

Conclusion

A high proportion of long-chain PUFAs among cord serum phospholipids may predispose to allergy development. The mechanism is unknown, but may involve dampening of the physiologic immune activation in infancy needed for proper maturation of the infant's immune system.

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Autoimmune Lymphoproliferative Syndrome and Epstein-Barr Virus-Associated Lymphoma

Case Reports in Immunology
Volume 2013 (2013), Article ID 245893, 5 pages
http://dx.doi.org/10.1155/2013/245893

Case Report

Autoimmune Lymphoproliferative Syndrome and Epstein-Barr Virus-Associated Lymphoma: An Adjunctive Diagnostic Role for Monitoring EBV Viremia?

Romina Pace¹ and Donald C. Vinh²

¹Department of Medicine, McGill University Health Centre, Montreal, QC, H3G 1A4, Canada
²Division of Infectious Diseases, Division of Allergy & Clinical Immunology (Department of Medicine), Department of Medical Microbiology, Department of Human Genetics, McGill University Health Centre, Montreal General Hospital, 1650 Cedar Avenue, Rm A5-156, Montreal, QC, H3G 1A4, Canada

Received 30 May 2013; Accepted 2 July 2013

Academic Editors: N. Martinez-Quiles, A. E. Tebo, M. Trendelenburg, and A. Vojdani

Copyright © 2013 Romina Pace and Donald C. Vinh. This is an open access article distributed under theCreative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Autoimmune lymphoproliferative syndrome (ALPS) is a genetic disorder of lymphocyte homeostasis due to defects in FAS-mediated apoptosis. ALPS is characterized by childhood onset of chronic lymphadenopathy and splenomegaly, autoimmunity, an expanded population of double-negative T cells (DNTCs), and an increased risk of lymphoma. This propensity for lymphoma in ALPS is not well understood. It is possible that lymphomagenesis in some of these patients may result from Epstein-Barr virus (EBV) infection exploiting the defective T-cell surveillance resulting from impaired FAS-mediated apoptosis. Case Presentation. We report the first case, to our knowledge, of lymphoma in a patient with ALPS that was clinically heralded by progressively increasing EBV viremia. We discuss its practical implications and the possible immune pathways involved in the increased risk for EBV-associated lymphoproliferative disorders in ALPS patients. Conclusion. In patients with ALPS, distinguishing chronic lymphadenopathy from emerging lymphoma is difficult, with few practical recommendations available. This case illustrates that, at least for some patients, monitoring for progressively increasing EBV viremia may be useful.

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Anaphylaxislike cholinergic urticaria

1. Darío Antolín-Amérigo, MD⇑

1. Physician in the Allergy Division at the Hospital Universitario Ramón y Cajal in Madrid, Spain.

1. Correspondence: Dr Darío Antolín-Amérigo, Hospital Universitario Ramón y Cajal, Servicio de Alergia, Carretera de Colmenar Km 9,100 s/n, 28049, Madrid, Spain; telephone +34 91-3368000; fax +34 91-3580614; e-maildario.antolin@gmail.com

1. Petruta Cristina Vlaicu, MD

1. Physician in the Allergy Division at the Hospital Universitario Ramón y Cajal in Madrid, Spain.

1. Belén De La Hoz Caballer, MD PhD

1. Physician in the Allergy Division at the Hospital Universitario Ramón y Cajal in Madrid, Spain.

1. Moisés Sánchez Cano, MD PhD

+Author Affiliations

1. Physician in the Allergy Division at the Hospital Universitario Ramón y Cajal in Madrid, Spain.

Cholinergic urticaria (CU) can be defined as itching and whealing associated with exercise, hot showers, sweating, anxiety, or any other condition that increases the body’s core temperature. Cholinergic urticaria might present in a local or generalized form. The latter is characterized by the abrupt appearance of small wheals surrounded by a pronounced erythematous flare reaction beginning over the upper thorax and neck and subsequently spanning practically the entire body. Exercise-induced anaphylaxis should be ruled out.

This Article

1. Canadian Family Physician July 2013 vol. 59 no. 7745-746

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