Browsing by Author "Thabane, Lehana"
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- ItemAdvancing global health through cardiovascular research, mentorship, and capacity building : in memoriam, professor Bongani Mayosi (1967–2018)(BMC (part of Springer Nature), 2018-10-03) Nachega, Jean B.; Ntsekhe, Mpiko; Volmink, Jimmy; Thabane, LehanaENGLISH ABSTRACT: No abstract available
- ItemCurrent knowledge and future research directions on fecal bacterial patterns and their association with asthma(Frontiers Media, 2016) Claassen-Weitz, Shantelle; Wiysonge, Charles S.; Machingaidze, Shingai; Thabane, Lehana; Horsnell, William G. C.; Zar, Heather J.; Nicol, Mark P.; Kaba, MamadouENGLISH SUMMARY : Asthma is a complex respiratory condition that involves interplay between genetic predisposition, environmental, and immunological factors (Edwards et al., 2012). It is considered to be one of the most common chronic diseases, affecting ~300 million people (Masoli et al., 2004), and causing an estimated 250,000 deaths annually (Bateman et al., 2008). Furthermore, because of an increased Westernized lifestyle and urbanization in developing countries, it is estimated that by 2025 the global burden of asthma will increase by 100 million people (Masoli et al., 2004).
- ItemEffects of postnatal interventions for the reduction of vertical HIV transmission on infant growth and non-HIV infections : a systematic review(BioMed Central, 2013-12-20) Zunza, Moleen; Mercer, Gareth D.; Thabane, Lehana; Esser, Monika; Cotton, Mark F.Introduction: Guidelines in resource-poor settings have progressively included interventions to reduce postnatal HIV transmission through breast milk. In addition to HIV-free survival, infant growth and non-HIV infections should be considered. Determining the effect of these interventions on infant growth and non-HIV infections will inform healthcare decisions about feeding HIV-exposed infants. We synthesize findings from studies comparing breast to formula feeding, early weaning to standard-duration breastfeeding, breastfeeding with extended antiretroviral (ARV) to short-course ARV prophylaxis, and alternative preparations of infant formula to standard formula in HIV-exposed infants, focusing on infant growth and non-HIV infectious morbidity outcomes. The review objectives were to collate and appraise evidence of interventions to reduce postnatal vertical HIV transmission, and to estimate their effect on growth and non-HIV infections from birth to two years of age among HIV-exposed infants. Methods: We searched PubMed, SCOPUS, and Cochrane CENTRAL Controlled Trials Register. We included randomized trials and prospective cohort studies. Two authors independently extracted data and evaluated risk of bias. Rate ratios and mean differences were used as effect measures for dichotomous and continuous outcomes, respectively. Where pooling was possible, we used fixed-effects meta-analysis to pool results across studies. Quality of evidence was assessed using the GRADE approach. Results and discussion: Prospective cohort studies comparing breast- versus formula-fed HIV-exposed infants found breastfeeding to be protective against diarrhoea in early life [risk ratio (RR)=0.31; 95% confidence interval (CI)=0.13 to 0.74]. The effect of breastfeeding against diarrhoea [hazard ratio (HR)=0.74; 95% CI=0.57 to 0.97] and respiratory infections (HR=0.65; 95% CI=0.41 to 1.00) was significant through two years of age. The only randomized controlled trial (RCT) available showed that breastfeeding tended to be protective against malnutrition (RR=0.63; 95% CI=0.36 to 1.12). We found no statistically significant differences in the rates of non-HIV infections or malnutrition between breast-fed infants in the extended and short-course ARV prophylaxis groups. Conclusions: Low to moderate quality evidence suggests breastfeeding may improve growth and non-HIV infection outcomes of HIV-exposed infants. Extended ARV prophylaxis does not appear to increase the risk for HIV-exposed infants for adverse growth or non-HIV infections compared to short-course ARV prophylaxis.
- ItemAn empirical comparison of time-to-event models to analyse a composite outcome in the presence of death as a competing risk(2020) Haushona, Ndamonaonghenda; Esterhuizen, Tonya M; Thabane, LehanaIntroduction: Competing risks arise when subjects are exposed to multiple mutually exclusive failure events, and the occurrence of one failure hinders the occurrence of other failure events. In the presence of competing risks, it is important to use methods accounting for competing events because failure to account for these events might result in misleading inferences. Methods and Objective: Using data from a multisite retrospective observational longitudinal study done in Ethiopia, we performed sensitivity analyses using Fine-Gray model, Cause-specific Cox (Cox-CSH) model, Cause-specific Accelerated Failure Time (CS-AFT) model, accounting for death as a competing risk to deter- mine baseline covariates that are associated with a composite of unfavourable retention in care outcomes in people living with Human Immune Virus who were on both Isoniazid preventive therapy (IPT) and antiretrovi- ral therapy (ART). Non-cause specific (non-CSH) model that does not account for competing risk was also per- formed. The composite outcome comprises of loss to follow-up, stopped treatment and death. Age, World Health Organisation (WHO) stage, gender, and CD4 count were the considered baseline covariates. Results: We included 3578 patients in our analysis. WHO stage III-or-IV was significantly associated with the composite of unfavourable outcomes, Sub-hazard ratio (SHR) = 1.31, 95% confidence interval (CI):1.04–1.65 for the sub-distribution hazard model, hazard ratio [HR] = 1.31, 95% CI:1.05–1.65, for the Cox-CSH model, and HR = 0.81, 95% CI:0.69–0.96, for the CS-AFT model. Gender and WHO stage were found to be signifi- cantly associated with the composite of unfavourable outcomes, HR = 1.56, 95% CI:1.27–1.90, HR = 1.28, 95% CI: 1.06–1.55 for males and WHO stage III-or-IV, respectively for the non-CSH model. Conclusions: Results show that WHO stage III-or-IV is significantly associated with unfavourable outcomes. The results from competing risk models were consistent. However, results obtained from the non-CSH model were inconsistent with those obtained from competing risk analysis models.
- ItemImpact of tuberculosis on mortality among HIV-infected patients receiving antiretroviral therapy in Uganda : a prospective cohort analysis(BioMed Central, 2013-07-13) Chu, Rong; Mills, Edward J.; Beyene, Joseph; Pullenayegum, Eleanor; Bakanda, Celestin; Nachega, Jean B.; Devereaux, P. J.; Thabane, LehanaBackground: Tuberculosis (TB) disease affects survival among HIV co-infected patients on antiretroviral therapy (ART). Yet, the magnitude of TB disease on mortality is poorly understood. Methods: Using a prospective cohort of 22,477 adult patients who initiated ART between August 2000 and June 2009 in Uganda, we assessed the effect of active pulmonary TB disease at the initiation of ART on all-cause mortality using a Cox proportional hazards model. Propensity score (PS) matching was used to control for potential confounding. Stratification and covariate adjustment for PS and not PS-based multivariable Cox models were also performed. Results: A total of 1,609 (7.52%) patients had active pulmonary TB at the start of ART. TB patients had higher proportions of being male, suffering from AIDS-defining illnesses, having World Health Organization (WHO) disease stage III or IV, and having lower CD4 cell counts at baseline (p < 0.001). The percentages of death during follow-up were 10.47% and 6.38% for patients with and without TB, respectively. The hazard ratio (HR) for mortality comparing TB to non-TB patients using 1,686 PS-matched pairs was 1.37 (95% confidence interval [CI]: 1.08 – 1.75), less marked than the crude estimate (HR = 1.74, 95% CI: 1.49 – 2.04). The other PS-based methods and not PS-based multivariable Cox model produced similar results. Conclusions: After controlling for important confounding variables, HIV patients who had TB at the initiation of ART in Uganda had an approximate 37% increased hazard of overall mortality relative to non-TB patients.
- ItemInteractive weekly mobile phone text messaging plus motivational interviewing in promotion of breastfeeding among women living with HIV in South Africa : study protocol for a randomized controlled trial(BioMed Central, 2017-07-17) Zunza, Moleen; Cotton, Mark F.; Mbuagbaw, Lawrence; Lester, Richard; Thabane, LehanaBackground: South Africa recently phased out access to free formula milk in the public sector in support of breastfeeding for women living with HIV. Few women living with HIV in South Africa choose breastfeeding and among those who do, many stop breastfeeding early. We sought to explore the feasibility of using mobile phone text messaging coupled with motivational interviewing to enhance adherence to breastfeeding practices. Methods and design: A randomized, parallel group, single-center pilot trial. Electronic sequence generation and random allocation will be done centrally. Women of low socioeconomic status, from Cape Town, South Africa will be randomly assigned within 24 h of giving birth at a primary healthcare clinic to a structured weekly text message plus motivational interviewing and usual standard of care, using a permutation of different block sizes. Criteria for feasibility success will include: five participants recruited per week (over 12 weeks), about 75% of all eligible participants consent for study participation, complete evaluation of outcomes in at least 70% of all recruited participants, breastfeeding adherence rates of at least 70% in the intervention group, six months after delivery. Participants will be evaluated soon after giving birth and post-delivery at weeks 2, 6, 10, and 24. Primary analysis will follow the “intention-to-treat” principle. Sub-group analysis will be used to assess sub-group effects. Discussion: This pilot trial will evaluate the feasibility of conducting a larger trial on communication and support approaches to improve adherence to breastfeeding by HIV-infected women. Text messaging and motivational interviewing are simple interventions which may allow participants to access personalized adherence advice and support. Trial registration: ClinicalTrials.gov: NCT02949713. Registered on 26 October 2016; Pan African Clinical Trial Registry PACTR201611001855404. Registered on 8 November 2016.
- ItemInterventions for treating tuberculous pericarditis(John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration, 2017) Wiysonge, Charles S.; Ntsekhe, Mpiko; Thabane, Lehana; Volmink, Jimmy; Majombozi, Dumisani; Gumedze, Freedom; Pandie, Shaheen; Mayosi, Bongani M.Background: Tuberculous pericarditis – tuberculosis infection of the pericardial membrane (pericardium) covering the heart – is becoming more common. The infection can result in fluid around the heart or fibrosis of the pericardium, which can be fatal. Objectives: In people with tuberculous pericarditis, to evaluate the effects on death, life‐threatening conditions, and persistent disability of: 1. 6‐month antituberculous drug regimens compared with regimens of 9 months or more; 2. corticosteroids; 3. pericardial drainage; and 4. pericardiectomy. Search methods: We searched the Cochrane Infectious Diseases Group trials register (January 2005); the Cochrane Controlled Trials Register (Issue 4, 2004); MEDLINE (1966 to January 2005); EMBASE (1980 to January 2005); and checked the reference lists of existing reviews. We also contacted organizations and individuals working in the field. Selection criteria: Randomized and quasi‐randomized controlled trials of treatments for tuberculous pericarditis. Data collection and analysis: Two reviewers independently assessed trial quality and extracted data. Meta‐analysis using fixed effects models calculated summary statistics, provided there was no statistically significant heterogeneity, and expressed results as risk ratio. Study authors were contacted for additional information. Main results: Four trials met the inclusion criteria, with a total of 469 participants. Treatments tested were adjuvant steroids and surgical drainage. Two trials with a total of 383 participants tested adjuvant steroids in participants with suspected tuberculous pericarditis in the pre‐HIV era. Fewer participants died in the intervention group, but numbers were small (risk ratio [RR] 0.65; 95% confidence interval [CI] 0.36 to 1.16, n = 350). One small trial tested steroids in HIV positive participants with effusion showed a similar pattern (RR 0.50; 95% CI 0.19 to 1.28, n = 58). One trial examined open surgical drainage compared with conservative management, and showed surgery relieved cardiac tamponade. Authors' conclusions: Steroids could have important clinical benefits, but the trials published to date are too small to demonstrate an effect. This requires large placebo controlled trials. Subgroup analysis could explore whether effusion or fibrosis modify the effects. Therapeutic pericardiocentesis under local anaesthesia and pericardiectomy also require further evaluation.
- ItemQuality of abstracts of pilot trials in heart failure : a protocol for a systematic survey(Elsevier, 2017) Isiguzo, Godsent; Zunza, Moleen; Chirehwa, Maxwell; Mayosi, Bongani M.; Thabane, LehanaIntroduction: Pilot trials are initial small-scale studies done to inform the design of larger trials. Their findings like other studies are usually disseminated as peer-reviewed journal articles. Abstracts are used to introduce the contents to readers, and give a general idea about the full reports and sometimes are the only source of information available to readers. Despite their importance, the contents of abstracts of trial reports are usually not informative enough and lack the essential details. Methods and analysis: This is a protocol for a planned systematic survey with a primary aim of analyzing the reporting quality measured as the completeness of the reporting of pilot trial abstracts in heart failure. The secondary aim will be to explore factors associated with better reporting quality. Abstracts of heart failure pilot trials in humans (journal and conference abstracts) published in the English language from 1 January 1990 to 30 November 2016 will be assessed to determine the reporting quality, based on the CONSORT 2010 statement extension to randomized pilot and feasibility trials. All non-pilot/feasibility trials and non-human pilot trials will be excluded. We will search Medline (PUBMED), Cochrane controlled trials register, Scopus and African wide information databases for pilot trials in heart failure. Title and abstracts of identified studies will be screened for inclusion and data extracted independently by two reviewers in duplicate without using the full text. Reported and unreported items on the abstracts will be presented as frequencies and percentages, a descriptive analysis will be used to interpret the reporting quality and regression analysis used for characteristics associated with greater statistical reporting at 95% confidence interval.
- ItemQuality of pilot trial abstracts in heart failure is suboptimal : a systematic survey(BioMed Central, 2018-05-31) Isiguzo, Godsent C.; Zunza, Moleen; Chirehwa, Maxwell; Mayosi, Bongani M.; Thabane, LehanaBackground: Pilot trials are miniature researches carried out with the sole aim of acting as the precursor for larger more definitive studies. Abstracts are used to summarize and introduce the findings to the reading audience. There is substantive empirical evidence showing that abstracts, despite their important roles, are not informative enough, lacking the necessary details. This systematic survey was designed to assess the quality of reporting of heart failure pilot trial abstracts. The quality of reporting was defined as the completeness of reporting based on adherence to the CONSORT extension for reporting of pilot trial abstracts. We also identified factors associated with reporting quality. Methods: We searched MEDLINE (PubMed), Cochrane Controlled Trials Register, Scopus, and African-wide information databases for abstracts from heart failure pilot trials in humans published from 1 January 1990 to 30 November 2016. These were assessed to determine the extent of adherence to CONSORT extension checklist for reporting of abstracts of pilot trials. We screened identified studies for inclusion based on title and abstract. Data were independently extracted by two reviewers using the checklist. We used regression analysis to assess the association between completeness of reporting (measured as the number of items in the CONSORT extension checklist for reporting of abstracts in pilot trials contained in each abstract) and factors influencing the quality of the reports. Results: Two hundred and twenty-eight (228) articles were retrieved, of which 92 met the inclusion criteria. The mean CONSORT extension score was 8.3/16 (standard deviation 1.7); the least reported items were the source of funding (1% [1/92]), trial registration (13% [12/92]), randomization sequence (13% [12/92]), number randomized to each arm (16% [15/92]), and number analyzed in each arm (16% [15/92]). Multivariable regression analysis showed that pharmacological intervention pilot trials [incidence rate ratio (IRR) = 0.88; 95% confidence interval (CI), 0.81–0.97] were significantly associated with better reporting. Other factors such as structured abstract (IRR = 1.10; 95% CI, 0.99–1.23) and CONSORT endorsement (IRR = 1.10; 95% CI, 0.99–1.23) only showed minimal relationship with better reporting quality. Conclusion: The quality of reporting of abstracts of heart failure pilot trials was suboptimal. Pharmacological intervention was significantly associated with better reporting. These findings are consistent with previous research on reporting of trials.
- ItemReporting of methodological studies in health research : a protocol for the development of the Methodological Study reporting Checklist (MISTIC)(BMJ Publishing, 2020-12) Lawson, Daeria O.; Puljak, Livia; Pieper, Dawid; Schandelmaier, Stefan; Collins, Gary S.; Brignardello-Petersen, Romina; Moher, David; Tugwell, Peter; Welch, Vivian A.; Samaan, Zainab; Thombs, Brett D.; Nørskov, Anders K.; Jakobsen, Janus C.; Allison, David B.; Mayo-Wilson, Evan; Young, Taryn; Chan, An-Wen; Briel, Matthias; Guyatt, Gordon H.; Thabane, Lehana; Mbuagbaw, LawrenceIntroduction: Methodological studies (ie, studies that evaluate the design, conduct, analysis or reporting of other studies in health research) address various facets of health research including, for instance, data collection techniques, differences in approaches to analyses, reporting quality, adherence to guidelines or publication bias. As a result, methodological studies can help to identify knowledge gaps in the methodology of health research and strategies for improvement in research practices. Differences in methodological study names and a lack of reporting guidance contribute to lack of comparability across studies and difficulties in identifying relevant previous methodological studies. This paper outlines the methods we will use to develop an evidence-based tool—the Methodological Study reporting Checklist—to harmonise naming conventions and improve the reporting of methodological studies. Methods and analysis: We will search for methodological studies in the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Embase, MEDLINE, Web of Science, check reference lists and contact experts in the field. We will extract and summarise data on the study names, design and reporting features of the included methodological studies. Consensus on study terms and recommended reporting items will be achieved via video conference meetings with a panel of experts including researchers who have published methodological studies. Ethics and dissemination: The consensus study has been exempt from ethics review by the Hamilton Integrated Research Ethics Board. The results of the review and the reporting guideline will be disseminated in stakeholder meetings, conferences, peer-reviewed publications, in requests to journal editors (to endorse or make the guideline a requirement for authors), and on the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) Network and reporting guideline websites. Registration: We have registered the development of the reporting guideline with the EQUATOR Network and publicly posted this project on the Open Science.
- ItemResearching complex interventions in health : the state of the art(BMC Health Services Research, 2016) Craig, Peter; Rahm-Hallberg, Ingalill; Britten, Nicky; Borglin, Gunilla; Meyer, Gabriele; Kopke, Sascha; Noyes, Jane; Chandler, Jackie; Levati, Sara; Sales, Anne; Thabane, Lehana; Giangregorio, Lora; Feeley, Nancy; Cossette, Sylvie; Taylor, Rod; Hill, Jacqueline; Richards, David A.; Kuyken, Willem; von Essen, Louise; Williams, Andrew; Hemming, Karla; Lilford, Richard; Girling, Alan; Taljaard, Monica; Dimairo, Munyaradzi; Petticrew, Mark; Baird, Janis; Moore, Graham; Odendaal, Willem; Atkins, Salla; Lutge, Elizabeth; Leon, Natalie; Lewin, Simon; Payne, Katherine; Van Achterberg, Theo; Sermeus, Walter; Pitt, Martin; Monks, ThomasENGLISH SUMMARY : Keynote presentations