帕金森病患者群体的差异:教学医院与其他环境之间的差异以及临床试验的影响
Priti Gros1,2,3,4, Connie Marras1,2,3,4, Xuesong Wang4
1Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network Toronto, Toronto, Ontario, Canada.
概括
在教学医院进行疾病修饰疗法 (DMT) 试验的帕金森病 (PD) 患者年轻,社会经济上有利. 这些发现表明,PD临床试验可能不代表PD总体人群,突出了健康公平问题.
科学领域:
- 神经学 神经学
- 临床试验 临床试验
- 健康 公平 卫生 公平
背景情况:
- 帕金森病 (PD) 疾病修饰疗法 (DMT) 试验通常从教学医院招募参与者.
- 目前尚不清楚这些试验参与者是否准确地代表了更广泛的PD人群.
研究的目的:
- 为了比较神经病学家在教学医院看到的PD个体 (早期疾病阶段,DMT试验资格的代理) 与其他环境中看到的个体.
- 为了确定这些群体之间的人口和临床差异.
主要方法:
- 一项回顾性队列研究,利用来自加拿大安大略省 (1995-2017) 的基于人口的数据.
- 确定的PD个体和≥1次在3年内访问教学医院神经科医生作为DMT试验资格的代理.
- 比较人口因素 (年龄,性别,收入,农村,边缘化) 和并发症.
- 评估到关键临床里程碑的时间 (药物升级,手术/输液,家庭护理,痴呆,长期护理,死亡).
主要成果:
- 在19948名患有PD的个人中,22.0%的人被教学医院神经科医生看过.
- 在教学医院看到的个体更年轻,来自社会经济上更有利的地区,并具有较少的并发症.
- 他们经历了更多的药物升级,手术/输液疗法和家庭护理.
- 相反,与其他环境相比,他们的痴呆症,长期护理入院和死亡率较低.
结论:
- 患有PD的个体被医院神经病学家早期观察到,与普通PD人群有很大的差异.
- 疾病修饰疗法 (DMT) 在PD中的试验可能会排除患病进展较快的个体和来自边缘化社区的个体.
- 这些差异凸显了PD研究和护理中的重大健康公平问题,影响了试验结果的概括性.
相关概念视频
01:24Parkinson's Disease: Treatment
995
Neurodegenerative disorders, such as Parkinson's Disease (PD), involve the gradual and irreversible destruction of neurons in particular brain areas. These disorders exhibit standard features like proteinopathies, selective vulnerability of some neurons, and an interaction of intrinsic properties, genetics, and environmental influences in neural injury.
Parkinson's Disease is primarily a result of the loss of dopaminergic neurons in the substantia nigra pars compacta. The cornerstone of...
Parkinson's Disease is primarily a result of the loss of dopaminergic neurons in the substantia nigra pars compacta. The cornerstone of...
995
01:15Parkinson's Disease: Overview
1.8K
Neurodegenerative disorders are progressive diseases that cause irreversible damage and loss to neurons in specific brain areas. Examples of these disorders include Parkinson's disease, Alzheimer's disease, Multiple Sclerosis (MS), and Amyotrophic Lateral Sclerosis (ALS). These disorders share characteristics such as proteinopathies, selective neuronal vulnerability, and a complex interplay between genetic and environmental factors. The primary therapeutic goal for these conditions is...
1.8K
01:16Clinical Trials
10.2K
Clinical trials are prospective experimental studies conducted on humans to determine the safety and efficacy of treatments, drugs, diet methods, and medical devices. Using statistics in clinical trials enables researchers to derive reasonable and accurate conclusions from the collected data, allowing them to make wise decisions in uncertain situations. In medical research, statistical methods are crucial for preventing errors and bias.
There are four phases in a clinical trial. A phase one...
There are four phases in a clinical trial. A phase one...
10.2K
01:11Clinical Trials: Overview
4.6K
Clinical development focuses on how the drug will interact with the human body and encompasses four key phases of clinical trials, each serving a specific purpose in assessing the safety and effectiveness of new drugs. These phases overlap and build upon one another. Phase I involves a small group of healthy volunteers (typically 20-80 individuals) or, in cases where significant toxicity is expected, patients with the targeted disease, such as cancer or AIDS. The volunteers are tested for...
4.6K
01:37Neural Regulation
43.2K
Digestion begins with a cephalic phase that prepares the digestive system to receive food. When our brain processes visual or olfactory information about food, it triggers impulses in the cranial nerves innervating the salivary glands and stomach to prepare for food.
43.2K
01:09Bioequivalence of Drugs: Drugs with Multiple Indications
151
The concept of therapeutic equivalence (TE) in drugs with multiple indications is complex. A generic drug may be therapeutically equivalent to a brand-name product for one specific indication, but this doesn't necessarily mean it's equivalent for all other indications. Evidence of TE in one patient group and bioequivalence shown in healthy volunteers can support—but not confirm—TE for other indications. However, definitive proof requires individual clinical studies for each...
151