Variation in the prescription drugs covered by health systems across high-income countries: A review of and recommendations for the academic literature

BackgroundBecause not all medicines are equally safe, effective, and affordable, health systems often use formularies to define explicitly which medicines will be included and excluded from coverage.ObjectiveWe sought to synthesize methods and findings from published studies of formulary variation across health systems in high-income countries.MethodsWe conducted a systematic review of peer-reviewed research papers published from 2000 to 2017, inclusively. Because of the heterogeneous nature of the literature, we used an inductive approach to summarize methods and findings.ResultsNine studies met our study inclusion criteria. Included studies used a variety of methods for selecting medicines for analysis, for measuring coverage levels, and for measuring concordance between formularies. Studies assessing variations in coverage of all licensed medicines and found lower rates of cross-national coverage variation than studies of coverage for selected specialty drugs and indications. The one study that focused on coverage of high-volume medicines found the most complete and consistent levels of formulary listings across countries.ConclusionAlthough published studies contain interesting findings that likely have prompted discussions about their policy implications, the literature can be improved with greater transparency concerning the overarching objective of work in this area and more rigor concerning the selection, analysis, and reporting of data.     

Evaluating Matching‐Adjusted Indirect Comparisons in Practice: A Case Study of Patients with Attention‐Deficit/Hyperactivity Disorder

Differences in patient characteristics across trials may bias efficacy estimates from indirect treatment comparisons. To address this issue, matching‐adjusted indirect comparison (MAIC) measures treatment efficacy after weighting individual patient data to match patient characteristics across trials. To date, however, there is no consensus on how best to implement MAIC. To address this issue, we applied MAIC to measure how two attention‐deficit/hyperactivity disorder (ADHD) treatments (guanfacine extended release and atomoxetine hydrochloride) affect patients' ADHD symptoms, as measured by the ADHD Rating Scale IV score. We tested MAIC sensitivity to: matched patient characteristics, matched statistical moments, weighting matrix, and placebo‐arm matching (i.e., matching on outcomes in the placebo arm). After applying MAIC, guanfacine and atomoxetine had similar reductions in ADHD symptoms (Δ: 0.4, p < 0.737). The results were similar for three of four sensitivity analyses. When we applied MAIC with placebo‐arm matching, however, guanfacine reduced symptoms more than atomoxetine (Δ: ?3.9, p < 0.004). We discuss the implication of this finding and advise MAIC practitioners to carefully consider the use of placebo‐arm matching, depending on the presence of residual confounding across trials. Copyright © 2016 John Wiley & Sons, Ltd.     

Multiple comparisons with two controls for ordered categorical responses

In clinical studies, ordered categorical responses are common. To compare the efficacy of several treatments with a control for ordinal responses, the normal latent variable model has recently been proposed. This approach conceptualizes the responses as manifestations of an underlying continuous normal variable. In this article, we extend this idea to develop the multiple comparison method for use when there are two controls in the clinical trial. The proposed method is constructed such that the familywise type I error rate is controlled at a prespecified level. In addition, for a given level of test power, the procedure to evaluate the required sample size is provided. The proposed testing procedure is also illustrated by an example from a clinical study.     

医科大学生科学素质教育探析

转变教育观念,深化教育改革,重视和加强医科大学生的科学素质教育,是当今时代赋予高等医学院校的责任。文章论述了加强医科大学生科学素质教育是当今时代的要求,透析了目前医科大学生科学素质不高的现状和原因,提出了加强医科大学生科学素质教育的途径和方法。     

False discoveries in genome scanning

Methods of multiple comparisons were applied to linkage analysis in the case of genome scanning. Data for Problem 2A were used. P-Values were calculated for all 440,400 possible tests of linkage. Plots of distribution functions and false discovery rate are shown. © 1997 Wiley-Liss, Inc.     

Parental support in neonatal intensive care units: a cross-cultural comparison between New Zealand and Japan

This is a cross-cultural comparative study involving both quantitative and qualitative data analyses. This study examines sources of parental stress in the two neonatal intensive care units (NICUs) located in New Zealand and Japan and explores how cultural norms of NICU care environments influence parental stress-related experiences and nursing support. The three main sources of data collection were the following: a NICU staff interview, parental interview, and parental questionnaire survey, the PSS: NICU. Thirty-one pairs of parents in each NICU (N = 121) participated in this study. The differences between the two NICUs in terms of the NICU care environment and sources of parental stress within the NICU contexts were identified, highlighting NICU characteristics associated with the sources of stress in the two NICUs. Recognition of the norms of NICU care environments that may hinder parent-staff communication is an important element of NICU nursing practice.     

What's in a Self‐report? A Comparison of Pregnant Women with Self‐reported and Hospital Diagnosed Eating Disorder

The aim of this study was to examine how similar pregnant women with self‐reported lifetime eating disorder (ED) were to pregnant women with a hospital diagnosis of ED. A total of 83 731 pregnant women enrolled in the Danish National Birth Cohort reported on ED, and by linkage to the Danish health registers, hospital diagnoses of ED were obtained. Characteristics of women with self‐reported ED, hospital diagnosed ED and without ED were compared using chi‐square tests, t‐test and logistic regression models with robust standard errors. In total, 4.8% women reported ED, and 0.5% had a hospital diagnosis of ED recorded in the health registers. Women with self‐reported ED were comparable with women with hospital diagnosed ED on most reproductive and health characteristics, while they differed from women without ED concerning all characteristics studied. Our findings highlight that women with self‐reported ED have impaired function and adverse health outcomes, consistent with diagnosable ED. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.