abstract: Clinical Outcome Prediction by MicroRNAs in Human Cancer: A Systematic Review

Clinical Outcome Prediction by MicroRNAs in Human Cancer: A Systematic Review

Background
MicroRNA (miR) expression may have prognostic value for many types of cancers. However, the miR literature comprises many small studies. We systematically reviewed and synthesized the evidence.

. ........The median hazard ratio for poor outcome in externally validated studies was 2.52 (IQR = 2.26–5.40). For all classifier miRs in studies that evaluated overall survival across diverse malignancies, the miRs most frequently associated with poor outcome after accounting for differences in miR assessment due to platform type were let-7 (decreased expression in patients with cancer) and miR 21 (increased expression).

Conclusions MiR classifiers show promising prognostic associations with major cancer outcomes and specific miRs are consistently identified across diverse studies and platforms. These types of classifiers require careful external validation in large groups of cancer patients that have adequate protection from bias.

Outcomes Research Institute Releases Priorities - in Public Health & Policy, General Professional Issues from MedPage Today - comments until March 15

WASHINGTON -- The new institute created by the Affordable Care Act (ACA) to study which medical treatments are the most effective will focus on broad areas of healthcare instead of specific drugs or procedures, according to a draft of its research priorities.
The institute, called the Patient Centered Outcomes Research Institute (PCORI), is a nonprofit organization with a 21-member board that will identify areas that can benefit from comparative effectiveness research, fund the research through $3 billion in grants over the next decade, and provide patients and clinicians with research findings.
Opponents of the healthcare reform law charge that PCORI will make decisions that will lead to clinical rationing.
Supporters of the ACA, however, say comparative effectiveness research is crucial to improving the U.S. healthcare system and that it won't lead to denying access to certain drugs or procedures. The law specifically prohibits the panel's recommendations from being "construed as mandates for practice guidelines, coverage recommendations, payment, or policy recommendations."........
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In draft recommendations released Monday, the PCORI board identified five broad areas where it determined comparative effectiveness research is needed. They are:

• Assessment of options for prevention, diagnosis, and treatment, with research focusing on patient preferences and decision-making as well as various factors that may affect patient outcomes.
• Improving healthcare systems, including focusing on coordination of care for patients with multiple medical conditions, and how use of nonphysician providers affects patient outcomes.
• Communication and dissemination of research, including ways to provide information to patients that helps them to talk with their healthcare providers about it, and ways to use electronic data (e-records) to support decision-making.
• Addressing disparities, including ensuring that research into the benefits and risks of various medical options addresses the needs of all patient populations.
• Designing "quick, safe, and efficient" patient-centered outcomes research and methodological research, and studying ways to improve the quality and usefulness of clinical data and follow-up studies.

"These priorities and agenda give a framework to and identify the broad questions that must be addressed so that patients can make better and more personalized decisions in partnership with their clinicians across all areas of health," said PCORI Executive Director Joe Selby, MD, MPH, in a press release.
Selby added that the early agenda is a starting point and PCORI hopes that patients, healthcare providers, and others will provide feedback and "think boldly" about research projects in all five areas.
The draft will be available for public comment until March 15, and PCORI will hold a public meeting in Washington on Feb. 27.

Response: An opportunity to refine our understanding of "response shift" and to educate researchers on designing quality research studies

Journal Quality of Life Research
Issue Volume 19, Number 4 / May, 2010

Commentary
An opportunity to refine our understanding of “response shift” and to educate researchers on designing quality research studies: response to Ubel, Peeters, and Smith

Bryce B. Reeve1 Contact Information
(1) Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, EPN 4088, 6130 Executive Blvd., MSC 7344, Bethesda, MD 20892-7344, USA

Abstract
There is no advantage at this time to abandon the term “response shift” as suggested by Ubel et al. (Qual Life Res, 2010). The term is well known in the research field and has impacted the way we think about measuring quality of life (QOL) longitudinally. However, Ubel et al. (Qual Life Res, 2010) have provided the incentive to start an open dialogue on the subject with opportunities to refine the language of response shift and educate researchers. In this article, we identify opportunities in designing research studies to minimize or account for response shifts by considering the (1) selection of QOL concepts to measure, (2) questionnaires used to assess the QOL concepts, (3) design of the research study, (4) target population, and (5) analyses and reporting of results. Careful consideration of each of these issues will help us identify new methodologies and improved study designs that will move the QOL research field forward.