Evidence map›Paper›PMID 29577741›Full record

ArticleClinical trials (London, England)2018

LIBERTI: A SMART study in plastic surgery.

Jonathan C Hibbard, Jonathan S Friedstat, Sonia M Thomas, Renee E Edkins, C Scott Hultman, Michael R Kosorok

Open access · greenAbstract read
In one paragraph

Article in Clinical trials (London, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
0.9field-weighted citation impact, top 24% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Review
  4. Adaptive Enrichment Designs in Clinical Trials.Annual review of statistics and its application · 2021
    Article
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Jonathan C Hibbard1 Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Jonathan S Friedstat3 Division of Burns, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Sonia M Thomas4 RTI International, Research Triangle Park, NC, USA.
Renee E Edkins5 Division of Plastic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
C Scott Hultman5 Division of Plastic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Michael R Kosorok1 Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
University of North Carolina at Chapel Hill · USMassachusetts General Hospital · USRTI International · US

Funding

Re-Entry Supplement: Investigation of Oral Microbial Enzymes for the Detection and Treatment of Periodontal DiseaseUL1TR002489 · NCATS · UNIV OF NORTH CAROLINA CHAPEL HILL · PI BUSE, JOHN BERNARD, SHAHEEN, NICHOLAS J · 2018 to 2022
$48.6M
North Carolina Translational & Clinical Sciences Institute (NC TraCS)UL1TR001111 · NCATS · UNIV OF NORTH CAROLINA CHAPEL HILL · PI BUSE, JOHN BERNARD, CAREY, TIMOTHY S · 2013 to 2017
$43.9M
Statistical Methods for Cancer Clinical TrialsP01CA142538 · NCI · UNIV OF NORTH CAROLINA CHAPEL HILL · PI DAVIDIAN, MARIE, KOSOROK, MICHAEL R · 2010 to 2019
$21.3M
NCATS NIH HHS UL1 TR001111NCATS NIH HHS UL1 TR002489NCI NIH HHS P01 CA142538
6 · The paper itself

Abstract

BACKGROUND/

aimsLaser treatment of burns scars is considered by some providers to be standard of care. However, there is little evidence-based research as to the true benefit. A number of factors hinder evaluation of the benefit of laser treatment. These include significant heterogeneity in patient response and possible delayed effects from the laser treatment. Moreover, laser treatments are often provided sequentially using different types of equipment and settings, so there are effectively a large number of overall treatment options that need to be compared. We propose a trial capable of coping with these issues and that also attempts to take advantage of the heterogeneous response in order to estimate optimal treatment plans personalized to each individual patient. It will be the first large-scale randomized trial to compare the effectiveness of laser treatments for burns scars and, to our knowledge, the very first example of the utility of a Sequential Multiple Assignment Randomized Trial in plastic surgery.

methodsWe propose using a Sequential Multiple Assignment Randomized Trial design to investigate the effect of various permutations of laser treatment on hypertrophic burn scars. We will compare and test hypotheses regarding laser treatment effects at a general population level. Simultaneously, we hope to use the data generated to discover possible beneficial personalized treatment plans, tailored to individual patient characteristics.

resultsWe show that the proposed trial has good power to detect laser treatment effect at the overall population level, despite comparing a large number of treatment combinations. The trial will simultaneously provide high-quality data appropriate for estimating precision-medicine treatment rules. We detail population-level comparisons of interest and corresponding sample size calculations. We provide simulations to suggest the power of the trial to detect laser effect and also the possible benefits of personalization of laser treatment to individual characteristics.

conclusionWe propose, to our knowledge, the first use of a Sequential Multiple Assignment Randomized Trial in surgery. The trial is rigorously designed so that it is reasonably straightforward to implement and powered to answer general overall questions of interest. The trial is also designed to provide data that are suitable for the estimation of beneficial precision-medicine treatment rules that depend both on individual patient characteristics and on-going real-time patient response to treatment.

Indexed as

BurnsCicatrix, HypertrophicDermatologic Surgical ProceduresHumansLaser TherapyPrecision MedicineRandomized Controlled Trials as TopicResearch DesignSurgery, PlasticTreatment Outcomeburnclinical trialCO2 laserdynamic treatment regimedynamic treatment rulefactorial experimentHypertrophic scarringindividualized treatment rulelaser treatmentoutcome-weighted learningplastic surgeryprecision medicinepulsed-dye laserQ-learningSequential Multiple Assignment Randomized Trialsurgery

Identifiers

PMID29577741
PMCPMC5990436
OpenAlexW2789597704

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.