Tesis Doctorales de la Universidad de Alcalá
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Autor/aStallings , Elena Christine
DepartamentoBiología de Sistemas
Director/aZamora Romero, Javier
Codirector/aAlbillos Martínez, Agustín
Fecha de defensa11/02/2022
CalificaciónSobresaliente Cum Laude
ProgramaCiencias de la Salud (RD 99/2011)
Mención internacionalSi
ResumenPrecision medicine is a term used to describe the treatment or interventions focusing on patients based on their individual characteristics, such as disease severity, genetic traits or sex. Sex plays an influential role in health and disease and using the characteristic of sex in precision medicine can improve outcomes for both males and females. Publications in health research are continuously increasing in amount and updating which makes it difficult for clinicians to keep updated with the best evidence. To address this challenge, systematic reviews (SRs) were developed and just as with every other area in research new methods for SRs are needed. The primary objective of this PhD thesis is to highlight sex inequities in healthcare. This was done through an analysis of risk factors for pregnant women with Covid-19 in a living systematic review and by assessing the potential role of sex (being a male or a female) as a prognostic factor (PF) in patients with pulmonary embolism. As secondary objectives I looked at developing novel methods to aid in these reviews of risk factors and prognostic factors. This was done through the development of a prognostic factor search filter for use in systematic review searches and the modification and discussion of tools and methods employed in a prognostic factor systematic review. Overall, this thesis found that: 1) Pregnant women are considered to be a high-risk group for covid-19 infection and those with the infection need extra medical attention as they are more likely to experience preterm birth or be admitted to the intensive care unit. 2) Preliminary results of the systematic review of sex as a prognostic factor in patients with pulmonary embolism show that there is no association between sex and mortality. However, we have still yet to rate the quality of the evidence, so more higher quality studies may be needed to confirm this. 3) The development of a PF search filter that is both sensitive and specific is not an easy task due to the poor indexing of PF studies in databases. Our filter yielded a sensitivity of 95% and a specificity of 41%, so more research is needed to increase the filters specificity. 4) When carrying out a systematic review investigating sex as a PF, researchers must keep in mind that various adaptations must be made to the review process. These adaptations include modifying the PF section of the data extraction template, adjusting certain sections of QUIPS (after ROB) and extracting data on the sex and gender terms used throughout the included studies. This thesis highlighted the level of awareness and the role that sex plays in healthcare and health research. Sex should play a central role in personalized medical care. Although more studies providing sex specific evidence are being carried out, there still remains significant shortcomings in effectively implementing sex specific health care.