A logistic model for prediction of massive transfusion was developed and validated at multiple sites but achieved only moderate performance.
We describe our experience from different angles including the use of multiple sites to achieve adequate sample size, standardizing diagnosis of disease, identifying cancer cases at the time of diagnosis, control selection procedures, logistics of study implementation, questionnaire development and interviewing, biologic specimens, and procedures for protection of human subjects.
With well-defined kinase stimulus, we now turn to the main puzzle of whether a multisite protein is switch-like in its degradation, most importantly, why multiple sites may help to achieve this property.
Further study of partial inhibition at the important reactions demonstrates that high signal attenuation is achieved when multiple sites in downstream signaling modules are targeted.
In the future, treatment strategies may increasingly explore the use of drug combinations acting at multiple sites of aberrant immunoregulation to achieve disease quiescence and immune tolerance.
The significance of tumour heterogeneity and aggressiveness should not be underestimated in the interpretation of data which extend the indication for metastasectomy to multiple sites with the aim of achieving complete resection.
The best outcome has been observed after resection of metachronous solitary or oligometastases in the lung, but similar survival rates were reported for other sites, including liver, pancreas, bone and even multiple sites, provided that complete resection was achieved.
A single, streamlined approval process would considerably reduce the administrative burden and lead time for performing studies using electronic health records in multiple sites, but whether this can be achieved is unclear.
Our goal of maximising representativeness is achieved by recruiting at multiple sites with few patients in each, so such fragmented and diverse local administrative systems present a challenge.
